‘Health is not an expense, it's an investment’

Dr Bente Mikkelsen is a leading voice in global health, with extensive experience shaping international responses to non-communicable diseases (NCDs). Formerly Director of NCDs at the World Health Organization, Dr Bente now serves on the World Diabetes Foundation’s (WDF) Board, bringing deep experience in health systems leadership and global governance. Her work has also spanned research, innovation, the development agenda and the leadership needed to turn global commitments into country-level action.

In this interview she shares a conviction that has shaped her career: health is an investment in people, in systems, and in the belief that change is possible.

The case for NCD action

The case for investing in NCDs is clear. Between 2011 and 2030, NCDs are estimated to cost the global economy 47 trillion USD. Diabetes alone is estimated to account for one trillion USD in health expenditure. Addressing the growing burden of NCDs is therefore not only a health imperative; it also delivers a high return on investment, with every dollar invested estimated to generate a sevenfold return.

“Health is not an expense, it’s an investment,” Dr Bente says, a message she has repeated throughout her career.

WDF entered the global health stage when diabetes and NCDs were still largely absent from development debates. From the beginning, the Foundation worked to integrate diabetes into health systems and position it within broader NCD agendas, including primary care, universal health coverage, maternal and child health, humanitarian response and protracted crises. This early work helped build a platform for NCDs, alongside other actors pushing for their inclusion in global health policies and funding. A key turning point came in 2011, when heads of state and government recognised NCDs as one of the major global public health challenges of the century. The later inclusion of NCDs in the Sustainable Development Goals confirmed the urgency of that agenda.

In 2018, WDF supported WHO and the Government of Denmark in convening the first global dialogue on sustainable financing for NCD responses. The meeting helped push the NCD funding gap onto the development agenda and reinforced the need to embed NCDs within sustainable development, universal health coverage and domestic health financing.

Through these shifts in global health priorities, WDF has remained steadfast in its commitment to the NCD agenda, focused on policy change while ensuring that diabetes prevention, treatment and care reach those who need them most.

Nevertheless, much of the responsibility for addressing NCDs continues to fall on national governments, often with too little external support. With less than two per cent of development assistance for health directed towards NCDs, progress has been slow. From Dr Bente’s perspective, this is not simply a funding gap, but a question of priorities. In a global health landscape marked by competing demands and constrained resources, it is increasingly important to ask whether we can afford not to address NCDs.

Moving the needle

Moving the needle on NCDs means taking a long, system-wide view. This principle has guided WDF from the beginning. Since 2002, WDF has helped address this gap through 633 partnership projects across 121 countries, supporting locally led efforts to strengthen health systems and expand access to diabetes care and prevention.

By investing in systems rather than short-term fixes, the Foundation helps countries build and embed responses they can lead and sustain over time. For Dr Bente, this is one of WDF’s key strengths.

“You cannot build silos. You need to build it into the system and strengthen the system,” she says. That belief has shaped WDF’s approach from the outset. Rather than setting up parallel programmes, the Foundation works with national systems and supports country-led efforts designed to last beyond individual projects.

Integration is central to WDF’s approach. It is also essential to how health systems should work if they are to respond to people’s needs holistically and across the life course, while taking account of other health conditions and priorities. One example is maternal and child health, including the long-term implications of gestational diabetes for both mothers and children. As a trained gynaecologist and obstetrician, this resonates deeply with Dr Bente. Speaking at the NCD and maternal health side event at the UN General Assembly in New York in September, she saw this agenda receive the attention it has long deserved.

For Dr Bente, this is one of the reasons her relationship with WDF has mattered for so long. She recalls her first encounters with the Board not as a member, but in her role as WHO Director for NCDs, when she presented the Global Coordination Mechanism for NCDs in 2014. WDF was the first partner to support the mechanism, an early signal of the Foundation’s belief that partnerships would be essential to advancing the NCD agenda. She remembers how meaningful it was to engage with a Board that listened attentively, asked thoughtful questions, and offered strong backing. “I was so happy to have the support,” she reflects, describing it as a turning point that opened the door to deeper collaboration and greater impact.

The Global Diabetes Compact was launched on the 100th anniversary of the discovery of insulin, in recognition that treatment and care remain inaccessible for more than half of people living with diabetes or at risk of developing it. WDF has supported the initiative from the outset, from the design phase through to country support. Today, it is a vibrant partnership with more than 100 partners and has just marked its fifth anniversary. For Dr Bente, this work reflects a wider lesson: lasting change requires focus, patience and the discipline not to try to do everything at once.

Dr Bente also points to WDF’s long-standing support for people living with NCDs in vulnerable and humanitarian settings. The 2024 Global High-level Meeting on NCDs in Humanitarian Settings in Copenhagen helped bring greater visibility to an area that still receives too little attention. For her, this work shows why national advocacy remains essential, particularly when countries are preparing for, responding to, or recovering from crises.

Hope as a guiding principle

Beneath this emphasis on focus lies something equally important in Dr Bente’s leadership: hope. She is clear that change is necessary and, most of all, achievable.

“I think it’s possible to see real change coming around,” she says. “And I want to be part of that success story, because I think we need, as a world, to give people hope.” 

For Dr Bente, this depends on showing what works, making progress visible, and ensuring that change is owned and led by countries themselves.

That sense of possibility is, in part, a response to what she has seen happen when institutions lose patience. Throughout her career, Dr Bente has seen how quickly ambition can be undermined by narratives of impossibility. “I felt as an NCD director that the world needs to believe that it’s possible,” she reflects, pointing to how often global debates default to claims that change is “too expensive” or simply cannot be done.

One of the greatest risks in global health, she warns, is withdrawal when results are not immediate. Initiatives often begin with enthusiasm, only to lose momentum when change proves slow. The damage is not only to programmes, but to trust and confidence. As she puts it, if people begin to pull back just as change starts, much of that progress can be lost.

Which is why, for her, hope is more than a feeling; it is a responsibility. Hope is not about ignoring crises or minimising setbacks, but showing, clearly and consistently, that progress is possible. For Dr Bente, investing in health ultimately means investing in something larger: the possibility of a more equitable future.