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仅有事实还不够

仅有事实还不够



我们翻译这篇文章的理由


当我们身处事件之中,对事实的捕捉和对线索的把握可以让我们还原该事件的全貌。但是只看单一的事件可能会导致扁平化的理解,甚至迷失在细节之中。如果可以跳出事实之外,以一种更宏观的视角进行观察,将能触发更多层次的思考,重塑我们的观念,为与人类生活的明天相关的讨论赋予更多价值和意义。

——劼怡


👇


仅有事实还不够


作者:Richard Horton

译者:不   锁

校对:王雅婧

推荐:邬璐雪

策划:王雅婧、劼  怡


Facts are not enough

仅有事实还不够


We are in the midst of a struggle. A struggle for the soul of global health. On one side, the intelligent idealists. Those who sincerely believe that by describing the world in ever more refined and precise ways we will advance closer to an elusive truth. A truth that will unlock the extraordinary potential that is global health. The Global Burden of Disease is the divine apotheosis of intelligent idealists. And universal health coverage their Garden of Eden. 

我们正身处一场斗争,一场关乎全球健康的内涵的斗争。斗争的一方是聪明的理想主义者,他们真诚地相信通过以一种更精妙、准确的方式描述所身处的世界,我们就能离那遥不可及的真相更近一步,释放全球健康的巨大潜力。全球疾病负担(Global Burden of Disease)研究是他们眼里的“神”,全民健康保险则是他们的伊甸园。

译注:
全球疾病负担研究是一个综合区域性和全球性的疾病负担研究,内容包括死亡率和预期寿命的全球趋势、死因及伤残的全球趋势、导致过早死亡和伤残的危险因素的全球趋势、人口和生育率的全球趋势、实现与健康相关可持续发展目标的进展和挑战等诸多子项。

On the other side of this struggle, the innocent cynics. Those who anticipate the worst, cast scorn on the idealism of their rivals, and are contemptuous of the complacency of much of global health today. The innocent cynics are convinced that people must change their lives utterly. They are moral preachers who live by moral example. They long for a life more attuned to the natural systems of the world. As advocates and activists, intelligent idealists see disease, disability, and risk as a trinity of danger to be controlled and defeated. Innocent cynics, by contrast, see their task as reimagining the meaning of health. Removing the idea of health from the clinic and resituating it in society, in Nature. 

斗争的另一方是天真的犬儒主义者。他们做着最坏的打算,嘲笑对立阵营的理想主义,蔑视人们对当前全球健康现状的沾沾自喜。他们深信人们必须彻底改变现在的生活方式。作为仰赖道德榜样生活的道德传教士,他们也渴望与世界的自然秩序更为和谐的生活。聪明的理想主义者既是提倡者也是践行者,他们视疾病、残疾和风险为三位一体的恶魔,是亟需人类控制和攻克的危险。而天真的犬儒主义者则把重塑健康的定义视为己命——从医疗机构手中重夺关于健康的话语权,将其重置于社会和自然的语境内。


It’s unclear who will win this struggle. But, make no mistake, it is a struggle whose resolution—and reconciliation—will define the trajectory for the survival of our species.

虽然结局还未明朗,但可以肯定的是,无论最后花落谁家(或双方和解),这场争斗的走向都会决定人类物种的生存轨迹。


In resolving this struggle, we must ask questions usually considered outside the scope of international health. A Public Health Emergency of International Concern gives us a unique opportunity. 

在此过程中,我们必须对看似与全球健康无关的问题发问。一场国际公共卫生紧急事件(Public Health Emergency of International Concern)为我们提供了一个很好的切入点。


First, what are the supreme guiding values of global health? Hitherto, the answer has been equity. But, as we have seen from China’s efforts to contain COVID-19, perhaps we should consider liberty an equally fundamental value. Without liberty of expression—for health workers, policy makers, the public, and media—there is no means to forge a common view about the future (including the future health) of a society. 

首先,全球健康至高的指导价值是什么?迄今为止,答案一直是“公平”。但是,中国控制COVID-19的努力已经启示我们,或许应予以“自由”同样的地位。对于卫生工作者、政策制定者、公众和媒体而言,没有言论自由,就无法对社会的未来(包括未来健康)形成共识。


Second, how important is the political system for health? Global health is typically agnostic about the kind of political system a country chooses to adopt. Global health and its institutions see health systems as separate—technically, socially, economically—from the political ideologies of nations. This view is not sustainable. We cannot say that the terms of political engagement within a country are irrelevant to our hopes for health. 

第二,政治制度对健康有多重要?全球健康通常不关心一个国家的政治制度。无论是技术、社会还是经济层面,全球健康及其机构都视卫生系统是与国家政治意识形态全然独立的存在。这一观点不会永远成立,我们无法断言一个国家内部的政治参与条件与我们对健康的期许毫不相关。


Third, what is prosperity? Conventionally, prosperity means monetary wealth. But could we redefine prosperity to mean something else, something more? Prosperity as the wellbeing of the community in synchrony with its environment. 

第三,什么是繁荣?传统意义上,繁荣只意味着金钱上的富足。但,我们可以赋予繁荣更多内涵,将其定义为人类与环境和谐共荣的福祉。


Fourth, how should we consider the place of the human body in society? How do we better connect the social to the biological? How do we incorporate the world in which we live into our biological selves? Our bodies and the illnesses they express tell stories about our lives. Our task is to uncover those stories and to link them back to our bodies and our health. 

第四,我们应该如何看待人的身体在社会中的位置?如何将我们的社会性与生物性更好地关联起来?又该如何将我们所身处的世界融入生物意义上的自我?我们的身体与疾病记载了我们的生活,而我们的任务就是发现这些故事背后的意义,进而帮助我们理解躯体和健康的关系。


Fifth, what do we mean by health anyway? Whatever we say about the absence of disease or a state of complete wellbeing, the idea of health is also related to our sense of what our lives have been and what they might be in the future. Isn’t health contingent on the purpose we envision for our life, and the possibilities we have for enacting that purpose? In other words, isn’t health also about our capacity to achieve meaning in our lives?

第五,论及健康我们究竟在意指什么?除了谈论“没有疾病”或“身心状况良好”之外,健康的概念还与我们对一直以来的生活状态,以及未来会怎样的感受有关。难道健康不是取决于我们对于生活目标的构想吗?难道健康不是取决于这些目标实现的可能性吗?换言之,难道健康不也与我们实现人生意义的能力有关吗?


The next 30 years will bring dramatic changes to the conditions for health. In the Anthropocene, increasingly dysfunctional Earth systems—land, water, climate. A broken food system that is driving a double burden of malnutrition. Progressive erosion of health from predatory commercial practices. Population shifts—extraordinary increases and declines, urbanisation, and accelerating migration. Gathering recognition of the intersection between an array of inequalities— from gender to class, ethnicity to education, mental to physical health. An appreciation of the linkages between animal and human health. And a new word: infodemics. Epidemics of misinformation that limit, inhibit, and retard responses to health threats. These forces are among the complex coordinates that frame the struggle between intelligent idealists and innocent cynics. 

未来三十年将会见证人类健康状况翻天覆地的变化。在人类世(Anthropocene),土—水生态系统和气候日益失调。食物系统的崩溃为营养不良新添另一重负担。侵略性商业活动使我们的健康每况愈下。人口异常增减、城市化和加速移民导致人口结构急剧变化。从性别到阶层,从种族到教育,从心理健康到生理健康,种种不平等的交汇逐步成为认知上的共识。动物和人类健康之间的联系得到审视。“信息瘟疫”(infodemics)走入人们视线,虚假消息的泛滥,限制、延迟了我们对健康威胁的及时回应。这些错综复杂的力量,正是促成聪明的理想主义者和天真的犬儒主义者争斗的原因之一。

译注:人类世,又称人新世,是一个尚未被正式认可的地质概念,用以描述地球最晚近的地质年代。

If we are to protect the gains we have made, we will have to look at health and the meaning of health from a different perspective. The courage to make that radical positional shift is our greatest challenge of all.

如果我们要保护人类已有的成果,我们就必须从一个全新视角看待健康及健康的含义。我们所面对的最大挑战是敢于彻底改变立场。

 

👇


参考阅读:


健康上巨大的差异并不单单是一个贫富差距的问题。仅仅是贫穷并不足以导致疾病,但不平等却会。的确,诸如自杀、心脏病、肺病、肥胖和糖尿病这类问题,都是与社会弱势紧密相关。在任何国家,处于社会弱势的人们都遭受着健康弱势和相对短的寿命。在国家内,个人的社会地位越高,他们越健康。
这种健康上的不平等无法用一般的理论来解释。改善健康的传统方法始终强调技术手段和个体行为的变化,但这些方法只能进行到此已止步不前。真正能起作用的是为人们创造环境和条件,使他们能掌控自己的生活,有按自己意愿生活的权力。

《健康鸿沟》简介
https://book.douban.com/subject/30401701
本书收录了桑塔格两篇重要论文“作为隐喻的疾病”及“爱滋病及其隐喻”,在文章中桑塔格反思并批判了诸如结核病、爱滋病、癌症等如何在社会的演绎中一步步隐喻化,从“仅仅是身体的一种病”转换成了一种道德批判,并进而转换成一种政治压迫的过程。

《疾病的隐喻》,苏珊·桑塔格
https://book.douban.com/subject/1064734/






仅有事实还不够

  • 本文原载于 The Lancet

  • 原文链接:https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30405-0/fulltext



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