International Study Prompts Rethink on the Rise of Diabetes in Cities

• Pioneering new research led  by University College London (UCL)  for the Cities Changing Diabetes partnership shows socio-cultural factors including time pressure, commuting time and where you live play significant roles in diabetes vulnerability¹
• Findings from the world’s largest-ever study of urban diabetes – in five cities which together are home to 60 million people - suggest cities must reconsider public health and city planning strategies to address the rise of the condition
• Over 400 million people worldwide have diabetes, more than two thirds of whom live in cities^2,3
• Partnership initiator Novo Nordisk has pledged to invest over 20 million USD of expert resource and research funds in Cities Changing Diabetes by 2020
• The findings will be presented to delegates at an international Summit in Copenhagen on Monday 16 November where it will also be announced that in 2016, Vancouver and Johannesburg will join Mexico City, Shanghai, Tianjin, Copenhagen, and Houston as partner cities

BAGSVAERD, DENMARK, 16 NOVEMBER 2015

International research led by University College London (UCL) as part of the ‘Cities Changing Diabetes’ partnership programme challenges current scientific understanding of the rapid rise of diabetes in cities. The findings suggest that in cities around the world, social and cultural factors play a far more important role in the spread of the epidemic than previously thought.

More than two thirds of the world’s 400 million people with diabetes live in urban areas.^1,2 The year-long study for Cities Changing Diabetes, a unique public-private-academic partnership, sought to better understand what makes people vulnerable to type 2 diabetes in cities in order to inform solutions for one of the most pressing modern-day public health challenges. To explore this complex issue, more than 550 interviews were undertaken with at-risk and diagnosed people in five major cities – Copenhagen, Houston, Mexico City, Shanghai and Tianjin.

“By largely focusing on biomedical risk factors for diabetes, traditional research has not adequately accounted for the impact of social and cultural drivers of disease,” says David Napier, Professor of Medical Anthropology, UCL. “Our pioneering research will enable cities worldwide to help populations adapt to lifestyles that make them less vulnerable to diabetes.”

The study found that diabetes vulnerability in cities is linked to a complex mix of social and cultural factors1– responsible for both putting people at greater initial risk and subsequently making them less likely to be diagnosed, receive treatment and maintain good health. The identified social factors included financial, geographical, resource and time constraints while cultural determinants included the perception of body size and health and deep-seated traditions.¹

“The insights we have gained from the Cities Changing Diabetes research have fundamentally changed the way we think about diabetes in our city,” said Dr Armando Ahued Ortega, Minister of Health of Mexico City. “This new understanding of sociocultural risk factors will guide the development of increasingly efficient and targeted public health policies to support the health and wellbeing of our citizens.”

KEY FINDINGS FROM STUDY CITIES¹

• In Houston, the traditional notion of disadvantage being equal to vulnerability is no longer the rule and both people with and without financial constraints may be vulnerable to diabetes
• In Mexico City, gender roles may contribute to increased vulnerability as women neglect their own health to avoid being seen as burdensome
• In Copenhagen, diabetes is often not highest in a person's hierarchy of need, given many other social and health issues such as unemployment, financial difficulties and loneliness
• In Shanghai, the cultural trend for the denial of hardship was seen to prevent people with diabetes from seeking help from friends, family and healthcare professionals
• In Tianjin, people with diabetes reported a wide range of causes of the condition including poor food choices, overworking and poor mental health

Prompted by the findings, Novo Nordisk has pledged to support the fight against urban diabetes via the investment of 20 million USD of expert resource and research funds by 2020. Commenting on the promise, Lars Rebien Sørensen, president and chief executive, Novo Nordisk said:

“We have a longstanding commitment to provide more than just pharmaceuticals to the fight against diabetes. Research of this nature illustrates precisely why we initiated Cities Changing Diabetes - to fundamentally change the trajectory of the disease through targeted actions informed by new understanding.”

The Cities Changing Diabetes partnership has three distinct but interconnecting phases – mapping, sharing and action. With the initial mapping phase now complete, the Copenhagen Summit meeting will see 250 expert delegates from around the world come together to discuss the learnings and discuss solutions to tackle diabetes in cities.

In the longer-term, the partnership aims to tackle the rise of diabetes in cities around the world via the sharing of insights and knowledge of participants. In 2016, Vancouver and Johannesburg will become the latest cities to join the programme and contribute to the international pool of evidence.