Almost 100 years ago, Novo Nordisk set out on a journey to change diabetes. Today we supply close to half the world’s insulin and are the largest private investor in diabetes research, including the search for a cure for type 1 diabetes. Our founders could hardly have envisioned the company we are today, but neither could they have grasped the way diabetes would turn into one of the 21st century’s most pressing public health challenges.
Today, 415 million people live with diabetes, corresponding to 8.8% of the global adult population, the majority with type 2 diabetes. What has doubled the incidence of diabetes since 2000? Why is this trajectory seemingly unstoppable with a predicted 642 million with diabetes in 2040, and why is it growing most alarmingly in low- and middle-income countries, home to already three-quarters of all people with diabetes? Unhealthy diet, sedentary lifestyle and resulting obesity are among the leading risk factors, but what we recently discovered is that it is much more complex than that, and intrinsically linked to the ‘risk cocktail’ of city life.

Cities are the frontline in the fight against diabetes

Today, more than half of the world’s population lives in urban areas. So do two-thirds of all people with diabetes. That makes cities an important focal point for tackling the disease. However, there is a need to better understand what drives urban diabetes in particular. For the past 20 months, as part of the Cities Changing Diabetes program, Novo Nordisk has been collaborating in a unique public-private-academic partnership with University College London (UCL) and five study cities — Mexico City, Houston, Copenhagen, Tianjin and Shanghai, collectively representing 60 million people — to understand how urbanization links to diabetes. The results of this pioneering new research were recently presented. They challenge current scientific understanding of the rapid rise of diabetes in cities and suggest that social and cultural factors play a far more important role in the spread of the epidemic than previously thought.

Cities Changing Diabetes Summit 2015, CCD2015
Cities Changing Diabetes Summit. Photo courtesy of Novo Nordisk.

 

Time pressure, commuting time and where you live play significant roles in diabetes vulnerability. Is it safe to go out, is the water safe to drink, how do local traditions and conventions shape the way we live? Loneliness, perception of self, one’s body and one’s health, and where diabetes ranks in a person’s individual hierarchy of needs are also important factors. The new insights suggest that cities must reconsider public health and city planning strategies to address the rise of the condition.

What we have learned is that if we are to change the diabetes trajectory, a clinical response is essential but not enough. We need to look at the problem differently. We have to turn more of our collective resources, effort and imagination towards social factors and cultural determinants that put people at risk in the first place, and understand why good outcomes are so hard to achieve. Acting on these new insights, we need to bring new combinations of people and perspectives together to design new and different interventions.

That’s why we are working to put urban diabetes at the top of the healthcare agenda — and put it on the agenda of those designing and managing cities for the future, including an exciting new collaboration with the C40 network of mayors. Novo Nordisk has pledged to invest over US$20 million of expert resource and research funds in Cities Changing Diabetes by 2020, and we are happy that Johannesburg and Vancouver will join in the fight against urban diabetes in 2016.

As an immediate next step for the program, all five original partner cities have committed to deliver local actions that address the challenges identified by the mapping phase. Areas for focus as voted for by the recent Cities Changing Diabetes summit delegates will include community-level action beyond the traditional scope of clinical care and the integration of health within urban planning and municipal policies.

At the local level, we have engaged hundreds of influential stakeholders including NGOs, faith-based organizations, employers, health providers, and insurers to learn about results at numerous stakeholder gatherings and town hall meetings. These groups have shared their insights and discussed possible actions to address the local challenges in prevention, early detection and better treatment of diabetes.

To quote Dr. Amando Ahued Ortega, Minister of Health in Mexico City: “The insights we have gained from the Cities Changing Diabetes research have fundamentally changed the way we think about diabetes in our city. This new understanding of sociocultural risk factors will guide the development of increasingly efficient and targeted public health policies to support the health and well-being of our citizens.” Novo Nordisk is proud to be a catalyst for what could be a fundamentally new way of preventing and managing diabetes.

To learn more about urban diabetes and the Cities Changing Diabetes program, visit www.citieschangingdiabetes.com or explore the   #UrbanDiabetes hashtag.

Charlotte Ersbøll is Corporate Vice President of Corporate Stakeholder Engagement in Novo Nordisk, a Danish based pharmaceutical company leading in the fight against diabetes. She is responsible for corporate sustainability, corporate public affairs, government affairs and trade policy at Novo Nordisk, as well as setting the direction for the company’s global access to diabetes care strategy.