美国国家公共电台 NPR In Diabetes Fight, Lifestyle Changes Prove Hard To Come By In Mexico（在线收听）

STEVE INSKEEP, HOST:

Here's a fact that tells you something about a country. It's the leading cause of death. The leading cause is different in different nations. In the United States, for example, it's long been heart disease. But as heart disease treatment improves, cancer is starting to take over. In Mexico, the leading cause of death is now diabetes. Researchers say up to half the country could suffer from diabetes if current trends continue. NPR's Jason Beaubien reports on what's going wrong.

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JASON BEAUBIEN, BYLINE: Tona Barrientos is a doctor and an epidemiologist with Mexico's National Institute of Public Health in Mexico City. He's also a runner. Walking through the neighborhood in between his office and his home, Barrientos points out that Mexico City is an incredibly hard place to go out for a run.

TONA BARRIENTOS: I mean, the only place for you to really run is the sidewalk. You cannot run on the street because you'll probably get run over.

BEAUBIEN: But the sidewalk isn't the easiest place to jog, either. The surface is an uneven mix of broken cement slabs and cobblestones. Street vendors have set up little tables and carts to sell everything from electrical supplies to fried pork cracklings.

BARRIENTOS: There's a lot of obstacles (laughter), a lot of stuff and people. And there's these street carts and people selling stuff on the street. And you need to deal with that.

BEAUBIEN: Also the smog on some mornings is so thick it makes your lungs tingle.

BEAUBIEN: You can smell it, right? The smell is - it's hard.

BEAUBIEN: To combat obesity, Mexican health officials have been telling people to get out and exercise. But in Mexico City, that could be a hard sell. Type 2 diabetes is a so-called lifestyle disease. And it's mushroomed as Mexicans diets and work habits have changed dramatically over the last 40 years. Several generations ago, diabetes was almost unheard of in Mexico.

Now, it's the leading cause of death. Mexicans with indigenous ancestry also have a genetic predisposition for the condition that makes them more likely to develop the disease than Caucasians. But the main driver of diabetes in Mexico and globally is still what a person eats. Barrientos says that by 2030, 17 percent of all Mexican adults could have diabetes.

BARRIENTOS: And that, of course, opens a lot of questions in terms of sustainability, for instance. So can you really sustain a public health system with 17 percent of your population being diabetic, especially if you are not prepared to control the diabetes?

BEAUBIEN: If left uncontrolled, diabetes can have grave health consequences. It can lead to blindness, nerve damage, even kidney failure. Barrientos says Mexico's experience with anti-tobacco campaigns could hold lessons now for health officials trying to curb diabetes.

BARRIENTOS: The only moment in which we started to see a real change is when we started to change the rules of the game. And we started by saying, well, we're going to increase the price of cigarettes because we know that the more expensive it is, the less you're going to be willing to spend your precious money on something that is not good for you.

BEAUBIEN: In an effort to cut soda consumption, the government in 2014 imposed a one-peso-per-liter tax on sugar-sweetened beverages. At the time, Mexico was the leading per capita consumer of soda in the world. In regulatory filings that year, Coca-Cola said the annual per capita consumption of its beverages in Mexico was more than 600 eight-ounce servings per year.

That means on average, every Mexican was having nearly two glasses of coke products every day. And that doesn't even count the amount of other sugary beverages they were drinking. Alejandro Calvillo, the head of a consumer group called El Poder del Consumidor, says soda is making Mexicans sick. And those cheap sugary drinks are available all over the country.

ALEJANDRO CALVILLO: And you can see the promotions - three liters of Coke, $1.10, something like that.

BEAUBIEN: Walking just outside his office in Mexico City, he points out that there are little shops selling soda and junk food on just about every block.

CALVILLO: Coke in Mexico have more than 1.5 million places that sell Coke. The presence of these products are everywhere.

BEAUBIEN: Calvillo was one of the advocates for the 2014 soda tax, although he would have liked the tax to have been even higher, saying it would have given the government more resources to combat diabetes.

CALVILLO: People no have information. You go to Chiapas in the indigenous community, you can see the kids with baby bottle drinking Coke, you know? And the government is not doing anything. It's crazy, you know?

BEAUBIEN: The head of the country's carbonated beverage trade association, Jorge Terrazas, says soda is being unfairly blamed for Mexico's high rates of obesity and diabetes.

JORGE TERRAZAS: There's not a conclusive scientific evidence demonstrating the relation between the intake of soft drinks with overweight.

BEAUBIEN: He points out that the average per capita intake of calories in Mexico far exceeds the World Health Organization's recommendation of 2,000 per day. And he adds that most of those calories are coming from things other than soda. But Calvillo and other anti-soda campaigners say sugar is a big part of the problem. And they say relying on individuals alone to change their lifestyles won't solve Mexico's diabetes crisis. Jason Beaubien, NPR News.

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