“When the history of the 21st century is written, it will be about the growth of cities and urbanization.”
Speaking before an audience of community leaders, local medical professionals, and press in Houston, Texas, is Novo Nordisk Global’s CEO Lars Rebien Sørensen. “For the first time in human history,” Sørensen explains, “more people are living in cities than in rural areas. Why can’t we make cities more human and healthy to live in?”
Of the estimated 382 million people worldwide who have diabetes, nearly two-thirds live in urban areas. Globally, those who live in cities are two to five times more likely to have diabetes. Faced with this “emergency in slow motion,” Novo Nordisk launched Cities Changing Diabetes – an ambitious program that seeks to map, analyze, and take action on how to address the growing epidemic of lifestyle-related, preventable diabetes in a handful of cities around the globe.
Houston – the “Energy Capital of the World” and home to the prestigious Texas Medical Center – was announced this week as Novo Nordisk’s third city (after Mexico City and Copenhagen) to join the Cities Changing Diabetes initiative.
For the first time, private and public stakeholders will come together to analyze the urban diabetes problem and develop coordinated solutions. With a population of over two million people (larger than Sørensen’s entire home country of Denmark), Houston is the fourth largest and one of the fastest growing cities in the United States. Over 11% of adults in the Houston area have diagnosed diabetes, more than the Texas state average of 8%.
With an influx of people into industrialized, crowded areas comes the need to address basic elements of urban infrastructure – how we live, move, work, eat, play, and thrive in these environments. In the past, there has been a focus on diabetes only in at-risk subpopulations. What public health researchers see when delving a little deeper into the complexities of urban diabetes, however, is that diabetes risk can vary from 5-20% across the same county, as it does in Harris County. In Copenhagen, for instance, people living in the center of the city are likely to live, on average, seven years longer than people living in other parts of the city – a city 1/18th the size of Houston
Across Harris County, home to over four million people, the prevalence and risk of type 2 diabetes is high in certain neighborhoods irrespective of race or age. As Director of Houston Department of Health and Human Services Stephen Williams said at the event, “The contributing factors may be more complex than the disease itself.” In one neighborhood, it might be an issue of access to healthcare. In another, safe public spaces for walking and outdoor exercise.
There are also the issues of stigma and access to screening opportunities and healthcare that we know are at play in the United States. “Diabetes is not just a touch of sugar,” Williams said to an audience who nodded knowingly at the familiar Southern phrase. “It is a very costly and very serious illness.”
Dr. Stephen Linder, University of Texas School of Public Health, will be working locally to map and analyze the problem using “an international comparative component that’s never been used before.” His team will begin by looking at how the risk of diabetes is distributed across the county and at disparities to develop a better understanding of how prevention will work in the context of how people actually live – their budget of time, financial barriers, where they live and the opportunities for physical exercise. “Settings matter when it comes to who gets sick and who doesn’t,” he explained.
Together the many stakeholders in the initiative – globally, this includes organizations the University College of London and the Clinton Global Initiative, locally the American Diabetes Association and the Harris County Health Alliance – hope to be able to map the problem comprehensively, share the data that they’ve collected, and develop an action plan to help people in urban communities make choices that change their risk.
Dr. Linder spoke of the pre-disposed populations, but also the vulnerable populations – children for whom a future with diabetes is already written if we do not actively change their environments. “Prevention hasn’t been given enough emphasis,” Dr. Linder explained.
An employer of over 40,000 people himself, Sørensen sees employers as being active players in a solution, especially as people move into cities in no small part due to opportunities for employment. “Employers should be far more interested in their cohort of employees,” he said. “We may change insurance companies and providers along the route, but we will own the well-being of our employees.” He advocates for voluntary health screenings, access to healthy nutrition, smoke free environments, and opportunities for exercise.
With only five cities planned internationally for the Cities Changing Diabetes initiative, Novo Nordisk hopes that this will proliferate into a community of cities that can take the methods and data they glean and implement solutions for their own populations.
Houston distinguished itself in the selection process from among other major cities in the United States in no small part because there were already efforts to address the urgency of diabetes and a willingness from public officials and programs to work together, such as through Houston’s launch of a Diabetes and Wellness Network community center in the heart of Houston’s Third Ward. Mayor Annise D. Parker delivered a televised address at the launch event stating her commitment to this three-year campaign with Novo Nordisk.
Jesper Høiland, President of Novo Nordisk Inc, pledged his commitment to be on hand for the city as they navigate this uncharted landscape and promised that he would be making frequent trips to the city. “I was thinking on the plane of the famous phrase, “Houston, we have a problem.” Perhaps we should be saying, “Houston, we have a problem…with diabetes,” he said.
Dr. Faith Foreman, Assistant Director of Houston Department of Health and Human Services didn’t skip a beat as she reiterated how Houston strives to be a leader. “Actually, the first word spoken on the moon was ‘Houston.’ ‘Houston, Tranquility Base here. The Eagle has landed.’”
We will hope that this ambitious international effort to curb the urban epidemic is ultimately one small step for cities… and one giant leap toward eradicating global diabetes.
IDF Diabetes Atlas. International Diabetes Federation. 2013. 6th edn.
 Mbanya JC et al. Diabetes in sub-Saharan Africa. Lancet 2010; 375(9733):2254-2266