評(píng)論
打印
Your Excellency, Prime Minister Lee Hsien Loong, Minister Gan, honourable ministers, distinguished experts, colleagues in public health, ladies and gentlemen,
李顯龍總理閣下、顏部長(zhǎng)閣下、尊貴的各位部長(zhǎng)、尊敬的各位專家、公共衛(wèi)生界的各位同事、女士們、先生們，
It is a great honour to address a ministerial meeting on universal health coverage in Singapore, a city-state with an inclusive health system known for its affordable excellence. Last year, Bloomberg’s second annual ranking of countries with the most efficient health care placed Singapore at the top.
我深表榮幸能在新加坡的這次全民健康覆蓋問(wèn)題部長(zhǎng)級(jí)會(huì)議上發(fā)言，這個(gè)城市國(guó)家以其出色且負(fù)擔(dān)得起的包容性衛(wèi)生系統(tǒng)而聞名。去年，在彭博社關(guān)于衛(wèi)生保健最具成效的國(guó)家的第二次排名中，新加坡名列榜首。
WHO also places Singapore at the top for key health indicators, especially maternal and infant mortality, two of the most sensitive indicators of a well-functioning health system. Through foresighted and visionary planning, Singapore achieved first-rate health care, with outstanding health outcomes, at a cost lower than in any other high-income country in the world.
世衛(wèi)組織也將新加坡排在關(guān)鍵衛(wèi)生指標(biāo)的前列，尤其是在孕產(chǎn)婦和嬰兒死亡率方面，這兩個(gè)指標(biāo)是運(yùn)轉(zhuǎn)良好的衛(wèi)生系統(tǒng)的最敏感指標(biāo)。新加坡通過(guò)其高瞻遠(yuǎn)矚的規(guī)劃，實(shí)現(xiàn)了一流的衛(wèi)生保健，衛(wèi)生成果斐然可觀，而費(fèi)用則低于世界上任何其它高收入國(guó)家。
This achievement was firmly anchored in a value system that places a premium on fairness and inclusiveness as a route to social cohesion, stability, and harmony.
此一成就是堅(jiān)實(shí)地奠定在這樣一種價(jià)值體系上，即把公正和包容性視為社會(huì)凝聚、穩(wěn)定與和諧之源。
Research guided individual strategies, but so did the wishes of the public, with opinion polls undertaken and conversations started to ensure that changes in the health system won public support and approval.
研究工作引導(dǎo)具體戰(zhàn)略，但公眾的意愿也起到引導(dǎo)作用，民意調(diào)查和對(duì)話確保了衛(wèi)生系統(tǒng)的變革贏得公眾的支持和贊同。
As we have just heard, Singapore’s version of universal health coverage balances the advantages of competitiveness and other market forces with the need for state intervention to steer these forces in the right direction. It balances freedom to choose providers, services, and facilities with an obligatory health savings account, the MediSave plan, with its emphasis on individual responsibility.
正如我們剛剛聽(tīng)到的，新加坡的全民健康覆蓋模式，平衡了競(jìng)爭(zhēng)和其它市場(chǎng)力量與需要國(guó)家干預(yù)來(lái)引導(dǎo)這些力量保持正確方向二者之間的好處。它對(duì)選擇供應(yīng)商、服務(wù)和設(shè)施的自由與強(qiáng)制性健康儲(chǔ)蓄賬戶，即醫(yī)療儲(chǔ)蓄計(jì)劃作了平衡，后者強(qiáng)調(diào)了個(gè)人的責(zé)任。
There is no free lunch. The plan works to protect against the over-consumption of care. To help inform responsible decisions, the Ministry of Health publishes hospital bills for common illnesses on its website.
世上沒(méi)有免費(fèi)的午餐。該計(jì)劃有效地防止了醫(yī)療的過(guò)度消費(fèi)。為幫助形成負(fù)責(zé)任的決定，衛(wèi)生部在其網(wǎng)站上公布了一般疾病的醫(yī)院賬單。
Another innovation, MediShield Life, embodies the principle of collective responsibility through risk pooling. This is the safety net. It protects households from falling into financial ruin when medical bills are especially high. Studies conducted by WHO show that catastrophic medical bills force 100 to 150 million people below the poverty line every year. While many governments are working hard to lift people out of poverty, these efforts can be offset when the health system and its financing actually contribute to poverty.
另一項(xiàng)創(chuàng)新，即終身健康保險(xiǎn)，通過(guò)風(fēng)險(xiǎn)共擔(dān)，體現(xiàn)了集體責(zé)任的原則。這是一個(gè)安全網(wǎng)絡(luò)。它保護(hù)家庭在醫(yī)療花費(fèi)太高的情況下免于傾家蕩產(chǎn)。世衛(wèi)組織的研究表明，每年有1億到1.5億人因?yàn)?zāi)難性的醫(yī)療費(fèi)用跌至貧困線以下。許多政府正在大力幫助民眾脫貧，如果衛(wèi)生系統(tǒng)及其收費(fèi)實(shí)際上是在加劇貧困，則這些努力都將落空。
As Singapore’s Minister of Health observed earlier this year, the scheme tells people that they “need not face life’s uncertainties alone, especially those who meet unexpected shocks in their life journeys.”
正如新加坡衛(wèi)生部長(zhǎng)今年早些時(shí)候所言，該項(xiàng)計(jì)劃告訴民眾，他們“尤其是那些在生命旅途中遭遇意外變故的人，不會(huì)獨(dú)自面對(duì)生活中的不穩(wěn)定性。”
Of course, not all of these innovations can be applied elsewhere. UHC is intrinsically country-owned. To work well, it must be home grown in line with each country’s culture, domestic political institutions, the legacy of the existing health system, and the expectations of citizens.
當(dāng)然，所有這些創(chuàng)新，并非在任何地方都適用。全民健康覆蓋本質(zhì)上是國(guó)家所有。要想行之有效，它必須根據(jù)每個(gè)國(guó)家的文化、國(guó)內(nèi)政治體制、現(xiàn)行衛(wèi)生系統(tǒng)的遺產(chǎn)和公民的期望因地制宜。
In achieving UHC, Singapore had some distinct advantages. The huge challenge of extending health services to reach remote and impoverished rural areas was non-existent. Singapore has only one rural area, a small island and tourist attraction.
在實(shí)現(xiàn)全民健康覆蓋方面，新加坡有一些獨(dú)特的優(yōu)勢(shì)。不存在需要將衛(wèi)生服務(wù)擴(kuò)展到邊遠(yuǎn)和貧窮農(nóng)村地區(qū)的挑戰(zhàn)。新加坡只有一處農(nóng)村，是一個(gè)小島和旅游勝地。
A tradition of cross-ministry collaboration makes it easier to address the upstream causes of ill health through environmental improvements and the use of fiscal and regulatory measures to encourage healthy lifestyles.
跨部門合作的傳統(tǒng)使之可以通過(guò)環(huán)境改善和采取財(cái)政和監(jiān)管措施來(lái)鼓勵(lì)健康的生活方式，從而解決健康不良的上游原因。
Singapore has also enjoyed political stability and a high level of public trust in government for decades. That helped as well.
幾十年來(lái)，新加坡還保持了政治穩(wěn)定，政府的公信力極高。這也是很有幫助的。
With these advantages, UHC in Singapore has gone beyond providing and financing fair and inclusive health care. UHC in Singapore has worked as a strategy for building an inclusive, caring, and progressive society. These are assets for any country in the world.
出于這些優(yōu)勢(shì)，全民健康覆蓋在新加坡不僅僅是提供公平和包容性的衛(wèi)生保健，并為之籌資。新加坡的全民健康覆蓋成為建設(shè)一個(gè)包容、關(guān)愛(ài)和進(jìn)步社會(huì)的戰(zhàn)略。這些對(duì)世界上任何國(guó)家都是一筆財(cái)富。
Ladies and gentlemen,
女士們，先生們，
Our world is in turmoil from multiple causes. The signs are there for anyone to see: fluctuating currencies, unstable economies, prolonged conflicts, ethnic clashes, and inexplicable acts of violence. Organized acts of terrorism are the newest omnipresent and unpredictable threat.
我們的世界因多種原因而變亂不定。這方面的跡象有目共睹：貨幣波動(dòng)、經(jīng)濟(jì)動(dòng)蕩、曠日持久的沖突、種族糾紛、不可思議的暴力行為。有組織的恐怖主義活動(dòng)則是一種最新威脅，它無(wú)處不在，難以預(yù)料。
The climate is changing, antibiotics are failing, and health care costs are soaring. Inequalities, in income levels, opportunities, and access to social services, both within and between countries, have reached the highest levels seen in nearly a century.
氣候變化，抗生素失靈，衛(wèi)生保健費(fèi)用扶搖直上。國(guó)家之內(nèi)和國(guó)家之間在收入水平、機(jī)會(huì)和獲取社會(huì)服務(wù)方面的不平等，已經(jīng)達(dá)到了近百年來(lái)曾未見(jiàn)過(guò)的最嚴(yán)重程度。
Countries are losing their middle classes, the backbone of democracy. Last month’s Oxfam report on wealth distribution contains a startling statistic: just 80 rich and powerful people own more of the world’s total wealth than 3.5 billion people at the other end of the scale.
各國(guó)正在失去其作為民主制中堅(jiān)的中產(chǎn)階級(jí)。上個(gè)月樂(lè)施會(huì)關(guān)于財(cái)富分配問(wèn)題的報(bào)告載有令人震驚的統(tǒng)計(jì)數(shù)字：僅僅80個(gè)有財(cái)有勢(shì)者，其在世界總財(cái)富中所占份額，就超過(guò)了底層的35億人。
Many economists take optimism from the fact that several of the world’s fastest growing economies are in Africa, often fuelled by foreign extractive industries. But if you look at income distribution within these countries, what we are really seeing is more and more rich countries full of poor people.
許多經(jīng)濟(jì)學(xué)家感到樂(lè)觀的是，世界上有若干增長(zhǎng)最迅速的經(jīng)濟(jì)體在非洲，它們背后往往是外國(guó)采掘工業(yè)在推波助瀾。但注意一下這些國(guó)家的國(guó)內(nèi)收入分配，我們不難看到，在這些越來(lái)越富裕的國(guó)家中，到處都是窮人。
An African medical blogger contrasted growths in GDP with weaknesses in health systems laid bare by the Ebola outbreak. He asked the following question. What good does it do to cover the ceiling of your house with golden paint when the walls and foundation have cracks?
一個(gè)非洲醫(yī)學(xué)博客拿國(guó)內(nèi)生產(chǎn)總值的增長(zhǎng)與埃博拉疫情顯露的衛(wèi)生系統(tǒng)的薄弱作出比較。他提出了如下問(wèn)題：如果墻壁和地基都在坍塌，則在屋頂上描金敷彩，又有什么意義？
Decades of experience tell us that this world will not become a fair place for health all by itself. Health systems will not automatically gravitate towards greater equity or naturally evolve towards universal coverage.
幾十年的經(jīng)驗(yàn)教訓(xùn)告訴我們，這個(gè)世界單憑自身，不會(huì)成為一個(gè)有利健康的公平場(chǎng)所。衛(wèi)生系統(tǒng)不會(huì)自動(dòng)傾向于更大程度的公平，或自然而然地演化出全民覆蓋。
Economic decisions within a country will not automatically protect the poor or promote their health. Globalization will not self-regulate in ways that ensure fair distribution of benefits. International trade agreements will not, by themselves, guarantee food security, or job security, or health security, or access to affordable medicines.
國(guó)家內(nèi)的經(jīng)濟(jì)決策不會(huì)自動(dòng)去保護(hù)窮人或增加他們的財(cái)富。全球化不會(huì)自我調(diào)節(jié)，確保利益的公平分配。國(guó)際貿(mào)易協(xié)定本身，不會(huì)保障糧食安全、就業(yè)安全，衛(wèi)生安全，或獲取可負(fù)擔(dān)的醫(yī)藥。
All of these outcomes require deliberate policy decisions.
所有這些成果都要求作出深思熟慮的政策決定。
Universal health coverage is one of the most powerful social equalizers among all policy options. It is the ultimate expression of fairness. If public health has something that can help our troubled, out-of-balance world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.
全民健康覆蓋是所有政策選項(xiàng)中最有力的一個(gè)社會(huì)平衡器。它是公正的終極表達(dá)。公共衛(wèi)生如果能對(duì)我們這個(gè)擾攘不斷的、失衡的世界有所幫助，那就在于：越來(lái)越多的證據(jù)顯示，運(yùn)轉(zhuǎn)良好的包容性衛(wèi)生系統(tǒng)將促進(jìn)社會(huì)的凝聚、公平和穩(wěn)定。它們將社會(huì)聚攏在一起，幫助緩和了社會(huì)緊張局勢(shì)。
At a time when policies in so many sectors are actually increasing social inequalities, I would be delighted to see health lead the world towards greater fairness in ways that matter to each and every person on the planet.
在如此之多部門的政策實(shí)際上正在加劇社會(huì)的不平等之時(shí)，我很高興能看到，衛(wèi)生以對(duì)地球上每個(gè)人都很重要的方式，引領(lǐng)世界走向更大的公平。
