The Connection Between Urbanization and Blood Sugar Levels

By Jamie Bussin 

On Episode #212 of The Tonic Talk Show I spoke with Adam Marsella, the Director of External Affairs at Novo Nordisk Canada Inc. and the Canadian spokesperson for “Cities Changing Diabetes”, about the connection between urbanization and the rise of Type 2 Diabetes; and how municipalities are organizing to fight the disease with public health and wellness initiatives. The following is a digest of our conversation.

What is “Cities Changing Diabetes”? The program started back in 2014 as a public/private partnership model that we’ve developed over time. It was based on this notion that we don’t know nearly enough about how living in an urban environment either increases risk factors for diseases like diabetes or conversely how living in an urban environment can benefit your health – depending on the environment and services available. The program is designed to address some of the social and cultural factors that increase vulnerability to Type 2 Diabetes and serious chronic diseases like obesity. We started with a handful of cities in 2014 and have grown to 40 (ie. Rome, Philadelphia, Copenhagen) with the city of Mississauga being the latest to join.

What is the connection between urbanization and diabetes? Cities are engines of economic growth and innovation. They are also where over half of the world’s population resides. Yet some of the drivers of their prosperity also lead to widening health inequalities. Urban environments significantly impact how people live, travel, play, work and eat – factors that, in combination, affect the rise in diabetes. This puts cities on the front line of the diabetes challenge.  There are more than 400 million people currently living with diabetes. That number is expected to climb to well over 700 million by 2045 if we don’t do something. Half the world’s population lives in cities – for reasons of opportunity and prosperity. We know that cities fundamentally change the way we live, work and eat. That isn’t to say that diabetes isn’t an important issue in a rural environment, but there are specific and unique challenges to living in an urban center.

Why did Mississauga take up the program? We know that rates of diabetes in Mississauga (and all of Peel Region) are well above the provincial average. At the age of 65 there is a big jump in vulnerability in Peel Region – 1 in 3 adults. Layer on that  the fact that more than 50% of Peel Region identifies as Asian, South Asian, Black, Arab, Hispanic or Indigenous. Those groups are at an increased risk of developing type 2 diabetes, so there’s more risk factor in Mississauga. The flipside is that there is potential to do some innovative things. It is one of the most diverse cities on the planet and a landing place for newcomers. It presents a great opportunity to bend the curve.

How do cities benefit from participating in the program? We know that each city presents its own unique challenges. What works in Copenhagen wouldn’t necessarily work in a suburban municipality like Mississauga which was built a certain way, at a certain density, around the automobile. This speaks to some of the principles of the Urban Diabetes Declaration, which is part of the program and tries to incorporate health into every policy. It gets into things like food deserts, build density and walkability and solutions. But nothing happens without community engagement,  which is what the program is based on.


Jamie Bussin is the Publisher and Editor in Chief of The Tonic Magazine and Host of The Tonic Talk show. For more information about this program visit: