評論
打印
Ladies and gentlemen,
女士們，先生們，
As the world enters the post-2015 era, it faces health challenges that are far more complex than they were at the start of this century.
世界正在進入2015年后時代，它所面臨的衛生挑戰的復雜性，要遠遠超出本世紀初。
The sharp distinctions between health problems in wealthy and developing countries are dissolving. Everywhere, health is being shaped by the same universal pressures: the globalized marketing of unhealthy products, population ageing, and rapid urbanization.
富國與發展中國家在衛生困擾上的明顯差異正在消失。所有地方的衛生工作都受到同樣的普遍壓力：不健康產品的全球化推銷、人口老齡化和迅速的城市化。
Our very definition of what constitutes socioeconomic progress is being challenged.
我們關于社會經濟進步為何的定義本身正在受到挑戰。
Beginning in the 19th century, improvements in hygiene and living conditions were followed by vast improvements in health status and life-expectancy. These environmental improvements aided the control of infectious diseases, totally vanquishing many major killers from modern societies.
從十九世紀開始，伴隨衛生和生活條件的改善，是健康狀況和預期壽命的巨大改善。這些環境改善幫助控制了傳染病，在現代社會徹底消滅了許多主要的致命疾病。
Today, the tables are turned. Instead of diseases vanishing as living conditions improve, socioeconomic progress is actually creating the conditions that favour the rise of noncommunicable diseases. Economic growth, modernization, and urbanization have opened wide the entry point for the spread of unhealthy lifestyles.
如今，形勢急轉直下。疾病沒有隨生活條件的改善而消失，社會經濟進步實際上正在造成有利于非傳染性疾病出現的條件。經濟增長、現代化和城市化為不健康生活方式的蔓延敞開了大門。
The ancient burden of deaths from infectious diseases has been joined by a newer burden of even more deaths from NCDs. Rapid unplanned urbanization has added a third burden: deaths from road traffic crashes and the mental disorders, substance abuse, and violence that thrive in impoverished urban settings.
除過傳染病致死這一古已有之的負擔，新增了非傳染性疾病造成甚至更多死亡的負擔。迅速和無計劃的城市化加重了第三個負擔：道路交通事故和精神疾病、物質濫用以及城市貧窮環境中迅速滋生的暴力行為造成的死亡。
The rise of NCDs adds considerably to the costs of health care. The costs of cancer care, for example, are becoming unaffordable for even the wealthiest countries in the world. In 2012, the US Food and Drug Administration approved 12 drugs for various cancer indications. Of these 12, 11 were priced above $100,000 per patient per year. How many countries can afford this cost?
非傳染性疾病的加劇導致衛生保健成本大增。例如，甚至對世界上最富有的國家而言，癌癥護理的費用也正在令人不堪重負。2012年，美國食品和藥物管理局為各種癌癥適應癥批準了12種藥物。在這12種藥物中，有11種 的價格超過每個病人每年10萬美元。有多少國家能夠負擔得起這筆費用？
Prevention is by far the better option, but this, too, is more problematic than for infectious diseases, many of which can be prevented by vaccines or cured by medicines, all delivered by the health sector.
迄今為止，預防是更好的選擇，但相對于預防傳染病，它也問題多多，許多傳染病是疫苗接種可以預防或藥物可以治愈的，而且它們均由衛生部門提供。
The root causes of NCDs reside in non-health sectors. They escape the direct purview of health. When health policies cross purposes with the economic interests of sectors like trade or finance, economic interests will trample health concerns nearly every time.
非傳染性疾病的根源在于非衛生部門。它們不在衛生部門的直接權限范圍之內。當衛生政策與貿易或金融等部門的經濟利益不一致時，幾乎每次都是經濟利益踐踏健康方面的考慮。
Implementation of the WHO Framework Convention on Tobacco Control is a notable exception. It provides one of the best examples of cross-ministry collaboration, driven by overwhelming evidence of the health and economic costs of tobacco use.
執行《世衛組織煙草控制框架公約》是一個明顯的例外。它提供了跨部門合作的最佳范例之一，關于煙草適用的健康成本和經濟成本的壓倒性證據激勵了這一合作。
It tells us that the health sector, working in tandem with others, can generate huge benefits. It can even tackle a powerful, devious, and dangerous industry on multiple fronts, including through fiscal and regulatory measures.
它告訴我們，衛生部門與其它部門攜手努力，可以產生巨大效益。它甚至可以在多條戰線，包括通過財政和監管措施，對付一個有權有勢、陰險狡猾和危險的行業。
As yet another challenge in the post-2015 era, health and medical professionals in every region of the world are losing their first-line antimicrobials as drug resistance develops. In several cases, second-line medicines are failing as well. For some cases of multi-drug resistant tuberculosis and gonorrhoea, even last-resort antibiotics fail.
2015年后時代的另一個挑戰是，隨著耐藥性的發展，世界每一地區的衛生和醫療專業人員正在失去他們的一線抗菌素。在若干情況下，二線藥品也失靈了。在一些耐多藥結核病和淋病案例中，甚至作為最后手段的抗生素也失靈了。
With few replacement products in the pipeline, the world is moving towards a post-antibiotic era in which common infectious diseases will once again kill. A post-antibiotic era is a game-changer on a par with climate change. But antimicrobial resistance will kill us before climate change.
由于正在開發的替代產品很少，世界正在走向后抗生素時代。在這個時代中，普通的傳染病將再次戕害生命。同氣候變化一樣，后抗生素時代也將改變游戲規則。但抗菌素耐藥性將先于氣候變化，將我們致于死地。
Ladies and gentlemen,
女士們，先生們，
I began with the strategies used by Singapore to achieve and sustain universal coverage. Let me conclude with the strategies used in a very different country: Bangladesh.
我開頭講的是新加坡為實現和維持全民覆蓋所采用的戰略。讓我以一個迥然不同的國家采用的戰略作為結束：孟加拉國。
The Bangladeshi story shatters the long-held assumption that countries must first reduce poverty, then better health will follow almost automatically. Bangladesh decided to reverse the order by first freeing populations from the misery caused by ill health.
孟加拉國的故事駁斥了人們長期以來的假設，即國家必須首先減貧，則健康自然就會有所增進。孟加拉國決定顛倒這個次序，先讓民眾免遭健康不良帶來的苦難。
Driven by a commitment to equity, the country aimed for universal coverage of its vast and very poor population with a package of high-impact interventions. To compensate for a severe shortage of doctors and nurses, the country trained and then closely supervised a brigade of community health workers, mostly women, who followed a doorstep-delivery approach.
在實現公平的承諾的推動下，該國的目標是利用一整套影響力巨大的干預措施，對其為數眾多的非常貧窮的人口實現全民覆蓋。為彌補醫生護士的嚴重短缺，該國培訓了一大批采取上門交付方式的社區保健人員，主要是女性，并對其進行密切監督。
The country also used its world-class research capacity to experiment with innovations. Formal and contractual arrangements were made with nongovernmental organizations that were best placed to win community trust and reach marginalized populations. Improvements in school enrolment, especially for girls, and in agriculture brought huge benefits for health.
該國還利用其世界水平的研究能力進行創新實驗。與非政府組織作出正式的合同安排，這些組織最有可能贏得社區信任，抵達邊緣人群。入學率的提高，特別是農村女孩入學率的提高，給健康帶來巨大的好處。
The efforts of Bangladesh were driven by another reality. When government health services fail to reach poor areas, private providers and shops selling medicines will mushroom. Charges for services from these unregulated and largely unqualified health care providers work to deepen poverty, not reduce it. To prevent this from happening, the government built and ran nearly 12,000 strategically located community clinics
另一種現實也是驅動孟加拉國努力的因素。在貧困地區，當政府的衛生服務鞭長莫及時，私人供應商和出售藥品的商店就會蜂擁而起。這些不受管控且基本上無資質的醫療保健提供者對服務的收費，加劇而不是減少了貧窮。為防止這種情況發生，政府建立并管理了近1.2萬個位于戰略位置的社區醫務所。
Perhaps most important was the strong strategic bias towards women and girls. The approaches used explicitly recognized that empowered women will turn health into a nation-building strategy.
或許最重要的是對婦女和女孩的強大戰略傾斜。所采用的方法明確承認，能力增強后的婦女將使健康成為一項國家建設戰略。
Their needs, including for sexual and reproductive health services, came first. Their human rights were legally protected. That approach led to a stunning reversal in excessive mortality of girls compared with boys
她們的需要，包括對性健康和生殖健康服務的需要被擺在了首要位置。她們的人權得到了法律保護。伴隨這一方針，女孩的死亡率大大高于男孩的現象得到了顯著扭轉。
As we have learned from ample evidence, investing in health is investing in economic growth, investing in the health and well-being of people. Every country needs healthy human capacity to sustain development. Without this capacity, it is hard to even begin to talk about sustainable development.
正如我們從充足的證據中所了解，投資于衛生，就是投資于經濟增長，投資于人民的健康和福祉。每個國家要維持發展，都需要健康的人力資源。沒有這一能力，甚至很難開始談論可持續發展。
The Singapore experience and all of the other experiences we have heard about give us one compelling message. Any country that really wants to move towards universal health coverage can do so. There are no excuses.
新加坡的經驗和我們聽到的所有其它經驗，都傳遞了一個令人信服的信息。任何國家，只要真正希望實現全民健康覆蓋，都是可以做到的。不存在任何借口。
Health is likely one of the most precious commodities in life. But it is highly political and it requires investment. You need political leadership. You need commitment. And you need a conversation with the public, as has been done here in Singapore. I thank you for the opportunity to participate in this discussion.
健康可能是生命中最寶貴的商品之一。但它是高度政治性的，而且還要投入資金。需要政治領導。需要承諾。需要與公眾對話，就像新加坡所做的那樣。感謝大家使我有機會參加這次討論。
Thank you.
謝謝大家。
