The team hammers out four key messages. First, the economic argument that is most likely to be repeated in the corridors of power: the returns from investment in healthcare are big. By avoiding long periods of poor health, we increase the value of additional life years (VALYs, in healthcare acronym jargon), which generates an economic return that outweighs the healthcare investment we've put in by a factor of between nine and 20. It's striking that spending what seems like a huge sum of money will often deliver big economic returns.
該團(tuán)隊敲定了四條關(guān)鍵信息。首先,最有可能在權(quán)力走廊里重復(fù)的經(jīng)濟(jì)論點(diǎn)是:醫(yī)療投資的回報很高。通過避免長期不佳的健康狀況,我們增加了額外壽命年的價值(醫(yī)療保健術(shù)語縮寫為VALYs),從而產(chǎn)生的經(jīng)濟(jì)回報比我們投入的醫(yī)療保健投資多出9到20倍。花一大筆錢通常會帶來巨大的經(jīng)濟(jì)回報,這一點(diǎn)令人吃驚。
The second point is that the convergence is achievable in less than a generation. Presumably this means that investors can look to make money relatively quickly, too. Governments can be confident of balancing their books fairly soon after a large initial outlay. To be able to see an effect in a matter of years helps turn the convergence from a vision document to actionable policy.
第二點(diǎn)是,這種趨同在不到一代人的時間內(nèi)就可以實(shí)現(xiàn)。這大概意味著投資者也可以相對快速地賺錢。政府有信心在一大筆初始支出之后很快就能平衡收支。能夠在幾年時間內(nèi)看到效果有助于將這種趨同從一紙愿景文件轉(zhuǎn)變?yōu)榭尚袆拥恼摺?/p>
The third point is that governments are underusing fiscal policies in healthcare. In other words, by increasing the tax on tobacco and alcohol, deaths from noncommunicable diseases and from injuries can be sharply reduced in low- and middle-income countries. For example, a 50% price increase in cigarettes in China would prevent 20 million deaths and produce tax revenue of $20bn annually in the next 50 years. The same price increase over the same time period in India would save 4 million lives and bring in an extra $2bn a year in tax. Reducing the subsidies paid to fossil fuel companies also has the effect of improving general health, mostly through the reduction in respiratory diseases.
第三點(diǎn)是,政府在醫(yī)療保健方面沒有充分利用財政政策。換句話說,通過提高對煙草和酒精的征稅,中低收入國家可大幅減少非傳染性疾病和傷害造成的死亡。例如,中國香煙價格上漲50%,將在未來50年防止2000萬人死亡,并每年產(chǎn)生200億美元的稅收。在同一時期內(nèi),印度同樣的價格上漲將挽救400萬人的生命,并帶來每年20億美元的額外稅收。減少對化石燃料公司的補(bǔ)貼也有改善總體健康的效果,主要是通過減少呼吸道疾病。
But it's the fourth point that is most important for us: that universal healthcare is the most efficient way to achieve a convergence in global health. The Lancet's framework was written before Covid-19, but the response of various countries to the crisis shows that universal healthcare is a good protector for pandemics, too.
但第四點(diǎn)對我們來說是最重要的:全民醫(yī)療是實(shí)現(xiàn)全球衛(wèi)生一體化最有效的方式。《柳葉刀》的框架是在新冠爆發(fā)之前編寫的,但各國對危機(jī)的反應(yīng)表明全民醫(yī)療也是預(yù)防大流行的良好屏障。
Jeremy Farrar is director of the Wellcome Trust, one of the world's largest medical research charities, with an endowment of about £30bn. As someone with experience of problem-solving in global health, he is well placed to advise us on how to spend the trillion dollars. "The bedrock of your spending must be on universal healthcare," he told me. An equitable system of healthcare is necessary to improve maternal health, child health, to improve end of life care and to fight epidemics. "Almost anything else is not equitable, not efficient and will not deliver what you need sustainably."
維康信托基金會世界上最大的醫(yī)學(xué)研究慈善機(jī)構(gòu)之一,捐款達(dá)300億英鎊,杰里米·法勒是維康信托基金會的負(fù)責(zé)人。作為一個在解決全球衛(wèi)生問題方面經(jīng)驗(yàn)豐富的人,他完全有資格就如何花費(fèi)這萬億美元提出建議。“你的支出必須以全民醫(yī)保為基礎(chǔ),”他告訴我。一個公平的醫(yī)療保健系統(tǒng)對于改善孕產(chǎn)婦健康、兒童健康、改善臨終護(hù)理和抗擊流行病是必要的。“其他幾乎所有東西都是不公平的、低效的,也無法提供你可持續(xù)需要的東西。”