Global health remains more a promise than a reality. As a leading diabetes care company, we believe we can play an important role in helping people with diabetes around the world achieve greater access to health.

We translate this vision into action with our LEAD initiative – Leadership in Education and Access to Diabetes care. In 2002, LEAD began to lay the groundwork for funding projects in various developing countries, all rooted in our business model for ensuring access to health in the developing world. Today, nearly 177 million people around the world have diabetes. By 2030, the World Health Organization (WHO) expects the number of people with diabetes to rise to more than 370 million. Two-thirds of this alarming increase in diabetes will occur in developing countries, where prevalence rates are increasing rapidly among ounger and productive populations. If nothing is done to check this disturbing trend, many poor countries that can least afford the heavy burden of diabetes and its late complications, will be left to  bear the social and economic costs. LEAD is modelled on the four priorities of WHO for improving access to healthcare in the developing countries.

Without sufficient healthcare infrastructure, no country, particularly the poorer ones, can hope to overcome the rapid rise of diabetes. We believe that Novo Nordisk can play an important role in contributing to improving people’s health over and above our primary role as a supplier of diabetes products and delivery systems. To that effect, in 2000 we launched a National Diabetes Programme (NDP) to promote and enhance the development and implementation of such programmes through the Novo Nordisk global network of international affiliate companies. We want to enhance these programmes
where they already exist, and support their development in countries without current plans, by working with healthcare professionals, patient organisations, government and other relevant stakeholders. At the NDP workshops in 2001 and 2002, 41 of 60 international affiliates were represented. After completing a baseline survey of diabetes in the country in which they operate, 34 made a plan for a national programme in their country. These addressed a range of issues from early detection to aged care programmes and better clinical guidelines. Plans are now being implemented.

In 2002, as part of our World Partner Programme (WPP), we fulfilled our target of  developing a model for sustainable diabetes care for helping people with diabetes in poor countries to gain access to diabetes care. The WPP began its work in 2001 with an in-depth, factfinding analysis of diabetes care in six developing countries: Bangladesh, Malaysia, Tanzania, Zambia, El Salvador and Costa Rica. The model points out interesting opportunities to improve diabetes care in the developing world while remaining a viable and profitable business. It is based on the premise that three basic keystones and their critical success factors influence the delivery and quality of diabetes care in the developing world. All of these need to be in place in order for a country’s diabetes care system to  function optimally and effectively. In 2003, we will continue this work and establish  partnerships with patient organisations, ministries of health and other stakeholders. We will initiate and develop partnerships in the six countries which were the focus of the WPP as well as China and India – the countries in the world with the highest number of people with diabetes. Part of the effort will be devoted to establishing national diabetes programmes. We have selected the activities in close consultation with our stakeholders in the countries. These include a workshop in India with key health policymakers from the various states; initiating a centre of excellence at the University Hospital in Tanzania by establishing  a clinic for treatment of foot problems associated with diabetes; and helping to form national diabetes plans in El Salvador, Tanzania and China. Other projects include: clinical guidelines update and training of general practitioners in Costa Rica and Malaysia; recruiting and training diabetes educators in Tanzania, Bangladesh, El Salvador and
Zambia; implementation of a cool-chain system for insulin in Bangladesh; and patient  education programmes in all eight countries. We will also be collaborating with WHO and the International Diabetes Federation.

In 2001 we decided to offer our insulin products to the public health systems in the 49 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. This allows us to maintain an overall profitability while still achieving the goal of affordable pricing. It should be noted that the price of our insulin in these countries has always been substantially reduced compared to world-market prices. We have reviewed the impact of this maximum pricing initiative during 2002 and found that Novo Nordisk has traded in 30 of the 49 LDC countries. In three countries the pricing policy resulted in a reduction below the maximum price, in 16 countries the price stayed below the 20% threshold and in 11 countries the price did not decrease below this threshold. We are working with governments, wholesalers, hospitals, pharmacists – all of those involved in the retail distribution chain – to encourage them to eliminate or reduce mark-ups or taxes to ensure that the reduced cost for insulin directly benefits the patient, which unfortunately is not always the case. We are also working with patient organisations to lobby decision-makers to ensure that people with diabetes benefit directly from reduced prices for insulin.

To address the need for additional funding, Novo Nordisk established the World Diabetes Foundation (WDF) in November 2001 with an endowment of DKK 500 million (EUR 67 million) to be spent over the next decade. The foundation aims to improve diabetes care in the poorest countries through funding of education, capacity building, distribution and procurement of essential medicines. The World Diabetes Foundation is governed independently of Novo Nordisk by a five-member Board of Directors, comprised of individuals with expertise in the fields of diabetes and access to health. The members are Chairman of the Board Sir George Alberti, president of the International Diabetes Federation; Professor Ib Bygbjerg of the Institute of Public Health, Department of International Health, the Panum Institute, Denmark; Ida Nicolaisen, senior research fellow, Nordic Institute of Asian Studies, University of Copenhagen, Denmark; Vice Chairman of the Board Anil Kapur, vice president of Novo Nordisk International Operations and managing director, Novo Nordisk India; and Lars Rebien Sørensen, president and chief executive officer of Novo Nordisk A/S. “There is far too little funding available
for innovative and helpful programmes to improve care for people with diabetes in the developing world,” says Sir George Alberti. “The World Diabetes Foundation was created to fill that gap, but it is not just a question of giving handouts. We are looking very much at sustainability – at projects that will have a longterm benefit for people with  diabetes.” In 2002 the World Diabetes Foundation approved 12 projects out of 44  applications, representing DKK 82 million (EUR 11 million) of which DKK 44 million
was donated by the World Diabetes Foundation and DKK 38 million by others. The projects will take place in Latin America, Africa and Asia. Each project meets the requirement of sustainable diabetes care by including elements of education, training, awareness raising and capacity building. Examples are: the establishment of four diabetes treatment clinics in Bolivia and the formation of a national diabetes plan in Cameroon. The World Diabetes Foundation is also collaborating with other institutions. At the World Summit on Sustainable Development in Johannesburg in 2002, the World Diabetes Foundation joined forces with Danida, the development agency of the Danish Ministry
of Foreign Affairs, to work together towards preventing diabetes and its longterm complications in developing countries. The joint initiative will kick off in 2003 with two projects aimed at strengthening the national healthcare systems in selected developing  world countries. Together with the International Diabetes Federation, the world Diabetes
Foundation is also funding positions at WHO in order to double WHO’s efforts towards
diabetes education and awareness.
For more information, visit
www.worlddiabetesfoundation.org