[2007.02.07] How to save a billion lives 如何挽救10亿生命

by yizhongren

Smoking
吸烟

How to save a billion lives
如何挽救10亿生命

Feb 7th 2008 | NEW YORK
From The Economist print edition
A war against the weed spreads and escalates, though the odds are unequal
反烟斗争：扩散升级，胜算不一。

（图片来源：Panos）

EVEN more than tempting liquors like tequila, tobacco is a pleasure that the Old World wishes it had never taken from the New. In 1492, when Christopher Columbus was met by tribesmen with “fruit, wooden spears and certain dried leaves which gave off a distinct fragrance”, he threw the last gift away. But his shipmates brought home the custom of sucking in the smoke, and the taste spread so rapidly that in 1604 King James I of England was prompted to issue a denunciation of the “manifold abuses of this vile custome”.
烟草，比烈性龙舌兰酒更诱人，但是东半球多么希望它从来没有从美洲引入这一享受。1492年，克里斯托弗·哥伦布 (Christopher Columbus）登上新大陆，当地部落族人把散发独特香味的果子、木剑和干叶子”赠予他，他把那些干叶子统统扔掉了。但他的船员们把吸烟的习惯带回了家，这一风气流传得非常迅速促使1604年英王詹姆士一世（King James I ）对“各种形式的放纵这种恶习”发表谴责。

Vile indeed, but habit-forming and therefore lethally dangerous: it cuts short the lives of between a third and half of its practitioners. According to the World Health Organisation (WHO), perhaps 100m people died prematurely during the 20th century as a result of tobacco, making it the leading preventable cause of death and one of the top killers overall. Another 1 billion more may die from it in this century if current trends continue unchecked.
吸烟有百害而无一利，但却容易成瘾，因此危害是致命的：吸烟者中三分之一到一半的人寿命缩短。根据世界卫生组织 （WHO）的估计，20世纪可能有1亿人因吸烟而早亡，使吸烟成为一个主要的却是可以避免的死亡因素，成为人类健康一大杀手。

In recent years smoking has been sharply restricted in some unlikely places. In 2004 Ireland amazed the world by successfully imposing a tobacco ban on all workplaces; and at the start of this year, France’s café culture suddenly went smoke-free. The draconian curbs introduced by California in 1998 have been followed, at least in part, by well over half America’s states. But the number of smokers in China, India and other developing countries is continuing to grow, as addiction spreads faster than information.
近年来，在一些看似不太可能的地方，吸烟却遭受着严厉的限制。2004年，爱尔兰成功地在所有工作区域禁烟，让整个世界眼前一亮；2008年伊始，法国的咖啡馆突然成了无烟区。1998年美国加利福尼亚州大刀阔斧的控烟行动得到美国过半数的州纷纷响应，不是全部照搬也至少是部分效法。但是，中国、印度和其他发展中国家，烟草比信息传播得还快，烟民数量正持续增长。

Hence the determination of almost everybody involved in global public health to escalate the war on smoking. Over 150 countries have already ratified the Framework Convention on Tobacco Control, which requires countries to take a range of anti-smoking measures. Last July negotiators agreed on international norms for banning smoking in public places. Next week they meet in Geneva to discuss a protocol on tobacco smuggling.

由此可见，几乎每一个致力于全球公共健康的人都决心加大禁烟力度。已有150多个国家通过了《烟草控制框架公约》（Framework Convention on Tobacco Control）。该公约要求缔约国采取一系列反吸烟措施。去年7月，各国谈判代表就在公共场所禁烟的国际准则达成一致。下周他们将在日内瓦讨论打击烟草走私的公约。

In addition to new international rules, the WHO is pushing for aggressive policies at the national and local levels. On February 7th Margaret Chan, the WHO’s director-general, and Michael Bloomberg, New York’s zealously anti-smoking mayor, were due to unveil the most comprehensive survey of tobacco use ever carried out. The venue was fitting. Tom Frieden, the city’s health commissioner, notes that the mayor’s efforts have reduced smoking among the adults in New York by 20% and among teenagers in public schools by 50%. Mr Bloomberg’s private charity, which supports many anti-smoking efforts worldwide, also funded the global survey, known as MPOWER.
除了新的国际准则外，世界卫生组织正在推动更加严厉的政策在国家和地区层面执行。2月7日，总干事陈冯富珍（Margaret Chan）和热心 反烟的纽约市长迈克尔·布隆伯格（Michael Bloomberg）将发布有史以来最全面的烟草消费调查报告。选择纽约发布反烟报告再合适不过了。纽约市卫生局长汤姆·弗里登（Tom Frieden）说，市长的努力使纽约成人吸烟率下降了20%， 公共学校就读的未成年人吸烟率降低了50%。布隆伯格用个人慈善基金资助世界各地的反烟行动，也赞助了这次名为“MPOWER”的全球调查。

The study is “a call to action to avoid a public-health catastrophe”, says Douglas Bettcher, head of the Tobacco Free Initiative at the WHO. The report lists the anti-smoking efforts of countries worldwide, offering benchmarks for aspiring reformers. What the survey shows, says Dr Bettcher, is that most countries have yet to implement even those policies that are proven to work.
世界卫生组织无烟草行动负责人道格拉斯·贝彻（Douglas Bettcher）称这个调查“呼吁采取行动，以避免公共卫生灾难”。 该报告列举了世界各国为禁烟所做的努力，为雄心勃勃的改革者提供了基准。贝彻说这个报告显示出，甚至那些已证明有效的政策在大多数国家也还没有得到执行。

The WHO says countries must do six related things. The first is to improve the quality of data on tobacco use. The second is to impose sweeping Irish-style smoking bans; only 5% of the global population is now covered by such curbs. The third is to intensify efforts to induce and assist smokers to drop the habit. Only nine countries offer the kind of well-funded, accessible programmes of which the WHO approves.
世界卫生组织称各国必须执行六项方针。第一，改进对烟草消费的数据统计。第二，实行爱尔兰式的全面禁烟；类似控烟措施仅保护了全球5%的人口。 第三， 加大努力说服并协助吸烟者戒烟。只有9个国家设有世界卫生组织认可的资金充足且操作性强的项目。

Those ideas concern the existing users of tobacco; another three are aimed at persuading people not to light up in the first place. It may be hard to believe, but the WHO insists that most smokers still do not understand the full extent of the health risks. It wants all countries to mandate large, grotesque pictorial warnings on cigarette packets. Another policy proven to work (in the handful of countries, representing 5% of the world’s population, to have tried it) is a complete ban on marketing. The agency is adamant that “partial bans on tobacco advertising, promotion and sponsorship do not work.”
这三项方针都涉及到现有烟民；另外三项方针旨在劝说人们从一开始就远离烟草。如果说大多数的吸烟者仍未完全了解吸烟对健康的危害，我们也许很难相信，但是世界卫生组织坚持这样认为。世卫组织希望所有国家在香烟包装上强制性地使用显著且丑化的警告图示。另外一项行之有效的政策（在人口总数占世界5%的一些国家中已经进行了尝试）是全面禁止香烟广告和促销。世卫组织坚定地认为“只片面地禁止香烟广告、促销和赞助的根本不管用”。

The final prescription offered by the WHO is also the most powerful one: higher taxes. Studies show that raising tobacco taxes by a tenth may cause a 4% drop in consumption in rich countries and an 8% drop in poor ones, with tax revenue rising despite lower sales. The agency wants a 70% increase in the retail price of tobacco, which it says could prevent up to a quarter of all tobacco-related deaths worldwide. The claim is that higher taxes not only bring in revenue to fund anti-smoking efforts; they actually benefit the poor.
世卫组织开出的最后一副药方也是最强有力的：提高烟草税。研究表明，在发达国家，烟草税提高10%可以使烟草消费降低4%，在经济过后国家则降低8%，销量虽然减少，但是总税收仍然增加。世卫组织建议将香烟零售价提高70%，称这样可使全球与吸烟有关的死亡降低四分之一。高税收不仅能为反烟行动提供资金；实际上越没钱越能从中受益。

How come? A forthcoming paper by two scholars (Jonathan Gruber of the Massachusetts Institute of Technology and Botond Koszegi of the University of California) notes that smokers face a familiar choice between short-term pleasure and a long-term desire to quit. Tobacco taxes are an incentive to make the right choice, and because the poor are price-sensitive, they benefit the most. Indeed, the authors calculate that in the United States, “the monetary value of the health damage from a pack of cigarettes is over $35 for the average smoker, implying both that optimal taxes should be very large and that cigarette taxes are likely progressive.”
怎么会呢？两位学者（麻省理工大学的Jonathan Gruber 和加利福尼亚大学的Botond Koszegi）即将发表的研究论文指出，要在短暂的快感和戒烟的长期向往之间抉择，这对吸烟者来说已是老生常谈。 烟草税是让他们做出正确选择的动力，而且由于穷人对价格变动更加敏感，他们是最大的受益者。 实际上，两位学者经过计算，在美国“平均起来， 一包烟对每个吸烟者的健康危害相当于35美元多的花费，由此引申出最佳的税收应该定的很高才对，而且烟草税应采用累加税率。”

The practical argument for action is simpler: the tobacco industry is getting the world’s poor hooked before governments can respond. In recent years, as rich countries have clamped down on smoking, tobacco firms have shifted their focus to poorer places. A study by Britain’s Bath University found that by using aggressive tactics, such as targeting women, international tobacco firms had helped to double smoking rates in Russia since 1991.
有一个很简单的论断可以支持上述做法：烟草业已经在各国政府能做出回应之前牢牢地拴住了穷人的口袋。近年来，随着发达国家遏制吸烟，烟草厂商已经把焦点转向了贫穷地区。英国巴斯大学（Bath University）一项研究表明发现，跨国烟草公司攻击性的策略，例如瞄准女性消费者，已导致俄罗斯目前的吸烟率比1991年翻了一番。

The tobacco industry is regrouping in order to focus on “promising” markets and escape the pesky lawsuits it is likely to face in rich, litigious countries. For example, Altria, a global tobacco concern based in the United States, plans to spin off Philip Morris International as a stand-alone foreign entity in late March. China is now home to more than a quarter of the world’s smokers; it will soon be manufacturing Marlboro cigarettes for Philip Morris, and the firm will be exporting Chinese tobacco to other countries.
烟草业正在重组以在“新兴”市场集中火力并且避免在经济发达、法制化程度高的国家惹来麻烦的官司。例如，全球关注的烟草巨头美国阿尔特里亚
(Altria)集团计划在3月底将子公司菲利普·莫里斯国际公司 （Philip Morris International） 剥离出去使之获得独立地位在国外运营。目前中国的烟民数量占全世界的四分之一；不久中国将为菲利普莫里斯生产万宝路（Marlboro）香烟，而且该公司还会将中国产的香烟出口到其他国家。

At times, the strategy used by public-health campaigners may seem heavy-handed; they retort that nothing else can work against a rich adversary. Indeed, Dr Bettcher argues that just as mosquitoes convey malaria, Big Tobacco is the “vector spreading this epidemic”. And eradicating tobacco may prove every bit as hard as fighting insect-borne disease.
很多时候， 公共卫生活动家所采用的战略看似残酷；他们反驳说，要与一个富有的对手抗衡，没有任何其他办法。的确，贝彻博士解释道，就像蚊子传播疟疾一样，烟草业就是“吸烟流行病的传染源”。铲除烟草会像防治昆虫传染病一样，点点滴滴都很艰辛。