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除了疫情,美国还有好几个问题亟待解决

除了疫情,美国还有好几个问题亟待解决

Kyu Rhee 2020年08月03日
不仅需要压平新冠疫情增长曲线,还要解决精神疾患、慢性病和健康不公平等问题。

2020年7月28日,加利福尼亚州埃尔森特罗市埃尔森特罗地区医疗中心,一名护士在新冠肺炎患者所在的ICU病房窗户上写字。图片来源:Mario Tama—Getty Images

新冠疫情让每个人都深受其害,其中以弱势群体受影响最为严重。激增的医疗需求让美国卫生系统的脆弱性暴露无遗,也让我们看到了社会不平等、结构性种族主义和健康不公平造成的深远影响。

许多充满英雄主义精神的普通人甘冒风险奋战在抗疫一线,其中既有一线的医护、急救人员,也有那些为保障关键服务正常运行而奋不顾身的人。那些为寻找有效疫苗和治疗方法而拼命工作的科学家也一样是我们心中的英雄。与此同时,我们也必须认识到,全球民众为抗击疫情做出了重大牺牲,人们用实际行动再一次向世界证明每一个生命都值得被珍视。

疫情期间,新冠肺炎曲线能够相对直观地展示疫情的控制情况,并为国际社会提供了一个易于理解的基准,因此为人们所更多地关注。可以看到,借助循证医学方法,有些社区正在逐步压平曲线,而有些社区则走上了错误的方向。

展望未来,面对尚未控制的疫情和即将到来的流感季,我们需要探究如何才能使感染曲线变得平缓。因此,我们必须重拾急迫感,认识到接种疫苗对挽救生命、节约资金的重要性,同时,我们还要继续齐心协力推进有效新冠疫苗的研发工作。

虽然在应对传染病问题时,美国需要坚持科学的严谨性,要以实证为准绳,积极采用非药物干预措施,但本次疫情太过复杂,不能仅从一个角度加以思考。要想从新冠疫情中全身而退、为未来塑造一个更好的医疗卫生体系,我们必须解决三个问题:

精神疾患

疫情爆发前,美国就已经存在精神疾病患病率不断上升的问题,加之心理诊所过于分散,导致难以妥善解决人们日益增长的诊疗需求。如今,受疫情影响,许多地方的就地避难政策已经实施了数月之久,让美国又陷入了一场精神健康危机的边缘。

受诸多心理创伤诱因的影响,比如,大量民众去世、失业率攀升、经济困难、社交隔离以及对未来的普遍恐惧等,三分之一的美国人报告自己遇到了慢性焦虑问题。令人难过的是,受疲劳工作、工作压力和精神创伤等因素影响,美国的一线医护人员极易产生心理健康问题,有59%的医护人员表示,新冠疫情导致其心理健康状况有所下降。

专家警告称,精神健康问题或将大面积出现,随之而来的将是药物滥用、亲密伴侣暴力和涉枪自杀案件的上升。缺乏资金支持、被污名化、求诊极不方便且分布分散的美国精神卫生体系将难以应对当前的危机,面对后疫情时代可能出现的精神问题爆发自然也会显得捉襟见肘。

慢性病

最近一段时间,美国的医院和卫生体系几乎都不得不把所有的医疗资源投入到新冠肺炎高危病患的救治中。由于实施就地避难政策,许多医护人员和社区卫生中心被要求暂停开展常规的保健随访及基本的疾病预防服务。许多医院和医疗机构因此出现了财务危机,尤其是当你考虑到美国几乎所有的医疗开支都用于慢性疾病和精神疾病时,就会知道这些重要的医疗资源未来的运营甚至可能都会面临问题。

由于害怕感染新冠肺炎,许多患者不愿接受慢性病的预防性治疗和管控。疫苗接种和癌症等慢性疾病筛查也基本陷于停滞,数百万人因此面临罹患传染病或慢性病的威胁,也可能因此错过在疾病早期获得即时诊断的机会。实际上,最近的研究显示,死于心脏病、中风和糖尿病等慢性疾病的人数已经出现了增加。

健康不公平

疫情爆发仅数月之后,近一半美国家庭失去了收入,这一情况在低收入群体和少数族裔群体尤为突出。新冠疫情还暴露了美国卫生体系由来已久且异常严重的健康不公平问题。医疗资源的不足对少数族裔社区的影响尤为严重,其中尤以城市中的黑人群体受害最深。据新冠疫情追踪项目与波士顿大学反种族主义研究中心联合推出的新冠肺炎各种族数据跟踪器显示,死于新冠肺炎的黑人(非裔美国人)数量约为一般大众的近两倍之多。

这场危机随之又进一步拉大了黑人团体内部的贫富差距。这一点我们从失业率的对比中能清楚看出:当前,全美的平均失业率为11.1%,而黑人劳工的失业率则仍然维持在15.4%的高位。新冠疫情让贫富差距进一步拉大,让健康不公平问题进一步恶化。越来越多的人意识到,结构化的种族主义是健康不公平危机的罪魁祸首之一。在意识到这一不公的同时,也有许多人开始行动起来,希望能够切实解决这一问题。

四管齐下

因此,我们必须通力合作,燃放新的活力,借助科学与合作以一种整合策略同时解决传染病(以新冠疫情为重点)、精神疾患、慢性病和健康不公平等四大问题。否则弱势群体将面临更大风险,我们的医疗卫生体系也将背上更大负担。

历史一再证明,我们可以在危机中浴火重生。只要能够找对目标,加上整个医疗卫生体系的通力合作,我相信危机之后我们将变得更强大。我们必须对美国的卫生与经济体系进行改革,为全球民众,尤其是最弱势群体打造一个更加公平的未来。(财富中文网)

作者Kyu Rhee是初级保健医生、公共政策硕士、IBM副总裁兼首席卫生官。

译者:Feb

新冠疫情让每个人都深受其害,其中以弱势群体受影响最为严重。激增的医疗需求让美国卫生系统的脆弱性暴露无遗,也让我们看到了社会不平等、结构性种族主义和健康不公平造成的深远影响。

许多充满英雄主义精神的普通人甘冒风险奋战在抗疫一线,其中既有一线的医护、急救人员,也有那些为保障关键服务正常运行而奋不顾身的人。那些为寻找有效疫苗和治疗方法而拼命工作的科学家也一样是我们心中的英雄。与此同时,我们也必须认识到,全球民众为抗击疫情做出了重大牺牲,人们用实际行动再一次向世界证明每一个生命都值得被珍视。

疫情期间,新冠肺炎曲线能够相对直观地展示疫情的控制情况,并为国际社会提供了一个易于理解的基准,因此为人们所更多地关注。可以看到,借助循证医学方法,有些社区正在逐步压平曲线,而有些社区则走上了错误的方向。

展望未来,面对尚未控制的疫情和即将到来的流感季,我们需要探究如何才能使感染曲线变得平缓。因此,我们必须重拾急迫感,认识到接种疫苗对挽救生命、节约资金的重要性,同时,我们还要继续齐心协力推进有效新冠疫苗的研发工作。

虽然在应对传染病问题时,美国需要坚持科学的严谨性,要以实证为准绳,积极采用非药物干预措施,但本次疫情太过复杂,不能仅从一个角度加以思考。要想从新冠疫情中全身而退、为未来塑造一个更好的医疗卫生体系,我们必须解决三个问题:

精神疾患

疫情爆发前,美国就已经存在精神疾病患病率不断上升的问题,加之心理诊所过于分散,导致难以妥善解决人们日益增长的诊疗需求。如今,受疫情影响,许多地方的就地避难政策已经实施了数月之久,让美国又陷入了一场精神健康危机的边缘。

受诸多心理创伤诱因的影响,比如,大量民众去世、失业率攀升、经济困难、社交隔离以及对未来的普遍恐惧等,三分之一的美国人报告自己遇到了慢性焦虑问题。令人难过的是,受疲劳工作、工作压力和精神创伤等因素影响,美国的一线医护人员极易产生心理健康问题,有59%的医护人员表示,新冠疫情导致其心理健康状况有所下降。

专家警告称,精神健康问题或将大面积出现,随之而来的将是药物滥用、亲密伴侣暴力和涉枪自杀案件的上升。缺乏资金支持、被污名化、求诊极不方便且分布分散的美国精神卫生体系将难以应对当前的危机,面对后疫情时代可能出现的精神问题爆发自然也会显得捉襟见肘。

慢性病

最近一段时间,美国的医院和卫生体系几乎都不得不把所有的医疗资源投入到新冠肺炎高危病患的救治中。由于实施就地避难政策,许多医护人员和社区卫生中心被要求暂停开展常规的保健随访及基本的疾病预防服务。许多医院和医疗机构因此出现了财务危机,尤其是当你考虑到美国几乎所有的医疗开支都用于慢性疾病和精神疾病时,就会知道这些重要的医疗资源未来的运营甚至可能都会面临问题。

由于害怕感染新冠肺炎,许多患者不愿接受慢性病的预防性治疗和管控。疫苗接种和癌症等慢性疾病筛查也基本陷于停滞,数百万人因此面临罹患传染病或慢性病的威胁,也可能因此错过在疾病早期获得即时诊断的机会。实际上,最近的研究显示,死于心脏病、中风和糖尿病等慢性疾病的人数已经出现了增加。

健康不公平

疫情爆发仅数月之后,近一半美国家庭失去了收入,这一情况在低收入群体和少数族裔群体尤为突出。新冠疫情还暴露了美国卫生体系由来已久且异常严重的健康不公平问题。医疗资源的不足对少数族裔社区的影响尤为严重,其中尤以城市中的黑人群体受害最深。据新冠疫情追踪项目与波士顿大学反种族主义研究中心联合推出的新冠肺炎各种族数据跟踪器显示,死于新冠肺炎的黑人(非裔美国人)数量约为一般大众的近两倍之多。

这场危机随之又进一步拉大了黑人团体内部的贫富差距。这一点我们从失业率的对比中能清楚看出:当前,全美的平均失业率为11.1%,而黑人劳工的失业率则仍然维持在15.4%的高位。新冠疫情让贫富差距进一步拉大,让健康不公平问题进一步恶化。越来越多的人意识到,结构化的种族主义是健康不公平危机的罪魁祸首之一。在意识到这一不公的同时,也有许多人开始行动起来,希望能够切实解决这一问题。

四管齐下

因此,我们必须通力合作,燃放新的活力,借助科学与合作以一种整合策略同时解决传染病(以新冠疫情为重点)、精神疾患、慢性病和健康不公平等四大问题。否则弱势群体将面临更大风险,我们的医疗卫生体系也将背上更大负担。

历史一再证明,我们可以在危机中浴火重生。只要能够找对目标,加上整个医疗卫生体系的通力合作,我相信危机之后我们将变得更强大。我们必须对美国的卫生与经济体系进行改革,为全球民众,尤其是最弱势群体打造一个更加公平的未来。(财富中文网)

Kyu Rhee, a primary-care physician and master of public policy, is vice president and chief health officer at IBM. 作者Kyu Rhee是初级保健医生、公共政策硕士、IBM副总裁兼首席卫生官。

译者:Feb

The COVID-19 pandemic has affected us all, but the most fundamentally devastated are the already vulnerable communities.The demand for care brought on by COVID-19 has exposed the fragile nature of our health system and shed light on the alarming and pervasive influence of inequities, structural racism, and health disparities.

Among the many heroes helping us survive the pandemic are frontline health care workers, first responders, and the people who have kept vital services open and accessible, despite their own personal health risks.Equally heroic are the scientists leading the desperate search for a viable vaccine and effective therapies.At the same time, we must recognize that all global citizens have made significant sacrifices and continue to demonstrate that we are all essential.

Considerable attention has been focused on the COVID-19 curve—a relatively intuitive framework that has provided the global community with an easily understood benchmark on how to measure progress in addressing the spread of the virus and reducing transmission.Some communities are just beginning to flatten the curve with evidence-based approaches, while others are moving in the wrong direction.

As we look ahead, we need to examine how we address the infectious disease curve with the reality of an unrelenting increase in COVID-19 cases and the impending onset of the annual flu season.In this context, it will be critical to adopt a renewed sense of urgency to recognize that vaccinations save lives and money, and continue to harness our collective energy around the development of effective COVID-19 vaccines.

While it is critical that we address the infectious disease curve with scientific rigor and evidence-based policies and nonpharmaceutical interventions, this pandemic is far too complex to be thought of in just one dimension.To successfully emerge from the pandemic and begin to reimagine a better health system for the future, we must confront and flatten three additional impact curves:

Mental illness

Even before the pandemic, our country faced growing rates of mental illness and a fragmented infrastructure unable to properly address the increased need for mental-health services.Now, months into shelter-in-place restrictions in many localities due to the virus, the country is on the verge of a rapidly escalating mental-health crisis.

One in three Americans report chronic anxiety driven by factors that are catalysts for psychological trauma—an overwhelming number of lost lives, increased unemployment and economic hardship, social isolation from friends and family, and a general fear for the future.Sadly, our frontline health care workers are at a heightened risk of mental-health disorders from burnout, job-related stress, and trauma, and 59% of health care workers say their mental health has declined as a result of the COVID-19 crisis.

Experts warn that a looming wave of mental-health conditions is imminent, with cases of substance abuse, intimate partner violence, and gun suicides on the rise.Our fragmented U.S. mental-health system—already vastly underfunded, stigmatized, and difficult to access—is not adequately prepared to handle the current crisis and the future post-COVID-19 surge.

Chronic diseases

Hospitals and health systems have been forced to focus almost exclusively on treating high-risk COVID-19 patients.Many medical practices and community health centers have been required to discontinue routine health and wellness visits and basic preventive services because of shelter-in-place orders.As a result, many hospitals and medical practices are facing a fiscal crisis, leaving the future operations of these vital health resources at risk, particularly when you consider that nearly all of America’s health care spending is on chronic diseases and mental illness.

Many patients have been reluctant to seek preventive care and management for chronic conditions for fear of being exposed to COVID-19.Likewise, preventive services like vaccinations and screenings for chronic diseases like cancer have essentially been put on hold, leaving millions at risk of escalating infectious and chronic diseases or missing a critical diagnosis at early stages of a disease.In fact, recent research is showing excess deaths from chronic diseases like heart disease, stroke, and diabetes.

Health inequities

After only a few months of this pandemic, half of U.S. adults live in households that have lost income, especially in low-income and minority communities.COVID-19 is also exposing the devastating health inequities that already existed in our health system.The shortcomings disproportionately impact minority communities, most notably Black Americans in urban areas. According to the COVID Racial Data Tracker, a joint project of the COVID Tracking Project and the Boston University Center for Antiracist Research, deaths from COVID-19 are nearly two times greater for Black or African-Americans, compared with the general population.

And the downstream consequences of this crisis have accelerated the economic disparities within the Black community.This is clearly evident when you consider that the national unemployment rate average is currently at 11.1%, while the jobless rate remains highest for Black workers at 15.4%.COVID-19 has only accelerated the economic divide, creating an escalating crisis of health disparity.There is a growing consensus that structural racism has contributed to the current health disparity crisis.At the same time, there is an emerging movement to not only acknowledge this injustice, but to address it in a meaningful way.

Focusing on all four

We must collectively design an integrated strategy to address and flatten all four curves—infectious diseases (with an emphasis on the coronavirus), mental illness, chronic diseases, and health inequities—with a renewed vigor and a commitment to science and collaboration. Otherwise, we leave already vulnerable communities at increased risk and our health system with even more burdens.

History has taught us that we can emerge stronger from crises. With the right focus and teamwork across the health system, I am confident we do the same from this crisis. We must transform our health and economic systems to create a more equitable future for all global citizens—especially the most vulnerable ones.

Kyu Rhee, a primary-care physician and master of public policy, is vice president and chief health officer at IBM.

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