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新冠病毒与经济不平等:一种恶性循环
As Coronavirus Deepens Inequality, Inequality Worsens Its Spread

来源:纽约时报    2020-03-17 11:54



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        As the coronavirus spreads across the globe, it appears to be setting off a devastating feedback loop with another of the gravest forces of our time: economic inequality.        随着新型冠状病毒在全球蔓延,它似乎正在与我们这个时代的另一个最严峻问题——经济不平等——形成一种毁灭性的反馈圈。
        In societies where the virus hits, it is deepening the consequences of inequality, pushing many of the burdens onto the losers of today’s polarized economies and labor markets. Research suggests that those in lower economic strata are likelier to catch the disease.        在病毒肆虐的社会中,新冠病毒正在带来加深不平等的后果,将许多负担推到在如今两极分化的经济和劳动力市场中处于不利地位的人身上。研究表明,那些处于较低经济阶层的人更有可能感染这种疾病。
        They are also likelier to die from it. And, even for those who remain healthy, they are likelier to suffer loss of income or health care as a result of quarantines and other measures, potentially on a sweeping scale.        他们也更有可能死于这种疾病。而且,即使对那些保住了健康的底层人来说,他们也更有可能因为隔离和其他措施而遭受收入损失或失去医疗保障,这种影响可能是大范围的。
        At the same time, inequality itself may be acting as a multiplier on the coronavirus’s spread and deadliness. Research on influenza has found that in an epidemic, poverty and inequality can exacerbate rates of transmission and mortality for everyone.        与此同时,不平等本身可能会对新冠病毒的传播和致命性产生倍数效应。对流感的研究发现,疾病流行时,贫困和不平等可能会加剧疾病的传播速度和死亡率,影响到每个人。
        This mutually reinforcing cycle, experts warn, may be raising the toll of the virus as it widens the socioeconomic divides that are thought to be major drivers of right-wing populism, racial animosity and deaths of despair — those resulting from alcoholism, suicide or drug overdoses.        专家警告,这种相互强化的循环可能会增加新冠病毒造成的死亡,同时让社会经济的鸿沟进一步扩大,人们认为这种鸿沟是右翼民粹主义、种族仇恨,以及绝望导致酗酒、自杀或吸毒过量造成的死亡增长的主要驱动因素。
        “These things are so interconnected,” said Nicole Errett, a public health expert who co-directs a center on extreme event resilience at the University of Washington. “Preexisting social vulnerabilities only get worse following a disaster, and this is such a perfect example of that.”        “这些事情有很大的相互关联,”华盛顿大学(University of Washington)公共卫生专家尼科尔·埃里特(Nicole Errett)说,她是一个研究极端事件发生时社会韧性的中心的联合主任。“一场灾难过后,原有的社会脆弱性只会变得更糟,这次疫情就是一个完美例子。”
        Because each low-income family forced to accept a higher risk of exposure can infect others, she added, the consequences of inequality, while most obviously felt by the poor, “put the broader society at risk.”        她补充说,由于每个被迫接受更高暴露风险的低收入家庭都存在感染他人的可能,尽管穷人对不平等的后果有最明显的感受,但这些后果“将更广泛的社会置于危险之中”。
        How Inequality Worsens the Coronavirus        不平等如何加剧新冠病毒疫情
        Two major risk factors are thought to make the coronavirus deadlier for those who catch it: old age and preexisting health conditions.        人们认为两个主要的危险因素让新冠病毒感染者有更高的死亡率:年纪大以及存在基础病。
        But a body of research points to a third: low socioeconomic status.        但大量研究指出,还存在第三个因素:社会经济地位低下。
        Even for those well above the poverty line, studies find that low income relative to the rest of society is associated with higher rates of chronic health conditions such as diabetes or heart disease.        研究发现,即使对那些生活水平远高于贫困线的人来说,相对于社会其他阶层,低收入与糖尿病或心脏病等慢性病的更高发病率有关。
        This has not always been the case. As inequality has risen, health disparities have widened. Preventive care and health education have steadily tilted toward the educated and the well-off.        情况并不总是这样。随着不平等的加剧,健康差距也在拉大。预防保健和健康教育一直在逐渐向高学历和富裕阶层倾斜。
        As a result, people at the lower ends of society are about 10% likelier to have a chronic health condition.        结果是,社会底层的人患慢性疾病的可能性比平均风险高出10%。
        Such conditions can make the coronavirus up to 10 times as deadly, according to recent data from the Chinese Centers for Disease Control and Prevention.        据中国疾病预防控制中心最近的数据,患有慢性疾病能让新冠病毒的致死率比平均值高出10倍。
        Taken together, these two statistics suggest that COVID-19 can be about twice as deadly for those along their society’s lower rungs.        将这两个数据加起来考虑,对生活在社会底层的人来说,新冠病毒肺炎的致死率可能是平均病死率的两倍。
        At the same time, people with lower incomes tend to develop chronic health conditions between five and 15 years earlier in life, research finds.        与此同时,研究发现,收入较低的人患慢性疾病的时间往往比一般人提早5至15年。
        Put another way: Health organizations have said that people older than 70 are at drastically greater risk of dying from the coronavirus.        换句话说,卫生组织已表示,70岁以上的人死于新冠肺炎的风险要大得多。
        But the research on chronic health conditions suggests that the threshold may be as low as age 55 for people of lower socioeconomic status.        但慢性病的流行病学研究表明,对于社会经济地位较低的人来说,这个门槛可能低至55岁。
        Those numbers capture only a sliver of the ways that inequality can make the coronavirus deadlier.        这些数字只反映了不平等能让新冠病毒更致命的一小部分原因。
        In China, many workers are employed informally and so cannot count on social services if they take time off — especially those in service jobs that require regular contact with other people. As a result, the people who can least afford care are often at greatest risk of transmission.        在中国,许多工人非正式就业,所以,如果他们不上班就不能指望得到社会服务,尤其是那些需要经常与其他人接触的服务行业从业者。结果是,那些最负担不起医疗费用的人往往面临着最大的传播风险。
        Government-imposed shutdowns, like those announced by France and Spain this weekend, do come with some worker protections. But small businesses will probably struggle to keep paying employees beyond any guaranteed sick days, particularly those in retail or other sectors that cannot work from home.        法国和西班牙等国这个周末宣布的政府强制停业,确实为工人提供了一些保障。但小企业可能在必须提供的带薪休假福利之后很难继续支付员工工资,尤其是那些无法在家工作的零售或其他行业。
        In Japan, which has some of the lowest inequality of any major economy, people with jobs such as taxi driving enjoy a degree of security that rarely exists in other countries.        日本在所有主要经济体中的不平等程度最低。在那里,从事出租车司机等工作的人所享有的安全保障,高到其他国家几乎不可想像的程度。
        In Italy, in contrast, taxi drivers — already struggling on hourly wages undercut by the rise of ride-hailing services — scour for fares amid the outbreak.        相比之下,意大利的出租车司机在疫情暴发期间仍在四处找活儿。网约车的兴起压低了他们的时薪,已经让出租车司机的生活陷入困境。
        “I have got a mortgage, bills and groceries to pay,” said Andrea Arcangeli, a taxi driver and father of two from Rome. “I can’t stay home.”        “我有房贷要还,有账单要付,还得买吃的东西,”家住罗马的出租车司机安德列亚·阿尔坎杰利(Andrea Arcangeli)说,他是两个孩子的父亲。“我不能呆在家里。”
        He said he had made only 18 euros — about $20 — in a day’s work.        他说,他工作了一天只挣了18欧元(约合140元人民币)。
        At the Nihonjo Taxi Company in Osaka, Japan, cabbies have a modest guaranteed monthly income, and the president, Atsunori Sakamoto, said he is selling off assets before letting drivers go.        日本大阪的日本城计程车株式会社(Nihonjo Taxi Company)的出租车司机每月有不高的基本收入保障,社长坂本笃纪(Atsunori Sakamoto)说,他正在出售资产,之后才会考虑解雇司机。
        Still, even in Japan, these lower rungs of employment are hit harder than their white-collar counterparts. While office workers telecommute, with little fear of losing their jobs, Sakamoto said that if business does not pick up in a few months, he may have to let drivers go.        尽管如此,即使在日本,这些较低收入的就业阶层受到的冲击仍比白领阶层的要大。坂本笃纪说,办公室职员可以远程办公,而且几乎不用担心失去工作,但如果几个月后出租车生意仍无起色的话,他可能不得不解雇司机。
        How the Coronavirus Worsens Inequality        新冠病毒如何加剧不平等
        When inequality is high, the cost of living tends to rise, forcing more lower-income families to live paycheck to paycheck. At the same time, the decline of labor unions and the rise of part-time work means that low-income workers have fewer protections.        社会不平等程度偏高时,生活成本往往会上升,迫使更多的低收入家庭成为月光族。与此同时,工会的衰落和兼职工作的兴起意味着,低收入工人得到的保障更少。
        As a result, crises like the coronavirus can deepen the gap between the haves and have-nots.        结果是,新冠病毒这样的危机会加深贫富之间的差距。
        Lara Fulciniti, a waitress in a suburb of Milan, was barely covering her mortgage and car payments before the epidemic hit. As hourly work evaporates, she has fallen behind.        米兰郊区的女服务员拉拉·富尔奇尼蒂(Lara Fulciniti)在疫情暴发前只能勉强支付房贷和车贷。随着工作小时数的减少,她已经无力偿还这些贷款。
        “I am not ashamed to say I did not pay my bills this month,” she said. “I had to choose between those and groceries.”        “我毫不羞愧地说,我这个月没有还贷,”她说。“我必须要在还贷和买菜之间做出选择。”
        She fears, even more than catching the coronavirus, that her son’s school will reopen before she gets work, bringing gas and school lunch bills she cannot afford.        她有甚至比感染新冠病毒更大的担心,那就是儿子的学校会在她找到工作之前复课,那会让她需要支付的汽油和学校午餐费超过她所能承担的开销。
        Unequal access to health care in any country makes getting sick especially expensive for the poor.        在任何国家,获得医疗机会的不均等都让生病对穷人来说是更大的负担。
        In the United States, 90% of people whose income is in the top quarter have paid sick leave at work, while only 47% of those in the bottom quarter do.        在美国,收入在前25%的人当中有90%的人可休带薪病假,而收入在后25%的人中只有47%的人可休带薪病假。
        Last year, 26% of Americans deferred health care because they could not afford it, one Gallup poll found. In another survey, 1 in 4 said someone in their family had skipped a doctor-recommended test they could not afford, and 1 in 6 said that someone in their family had skipped prescribed medication.        盖洛普(Gallup)的一项调查发现,去年有26%的美国人因为负担不起医疗费用而推迟了治疗。在另一项调查中,四分之一的受访者说,他们的家人中有人因为支付不起费用而没有做医生建议的检查,六分之一的受访者说,他们的家人中有人选择不买医生开的处方药。
        Health experts fear that these costs will accelerate outbreaks, particularly as stories circulate of four-digit bills for coronavirus testing or treatment.        卫生专家担心,医药费用的问题会加速疫情的暴发,尤其是在关于新冠病毒检测或治疗的费用高达数千美元的报道四处流传的时候。
        This can affect everyone. One U.S. study found that state-mandated sick day policies reduce the spread of an influenza epidemic by up to 40%. Most states have no such policy and could see far more infections as a result.        这会影响到每个人。美国的一项研究发现,有法定带薪病假政策的州,可让流感疫情的传播减少40%。美国的大多数州没有这种政策,结果可能会是更多的感染。
        Labor inequality and poor workplace protections may exacerbate the spread of norovirus, a highly contagious stomach bug. Research by the Centers for Disease Control and Prevention found that 1 in 5 food service employees went to work while sick with vomiting or diarrhea for fear of losing their jobs if they stayed home, turning restaurants into vectors for norovirus outbreaks.        劳动力不平等和工作场所保护不力也许加剧了诺如病毒的传播,这是一种具有高度传染性的肠胃疾病。美国疾病控制与预防中心的研究发现,25%的食品服务行业工人在有呕吐或腹泻症状时仍去上班,因为他们担心如果呆在家里会失去工作,这让餐馆成为诺如病毒暴发的载体。
        Such conditions may have severely elongated the H1N1 epidemic in the United States, which killed 12,469 Americans in 2009 and 2010, according to a study by the Institute for Women’s Policy Research.        根据美国妇女政策研究所(Institute for Women’s Policy Research)的一项研究,生病后不敢休假可能严重延长了H1N1型流感在美国的流行,2009年至2010年流行的H1N1导致12469名美国人死亡。
        Although public health officials had urged social distancing — also a cornerstone of coronavirus prevention — spotty access to health care and the economics of part-time employment led 3 in 10 workers with H1N1 symptoms to continue going to work, the study found. The researchers concluded that this behavior drove a staggering 27% of all infections.        研究发现,尽管公共卫生官员曾敦促人们保持距离(这也是预防新冠病毒的一个基本做法),但由于有些人支付不起医疗费用以及兼职工作者的经济状况,30%有H1N1症状的人继续工作。研究人员得出的结论是,所有患者中高达27%的病例是带病工作造成的。
        The Pandemic Inequality Feedback Loop        大流行病的不平等反馈圈
        When a health crisis hits entire segments of society, it can set off a cycle in which declining economic status leads to rising rates of chronic illness. That, in turn, further depresses productivity and raises health care costs, leading to more poverty, which leads to more disease.        一场公共卫生危机给整个社会阶层带来冲击时,危机可能会引发一种经济地位下降导致慢性病发病率上升的循环。反过来,这会进一步降低生产率,增加医疗成本,导致更多的贫困,从而导致更多的疾病。
        According to a 2010 study by a British biological sciences journal, Proceedings of the Royal Society B, whole communities can become caught in a “disease-driven poverty trap” in which “the combined causal effects of health on poverty and poverty on health implies a positive feedback system.”        英国生物科学期刊《皇家学会学报B辑》(Proceedings of the Royal Society B) 2010年发表的一项研究显示,整个社会阶层可能陷入一个“疾病导致的贫困陷阱”,在这个陷阱中,“健康对贫困的因果关系以及贫困对健康的因果关系暗示着一个正反馈系统”。
        Families reliant on hourly work are already running out of money, forcing many back out to look for jobs. Because communities tend to cluster by economic status, Errett said, the people who are both at the greatest risk of infection and likely to suffer most from the virus are all in proximity, multiplying the risk.        依赖小时工作挣钱的家庭手中已经没有了现金,迫使他们中的许多人不得不出去找工作。由于社区往往是在经济地位的基础上形成的,埃里特说,那些感染风险最大、受病毒影响最严重的人住的地方很近,这大大增加了感染风险。
        Because diseases do not respect the barriers that separate rich from poor, health inequality is a problem for everyone. A study from Delhi, India, one of the world’s most economically polarized cities, found that its slums served as citywide accelerants for an influenza outbreak.        因为疾病并不会尊重将贫富社区分开的屏障,所以健康不平等是所有人的问题。印度德里是世界上经济两极分化最严重的城市之一,来自那里的一项研究发现,德里的贫民窟是流感在全城暴发的催化剂。
        “Public health isn’t just about your own personal health; it’s about the health of the public at large,” Errett said. “If there’s one person who can’t get treatment, that person is posing a risk to everyone.”        “公共卫生不只是关乎你的个人健康,也事关整个公众的健康,”埃里特说。“如果有一个人得不到治疗的话,这个人会给所有人带来危险。”
                
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