Urbanisation is not just changing where we live; it is having a profound influence on how well we live. Cities concentrate people, opportunities, and services, including health. When cities are well planned and managed, people’s health can surpass that seen in rural areas. But cities can also concentrate hazards to health – and this is becoming increasingly evident in the case of type 2 diabetes, says Niels Lund, Vice President for Health Advocacy, Novo Nordisk
Across the world, we are seeing that city lifestyles are increasing people’s vulnerability to diabetes and other non-communicable diseases (NCDs) – a phenomenon the World Health Organization has called the “new urban epidemic”. The convenience of urban transport, reduced physical labour and rise of sedentary lifestyles, plus changes in what and how much people eat, have collectively contributed to the formation of cities that promote high risk of obesity, and put people at risk of developing type 2 diabetes.
As a result, cities are now the frontline for tackling diabetes. While half the world’s population now live in cities, towns and cities are home to two-thirds of people living with diabetes. By the 2040s this could rise to three in four people with diabetes. Yet already, the disease is shortening millions of people’s lives, costing national health systems billions of dollars, and undermining urban economic growth. It’s an issue where everybody living in a city stands to win or lose; that’s why urban health is a policy for all people.
That’s also why in 2014, we set out to put a spotlight on urban diabetes, and Novo Nordisk partnered with University College London (UCL) and Steno Diabetes Centre to initiate the Cities Changing Diabetes programme. The programme has grown into a global coalition of nine international cities with over 75 million residents, and over 100 expert partners united in the fight against the disease.
Cities Changing Diabetes recently published new research that brings to life the scale of the challenge: three-quarters of a billion people could have diabetes by 2045 – a catastrophic rise that cannot be treated by medicine alone. With related costs that could climb to USD $1 trillion a year by 2045, health systems around the world will become unable to effectively treat patients sustainably.
To understand the future trajectory of the disease and scale of the challenge, we developed the Diabetes Projection Model. For the first time, this shows what it will take to ‘bend the curve’ on diabetes prevalence at a global, country and city level. Achieving this would stop more than 100 million people becoming patients between now and 2045 and ensure that healthcare systems can focus on delivering the best outcomes for those with the disease.
As a partnership we asked ourselves what winning would look like: what will cities need to do, in reality, to alter the trajectory of the rise in diabetes? We arrived at the following three actions that we believe must be a priority for city leaders, planners, and occupants if we are to stand a chance of pushing back the disease:
Get behind the new global goal
New data from the Cities Changing Diabetes modelling shows that to bend the curve we must set a bold goal – where no more than 1 in 10 adults globally has diabetes. That means tackling the most significant modifiable drivers of the condition, and the single biggest of these: obesity. We need ambitious action to reduce obesity by 25% globally by 2045 to hold the rise of diabetes and save health systems US $200 billion a year. Some time ago the world woke up to the devastating impact of climate change and came together to set a goal to curb carbon emissions. We now need to work towards a similar level of consensus and ambition on diabetes, starting with cities.
Understand the city-level realities
The situation is different in every city, based on current obesity and diabetes levels, the age of their citizens and other drivers of the disease. First-hand experience has shown cities need to start by mapping the scale of the challenge that they face and the factors driving it. In a handful of cities we’ve been working with, those differences play out dramatically. In Rome, rapid population growth has meant the number of people diagnosed with diabetes has growth by 60% over the past 15 years alone, and by 2045 the prevalence could reach 10.4% of the adult population if no action is taken. Through a mapping framework called ‘Rule of Halves’, Rome has been able to highlight the gaps in diabetes care, the differences between neighbourhoods and the socioeconomic factors impacting the prevalence of the disease.
The cities who have pioneered action on urban diabetes have discovered the need to look differently at how the social and cultural dynamics of city life put people at risk in the first place. Fieldwork has revealed that some of the most vulnerable groups had never previously been on the radar of public health experts. In Copenhagen, a city frequently named the world’s healthiest city, research revealed inequalities in diabetes management that mean that it is single, middle-aged, men who are the most vulnerable to the disease. Vancouver is now pioneering a new research tool to engage citizens to help identify the most significant local vulnerabilities and, on the back of it, co-create interventions likely to be effective in the city.
Cities and health leaders need to forge a shared action plan
To guide action which matches the scale of the challenge, city and health leaders need to work in partnership with other stakeholders in the city to set a goal for what it will take to hold back the rise of diabetes in their city. There is a growing body of research techniques, knowledge and experience to help cities to get started, set a goal, and to accelerate their own action. These are being captured in a series of tools that have recently been made publicly available.
Houston is a good example of a city thinking differently about how healthcare community can be engaged at the grassroots as well as at the grass-tops. With faith playing a major role in the lives of Houstonians – approximately half of the population belong to a house of faith of some form – the city’s Health Department, in partnership with Houston’s faith leaders, staged a Faith and Diabetes Summit. This brought together more than 100 participants representing leaders from city houses of faith including Buddhists, Muslims, Hindus, Jews and Christians. The next step is a six-week train-the-trainer course that prepares two congregational members from each house of faith to implement prevention programmes among their peers.
Whether you’re a Mayor or a citizen or one of the millions of people in between, today you stand on the frontline of a battle with a new urban epidemic. The moment has come in which together we need to tackle urban health and wellbeing with a new focus and resolve – starting, I believe, with the scourge of urban diabetes.
We can model the diabetes trajectory globally and in any city, and see what it will take to bend it. We have the opportunity to create real momentum behind a shared goal. By playing our part in preventing the rise of diabetes, we can all play an important role in creating conditions for the sustainable healthcare systems of tomorrow. Beginning with action in cities, together, we can – and must – bend the curve of diabetes.
Niels Lund is Vice President for Health Advocacy in Novo Nordisk, a global healthcare company with more than 90 years of innovation and leadership in diabetes care. In addition to his role in Cities Changing Diabetes, an international public-private partnership that aims to prevent the rise in urban diabetes, Niels acts as co-Chair of the Health Strategy Officers Council in the World Economic Forum.