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The right treatment

文章选自2017/8/26的The Economist。 这里对文章进行生词释义和句子分析，仅供学习使用，欢迎交流。

导读: 发展中国家的医疗系统逐年进步， 但是对于初等医疗水平依然很低。 作者讨论了初等医疗对于治疗慢性病， 提供快速及时的医疗咨询的重要意义，并给出了典范

正确的医疗

How developing countries should improve primary health care

发展中国家应该如何提高初等医保水平

• primary health care: 初级医保

IN POOR countries people are living longer and healthier lives than ever. Since 2000 child mortality has fallen by almost half. The rate of new HIV/AIDS infections has dropped by 40%. About 7m deaths from malaria have been prevented.

在贫困国家人们比以往更加长寿和健康。 自从2008年以来，儿童死亡率已经降低了大约一半

• child mortality: 儿童死亡率

Yet there is much more to be done. By one measure, the World Health Organisation reckons about 400m people still have no access to primary care—the basic form of medicine that should be at the forefront of any well-run health system. The real figure is probably much higher. And even for those fortunate enough to see a general practitioner, or more usually a semi-trained medic or quack, treatment is often dire.

然而还有更多需要做。 据统计， 世界卫生组织认为大约4千万人仍然没有初级医疗保障--一种在健全的医疗系统中最基础，最重要的医疗形式

• by one measure: 据统计
• at the forefront of: 处于...最重要的位置
• well-run health system: 运行良好的医疗系统
• general practitioner: 全科医生
• semi-trained medic: 培训中的医科学生
• quack(n.): 冒牌医生
• dire(adj.): 急迫的
  e.g. be in dire straits 陷入极度困境

The poor state of primary care will matter even more as the burden of disease in poor countries comes to resemble that in rich ones, shifting from infectious diseases to chronic conditions (see page 49). By 2020 non-communicable diseases will account for about 70% of deaths in developing countries. But the majority of people with high blood pressure, diabetes or depression do not get effective treatment—and may not even know they have a problem. They deserve better.

贫穷国家的基础医疗将更加重要随着在贫穷国家的疾病负担与富裕国家一样，从流行病转变到慢性病

• come to resemble: 就像
• infectious disease: 传染病
• chronic disease: 慢性病
• non-communicable disease: 慢性非传染性疾病

Primary health care is not flashy, but it works. It is the central nervous system of a country’s medical services—monitoring the general health of communities, treating chronic conditions and providing day-to-day relief. It can ensure that an infectious disease does not become an epidemic. Before the Ebola outbreak of 2014, nearly half of Liberians could not afford primary care and the deadly virus spread quickly. In parts of west Africa with better primary care, it was more easily contained.

初等医疗保障并非华而不实的， 它确实有效。 它是这个国家的医疗系统的中枢神经系统--监控着社区健康状况， 治疗慢性疾病和提供日常的救助

• flashy(adj.): 华而不实的
• central nervous system: 中枢神经系统
• chronic condition: 慢性疾病
• day-to-day: 日常的，每天的
• epidemic(n.): 传染病

Neglect of primary care is often the unintended result of good intentions. International aid-givers have concentrated much of their effort on cutting the rates of individual infectious diseases, partly because success at treating them is easier to measure. Governments in many developing countries, meanwhile, have ploughed scarce money into visible and expensive hospitals in big cities. Between 2002 and 2013 the number of larger hospitals in China nearly doubled, whereas the tally of primary-care providers shrank by 6%. China now has more hospital beds per person than America.

对于初等医疗的忽略通常是良好规划导致的无意的结果。 国际救助者已经提供了很多努力用于降低个人传染病率， 部分是因为传染病的治疗更好测量

• unintended result: 非计划中结果
• aid-giver(n.): 救助者
• plough scarce money into:将紧缺的资金投入到...
• the tally of:账目

Such lopsidedness is wasteful. Primary care can deal with the vast majority of medical consultations. Expanding primary care tends to bring marked improvements. Brazil’s “Family Health Programme”, which costs barely $50 a person and covers roughly half the population, has cut infant mortality and needless hospitalisation. Rwanda, Sri Lanka and Thailand have had similar success. Costa Rica spends far less than the global average on health, but has the highest life expectancy in the Americas after Canada and Chile, thanks to its impressive primary care.

这样的不均衡是一种浪费。 初等医疗可以应对大量主要的医疗咨询。 扩大初等医疗可以带来更显著的提升

• lopsidedness(n.): 不匀称, 不均衡
• medical consultation: 医疗咨询
• marked improvements: 显著的改善
• cut infant mortality: 削减了婴儿死亡率

There are plenty of good examples to follow. The first step should be to train those already providing care, who are often private practitioners, ranging from drug dispensers to dubious healers. Some medical bodies would like to see care-providers without formal medical qualifications banned, but the evidence is that even short training courses can greatly improve their diagnoses. In South Africa a scheme called the Practical Approach to Care Kit (PACK) uses checklists to train health workers without medical degrees to diagnose 40 common symptoms and treat 20 chronic conditions.

这里有很多好的例子。 第一步应当训练那些已经能提供医疗的人，这些人通常是私人医师， 从药剂师到不可靠的医师

• dubious healer: 不可靠的医师
• drug dispenser: 药剂师
• improve their diagnoses: 提升诊断水平
• common symptoms: 常见症状

A second step is to make better use of technology. In Delhi’s 158 mohalla (community) clinics, the first of which opened in 2015, a testing-kit costing $640 can run 33 common medical tests. Rwanda is trying out a telemedicine scheme to make it easier for patients in rural areas to speak to a doctor. DHIS 2, a free, open-source system for collecting and sharing health data, is used in 47 countries.

第二步就是确保科技得到更好地利用技术。 在德黒的158家诊所，正试用价值640美元的可用33次的检测套装

• testing-kit: 检测套装
• try out: 试验
• telemedicine scheme: 远程诊断计划

A third important change is to design better incentives. Even when clinicians know how to deal with patients properly, they may not do so. Sometimes pressure from patients leads them to overprescribe antibiotics. The problem is made worse when doctors profit from the drugs they prescribe or the tests they order. Better to follow Rwanda, where health workers are rewarded for following clinical guidelines, not for the prescriptions they issue.

有一个重要变化是设计更好的动机。尽管临床医生可用更好地处理病人的问题， 但是他们可能不会那么做

• overprescribe(v.): 过量开药
• antibiotics(n.): 抗生素
• clinical guidelines: 临床指导

Reading the vital signs
In much of the rich world, ageing populations and new technology are leading policymakers to rethink their health services. Many have belatedly realised that, for chronic conditions, there are better and cheaper alternatives to hospitals. Poorer countries have a chance to anticipate these changes. They should seize it.

在丰富的世界上， 老龄化的人口和新科技正引导决策之重新思考他们的医疗服务

• vital(adj.): 极其重要的
• anticipate these changes: 未雨绸缪