Public-Private Partnerships: Limelight on Diabetes. Renuka Gadde VP, Global Health October 18, 2012

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1 Public-Private Partnerships: Limelight on Diabetes Renuka Gadde VP, Global Health October 18, 2012

2 About BD (Becton, Dickinson and Company) Medical technology company $7.5B 29,000 employees Four Areas of Focus 1. Reducing the spread of infection Legal Entities Plant locations Corporate Office Products relevant to Diabetes and Women s Health 2. Advancing global health 3. Enhancing therapy 4. Improving disease management AD Immunization Syringes Blood Collection CD4 Testing TB Diagnostics Pen Needle

3 Focus Needed Now More Than Ever Before Cancer, diabetes, and heart disease are no longer the diseases of the wealthy. Today, they hamper the people and economies of the poorest populations even more than infectious disease. This represents a public health emergency in slow motion. Ban Ki-Moon, United Nations Secretary-General

4 Environment Summary Non-communicable diseases are a heavy burden on the progress for global health Diabetes disproportionately affects people in developing & emerging countries Data reveals the inextricable link of diseases of the poor including those between HIV, TB, and Diabetes Healthcare systems must be strengthened to cope with this burden of chronic disease Leading NCD experts are calling for linkages with healthcare systems strengthening efforts associated with funding for infectious diseases Diabetes Opportunity BD is uniquely positioned to take an industry leadership role in this effort by leveraging our deep competencies in diabetes care and global health experience in immunization, HIV/AIDS, and TB to: Advocate for effective use of funding in health systems strengthening efforts Partner with other organizations to demonstrate benefits of patient centric care Invest in new technologies across the company to improve patient management Expected Outcome: Create sustainable markets for our products where there are tremendous human needs, but insufficient ways to address them

5 Diabetes is a Huge Developing World Issue Key Statistics 500M Number of people with Diabetes in the future 4 of 5 Cases in Low/Middle Income Countries 3.5M Annual Deaths from Diabetes in LMIC 80% Diabetics undiagnosed in Africa Urbanization and Risk of Diabetes Move from rural to urban doubles risk Move to mega-city (>10MM) raises risk fourfold Sedentary lifestyle, affordable transport, inability to raise food and poor food options all lead to a higher risk Rural areas access to communications that promote western food raises risk Implications Segmentation of markets by urban and rural is insufficient Need socioeconomic segmentation: urban slums Adoption of low-cost innovations developed for RLS will occur within countries and across borders

6 Diabetes Burden in India Start with 100 patients Initiation India Diabetes Population 51.7 Million 100 Diagnosis Diabetes Diagnosed 14 Million 27% Diabetes NOT Diagnosed 37.7 Million 73% 73 Opt for treatment 7 Million Treated 50% 7 Million NOT treated 50% 13.5 Treatment Choice Insulin 1.4 Million 20% No Insulin 5.6 Million 80% 10.8 Device Choice Pens 0.35 Million 25% Vials 75% 1.05 Million 2 Total # patients dropping out at each stage 0.5

BD s History in Diabetes BD manufactured its first syringe made

BD launches the world s smallest needle BD Ultra-Fine Nano BD

JDRF and BD Collaborate to Improve Insulin Pump Delivery 2011 2012

7 BD s History in Diabetes BD manufactured its first syringe made specifically for insulin injection. BD launches the world s smallest needle BD Ultra-Fine Nano BD AutoShield Duo Pen Needle s BD Insulin Syringes 2010 JDRF and BD Collaborate to Improve Insulin Pump Delivery JDRF and BD Collaborate to Develop More Accurate and Reliable Glucose Monitoring Devices for People with Type 1 Diabetes

Examples of Some of our Programs and Partnerships BD Diabetes Makeover Three

, and NYC 14 people total participated in the Diabetes Makeover program Program

8 Examples of Some of our Programs and Partnerships BD Diabetes Makeover Three programs launched over two years ( ) Nationwide, Washington, D.C., and NYC 14 people total participated in the Diabetes Makeover program Program helped participants learn how to improve their diabetes management to live healthier lives. Each participant was made over by the BD Diabetes Dream Team a team of the nation s leading diabetes clinical, nutrition and fitness experts, as well as a lifestyle consultant.

India Diabetes Educator Project Project HOPE, BD, Lilly and Bayer HealthCare

distance learning Trained over 4,000 healthcare professionals, including nurses,

9 India Diabetes Educator Project Project HOPE, BD, Lilly and Bayer HealthCare created a four-year collaboration to address the national diabetes crisis in India in BD Developed a training curriculum with Project Hope and IDI and provides long distance learning Trained over 4,000 healthcare professionals, including nurses, and dieticians, in diabetes education. 60 master trainers trained and 18 collaborative training centers were set up for onsite patient diabetes education training.

Workplace Wellness Program with CII Expansion of India Diabetes Educators Project with Project HOPE in 2011 Piloted program at five industry sites with a communication package that promotes Diabetes

10 Workplace Wellness Program with CII Expansion of India Diabetes Educators Project with Project HOPE in 2011 Piloted program at five industry sites with a communication package that promotes Diabetes prevention education Motivation and voluntary testing for diabetes Lifestyle education and linkages to services. BD is working with CII to deliver an end-to-end six months intervention in two industries. Provided this material to MOHFW for their use under their NCD campaign

11 The Art of Living This program is an expansion of the India Diabetes Educators Project. It aims to strengthen their existing focus on living well to include: Diabetes prevention education to Yuvacharyas Linkages to labs for voluntary testing for diabetes Lifestyle education and linkages to appropriate health care services The program targets 6,000 slum population across 4 slums in Bangalore. Screening followed by intensive follow-up with 500 at risk diabetics for 18 months to monitor adherence, blood parameters and BMI. Demonstrate model for concept of community-based education and management of diabetes through selfmotivated behavior change

First India Insulin Injection Technique Guidelines First of its kind effort in India to increase clinicians focus on Injection technique, impacting long term patient outcomes.

12 First India Insulin Injection Technique Guidelines First of its kind effort in India to increase clinicians focus on Injection technique, impacting long term patient outcomes. 13 Top and most respected KOLs across country signed to be on Advisory Board to develop India guidelines. Guidelines developed after review by 75 clinicians from across India and 6 clinicians from India sub continent. Guidelines accepted for publication in Indian Journal of Endocrinology and Metabolism November 2012 Issue. The Forum for Injection Technique (FIT) was developed to establish and promote best practice in injection technique for all involved in diabetes care.

China Diabetes Education Program Since 2008, Project HOPE, BD, Lilly and Roche Diagnostics established

Created a body of 500 Medical Professionals with expertise in the diagnosis and treatment of diabetes care

13 China Diabetes Education Program Since 2008, Project HOPE, BD, Lilly and Roche Diagnostics established diabetes training centers, and developed diabetes education and training materials supported by the Ministry of Health and government. Nine Centers of Excellence continue to be referral sites for difficult to treat patients. Created a body of 500 Medical Professionals with expertise in the diagnosis and treatment of diabetes care with skills in teaching primary care physicians. Developed a train-the-trainer model to be replicated in other geographies. BD contributed both financial and products donations to this collaborative program.

in their communities, wearing blue, walking 366 steps (each step representing

14 BD Celebrates World Diabetes Day BD associates around the globe demonstrate their support for World Diabetes Day by: hosting diabetes awareness activities in their communities, wearing blue, walking 366 steps (each step representing one million people with diabetes) and forming the traditional symbolic blue circle.

15 Diabetes Care Strengthens Global Health Position Need for Patient Management HIV ---- Diabetes ---- TB HIV & TB HIV Patients 10X more likely to develop TB HIV & Diabetes Use of some ART can increase risk of Diabetes by 3X TB & Diabetes Diabetes patients 3X more likely to develop active TB Opportunity: BD has deep expertise in all three diseases, combined with a long-standing focus on health systems strengthening that we can further leverage

cervical cancer in the developing world.

16 BD-PEPFAR Collaborations BD and PEPFAR collaborate in five areas, which include lab strengthening, wellness centers for healthcare workers, safer blood collection, preventing violence against girls, and addressing breast and cervical cancer in the developing world. These collaborations are designed to strengthen healthcare systems and address root causes of the spread of disease in the developing world.

Leveraging Existing HIV/AIDS Platforms: Labs for Life Collaboration Labs for Life builds on prior five-year PPP that focused on improving overall lab systems in sub-saharan Africa.

17 Leveraging Existing HIV/AIDS Platforms: Labs for Life Collaboration Labs for Life builds on prior five-year PPP that focused on improving overall lab systems in sub-saharan Africa. New collaboration will include Uganda, Kenya, Ethiopia and Mozambique and also India will focus on: Quality improvement for laboratory services to attain national, regional, or international accreditation Laboratory Human Resources training on pathology, forecasting and optimization Curriculum development and training on equipment maintenance Collaboration with the ACILT and ASLM to strengthen local capacity and promote country ownership Deployment of POC guidelines Leverage systems and capabilities established for HIV to also effectively address diabetes

18 Closing Comments Collectively, we can provide a rapid response to this emerging emergency. The consequences of not addressing diabetes can simply be stated as costing a life and in many cases over a life time. 50% of WW amputations from diabetes; 50,000/yr in India. Aravind Eye: Diabetics 25x more likely to suffer blindness. Diabetes is the underlying cause for Cardio Vascular deaths. We can reverse this condition and manage the condition. At BD, we are committed to this goal.

Improving Access to Healthcare in the Developing World. Renuka Gadde VP, Global Health 21 October 2012

Improving Access to Healthcare in the Developing World Renuka Gadde VP, Global Health 21 October 2012 BD Overview Medical technology company founded in 1897 Global turnover $7.8 billion, 44% in US 29,000