European Congress on Obesity, Glasgow, April 2019 | Teddy Sun, Thomas Hilberg Rahbek, Ole Kjerkegaard Nielsen, Mette Bøgelund, Laurie Twells, Altynai Satylganova, Niels Lund, Stephen Charles Gough

The achievement reducing premature mortality from NCDs by one third by 2030 (SDG 3.4) requires reduction in rates of obesity. The aim of this study was to illustrate the projected impact of BMI on NCD-related premature mortality in 2030 in five high-income and upper-middle-income countries. A BMI Mortality Model was developed based on population projection data on BMI, age and gender distribution in 200 countries and applied associations between BMI and premature mortality from NCDs. When compared to the linear growth scenario, application of the status quo scenario resulted in the following decrease in premature NCD-related deaths by 2030: 5% decrease in Brazil, Denmark, and Mexico, 6% in Canada, and 7% in the UK. If there is no overweight or obesity by 2030 (no excess weight scenario) premature mortality will decrease by 25% in Brazil, 26% in Denmark, 28% in Mexico, 30% in Canada, and 31% in United Kingdom. This study provides important evidence on the extent to which excess BMI impacts the premature mortality from NCDs in selected countries.

European Public Health Conference, Liubljana, November 2018 | Bjarne B Jensen, Louise Hesseldal, David Napier

Despite abundance of interventions to prevent or live a healthy life with T2D, vulnerable people are often less likely to join. An objective of CCD is to learn if interventions to prevent or improve management of T2D which include community involvement and are tailor-made based on local research are able to attract vulnerable citizens. Creating interventions based on local research findings allow tailor-made design to fit citizens’ specific needs. Involving the community strengthens its empowerment and more vulnerable individuals participate. Involving communities in designing interventions is crucial for targeting vulnerable people. Providing training to peers and professionals based on local research ensures relevance to local context.

European Public Health Conference, Liubljana, November 2018 | Huxley, T H Rahbek, S Nielsen

Climate change and NCDs are both increasingly pressing issues faced by cities. Clustering of populations in urban areas is a challenge for health, environment and liveability of cities, but also makes them central for a joint intervention. An objective of the C40/CCD partnership is to learn how cities can be supported to strengthen the case for investment in climate actions by demonstrating the derived health benefits. The results show benefits of investing in walking initiatives and help the city estimate potential benefits/drawbacks of urban actions and how similar interventions could be expanded across the city. The well-being of the city is important to the well-being of its citizens.

International Conference on Urban Health, Kampala, November 2018 | Huxley, T H Rahbek, S Nielsen

Climate change and NCDs share similar root causes, such as urbanization, mechanization, overconsumption and motorized transport. Cities are central to the solution, having more than 50% of the world’s population and 70% of the total carbon emissions. The partnership led to the development of an evaluation tool for urban walkability and bikeability, which as per today has been tested in 12 cities, providing valuable insights for planning healthy and sustainable cities. The tool enabled estimating social, environmental and economic benefits in each city for specific projects. The novel evaluation tool quantifies the burden and the benefits, providing a data-based foundation, strengthening the advocacy for investing in more health and climate actions.

International Conference on Urban Health, Kampala, November 2018 | Napier D, Hesseldal L, Nielsen S, Volkmann A

Social factors and cultural determinants present both barriers and opportunities for successful prevention, care and management of T2D. The aim was to better understand what makes certain people vulnerable to T2D in five diverse cities. The presence and nature of socio-cultural factors in diabetes was assessed to understand the complexity of vulnerability.The basis of the assessment was a Diabetes Vulnerability Assessment (D-VA) instrument based on a semi-structured interview protocol, to collect information relating to health, wellbeing, and the lived experience of T2D. Eight locally distinct and globally shared social factors and cultural determinants were identified. A range of cultural, social, environmental, psychological, and biological factors increase (or mitigate) vulnerability. Specific combinations of these factors make some people more vulnerable to developing diabetes or to suffer from diabetes-related complications.

European Association for the study of diabetes, Berlin, November 2018 | A-M Volkmann, L Hesseldal, M Bagger, D Napier

Cities are an important focal point for researching diabetes and for improving its prevention, care and management. The success of any intervention is significantly influenced by inter-related geographical, economic, environmental, social, and cultural factors, which up until now have been under-explored. In order to obtain data about relevant environmental, social and cultural factors that make certain people vulnerable to T2D, Vulnerability Assessments were carried out in five cities around the world. The research identified a set of social factors and cultural determinants relevant to type 2 diabetes vulnerability that were evident across all cities with considerable local variations. ‘Traditions and Conventions’ was one such factor. Where local traditions and conventions encourage specific individual behaviours, community-based interventions may prove ineffective, even if there are good local care providers present.

European Association for the study of diabetes, Berlin, October 2018 | S Nielsen, D Napier, BB Jensen, A Moses, N Lund

We have previously demonstrated that targeting a global diabetes prevalence stabilised at 10% by 2045 requires 25% reduction of obesity prevalence. The study shows how regional prevalence of T2D is affected from 2017 to 2045 in a past trend scenario assuming that future increase in obesity prevalence is extrapolated linearly and in a target scenario assuming that obesity prevalence is reduced by 25% in 2045. BMI data for all countries in the world 2000-2014 were obtained. NAC and EUR where obesity has been on the rise for decades have the highest T2D prevalence but also the slowest future increases. In regions with lower T2D prevalence like AFR, the number of people with T2D will increase up to three fold in the coming three decades unless obesity prevalence is reduced. To realise the target scenario, health should be integrated into all policies in order to contribute to reduce the obesity and T2D burden.

American Diabetes Association Scientific Sessions, Orlando, June 2018 | D. Napier, Lund N, Bagger M, BB Jensen

Cities are a focal point for tackling diabetes. As part of CCD five diverse cities have implemented actions based on 740 individual interviews with people with type 2 diabetes or at increased risk of developing it. Based on participants’ perspectives on socio-cultural barriers to live a healthy life action plans were created relevant to the local diabetes challenge and city context and tailor-made interventions were designed. The research insights led to four arenas for impactful interventions:

• Health promoting policies

• Urban planning

• Community involvement

• Health system strengthening

In conclusion, insights from the research have directly guided development of city-specific tailor-made interventions within four arenas.

European Congress on Obesity (ECO), Vienna, 5/1/2018 | Moses A, Lund N, Jensen BB, Napier D

Type 2 diabetes (T2D) is influenced by various factors and long delays between these initiating factors and their effects. The rise is primarily driven by population growth and ageing, physical inactivity, unhealthy diet, rising overweight and obesity. The most significant modifiable driver is excess body weight. One aim of CCD is to model how future diabetes prevalence will be impacted if the current obesity level is extrapolated linearly. Population data for all countries in the world were obtained from the Non-communicable Disease Risk Factor Collaboration. Stabilising the global diabetes prevalence at 10.0% by 2045 will require global obesity rate to be decreased by 25% by 2045 compared to 2017. The global prevalence of obesity and diabetes is projected to increase dramatically unless prevention of obesity is significantly intensified.

Intergovernmental Panel on Climate Change (IPCC) – Cities and Climate Change Science Conference, Edmonton, March 2018 | Huxley R, Bagger M, Lund N

Climate change and NCDs share the same root causes, which means that shared opportunities for joint action exist. To demonstrate social, environmental, and economic benefits of bikeability and walkability in twelve cities, understand how cities can highlight climate and health benefits from action using best available city data, and develop a global standard approach. Methods: C40 and Novo Nordisk are collaborating to tackle the root causes of climate change and T2D in cities. The social, environmental, and economic benefits of bike share scheme in Mexico City were evident. By demonstrating wider benefits from climate action, cities can facilitate urban development that reduces greenhouse gas emissions while increasing citizens’ health, wellbeing and economic opportunities.

European Congress on Obesity (ECO), Vienna, 5/1/2018 | Volkmann A, Hesseldal L, Bagger M, Napier D

Lifestyle modification and interventions have shown to be effective in weight reduction and diabetes prevention, but they are significantly influenced by environmental, social, and cultural factors. The way a person integrates oneself into the social environment and comparatively evaluates what is normative can create explicit vulnerability to T2D. When normative body images change, so does the perception of what a ‘healthy body’ might look like. Vulnerability Assessments were carried out in Copenhagen, Houston, Mexico City, Shanghai, Tianjin to understand what makes certain people vulnerable to T2D by identifying relevant environmental, social and cultural factors. The research identified a set of social factors and cultural determinants relevant to T2D vulnerability. ‘Perception of Self and Other’ impacts vulnerability to T2D. Awareness of this determinant and insights on how it manifests locally should inform and guide local tailor-made interventions.

International Diabetes Federation Congress, Abu Dhabi, December 2017 | Napier D, Volkmann A, Hesseldal L, Bagger M

Cities are ideal sites for studying T2D and for understanding better what drives this condition globally. Social factors and cultural determinants constitute both barriers and opportunities for successful prevention, care and management of T2D. We present a novel research approach, the Diabetes Q Assessment (D-QA) that explores priorities, attitudes, and shared points of views among people living with T2D. The aim of the D-QA is to understand the presence and impact of local social factors and cultural determinants of T2D across specific population sub-groups to inform interventions and improve both care and management. It enables cities to identify specific barriers and opportunities to successful care and prevention that can inform future interventions and policies. Through a deeper understanding of how the social factors and cultural determinants of diabetes play out in a given city, diabetes prevention and care can be improved upon and tailored to specific target groups.

International Diabetes Federation Congress, Abu Dhabi, December 2017 | Bagger M, Huxley R, Lund N

Climate change and NCDs share the same root causes such as urbanisation, overconsumption, motorised transportation, lack of green space, and air pollution. However, that also means that there are shared opportunities for joint action. The aim is to demonstrate social, environmental, and economic benefits of bikeability and walkability in eleven cities. Collection and analysis of raw city data are provided by relevant city teams directly supported by C40. By demonstrating wider benefits from climate action, cities can facilitate urban development that reduces air pollutants, greenhouse gas emissions and climate risks, while increasing the citizens’ health, wellbeing, and economic opportunities. The research aims to accelerate actions on climate and health by enabling cities to make a stronger case for action.

International Diabetes Federation Congress, Abu Dhabi, December 2017 | Bagger M, Napier D, Jensen BB, Moses A, Lund N

The increase in diabetes prevalence is one of today’s major health challenges with 415 million people living with the condition globally. The global rise in prevalence primarily is driven by population growth and ageing, physical inactivity, rising overweight and obesity as well as unhealthy diet. Cities have a great potential to contribute to tackle the obesity and diabetes challenges and reduce their healthcare burden. To increase the understanding of drivers behind the escalating occurrence of T2DM in urban settings, we aim to illustrate the degree that obesity drives the current and future prevalence of T2DM in an open cohort. The model will estimate how much of the projected prevalence of T2DM is driven by obesity and how theoretical reductions in the obesity prevalence will impact the future prevalence of T2DM. The model is designed to assist policy makers in building a stronger case for developing and implementing more effective public health strategies to target a reduction of obesity.

International Conference on Urban Health, Coimbra, September 2017 | Bagger M, Huxley R, Lund N

Climate change and NCDs are two of the defining challenges of the 21th century. They share root causes such as urbanisation, overconsumption, motorised transportation, lack of green space, and air pollution, meaning there is opportunity for joint action. Collection and analysis of raw data regarding bikeability and walkability are provided by relevant city teams directly supported by C40. The research results will demonstrate a wide range of social, environmental and economic benefits from bikeability and walkability actions in seven large cities across the world. By demonstrating the wider benefits from climate action, cities can facilitate urban development that reduces greenhouse gas emissions and climate risks, while increasing the citizens’ health, wellbeing and economic opportunities.

International Conference on Urban Health, Coimbra, September 2017 | Napier D, Volkmann A, Bagger M, Hesseldal L, Lund N

Social factors and cultural determinants present both barriers and opportunities for the successful prevention, care and management of (T2D). We present a novel research approach, the Diabetes Q-Assessment (D-QA), to understand the presence and impact of local social factors and cultural determinants of T2D in cites. The result is an in-depth analysis of the presence and impact of specific social factors and cultural determinants and how these constitute barriers and opportunities for the identified participant groups. The D-QA enables cities to identify barriers and opportunities to successful prevention and care that can inform interventions and policies. Through a deeper understanding of how the social factors and cultural determinants of T2D play out in a given city, prevention and care can be improved upon and tailored to specific target groups.

Österreichische Diabetes Gesellschaft (44th Annual Meeting of the Austrian Diabetes Association), Austria, November 2016 | Nolan J

We believe change can be achieved by putting urban diabetes: At the top of the healthcare agenda and on the agenda of those designing and managing cities. Action is taken on both global and city levels at three stages: map, share and act. The global research framework exists of the Rule of Halves and Assessment of Social Factors and Cultural determinants. Results from the first 5 cities show social factors contributing to T2D are: financial constraints, time constraints, resource constraints and geographical constraints. Cultural determinants include: agency and opportunity, traditions and conventions, views of health and illness, self and other, and change and transition.

Österreichische Diabetes Gesellschaft (Joint Session of the Austrian Diabetes Association and Austrian Obesity Association at the European Forum Alpbach), Austria, November 2016 | Nolan J

We believe change can be achieved by putting urban diabetes: At the top of the healthcare agenda and on the agenda of those designing and managing cities. Action is taken on both global and city levels at three stages: map, share and act. The global research framework exists of the Rule of Halves and Assessment of Social Factors and Cultural determinants. Results from the first 5 cities show social factors contributing to T2D are: financial constraints, time constraints, resource constraints and geographical constraints. Cultural determinants include: agency and opportunity, traditions and conventions, views of health and illness, self and other, and change and transition.

American Diabetes Association Scientific Session, New Orleans, June 2016 | Napier D, Volkmann A, Hesseldal L, Bagger M

Cities are an important focal point for researching diabetes and improving prevention, care, and management. The aim is to research urban diabetes and its drivers and to place the condition high on the global urbanisation agenda. In each city, a Vulnerability Assessment3 was conducted to understand the local status and what makes certain people vulnerable to diabetes and its complications by identifying the social factors and cultural determinants that plausibly impact vulnerability. Results from the first 5 cities show social factors contributing to T2D are: financial constraints, time constraints, resource constraints and geographical constraints. Cultural determinants include: agency and opportunity, traditions and conventions, views of health and illness, self and other, and change and transition. They can be identified and analysed to inform and likely guide intervention and policy change.

International Conference on Urban Health, San Francisco, April 2016 | Napier D, Nolan J, Volkmann A, Hesseldal L, Lund N

The increase in T2D in urban areas provides complex challenges that call for a new research approach. We present the Diabetes Vulnerability Assessment for assessing factors that make individuals vulnerable to developing diabetes and to suffering from complications. Five cities participated in the study. Local academic partners together with UCL conducted the research. The DV-A was implemented to assess local givens in the formal, the community, and the vulnerability domains as they relate to participants’ social and cultural circumstances, their health, health care, and diabetes. The factors identified, like financial, time, resource and geographical constraints are shared across cities, but manifest themselves in unique ways locally.

International Conference on Urban Health, San Francisco, April 2016 | Nolan J, Napier D, Bagger M, Lund N

Cities concentrate people, opportunities and services, including those for health. Cities can also concentrate risks and hazards to health – this is evident in the case of type 2 diabetes. In each of the cities, the extent of the urban diabetes challenge is mapped by applying quantitative research and an understanding of the drivers behind urban diabetes is generated through qualitative research. Together this will uncover new knowledge about the local diabetes burden, the social factors and cultural determinants behind urban diabetes.

International Diabetes Federation World Congress, Vancouver, December 2015 | Nolan J

International Diabetes Federation World Congress, Vancouver, December 2015 | Napier D, Nolan J, Lund N

Given the complexity of the challenges posed by the rapidly increasing prevalence of diabetes in urban areas, a multidisciplinary approach combining quantitative and qualitative data is essential to understand the problem. The aim of CCD is to understand urban diabetes and to increase awareness. Quantitative and qualitative research is performed in five study cities, which creates a repository of detailed “stories” derived from the interviews that are grouped according to their respective case definitions. The analysis of the interviews yields a set of locally valid vulnerability indicators and vulnerability cases. This research is designed to convey new insights about cultural, social and environmental risk factors for developing diabetes and its complications in urban areas.

International Diabetes Federation World Congress, Vancouver, December 2015 | Napier D, Nolan J, Lund N

Cities are an important focal point for tackling diabetes. However, there is a need to better understand what drives diabetes in urban areas. The programme will help to clarify the factors underlying diabetes in cities, to share the knowledge and apply this to local solutions. It consists of three elements: Map: mapping of diabetes in study cities. Share: sharing of results from study cities in order to drive action globally. Act: acting by implementing solutions to tackle diabetes in cities. A combination of quantitative and qualitative research will help the cities understand diabetes risk factors and provide evidence-based recommendations to inform decisions about prevention and intervention.