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Background
Paper For the Workshop "Stakeholder
Citizenship and the Health Sector" 2/3
February 2002, NY A preliminary Collection of Example Activities, Organisations, Networks and Resoruces in the Areas of Health and Corporate / Stakeholder Citizenship
2.
Examples of Activities, Organisations, Networks
/ PART I Aarhus
Convention - UN ECE The
UN ECE Regional Convention on Access to Information, Public Participation in
Decision-Making, and Access to Justice in Environmental Matters The
Aarhus Convention is a new kind of environmental agreement. It links
environmental rights and human rights. It establishes that sustainable
development can be achieved only through the involvement of all stakeholders. It
links government accountability and environmental protection. It focuses on
interactions between the public and public authorities in a democratic context
and it is forging a new process for public participation in the negotiation and
implementation of international agreements. NGOs
were involved in the drafting of the Convention before and during the Aarhus
conference and were given the responsibility of organising an NGO Session — a
half-day dialogue between themselves and ministers on the subject of public
participation. http://www.unece.org/env/pp/ Also
see UNED at
http://www.earthsummit2002.org/msp/examples/ex-aarhus.htm Access
Initiative World
Resources Institute (WRI) is working with The Environmental Management and Law
Association EMLA, Budapest, Corporación PARTICIPA, Santiago, and The Thailand
Environment Institute TEI on The Access Initiative - An Initiative To Promote
Access to Information, Participation, and Justice in Environmental
Decision-Making. The
Access Initiative is a global coalition of public interest groups seeking to
promote principles of public access to information, participation and justice in
environmental decision-making. Led by WRI, EMLA, Corporación Participa and TEI,
the Access Initiative is developing and pilot testing assessment tools designed
to assist civil society organizations in promoting the implementation of the
access principles at the national level. We are developing assessment tools and
taking stock of the degree to which national governments have implemented
systems to ensure transparent, participatory, and fair decision-making in
accordance with their commitments made at the Rio Summit in 1992. The site
presents and seeks input to the assessment tools. It also provides updates on
participants and progress. website:
http://www.wri.org/governance/accessinit.html ANPED
– The Northern Alliance for Sustainability ANPED
works in the following areas: Sustainable
Production and Consumption (SPAC): Unsustainable
patterns of consumption and production in northern societies are one of the
major threats to our future. Specific work has been undertaken on the following
themes: Genetically
Modified Organisms; Extended
Producer Responsibility; Export
Credit Agency reform; Sustainable
Consumption; Corporate
Accountability and Responsibility; SPAC Watch; Environmental
Rights. Local
Sustainability : We
support local activities to further Sustainable Development. Building capacity
in local participatory democracy is a key objective of our Local Sustainability
program. We do this by organising skillshares for NGO’s interested in local
work and by organising workshops at international conferences. Environment
and Health: As
ANPED is currently functioning as the secretariat of the European Health &
Environment Network (eHEN), ANPED is playing an important role in the field of
Environment and Health. The task of this network is to take forward work on
Environment and Health issues that came out of the WHO Ministerial Conference in
London and out of the Healthy Planet Forum, the NGO forum which was organised
during that Ministerial meeting. We manage the eHEN
website. Program
Area:
SUSTAINABLE
PRODUCTION AND CONSUMPTION / Corporate Accountability: Corporations
are playing an ever-increasing important role in the shaping of society. Some
corporations are so large that they have become more powerful than most
nation-states. But even the impact of small and medium-sized enterprises cannot
be ignored. But, especially Trans-National Corporations (TNCs) have an
unprecedented impact on the economy, the social structure of the countries they
operate in, and the environment in which their subsidiaries, suppliers, and
partners are situated. Famous examples of the negative impact of corporations on
sustainable development are the chemicals disaster in Bhopal with Union Carbide,
the Human Rights problems in Nigeria with Shell, and the terrible environmental
and labour conditions at the Irian Jaya Mine of Freeport McMoran. More recently,
events like the cyanide spill in Romania, the discovery of sweatshop labour
conditions in the supply chain of Nike, and the seeking of lower environmental
standards by Exxon in Cameroon show that there is still a need to find ways that
ensure the full positive potential of corporate behaviour in sustainable
development. Even
though the impact of corporations goes beyond the mere financial or economic
impact and is clearly also environmental and social, there is little
accountability of corporations to society on those matters. Some national
governments have implemented environmental laws and regulations, and child and
forced labour is illegal in every country in the world. Yet these measures do
not stop corporations from abusing the environment and the people that work for
them and live around their factories. Corporations seem to be able to get away
with it... most of the time. Corporate
accountability, that is in our work the ability of society to control the
behaviour of corporations in those fields where that behaviour affects their
sustainable wellbeing, is something that is missing in our world today, and
sadly is missing also from the global political agenda. There are few tools
available but they are either too costly to implement every time (consumer
campaigns and boycotts), or are unable to deal with the global magnitude of the
problem at hand (courts under national laws). Instead
of regulating corporate behaviour, the governmental effort internationally has
been to deregulate and to extend more and more freedoms to corporations. The
last attempt to codify corporate freedom was the ill-fated OECD based
negotiations on the Multilateral Agreement on Investments (MAI). Responsible
corporate environmental and social behaviour is not enforced, but instead is
left to corporate self-regulation. A great deal of value can be found in
voluntary approaches: Voluntary approaches give ownership of the policy to those
that espouse them and thereby may help to increase the chances of real
implementation. Yet, voluntary approaches do not deal with so called free riders
(those that make a buck out of the fact there is no regulation) and in many
cases the word voluntary means that if the plans are not implemented there is no
sanction. When voluntary policies are broken, there is no redress in court for
those who were affected negatively. Responsible corporate behaviour under a
voluntary regime also becomes more optional than the current global
environmental and social situation warrants. Worst yet, the simple market-based
voluntary approach has been shown in theory to also not be able to meet some of
the minimal targets that need to be set to achieve sustainable development. website:
www.anped.org Aventis
Triangle Forum of the Aventis Foundation The
Aventis Triangle Forum is a high-level meeting of decision makers, scientists
and artists from North America, Asia and Europe to address questions of global
change. In 2000, through three structured discussions, the Aventis Triangle
Forum addressed our ability to build a common, sustainable future. The
government leaders who participated in the Forum, as well as the key people from
business, academia and civil society, will take back to their countries link
among issues and the outlines of a common agenda to be pursued in parallel
around the globe. website:
http://www.aventis-triangle-forum.net/ BP
Amoco plc BP Corporate reporting. Guide
to our HSE and Social reporting: "The
company is committed to respond to the challenges posed by the objective of
sustainable development. In our view sustainable development is a long-term
strategic issue which will involve business in considerations beyond its normal
responsibilities. Technology will play a central role in developing new
approaches. The priorities for meeting economic, social and environmental needs
in emerging markets in a sustainable way will be as important as, but different
from, those in developed economies. Firstly,
BP is a member of the California Fuel Cell Partnership. This is a high
profile effort centered in Sacramento, California, aimed at demonstrating the
feasibility of manufacturing and operating efficient, clean fuel cell vehicles
and fuel distribution systems under real operating conditions. Other members
include two energy companies, seven automobile manufacturers and several
government agencies. Secondly,
we are members of the World
Business Council for Sustainable Development's 'Sustainable Mobility' Project.
This project aims to develop a profile for mobility in the year 2030 which is
achievable, affordable and sustainable in terms of conserving the worlds
resources and cleaning the environment, whilst allowing all regions to develop
to their maximum potential. In
the second category, there are several activities to mention. We
have a package of environmentally driven co-operative activities with General
Motors. This includes jointly developing a fuel processor and
fuel quality requirements for a gasoline fuel cell vehicle, expanding the UK LPG
vehicle/cleaner fuel market, fuelling a low emission diesel-electric hybrid bus
in New York City, developing novel clean diesel fuels, and some innovative
in-vehicle and community outreach ventures. With
Ford Motor Company,
we have announced joint project funding for a major novel carbon dioxide
management research project at Princeton University, and are actively
studying options for joint activity in improved vehicle efficiency and
developing world initiatives. Both GM and Ford have also actively participated
in our cleaner fuels launch programme in the USA. Last,
but not least, we have two key fuel cell development activities with DaimlerChrysler.
The first is a joint study of the potential for using methanol as a clean retail
fuel for fuel cell vehicles. The second is our involvement in DaimlerChrysler's
Citaro fuel cell bus programme in Europe and Australia, in which we will provide
clean hydrogen as the fuel at six of the proposed customer bus company
sites." BP
Foundation: The
BP Foundation is partnering with UNDP and Save the Children Federation to help
raise living standards in East Timor. The BP Foundation, an affiliate of BP,
last month provided US$95,000 for two projects. The first, supported by a
US$20,000 grant, is the UNDP participatory poverty assessment, which will gather
data from local communities to identify and finalize development strategies to
help reduce poverty. The second
project, aided by a US$75,000 grant, is a microfinance programme in Dili, the
capital, run by Save
the Children. It will enable loans and cover start up costs and some
operating expenses. The programme helps create viable small businesses and aims
to reach the most disadvantaged communities, especially women and children.
"BP has been working closely with the United Nations and the
community to find ways to reduce poverty in East Timor, and these projects build
on the work already underway," said Tim Ind, regional manager of Air BP.
Gwi-Yeop Son, acting representative of UNDP, said: "We commend the support
of BP, as we believe that partnerships with the private sector invigorate the
fight against poverty." http://www.undp.org/dpa/frontpagearchive/2002/january/3jan02/index.html Consensus
Building Institute Consensus
building involves informal, face-to-face interaction among representatives of
stakeholding groups. It aims for "mutual gain" solutions, rather than
win-lose or lowest common denominator outcomes. Consensus building approaches
are broadly applicable in all parts of the world and to the full range of
international issues. Conflicts in the international arena involve multiple
parties— nations, private actors, and NGOs. CBI is engaged in the assessment
of numerous multilateral negotiations and institutional interventions designed
to prevent or resolve conflict. http://www.cbi-web.org/ CRESP
- Consortium for Risk Evaluation with Stakeholder Participation A
key purpose of CRESP is to develop an independent institutional mechanism to
develop data and methodology to make risk a key part of its decision making.
CRESP works by improving the scientific and technical basis of environmental
management decisions leading to protective and cost-effective cleanup of the
US's nuclear weapons and to enhance stakeholder understanding of the nation's
nuclear weapons production facility waste sites.
CRESP is committed to
integrating risk evaluation with the concerns and duties of various
stakeholders, including regulators, who are affected by or are responsible for
the cleanup.
It is seeking to
understand the perceptions, dynamics and interests among stakeholders as it
responds to their requests for data and technical perspective. The
CRESP library collection contains Scholarly Products produced by CRESP
researchers, government documents related to CRESP research, and a variety of
related research and general literature in the area of risk evaluation, nuclear
clean-up and environmental issues. The CRESP Library Collection can be searched
online with the CRESP Library Catalog. website:
http://www.cresp.org/library.html Environment
Council UK. The Brent Spar Dialogue Process Shell
Expro’s Brent Spar floating oil storage buoy attracted international media
attention when a
Government approved
plan to dispose of it in the deep NE Atlantic was subject to a Greenpeace
campaign. Following
the decision to drop the plan and revisit the options for disposal, Shell Expro
in
conjunction with The
Environment Council developed a dialogue process to run in parallel and interact
with the technical
development process to review all options.
The process was
designed to be flexible to meet the needs of stakeholders and run in parallel
with the
technical option
development. It encompassed a wider communications plan which included regular
media briefings, an
Internet site and information circulars to a database of interested parties and
groups who agreed to
be on a list of contacts. website:
www.the-environment-council.org.uk Also
see UNED case study at http://www.earthsummit2002.org/msp/ex-brentspar.htm GAVI
– Global Alliance for Vaccination and Immunization
GAVI
is a partnership dedicated to ensuring that all children, however poor, have
equal access to these vaccines. It also works to spur the development of new
vaccines against major killers that primarily affect the world’s poorest
people. It is founded on the principle that immunization is a human right and a
key step towards overcoming poverty. Board
members include: ·
The
Bill and Melinda Gates Children’s Vaccine Program at PATH ·
National
Governments ·
IFPMA
Public
Health and Research Institutions · World
Bank ·
Rockefeller
Foundation ·
UNICEF
·
WHO
The
Vaccine Fund is GAVI’s mechanism to raise new resources and channel them to
health systems in the world’s
poorest countries. Since the partners of the Alliance provide
direction and support, administrative costs are kept low – approximately 98%
of Global Fund resources go directly to countries. The Vaccine Fund was created
with an initial grant of $750 million from the Bill & Melinda Gates
Foundation. Since, the governments of Norway, the United Kingdom, the United
States and the Netherlands have raised total resources to above $1 billion for
2001-2005. More countries, corporations and foundations are expected to
contribute to the Vaccine Fund. Principal efforts are to:
provide new and under-used vaccines, with corresponding safe immunization
equipment, and to help governments strengthen their basic immunization services.
Vaccine
Fund created with initial $750 million grant from the Gates Foundation, and
further $250+ million from governments of Norway, UK, USA and
the for 2001-2005???.
The
fund is financially independent and makes its funding decisions based on the
recommendations of the GAVI
Board???.
Initial 5 year commitments for more than $600 million. Of
the 25 countries that were approved in the first three rounds, 11 countries have
already received their first instalment of financial support from the Vaccine
Fund to strengthen their health infrastructures, and 5 have received shipments
of vaccines. Working with newly developed, long-term purchasing agreements with
manufacturers, GAVI and the Vaccine Fund have already committed to purchase more
than 300 million doses of vaccines over the next three years. “The
power of GAVI is in the collaboration between partners”, said Ms Bellamy, who
will take over as chair of the GAVI board, following the two-year term of Dr Gro
Harlem Brundtland, Director-General of WHO.
“When
you have UN agencies, industrialized country donors, vaccine manufacturers, and
developing country health officials all sitting around the same table, public
health programs can be much more effective.” website
: www.vaccinealliance.com Global Corporate Governance Forum To
meet the growing demand for governance reform worldwide the World Bank Group and
OECD have entered into a framework agreement for cooperation, at the heart of
which is the convening of the World Bank Group and OECD Global Corporate
Governance Forum. This is a new international initiative which will bring
together the leading bodies engaged with governance reform worldwide:
multilateral banks active in developing countries and transition economies,
international organizations, country groupings, engaged with governance reform,
alongside professional standards setting bodies, and the private sector. The
Forum provides a convening venue for the leading players in governance
worldwide. Its theme of partnership between the public and private sector is
established through a Private Sector Advisory Group, which comprises
internationally recognized business leaders serving in an individual capacity,
drawn from developing, developed and transition economies. website:
http://www.gcgf.org/ Global
Reporting Initiative The
Global Reporting Initiative
is an international multi-stakeholder effort to create a common framework for
voluntary reporting of the economic, environmental, and social impact of
organisation-level activity. GRI's mission is to elevate the comparability and
credibility of sustainability reporting practices worldwide. The GRI
incorporates the active participation of businesses, accountancy, human rights,
environmental, labour and governmental organisations. The
Global Reporting Initiative (GRI) was established in late 1997 with the mission
of developing globally applicable guidelines for reporting on the economic,
environmental, and social performance, initially for corporations and eventually
for any business, governmental, or non-governmental organisation (NGO). Convened
by the Coalition for Environmentally Responsible Economies (CERES)
in partnership with the United Nations Environment Programme (UNEP),
the GRI incorporates the active participation of corporations, NGOs, accountancy
organisations, business associations, and other stakeholders from around the
world. The
GRI vision is bold. It has brought together disparate reporting initiatives into
a new multi-stakeholder, global process with long-term implications for
disclosure, investment and business responsibility. Its success will lead to:
On the basis of this vision, the United Nations Foundation awarded a $3 million partnership grant to CERES and UNEP to support GRI activities. From 2000 - 2002, the GRI will pursue:
website:
http://www.globalreporting.org/ Global Sullivan Principles of Corporate
Social Responsibility The
objectives of the Principles are to support economic, social and political
justice by companies where they do business, thereby, helping to improve the
quality of life for communities, workers and children with dignity and equality.
Companies
are encouraged to endorse a set of principles consistent with the legitimate
role of business. These principles involve developing and implementing company
policies, procedures, training and internal reporting structures to ensure
commitment to these Principles throughout the organization. website:
http://www.globalsullivanprinciples.org/ International
Confederation of Free Trade Unions The
International Confederation of Free Trade Unions (ICFTU), was set up in 1949 and
has 225 affiliated organisations in 148 countries and
territories on all five continents, with a membership of 157 million. Priorities for Action: At its 16th World Congress in Brussels in June 1996, the ICFTU laid down five priorities for action:
On
Multinational Enterprises:
International Council for Local
Environmental Initiatives (ICLEI) ICLEI
is the international environmental agency for local governments. Local
Agenda 21 is the action plan for a sustainable development of a municipality,
set up by local authority together with the local stakeholders and citizens,
aiming to enhancing
the sustainability of communities through: environmental protection; economic
vitality; and community well-being. Steps toward a more sustainable future
include developing community-driven strategic planning and collaborative
regional planning; improving community and building design; decreasing sprawl;
and creating strong, diversified local economies while increasing jobs and other
economic opportunities. website:
http://www.iclei.org/ Living With the Genie On
March 5-7, 2002, 300 people will come together at Columbia University's Low
Library Rotunda to discuss one of the great challenges facing our increasingly
global society: the governance of scientific and technological change. No
society is equipped to deal with the accelerating impacts of science and
technology. Today, many different areas of science and technology are advancing
synergistically, multiplying the rate and magnitude of both technological change
and societal transformation. On the one hand, access to advanced technologies
proliferates, and the production of novel, transforming technologies is becoming
routine. On the other, the distribution of the benefits and costs of scientific
and technological advance is highly uneven, both within nations and between
them. Meanwhile, the culture of discovery and innovation is changing as private
funding outpaces public research investments, patent protection expands to
emerging types of research findings, and ownership of knowledge becomes a
critical issue in the global marketplace. Institutions of governance designed to
safeguard the collective public interest are unable to keep pace with the
transformations created by emerging knowledge and innovation. No more powerful
and complex symbol of this tension can exist than the unspeakably horrifying
September 11th collision between those who possess unprecedented technological
sophistication and those who resorted to the simplest tools to express their
utter alienation from the human community. In
the face of such challenges, we seek to stimulate a broad societal commitment to
reflection, discourse, and action about how society should govern the way that
it continually remakes the world with science and technology. website:
http://www.livingwiththegenie.org/ Mining, Minerals and Sustainable
Development Project (MMSD) MMSD
is an independent two-year project of participatory analysis seeking to
understand how the mining and minerals sector can contribute to the global
transition to sustainable development. MMSD is a project of the International
Institute for Environment and Development (IIED) commissioned by the World
Business Council for Sustainable Development (WBCSD). Find reports, draft
reports, charters, calls, guidelines, etc. http://www.iied.org/mmsd/index.html Also
see UNED case study at http://www.earthsummit2002.org/msp/ex-mmsd.htm A
set of Principles for Stakeholder Engagement has been developed as part of
IIED's Mining and Minerals for Sustainable Development project, commissioned by
the World Business Council for Sustainable Development. http://www.iied.org/mmsd/global_act/stakeh.html#principles
Montreal International Forum (FIM) FIM
provides a neutral setting for an annual forum in Montreal for reflection and
active learning about the interaction between civil society and the multilateral
system. In so doing, the Forum draws lessons from NGO experiences that can
strengthen the voice and participation of civil society actors in the
multilateral system. Beginning in May 2002, FIM will also convene a larger
biennial conference with a similar objective.
Find
FIM-commissioned discussion papers of case studies wherein civil society
organizations have influenced the multilateral system. Website in English and
French. website
specialized on civil society participation in multilateral institutions: http://www.fimcivilsociety.org/ Novartis International AG "The foundation of our approach is
written in our Corporate
Citizenship Policy. It is an expansion of the existing Health,
Safety and Environment (HSE) Guidelines, the Code
of Conduct and refers to all aspects of the
UN Global Compact. It is consistent with the Novartis core values and
based on the fundamental rights of every individual, such as the protection of
privacy, freedom of opinion and expression, freedom of association,
non-discrimination, and the right to be heard. Our Business Sectors are
currently establishing proper structures and allocating sufficient resources;
the process is complemented by audit checklists and practical measures such as
transparent communication, regional management workshops, rigorous reviews of
internal practices, updating of business procedures, performance assessments,
controls, and changes of technology standards, among others. In
the era of globalization, Novartis faces an increasingly complex situation
because innovation can sometimes lead to risks, costs and imbalances that extend
beyond national borders. Novartis cannot solve these issues alone and so it aims
to build partnerships with other stakeholders such as the various public
institutions, international organizations, and the private sector. The
co-operation with them can lead to a more sustainable development, which in this
case means the more equitable sharing of the benefits of innovation. Novartis
is working together with leading public and private organizations to improve the
health of people living in the developing world. This public-private partnership
can better utilize the resources and strengths of each partner. For instance,
Novartis supplies at cost an innovative malaria treatment, Coartem, to the World
Health Organization (WHO) for use in developing countries. In a global effort to
eliminate leprosy, the Novartis
Foundation for Sustainable Development provides multi-drug therapy
for free to the WHO. It is a $35 million commitment to eliminate the disease by
2005. In
endemic malaria areas, Novartis provides its innovative malaria
drug at cost to the WHO. There
are various patient assistance programs for
leukemia and support projects for the children of AIDS victims. A
Research Center for Tropical Diseases has been established. The Novartis
Foundation (http://www.novartisfoundation.com/)
aims to improve the quality of life of the poorest people in developing
countries through programs & contributions to development policy
discussions. Projects and Programs
include work on: leprosy
& health; social
development; publicaions on development Issues; business
ethics & globalization; population
growth & sustainable development; development Dialogue; international
symposia; cooperation
with other organizations. Singapore
research institute for tropical diseases: Basel
/ Singapore, 8 November 2001 –
Novartis
announced today the establishment of a new tropical diseases research center in
Singapore involving a SGD 220 million investment. The center will be called the
Novartis Institute for Tropical Diseases and is the result of an
agreement between Novartis and the Singapore Economic Development Board (EDB).
The objective of the Institute is to advance medical research in the area of
progressive infectious and parasitic diseases that affect so many people in the
developing world. Historically, due to the high cost of drug discovery and
development, there has been little focus on funding research in this area,
especially as the financial returns have been viewed as unattractive. Novartis
views this as a long term endeavor to enhance the discovery of preventative and
effective treatments for diseases like tuberculosis (TB) and dengue, and
ultimately reduce the overall affliction of tropical diseases and improve the
prosperity of developing countries. AIDS
Orphans in Tanzania: The
Humuliza project conducts 14-week programs with orphans with the aim of
stabilizing the children psychologically and socially. The program is based on
group interventions and also a "child-to-child" approach. This
recognizes that chilren who have similar experiences can benefit from exchanging
information and understanding that their situation is not unusual and is in no
way a "failure." This approach also takes account of the fact that
young people are much more willing to accept emotional support from people of
their own age than from adults. There
are also some income-generating methods that the project uses. For example, the
project offers the orphans to work for their breadwinners, such as grandparents,
and receive 150 Tanzanian schillings for each completed project. This enable the
children to make a contribution to supporting themselves, while at the same time
promoting cohesion between the generations. In some cases, the project also pays
school fees. CareCard
Drug Discount Progam to Aid Needy Elderly Who Lack Prescription Drug Coverage: Novartis Pharmaceuticals Corporation introduced a discount
program called the Novartis CareCard. Scheduled for official launch in January
of 2002, the CareCard is designed to make prescriptions more affordable for
low-income elderly who lack drug coverage. An estimated 10 million Americans are
expected to qualify for the CareCard. Novartis also issued an industry-wide call
to action, encouraging other pharmaceutical companies to create programs to
deliver real value to the low-income elderly.The Novartis Care CardSM
will be available free of charge. With the Novartis Care CardSM
program eligible Medicare recipients should receive savings of 25% or more on
selected Novartis outpatient products. Eligible Participants must have annual
income less than 300% of the Federal Poverty Level (approximately $26,000 for an
individual; $35,000 for a couple) and not currently have alternative
prescription drug coverage such as Medicaid, Medigap, or employer-sponsored
retiree coverage. Novartis
Germany Forum events: Partnerships
and external activities enable Novartis to increase its knowledge base and
extend its effectiveness in managing health, safety and environment issues.
Partnerships are also essential for working toward sustainable development and
the global issues facing our company and society today. Some of their key
partnerships: Public forums - held in Germany, Italy and Japan with different
stakeholders to discuss controversial topics related to our activities, learn
from stakeholder perspectives and collaborate on developing new solutions. http://www.novartis.com/hse/stakeholder_relations.shtml.
Also see UNED case study at http://www.earthsummit2002.org/msp/examples/ex-novforum.htm Novo Nordisk A/S Specialist in Diabetes
care. Diabetes: 150 million people in the world currently suffer from
diabetes, but little appears to be underway in the developing countries to
alleviate its impact or combat its growth. Novo Nordisk’s LEAD
initiative (Leadership in Education and Access to Diabetes care) programme will share knowledge, develop local capacity
and provide cheap drugs (at max 20% of price in developed world) and financial
support. Structured along WHO declared focus areas for improving access to
healthcare in developing countries:
Novo
Nordisk: World Diabetes Foundation: On
13 November 2001, Novo Nordisk announced
it will establish an international foundation - the World
Diabetes Foundation
(WDF)
- to support, financially and otherwise, projects aimed at increasing awareness
and knowledge of diabetes; preventing, diagnosing and treating diabetes;
educating and training health professionals; improving distribution of medicine;
and improving access to proper diabetes care. Subject
to shareholder approval at its Annual General Meeting in March 2002, Novo
Nordisk will donate approximately 500 million DKK (approximately 67 million
EURO) to the foundation over the next ten years.
|
 |
Lack of
healthcare infrastructure, |
|
Social and
political factors such as civil conflicts, |
|
Lack of
education and |
|
Shortage of
financial resources. |
Mechanisms for public financing of
healthcare are non-existent in most developing countries, thus health costs
typically represent out-of-pocket expenditure for people with severely limited
means. (According to WHO, 80% of people in developing countries pay directly for
some or all of their own medicines). In many instances, the choice is between
healthcare and food or clothing. Such financial constraints inevitably result in
under-consumption of healthcare services.
Diabetes is a huge problem in
the developing world: Although infectious diseases still constitute the
leading cause of mortality and morbidity in developing countries, WHO predicts
that non-communicable diseases such as diabetes, cardiovascular disease, cancer
and chronic respiratory diseases will become the world’s main disablers and
killers within the next quarter-century. Diabetes can be found in almost every
population in the world and its prevalence has reached epidemic proportions.
Using epidemiological data, WHO estimated the global burden of diabetes at 135
millions in 1995, with the number reaching 300 millions by the year 2025. Most
of this increase will occur in developing countries, which will therefore bear
the brunt of the diabetes epidemic in the 21st century. The diabetes pandemic
— which consists primarily of Type 2 diabetes — has evolved in association
with rapid cultural changes, aging populations, increasing urbanisation, dietary
changes, decreased physical activity and other unhealthy lifestyles and
behavioural patterns. Without effective prevention and control programmes,
diabetes will most likely continue to increase globally. Recent research shows
that diabetes is the leading cause of blindness in people aged 20-74 years and
it is also the leading cause of end-stage renal disease. The risk of leg
amputation, heart disease and stroke is much higher for people with diabetes
compared to those without diabetes. In developing countries, the prevailing
poverty, ignorance, illiteracy and poor health consciousness further add to the
problem. Studies have shown that for uneducated, unemployed people, especially
those living in semi-urban or rural areas with no access to even the bare
minimum of healthcare facilities, there are likely to be delays in diagnosis,
and serious diabetes-related complications. Furthermore, many people with Type 1
(ie insulin dependent) diabetes die before they are diagnosed or soon after
diagnosis due to inadequate access to treatment. In addition to personal
suffering, diabetes accounts for a significant amount of national healthcare
spending: In the US, more than one out of ten USD for healthcare is spent on
diabetes, and one out of four Medicare dollars pays for healthcare for people
with diabetes. With the present trend, diabetes is likely to take more than a
third of the health budgets in 15 to 20 years. A 1997 WHO report concluded that
due to its frequency and to the cost and suffering imposed by its complications,
diabetes is one of the most daunting challenges posed today by chronic diseases.
Thus, it is clear from the available
information that in the future diabetes will constitute a severe burden on the
already fragile and under-resourced healthcare systems in the developing world.
Most of current health-related initiatives in developing countries are aimed at
high-profile communicable diseases, such as HIV/AIDS, tuberculosis and malaria.
In fact, developing countries face a double burden of disease. They suffer a
considerable backlog of common infections and malnutrition. At the same time and
without having addressed these challenges, they have to cope with the emerging
problem of non-communicable diseases, of which diabetes is one of the most
common.
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The
WDF is part of a broader Novo Nordisk LEAD initiative.