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全球扶贫,应该从这个方面入手

Clifton Leaf 2018年09月24日

2000年以来有10亿人口摆脱了贫困,但其中3/4都来自中国和印度,对其他国家的穷人该怎么办?

几十年来,埃塞俄比亚人民在这片土地上似乎经历着无穷无尽的贫困,人道主义危机接踵而至。1973年至1974年间,干旱引发的饥荒大约造成了30万人死亡。1980年代中期,又经历了一场更加严重的饥荒,死亡人数是上一次的两倍之多。在1990至2000年间的第三次饥荒中,饿死的人比上一次还要多数万人。

但是从此之后,埃塞俄比亚大步向前,大力发展经济,同时注重打造同样重要的社会综合安全网络,比尔和梅琳达盖茨基金会称埃塞俄比亚正处在正确的发展道路上,“2050年前几乎可以消除赤贫”。

卢旺达在20多年前因为种族大屠杀致使国家分崩离析。在这段恐怖经历后,该国政府一直高度重视对少年儿童的保护,大力投资于医疗卫生事业,包括加倍投放疫苗,广泛开展社区卫生员项目。取得的成就:2000年至2015年,5岁以下儿童的死亡率以创纪录的速度快速下降。

越南的人均GDP只有美国的1/25,但越南15岁的学生在国际数学和科学考试中成绩远超美国和大部分欧洲同龄人。为什么?同样的,其中一个原因是投资。根据世界银行的数据,越南近6%的GDP用于教育。(美国为约5%。)

9月18日,比尔和梅琳达·盖茨撰写的《目标守卫者2018年数据报告》(Goalkeepers 2018 Data Report)发布,报告突显了上述三个国家的惊人成就。报告在华盛顿大学健康指标和评估研究所的协助下完成,对联合国17个可持续发展目标的当前进度进行了评估,结果却无法让人高枕无忧。每一个看似令人欣慰的数字都伴随着一个令人担忧的数字。在全球对抗贫困和疾病的战役中,每一个前景喜人的进步都可能因为我们减少关注或投入导致危机。

“我欣赏今年《目标守卫者》报告的精确性,报告精准关注确实取得进步的国家和仍然需要进步的国家,”盖茨基金会CEO 苏·德斯蒙德博士说,她自2013年担任基金会CEO,之前是顶尖的癌症研究专家、生物科技领域高管以及加利福尼亚大学校长。“2000年以来有10亿人口摆脱了贫困,这是惊人的进步。但如果你看看其中的数据,3/4都来自中国和印度,”她说。

结果是全球剩余的贫困人口主要集中在一个地方:非洲。如果当前的人口变化和经济发展趋势保持不变,未来情况还会更糟。到2050年,世界上86%的极度贫困人口(每天平均生存费用为1.9美金)将生活在撒哈拉以南非洲。而且其中近一半的人口将集中在两个国家:刚果(金)和尼日利亚。

这就是报告中指出的二元论。“未来的希望是:如果你投资健康、投资教育,情况就会好转,”德斯蒙德-赫尔曼说。如果我们把亚洲大部分地区和印度的成功战略用于非洲,我们能迎来“撒哈拉以南非洲的第三次脱贫浪潮,会赋予一批人技能和机遇。可能存在的危险时:如果上述愿景没有实现,非洲年轻人(非洲人口的60%都在25岁以下)将失去机会,在不平等中挣扎。”

如果第二种情况不幸成真,那就是滋生不稳定、暴力和大规模移民的温床,而且,正如现在中非战乱地区埃博拉持续肆虐,全球性健康威胁也可能在这张温床上生根发芽。然而盖茨夫妇在报告中弱化了这种担忧,他们认为有一个强有力的理由驱使人们采取行动——因为这是个投资案例:是一个利用“年轻人的无穷潜力来驱动增长”的好机会。他们在报告中写道,非洲年轻人“是未来的活动家、创新者、领导者和劳动者。”

关于如何挖掘这个人力资源宝库,他们计划主要聚焦在以下四个主要领域。

投资健康

盖茨基金会的首要关注是解决发展中国家面临的主要健康问题,包括疟原虫疟疾、HIV、肺结核、肺炎以及仍然导致许多孩子生病甚至死亡的腹泻疾病。基金会未来的部分核心战略仍将与之前保持一致:疫苗,这是在公共卫生领域最“一本万利”的投资,德斯蒙德-赫尔曼说。“疫苗和蚊帐(防止受到携带疟疾的蚊子叮咬)是政府可以保护儿童的低成本方式。”(仅蚊帐就可以防止超过5亿起疟疾的发生。)“我们基金会可以和这些国家的政府合作,劝说他们的卫生部长和财政部长,告诉他们这项投资回报丰厚,”她说。

在健康领域,创新十分关键。轮状病毒是导致腹泻的主要病毒,目前因为默克集团和葛兰素史克制造的疫苗得到了预防。如果默克集团正在测试的一种新疫苗证明有效,埃博拉也能得到预防。“你可能会说,‘我为什么要关心刚果(金)?我为什么要关心尼日利亚?’埃博拉再次提醒我们,世界上任何地方的健康危机都可能成为全球性危机,”德斯蒙德-赫尔曼说。“而且这种疫苗的面世,得益于私营部门的直接投资。”

For decades, Ethiopia was a land of seemingly unending poverty, beset by one humanitarian crisis after another. A drought-induced famine in 1973–74 was estimated to have left 300,000 dead. A still greater famine, in the mid-1980s, killed twice as many. A third, in 1990–2000, starved tens of thousands more.

Since then, however, Ethiopia has made such remarkable strides in growing its economy—and just as important, in building a comprehensive social safety net—that the Bill & Melinda Gates Foundation now says it’s on track to “almost eliminate extreme poverty by 2050.”

Rwanda, a country torn apart by genocide barely a generation ago, has spent the years since that horror protecting its current generation of children by investing in health care—doubling down on vaccination efforts and supporting a widespread community health worker program. The result: Between 2000 and 2015, the mortality rate of kids under 5 fell at a record pace.

Fifteen-year-old students in Vietnam, a country where per capita GDP is less than 1/25th what it is in the United States, sharply outperform their American and most European counterparts on international math and science tests. Why? One reason, again, is investment. Vietnam spends nearly 6% of its GDP on education, according to the World Bank. (The U.S. spends about 5%.)

All three of these surprising achievements are highlighted in the Goalkeepers 2018 Data Report, written by Bill and Melinda Gates and released on Sept. 18. But the dispatch—an assessment of the progress made so far on the United Nations’ 17 Sustainable Development Goals and done with the help of the University of Washington’s Institute for Health Metrics and Evaluation—is anything but rah-rah. For every encouraging data point, indeed, there is one that alarms. For every promising advance in the global war on poverty and disease is a perilous outcome if we lose focus or steam.

“What I like about this year’s ¬Goalkeepers report is that it’s precise, ¬homing in on countries where there has been genuine progress as well as the places where it still needs to happen,” says Dr. Sue Desmond-Hellmann, who was a leading cancer researcher, a biotech executive, and the chancellor of the University of California, San Francisco, before becoming CEO of the Gates Foundation in 2013. “It’s fantastic that a billion people, for example, have lifted themselves out of poverty since 2000—that’s just astounding. But if you look at the numbers, three-quarters have been in China and India,” she says.

The result is a concentration of the planet’s remaining poor largely in one place: Africa. And if the current population and economic trends hold, it’s going to get worse. By 2050, 86% of the world’s extreme poor—those surviving on the equivalent of $1.90 a day—will be living in sub-Saharan Africa. Close to half of this total, moreover, will reside in just two countries: the Democratic Republic of the Congo (DRC) and Nigeria.

Which brings us back to that Janus-like dualism in the report. “The promise is, if you invest in health, if you invest in education, great things happen,” says Desmond-Hellmann. If we apply the same strategy that worked in much of Asia and India, we could have “a third wave of poverty reduction in sub-¬Saharan Africa, another wave of empowered people and opportunity. The peril is, if it doesn’t happen, you’re going to have African youth [nearly 60% of the continent’s population is under the age of 25] who won’t have that opportunity and who will struggle with inequality.”

The latter environment is a petri dish for instability, violence, mass migration, and—as we’re seeing now with a continuing outbreak of deadly Ebola in a war-torn region of Central Africa—a potential threat to global health as well. In their report, however, Bill and Melinda Gates de-emphasize such concerns in favor of what they see as a more compelling reason for action—an investment case: a chance to harness “young people’s enormous potential to drive growth.” Africa’s youth, they write, “are the activists, innovators, leaders, and workers of the future.”

Their blueprint for tapping into this giant reservoir of human capital focuses on four key areas.

Invest in health

The Gates Foundation’s primary focus is tackling the major health challenges of the developing world—eradicating malaria, HIV, tuberculosis, pneumonia, and the diarrheal diseases that still sicken and kill many children, despite the enormous progress that’s been made so far in preventing infections. A central part of the strategy going forward is the same as it has been until now: vaccination—which offers “the greatest bang for the buck” in public health, Desmond-Hellmann says. “Vaccines and bed nets [to prevent bites from malaria-carrying mosquitoes] are low-cost ways that governments can protect their children.” (Bed nets alone have prevented more than 500 million cases of malaria.) “We, as a foundation, can work with those governments—we can talk to the Minister of Health and the Minister of Finance about the wonderful returns on investment,” she says.

Innovation here is critical. Rotavirus, a major cause of diarrhea, is preventable now because of vaccines made by Merck and GSK. Ebola may well be, too, if a new experimental Merck vaccine, now being tested, proves to be effective. “You might say, ‘Why do I care about DRC? Why do I care about Nigeria?’ Well, Ebola reminds us again that a health crisis anywhere is a health crisis everywhere,” says Desmond-Hellmann. “And having the vaccine available is a direct result of investment by the private sector.”

图:2016年NTD(热带疾病)和疟疾发病率最高的国家(每1000人中至少100起)
疟疾:每年全球新增数  NTD:全球患病率

投资教育

盖茨基金会的CEO说,“通过投资教育,越南过去25年的GDP增长率超300%。”但是投资回报不仅仅体现在经济上。“决定儿童健康状况的一个重要因素是母亲的受教育水平,”她说。“如果投资教育,尤其是如果能让教育同时惠及男孩和女孩——我们高兴的看到世界大多数地区在男女教育平等上做出了努力,也是在投资这些女孩成为年轻母亲时的未来,投资她们孩子的健康。”

投资卫生

许多慈善家都把自己的目标定为提供清洁水源。盖茨基金会将关注点放在了健康领域的另外一个重要因素上:卫生。正如德斯蒙德-赫尔曼所说:“我们的其中一项原则是做别人做不到或者不愿意做的事。”

基金会“投资修建了很多厕所,特别是在印度,因为印度有一项为全体人民提供安全厕所的大型全国性项目,”她说。另外一个关注点是帮助没有污水管道系统(也没钱修建)的社区采用一种相对便宜的应对方法,该系统称为“污泥管理”,可以对污水进行运输、干燥和处理。

Invest in education

“Vietnam,” says the Gates Foundation CEO, “drove their gross domestic product growth 300-plus percent over 25 years by investing in education.” But the ROI here isn’t just economic. “One of the strongest determinants of a child’s health is the educational status of his or her mom,” the CEO says. “And so when you invest in education—and particularly include both boys and girls, which most of the world happily does now—you’re investing in the future of those young women as mothers, too, as well as in the health of their children.”

Invest in sanitation

Many philanthropies have made providing access to clean water their goal. The Gates Foundation is turning its attention to another social determinant of health: sanitation. Says Desmond-¬Hellmann: “It’s part of our theme that we’ll do things that others can’t or won’t.”

The foundation has “made a lot of investments in toilets, particularly in India, which has a massive national program to have safe toilets for all their citizens,” she says. Another focus is helping communities that don’t have a sewer system (and can’t afford to build one) to leapfrog into a less expensive approach called “fecal sludge management”—a system that safely transports, dries, and treats the waste.

图:2016年HIV/艾滋病和肺结核发病率最高的国家(每1000人中至少2起)
HIV:每年全球新增数  肺结核:每年全球新增数

支持计划生育

快速的人口增长导致贫困地区更难打破贫困的锁链。根据《目标守卫者2018年数据报告》,非洲的贫困率哪怕下降一半,贫困人口的数量也将保持不变,因为2050年地区总人口数预计几乎要翻一番。

德斯蒙德-赫尔曼称,基金会的目标十分简单:确保每一位想避孕的女性都能自主避孕。“我们的理念是,女性应该能够决定她想生几个孩子,决定想和谁一起生孩子。对于我而言,这是赋予女性权利,而非殖民主义。”(财富中文网)

译者:Agtha 

Support family planning

Rapid population growth makes it harder for regions to break the chains of poverty. In Africa, even a 50% reduction in the poverty rate would leave the number of poor people essentially the same because the population is projected to nearly double by 2050, the Goalkeepers 2018 Data Report points out.

Desmond-Hellmann says the foundation’s aim is simple: making sure that every woman who wants contraception can get it. “Our philosophy is that a woman should be able to have the number of children she wants and with whom she wants. And that is, for me, female empowerment, not colonialism.”

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