​For ten years, Steno Diabetes Center Copenhagen (SDCC) has led efforts to improve the health of residents in the social housing area of Tingbjerg. The work is based on research-driven health promotion initiatives developed and implemented in close collaboration with local residents, the area-based social development plan, local associations, municipal administrations, centres and institutions, as well as external partners.

The project has attracted international interest because, across the Western world, social disadvantage and poor health are closely linked. Both are more prevalent among residents of social housing and disadvantaged neighbourhoods than in the general population.

“The Tingbjerg initiative is built on the understanding that diabetes is a complex disease. It requires attention not only to individual health, but also to the social conditions that play a major role in both disease development and prevention. This approach may also inspire internationally, where diabetes and other chronic diseases pose enormous challenges," says Magnus T. Jensen, CEO of Steno Diabetes Center Copenhagen.

Steno's analyses of data from Statistics Denmark show that:

• Before the initiative in Tingbjerg, the prevalence of type 2 diabetes was almost twice as high in Tingbjerg as in the rest of Denmark.
• During the intervention period, prevalence increased nationwide but decreased in Tingbjerg.
• The prevalence of type 2 diabetes in Tingbjerg is now at the same level as in the rest of Denmark.
  

The graph below shows the estimated incidence of new cases of type 2 diabetes in Tingbjerg and Denmark from 2003 to 2022 per 100,000 citizens. The health promotion initiative in Tingbjerg began in 2015 — the point at which the diabetes curve starts to bend in the neighbourhood.

New cases of type 2 diabetes. Estimated incidence of new cases of type 2 diabetes in Tingbjerg and Denmark from 2003 to 2022 per 100,000 citizens. The health promotion initiative in Tingbjerg began in 2015 — the point at which the diabetes curve starts to bend in the neighbourhood.
Source: Steno Diabetes Center Copenhagen​

“It is thought-provoking that the decline in new diabetes cases in Tingbjerg occurs during the same period as the preventive initiative to improve residents' health. The figures cannot demonstrate a direct causal relationship, but we believe our efforts have had an effect," says Paul Bloch, Research Manager at Steno Diabetes Center Copenhagen.

Scaling the initiative nationwide​

In Tingbjerg, initiatives have included the establishment of a health network for residents with chronic diseases and their relatives, organised Nordic walking activities, the creation of “Fælleshaven" (the Community Garden) as a safe meeting place for residents and associations, support for setting up a bicycle workshop, a cider press, gardening projects, poultry keeping, beekeeping, a residents' restaurant and a café.

There is also active case-finding of people with type 2 diabetes or prediabetes, a locally based diabetes nurse, and support to help residents attend appointments within the healthcare system.

Chair of the Regional Council Lars Gaardhøj (Social Democrats) strongly supports the holistic perspective underlying the work in Tingbjerg.

“We cannot look at disease in isolation. We need to look at the kind of life people are able to live in everyday circumstances. These are precisely the kinds of experiences we must bring into preventive efforts and into the upcoming health councils, where the region and municipalities will work together to create the framework for better health for citizens," says Lars Gaardhøj, who welcomes the fact that the experience is already inspiring others — including the forthcoming Public Health Act.

Steno is now working to transfer the experience from Tingbjerg to the social housing sector more broadly. This includes both social and health-promoting initiatives targeting children and families, as well as diabetes-focused initiatives for adults.

On 5 February, the Ministry of the Interior and Health and the Danish Health Authority visited Tingbjerg to gather inspiration for the drafting of a forthcoming Public Health Act, which could strengthen opportunities to extend the Tingbjerg approach nationwide and across social housing areas more generally. BL – The Danish Social Housing Association – and the National Building Fund, along with several municipalities and social housing areas, have already expressed interest in a model for implementing the Tingbjerg initiative elsewhere in Denmark.