陳馮富珍總幹事在世界衛生峯會上的主旨講話
Keynote Address at the World Health Summit
在世界衛生峯會上的主旨講話
Dr Margaret Chan, Director-General of the World Health Organization
世界衛生組織總幹事 陳馮富珍博士
Berlin, Germany
德國 柏林
11 October 2015
2015年10月11日
Excellencies, honourable ministers, distinguished participants, ladies and gentlemen,
諸位閣下，各位尊敬的部長，尊敬的與會者，女士們、先生們：
The world has changed dramatically since the start of this century, when the Millennium Development Goals became the focus of international efforts to reduce human misery.
本世紀初，千年發展目標成爲減少人類苦難的國際努力的焦點。自那之後，全世界已經發生巨大變化。
At that time, human misery was thought to have a discrete set of principal causes, like poverty, hunger, poor water and sanitation, several infectious diseases, and lack of essential care during pregnancy, childbirth, and childhood.
當時，人們認爲，人類苦難有一系列不相關聯的主要原因，例如貧困、飢餓、缺乏飲用水和衛生設施、多種傳染病以及在妊娠、分娩和兒童期缺乏基本診療服務。
The results of that focus, and all the energy, resources, and innovations it unleashed, exceeded the wildest dreams of many. It demonstrated the power of international solidarity and brought out the best in human nature.
當時的關注及其帶來的所有能源、資源和創新所產生的結果已經超出許多人最狂野的想象。它顯示了國際團結的力量和人性最美好的一面。
Maternal and child mortality fell at the fastest rate in history, with some of the sharpest drops recorded in sub-Saharan Africa. Each day, 17,000 fewer children die than in 1990. AIDS reached a tipping point in 2014 when the number of people newly receiving antiretroviral therapy surpassed the number of new infections.
孕產婦和兒童死亡率以歷史上最快的速度下降，其中一些最大降幅出現在撒哈拉以南非洲。與1990年相比，兒童死亡人數每天減少1.7萬名。2014年，艾滋病達到一個轉折點：新接受抗逆轉錄病毒治療的人數超過了新發感染數。
Since the start of the century, an estimated 37 million lives were saved by effective diagnosis and treatment of tuberculosis. Over the same period, deaths from malaria declined by 60%. An estimated 6.2 million lives, mainly in young African children, were saved.
據估計，自本世紀初以來，有效診斷並治療結核病已經挽救了3700萬人的生命。同時，瘧疾死亡降低了60%，約620萬人獲救，其中主要是非洲幼童。
Drug donations by the pharmaceutical industry allowed WHO to reach more than 800 million people each year with preventive therapy for river blindness, lymphatic filariasis, schistosomiasis, and other neglected topical diseases. These are ancient, debilitating diseases that anchor more than a billion people in poverty. By reaching so many millions, we are paving the way for a mass exodus from poverty.
製藥企業捐贈的藥品使世衛組織能夠每年爲8億多人提供針對河盲症、淋巴絲蟲病、血吸蟲病和其它被忽視熱帶病的預防性治療。這些令人衰弱的古老疾病主要影響10億貧困人口。通過爲上億人提供藥物，我們正在爲大量人口擺脫貧困鋪平道路。
I would like to thank the German government, Chancellor Merkel, and other G7 leaders for putting these diseases on the global agenda. If we believe in poverty reduction, we must address these neglected diseases. I also thank the private sector for providing preventive medicines at no cost. This is how public-private partnerships work at their best.
我要感謝德國政府、默克爾總理和其它七國集團領導人將這些疾病納入全球議程。如果我們相信減貧，我們就必須處理這些被忽視的疾病。我還要感謝私營部門免費提供預防用藥。這正是最有利於公私夥伴關係發揮作用的方式。
Last month, the United Nations General Assembly finalized a new agenda for sustainable development. The number of goals has grown from 8 to 17, including one for health. The related targets increased 8-fold, from 21 to 169.
上個月，聯合國大會確定了可持續發展新議程。目標數量從8個增加到17個，其中包括一個衛生目標。相關具體目標增加七倍，從21個到169個。
The factors that now govern the well-being of the human condition, and the planet that sustains it, are no longer so discrete. The new agenda will try to shape a very different world.
現在，決定人類福祉和星球狀況的因素再也不是不相關聯。新議程將努力塑造一個非常不同的世界。
This is a world that is seeing not the best in human nature, but the worst: international terrorism, senseless mass shootings, bombings in markets and places of worship, ancient and priceless archaeological sites reduced to rubble, and the seemingly endless armed conflicts that have contributed to the worst refugee crisis since the end of the second World War.
在這個世界上，我們看到的不是人性中最美好的一面，而是最糟糕的：國際恐怖主義、毫無人性的大規模槍擊事件、集貿市場和禮拜場所的爆炸、古老而珍貴的考古遺址淪爲瓦礫堆以及已經造成二戰結束以來最嚴重難民危機的似乎永無終止的武裝衝突。
Ladies and gentlemen,
女士們、先生們，
Since the start of this century, newer threats to health have gained prominence. Like the other problems that cloud humanity’s prospects for a sustainable future, these newer threats to health are much bigger and more complex than the problems that dominated the health agenda 15 years ago.
自本世紀初以來，新的衛生威脅愈發突出。和其它爲人類可持續未來前景罩上陰影的問題一樣，衛生面臨的這些更新的威脅比15年前主導衛生議程的那些問題更大也更復雜。
All around the world, health is being shaped by the same powerful forces, like population ageing, rapid urbanization, and the globalized marketing of unhealthy products.
在全世界，衛生都受到同樣強大力量的影響，包括人口老齡化、快速城市化和不健康產品的全球營銷。
Under the pressure of these forces, chronic noncommunicable diseases have overtaken infectious diseases as the world’s biggest killers. This shift in the disease burden has profound implications. It challenges the very way socioeconomic progress is defined.
在這些力量的壓力下，慢性非傳染性疾病已經超過傳染病成爲全世界第一大死因。疾病負擔方面的這一變化具有深遠影響。它直接挑戰人類對於社會經濟進步的定義。
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.
自19世紀以來，衛生和生活條件的改善使人類健康狀況大幅度改善，預期壽命大幅度延長。這些環境方面的改善有助於控制傳染病，使許多主要死因從現代社會消失。
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.
今天，形勢發生了逆轉。疾病沒有隨着生活條件改善而消失，相反，社會經濟進步正在創造助長非傳染性疾病增加的條件。經濟增長、現代化和城市化爲不健康生活方式的傳播大開其門。
The world is ill-prepared to cope with NCDs. Few health systems were built to manage chronic if not life-long conditions. Even fewer doctors were trained to prevent them. And even fewer governments can afford to treat them.
全世界都沒有做好應對非傳染性疾病的準備。沒有哪些國家的衛生系統是爲了管理慢性乃至終身疾病而建立起來的。受過預防慢性病培訓的醫生數量更少。能夠負擔得起慢性病治療的政府數量還要少。
In some countries, the costs of treating diabetes alone absorb from 25% to 50% of the entire health budget. As a recent Lancet Oncology Commission concluded, the costs of cancer therapy are becoming unaffordable, even for the wealthiest countries in the world. Many newly approved cancer drugs cost more than $120,000 per person per year.
在一些國家，單是治療糖尿病的支出就佔去整個衛生預算的25%至50%。正如最近《柳葉刀》腫瘤學委員會得出的結論，癌症治療的費用將超出各國負擔能力，即使世界上最富裕的國家也是如此。許多新批准的抗癌藥費用超過每人每年12萬美元。
The climate is changing. WHO’s recent estimate that air pollution kills around 7 million people each year has finally given health a place in debates about the consequences of climate change. Worldwide, this past July was the hottest since at least 1880, when records began. This year’s thousands of deaths associated with heat waves in India and Pakistan provide further headline evidence of the health effects of extreme weather events.
氣候正在發生變化。世衛組織最近估計，空氣污染每年造成約700萬人死亡。這終於使衛生問題在有關氣候變化後果的辯論中獲得一席之地。剛過去的七月是自1880年有記錄以來最熱的。今年有數千人在印度和巴基斯坦熱浪中死亡，消息佔據了頭條，也是極端天氣事件造成健康影響的進一步證據。
Antimicrobial resistance has become a major health and medical crisis. If current trends continue, this will mean the end of modern medicine as we know it. WHO warmly welcomes the G7 health ministers declaration and the commitment it makes to address this crisis in all its multiple dimensions.
抗微生物藥物耐藥性也已成爲主要衛生和醫藥危機。如果目前的趨勢繼續下去，這將意味着我們所知的現代醫藥的終結。世衛組織熱情歡迎七國集團衛生部長做出的有關全面應對此危機的宣言和承諾。
No one working in public health should underestimate the challenges that lie ahead. These newer threats to health do not neatly fit the biomedical model that has historically guided public health responses. Their root causes lie outside the traditional domain of public health.
公共衛生領域的每一個人都不應低估未來的挑戰。衛生面臨的這些更新威脅不能完全適用歷史上一直指導着公共衛生應對工作的生物醫藥模式。其根源在公共衛生傳統領域之外。
The health sector acting alone cannot protect children from the marketing of unhealthy foods and beverages, persuade countries to reduce their greenhouse gas emissions, or get industrialized food producers to reduce their massive use of antibiotics.
衛生部門單打獨鬥不能保護兒童不受不健康食品飲料營銷的影響，不能說服各國減少溫室氣體排放，也不能讓工業化食品生產商減少抗生素的大規模使用。
The newer threats to health also lie beyond the traditional domain of sovereign nations accustomed to governing what happens in their territories. In a world of radically increased interdependence, all are transboundary threats.
衛生面臨的更新威脅也在習慣於在本國領土範圍內進行治理的主權國家的傳統領域之外。在一個相互依存急劇上升的世界，所有威脅都是跨國威脅。
The globalized marketing of unhealthy products respects no borders. By definition, a changing climate affects the entire planet.
不健康產品的全球化營銷不受邊界限制。根據定義，正在變化的氣候也影響整個星球。
As sharply illustrated by malaria, tuberculosis, and bacteria carrying the NDM-1 enzyme, drug-resistant pathogens are notorious globe-trotters. They travel well in infected air passengers and through global trade in food. In addition, the growth of medical tourism has accelerated the international spread of hospital-acquired infections that are frequently resistant to multiple drugs.
正如瘧疾、結核病和攜帶Ⅰ型新德里金屬β-內酰胺酶（NDM-1）的細菌所突出表明的那樣，耐藥病原體是惡名昭彰的全球旅行者。它們在被感染航空乘客體內並通過全球食品貿易旅行。此外，醫療旅遊的增長也加快了醫院獲得性感染的國際傳播，而這類感染往往對多種藥物耐藥。
We face other challenges. The poverty map has changed. Today, 70% of the world’s poor live in middle-income countries. This is a game-changing statistic. Growth in GDP has long been the yardstick for measuring national progress.
我們還面臨其它挑戰。貧困地圖已然發生變化。今天，全世界70%貧困人口生活在中等收入國家。這一統計數據改變了遊戲規則。國民生產總值（GDP）的增長長期以來一直是衡量國家進步的標準。
If the economy is doing well, where is the incentive to invest in equitable health care? The world does not need any more rich countries full of poor people.
如果經濟狀況很好，投資於公平衛生保健的動力何在？全世界再也不需要任何滿是貧困人口的富裕國家。
Our world is profoundly interconnected and this, too, has consequences. The refugee crisis in Europe shattered the notion that wars in faraway lands will stay remote. The Ebola outbreak shattered the notion that a disease of poor African nations will have no consequences elsewhere.
我們的世界深刻地相互關聯，而這，也有其後果。歐洲的難民危機打碎了遙遠之地的戰爭將永遠遙遠的觀念。埃博拉疫情打碎了某個貧困非洲國家的疾病不會對其它地方產生後果的觀念。
Ladies and gentlemen,
女士們、先生們，
In the most dramatic and tragic way possible, the Ebola outbreak focused international attention on the need to invest in health systems, especially in fragile and vulnerable states.
埃博拉疫情以最具戲劇性和悲劇性的方式使國際社會注意到需要投資於衛生系統，特別是在脆弱和弱勢國家。
WHO welcomes the G7 commitment to act on lessons learned from Ebola. I welcome, in particular, the emphasis it places on strengthening health systems as a first line of defence against the infectious disease threat.
世衛組織歡迎七國集團有關在埃博拉疫情教訓基礎上採取行動的承諾。特別是，我歡迎七國集團強調加強衛生系統使之成爲針對傳染病威脅的第一道防線。
As noted, the goal is to build resilient and sustainable health systems that offer quality, comprehensive care and aim to progressively achieve universal health coverage.
如前所述，目標是建設有恢復力的可持續衛生系統，提供高質量的全面診療服務並逐步實現全民健康覆蓋。
The attention given to health systems is a most welcome focus that was not present when the Millennium Development Goals were agreed 15 years ago.
對衛生系統的關注最令人高興，這種關注在15年前商定千年發展目標時並不存在。
The global health initiatives that brought such spectacular results did so largely through the delivery of commodities, like bednets, vaccines, and cocktails of medicine. Confronted with weak health systems, the initiatives often built their own parallel systems for procurement, delivery, financial management, and reporting.
在很大程度上，各項全球衛生倡議能夠帶來如此令人驚歎的結果是因爲它們提供了商品，例如蚊帳、疫苗和藥物雞尾酒。面對薄弱的衛生系統，這些倡議常常建立起自己的採購、供貨、財務管理和報告系統。
Fortunately, many development partners now recognize that virtually all health targets on the new development agenda need a well-functioning and inclusive health system to achieve sustainable results.
幸運的是，許多發展夥伴現在已經認識到新發展議程上幾乎所有具體衛生目標都需要具有包容性且運轉良好的衛生系統才能實現可持續的結果。
Last month, 267 prominent economists from 44 countries published a declaration in the Lancet. That declaration called on global leaders to prioritize a pro-poor pathway to universal health coverage as an essential pillar of sustainable development.
上個月，來自44個國家的267位傑出經濟學家在《柳葉刀》上發表宣言，呼籲全球領導者將以有利於窮人的方式實現全民健康覆蓋並使之成爲可持續發展的必要支柱確定爲重點。
The economic arguments for doing so are compelling. UHC transforms livelihoods as well as lives, and works as a poverty-reduction strategy. The economic benefits of investing in UHC are estimated to be more than ten times greater than the costs.
這樣做的經濟理由是有說服力的。全民健康覆蓋會改變民生和生命，並且有助於減貧。投資於全民健康覆蓋的經濟效益預計將十餘倍於其成本。
The evidence is now overwhelming that providing quality health services free at the point of delivery helps end poverty, boosts growth, and saves lives. UHC cushions shocks on communities when crises occur, whether these arise from a changing climate or a runaway virus.
有關在服務提供點免費提供高質量衛生服務有助於終結貧困、促進增長並挽救生命的證據令人信服。危機發生時，全民健康覆蓋可以緩衝社區面臨的衝擊，不論危機來自氣候變化還是病毒失控。
Under normal conditions, UHC builds cohesive and stable societies and underpins economic productivity. These are valued assets for every country in the world.
正常情況下，全民健康覆蓋使社會更有凝聚力、更穩定，且支撐經濟生產率。這是世界上所有國家的寶貴資產。
Thank you.
謝謝大家。
