原文:http://mp.weixin.qq.com/s?__biz=MzU1MDQwNTgzMg==&mid=2247491571&idx=1&sn=2c79f7f97f6cb82c109e7344283e8127&chksm=fba04c54ccd7c54289f48d6d99a9ca669a8a371815cac316501040a5cabb52b8dac01801e84e#rd
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导读
感谢思维导图作者
Tracy,女,设计爱好者,推理烧脑粉
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听力|精读|翻译|词组
The forgotten problem
被遗忘的问题
英文部分选自经济学人20200829期Leaders版块
Dementia
痴呆症
The forgotten problem
被遗忘的问题
It requires more research, better provision for long-term care and changes in individual behaviour
这需要进行更多研究、提供长期护理以及改变个体行为
Of all the troubles facing the world, the rising prevalence of dementia might seem among the less pressing. The reason behind it—longer lifespans—is to be cheered; it does not advance at the speed of a viral infection but with the ponderous inevitability of demographic change; and its full effects will not be felt until far into the future. But the reality is very different. As our special report this week makes clear, dementia is already a global emergency. Even now, more people live with it than can be looked after humanely. No cure is in the offing. And no society has devised a sustainable way to provide and pay for the care that people with it will need.
在全世界面临的所有问题中,痴呆症患病率上升这一问题似乎并不那么紧迫。痴呆症背后的原因——更长的寿命——令人津津乐道;它并不会按照病毒感染的速度发展,但却必然随着人口结构的变化会缓慢而沉重地呈现;并且它的全部影响在短期内并不会显现。但现实却截然不同。正如我们本周的特别报告表明,痴呆症已经成为全球性紧急事件。即使是现在,很多病患并不能获得人道照顾。目前也没有治愈方法。而且没有哪个国家能够设计出一种可持续的方式来提供和支付患者所需的护理。
注:In the offing: likely to appear or happen soon 即将发生
“Dementia” is an umbrella term for a range of conditions, with a variety of causes, of which the most common is Alzheimer’s disease, accounting for 60-80% of cases. It usually starts with forgetfulness and a mild loss of cognitive functioning. But as it advances, people lose the ability to look after themselves. Many require round-the-clock care long before they die. It does not just affect the elderly, but they are much more likely to have it—and life expectancy globally has climbed from not much more than 30 a century ago to over 70 now, and over 80 in rich countries. By some estimates, 1.7% of 65- to 69-year-olds have dementia and the risk of developing it doubles every five years after that. At present, about 50m people around the world have the condition, a number expected to rise to 82m by 2030 and 150m by 2050. Most of the new cases are in the developing world, where populations are rising and ageing.
“痴呆症”是一系列病症的总称,其病因多种多样,其中最常见的是阿尔茨海默氏病,占病例的60-80%。它通常从健忘和轻度的认知功能丧失开始。但是随着疾病的恶化,患者会失去照顾自己的能力。许多患者在去世前很长一段时间内需要全天候的护理。该病并不局限于老年人,但是老年人罹患痴呆症的可能性更大,全球的预期寿命已从一个世纪前的刚刚超过30岁上升到现在的70多岁,在富裕国家则超过80岁。据估计,在65岁至69岁的人群中,有1.7%患有痴呆症,此后每年老五岁患痴呆症的风险就会增加一倍。目前,全世界约有5,000万人患有这种疾病,预计这一数字到2030年将上升到8200万,到2050年将上升到1.5亿。大多数新病例都出现在人口递增和老龄化的发展中国家。
The problems these numbers will bring everywhere have already been felt in countries where people are older, and especially acutely during lockdowns—witness the difficulty of looking after people with dementia in their own homes, and the large numbers in overstretched care homes who receive little individual attention. As families shrink, single children and grandchildren will struggle to cope with their old folk. Already, dementia care has had a knock-on effect on general health care. Before the pandemic as many as a quarter of beds in British hospitals were occupied by people with dementia. There was nowhere else for them to go.
这些数字将给全世界带来麻烦,现在已经在老年人占比较多的国家中得到了体现,尤其是在疫情封城期间——人们见证了在家里照顾痴呆症患者的困难,而在超负荷运转的护理中心,大量的老年人个体几乎得不到关注。随着家庭规模的缩小,独生子女和孙辈将难以照顾家里的老人。痴呆症护理已经对一般医疗保健产生了连锁反应。在新冠肺炎病大流行之前,英国医院里多达四分之一的床位被痴呆患者占据。他们无处可去。
注:Knock-on: causing other events to happen one after another in a series产生连锁反应的
Not all the news is bad. Recent research has shown that behaviour such as smoking less, exercising more and losing weight in middle age has reduced the risk of dementia among old people in some Western countries in the past 30 years. And America’s Food and Drug Administration has promised to decide by March 2021 whether to license a drug said to be the first to stem cognitive decline in Alzheimer’s patients. But the risk of dementia still seems to be rising in much of the world and any new therapy in the foreseeable future is likely to benefit only some patients partially.
并非所有的消息都是坏消息。最近的研究表明,在过去30年里,在一些西方国家,诸如少吸烟、多运动和中年减肥等行为降低了老年人患痴呆症的风险。美国食品和药物管理局(FDA)承诺,在2021年3月前决定是否批准一种药物,该药物据说是首个可以阻止阿茨海默症患者认知能力下降的药物。但是在世界上许多地方,痴呆症的风险似乎仍在上升,在可预见的未来,任何新的治疗方法都可能只惠及部分患者。
That is why governments should act now to lessen the social and economic harm from the growing prevalence of dementia. The first step is to recall the urgency with which many were promising to tackle the problem just a few years ago—in 2013, for example, when David Cameron, then Britain’s prime minister, used the rotating chairmanship of the G8 to convene a “dementia summit”, which promised to fund research with the goal of finding a “disease-modifying treatment” by 2025. Instead, funding for work on dementia has lagged far behind that for cancer or coronary heart disease. And as the pandemic hampers or prevents clinical trials and research, and sucks resources away from other areas, dementia risks again being left behind.
这就是为什么政府现在应该采取行动,以减轻痴呆症患病率的上升对社会和经济的危害。第一步是重新唤起几年前许多国家承诺解决这一问题的紧迫性——例如,2013年,时任英国首相戴维·卡梅伦(David Cameron)利用八国集团轮值主席的身份召开了一次“痴呆症峰会”,该峰会承诺为痴呆症研究提供资金,以期在2025年之前找到“改善疾病的疗法”。然而,用于痴呆症的研究经费远远落后于癌症或冠心病。由于新冠肺炎大流行阻碍或阻止临床试验和研究,并消耗了其他领域的资源,痴呆症的研究工作有再次被甩在后边的风险。
Governments also need to think about long-term care for people with dementia. The question that is most often asked is how to pay for it. Japan’s compulsory long-term-care insurance scheme, requiring everyone aged 40-65 to pay a premium, seems attractive, as it avoids penalising the young. But it is not self-financing. The increasing burden there as elsewhere will fall on individuals and the taxpayer.
政府还需要考虑对痴呆症患者进行长期护理。最常被问到的问题是如何支付这一护理费用。日本强制的长期护理保险计划要求所有40-65岁的人支付保险费,这看起来很有吸引力,因为它避免将年轻人陷入不利的处境。但这个计划不是经费自筹。和其他地方一样,日益增加的资金负担将落在个人和纳税人身上。
And an even more fundamental question than who pays for care is: who will do it? Undertaken with humanity and dignity, it is extremely labour-intensive. Technology can help lighten the load—using remote monitoring to let people stay at home and, perhaps in future, robots to perform some basic tasks . But looking after people with dementia requires people. The job is usually classified as low-skilled and is often poorly paid. In fact it demands huge reserves of patience, empathy and kindness. It should be better rewarded and more highly regarded even though that would add to the bill. In countries such as Japan and Britain, with acute shortages of care-workers, immigration will have to be made easier for those willing and able to do it.
比谁来支付医疗费用更根本的一个问题是:谁来提供这一医疗服务?这项高度劳动密集型的工作涉及人道和尊严。科技可以帮助减轻负荷——利用远程监控让人们呆在家里,也许在未来,机器人可以执行一些基本的任务。但是照顾痴呆症患者需要人。这类工作通常被归类为低技术含量和低报酬的工种。事实上,这需要大量的耐心、同理心和仁爱之心。这份工作应该得到更好的奖励和更高的认可,即使这样会增加费用。在像日本和英国这类护理人员严重短缺的国家,必须让那些有意愿和能力从事该项工作的人更加容易移民。
Lastly, evidence suggests that as many at 40% of cases of dementia can be delayed or averted by changing behaviour earlier in life. The trouble is that public-health campaigns have a patchy record and they do nothing for dementia’s most intractable pre-existing condition—old age. No cure, insufficient financing and a tricky public-health message: perhaps that is enough to make you throw up your hands in despair. Instead, however, it only underlines how the solutions to dementia, like the disease itself, will take decades to unfold. It is yet another reason to start working on them right away.
最后,有证据表明,40%的痴呆病例可以通过改变早年的行为来推迟或避免。问题是,公共卫生宣传以往都很不可靠,而且它们对痴呆最棘手的先决条件——衰老——无能无力。也许无药可医、资金不足和难以捉摸的公共卫生信息足以让你绝望地举手投降。然而,这一切也足以证明,正如痴呆症的形成是个长期的过程,如何解决痴呆症的问题也需要几十年的时间才能弄清楚。这也是另一个让我们马上开始行动起来的原因。
注:
In the context of healthcare in the United States, a pre-existing condition is a medical condition that started before a person's health benefits went into effect. Before 2014 some insurance policies would not cover expenses due to pre-existing conditions.“Pre-exisiting condition”意为早就存在的疾病。在美国医疗里,这个词语用来指在医疗保险条款生效之前就已经有的疾病。但是文章中用了condition的另一个意思,“条件”,指衰老是痴呆症的先决条件。
翻译组:
Sylvia,女,爱健身的小翻译,经济学人粉儿
Melody,女,咨询搬砖逐渐熟练工,经济学人粉丝儿
Mai,男,经济学博士,世界那么大,我想活得久一点
校对组:
Neil, 男,外贸民工,经济学人铁粉
Wesley,男,英语老师,经济学人铁粉
Hannah,女,英语教书匠,经济学人粉丝
Carole,女,经济硕士,在成为经济学人铁粉的路上
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观点|评论|思考
感想一
Samantha,女,不吃米饭,邓伦未婚妻
从1996年开始的每个6年,由财政拨款支持的德国老年病学研究中心(DZA)都会出具一份名为《人生后半段》的本国高龄群体普查报告。除了一些常见内容,比如经济状况、社会关系和就医频率等等,还会以问卷或采访的方式了解他们对未来的担忧。2020年的数据尚未全部完成,但目前已有超过半数受访者表示,阿尔茨海默症是最可怕的生活灾难之一,与之同列的还有行动不便、贫困,和中风。作为欧洲经济领跑者的德国同时也是全球第三大老龄化社会,从他们的调查中能看到,西方世界对阿尔茨海默症的恐惧可见一斑。
体面优雅的变老是人人都希望做到的事。以前在家的时候常听到长辈们聊天说,老了可不要给孩子们添负担,要快快的“走”。我们中国人讲孝顺,归根到底还是出于对老人的爱,因为他们先爱了我们。绝大部分老人们是如此的不想给孩子惹麻烦,爱到了不计代价、遗忘自我的程度,而现在关于“遗忘“的医学难题已困扰世界。独生子女一代的三十而立,没见几个真的能立起来的;父母们都已六十上下,他们的老去速度比预想中的快太多。就不要再说怕什么添负担,可以为爱负担是一件有福气的事,要好过来不及负担的遗憾,更好过负担不起的无奈。
死和遗忘都很可怕,并无可比性。《寻梦环游记》里坐着摇椅的老奶奶听到熟悉的Remember me旋律就能记起童年往事,从而让自己爸爸的灵魂不再受困于某个中间地带。做一个被记住的人,好好爱自己,并把生命花在更值得的人和事上;也要尽量做一个温柔的人,不管你记不记得我,我都永远会记得你。
感想二
Tracy,女,设计爱好者,推理烧脑粉
之前在经济之声《笑傲江湖》看过一个采访,是关于国内第一家植物人看护机构的创业故事。创始人卖房借钱,只为了守护躺在病房里的植物人。
大部分人都清楚植物人意味着什么,而对于老年痴呆症,很多人还仅仅停留在老人出现认知障碍上,殊不知,随着痴呆症的逐渐严重,对于老人的看护,陪伴和照顾是需要家人和医护尽可能的全天陪伴的。而大多数子女,尤其是独生子女,如何做到平衡支付看护费用的经济来源与全程陪伴的时间付出,是一个巨大的问题。《都挺好》这部电视剧的结尾苏大强就患了老年痴呆症,长女明玉辞掉工作,全心陪伴父亲。放在现实中,有多少人具备明玉的经济实力,以及医护条件呢?
这篇文中提到的方法都是可行的,如果真的能将医护中心,从业人员,公益宣传,费用来源这些方面都解决,不止是老年痴呆症,其他的需要长久护理的疾病的解决办法都可以被复制。
问题就在于,这些方法能不能被落实。当然我们看待问题要积极,在世界上看不见的地方,有很多人心怀天下,在做着惠及他人一生的事情,而这,需要我们每一个人的力量与帮助。
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