Rapid Rise in Diabetes Linked to Spread of Urbanisation 城市化發展與糖尿病激增

安德魯·沃德 蔣璐璐

What has caused global incidence of diabetes1 to more than double since 2000？ The obvious answer is unhealthy diet， sedentary2 lifestyle and the resulting obesity—one of the main risk factors behind the disease.

The number of people living in urban areas now surpasses those in rural settings， and two-thirds of the world’s 415m diabetics are city dwellers.

A research report led by University College London sheds light on the “risk cocktail” linking the disease with city life. Factors range from increased junk food consumption and lack of safe spaces for exercise to social isolation and economic inequalities.

David Napier， professor of medical anthropology3 at UCL， said that， by focusing on medical factors， traditional research had failed to capture “the social and cultural drivers” that made urban populations especially vulnerable to type 2 diabetes4—the type often linked to obesity.

The proportion of people living in cities increased from 30 per cent in 1950 to 54 per cent in 2014， according to the UN， with a forecast for it to reach two-thirds by 2050 as countries such as China and India rapidly industrialise.

Prof Napier said policymakers and urban planners must come up with strategies to promote healthier living if the exodus5 from the countryside was not to accelerate the growth of diabetes and other chronic conditions such as heart disease and cancer.

Around the world， about one in 11 adults on average have diabetes， and three-quarters of them are in developing countries， according to data published by the International Diabetes Federation6. The total number is forecast to rise from 415m to 642m by 2040.

This trend is exacting7 a heavy human and economic toll. Diabetes， which causes a person’s blood sugar to become too high， requires life-long treatment and， if uncontrolled， can lead to heart attack， stroke， eye problems and amputations. The disease accounts for 12 per cent of global health expenditure， at about $673bn. This figure is forecast to top8 $800bn by 2040.

The UCL research was based on interviews with diabetics and those at risk of the disease in five cities—Copenhagen， Houston， Mexico City， Shanghai and Tianjin—taking part in a global project to develop policies to break the link between diabetes and urbanisation.

Prof Napier said the study revealed a complex mix of risk factors. For example， in Mexico City， people were deterred9 from using cycle paths and parks because of fear of muggings10 and wild dogs. “People want a safe place to come out and exercise with lighting and security，” he said. “So they use a parking lot at Walmart.”

As the number of Chinese city dwellers has increased so has its number of diabetics. China already has more than three times as many cases as the US and incidence is forecast to increase to 150.7m by 2040.

Even in Copenhagen， a city with plentiful green space， bike lanes and strong public services， the study found pockets11 of high diabetes rates in communities with lower levels of education and employment and high concentrations of immigrants. This highlighted the need to target prevention measures at hard-to-reach parts of the urban population， said Prof Napier.

The UCL findings were presented at a summit in the Danish capital when Johannesburg and Vancouver became the latest additions to the network of cities co-operating on anti-diabetes initiatives12.

The project， known as Cities Changing Diabetes， is backed13 by $20m from Novo Nordisk， the world’s biggest manufacturer of insulin for diabetics. The Danish group has benefited from surging14 incidence of the disease， but Lars Rebien Sorensen， chief executive15， insisted that it was committed to helping promote prevention.

“We want to be part of the conversation，” he said. “If we were only focused on getting people diagnosed and treated with our products we would not gain the respect we need to be a trustworthy partner.”

自2000年以來，全球糖尿病發病率增長了一倍以上，原因何在？答案顯而易見：飲食不健康，久坐不動以及由此造成的肥胖——此為誘發糖尿病的元兇之一。

目前，全球城市居民人數已超過農村，而全世界4.15億糖尿病患者中有三分之二是城市居民。

由倫敦大學學院（UCL）牽頭撰寫的一份研究報告點明了將城市生活與糖尿病相關聯的“混合型風險因素”。這些因素形形色色，涵蓋很廣，既包括垃圾食品消費增加、可供鍛煉的安全場所缺乏，也包括社會隔絕和經濟發展不均衡。

UCL醫學人類學教授戴維·納皮爾認為，糖尿病傳統研究只關注醫學方面的因素，忽視了導致城市居民尤其容易罹患2型糖尿病的“社會文化因素”。2型糖尿病多與肥胖有關。

聯合國數據顯示，城市居民人口占世界總人口的比例已從1950年的30%上升到2014年的54%，隨著中國、印度等國家的快速工業化，到2050年，城市人口占世界總人口比重預計將達到2/3。

納皮爾教授指出，政策制定者和城市規劃者必須提出促進居民健康生活的策略，防止糖尿病及心臟病和癌癥等慢性疾病的發病率因農村人口涌入城市而加速升高。

國際糖尿病聯合會公布的數據顯示，全世界平均每11名成年人中就有1人患有糖尿病，其中3/4的患者來自發展中國家。到2040年，全球糖尿病患病總人數預計將從4.15億增長到6.42億。

這將導致許多人失去生命，經濟遭受重大損失。糖尿病患者血糖非常高，需要終生接受治療，如果不加控制，還會導致心臟病、中風、眼疾和截肢。全球糖尿病醫療保健支出總額約為6730億美元，占全球醫療費用的12%。到2040年，這一數字預計將超過8000億美元。

UCL此項研究是基于對哥本哈根、休斯頓、墨西哥城、上海和天津這五座城市糖尿病患者及高危人群的訪談展開的。該研究所屬的全球項目旨在幫助各國制定政策，使城市化進程與糖尿病發病脫鉤。

納皮爾教授認為，這項研究揭示了多種危險因素的錯綜復雜。以墨西哥城為例，人們不敢上自行車道騎車，也不敢去公園，怕遭遇搶劫和碰到野狗。納皮爾教授說：“人們需要一個安全的地方進行室外鍛煉，配備照明和安保措施，所以大家會去沃爾瑪的停車場。”

隨著中國城市居民數量增加，糖尿病患者人數也逐年攀升。中國糖尿病病人已超美國三倍，到2040年，中國糖尿病病人預計將增加到1.507億。

哥本哈根綠化覆蓋率高，自行車道隨處可見，各項公共服務設施完備，但此次研究發現，在受教育程度偏低、就業率不高及移民比較集中的區域，糖尿病發病率仍然較高。納皮爾教授認為，這說明我們要特別針對城市人口中的死角人群推出預防措施。

UCL的研究成果在哥本哈根舉行的國際峰會上發布。峰會上，約翰內斯堡和溫哥華兩座城市作為新成員加入了各城市攜手開展的抗擊糖尿病行動。

這一行動名為“城市改變糖尿病”，得到諾和諾德公司2000萬美元的資金支持，該公司是全球最大的胰島素（用于治療糖尿病）制造商。全球糖尿病發病率激增使這家丹麥公司獲利頗豐，但公司總裁拉爾斯·雷比恩·索倫森強調，公司始終致力于助推糖尿病的預防工作。

他說：“我們希望成為行動的一分子。如果我們只關注用自己的產品確診和治療糖尿病，我們不會贏得必要的社會尊重而成為值得信賴的合作伙伴。”□

（譯者單位：對外經濟貿易大學）

1 diabetes糖尿病，一種以高血糖為特征的代謝疾病，患者體內無法分泌足量胰島素，血液中葡萄糖水平升高，導致各種組織，特別是眼、腎、心臟、血管、神經的慢性損害和功能障礙。? 2 sedentary在工作或活動中久坐;也指人不愛運動，長時間坐著。? 3醫學人類學，屬于醫學應用學科，是人類學的一個分支，以病人對疾病的社會心理反應為重心，而不是以疾病本身為重心，主要關注生病行為，即病人對疾病的社會心理反應。

4 2型糖尿病，原名成人發病型糖尿病，患者多在35～40歲之后發病，占糖尿病患者90%以上。2型糖尿病患者體內產生胰島素的能力并非完全喪失，有的患者體內胰島素甚至產生過多，但胰島素的作用效果較差，因此患者體內的胰島素呈相對缺乏，可通過某些口服藥物刺激體內胰島素分泌，但后期仍有一些病人需要使用胰島素治療。? 5 exodus指（人）大批離去、成群外出。? 6國際糖尿病聯合會（簡稱IDF），1949年6月成立于比利時布魯塞爾，旨在組織和指導各會員機構開展對糖尿病的防治研究及教育，傳播有關糖尿病的正確信息，采取行動改善患者的物質條件，提高社會福利。

7 exact使付出代價，造成不良后果。? 8 top超過某一特定數量。? 9 deter使不敢，使躊躇。? 10 mugging搶劫。

11 pocket指與周圍環境不同的一小部分人或地區。通常以pockets of +名詞形式出現。? 12 initiative積極的行動;倡議。? 13 back支持，資助。? 14 surging激增的;急劇上升的。? 15索倫森于2017年卸任，公司現任全球總裁兼CEO為周賦德（Lars Fruergaard J?rgensen）。