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强制之外的因素

天之聪教育 2012-06-28 未知 344次

 

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Beyond the mandate

强制之外的因素

Improving America’s health will take more than universal insurance

全民医保不足以提高美国健康水平

 


 

MARCH brought frenzied attention to Barack Obama’s health law. The Supreme Court heard arguments over its constitutionality. Outside the court, supporters waved their neatly printed posters and tea-partiers waved their scrawled, angry ones. The ruckus centred on Mr Obama’s mandate to buy insurance. America is the rare Western country without a universal insurance scheme. But, as a new study points out, a lack of insurance is only part of America’s health problem.

三月,奥巴马的医保改革法成为了关注的焦点。最高法院就其是否违宪这一议题举行了听证会。法庭之外,该法的支持者挥动着印刷整洁的海报,茶党则摇晃着他们字迹潦草、充满怒气的横幅。骚动聚焦在奥巴马强制购买医保上。美国没有全民医保方案,这在西方国家里并不常见。不过,一项新研究表明,缺少保险只是美国的健康问题之一。

On April 3rd the University of Wisconsin and the Robert Wood Johnson Foundation, a philanthropic outfit, released a new report on health in America’s counties. The report is part of a string of efforts to sort through the mounds of data on health and the factors that affect it. The jumble of information does not reveal a perfectly clear picture. But it begins to illuminate the particular nature of America’s health and why it is so dismal.

4月3日,威斯康星大学与慈善机构罗伯特伍德约翰逊基金会发布了关于美国各郡健康状况的新报告。该报告是一系列举措中的一项,旨在理清医疗状况档案,探究其影响因素。该报告信息繁杂,并未展现出一幅完美的清晰图景,但它初步阐释了美国健康问题的核心,也初步指出了美国健康现状如此糟糕的原因。

America, it is often noted, spends more on health care yet has worse results than other rich countries. Its infant-mortality rate, for example, is double that of Sweden, Germany and France (to name only a few). A closer look reveals conflicting trends within America itself. A recent ranking of states’ health, sponsored by the foundation of UnitedHealth, America’s biggest insurer, was filled with contradictions. America is making good progress to reduce smoking and the toll of infectious disease, yet diabetes rates are climbing and tens of millions remain uninsured. The north-east is a picture of health compared with the South. Vermont, New Hampshire and Massachusetts are among the five healthiest states; Mississippi, Alabama and Louisiana are the lowest. Resources vary wildly from one state to another. Massachusetts has 192 primary-care doctors for every 100,000 people; Idaho has just 78. Behaviour is similarly spotty. In Florida whites are 30% more likely to smoke than blacks. In Minnesota the reverse is true.

人们往往会注意到,美国的医保花销多于其它富裕国家,其成绩却不尽如人意。比如说,美国的新生儿死亡率是瑞典、德国、法国等国的两倍。拉近观察距离,便能发现美国内部也存在着矛盾倾向。近日,一项对各州健康状况的评级(由美最大的保险公司—联合健康集团赞助)中就充满了矛盾倾向。美国在减少吸烟和感染死亡人数方面成果斐然,但糖尿病发病率持续攀升,数千万病人没有医疗保险。东北部地区健康状况好于南部地区。在健康排行榜上,佛蒙特州、新罕布什尔州、马萨诸塞州均跻身前五,密西西比州、阿拉巴马州、路易斯安那州排名垫底。各州医疗资源差异极大。马赛诸塞州每10万人拥有192名全科医生,爱达荷州只有78名。各州居民的行为习惯也参差不齐。佛罗里达州吸烟的白人比黑人多30%,明尼苏达州的情况正好相反。

The new report takes an even closer look, inspecting data for more than 3,000 counties. The authors, led by Bridget Booske Catlin of the University of Wisconsin, rank each state’s counties according to health outcomes: premature death, poor mental and physical health and low birth weights for babies. Separately, they examine the factors that influence health, such as clinical care, income and behaviour.

新报告进一步拉近了观察距离,逐一调查了3000多个郡的资料。在威斯康星大学的布里奇特.博斯克.卡特林(Bridget Booske Catlin)带领下,研究者根据医疗保健状况(婴幼儿死亡率、身心健康状况欠佳、新生儿体重过低等)为各郡排名。他们还单独研究了影响健康的因素,如临床护理、个人收入、行为习惯。

Wide gaps existed within each state. The five least-healthy counties generally had more than twice the teenage birth rate of the five healthiest counties, and more than twice the share of poor children. Within counties, factors seem to contradict one another. In Putnam, New York’s healthiest county, 29% of adults are obese, compared with 28% in the Bronx, New York’s least-healthy county. Putnam also has higher rates of binge drinking—21% compared with 14% in the Bronx. Yet the Bronx has lower education rates, eight times the rate of teen pregnancies and New York’s highest concentration of fast-food restaurants. Lack of insurance, therefore, is only part of the puzzle.

各州州内的差异也很大。在健康状况最差的五个郡,青少年生育率比健康状况最好的郡高出一倍多,贫困儿童也多出一倍多。即使在各郡之间,各个因素似乎也相互矛盾。在纽约健康状况最好的帕特南,有29%的成年人肥胖,21%的人酗酒;而最差的布朗克斯区则只有28%的人肥胖,14%的人酗酒。不过布朗克斯的教育水平较低,青少年怀孕率是帕特南的八倍,快餐店的数量也高居纽约之最。因此,保险缺席只是健康难题的一个部分。

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