With approximately 537 million adults in the world living with diabetes – a figure that is projected to rise to 783 million by 2045 if no action is taken. Diabetes places a great burden on health systems, and we are committed to working with health authorities and other partners to prevent and treat the disease.

The Novo Nordisk social responsibility strategy, Defeat Diabetes , includes long-term ambitions to accelerate prevention to halt the rise of diabetes, provide access to affordable care for vulnerable patients in every country and to continue to drive innovation to improve lives.

Affordability of medicines is a global challenge and we know that some people in the USA living with diabetes are increasingly finding it hard to pay for their healthcare, including our diabetes medicines. Ensuring access and affordability is a responsibility we share with all involved in healthcare.

For information additional information about our approach to access & affordability, click here.

For information about how we work with prevention of chronic diseases, click here.

Performance
The estimated number of full-year patients reached with Novo Nordisk's Diabetes care products increased from 32.8 million in 2020 to 34.6 million in 2021. This 5% increase was primarily driven by growth in the GLP-1 franchise which increased by 1.3 million patients followed by the new-generation insulin franchise which grew by 0.7 million patients.

In 2021, the estimated number of patients reached with Novo Nordisk's Diabetes care products through the Access to Insulin Commitment was 1.7 million. Novo Nordisk also sold human insulin below the ceiling price of USD 3 in countries outside the commitment, reaching an estimated additional 2.2 million patients in 2021. During 2020, the ceiling price was lowered from USD 4 to USD 3 which affects the comparability of 2020 and 2021 results. Comparing 2021 and 2020 using the current ceiling price of USD 3, the result is an estimated increase of 40,000 patients reached in 2021. Using the previous ceiling price of USD 4, an estimated 3.4 million patients were reached in 2021 compared to 3.2 million in 2020. In addition to offering insulin at a low price, supply chain improvements and capacity building are also important levers in ensuring access to affordable care for vulnerable patients.

Type 1 diabetes (often referred to as childhood diabetes) is a lifelong, autoimmune condition which impairs the body’s ability to produce insulin. If left undiagnosed or untreated, excess glucose causes damage to organs which can result in severe health complications and, ultimately, in premature death. There is currently no prevention or cure and the only effective long-term treatment is multiple, daily injections of insulin.

Type 1 diabetes is one of the most common chronic childhood illnesses. The International Diabetes Federation (IDF) estimates that globally, more than 1.2 million young people under 20 years have type 1 diabetes and approximately 184,100 new cases are diagnosed each year. However, in low-resource settings, children with type 1 diabetes are often misdiagnosed or lack access to adequate healthcare services to manage their condition.

Changing Diabetes® in Children was established in 2009 as a public-private partnership to bridge these critical gaps in care. The partnership provides comprehensive diabetes care for children and youth living with type 1 in low- and middle-income countries. This includes free life-saving insulin and other medical supplies for persons up to 25 years of age.

Our ambition is clear: no child should die of diabetes. To learn more about Changing Diabetes® in Children, click here .

Performance
As part of Novo Nordisk’s Defeat Diabetes social responsibility strategy, Changing Diabetes® in Children aims to reach 100,000 vulnerable children and young people living with type 1 diabetes by 2030.

In 2021, 31,846 children were reached through Changing Diabetes® in Children, a 13% increase compared to the previous year.

The partnership is present in 18 countries by the end of 2021, following the addition of Ghana, Indonesia, Pakistan, and Peru during the year. Five more countries (Jordan, Lebanon, Malawi, Mozambique and Rwanda) are launching in early 2022 as part of an expanded partnership project with the World Diabetes Foundation.

We provide a safe workplace that promotes both mental and physical health, and overall well-being. Our company culture also plays a strong role in ensuring a diverse, fair and inclusive working environment. Together, this is what determines our ability to attract and develop some of the best talent from all over the world.

Our responsibility to respect labour rights applies to our global operations as a global minimum standard of business conduct. We track labour rights performance for all our employees in the workplace and verify whether labour rights risks are being effectively addressed.

For more information, download our Novo Nordisk Labour code of conduct (PDF )

We employ people in 80 countries globally. Since 2014, we have been a part of the living wage programme with an external global non-profit business network and consultancy. The objective is to ensure that all our employees are paid a living wage, i.e., adequate to purchase basic goods and services necessary to achieve a basic standard of living, based on calculations of living wages in the countries we operate in.

Performance
The number of employees increased in most areas, with the highest growth in Product Supply Quality & IT, partially countered by North America Operations. In 2021 we have hired 5,735 employees, an increase from the 4,226 new hires of 2020.

The employee turnover rate increased from 7.9% in 2020 to 11.0% in 2021 which is comparable to turnover rates in years prior to COVID-19.

We employ more than 50,000 people worldwide, all of which we have a clear commitment to provide a  healthy and safe working environment for. Supporting safety, physical health and mental well-being is fundamental to personal and professional growth.

We offer a healthy and engaging workplace, supported by a comprehensive Health and Safety programme. To this end, we have implemented our Health and Safety management system across our entire global organisation to ensure such conditions for all employees and contractors.

Corporate policy and governance
Our corporate values, the Novo Nordisk Way, with Essential no. 8 “We have a healthy and engaging working environment”, state clearly that health and safety is a key priority. Our global health and safety policy is based on our focus on prevention and continual improvement.

We strive to uphold a safe working environment and promote the health of our people.

This means that we:

• Operate by high health and safety standards throughout the world
• Promote a healthy lifestyle
• Ensure our employees are involved in how we maintain and improve health and safety
• Hold our people accountable for their actions regarding workplace safety
• Ensure that the working environment is not compromised for economic or productivity reasons
• Fulfil applicable legal requirements
• Follow relevant international conventions

Management system
The health and safety policy is governed and implemented through our global health and safety management system, which is described in a global procedure. The management system defines that health and safety of our employees is a managerial responsibility. The procedure contains specific health and safety requirements regarding e.g., risk assessments and emergency procedures and preparedness. The global procedure is supported by local instructions and dedicated training of all managers and health and safety staff as well as basic training of all employees in research, development and production. All production facilities have health and safety certifications according to ISO45001 and are audited regularly both internally and externally.

Every year, an organisational bottom-up management review is conducted with the Novo Nordisk Executive Management team as the governing body.

Strategy
Our health and safety strategy sets a clear direction to make continuous improvements. Through our global partnering approach, all business areas commit to specific targets and initiatives for identified health and safety challenges. The strategy is implemented in a partnering approach, with all business areas and aims to involve, inspire, and enable managers and employees to make sure that our people leave work every day as mentally healthy and physically fit as when they arrived. We want everyone in Novo Nordisk to act on the safety, physical and mental health and well-being of themselves and their colleagues.

The health and safety strategy drives improvements on our three focus areas and targets for safety, mental health and well-being and ergonomics, illustrated in the list below.

1. SAFETY
We continuously improve our safety culture and reduce the frequency of work accidents.
Novo Nordisk target: 10% annual improvement of accidents with absence per million work hours.

2. MENTAL WELL-BEING
We address well-being proactively and the share of employees reporting stress symptoms is continuously reduced.
EVP area target: 10% annual improvement of employees reporting stress symptoms.

3. PHYSICAL WELL-BEING
We continuously improve workplace ergonomics to increase physical well-being and reduce pain.
EVP area target: 5% annual improvement of employees reporting work-related pain.

Employee health promotion
Our global employee health promotion programme enables employees to act on their health by providing a framework for integrating health promotion into the workday, no matter if they work in a physically demanding or a sedentary work environment.

The programme is adapted locally by novo health ambassadors, and its content is co-created by employees across the organisation.

The employee health promotion programme offers activities, and encourages employees to act on their own health, within six pillars:

1. Physical activity
All employees are encouraged to be physically active.
Goal : all employees have opportunities to exercise.

2. Healthy eating
All employees are encouraged to have a balanced diet.
Goal : all employees have information and access to healthy food, so the healthy choice is the easy choice.

3. Individual mental well-being
All employees are encouraged to pay attention to their mental health.
Goal : all employees can access knowledge and tools to act on their mental well-being.

4. Health checks
All employees are encouraged to care for their health.
Goal : all employees have access to free health checks and guidance on how to act on their health.

5. Smoke free
Employees that smoke are encouraged to become smoke free.
Goal : all employees have access to help to stop smoking

6. Weight management
Employees at risk are encouraged to start and sustain healthy weight.
Goal : employees have access to weight management programmes and obesity prevention.

Below are some of the good health and safety practices and actions Novo Nordisk has taken globally:

• A global anti-harassment framework has been implemented to prevent workplace harassment. Trainings on respectful tone and anti-harassment is offered to human resources experts and managers globally.
• Global leadership guidelines have been developed, to promote mental well-being and support managers in taking responsibility for creating healthy workplaces.
• We train and educate our human resources experts and managers to have open dialogues with teams, so that issues in the psycho-social working environment and mental health are identified and addressed.
• Transport and traffic accidents are identified as a major risk area for medical representatives working in countries with unsafe public infrastructure. Preventive measures have been initiated in the organisation.
• Heavy manual lifting has been an ongoing challenge in production facilities and so we have limited this to a 15 kg maximum load.

We maintain workplace health promotion addressing physical and mental health and well-being by offering our novo health programme.

Performance
In accordance with the health and safety strategy, all business areas strive to prevent and improve our people’s working environment. The safety target is measured in accidents with absence per million working hours, generally known as “lost time accident/injury frequency rate” (LTAFR/LTIFR).

In 2021, Novo Nordisk had a LTAFR of 1.3, in line with 2020, and zero (0) work-related fatalities compared to one (1) in 2020. With regards to the accidents with absence for contractors, 14 were registered in 2021, once again decreasing from the 31 of 2020.

The focus area of mental health well-being is measured, in the annual global employee engagement survey, calculating the percentage of employees reporting symptoms of stress. Stress is defined by a situation where the employee may feel tense, restless, nervous or troubled, or unable to sleep at night because of the continuous thoughts of problems.

In 2021, 15.9% of Novo Nordisk employees reported symptoms of stress, a reduction from 18.3% in 2020, meeting the annual improvement target for mental well-being.

The focus area of physical well-being is also measured in the annual global employee engagement survey, calculating the percentage of employees reporting work-related physical pain.

In 2021, 8.1% of Novo Nordisk employees reported work-related physical pain, a reduction from 11.2% in 2020, therefore meeting the annual improvement target also for physical well-being.

Being a sustainable employer offering an inclusive and diverse working environment is an integrated part of being a sustainable business. While a number of initiatives have been launched to progress gender diversity in Novo Nordisk, only gradual progress has been made as the current share of women in senior leadership positions is 36% in 2021 compared with 35% in 2020 (defined as vice presidents, corporate vice presidents, senior vice presidents and executive vice presidents).

To underline Novo Nordisk’s commitment, accelerate progress and ensure leadership accountability, Novo Nordisk has defined the following global aspirational targets:

• Create an inclusive culture where all employees have a sense of belonging and equitable opportunities to realise
  their potential
• Achieve a balanced gender representation across all managerial levels
• Achieve a minimum of 45% women and a minimum of 45% men in senior leadership positions by the end of 2025

Balanced is defined as the range between 45%-55% to leave up to 10% flexibility for women and men and also allow for non-binary gender recognising that some employees may not wish to be categorised.

While gender is one dimension of diversity, Novo Nordisk fully recognises that diversity is any dimension that differentiates people and enables a diverse line of thought.

Performance
All management teams, from entry level upwards, are encouraged to focus on enhanced diversity, with the aim of ensuring a robust pipeline of talent for management positions. Gender diversity in management overall is 57% men and 43% women in 2021 compared with 59% men and 41% women in 2020. Among employees as a whole, the gender split is 49% women and 51% men in 2021, the same as in 2020. Gender diversity at BoD level for 2021 is 67% men and 33% women, compared with 62% men and 38% women in 2020.

Our overall guiding principle within taxation is to have a ' sustainable tax approach ', emphasising our business anchored approach to managing the impact of taxes while remaining true to the Novo Nordisk values of operating our business in a responsible and transparent manner. This means that we pay tax where value is generated and always respect international and domestic tax rules.

As a global business, we conduct cross-border trading, which is subject to transfer pricing regulations. We apply a 'Principal structure' in line with OECD principles, meaning all legal entities perform their functions under contract on behalf of the principals and are allocated an activity-based profit according to a benchmarked profit margin. The tax outcome of this operational model is reflected in the overview above, which shows our corporate income taxes by region. To ensure alignment between taxing authorities about the allocation of profit between our entities, we have Advance Pricing Agreements in place for geographies representing around 65% of our revenue worldwide.

Our tax policy has been approved by the Board of Directors. Read more about our Tax Policy here .

Performance
The total tax contribution in 2021 amounted to DKK 32,593 million split with 57% on taxes borne and 43% on taxes collected. In 2020, the split was 52% on taxes borne (DKK 13,676 million) and 48% on taxes collected (DKK 12,700 million).

The overall increase in total tax contribution from 2020 to 2021 is primarily related to ‘Corporate income taxes paid’. In 2020 the calculated corporate tax payable exceeded the prepayment of corporate income taxes in Denmark. These additional corporate income taxes have been paid in 2021. Furthermore, the profit before tax has increased for 2021, also resulting in an increase in ‘Corporate income taxes paid’.

Novo Nordisk makes annual donations to the World Diabetes Foundation (WDF), an independent trust, supports sustainable partnerships and acts as a catalyst to help others do more, and the Novo Nordisk Haemophilia Foundation (NNHF).

Performance
The WDF, an independent trust, supports sustainable partnerships and acts as a catalyst to help others do more. The amount granted to WDF has decreased from DKK 138 million in 2020 to DKK 92 million in 2021 as the donation in 2020 included a special one-off contribution of DKK 50 million. In 2021, the WDF Board of Directors approved funding to 13 partnership projects in 16 countries. See note 5.2 in the consolidated financial statements and worlddiabetesfoundation.org for additional information.

The NNHF supports programmes in low- and middle-income countries. Initiatives focus on capacity-building, diagnosis and registry, awareness and advocacy. Novo Nordisk agreed to a donation of DKK 20 million to NNHF in 2021 but due to financial considerations from NNHF the donation was not paid out. Since 2005, the NNHF has provided funding for 289 programmes in 83 countries. See nnhf.org for additional information.

We are committed to meeting our responsibility to respect human rights as defined by the UN Guiding Principles on Business and Human Rights . That means we recognise our responsibility to respect all internationally recognised human rights across our own activities and business relationships.

Read Novo Nordisk Human Rights Commitment and Novo Nordisk Human Rights Report .

We have translated our human rights commitment into actions, developing and continuously improving management systems, including:

• governance and accountability for human rights risks
• setting human rights expectations to all employees through the corporate human right requirements
• development of global systems to identify, assess, mitigate, prevent, track and internally report risks of potential and actual adverse human rights impacts every six months
• integration of human rights into the global Ethics Compliance Programme, Responsible Sourcing and other corporate processes
• awareness building and training on respect of human rights
• awareness building on reporting human rights concerns to the Compliance Hotline as our corporate grievance mechanism
• engagement with stakeholders to advance respect for human rights

Read more in our Novo Nordisk Human Rights Report .

Modern Slavery Statement
Read our latest and previous statements on the UK and Australia Modern Slavery Acts

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