Novo Nordisk’s approach

As a world leader in diabetes care, Novo Nordisk has for many decades been active in contributing to improving diabetes care globally. The number of people with diabetes worldwide is 194 million, expected to increase to 333 million by 2025 according to the International Diabetes Federation. Furthermore, 80% of these people live in areas that currently have little or no access to health. Global distribution of people with diabetes.

Type 2 diabetes, which accounts for 95% of all cases, has been linked to rising rates of obesity and too little exercise. Rapid cultural and social changes, increased urbanisation, an ageing population, and unhealthy lifestyle and behavioural patterns are contributing to an unprecedented boom in type 2 diabetes in the developing world, mirroring its longer-established rise in the West.

Many people with diabetes worldwide are unaware that they have the condition. In the developing world, many could not access or afford treatment even if they were aware of having diabetes. Estimates show that the rate of diagnosis in the developed world is currently around 70% and in the developing world around 40% (ranging from 25% to 60%).

In 2001 Novo Nordisk launched a strategy to improve access to health that is built on the four priorities for improving access to health.



 In carrying out this strategy, it works in partnership with a variety of stakeholders, including patient associations, healthcare professionals, NGOs and governments.

In January 2005 the United Nations launched a new practical plan to achieve the Millennium Development Goals within the next 10 years. One of the conclusions was that even well-governed poor countries cannot solve their problems without help from more affluent countries. It is not enough for companies from the affluent parts of the world to supply products and create jobs; they also have an important role to play in supporting the developing countries in creating infrastructure and building knowledge.

Novo Nordisk supports the United Nations Millennium Development Goals and its strategy on access to health recognises the link between poverty and ill health. To successfully contribute to providing global access to health, Novo Nordisk has found it necessary to focus both on the micro level, addressing individuals, and on the macro level, addressing systems and structures.

The hidden economic burden of diabetes, already huge, will increase in the future if nothing is done. Studies in the US and Denmark indicate that between 30% and more than 50% of the cost of diabetes may be indirect costs due to complications.

Novo Nordisk has estimated that globally currently 11% of all people with diabetes and 23% of those diagnosed are using insulin.

Insulin is not the universal treatment solution to diabetes, but these figures reflect that most people with diabetes receive less than optimum treatment, especially in the developing world, and as a consequence the burden of diabetes is likely to increase. Despite the existence of guidelines for medication, these are not followed even in the developed world and the consequence is a future of more people with costly and irreversible complications.

One of the fundamental issues is how this will impact in particular developing countries’ ability to grow and develop. The disease hits doubly by impeding people’s productive abilities as well as being costly to treat and to provide care for.

Low- and middle-income countries often lack the healthcare infrastructure to meet the needs of a growing number of people with diabetes. Lack of awareness and education about diabetes is a serious concern in the developing world but also persists in the rest of the world.

Performance 2005

Novo Nordisk believes that the only way to fight diabetes is by taking an approach  that combines increased awareness, education and prevention with improved access to treatment. The programmes or initiatives that make up the company’s approach are briefly described below together with performance highlights for 2005.

Building national healthcare capacity and developing national disease strategies is at the heart of the National Diabetes Programme (NDP). These are initiatives to improve access to treatment of diabetes based on partnership with many stakeholders and spearheaded by Novo Nordisk through its affiliates. Activities include educating nurses, doctors and patients, supporting diabetes patient organisations, equipping diabetes clinics, and working with governments to design national diabetes strategies. As of the end of 2005, there were 267 separate activities being carried out by Novo Nordisk affiliates in 46 countries in both the developed and the developing world. See an overview of the outreach of National Diabetes Programme activities.

Access to diabetes care is also an issue in the developed world. Some groups of people, due to ethnic background and genetic predisposition, experience a higher incidence of diabetes; some of them may also experience inequities in access to care. In 2005 Novo Nordisk’s initiatives to better serve the needs of low-income minority populations included:

• The Changing Diabetes Dialogue series, aimed at working with partners to identify barriers to care for low-income minorities. Dialogues so far have looked at communities in Greece and the Netherlands. The goal is to gather examples of best practice and make these available to those who work with diabetes worldwide.
  
  
• A three-year project with the University of California at Irvine in the US to identify cultural beliefs about diabetes among Vietnamese living in California. A ‘coaching’ technique is being tested, in which people with diabetes coach one another as such an approach may be effective in close-knit communities for improving treatment outcomes.
  
  
• A programme to fight diabetes in the Native American community in the US in which the incidence of diabetes is dramatically higher than in Caucasians. This programme is being conducted under the auspices of Novo Nordisk’s employee volunteer programme, TakeAction! Examples include support for the Association of American Indian Physicians, ‘Keeping Well With Diabetes’ materials geared toward Native Americans, funded research for an audiocassette for the Navajos of New Mexico, and sponsored scholarships for Native American nursing students.
  

In 2005 Novo Nordisk formed a Native American Advisory Council consisting of four high-powered and well-connected lay and healthcare professionals. As well as discussing many new ideas, the panel approved an initiative in collaboration with the Special Diabetes Program, which funds community programmes on Native American reservations.

Insulin therapy and improved care are part of the solution, but provision of medicines is not enough. Understanding the person behind the disease is necessary to obtain better health and quality of life for people affected by diabetes. Healthcare professionals acknowledge a lack of resources to identify and care for the many psychosocial problems as well as a major gap in regard to team-based patient-centred communication. 

Novo Nordisk has therefore created the global DAWN programme in collaboration with the International Diabetes Federation (IDF) and many other stakeholders to advocate putting people at the centre of diabetes care and facilitate actions worldwide. DAWN – Diabetes Attitudes Wishes and Needs – is an ongoing advocacy and action programme driven by Novo Nordisk to promote people-centred diabetes care and overcome the psychosocial barriers to effective self-management.

The DAWN programme provides an international framework for advocacy, guidelines, practical tools and best practices across the world. This includes, for example, national 'train-the-trainer' programmes for primary care physicians on the psychological aspect of care, and quality-of-life questionnaires for people with diabetes that several countries now incorporate into routine health evaluations. In addition, two international summits have been held to increase awareness and encourage debate and action on the issue. DAWN-related activities are an integral part of the National Diabetes Programme and are being carried out by Novo Nordisk and partners in more than 30 countries around the world.

Improving the affordability of essential drugs like insulin is also part of the solution to better access to care. In recognition of this, since 2001 Novo Nordisk has offered human insulin to the public health systems in the 50 Least Developed Countries (LDCs), as defined by the United Nations, at prices not to exceed 20% of the average price in the industrialised countries of North America, Europe and Japan.

In 2005 Novo Nordisk offered this pricing scheme to 50 countries and sold insulin to a total of 32 LDCs at or below this price, compared to 33 in 2004. In several cases, the government has not responded to the offer, either because there are no private wholesalers or other partners with which to work, or because wars or political unrest sometimes make it impossible to do business. 

Unfortunately, there is no way to guarantee that the price at which Novo Nordisk sells the insulin will be reflected in the final price on the pharmacist’s shelf. Novo Nordisk works with governments to encourage tenders, so that there is a greater chance that the preferential price will benefit the patient for whom it is intended.

The World Diabetes Foundation (WDF) was established by Novo Nordisk in 2001 with an endowment of DKK 500 million to be spent over a ten-year period. It is dedicated to supporting the prevention and treatment of diabetes in developing countries. It is governed independently of Novo Nordisk by a five-member Board of Directors and publishes its own Annual Report. Its activities have an estimated direct impact on 24 million people in more than 65 countries in the developing world.