Early Origins of Health

The global community is beginning to understand the enormity of the humanitarian, societal, and economic challenge that noncommunicable diseases (NCDs) present. The rates of diabetes, cardiovascular disease, cancer, and chronic respiratory diseases are rapidly increasing in almost all countries such that these are now among the world’s biggest killers. There is a growing recognition that the development of these diseases may have their roots in our earliest days of life within the uterine environment and up to the age of two years and that early intervention is a cost-effective means of preventing NCDs later in life. Therefore, pregnancy offers a unique window of opportunity to turn the tide of the NCD epidemic.

As part of our pledge toward the UN Secretary-General’s Global Strategy for Women’s and Children’s Health, Novo Nordisk is championing an initiative called the Early Origins of Health. Through new broad-based partnerships and on-the-ground interventions, we intend to promote an understanding of how healthy pregnancy and normal birth weight may hold the key to preventing diabetes and other NCDs.

In recent years, experts have honed in on the first 1,000 days – the uterine environment and the early years of life – as being a marker for the lifelong increased risk of several chronic diseases such as diabetes. Understanding how maternal and child health is linked to the prevention of diabetes and other NCDs will provide us with the ideal window of opportunity to change diabetes and other NCDs for good – a change that is likely to enhance the much-needed focus on maternal and child health. As a world leader in diabetes care, Novo Nordisk has a responsibility and also the competencies to contribute to sustainable solutions. However, when faced with a challenge of this magnitude, we need to carefully consider where we can have the greatest impact: immediately and over the long term.

Concretely, diabetes during pregnancy – known as gestational diabetes – is a serious condition that poses significant risk to both mother and child if it is not detected and managed. It also plays a crucial role in the lifelong risk of developing diabetes and other NCDs for both mother and child. The UN Population Fund estimates that gestational diabetes affects between 5 and 10 million pregnant women every year out of 210 million pregnancies worldwide. Universal screening for diabetes during pregnancy would help effectively address this, but in many parts of the world screening is not available and many experts therefore believe that the scale of the problem is underestimated. Gestational diabetes that is not managed can be harmful to both the mother and the child. Babies of mothers with gestational diabetes are typically larger, which contributes to health problems like damage to shoulders during birth, low blood glucose at birth, higher risk of breathing problems, and the need for delivery by caesarean section. Gestational diabetes is also associated with an increased risk of spontaneous abortion and pre-term delivery. In low-income countries, life-threatening complications develop in more than 5 percent of cases.

Researchers have also pointed out the long-term impact of gestational diabetes on both mother and child. Women with gestational diabetes have an increased risk of developing type 2 diabetes, metabolic syndrome, and cardiovascular disease. Children born to mothers with gestational diabetes also have an increased risk of developing diabetes, metabolic syndrome, and becoming overweight, a precondition to many NCDs.

But the challenge is much more complex and requires that we go beyond addressing gestational diabetes. Many chronic adult conditions, including diabetes, are found to be related to inadequate nutrition during pregnancy. The overarching aim of the Early Origins of Health initiative is to promote a healthy pregnancy that leads to a normal birth weight. And in this equation, nutrition is essential.

Therefore, in addressing this complex issue, we need to rely on a multi-sectoral partnership. As a company with expertise in diabetes care, we hold one piece of the puzzle. To have a sustainable impact, we need to ensure that a multitude of core capabilities are brought in to reflect the full scale of this daunting undertaking.
The Early Origins of Health initiative will rely on our colleagues in the private sector, including partners in the healthcare sector, who hold vital capabilities in the field of diagnostics and child and maternal health. The partnership will bring in companies representing the food and beverage, mobile technology, and sports sectors, as well as leading medical associations, the UN, and nongovernmental agencies. We look forward to working alongside Johnson & Johnson and PepsiCo – the other founding private sector partners – who will provide their expertise in the field of nutrition and health literacy.

Together, our aim is to design a blueprint that will enable women to achieve a healthy pregnancy and a normal birth weight for their children. This is not only a fundamental starting point for lifelong health and development, but also a fundamental step toward reversing the prevalence and easing the burden of diabetes and other NCDs. In joining this effort, partners acknowledge the need for positively influencing the women’s standing in society, including the cultural, family-related, political, and societal contexts set for maternal and child health. The development of health literacy among mothers and those influencing their health will be an indicator for the long-term impact of our efforts and the successful outcome of the partnership. Our focus will be on women living in low and medium human development countries where the unmet needs are most prevalent and where the full impact is greatest.

The scale and impact of Early Origins of Health will address several of the UN Millennium Development Goals: It will promote gender equality and empower women (goal 3); reduce child mortality (goal 4); improve maternal health (goal 5); combat HIV/AIDS, malaria, and other diseases such as diabetes (goal 6); and establish a global partnership for development (goal 8).

The first step is to build a consortium of likeminded partners; the second step will be to design a blueprint for what change would look like involving the core capabilities of the represented partners; the third step is to take the blueprint to relevant locations as a large-scale project. By setting relevant outcome indicators – including health outcomes and the level of health literacy in the target population – we aim to build a model designed for scalability.

We understand that this is a long-term commitment where results and concrete outcomes materialize over time. We pledge to stay on course and make the first 1,000 days the key to lifelong health.