世卫组织总干事陈冯富珍在全民健康覆盖问题部长级会议上的主旨发言（中英对照）

英文版：Keynote Address at the Ministerial Meeting on Universal Health Coverage.doc 

中文版：世卫组织总干事在全民健康覆盖问题部长级会议上的讲话.doc 

Keynote Address at the Ministerial Meeting on Universal Health Coverage: the Post-2015 Challenge

在全民健康覆盖问题部长级会议上的主旨发言：2015年后的挑战

 

Dr Margaret Chan, Director-General of the World Health Organization

世界卫生组织总干事 陈冯富珍博士

 

Singapore, 10 February 2015

新加坡，2015年2月10日

 

Your Excellency, Prime Minister Lee Hsien Loong, Minister Gan, honourable ministers, distinguished experts, colleagues in public health, ladies and gentlemen,

 

李显龙总理阁下、颜部长阁下、尊贵的各位部长、尊敬的各位专家、公共卫生界的各位同事、女士们、先生们，

 

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.

 

我深表荣幸能在新加坡的这次全民健康覆盖问题部长级会议上发言，这个城市国家以其出色且负担得起的包容性卫生系统而闻名。去年，在彭博社关于卫生保健最具成效的国家的第二次排名中，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.

 

世卫组织也将新加坡排在关键卫生指标的前列，尤其是在孕产妇和婴儿死亡率方面，这两个指标是运转良好的卫生系统的最敏感指标。新加坡通过其高瞻远瞩的规划，实现了一流的卫生保健，卫生成果斐然可观，而费用则低于世界上任何其它高收入国家。

 

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.

 

此一成就是坚实地奠定在这样一种价值体系上，即把公正和包容性视为社会凝聚、稳定与和谐之源。

 

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.

 

研究工作引导具体战略，但公众的意愿也起到引导作用，民意调查和对话确保了卫生系统的变革赢得公众的支持和赞同。

 

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.

 

正如我们刚刚听到的，新加坡的全民健康覆盖模式，平衡了竞争和其它市场力量与需要国家干预来引导这些力量保持正确方向二者之间的好处。它对选择供应商、服务和设施的自由与强制性健康储蓄账户，即医疗储蓄计划作了平衡，后者强调了个人的责任。

 

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.

 

世上没有免费的午餐。该计划有效地防止了医疗的过度消费。为帮助形成负责任的决定，卫生部在其网站上公布了一般疾病的医院账单。

 

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.

 

另一项创新，即终身健康保险，通过风险共担，体现了集体责任的原则。这是一个安全网络。它保护家庭在医疗花费太高的情况下免于倾家荡产。世卫组织的研究表明，每年有1亿到1.5亿人因灾难性的医疗费用跌至贫困线以下。许多政府正在大力帮助民众脱贫，如果卫生系统及其收费实际上是在加剧贫困，则这些努力都将落空。

 

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.”

 

正如新加坡卫生部长今年早些时候所言，该项计划告诉民众，他们“尤其是那些在生命旅途中遭遇意外变故的人，不会独自面对生活中的不稳定性。”

 

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.

 

当然，所有这些创新，并非在任何地方都适用。全民健康覆盖本质上是国家所有。要想行之有效，它必须根据每个国家的文化、国内政治体制、现行卫生系统的遗产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.

 

在实现全民健康覆盖方面，新加坡有一些独特的优势。不存在需要将卫生服务扩展到边远和贫穷农村地区的挑战。新加坡只有一处农村，是一个小岛和旅游胜地。

 

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.

 

跨部门合作的传统使之可以通过环境改善和采取财政和监管措施来鼓励健康的生活方式，从而解决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.

 

几十年来，新加坡还保持了政治稳定，政府的公信力极高。这也是很有帮助的。

 

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.

 

出于这些优势，全民健康覆盖在新加坡不仅仅是提供公平和包容性的卫生保健，并为之筹资。新加坡的全民健康覆盖成为建设一个包容、关爱和进步社会的战略。这些对世界上任何国家都是一笔财富。

 

Ladies and gentlemen,

 

女士们，先生们，

 

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.

 

我们的世界因多种原因而变乱不定。这方面的迹象有目共睹：货币波动、经济动荡、旷日持久的冲突、种族纠纷、不可思议的暴力行为。有组织的恐怖主义活动则是一种最新威胁，它无处不在，难以预料。

 

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.

 

气候变化，抗生素失灵，卫生保健费用扶摇直上。国家之内和国家之间在收入水平、机会和获取社会服务方面的不平等，已经达到了近百年来曾未见过的最严重程度。

 

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.

 

各国正在失去其作为民主制中坚的中产阶级。上个月乐施会关于财富分配问题的报告载有令人震惊的统计数字：仅仅80个有财有势者，其在世界总财富中所占份额，就超过了底层的35亿人。

 

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.

 

许多经济学家感到乐观的是，世界上有若干增长最迅速的经济体在非洲，它们背后往往是外国采掘工业在推波助澜。但注意一下这些国家的国内收入分配，我们不难看到，在这些越来越富裕的国家中，到处都是穷人。

 

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?

 

一个非洲医学博客拿国内生产总值的增长与埃博拉疫情显露的卫生系统的薄弱作出比较。他提出了如下问题：如果墙壁和地基都在坍塌，则在屋顶上描金敷彩，又有什么意义？

 

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.

 

几十年的经验教训告诉我们，这个世界单凭自身，不会成为一个有利健康的公平场所。卫生系统不会自动倾向于更大程度的公平，或自然而然地演化出全民覆盖。

 

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.

 

国家内的经济决策不会自动去保护穷人或增加他们的财富。全球化不会自我调节，确保利益的公平分配。国际贸易协定本身，不会保障粮食安全、就业安全，卫生安全，或获取可负担的医药。

 

All of these outcomes require deliberate policy decisions.

 

所有这些成果都要求作出深思熟虑的政策决定。

 

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.

 

全民健康覆盖是所有政策选项中最有力的一个社会平衡器。它是公正的终极表达。公共卫生如果能对我们这个扰攘不断的、失衡的世界有所帮助，那就在于：越来越多的证据显示，运转良好的包容性卫生系统将促进社会的凝聚、公平和稳定。它们将社会聚拢在一起，帮助缓和了社会紧张局势。

 

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.

 

在如此之多部门的政策实际上正在加剧社会的不平等之时，我很高兴能看到，卫生以对地球上每个人都很重要的方式，引领世界走向更大的公平。