Covid-19 turned us into health-obsessed societies. That needn’t be all bad


It’s time to emphasise prevention over cure. We’re currently scrimping on parks and pools to spend more on diabetes. 6park.com
预防胜于治疗。在公园和游泳池上省钱、却得在糖尿病治疗上花更多钱的做法将越来越行不通。“后疫情大政府”时代将成为新常态。



Three years ago this week, it sank in that this coronavirus thing was serious. I’d just attended a conference in London that, with hindsight, may have been a superspreader event. Hospitals were filling up. Several million deaths from the virus were — correctly — being predicted. Every plan you’d made was being cancelled. On March 11 2020, the World Health Organization declared Covid-19 a pandemic. Many of us spent the next two months indoors. 6park.com
三年前的这一周，人们开始意识到新冠这个东西确实很严重。我当时刚刚在伦敦参加了一场会议，事后看来，那场会议可能是个“超级传播事件”。医院开始拥挤。有人预测会有数百万人死于这种病毒——确实如此。我们的所有计划全部被取消。2020年3月11日，世界卫生组织(WHO)宣布新冠为大流行病(pandemic)。接下来的两个月，我们中的很多人都没有出门。 6park.com
   
That spring transported us into a new era that will probably last our lifetimes. It’s an era in which the top priority of rich countries is not consumption or climate or defence but health. Leaving aside the virus, our societies are the oldest in history, and getting older. Overwhelmed health services may never return to the barely manageable levels of demand of 2019. The past three years offer an early glimpse of the health-focused society. 6park.com
那个春天把我们带入了一个新时代，我们有生之年可能都会处在这个时代之中。在这个时代，富裕国家的首要任务不是消费、气候或国防，而是健康。即便没有这个病毒，我们的社会本身就是历史上最老龄化的社会，而且老龄化程度还在加深。不堪重负的医疗卫生服务可能永远无法恢复到2019年那种勉强可满足需求的水平。过去三年让我们初步瞥见了这个聚焦健康的社会会是什么样子。 6park.com
   
Longer lives are modernity’s best achievement, but also the priciest. More older people means more healthcare, more long-term care and more pensions. Democracies will spend that money, pushed by the ever-growing “grey vote”. That means the post-Covid big-state era will be the new normal. Then add on the costs inflicted by climate change. (We’ll scrimp on preventing it.) 6park.com
更长的寿命是现代性的最大成就，但也是最昂贵的成就。老年人增多意味着更多的医疗和长期护理需求，以及需要更多的养老金。在老年人选民群体不断壮大的推动下，民主国家会花这笔钱。这意味着“后疫情大政府”时代将成为新常态。然后还有气候变化造成的成本。（我们会在抗击气候变化上尽量省钱。） 6park.com
   
The first rule of this new era: less consumption. The traditional American presumption “that each generation will live better than its parents” is already being buried, an artefact of the growth years of 1946-2007. 6park.com
这个新时代的第一条规则是：减少消费。美国人一向秉持的“每一代都会比上一代生活得更好”的信念已经被粉碎——这本来就是1946年至2007年的经济增长时期营造的假象。 6park.com
   
Health and social care, which even in 2019 accounted for one in 10 jobs in rich countries, will become the go-to recruiters for anyone made redundant by artificial intelligence. That could help keep a long-term lid on unemployment. Rich countries will train more doctors and nurses, but as young people grow scarce, we will also keep importing immigrants. Immigration-obsessed politics is becoming a relic of the September 2001-February 2020 era (bar the UK government’s preoccupation with small boats). 6park.com
即使在2019年，医疗卫生和社会护理工作也占到了富裕国家十分之一的就业，这一领域将为被人工智能淘汰的失业者提供最多的再就业机会。这可能有助于在较长时间内抑制失业。富裕国家将培训更多的医生和护士，但随着年轻人越来越稀缺，我们也将继续引进移民。在2001年9月至2020年2月那个时代，移民问题是一个政治热点，之后这个问题将越来越不重要（除了英国政府还持续关注载着难民的小船）。 6park.com
   
But the most important factor in keeping people healthy isn’t healthcare. “Restricted access to medical care accounts for about 10 per cent of premature death,” concluded scholars Robert Kaplan and Arnold Milstein in their review of existing research. Diet, smoking and exercise matter more. The extreme case is the US: it outspends everyone else on healthcare, yet Americans now live seven years less than Spaniards. 6park.com
但保持人们健康最重要的因素并不是医疗卫生服务。学者罗伯特•卡普兰(Robert Kaplan)和阿诺德•米尔斯坦(Arnold Milstein)在对现有研究的综述中总结道：“在过早死亡中，约10%的原因是获取医疗服务受限。”饮食、吸烟和锻炼是更重要的影响因素。美国是一个极端的例子：美国在医疗卫生上的支出超过其他所有国家，但美国人现在的预期寿命比西班牙人短7年。 6park.com
   
So the health-focused society must emphasise prevention over cure. That means attacking obesity (and McDonald’s) the way we previously attacked smoking (and Philip Morris). For instance, only 13 per cent of British adults now smoke, following decades of decline, but obesity in England has jumped to 26 per cent. The NHS today spends about one-tenth of its budget on diabetes. 6park.com
因此，注重健康的社会必须强调预防而不是治疗。这意味着我们要像以前反对吸烟和烟草公司菲利普莫里斯(Philip Morris)那样反对肥胖和麦当劳(McDonald’s)。例如，在经历了几十年的下降之后，如今英国成年人的吸烟率仅为13%，但英格兰的肥胖率已跃升至26%。如今，英国国家医疗服务体系(NHS)约十分之一的预算用于治疗糖尿病。 6park.com
   
Better to stop people getting type 2 diabetes in the first place. How? In 2020, Dutch academics analysed 51 interventions that aimed to improve public health. They found that the biggest boost came from a tax on junk food, while the most cost-effective policy was “restriction on television commercials with high sugar/high-fat foods and beverages for children”. True, a tax on junk food would hit poorer people, who eat more of it, but we could support them with other payments or tax exemptions. And their health would benefit most. You can deride this as “the nanny state”, but it’s generally the state that has to pay for obesity. 6park.com
最好从一开始就防止人们患上2型糖尿病。怎么做？2020年，荷兰学者分析了51项旨在改善公共健康的干预措施。他们发现，对垃圾食品征税是最大的促进健康因素，而最具成本效益的政策是“限制高糖/高脂肪儿童食品和饮料的电视广告”。没错，对垃圾食品征税会打击吃垃圾食品更多的穷人，但我们可以通过其他补偿或免税来支持他们。而他们在健康方面的获益将最大。你可以嘲笑这是“保姆国家”，但通常是国家为肥胖买单。 6park.com
   
We can also overhaul work to improve workers’ physical and mental health. The four-day week seems to achieve that without hurting business, and also leaves people more time to care for elderly parents. After a big recent British trial, 92 per cent of participating companies decided to stick with four days. 6park.com
我们还可以改革工作制度，来改善劳动者的身心健康。四天工作周似乎在不影响企业经营的情况下实现了这一点，还让人们有更多时间照顾年迈的父母。在英国最近的一次大型试验之后，92%的参与公司决定坚持四天工作制。 6park.com
   
We can remodel cities to favour exercise. A walkable city like Barcelona makes you healthier, whereas car-dominated Dallas makes you sick. One in 10 premature deaths worldwide could be prevented if everyone did just 11 minutes of brisk walking a day, found a University of Cambridge-led review of academic papers covering more than 30 million participants. 6park.com
我们可以改造城市，使之有利于人们锻炼。像巴塞罗那这样适合步行的城市会让你更健康，而以汽车出行为主的达拉斯则会让你生病。剑桥大学(University of Cambridge)领导的一项对覆盖3000多万参与者的学术论文的综述发现，如果每个人每天都能拿出短短11分钟快走，全世界有十分之一的过早死亡可以避免。 6park.com
   
We can put public pools in every neighbourhood, hire more tennis coaches and dance teachers and build Spanish-style adult playgrounds. In Madrid recently, I watched an old lady pushing up weights with her ankles as she sat on a park bench. In my neighbourhood park in Paris, a group of local Chinese geriatrics gather every morning for exercise. All this improves community too. Sure, it costs money. But we’re currently scrimping on parks and pools so as to spend more on diabetes. 6park.com
我们可以在每个社区都建公共游泳池，聘请更多的网球教练和舞蹈老师，建造西班牙式的成人运动场。最近在马德里，我看到一位老太太坐在公园的长椅上用脚踝举重。在巴黎我家附近的公园里，每天早上都会有一群当地的中国老人聚在一起锻炼。所有这些也改善了社区。当然，这要花钱。但我们现在在公园和游泳池上省钱，却得把更多的钱花在治疗糖尿病上。 6park.com
   
The society of early March 2020 is gone for ever. That needn’t be all bad. 6park.com
2020年3月初的社会已经一去不复返了。这并不全是坏事。 6park.com