The success of public-private partnerships depends on engaging with community stakeholders to come up with broad-based interventions that have an impact on the target population.AFP/Getty Images
Costs are reduced when stakeholders with shared values and commitment join forces
The public-private partnership (P3) business model is proving to be an effective way of tackling the complex health issues of type 2 diabetes and obesity in Europe and Canada.
Two projects that aim to find ways to alleviate preventable chronic disease pressures on the health-care system are currently underway – Novo Nordisk’s global Cities Changing Diabetes (CCD) program and the Novo Nordisk Alberta Diabetes Fund (NOVAD), a partnership with the University Hospital Foundation and the Alberta government.
“Chronic diseases, like type 2 diabetes, have the highest cost outcomes in our system,” says Adam Marsella, director of external affairs at Novo Nordisk Canada, and spokesperson for Cities Changing Diabetes in Canada.
According to a 2017 study, new cases of diabetes in Canada were estimated to result in $15.36-billion in health-care costs by 2022, with almost two-thirds spent on acute hospitalizations and physician services.
Cities Changing Diabetes identifies and addresses the social, environmental and cultural determinants of chronic diseases like obesity and type 2 diabetes in urbanized areas, shares research and learnings about effective prevention and reduction strategies and creates change at the grassroots level. Since its launch in 2014, it has established programs in over 40 cities around the world, including Copenhagen, Denmark, Houston, Tex., and Leicester, England.
Dr. Jodi Abbott, president and CEO of the University Hospital Foundation, a partner in the current NOVAD program underway in Alberta, says providing community-specific approaches when looking at health issues can be both challenging and create opportunities for other improvements.
“When working with Métis settlements in Alberta on emergency response, it was key that they became a partner in the project,” says Dr. Abbott.
Once that connection was made, the project provided training that, in turn, created job opportunities, she explains.
“You have to have similar values from the outset in order to get to common ground,” she adds.
Finding partners that share those values means finding public and private entities that are committed to sitting at the same table for a long time.
“The biggest challenge is making sure we have ongoing funding because it takes time to see results,” says Dr. Abbott. “Through the innovation made possible by this partnership, not only are we saving more lives, we are also making an economic impact.”
“The issue of diabetes is so broad and challenging that no single stakeholder could tackle it on their own.”
— Adam Marsella, director of external affairs, Novo Nordisk Canada
The success of P3s, like CCD, hinges on engaging with community stakeholders to come up with broad-based interventions that have an impact, says Marsella, who is based in Mississauga, a city with one of the highest rates of diabetes in Ontario.
“It’s a fit-for-place program,” says Marsella. “What may work in Copenhagen doesn’t always work here.”
He cites Vancouver’s Raven Indigenous Impact Foundation (RIIF) as a best-in-class example of how a program adapts to the needs of the community it serves, while bringing diverse stakeholders together. Along with Raven Indigenous Capital Partners (RICP), which is one of the few venture funds that invests specifically in Indigenous-led startups, the RIIF mission is to improve the well-being of First Nations with finance models built on Indigenous-centred values.
The common approach CCD shares with RIIF is in the process of building a table that provides space for many voices, says Marsella.
Marsella says he’s taken learnings from the Indigenous Solutions Lab created by RIIF and applied them to other communities.
“Raven’s ISL is one of the first places I learned to purposely go slowly in a way that engages everyone,” he says. “It’s a community-driven process for creating change, and it’s really innovative.
“The issues coming from a remote Indigenous community will be different than those in Mississauga, but there is a commonality in the process of building trust between stakeholders.”
According to Lisa Mitchell, president and CEO of the Canadian Council for Public-Private Partnership, P3s have more robust approaches to funding and asset management than traditional public models that often result in delays and cost overruns.
The shared responsibility between governments, private industry and philanthropic organizations incentivizes private-service providers to stay on target and within budget, she says, which protects taxpayers with a return on investment far into the future.
“These projects are thinking 30 years down the road,” says Mitchell. “They’re forecasting the health services that are going to be provided.”
According to Mitchell, Canada has more than 350 P3s and has long been recognized as a global leader in the space. The learning that comes from P3-funded projects, many of which are 15 to 20 years long, are condensed and reported as the projects mature, making traditional key performance indicators and metrics difficult to provide.
Dispelling the misconceptions that these undertakings are motivated solely by profit, serving only private interest and producing little public benefit, Mitchell notes: “These assets are publicly owned. It’s not privatization.”
“P3s are unique because we can work collaboratively,” says Mitchell. “From a policy perspective, we can ask what the lessons are, how do we adapt and adjust the model.”
Marsella agrees that collaboration and like-mindedness is key to ensuring positive outcomes.
“The issue of diabetes is so broad and challenging that no single stakeholder could tackle it on their own,” he says. “We are in this for the long-term benefit, and we try to bring in partners with the same vision.”
Advertising feature produced by Globe Content Studio with Novo Nordisk Canada. The Globe’s editorial department was not involved.