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）

Ladies and gentlemen,

女士们，先生们，

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.

世界正在进入2015年后时代，它所面临的卫生挑战的复杂性，要远远超出本世纪初。

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.

富国与发展中国家在卫生困扰上的明显差异正在消失。所有地方的卫生工作都受到同样的普遍压力：不健康产品的全球化推销、人口老龄化和迅速的城市化。

Our very definition of what constitutes socioeconomic progress is being challenged.

我们关于社会经济进步为何的定义本身正在受到挑战。

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.

从十九世纪开始，伴随卫生和生活条件的改善，是健康状况和预期寿命的巨大改善。这些环境改善帮助控制了传染病，在现代社会彻底消灭了许多主要的致命疾病。

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，形势急转直下。疾病没有随生活条件的改善而消失，社会经济进步实际上正在造成有利于非传染性疾病出现的条件。经济增长、现代化和城市化为不健康生活方式的蔓延敞开了大门。

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.

除过传染病致死这一古已有之的负担，新增了非传染性疾病造成甚至更多死亡的负担。迅速和无计划的城市化加重了第三个负担：道路交通事故和精神疾病、物质滥用以及城市贫穷环境中迅速滋生的暴力行为造成的死亡。

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?

非传染性疾病的加剧导致卫生保健成本大增。例如，甚至对世界上最富有的国家而言，癌症护理的费用也正在令人不堪重负。2012年，美国食品和药物管理局为各种癌症适应症批准了12种药物。在这12种药物中，有11种 的价格超过每个病人每年10万美元。有多少国家能够负担得起这笔费用？

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.

迄今为止，预防是更好的选择，但相对于预防传染病，它也问题多多，许多传染病是疫苗接种可以预防或药物可以治愈的，而且它们均由卫生部门提供。

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.

非传染性疾病的根源在于非卫生部门。它们不在卫生部门的直接权限范围之内。当卫生政策与贸易或金融等部门的经济利益不一致时，几乎每次都是经济利益践踏健康方面的考虑。

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.

执行《世卫组织烟草控制框架公约》是一个明显的例外。它提供了跨部门合作的最佳范例之一，关于烟草适用的健康成本和经济成本的压倒性证据激励了这一合作。

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.

它告诉我们，卫生部门与其它部门携手努力，可以产生巨大效益。它甚至可以在多条战线，包括通过财政和监管措施，对付一个有权有势、阴险狡猾和危险的行业。

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年后时代的另一个挑战是，随着耐药性的发展，世界每一地区的卫生和医疗专业人员正在失去他们的一线抗菌素。在若干情况下，二线药品也失灵了。在一些耐多药结核病和淋病案例中，甚至作为最后手段的抗生素也失灵了。

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.

由于正在开发的替代产品很少，世界正在走向后抗生素时代。在这个时代中，普通的传染病将再次戕害生命。同气候变化一样，后抗生素时代也将改变游戏规则。但抗菌素耐药性将先于气候变化，将我们致于死地。

Ladies and gentlemen,

女士们，先生们，

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.

我开头讲的是新加坡为实现和维持全民覆盖所采用的战略。让我以一个迥然不同的国家采用的战略作为结束：孟加拉国。

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.

孟加拉国的故事驳斥了人们长期以来的假设，即国家必须首先减贫，则健康自然就会有所增进。孟加拉国决定颠倒这个次序，先让民众免遭健康不良带来的苦难。

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.

在实现公平的承诺的推动下，该国的目标是利用一整套影响力巨大的干预措施，对其为数众多的非常贫穷的人口实现全民覆盖。为弥补医生护士的严重短缺，该国培训了一大批采取上门交付方式的社区保健人员，主要是女性，并对其进行密切监督。

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.

该国还利用其世界水平的研究能力进行创新实验。与非政府组织作出正式的合同安排，这些组织最有可能赢得社区信任，抵达边缘人群。入学率的提高，特别是农村女孩入学率的提高，给健康带来巨大的好处。

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

另一种现实也是驱动孟加拉国努力的因素。在贫困地区，当政府的卫生服务鞭长莫及时，私人供应商和出售药品的商店就会蜂拥而起。这些不受管控且基本上无资质的医疗保健提供者对服务的收费，加剧而不是减少了贫穷。为防止这种情况发生，政府建立并管理了近1.2万个位于战略位置的社区医务所。

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.

或许最重要的是对妇女和女孩的强大战略倾斜。所采用的方法明确承认，能力增强后的妇女将使健康成为一项国家建设战略。

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

她们的需要，包括对性健康和生殖健康服务的需要被摆在了首要位置。她们的人权得到了法律保护。伴随这一方针，女孩的死亡率大大高于男孩的现象得到了显著扭转。

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.

正如我们从充足的证据中所了解，投资于卫生，就是投资于经济增长，投资于人民的健康和福祉。每个国家要维持发展，都需要健康的人力资源。没有这一能力，甚至很难开始谈论可持续发展。

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.

新加坡的经验和我们听到的所有其它经验，都传递了一个令人信服的信息。任何国家，只要真正希望实现全民健康覆盖，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宝贵的商品之一。但它是高度政治性的，而且还要投入资金。需要政治领导。需要承诺。需要与公众对话，就像新加坡所做的那样。感谢大家使我有机会参加这次讨论。

Thank you.

谢谢大家。