Access to health
About 194 million people worldwide have diabetes - 5.1 percent of all adults. By 2025, according to the International Diabetes Federation (IDF), this number is expected to soar to 333 million, or 6.3 percent of all adults. Furthermore, 80% of these will live in areas that currently have little or no access to health. Diabetes is a lifestyle disease well known in developed countries, but it is increasingly clear that it also hits people in the developing world that are unaware of their condition, and who could not access or afford treatment even if they were. Estimates show that the rate of diagnose in the developed world currently is around 70% and in the developing world around 40% (ranging from 25% to 60%).
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 optimal 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.
Diabetes in the developing world
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 care for.
A partnership approach
These are daunting figures, and the challenge they pose cannot be ignored. As a world leader in diabetes care, Novo Nordisk has initiated several programmes to increase access to better diabetes care in both the developed and developing world. All the programmes depend on working in partnership with many different stakeholders to meet the challenge of defeating diabetes head-on.
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. 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.
A Millennium Development Goal
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.
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.
Performance 2004
Since 2001, Novo Nordisk has had a four-pronged strategy to addressing access to health in the developing world that builds on the WHO’s four major focus areas for improving access to healthcare.
WHO priorities | Novo Nordisk response |
Development of a national health care strategy | National Diabetes Programme Diabetes Attitudes Wishes and Needs (DAWN) Programme, and socio-economic analysis. |
Building national healthcare capacity | National Diabetes Programme Diabetes Attitudes Wishes and Needs (DAWN) Programme, and socio-economic analysis. |
Best possible pricing | Best possible pricing scheme in LDCs |
Additional funding | World Diabetes Foundation funding projects in developing countries1 |
1 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 from Novo Nordisk. During its first three years of operation the WDF has supported more than 40 projects in developing countries.
These initiatives are estimated to reach out to 21 million people, 7.4 million of whom are in the developing world.
National Diabetes Programme
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 partnerships with many stakeholders and spearheaded by Novo Nordisk through its affiliates. Today there are 213 separate activities carried out by Novo Nordisk affiliates in 46 countries, in both the developed and the developing world. Activities reach out widely and include educating nurses, doctors and patients, supporting diabetes patient organisations, equipping diabetes clinics, and working with governments to design national diabetes strategies.
Setting up diabetes clinics in developing or emerging economies helps make diabetes care more widely available and accessible. Laboratory equipment allows for proper monitoring and follow-up care. Training and education of healthcare professionals has improved the capacity to properly diagnose and treat diabetes.
DAWN
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-centered communication.
Therefore Novo Nordisk has created the global DAWN programme in collaboration with the International Diabetes Federation (IDF) and many other stakeholders. DAWN – Diabetes Attitudes Wishes and Needs - is an ongoing advocacy and action programme driven by Novo Nordisk to promote people-centered diabetes care and overcome the psychosocial barriers to effective self-management. Today DAWN-related activities are an integral part of the National Diabetes Programme and are being carried out by Novo Nordisk and partners in 31 countries around the world.
Best possible pricing
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, 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 2004, Novo Nordisk offered this pricing scheme to 49 countries and sold insulin to a total of 33 LDCs at or below this price, compared to 16 in 2003. 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.
Socio economics: investment in health
Socio economics is about showing how investing in health can free resource for other social development purposes. Additional investments in better treatment at an early stage are offset by lower costs to society in the future due to less complications (lower hospitalisation costs, less nursing of irreversible disabilities and higher productivity). The socio economic consequences are reflected in Novo Nordisk’s current strategy and based on the objective to prevent complications from developing into an irreversible stage where only daily care and nursing homes can be offered.
The burden of diabetes is not so much the number of people with diabetes but their level of complication and how the resulting disabilities impact individuals’ wellbeing and socio economic development. Novo Nordisk has made an attempt to look into the future regarding the number of people with diabetes and their condition under different scenarios.
If current trends continue, the Danish diabetes population will increase by 19% over 20 years and the share of persons with heavy complications from 9% (14,800 people with diabetes) to 10% (19,000 people with diabetes). Assuming an alternative with an increased rate of obesity, the increase in the diabetes population would instead be 28% and the share of people with heavy complications (increasingly in the productive ages) will increase to almost 11% (21,300 people with diabetes). Read more about the forecasts.
Although other countries may have incidence and prevalence rates that differ from this, the case of Denmark is illustrative of how these trends will impact the overall composition of a diabetes population over time. The underlying idea is that the future can also be impacted in a positive direction with fewer people with diabetes or with a much larger share in a good condition if the progression of the disease is impacted.
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