The Contribution of Traditional Chinese Medicine to Sustainable Development

中醫(yī)藥對(duì)可持續(xù)發(fā)展的貢獻(xiàn)

– Keynote Address at the International Conference on the Modernization of Traditional Chinese Medicine

——在中醫(yī)現(xiàn)代化國際會(huì)議上的主旨演講

Dr. Margaret Chan, Director-General of the World Health Organization

世界衛(wèi)生組織總干事 ?陳馮富珍博士

Singapore, 23 October 2016

新加坡,2016年10月23日

Honourable ministers, distinguished participants, experts in traditional Chinese medicine, ladies and gentlemen,

尊貴的部長(zhǎng)們,尊敬的與會(huì)者們,中醫(yī)藥領(lǐng)域的專家們,女士們,先生們:

Every country in the world, including an advanced nation like Singapore, needs to be concerned about the sustainability of its health services.

世界每個(gè)國家,包括像新加坡這樣的先進(jìn)國家,都需要關(guān)注其衛(wèi)生服務(wù)的可持續(xù)性問題。

Population ageing is now a universal trend, affecting rich and poor countries in every region of the world. The globalized marketing of unhealthy products has made chronic noncommunicable diseases, like heart disease, cancer, and diabetes, the leading killers worldwide.

人口老齡化是當(dāng)今一種普遍趨勢(shì),影響著世界各區(qū)域的富國與窮國。不健康產(chǎn)品的全球化營銷已使心臟病、癌癥和糖尿病等慢性非傳染性疾病成為全世界的主要?dú)⑹帧?/div>

Economic growth and modernization, long associated with better health, are now creating conditions that leave more and more people living longer, sicker lives.

經(jīng)濟(jì)增長(zhǎng)和現(xiàn)代化長(zhǎng)期以來都與更好的健康聯(lián)系在一起,而現(xiàn)在造成的局面是,越來越多的人雖然壽命延長(zhǎng)了,卻處于不健康的狀態(tài)。

Most technology markets, like those for flat screen TVs and hand-held electronic devices, produce products that are progressively cheaper and easier to use. Not so for pharmaceuticals and medical devices, where new products are nearly always more expensive and more complex to use, often requiring specialized training.

大多數(shù)技術(shù)市場(chǎng),如平板電視和手持電子設(shè)備市場(chǎng),生產(chǎn)的產(chǎn)品越來越便宜和易于使用。但藥品和醫(yī)療器械市場(chǎng)卻不是這樣,這類市場(chǎng)的新產(chǎn)品幾乎總是更昂貴,使用起來更復(fù)雜,通常需要專門培訓(xùn)。

Even the richest countries in the world cannot afford new treatments for common conditions like cancer and hepatitis C that cost from $50 000 to $150 000 per patient per year.

即使是世界最富裕的國家也負(fù)擔(dān)不起用于癌癥和丙型肝炎等常見病癥的新治療方法,這些療法的費(fèi)用每名患者每年為5萬至15萬美元。

This trend is the opposite of sustainable development.

這種趨勢(shì)與可持續(xù)發(fā)展背道而馳。

At the same time, a growing number of countries are reforming their health systems with the aim of reaching universal health coverage, which is a key target under the Sustainable Development Goal for health.

與此同時(shí),越來越多的國家正在改革其衛(wèi)生系統(tǒng),旨在實(shí)現(xiàn)全民健康覆蓋,這是可持續(xù)發(fā)展目標(biāo)下的一個(gè)主要衛(wèi)生相關(guān)具體目標(biāo)。

In other words, countries are seeking to expand coverage with essential services at a time when consumer expectations for care are rising, costs are soaring, and most budgets are either stagnant or reduced.

換言之,在各國力求擴(kuò)大基本服務(wù)覆蓋面的同時(shí),消費(fèi)者對(duì)醫(yī)護(hù)服務(wù)的期望在不斷上升,費(fèi)用在飛漲,而多數(shù)預(yù)算則停滯或縮減。

Faced with this dilemma, and most especially the costs of treating lifestyle-related chronic diseases, many experts see a need to shift the model for health service delivery away from a strictly biomedical model, focused on individual diseases, towards a more holistic approach.

面對(duì)這種困境,特別是鑒于治療與生活方式相關(guān)的慢性疾病的費(fèi)用,許多專家認(rèn)為,需要將衛(wèi)生服務(wù)的提供模式從注重個(gè)體疾病的嚴(yán)格生物醫(yī)學(xué)模式轉(zhuǎn)向更加全面的方法。

This is an approach that stresses prevention as well as cure, offers integrated services that address the multiple determinants of health, and asks people to take more responsibility for their own health.

這種方法不僅強(qiáng)調(diào)治療也強(qiáng)調(diào)預(yù)防,并且提供綜合服務(wù)以解決健康的多重決定因素,要求人們對(duì)自己的健康承擔(dān)更多責(zé)任。

Apart from the need to do more for prevention, some countries are looking for approaches that stop people with minor complaints from flooding waiting rooms at clinics and in emergency wards.

除了需要加強(qiáng)預(yù)防外,一些國家正在尋找辦法,以避免有小病小痛的人蜂擁到診所和急診室。

In Europe, for example, pharmacists are trained to deal with common aches, pains, sniffles, and other complaints. They focus on symptoms, not diseases, and dispense over-the-counter products, including herbal remedies, to address these symptoms. In other words, they act as gatekeepers.

例如,在歐洲,藥劑師經(jīng)過培訓(xùn)可以治療常見的各種疼痛、感冒和其它小病。他們關(guān)注的是癥狀,而不是疾病,并分發(fā)非處方產(chǎn)品,包括草藥,來治療這些癥狀。換句話說,他們充當(dāng)守門人的角色。

This is one way to reduce the burden on health services. Traditional Chinese medicine is another.

這是減少衛(wèi)生服務(wù)機(jī)構(gòu)負(fù)擔(dān)的一種方法。另一種方法是中醫(yī)藥。

The World Health Organization welcomes this landmark conference on the modernization of traditional Chinese medicine. You seek, in particular, to give traditional medicine an evidence-based place within a health care system where mainstream modern medicine dominates.

世界衛(wèi)生組織歡迎這次具有里程碑意義的中醫(yī)藥現(xiàn)代化會(huì)議。你們特別希望在主流現(xiàn)代醫(yī)學(xué)占主導(dǎo)地位的衛(wèi)生保健系統(tǒng)中為傳統(tǒng)醫(yī)學(xué)提供一個(gè)有證據(jù)基礎(chǔ)的位置。

Your agenda says many things. You are looking at China’s experiences in clinics and hospitals where traditional and modern medicine offer integrated services, at the role of health services and policy research, and the use of biomedical knowledge to modernize traditional Chinese medicine.

此次會(huì)議議程的內(nèi)容很多。你們要研究中國診所和醫(yī)院在提供中西醫(yī)結(jié)合服務(wù)方面的經(jīng)驗(yàn),要審視衛(wèi)生服務(wù)和政策研究的作用,并要討論如何利用生物醫(yī)學(xué)知識(shí)推動(dòng)中醫(yī)藥現(xiàn)代化。

You are considering how more rigorous testing can meet the scientific standards needed for international recognition and acceptance. You are looking at the absolutely critical issue of safety, as demonstrated in well-designed clinical trials.

你們要考慮如何通過更嚴(yán)格的檢測(cè)來滿足為獲得國際認(rèn)可和接受所必須的科學(xué)標(biāo)準(zhǔn)。從精心設(shè)計(jì)的臨床試驗(yàn)可以看出,你們?cè)诳紤]極其重要的安全性問題。

You are also looking at the performance of traditional Chinese medicine for specific indications, including digestive disorders, and giving attention to the two forms of traditional medicine most often used in modern health systems, namely acupuncture and herbal remedies.

你們還要查看中醫(yī)藥對(duì)特定適應(yīng)癥(包括消化系統(tǒng)疾?。┑男Ч?,并關(guān)注針灸和草藥這兩種現(xiàn)代衛(wèi)生系統(tǒng)中最常用的傳統(tǒng)醫(yī)學(xué)形式。

All of these approaches can contribute to the modernization of traditional Chinese medicine.

所有這些方法都可推動(dòng)中醫(yī)藥現(xiàn)代化。

I am Chinese, and I have used traditional Chinese medicine throughout my lifetime. I have no doubt that these preparations soothe, treat many common ailments, and relieve pain.

作為中國人,我一直都使用傳統(tǒng)中藥。我毫不懷疑這些藥劑能緩解、治療許多常見疾病,并減輕疼痛。

But if I have a bad toothache, I go to the dentist.

但如果我牙痛難忍,我會(huì)去看牙醫(yī)。

Ladies and gentlemen,

女士們,先生們,

One approach when exploring the modernization of traditional Chinese medicine is to look at the shortcomings of modern medicine, both real and perceived. Paradoxically, these shortcomings have created a situation where traditional medicine meets a perceived need, yet earns a bad name at the same time.

在探討中醫(yī)藥現(xiàn)代化問題時(shí),可以審視一下現(xiàn)代醫(yī)學(xué)的缺點(diǎn),不論是真實(shí)的還是察覺到的。但奇怪的是,這些不足卻導(dǎo)致了一種局面,就是傳統(tǒng)醫(yī)學(xué)滿足了一種被很多人認(rèn)可的需求,卻得了個(gè)壞名聲。

In wealthy countries, the public often reacts in a negative way to health care that is seen as over-medicalized and over-specialized, with the patient treated like a collection of specialized body-parts on an assembly line, instead of a whole person.

在富裕國家,公眾往往對(duì)過度醫(yī)療化和過度專業(yè)化的衛(wèi)生保健有種消極反應(yīng),因?yàn)檫@類保健將患者當(dāng)作裝配線上一種專門身體部位的集合體而非一個(gè)完整的人來對(duì)待。

People want more control over what is done to their bodies. They want to self-regulate their own health.

人們希望能更多地掌控對(duì)其身體所作的治療。他們希望對(duì)自己的健康進(jìn)行自我調(diào)節(jié)。

As seen in the movement of vaccine refusal, science is often mistrusted, sometimes even vilified. Rumours spread via social media can carry more weight than hundreds of well-designed peer-reviewed research studies.

正如我們?cè)诰芙^疫苗接種的運(yùn)動(dòng)中所看到的,科學(xué)往往得不到信任,有時(shí)甚至遭到詆毀。通過社交媒體傳播的謠言可能比上百份精心編寫并獲得同行審評(píng)的研究報(bào)告更具影響力。

People are suspicious that powerful new drugs may have side effects that have either not yet been detected or were never honestly disclosed.

人們懷疑效力強(qiáng)大的新藥物可能具有尚未發(fā)現(xiàn)或從未誠實(shí)披露的副作用。

Some analysts attribute this dissatisfaction and mistrust to the system, the infrastructure, the training, the incentives, and the orientation of modern medical care.

一些分析師將這種不滿和不信任歸因于現(xiàn)代醫(yī)療保健的制度、基礎(chǔ)設(shè)施、培訓(xùn)、獎(jiǎng)勵(lì)措施以及導(dǎo)向。

In many countries, this system dictates that a doctor spend no more than around 20 minutes with each patient. In many outpatient clinics for primary care, the time spent with patients is 5 minutes or less.

在許多國家,現(xiàn)代醫(yī)療保健制度要求醫(yī)生用于每名患者的時(shí)間不得超過20分鐘。而在許多初級(jí)保健門診所,用于患者的時(shí)間僅5分鐘或更短。

During these few minutes, the doctor is expected to act, not talk, to order medicines, tests, and other interventions. This practice contrasts sharply with the approach used by traditional practitioners.

在這幾分鐘內(nèi),醫(yī)生要行動(dòng),不要說話,要就藥物、化驗(yàn)以及其它干預(yù)作出處方。這種做法與傳統(tǒng)醫(yī)學(xué)從業(yè)者的方法形成鮮明對(duì)比。

Moreover, the number of doctors practicing family medicine continues to shrink dramatically in favour of more, and better-paid, specialists and sub-specialists.

此外,從事家庭醫(yī)學(xué)的醫(yī)生數(shù)量繼續(xù)大幅減少,而出現(xiàn)了更多報(bào)酬更高的??漆t(yī)生和亞專科醫(yī)生。

Family physicians are a vanishing profession right at the time when the rise of noncommunicable diseases makes their skills essential for prevention and the continuity of sometimes life-long care.

隨著目前非傳染性疾病日益增多,家庭醫(yī)生的技能對(duì)于這類疾病的預(yù)防和有時(shí)持續(xù)終生的連續(xù)護(hù)理至關(guān)重要,但這一職業(yè)卻正在消失。

The phenomenal rise of the alternative medicine industry responds to some of these shortcomings in what modern medicine has to offer. In several North American and European countries, the production and sale of herbal medicines, dietary supplements, and other so-called “natural” products have become a huge and profitable industry, amounting to $32 billion a year in the USA alone.

替代醫(yī)學(xué)產(chǎn)業(yè)的驚人崛起彌補(bǔ)了現(xiàn)代醫(yī)學(xué)中的一些不足之處。在若干北美和歐洲國家,草藥、膳食補(bǔ)充劑以及其它一些所謂“天然”產(chǎn)品的生產(chǎn)和銷售已成為一個(gè)巨大的賺錢產(chǎn)業(yè)。僅在美國,該產(chǎn)業(yè)的年業(yè)務(wù)額便達(dá)320億美元。

The industry fiercely defends its territory, its claims, and its profits. Aggressive marketing that makes unsubstantiated claims has antagonized many in the medical establishment.

該產(chǎn)業(yè)極力捍衛(wèi)自己的領(lǐng)域、權(quán)利和利潤(rùn),通過一些毫無根據(jù)的聲稱展開積極營銷,招致了醫(yī)療界中很多人的怨憤。

As medical professionals argue, most alternative medicines are introduced onto the market, via over-the-counter sales or the internet, without any regulatory oversight.

醫(yī)療專業(yè)人士指出,大多數(shù)替代藥物系通過非處方銷售或因特網(wǎng)進(jìn)入市場(chǎng),不受任何監(jiān)管。

These arguments point to the critical contribution regulatory authorities can make to the modernization of traditional Chinese medicine. A drive aimed at licensing and regulatory control can bring legitimacy to traditional remedies, as has been done here in Singapore.

這些論點(diǎn)指出監(jiān)管機(jī)構(gòu)可以對(duì)中醫(yī)藥現(xiàn)代化做出重要貢獻(xiàn)。針對(duì)許可證發(fā)放和監(jiān)管控制采取行動(dòng)可以使傳統(tǒng)療法具有合法性,新加坡已經(jīng)這樣做了。

Singapore has also pioneered some good policies that protect against some perceived dangers of traditional Chinese medicine. For example, patients are referred for traditional treatments, like acupuncture, by doctors trained in Western medicine.

新加坡還開創(chuàng)了一些良好政策,幫助防止一些已察覺到的中醫(yī)藥危險(xiǎn)。例如,將患者轉(zhuǎn)診給受過西醫(yī)培訓(xùn)的醫(yī)生進(jìn)行針灸等傳統(tǒng)治療。

Having a doctor’s opinion as backup helps protect against the risk that what may seem to be uncomplicated complaints might actually be the early signals of a more serious condition.

征詢醫(yī)生的意見作為支持有助于防范風(fēng)險(xiǎn),有些看起來似乎不太復(fù)雜的小病痛實(shí)際上可能是一個(gè)更嚴(yán)重病癥的早期信號(hào)。