文 / 柳下婴（微信公众号：王不留）

本期我们选择的是3月11日《经济学人》周报封面文章，即社论区（Leaders）的首篇文章：《25万英国人消失之谜》（“The missing quarter of a million”）。

The missing quarter of a million

消失的25万

Britain has endured a decade of early deaths. Why?

10年来，英国一直承受着早逝之痛。为何？

The mystery of 250,000 dead Britons

25万英国人逝去的谜团

In recent years, Britain has been hit by one health crisis after another. First came the covid-19 pandemic—then backlogs in health and social care that the coronavirus exacerbated, and a long winter of strikes and overwhelmed emergency departments. But in the background, long before the pandemic hit, an even more disturbing story has been unfolding. Britain has endured a grim decade during which perhaps a quarter of a million people died younger than expected.

近年来，一波接一波的健康危机向英国袭来。首先是新冠大流行——紧接着是疫情使卫生和社会保健工作积压加剧，以及漫长的冬季罢工和急诊部门的不堪重负。但是在这一切的背后，早在新冠爆发之前，一个更令人不安的故事就已经拉开了序幕：英国经历了一个残酷的十年，这期间，大约有25万人过早地离开了人世。

By our calculations, that is the number of extra deaths Britain has suffered, compared with similar countries such as France and Denmark. The reason is that, in the early 2010s, life expectancy stalled in Britain compared with long-run trends and other countries. This slowdown in life expectancy struck all age groups, not just the elderly. And it disproportionately affected the poor. If you travel just 10km (six miles) from the poshest part of Kensington in London to New Cross Gate, life expectancy for men falls by a staggering 18 years, from 92 to 74. The burden these deaths place on the living is not just weighed in grief. When more people are dying and life expectancy is stagnating, a greater number of people are also living in ill health.

根据我们的计算，这是与法国和丹麦等类似国家相比，英国遭受的额外死亡人数。原因是，在21世纪第一个10年的早期，与长期趋势和其他国家相比，英国人的预期寿命停滞不前。预期寿命的下降波及所有年龄组，而不仅仅是老年人。它不成比例地影响了穷人（译者注：即穷人中预期寿命的下降比例更大）。如果你从伦敦肯辛顿最高档的地方到新十字门，这只有10公里（6英里）的路程，男性的预期寿命就会惊人地下降18岁，从92岁降到74岁。这些死亡带给生者的负担不仅仅是悲伤。当越来越多的人死亡，预期寿命停滞不前时，更多的人也生活在不健康之中。

Life expectancy in Britain, as in almost all other rich countries, had been rising for nearly two centuries. But something went wrong in the early 2010s. Life expectancy at birth today, at 81, is just eight weeks longer than it was in 2011. In a best-case scenario, in which the pace of improvement between 1980 and 2011 had been sustained, life expectancy today would have been over 83. By The Economist’s calculations, that is no minor difference: it implies that between 2012 and 2022 approximately 700,000 Britons died sooner than they might have.

英国人的预期寿命和几乎所有其他富裕国家一样，近两个世纪以来一直在增长。但是在21世纪第一个10年的早期出现了问题。今天出生的人预期寿命为81岁，仅比2011年多8周。在最好的情况下，如果1980年至2011年之间的改善速度保持不变，今天的预期寿命将超过83岁。根据《经济学人》的计算，这是一个不小的差别：这意味着在2012年到2022年之间，大约有70万英国人过早地离开了人世。（译者提示：标题和第一段曾讲到，10年间有25万人过早离开了人世。为什么这里是70万人？下文会有答案）

Two features make this figure even more worrying. Death comes mostly when people are old. But the slowdown in life expectancy has occurred across all age groups. Mortality rates have stalled for infants, and risen among young adults and the middle-aged. Death rates for 30- to 49-year-olds have steadily increased in Britain since around 2012, in sharp contrast with neighbouring countries.

两个特点使得这一数字更加令人担忧。死亡大多发生在人老的时候。但是，所有年龄组的人的预期寿命都在下降。婴儿死亡率停滞不前，年轻人和中年人死亡率上升。自2012年左右以来，英国30岁至49岁人群的死亡率稳步上升（译者短评：这个年龄段可以看作是一个人的“黄金时期”（prime years），因此，这个年龄段死亡率的上升的确是一大悲剧），与邻国形成鲜明对比。

Although the deaths have been spread across generations, they have not been spread across the income spectrum. Life expectancy has fallen among the poorest in society but risen for the richest. A poor English girl could on average expect to live 6.8 years less than a rich girl in 2011, but 7.7 less in 2017. For boys, the gap increased from 9.1 to 9.5 years over the same period.

虽然死亡人数在几代人之间分布，但并没有在收入范围内分布。社会中最贫穷者的预期寿命下降了，但最富有者的预期寿命却上升了。2011年，一个贫穷的英国女孩的平均预期寿命比一个富有的女孩少6.8年，但2017年少7.7年。在同一时期，男孩的差距从9.1岁增加到9.5岁。

The combined effect of the pandemic and global demographic trends can explain only some of Britain’s missing multitude. Though other rich countries have also experienced slowdowns, Britain has done the worst out of a cohort of its European peers. After stripping out the effects attributable to covid and the broad European slowdown from the toll of 700,000, you are still left with those 250,000 unexplained deaths.

新冠流行和全球人口趋势的综合影响只能解释英国消失人口的一部分。尽管其他富裕国家也经历了经济放缓，但英国在欧洲同行中表现最差。从70万人的死亡人数中剔除可归因于新冠和整个欧洲经济放缓的影响后，还剩下25万人的死亡无法解释。

Working out what has gone wrong is not easy. In America, where life expectancy has fallen even more sharply in recent years, “deaths of despair” from drugs, alcohol and suicide have done the most harm. The same is true for Scotland, where drug deaths have more than doubled in a decade; Dundee is now the drug-death capital of Europe. Yet although a similar problem may be brewing in England and Wales, the rate of drug deaths is nearly four times higher in Scotland.

找出哪里出了问题并不容易。在美国，近年来预期寿命下降得更快：毒品、酒精和自杀造成的“绝望死亡”造成的伤害最大。苏格兰的情况也是如此，那里的毒品死亡人数在十年内翻了一番以上；敦提（苏格兰东部港口城市——译者注）现在是欧洲的毒品死亡之都。然而，尽管英格兰和威尔士可能正在酝酿类似的问题，但在苏格兰，毒品死亡率却高出近四倍。

The recent struggles of the National Health Service (NHS) have played their part. Hospital waits of record lengths and a crisis in primary care jeopardise timely treatment. But delays in medical care cannot explain all the extra deaths, especially before the pandemic. Besides, the greatest improvements in life expectancy come not from treatment but from better diagnosis and prevention, and wider prosperity. This is where Britain appears to have fallen short. It could do much better in all three.

英国国民医疗服务体系（NHS）近来的困难也起到了一定作用。医院等待的时间创下纪录，初级保健出现危机，危及及时治疗。但是医疗方面的延误不能解释所有额外死亡的原因，特别是在新冠流行之前。此外，预期寿命的最大改善不是来自治疗，而是来自更好的诊断和预防，以及更广泛的繁荣。这就是英国似乎落后的地方。以下三个方面都可以做得更好。

First, diagnosis. Poorer Britons are 20% more likely to be diagnosed with cancer at a later stage, when the disease is more complex and expensive to treat. Having more NHS diagnostic centres would help, as well as cutting the pandemic-related backlog. Prescribing more statins for those at risk of heart attack or stroke would be good, too. Both treatments are cheap and cost-effective, and are recommended. But with around one in 11 NHS posts vacant, it will be tricky to find enough radiologists and general practitioners to make a difference.

第一，诊断。较贫穷的英国人在后期被诊断出癌症的可能性要高出20%，那时疾病更复杂，治疗成本更高。拥有更多的NHS诊断中心将有所帮助，同时减少与疫情相关的积压。给那些有心脏病发作或中风风险的人开更多的他汀类（statins）药物也会有好处。以上这两种治疗方法价格便宜，性价比高，值得推荐。但由于大约每11个NHS职位中就有一个空缺，要找到足够的放射科医生和全科医生来发挥作用将是很棘手的。

Next, prevention. Individuals bear responsibility for their own decisions but public-health interventions, from vaccines to anti-smoking and weight-loss programmes, can improve things. They also provide good value for money. One study found that it cost nearly four times as much to gain an extra year of good health via clinical interventions than through public-health programmes. Yet funding for the public-health grant, which is allocated to local authorities by central government and amounts to a mere 2% of the NHS budget, has been cut in real terms in recent years.

其次，预防。个人对自己的决定负有责任，但公共卫生干预，从疫苗到反吸烟和减肥计划，可以使局面得以改善。他们也提供了良好的性价比。一项研究发现，通过临床干预，以获得额外一年的良好健康状态的成本，是通过公共卫生项目的近四倍。然而，由中央政府分配给地方当局的公共卫生拨款，只占NHS预算的2%，近年来实际上已经被削减。

Ultimately the greatest improvements will come from raising the living standards of the poor. Their lower life expectancy has many causes, from less money to spend on home insulation or nutritious food, to the stress of financial insecurity. One useful long-term thing the government can do is help improve the country’s dreadful record on productivity by liberalising planning and devolving fiscal powers to local authorities.

最终，最大的改善将来自于提高穷人的生活水平。导致他们预期寿命较低的原因有很多，从用于房屋隔热或营养食品的支出减少，到经济不安全的压力。政府可以做的一件长期有用的事情，是通过放开规划和将财权下放给地方当局，帮助改善该国糟糕的办事效率记录。

Life after life

生生不息

The government should also recognise the role that deprivation plays in health. Reweighting funding formulas to benefit general practitioners in the poorest areas would be a good idea. They care for 10% more patients than practices in the richest areas, but receive 7% less cash. And as Jeremy Hunt, the chancellor of the exchequer, prepares his budget for March 15th, he should recognise how spending cuts show up in other areas. The data show that life expectancy was worst affected in the places with the largest relative declines in housing services and adult social-care spending between 2009 and 2019.

政府也应该认识到贫困对健康的影响。重新调整资助方案，使最贫困地区的全科医生受益，将是一个好主意。他们照顾的病人比最富裕地区的诊所多10%，但得到的现金却少7%。当英国财政大臣亨特（Jeremy Hunt）准备3月15日的预算时，他应该认识到削减开支在其他领域的表现。数据显示，2009年至2019年间，住房服务和成年人社会保障支出下降幅度最大的地区，预期寿命受到的影响也最大。

In its covid response, Britain went to extraordinary lengths to prevent its citizens from suffering an early death. The pandemic may be over, but that job is nowhere near complete.

为应对新冠疫情，英国曾做出了异乎寻常的努力，以防止其公民过早死亡。现在，疫情或许已经结束，但是这项工作还远未完成。

王不留注

柳下婴老师是我认识的英语大佬之一，擅长外文翻译，爱看《经济学人》。

根据不少考研朋友的建议，现在将其翻译作品，上传到百度网盘，在“柳下婴精翻系列”中，以PDF方式免费分享。欢迎下载。谢谢。