除了疫情，美國還有好幾個問題亟待解決
Kyu Rhee
2020-08-03
2020年7月28日，加利福尼亞州埃爾森特羅市埃爾森特羅地區(qū)醫(yī)療中心，一名護士在新冠肺炎患者所在的ICU病房窗戶上寫字。圖片來源：Mario Tama—Getty Images
新冠疫情讓每個人都深受其害，其中以弱勢群體受影響最為嚴重。激增的醫(yī)療需求讓美國衛(wèi)生系統(tǒng)的脆弱性暴露無遺，也讓我們看到了社會不平等、結(jié)構(gòu)性種族主義和健康不公平造成的深遠影響。
許多充滿英雄主義精神的普通人甘冒風險奮戰(zhàn)在抗疫一線，其中既有一線的醫(yī)護、急救人員，也有那些為保障關(guān)鍵服務(wù)正常運行而奮不顧身的人。那些為尋找有效疫苗和治療方法而拼命工作的科學家也一樣是我們心中的英雄。與此同時，我們也必須認識到，全球民眾為抗擊疫情做出了重大犧牲，人們用實際行動再一次向世界證明每一個生命都值得被珍視。
疫情期間，新冠肺炎曲線能夠相對直觀地展示疫情的控制情況，并為國際社會提供了一個易于理解的基準，因此為人們所更多地關(guān)注?？梢钥吹?，借助循證醫(yī)學方法，有些社區(qū)正在逐步壓平曲線，而有些社區(qū)則走上了錯誤的方向。
展望未來，面對尚未控制的疫情和即將到來的流感季，我們需要探究如何才能使感染曲線變得平緩。因此，我們必須重拾急迫感，認識到接種疫苗對挽救生命、節(jié)約資金的重要性，同時，我們還要繼續(xù)齊心協(xié)力推進有效新冠疫苗的研發(fā)工作。
雖然在應(yīng)對傳染病問題時，美國需要堅持科學的嚴謹性，要以實證為準繩，積極采用非藥物干預(yù)措施，但本次疫情太過復(fù)雜，不能僅從一個角度加以思考。要想從新冠疫情中全身而退、為未來塑造一個更好的醫(yī)療衛(wèi)生體系，我們必須解決三個問題：
精神疾患
疫情爆發(fā)前，美國就已經(jīng)存在精神疾病患病率不斷上升的問題，加之心理診所過于分散，導(dǎo)致難以妥善解決人們?nèi)找嬖鲩L的診療需求。如今，受疫情影響，許多地方的就地避難政策已經(jīng)實施了數(shù)月之久，讓美國又陷入了一場精神健康危機的邊緣。
受諸多心理創(chuàng)傷誘因的影響，比如，大量民眾去世、失業(yè)率攀升、經(jīng)濟困難、社交隔離以及對未來的普遍恐懼等，三分之一的美國人報告自己遇到了慢性焦慮問題。令人難過的是，受疲勞工作、工作壓力和精神創(chuàng)傷等因素影響，美國的一線醫(yī)護人員極易產(chǎn)生心理健康問題，有59%的醫(yī)護人員表示，新冠疫情導(dǎo)致其心理健康狀況有所下降。
專家警告稱，精神健康問題或?qū)⒋竺娣e出現(xiàn)，隨之而來的將是藥物濫用、親密伴侶暴力和涉槍自殺案件的上升。缺乏資金支持、被污名化、求診極不方便且分布分散的美國精神衛(wèi)生體系將難以應(yīng)對當前的危機，面對后疫情時代可能出現(xiàn)的精神問題爆發(fā)自然也會顯得捉襟見肘。
慢性病
最近一段時間，美國的醫(yī)院和衛(wèi)生體系幾乎都不得不把所有的醫(yī)療資源投入到新冠肺炎高危病患的救治中。由于實施就地避難政策，許多醫(yī)護人員和社區(qū)衛(wèi)生中心被要求暫停開展常規(guī)的保健隨訪及基本的疾病預(yù)防服務(wù)。許多醫(yī)院和醫(yī)療機構(gòu)因此出現(xiàn)了財務(wù)危機，尤其是當你考慮到美國幾乎所有的醫(yī)療開支都用于慢性疾病和精神疾病時，就會知道這些重要的醫(yī)療資源未來的運營甚至可能都會面臨問題。
由于害怕感染新冠肺炎，許多患者不愿接受慢性病的預(yù)防性治療和管控。疫苗接種和癌癥等慢性疾病篩查也基本陷于停滯，數(shù)百萬人因此面臨罹患傳染病或慢性病的威脅，也可能因此錯過在疾病早期獲得即時診斷的機會。實際上，最近的研究顯示，死于心臟病、中風和糖尿病等慢性疾病的人數(shù)已經(jīng)出現(xiàn)了增加。
健康不公平
疫情爆發(fā)僅數(shù)月之后，近一半美國家庭失去了收入，這一情況在低收入群體和少數(shù)族裔群體尤為突出。新冠疫情還暴露了美國衛(wèi)生體系由來已久且異常嚴重的健康不公平問題。醫(yī)療資源的不足對少數(shù)族裔社區(qū)的影響尤為嚴重，其中尤以城市中的黑人群體受害最深。據(jù)新冠疫情追蹤項目與波士頓大學反種族主義研究中心聯(lián)合推出的新冠肺炎各種族數(shù)據(jù)跟蹤器顯示，死于新冠肺炎的黑人（非裔美國人）數(shù)量約為一般大眾的近兩倍之多。
這場危機隨之又進一步拉大了黑人團體內(nèi)部的貧富差距。這一點我們從失業(yè)率的對比中能清楚看出：當前，全美的平均失業(yè)率為11.1%，而黑人勞工的失業(yè)率則仍然維持在15.4%的高位。新冠疫情讓貧富差距進一步拉大，讓健康不公平問題進一步惡化。越來越多的人意識到，結(jié)構(gòu)化的種族主義是健康不公平危機的罪魁禍首之一。在意識到這一不公的同時，也有許多人開始行動起來，希望能夠切實解決這一問題。
四管齊下
因此，我們必須通力合作，燃放新的活力，借助科學與合作以一種整合策略同時解決傳染病（以新冠疫情為重點）、精神疾患、慢性病和健康不公平等四大問題。否則弱勢群體將面臨更大風險，我們的醫(yī)療衛(wèi)生體系也將背上更大負擔。
歷史一再證明，我們可以在危機中浴火重生。只要能夠找對目標，加上整個醫(yī)療衛(wèi)生體系的通力合作，我相信危機之后我們將變得更強大。我們必須對美國的衛(wèi)生與經(jīng)濟體系進行改革，為全球民眾，尤其是最弱勢群體打造一個更加公平的未來。（財富中文網(wǎng)）
作者Kyu Rhee是初級保健醫(yī)生、公共政策碩士、IBM副總裁兼首席衛(wèi)生官。
譯者：Feb
新冠疫情讓每個人都深受其害，其中以弱勢群體受影響最為嚴重。激增的醫(yī)療需求讓美國衛(wèi)生系統(tǒng)的脆弱性暴露無遺，也讓我們看到了社會不平等、結(jié)構(gòu)性種族主義和健康不公平造成的深遠影響。
許多充滿英雄主義精神的普通人甘冒風險奮戰(zhàn)在抗疫一線，其中既有一線的醫(yī)護、急救人員，也有那些為保障關(guān)鍵服務(wù)正常運行而奮不顧身的人。那些為尋找有效疫苗和治療方法而拼命工作的科學家也一樣是我們心中的英雄。與此同時，我們也必須認識到，全球民眾為抗擊疫情做出了重大犧牲，人們用實際行動再一次向世界證明每一個生命都值得被珍視。
疫情期間，新冠肺炎曲線能夠相對直觀地展示疫情的控制情況，并為國際社會提供了一個易于理解的基準，因此為人們所更多地關(guān)注。可以看到，借助循證醫(yī)學方法，有些社區(qū)正在逐步壓平曲線，而有些社區(qū)則走上了錯誤的方向。
展望未來，面對尚未控制的疫情和即將到來的流感季，我們需要探究如何才能使感染曲線變得平緩。因此，我們必須重拾急迫感，認識到接種疫苗對挽救生命、節(jié)約資金的重要性，同時，我們還要繼續(xù)齊心協(xié)力推進有效新冠疫苗的研發(fā)工作。
雖然在應(yīng)對傳染病問題時，美國需要堅持科學的嚴謹性，要以實證為準繩，積極采用非藥物干預(yù)措施，但本次疫情太過復(fù)雜，不能僅從一個角度加以思考。要想從新冠疫情中全身而退、為未來塑造一個更好的醫(yī)療衛(wèi)生體系，我們必須解決三個問題：
精神疾患
疫情爆發(fā)前，美國就已經(jīng)存在精神疾病患病率不斷上升的問題，加之心理診所過于分散，導(dǎo)致難以妥善解決人們?nèi)找嬖鲩L的診療需求。如今，受疫情影響，許多地方的就地避難政策已經(jīng)實施了數(shù)月之久，讓美國又陷入了一場精神健康危機的邊緣。
受諸多心理創(chuàng)傷誘因的影響，比如，大量民眾去世、失業(yè)率攀升、經(jīng)濟困難、社交隔離以及對未來的普遍恐懼等，三分之一的美國人報告自己遇到了慢性焦慮問題。令人難過的是，受疲勞工作、工作壓力和精神創(chuàng)傷等因素影響，美國的一線醫(yī)護人員極易產(chǎn)生心理健康問題，有59%的醫(yī)護人員表示，新冠疫情導(dǎo)致其心理健康狀況有所下降。
專家警告稱，精神健康問題或?qū)⒋竺娣e出現(xiàn)，隨之而來的將是藥物濫用、親密伴侶暴力和涉槍自殺案件的上升。缺乏資金支持、被污名化、求診極不方便且分布分散的美國精神衛(wèi)生體系將難以應(yīng)對當前的危機，面對后疫情時代可能出現(xiàn)的精神問題爆發(fā)自然也會顯得捉襟見肘。
慢性病
最近一段時間，美國的醫(yī)院和衛(wèi)生體系幾乎都不得不把所有的醫(yī)療資源投入到新冠肺炎高危病患的救治中。由于實施就地避難政策，許多醫(yī)護人員和社區(qū)衛(wèi)生中心被要求暫停開展常規(guī)的保健隨訪及基本的疾病預(yù)防服務(wù)。許多醫(yī)院和醫(yī)療機構(gòu)因此出現(xiàn)了財務(wù)危機，尤其是當你考慮到美國幾乎所有的醫(yī)療開支都用于慢性疾病和精神疾病時，就會知道這些重要的醫(yī)療資源未來的運營甚至可能都會面臨問題。
由于害怕感染新冠肺炎，許多患者不愿接受慢性病的預(yù)防性治療和管控。疫苗接種和癌癥等慢性疾病篩查也基本陷于停滯，數(shù)百萬人因此面臨罹患傳染病或慢性病的威脅，也可能因此錯過在疾病早期獲得即時診斷的機會。實際上，最近的研究顯示，死于心臟病、中風和糖尿病等慢性疾病的人數(shù)已經(jīng)出現(xiàn)了增加。
健康不公平
疫情爆發(fā)僅數(shù)月之后，近一半美國家庭失去了收入，這一情況在低收入群體和少數(shù)族裔群體尤為突出。新冠疫情還暴露了美國衛(wèi)生體系由來已久且異常嚴重的健康不公平問題。醫(yī)療資源的不足對少數(shù)族裔社區(qū)的影響尤為嚴重，其中尤以城市中的黑人群體受害最深。據(jù)新冠疫情追蹤項目與波士頓大學反種族主義研究中心聯(lián)合推出的新冠肺炎各種族數(shù)據(jù)跟蹤器顯示，死于新冠肺炎的黑人（非裔美國人）數(shù)量約為一般大眾的近兩倍之多。
這場危機隨之又進一步拉大了黑人團體內(nèi)部的貧富差距。這一點我們從失業(yè)率的對比中能清楚看出：當前，全美的平均失業(yè)率為11.1%，而黑人勞工的失業(yè)率則仍然維持在15.4%的高位。新冠疫情讓貧富差距進一步拉大，讓健康不公平問題進一步惡化。越來越多的人意識到，結(jié)構(gòu)化的種族主義是健康不公平危機的罪魁禍首之一。在意識到這一不公的同時，也有許多人開始行動起來，希望能夠切實解決這一問題。
四管齊下
因此，我們必須通力合作，燃放新的活力，借助科學與合作以一種整合策略同時解決傳染?。ㄒ孕鹿谝咔闉橹攸c）、精神疾患、慢性病和健康不公平等四大問題。否則弱勢群體將面臨更大風險，我們的醫(yī)療衛(wèi)生體系也將背上更大負擔。
歷史一再證明，我們可以在危機中浴火重生。只要能夠找對目標，加上整個醫(yī)療衛(wèi)生體系的通力合作，我相信危機之后我們將變得更強大。我們必須對美國的衛(wèi)生與經(jīng)濟體系進行改革，為全球民眾，尤其是最弱勢群體打造一個更加公平的未來。（財富中文網(wǎng)）
Kyu Rhee, a primary-care physician and master of public policy, is vice president and chief health officer at IBM. 作者Kyu Rhee是初級保健醫(yī)生、公共政策碩士、IBM副總裁兼首席衛(wèi)生官。
譯者：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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