This is the third in a six-part series by our CEO, Mads Krogsgaard Thomsen, about how the Novo Nordisk Foundation is changing. Read Part One here, Part Two here, and look out for Part Four soon.
During a flight from New York to Copenhagen nearly 30 years ago, I had what I can only describe as a Eureka moment. I was coming home from a conference where I’d spoken with Ronald Kahn, then Research Director of Joslin Diabetes Center at Harvard Medical School. At the request of the US President, he’d written a report about the rising incidence of diabetes in the USA. It was that report that kept me awake on the flight home. To break the curve on diabetes, Kahn concluded, we have to stop focusing solely on blood sugar and instead grab the disease by its roots – childhood obesity.
At the time, this was revolutionary. It was also my first glimpse of the complex web of conditions and complications of which diabetes is just one part.
We now know that diabetes is shaped by many factors, just one of which is obesity, and that both these conditions increase the risk of cardiovascular and kidney disease. Collectively, these are known as cardiometabolic disease – a subset of noncommunicable disease caused by dysfunctions in the way the body turns food into energy.
But there’s so much we still don’t understand. How exactly do genetics and physiology interact with a person’s lifestyle and environment to drive these conditions? Why do they sometimes manifest differently depending on sex or ethnicity? And how do they interact with other conditions such as cancer or tuberculosis?
Tackling diabetes is part of our DNA here at the Novo Nordisk Foundation. But to move the needle not just on diabetes but cardiometabolic disease more broadly, we need a new, more holistic and more collaborative approach. Because the task is huge and we will get nowhere alone.
One third of global deaths
Billions of people around the world live with cardiometabolic disease. These conditions and their complications also cause around a third of global deaths – and the numbers are rising. It’s a crisis by any definition, but the world is not responding fast enough.
Despite some recent progress, research, prevention, education, and care in this area remain chronically underfunded, with severe consequences for individuals – especially those in vulnerable positions – and health services. All too often, people are blamed for their disease, while failings in food, health, and economic systems are largely neglected.
There are no quick fixes. But there are clear ways forward, and many others already doing great work. Let me share some examples of what we’re doing, often together with partners, to help address this global health crisis.
The need for knowledge
To make real progress, we need deeper scientific understanding of why these diseases develop and how they progress, as well as implementation research to understand how we get existing solutions to scale.
That’s why the Novo Nordisk Foundation is continuing to support the best research through both open calls and established research centres, with a focus on where our funding can make a real difference. For example, we’re supporting research on sex differences in cardiovascular disease, links between obesity and cancer, and the connection between cardiometabolic disease and the microbiome.
Cross-border, cross-sector collaborations are also crucial in the bid for new knowledge, as is a focus on translating this knowledge into practical, scalable solutions using data-driven technologies including AI.
The REACT initiative is a good example. In Denmark and Spain, researchers have joined forces to find new ways to detect atherosclerosis – often a precursor to cardiovascular disease – long before it causes harm, and even to stop it progressing. After launching in Europe, the study is actively collaborating with similar studies run from Singapore, India, and Tanzania, helping create a more global picture of this silent condition.
Building healthier futures
But research and innovation alone cannot solve the cardiometabolic challenge. We need to change the systems that fuel it.
The home-grown school meals initiatives we support are one way of doing that. Together with partners across East Africa, we’re boosting local food systems through research and innovation, supporting smallholder farmers to sustainably produce more nutritious crops to the fast-growing school meals programs. The result? Local food systems get more resilient, nutrition and learning outcomes improve, and we help address one of the root causes for children to develop cardiometabolic problems later in life.
We’re looking at health systems too. In India and East Africa, for example, we’re working with a large number of colleges through the PEP programme to better equip frontline health workers with the skills to diagnose, manage, and prevent cardiometabolic disease. Closer to home, the Steno Diabetes Centers are pioneering new ways of delivering care. Several centres have scrapped traditional appointment schedules in favour of needs-based systems, ensuring that those who need support can always get it.
The work is broad and complex, but the vision is clear: a world where cardiometabolic disease is prevented before it takes hold, and where everyone with these conditions can access high-quality, integrated care when they need it, leading to healthier lives.
Breaking the curve
Nearly three decades ago, that sleepless flight home taught me that real progress begins at the roots. Today, we know that the roots of cardiometabolic disease stretch across systems and continents – and so must our response.
The learning curves are steep – as are the curves plotting new cases of diabetes, heart disease, and kidney disease around the world. And those curves will only break if we and others join forces, pooling our skills and resources for the benefit of all. That is the road ahead, and we are committed to walking it together.
