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Examples PART II


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.

Also see UNED at



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.




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.




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.




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."



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.



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.




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.


Also see UNED case study at



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 :



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.




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:

Expanded credibility of sustainability reports using a common framework for performance measurement;

Simplification of the reporting process for organisations in all regions and countries;

Quick and reliable benchmarking;

More effective linkage between sustainable practises and financial performance.

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:

Creation of a permanent, independent host institution for the GRI;

Continued periodic revision of Sustainability Reporting Guidelines developed through the efforts of a global, multi-stakeholder process;

Extending the reach of GRI to all regions of the world to enlarge its reach and ensure continual feedback to enhance the quality of the Guidelines.




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.




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.
It has three major regional organisations, APRO for Asia and the Pacific, AFRO for Africa, and ORIT for the Americas. It also maintains close links with the European Trade Union Confederation (ETUC) (which includes all ICFTU European affiliates) and International Trade Secretariats, which link together national unions from a particular trade or industry at international level.

Priorities for Action:

At its 16th World Congress in Brussels in June 1996, the ICFTU laid down five priorities for action:

employment and international labour standards,

tackling the multinationals,

trade union rights,

equality, women, race and migrants,

trade union organisation and recruitment.

On Multinational Enterprises:

One of the most pressing tasks facing the international trade union movement is to address the power and influence of Multinational Enterprises (MNEs) as part of a trade union response to globalisation. The combination of the growth of foreign direct investment, technological changes, international financial markets and a wide range of deregulation and privatisation measures have made it possible for MNEs to be in the drivers' seat of the global economy.

The challenge for the international trade union movement is to ensure that companies respect workers' rights in every part of the world where their influence is felt and to establish a genuine global dialogue between unions and MNEs.

The International Trade Secretariats (ITS) have the primary responsibility for dealing with global companies. They are the major instruments for workers to come together at international level inside enterprises and industries. The ICFTU works in partnership with ITS in many areas including efforts to strengthen international trade union solidarity and build global social partnership.



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.



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.




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.

Also see UNED case study at

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.



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: 



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 ( 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. Also see UNED case study at



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

Develop national disease strategies

‘National Diabetes Strategies’: create collaborations with specific health authorities in setting up national diabetes strategies.


Build national healthcare capacity

‘DAWN’ (Diabetes Attitudes, Wishes and Needs) study analyses the behavioural, social and psychological aspects of diabetes; providing new patient information. ‘World Partner Project’ is a survey conducted in six developing countries for benchmarking good access practices. Aims to develop ‘sustainable diabetes models’ that benefit very low-income sufferers, with acceptable financial returns to providers.


Provide at best possible price

Tiered pricing structure is in place; insulin offered to public health systems in poorest countries at maximum of 20% of the average price in North America, Europe and Japan.


Provide additional funding

’World Diabetes Foundation’ (established 2001); independent foundation for funding diabetes care in developing countries; board includes experts, patient organisations, NGOs and minority representation from Novo Nordisk. EUR 67 million committed over ten years, for education, awareness and treatment 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. The WDF is part of a broader Novo Nordisk LEAD initiative.

Diabetes in the developing world: Scientific progress and technological innovations in the 20th century have brought about major improvements in global health and markedly improved the quality of life. However, the progress has not been evenly distributed all over the world, and there is an inverse relationship between the distribution of need and the distribution of resources.

The developing world carries 90% of the disease burden, yet poor countries benefit from only 10% of the resources that go to healthcare. Furthermore, while there is continued progress in developed countries, the situation in developing countries is deteriorating, and the gap between rich and poor is increasing. The situation is aggravated by the current AIDS epidemic, as most of the people with HIV/AIDS live in developing countries.

The WHO estimates that one-third of the world population still lacks regular access to essential drugs. This figure rises to over 50% in the least developed parts of Africa and Asia. Many factors become barriers to healthcare access in developing countries:

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.

Examples PART II

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