资本主义再次出手。这一次的目标，在饥饿与教育之后，轮到了健康。普通人在一种经济制度中所寻求的，并不是那些用来论证该制度及其基础的纯粹理论。

Capitalism strikes again. The target this time, after hunger and education, is health. What ordinary people look for in an economic system is not the mere theories which substantiate the system and its foundation.

普通人归根结底希望身体健康，餐桌上有足够的食物，夜里入睡时心中有安全感。一个成功的制度，应当使民众免于因流行病而丧失正常生活的能力，或是丧失生命的恐惧。

Ordinary people at the end of the day want to be healthy with enough food on the table and a sense of security when they go to bed. A successful system is the one that removes from the people the fear of losing their ability to function due to epidemic diseases or losing their lives altogether.

尽管资本主义之下财富与资源已有惊人增长，健康上的不安全感仍然困扰着全球各地的个人与国家。在世界上最富有的资本主义国家美国，健康危机多年来持续加剧。在美国的选举期间，健康危机已成为一个常议常新的争论话题。据估计，一个人一生中患上某种形式癌症的几率为44%。这一比率并未放缓，相反，在过去几年中急剧上升。换言之，财富的巨大增长和科技的进步，并未帮助人们对抗来自内部的敌人。心脏相关疾病每年夺去七十多万人的生命。据美国心脏协会统计，2006年有831,272人因心脏相关疾病而丧生。如此高的致命疾病发生率并非偶然，而是控制财富分配与资源配置的体制所直接造成的副产品。要看清这种资源配置的失衡，只需看看某一年度的预算，观察资源是如何分配的。图16中的曲线显示了美国过去七年可自由支配预算（须经国会和总统批准的预算）的构成情况（69、70）。美国每年在军事上的支出超过其预算的50%，而在教育和健康需求上的支出却不足14%。与此同时，众所周知，癌症、心脏病、糖尿病等流行性疾病所夺去的生命，远远多于直接战争或恐怖主义间接战争中死亡的人数。

Despite the extraordinary growth in wealth and resources under capitalism, health insecurity continues to haunt individuals and nations across the globe. In America, the wealthiest capitalist nation in the world, health crisis continues to escalate over the years. Health crisis has become a permanent subject of debate during election times in the USA. It is estimated that a man during his lifetime has a chance of 44% to have one form of a cancer disease68. This rate is not slowing down; on the contrary, it has increased dramatically during the past few years. In other words, the tremendous growth in wealth and advancement in technology is not helping in fighting an enemy from within. Heart-related problems consume more than seven hundred thousands lives a year. According to the American Heart Association, 831,272 lives vanished due to heart related diseases in 2006. Such high rate of fatal diseases is not accidental. This is a direct by-product of systems which control wealth distribution and resource allocation. To see this imbalance of resource allocation, just look at one of the annual budgets and see how the resources are allocated. The curves in figure 16 show a breakdown of the discretionary budgets (budget subject to approval by Congress and the president) for the past seven years in the United States (69, 70). The United States spends on military more than 50% of its budget every year, whereas it spends less than 14% on the education and health needs. In the meantime, it is a well-known fact that epidemic diseases such as cancer, heart problems, diabetes, and others consume much more lives than all those who die in direct wars or indirect wars of terrorism.

已故美国广播公司（ABC）主播彼得·詹宁斯（Peter Jennings）在名为《崩溃：美国的医疗保险危机》（Breakdown—America's Health Insurance Crisis）的纪录片中指出，医疗费用的飞涨和未参保人数的不断增加，都是医疗保险体系陷入危机状态的表现。据美国医疗保健研究与质量局（Agency for Healthcare Research and Quality）统计，2007年，美国65岁以下人口中有近五千四百万人没有医疗保险，占65岁以下人口的18%。当前的经济衰退还将使未参保的美国人队伍再增加七百万；到2010年，没有医疗保险的人将超过六千万。未参保人群中规模最大的是人口中最贫困的群体；在所有未参保者（一千五百万人）中，西班牙裔占32%。

Peter Jennings, the late ABC anchor, concludes in a documentary called “Breakdown—America’s Health Insurance Crisis,” that spiraling costs and the growing number of uninsured are all part of a health insurance system in a state of crisis71. According to the Agency for Healthcare Research and Quality, nearly fifty-four million Americans under age sixty-five, or 18% of the population under the age sixty-five, were without health insurance in 200772. The current economic downturn will contribute seven more million to the army of uninsured Americans73; by 2010 there will be more than sixty million people without health insurance. The largest group of uninsured people belongs to the poorest segment of the population; 32% of the total number of people without insurance (fifteen million) is Hispanics.

导致未参保人数增加的主要原因是贫困，这体现在医疗保险及相关保费的成本相对于人们的工资和收入不断上涨。即使雇主为员工提供保险，员工也往往无力承担其应付的那部分保费。

The main reason for the increased number of uninsured people is poverty, which is reflected in the increased cost of health insurance and related premium compared to the wages and income of people. Even if employees are offered coverage on the job, they can’t always afford their portion of the premium.

医疗保险费用在1999年至2009年间为员工上涨了119%74，是员工平均工资涨幅的三倍。1999年至2008年间，员工平均工资仅上涨了35%；见图17。由于医疗保险费用不断上涨，小型企业不愿为员工提供医疗保险。

Health insurance premiums have increased 119%for employees between 1999 and 200974, that is, three times more than the average increase in employee wages. The average wages increased only 35% between 1999 and 2008; see figure 17. Small firms refrain from offering health insurance due to rising health insurance premiums.

据估计，每年有两万两千人因无法获得合理的医疗资源而死亡。没有适当保险的人接受的预防性护理较少；他们的疾病被诊断时已处于更晚期，并且接受的治疗性护理也较少。这导致未参保人群的死亡率居高不下。

It is estimated that twenty-two thousand people die every year because they are unable to access reasonable health care resources. People without proper insurance receive less preventive care; they are diagnosed at more advanced stages of diseases and receive less therapeutic care. This leads to high mortality rates among uninsured individuals.

与教育的情况一样,缺乏适当的医疗保健会加深贫困,而贫困又会大幅减少个人获得的医疗保健。要打破这一恶性循环,仅仅增加药品、医疗设备和病床的供应是不够的。使个人能够获得适当医疗保健的,是这些资源的分配机制。高昂的医疗费用会摧毁家庭的经济福祉。对于没有医疗保险的低收入家庭中,有30%的家庭因医疗账单而承受重大经济负担,并因此陷入债务之中。75

As in the case of education, lack of proper health care deepens poverty, and poverty dramatically reduces health care for individuals. In order to break this cycle, more needs to be done than simply increasing the supply of drugs, health equipment, and hospital beds. It is the mechanism for distributing these resources that enables individuals to receive the proper health care. The high cost of health care destroys the economic well-being of families. Medical bills have a major financial impact on 30% of low-income families without health coverage75, pushing them into debt.

有保险与没有保险的人之间的差距日益扩大。因此，在获得惯常医疗来源、年度体检和预防性保健方面，健康鸿沟也随之扩大。

The disparity between those who have insurance and those who do not is growing more and more. As a result, the health divide has been widened in access to usual source of care, annual physical checkup, and preventive care.

自2000年至2007年间，全国十家最大的上市健康保险公司的利润增长了428%，而消费者支付的保费却越来越高，所获得的保障却越来越少。2008年，五家保险公司的利润总额超过了78亿美元。

Profits at ten of the country’s largest publicly traded health insurance companies rose 428% from 2000 to 2007, while consumers paid more for less coverage. In 2008, the total profit of five insurance companies topped $7.8 billion.

艾滋病（HIV/AIDS）、疟疾和结核病仍然是发展中国家数百万人生命面临的最严重威胁。发展中国家的卫生保健系统已恶化到极其严重的程度，以至于这些疾病以及其他疾病已经大规模流行。

HIV/AIDS, malaria, and tuberculosis continue to be the most serious threat to the life of millions of people in the developing countries. The health care systems in developing countries have deteriorated to extreme levels such that these and other diseases have become so epidemic.

根据联合国艾滋病规划署/世界卫生组织公布的数据，2007年确诊感染艾滋病的人数超过3300万。其中超过200万人在2007年死亡。自1981年以来，已有超过2500万人死于艾滋病。艾滋病受害者大多生活在世界上最贫穷的地区——撒哈拉以南非洲，那里有2200万人患有该病，150万人因此而失去生命。

According to published data by UNAIDS/World Health Organization, the number of people diagnosed with AIDS in 2007 was more than 33 million people. More than 2 million of them died in the year 2007. More than 25 million people have died of AIDS since 1981. The majority of the AIDS victims are in the poorest part of the world in sub-Saharan Africa, where 22 million people live with the disease and 1.5 million have vanished as a result.

随着财富和医疗保健设施的巨大增长，艾滋病的流行仍在全球范围内扩大。图18显示了全球艾滋病流行的趋势。在一些非洲国家，每三人中就有一人携带艾滋病/HIV病毒。在尼日利亚、埃塞俄比亚、俄罗斯、中国和印度生活的世界人口中，超过40%面临因艾滋病传播而带来的严重健康风险。预计到2010年，尼日利亚将有1000万至1500万例病例，埃塞俄比亚将有700万至1000万例。在这两个国家，由于极端贫困导致公共卫生基础设施匮乏，形势很可能会进一步恶化。预计到2010年，中国的艾滋病感染人数将达到1000万至1500万，印度则为2000万至2500万。

The epidemic of AIDS is growing worldwide despite the tremendous growth in wealth and health care facilities. Figure 18 shows the global trend in the AIDS epidemic. In some African countries, one out of three people carry the AIDS/HIV virus. More than 40% of the world population living in Nigeria, Ethiopia, Russia, China, and India face serious health risks due to spread of AIDS. Nigeria is projected to have 10-15 million cases by 2010, and Ethiopia 7-10 million. In both countries, the situation is likely to be aggravated by a lack of public health infrastructure due to extreme poverty. The AIDS population is expected to reach 10-15 million by 2010 in China and 20-25 million in India.

对发展中国家艾滋病治疗而言，最大的挑战是治疗费用高昂，每人每年约需10,000至15,000美元。即使在高度发达的国家，这笔费用也难以负担；这无疑是阻碍发展中国家患者获得适当治疗的主要障碍。鉴于艾滋病患者中贫困率很高，要看到这一灾难性疾病的转折点十分困难。由于贫困率居高不下，许多非洲国家将继续面临艾滋病的严重威胁。除非贫困这一流行病得到解决，否则艾滋病的希望依然渺茫。

The main challenge for AIDS treatment in developing countries is the high cost of the treatment which amounts to $10,000-$15,000 per person per year. This high cost is barely affordable in highly developed nations; this is certainly the main barrier which prevents patients in the developing world from getting the proper treatment. Given the high poverty rates among the population of AIDS, it is difficult to see a break point in this catastrophic disease. Given the high poverty rate, a large percentage of the African nations will continue to face serious threats from AIDS. Unless the epidemic of poverty is resolved, the hope out of AIDS remains slim.

贫困也是美国艾滋病病例的主要原因之一。美国艾滋病病例总数中有49%属于黑人群体,而黑人在全国总人口中所占比例不到15%。据估计,感染艾滋病毒的非裔美国人中有22%没有医疗保险76。

Poverty is also responsible for the majority of AIDS cases in the United States. Forty-nine percent of the total AIDS cases in the United States belong to the black population, which makes less than 15% of the total country’s population. It is estimated that 22% of the African Americans with HIV do not have health insurance76.

在美国，活动性肺结核病例数在1985年开始回升，此前它自20世纪50年代以来一直持续下降。肺结核卷土重来的原因有多个，包括艾滋病毒/艾滋病流行、贫困加剧、静脉注射毒品以及无家可归问题。值得注意的是，里根政府在1981年削减了食品券计划70亿美元。此次削减之后，与饥饿相关的问题，如贫血、肺结核、生长发育不良和骨质疏松，又重新出现。

In the USA, the number of active tuberculosis cases began to rise in 1985 after it had declined continuously since the 1950s. Several factors were behind the return of tuberculosis, including the HIV/AIDS epidemic, increased poverty, IV drug use, and homelessness. It is worth noting that the Reagan administration cut 7 billion dollars from the food stamp program in 1981. Immediately after this cut, hunger-related problems such as anemia, tuberculosis, poor growth, and osteoporosis crawled back.

美国疾病控制与预防中心（CDC）报告称，2005年美国有14,093例活动性肺结核（TB）病例，另有1000万至1500万人患有潜伏性结核感染。若患有糖尿病，潜伏性结核感染者中有30%会发展为活动性肺结核；几乎所有感染艾滋病毒（HIV）的人都会发展为活动性结核。与艾滋病的情况相似，在美国，结核病在贫困人群中最为高发：西班牙裔（每10万人中8.5例）和黑人（每10万人中9.4例），而白人为每10万人中1.1例。

The Centers for Disease Control and Prevention (CDC) reported 14,093 cases of active tuberculosis (TB) in the United States in 2005, and 10 to 15 million people with latent tuberculosis. Thirty percent of those with latent TB infection will progress into active tuberculosis if they have diabetes, and almost all with HIV infection will progress into active TB. As in the case of AIDS, tuberculosis in the United States is highest among the poor population of the Hispanics (8.5 cases per 100,000) and the blacks (9.4 per 100,000) compared to whites (1.1 cases per 100,000).

尽管有治疗方法，但由于资源匮乏以及优质药品供应不稳定，只有约37%的结核病病例得到了恰当的治疗。因此，耐多药结核病（MDR-TB）的发病率正在急剧上升，每年新增病例达三十万例。耐多药结核病的治疗费用是普通结核病的一百倍。再次说明，贫困和资源分配不均是造成又一种流行性疾病的原因。世界卫生组织（WHO）估计，如果不加以控制，到2020年将有3600万人死于结核病。图19显示，结核病病例仍在持续上升，并未放缓。

There are cures, yet only around 37% of TB cases receive proper treatment due to a lack of resources and unreliable supplies of quality drugs. As a result, multidrug-resistant TB (MDR-TB) incidence is surging, with three hundred thousand new cases each year. MDR-TB is a hundred times more expensive to treat than normal TB. One more time, poverty and unbalanced distribution of resources is responsible for another disease of epidemic proportions. The World Health Organization (WHO) estimates that 36 million people will die of tuberculosis by 2020 if it is not controlled79. Figure 19 shows that TB cases continue to be on the rise; it is not slowing down.

另一个主要杀手是疟疾，与结核病一样，耐药性正日益成为严重问题。世界卫生组织估计，每年有3亿至5亿病例，死亡人数为100万至300万，其中大多数是儿童。这种感染所造成的社会和经济负担是灾难性的。疟疾持续使撒哈拉以南非洲的人均GDP增长率每年下降约1.3个百分点。

Another major killer is malaria, and as with TB, drug resistance is a growing problem. WHO estimates that each year there are 300-500 million cases, with 1-3 million deaths—mostly children. The social and economic burden of such infection is catastrophic. Malaria continues to undercut sub-Saharan Africa’s GDP per capita growth rates by some 1.3 percentage points per year.