The need to produce innovative and cost-effective solutions that can be delivered in resource-deprived settings could not be more apparent.	在资源贫乏环境中提供具有成本效益的创新方案其必要性已经不能再明显了。


Consider pneumonia, which accounts for 15% of all deaths of children under five years old – nearly a million children – each year.	以占5岁以下儿童死亡人数15%的肺炎为例，15%意味着每年致死近百万儿童。


A key component of the treatment of hospitalized children with severe pneumonia is “bubble CPAP” (continuous positive airway pressure), in which a compressor delivers oxygen to the patient, ensuring a continuous flow of air during the treatment process.	“新生儿呼吸机”（持续气道正压通气）是因严重肺炎入院儿童治疗的关键部分，由压缩机为患者输送氧气，从而在整个治疗过程中保证连续的空气流。


In the developed world, mechanical ventilators provide the respiratory support of bubble CPAP.	在发达国家，持续气道正压通气这样的呼吸支持主要由机械式呼吸机负责提供。


But mechanical ventilators are far too expensive for developing-country health systems, leaving millions of patients in much of the Global South without access to life-saving bubble CPAP.	但发展中国家的医疗体系无法负担价格昂贵的机械式呼吸装置，从而导致成百上千万的全球南部患者得不到挽救生命的持续气道正压通气治疗。


But with a combination of medical expertise and inventive thinking, Jobayer Chisti, my colleague at the health research organization icddr,b, has developed a simple and affordable alternative to bubble CPAP using materials that are readily available even in poor countries, such as empty shampoo bottles and plastic tubing.	凭借专业医学知识和创新思维，我在医疗研究机构icddr,b的同事契斯堤（Jobayer Chisti）用空洗发水瓶和塑料管等即使在贫困国家都随处可见的原料研发了一种简单廉价的持续气道正压通气替代疗法。


Last year, Chisti and his team, in collaboration with colleagues from Australia and with funding from the Australian Agency for International Development, conducted a clinical trial in Bangladesh to compare the efficacy of this alternative apparatus to the low- and high-flow oxygen therapies recommended by the World Health Organization in resource-poor contexts.	去年，契斯堤率领其团队与来自澳大利亚的同事合作，在澳大利亚国际发展署的资助下在孟加拉国开展了一项临床实验，比较这种替代设备和世卫组织在资源匮乏环境下推荐的低或高流量吸氧疗法的实际效果。


The results were inspiring.	这项试验取得了振奋人心的成果。


Bubble CPAP delivered with the ultra-low cost apparatus was shown to be as effective as the standard low- and high-flow oxygen therapies.	结果显示这种超低成本设备提供的治疗与标准的低或高流量吸氧疗法有着同样的效果。


In fact, just 4% of infants died when treated with the improvised bubble CPAP device, compared with 15% of those receiving low-flow oxygen therapy.	事实上，用简易持续气道正压通气设备治疗的婴儿死亡率仅有4%，而接受低流量吸氧治疗的婴儿死亡率则为15%。


The case for further testing of Chisti’s alternative bubble CPAP delivery system – not to mention its implementation in places where alternative treatments are not available – is clear.	进一步测试契斯堤替代性持续气道正压通气疗法——更不用说在无法提供常规疗法的地区进行应用——的理由是十分清楚的。


If future trials demonstrate similar high efficacy, low-cost bubble CPAP could become the standard of care for pneumonia in resource-deprived settings, potentially saving thousands of lives every year.	如果未来的试验能表现出同样出色的疗效，那么低成本的气泡新生儿呼吸机可以成为资源匮乏地区治疗肺炎的标准疗法，从而每年可以因此挽救成千上万条生命。


But Chisti’s research has implications far beyond the invention itself.	但契斯堤研究的影响��远远不止其发明本身。


It reinforces the idea, which has been a defining motivation of my own work leading the Maternal and Child Health Division at icddr,b, that innovators living and working in resource-poor settings are among the best equipped to develop and test cost-effective health solutions.	他进一步证明了一直在引领我本人在icddr,b妇幼保健司的工作的理论，即在资源匮乏地区生活和工作的创新人士最有可能完成高成本效益疗法的研发及测试工作。


After all, nobody understands the limitations of a weak health-care system better than someone who has to work in one.	毕竟，最了解脆弱的医疗系统本身限制的莫过于其中的工作者。


That is why globally networked, developing-country-based health research institutes like icddr,b are invaluable.	这也告诉我们为什么像icddr,b这样全球联网并植根于发展中国家的医疗研究机构是非常宝贵的。


They provide a platform for local researchers and innovators to recognize opportunities that an outsider may never see, and to develop and evaluate their ideas in the precise environment for which they are designed.	它们为当地研究创新人士提供了了解外人可能永远无法了解的机遇的平台，并在完全切合设计目的的环境中设计和评估他们的想法。


With the data they collect, developing-country health-care innovators can set the stage for their clinical advances to be transformed into national public policies, not just in their own countries, but in resource-deprived communities worldwide.	利用搜集到的数据，发展中国家医疗创新人士可以搭建起临床进步转化为国家公共政策的平台，上述平台不仅适用于他们自己的国家，而且对世界各地资源匮乏的社区全都适用。


The results promise to transform the lives of neglected and impoverished people everywhere.	最终的结果有望彻底改变世界各地被忽视的贫困人口的生活。


Blood Quest	血液探秘


WASHINGTON, DC – In most developed countries, patients can be confident about the safety of blood transfusions.	华盛顿—在最发达国家，病人对输血安全性有信心。


The problem is that maintaining a steady, uncontaminated supply of donor blood is not always easy.	问题是保持稳定的无污染献血源有时并不容易。


Is it possible to ensure an adequate supply of safe blood once and for all?	有没有希望保证随时随地都有安全血液的充足供应？


Today’s blood supplies, often donated by volunteers, can be contaminated with HIV and other infectious agents.	当今血液供给——通常来自志愿捐献——可能被艾滋病和其他病原污染。


And donor blood must be kept in cold storage, where it has a 28-day shelf life.	献血者献的血必须冷藏，保质期为28天。


Given fear of contamination – and military interest in a more durable supply – research into synthetic alternatives has long been a medical priority.	出于污染担忧——以及更持久血源的军事利益——血液的合成替代品研究长期以来一直是医学的优先发展项目。


The idea of using blood substitutes was first advanced in the seventeenth century, and continues to attract researchers today.	使用血液替代品的思想起源于17世纪，至今仍吸引着研究者。


Several products that could revolutionize transfusion medicine have already been developed in the pursuit of shelf-stable, portable, one-type-fits-all blood substitutes, which could replace standard blood transfusions in extreme situations, such as on the battlefield.	在寻找储藏稳定、携带便捷、普遍是用的血液替代品（以便在战场等极端环境中代替标准输血操作）的过程中，一些可能引起输血医学革命的产品已经被开发出来。


But, after more than three decades of active research and development, no clinically viable product has obtained regulatory approval, owing to the significant scientific challenges.	但是，拜重大科学挑战所赐，在三十多年的积极研究和开发后，仍未有可临床使用的产品获得监管批准。


Blood is a complicated stew of plasma proteins, red blood cells, platelets, and other cellular components.	血液是复杂的混合液体，包含了血浆蛋白质、红细胞、血小板和其他细胞成分。


These elements perform crucial functions, such as transporting oxygen, nutrients, and immunoglobulins (which defend against infection), and regulating water content, temperature, and pH level.	这些元素实现着关键功能，比如输送氧气、营养物质和免疫球蛋白（可防卫传染病），并调节水含量、温度和pH水平。


In the early twentieth century, researchers began to examine hemoglobin – the protein responsible for carrying oxygen from the respiratory organs to the rest of the body – in red blood cells.	20世纪初，研究者开始考察红细胞中的血红蛋白——负责将氧气从呼吸器官送到身体其他部位的蛋白质。


They found that, when isolated from aging cells – whether from human or cow blood, or from genetically engineered sources – free hemoglobin can be rejuvenated, chemically stabilized, and re-infused as a blood “substitute” that can carry oxygen as effectively as red blood cells, but for a much shorter time.	他们发现，从老化细胞中分离出来后——不管来自人血或牛血，还是通过基因工程获得——自由血红蛋白可以重新焕发活力，化学结构稳定，并能作为血液“替代品”用于注射，其携氧效率不输于红细胞，但携氧时间短得多。


(Non-hemoglobin synthetic blood substitutes, known as fluorocarbons, have proved to be less effective oxygen carriers.)	（无血红蛋白的合成血液替代品，即所谓的氟碳化合物，携氧效率就比较低。 ）


But free hemoglobin can wreak havoc in the human body, causing hypertension, cardiac arrest, or even death.	但自由血红蛋白可能在人体内造成严重破坏，造成高血压、心脏骤停甚至死亡。


Indeed, in almost all living creatures, hemoglobin is encapsulated in red blood cells, which protect the body from the protein’s negative effects (and, in turn, protect hemoglobin from the body’s digestive enzymes).	事实上，在几乎所有生物中，血红蛋白都被封闭在红细胞中，以保护肢体免受这种蛋白质的消极作用（并反过来保护血红蛋白免受肢体消化酶的作用）。


Experts nonetheless believe that hemoglobin-based products can be used to save the lives of trauma patients, as well as to treat patients who object to donated blood on religious grounds (for example, Jehovah’s Witnesses).	尽管如此，专家仍相信，基于血红蛋白的产品可以用于拯救外伤病人，也能治疗因为宗教原因拒绝献血血源的患者（比如耶和华见证人（Jehovah’s Witnesses）信徒）。


Hemoglobin contains hemes, chemical compounds that contain iron – a transition metal that can undergo oxidation, or “rusting” processes.	血红蛋白包含了亚铁血红素，一种含有铁元素的化合物。 铁是一种过渡金属，可以氧化（或曰“生锈）。


Outside of red blood cells, “good” ferrous iron – the only oxygen-carrying form – is oxidized uncontrollably to form the “bad” ferric and “ugly” ferryl forms of hemoglobin.	在红细胞之外，“好”的亚铁——唯一的携氧形式——被不可控地氧化，形成“坏”的三价铁和“丑”的高价铁的血红蛋白形式。


When released into a person’s circulatory system, hemoglobin in these higher oxidation states eventually self-destructs, damaging molecules in surrounding tissue.	当血红蛋白被释放到人的循环系统中时，高价铁形式最终会自我毁灭，伤害周围组织的分子。


Given that these mischievous forms of hemoglobin are difficult to study in living systems, researchers have largely ignored them.	由于这些有害形式的血红蛋白难以在活着的系统中予以研究，研究者一般都忽视它们。 反之，他们将注意力集中在防止肾脏过滤输入的血红蛋白；


Instead, they have focused on strategies for preventing the kidneys from filtering the infused hemoglobin; the hemoglobin from leaking through the blood-vessel walls; and synthetic hemoglobin from destroying nitric oxide (a gas produced in blood vessels that helps them to dilate and increase blood flow).	防止血红蛋白漏出血管壁； 以及防止合成血红蛋白破坏一氧化氮上（一氧化氮是血管内产生的气体，它有助于血管膨胀，增加血流）。


Some researchers consider the reaction with nitric oxide the most problematic, because it raises blood pressure.	一些研究者认为一氧化氮的反应最有问题，因为这增加了血压。


But progress has been made in finding ways to control these oxidation reactions.	但在寻找控制这些氧化反应方面已经取得了进步。


Researchers (including at my laboratory) have investigated how the body naturally handles the occasional release of hemoglobin from aging red blood cells and from cells affected by blood diseases, such as hemolytic anemia.	研究者（包括我的实验室）已经研究了肢体如何自然处理偶然从老化红细胞和受血液疾病（如溶血性贫血）影响的细胞中释放出来的血红蛋白。


They have found that the body’s first line of defense against hemoglobin oxidation is a process of reduction, in which molecules like uric acid or ascorbic acid (vitamin C) impede oxidation by reducing the iron to a less oxidizing species.	他们发现，肢体的第一道血红蛋白氧化作用防线是一个还原过程，在这个过程中，尿酸分子和抗坏血酸（维生素C）分子通过将铁还原为较难氧化的形式来阻止氧化。


Moreover, a host of blood proteins are specialized scavengers of hemoglobin or its fragments.	此外，血液中含有一些蛋白质，专门用来清扫血红蛋白及其碎片。


They reduce its toxicity and safely clear it for further processing within specialized cells called macrophages.	它们降低血红蛋白的毒性，安全地将其清除，为在被称为巨噬细胞的专门作用细胞中的后续过程做准备。


For example, haptoglobin tightly binds to hemoglobin subunits, while hemopexin captures the heme when the hemoglobin releases it.	比如，触珠蛋白紧紧地绑定于血红蛋白的亚基上，而血液结合素在血红蛋白释放亚铁血红素将它们捉住。


Some recent therapeutic possibilities include the co-infusion of haptoglobin with hemoglobin in circulation or with vitamin C – additives that hold promising implications for the development of safe and effective blood substitutes.	最新的治疗可能性包括将触珠蛋白与血红蛋白一起注入循环系统，或者将维生素C作为添加成分，以此增加安全有效的血液替代品开发的成功机会。


Researchers must build on this progress.	研究者必须以这些进步为基础。


Safe blood substitutes and new therapeutic options that make blood transfusion more effective would significantly improve treatment in challenging situations.	让输血更有效的安全血液替代品和新治疗选择将显著改进挑战性状况的治疗。


Ultimately, that promises to save many lives.	最终，这可以拯救大量生命。


Closing the Health-Care Data Gap	填补医疗数据缺口


BOSTON – While much of the world today suffers from information overload, there are still places where information is scarce.	波士顿—如今，世界许多地方饱受信息过载之苦，但仍有一些地方信息稀缺。


And that scarcity sometimes costs people their lives.	而这种稀缺有时候会让人们失去生命。


In the maternity ward of Zanzibar’s largest public-health facility, Mnazi Mmoja Hospital, patient data are listed on a dry-erase board.	在桑给巴尔最大的公共卫生机构Mnazi Mmoja医院的产科病房，患者数据都写在一块白板上。


The information on the board consists of the number of women admitted, the type and severity of their conditions, and whether or not they survived.	上面的信息包括接收妇女数量、她们的状况的类型和严重性以及她们是否存活下来。


These data may be better than nothing, but not by much.	这些数据充其量只是聊胜于无。


There are no dates or timestamps or long-term filing systems.	没有日期或时间戳，也没有长期存档系统。


With photographs of the board strictly forbidden, records last only as long as they are on it.	给白板拍照是严格禁止的，因此记录只能保持到被擦去为止。


Zanzibar’s attitude toward health records is not unique.	桑给巴尔对卫生记录的态度并非独此一家。


In fact, Zanzibar is probably more careful than many other places throughout in Africa and Asia, where data-collection systems simply do not exist.	事实上，桑给巴尔也许比整个非洲和亚洲的许多其他地方谨慎多了，很多地方根本没有数据收集系统。


When a country suffers from such a data deficit, its public-health policies, budgets, and strategies are decided by political expediency or guesswork.	当一个国家数据赤字如此严重时，其公共卫生政策、预算和战略只能由政治权宜或猜测决定。


Sometimes the guesses are right, but most often they are not.	有时猜测正确，但大部分时间是错误的。


This is a major challenge for health-care systems in the developing world.	这是发展中世界所面临的一个重大卫生制度挑战。


Collecting accurate information on all patients (while still respecting privacy) is vital to tracking public-health threats, lapses in care, and medical errors, and is a necessary and essential condition for holding open and honest debates about health-care issues that can affect entire communities or countries.	收集所有患者的准确数据（同时尊重隐私）对于应对公共卫生威胁、护理过失和医疗错误来说至关重要，也是让影响整个社会或国家的公共卫生问题讨论变得公开诚实的必要条件。


According to a British Medical Journal analysis by Martin Makary and Michael Daniel of the Johns Hopkins University School of Medicine, in the United States, medical errors alone are the third leading cause of death, after heart disease and cancer.	据约翰霍普金斯大学医学院的马丁·马卡里（Martin Makary）和迈克尔·丹尼尔（Michael Daniel）在《英国医学期刊》（British Medical Journal）上的分析，在美国，医疗错误是第三大致死原因，仅次于心脏病和癌症。


In the context of their analysis, medical errors could include bad doctors, poor clinical judgment, miscommunications between staff members or departments, and incorrect diagnoses.	在他们的分析中，医疗错误包括坏医生、糟糕的临床判断、工作人员或科室之间的沟通不畅以及误诊等。


There is no reason to think this problem is confined to the US.	没有理由认为这一问题仅限于美国。


Health-care settings in the developing world often face even steeper challenges, such as lack of technical capacity among hospital management, staff shortages, poor training, low-quality medicines, and relative impunity for medical malpractice.	发展中国家的医疗条件往往面临更严峻的挑战，如医院管理层技术能力不足、人手短缺、缺乏优质训练、医疗品质低劣、医疗渎职惩罚相对不力等。


Unfortunately, because we have such limited data, we cannot know the extent to which any of these factors contribute to poor health outcomes and avoidable deaths in developing countries.	不幸的是，由于我们的数据过于有限，无从知道这些因素对发展中国家拙劣的健康结果和可避免的死亡的影响程度有多大。


Aside from potentially saving countless lives, reliable data can reduce costs, financially and psychologically.	可靠的数据不但有望拯救无数生命，还能降低成本，包括财务成本和心理成本。


The financial burden of health care in low- and middle-income countries is substantial, despite the progress that has been made in fighting HIV, malaria, and tuberculosis.	尽管在遏制艾滋病、疟疾和结核病方面取得了巨大进步，但中低收入国家的医疗财务负担仍然非常大。


Beyond these diseases, for which there is treatment and tracking, thanks partly to ample awareness, many illnesses go unidentified and continue to strain public-health services.	除了这些部分是因为认识充分而得到治疗和追踪的疾病，许多疾病根本没有得到识别，仍在制约公共卫生服务。


Understanding common causes of death is the only way to improve health care in communities with a high disease burden, patriarchal hierarchies, and large and dispersed rural populations that rely on traditional medicine.	对于疾病负担高昂、存在宗法等级制度以及以来传统医学的庞大而分散的农村人口的社会来说，认识死亡的共同原因是改善医疗的唯一办法。


In these settings, patient interactions with doctors are rare, so it is important to collect records on them at every opportunity.	在这样的环境中，患者与医生的很少有互动，因此抓住一切机会收集记录很重要。


Different societies have different health-care needs, and fully comprehending what they are is no easy task.	不同的社会医疗需求也不同，充分理解需求何在并不容易。


But we can begin the process with three steps.	但我们可以从三个步骤开始这一过程。


The first is to create awareness within communities.	首先是社区内部的意识创造。


All people want healthy and productive lives for themselves and their loved ones, so they will welcome new insights into why people in their community die or get sick.	所有人都希望自己和所爱的人获得健康和有活力的生活，因此他们必定欢迎关于所在社区的人为何死亡或得病的洞见。


With the advent of citizen journalism and social media, even in poor countries, public-awareness campaigns are now more affordable than ever.	在公民新闻（citizen journalism）和社交媒体时代，即使在贫穷国家，公共意识运动也要比从前更加容易。


The second step is to devise better ways to collect data.	第二步是制定更好的收集数据方法。


Many developing countries lack the funds, infrastructure, and training needed to use sophisticated data-collection tools; but that doesn’t mean they can’t make significant improvements in data collection.	许多发展中国家缺少使用复杂数据收集工具所需要的资金、基础设施和训练； 但这并不意味着它们不能在数据收集方面取得重大进步。


As Atul Gawande of Harvard University’s School of Public Health has shown, simple checklists can be effective in both collecting data and making better decisions.	哈佛大学公共卫生学院的阿图尔·贾万德（Atul Gawande）指出，简单的检查清单就可以在数据收集和做出更佳决策方面起到效果。


If health-care workers and policymakers know which data are useful and why, they will already be in a better position to change public-health outcomes.	如果卫生工作者和决策者知道哪些数据有用、为什么有用，就能能改变公共卫生结果。


The final step is to establish transparent oversight of the data being collected.	最后一步是建立透明的数据收集监督。


Some data may point to politically inconvenient or counterintuitive conclusions, and politicians could be tempted to sweep it under the rug.	一些数据可能引起政治不适或反直觉结果，导致政客将它们隐瞒。


In the age of social media and open-access journals, we should demand that newly collected data be made available to a broad range of people researching public-health issues and working in health-care settings.	在社交媒体和开放新闻时代，我们应该要求新收集数据对各类公共卫生问题研究者和卫生机构工作者开放。


Ultimately, we may not be able to prevent deaths caused by certain illnesses.	说到底，我们也许无法阻止某种疾病所引起的死亡。


But with more information, it is within our power to prevent those deaths that are caused by our own complacency or incompetence.	但有了更多信息，我们就有能力防止那些因为我们的自满或无能而引起的疾病。


Development 3.0	发展3. 0


BEIJING – Until the Industrial Revolution, the world was quite flat in terms of per capita income.	北京——在工业革命以前，世界各国人均收入相当。


But then fortunes rapidly diverged, with a few Western industrialized countries quickly achieving political and economic dominance worldwide.	但是从那以后，随着一些西方工业化国家在政治和经济方面迅速统治世界，各国财富急速分化。


In recent years – even before the financial crisis erupted in 2008 – it was clear that the global economic landscape had shifted again.	近些年，即使是在爆发2008年金融危机之前，全球经济形势已发生了显著变化。


Until 2000, the G-7 accounted for about two-thirds of global GDP.	直到2000年,七大工业国约占全球GDP的三分之二。


Today, China and a few large developing countries have become the world’s growth leaders.	今天,中国和一些大型发展中国家已经成为世界发展的领头人。


Yet, despite talk of a rising Asia, only a handful of East Asian economies have moved from low- to high-income status during the past several decades.	然而,尽管是在谈论亚洲的崛起,但是在过去几十年中只有少数的东亚经济体实现了从低收入到高收入的转变。


Moreover, between 1950 and 2008, only 28 economies in the world – and only 12 non-Western economies – were able to narrow their per capita income gap with the United States by ten percentage points or more.	此外，从1950年到2008年，世界上只有28个经济体能够以十个百分点或者更快的速度缩小与美国的人均收入差距，其中只有12个非西方经济体。


Meanwhile, more than 150 countries have been trapped in low- or middle-income status.	与此同时,150多个国家被困在低收入或中等收入的状态中。


Narrowing the gap with industrialized high-income countries continues to be the world’s main development challenge.	缩小与高收入工业化国家的差距仍是世界发展面临的主要挑战。


In the post-colonial period following World War II, the prevailing development paradigm was a form of structuralism: the aim was to change poor countries’ industrial structure to resemble that of high-income countries.	二战后的后殖民时期，结构主义模式是主流的发展模式，目标是为了改变贫困国家的产业结构，使其与高收入国家的产业结构相似。


Structuralists typically advised governments to adopt import-substitution strategies, using public-sector intervention to overcome “market failures.”	通常，结构主义者会建议政府采取进口替代策略，通过公共部门的干预来克服“市场失灵”。


Call this “Development Economics 1.0.”	称此为“发展经济学1. 0”。


Countries that adhered to it experienced initial investment-led success, followed by repeated crises and stagnation.	采用这种方式的国家，获得了初始投资导向型的成功，紧随其后的是不断的危机和萧条。


Development thinking then shifted to the neoliberal Washington Consensus: privatization, liberalization, and stabilization would introduce to developing countries the idealized market institutions that had been established in advanced countries.	从“发展思想”转变成新自由主义华盛顿共识，即私有化，自由化，稳定化，这些将会给发展中国家带去理想化的市场体系，这些体系在发达国家已经建立起来了。


Call this “Development Economics 2.0.”	称此为“发展经济学2. 0”。


The results of the Washington Consensus reforms were at best controversial, and some economists have even described the 1980’s and 1990’s as “lost decades” in many developing countries.	华盛顿共识改革的结果充其量也就只引起了一点争议，但在许多发展中国家，一些经济学家甚至将20世纪八九十年代描述为“迷失的年代”。


Given persistent poverty in developing countries, bilateral donors and the global development community increasingly focused on education and health programs, both for humanitarian reasons and to generate growth.	鉴于发展中国家持续贫困,双边捐助者和全球发展社区越来越关注该地区的教育和卫生项目,既是出于人道主义的原因又是为了带来经济增长。


But service delivery remained disappointing, so the focus shifted to improving project performance, which researchers like Esther Duflo at MIT’s Poverty Action Lab have pioneered with randomized controlled experiments.	但是服务提供系统却不尽人意，所以焦点转移到促进该项目的绩效，埃斯特·迪弗洛等麻省理工学院贫穷行动实验室的研究人员率先对此进行了随机对照试验。


I call this “Development Economics 2.5.”	我称其为“发展经济学2. 5”.


But, judging from experience in North Africa, where education improved greatly under the old regimes, but failed to boost growth performance and create job opportunities for educated youth, the validity of such an approach as a fundamental model for development policy is dubious.	在北非的旧体制下，人们的教育程度大幅提高，但是却没能促进经济发展，也没能给受过教育的青年创造就业机会。 从北非的经历来看，这种发展政策的有效性值得怀疑。


The East Asian and other economies that achieved dynamic growth and became industrialized did not follow import-substitution strategies; instead, they pursued export-oriented growth.	实现了动态增长和工业化的东亚及其他经济体,没有采取进口替代策略。 相反，他们追求出口导向型增长。


Likewise, countries like Mauritius, China, and Vietnam did not implement rapid liberalization (so-called “shock therapy”), which the Washington Consensus advocated; instead, they followed a dual-track gradual approach (and often continued to perform poorly on various governance indicators).	同样地，毛里求斯、中国和越南没有施行华盛顿共识所提倡的快速自由化（所谓的“休克疗法”），他们遵循一种双轨渐进的方法（但是各种管理指标却一直表现很差）。


Both groups of countries achieved great advances in education, health, poverty reduction, and other human development indicators.	在教育，卫生，缓解贫困和其他人类发展指标方面，两组国家都取得了巨大进展。


None of them used randomized control experiments to design their social or economic programs.	他们都没有使用随机控制实验来设计他们的社会或经济项目。


Today, a “Development Economics 3.0” is needed.	如今，需要一个“发展经济学3.


In my view, the shift from understanding the determinants of a country’s economic structure and facilitating its change is tantamount to throwing the baby out with the bath water.	0”。 我认为，从认识一个国家的经济结构到促使其改变，这种转化如同将婴儿和洗澡水一起倒掉。


Remember that Adam Smith called his great work An Inquiry into the Nature and Causes of the Wealth of Nations.	记住，亚当·斯密将其巨著称为《对国民财富产生的原因和性质的研究》（简称《国富论》）。


In a similar spirit, development economics should be built on inquiries into the nature and causes of modern economic growth – that is, on structural change in the process of economic development.	同样，发展经济学应该建立在现代经济增长的产生原因和性质的研究之上，也就是，在经济发展过程中的结构变化的研究。


Development thinking so far has focused on what developing countries do not have (developed countries’ capital-intensive industries); on areas in which developed countries perform better (Washington Consensus policies and governance); or on areas that are important from a humanitarian point of view but do not directly contribute to structural change (health and education).	迄今为止，“发展思想”主要关注发展中国家所没有的（发达国家的资本密集型产业），以及发达国家表现较好的方面（华盛顿共识的政策和管理方式），或者是在人道主义立场看来很重要但并未直接导致结构变化的方面（卫生和教育）。


In my book New Structural Economics, I propose shifting the focus to areas where developing countries can do well (their comparative advantages) based on what they have (their endowments).	在《新结构经济学》一书中，我提出，以发展中国家所拥有的（他们的禀赋）为基础，将焦点转向他们好的方面（他们的相对优势）。


With dynamic structural change starting from there, success will breed success.	动态结构变化从那里开���,成功将孕育成功。


In our globalized world, a country’s optimal industrial structure – in which all industries are consistent with the country’s comparative advantages and are competitive in domestic and international markets – is determined by its endowment structure.	在我们这个全球化的世界,一个国家的最佳产业结构，即所有的产业都符合国家的相对优势，在国内国际市场具有竞争优势，这种产业结构是由该国的禀赋结构所决定的。


A well-functioning market is required to provide incentives to domestic firms to align their investment choices with the country’s comparative advantages.	一个运转良好的市场需要激励国内企业的投资选择与该国的竞争优势相一致。


If a country’s firms can do that, the economy will be competitive, capital will accumulate quickly, the endowment structure will change, areas of comparative advantages will shift, and the economy will need to upgrade its industrial structure to a relatively higher level of capital intensity.	如果整个国家的企业能这样做，那么该国的经济将会具有竞争力，资本将会迅速积累，禀赋结构将会改变，有竞争优势的领域将会转化，经济也会需要升级其产业结构到一个相对较高的资本密集度。


So successful industrial upgrading and economic diversification requires first-movers, and improvements in skills, logistics, transportation, access to finance, and various other changes, many of which are beyond the first-movers’ capacity.	所以，成功的产业升级和经济多元化需要首位行动者,而且需要技能、物流、交通、融资渠道的提升,以及其他各种变化,许多都超出了首位行动者的能力。


Governments need to provide adequate incentives to encourage first-movers, and should play an active role in providing the required improvements or coordinating private firms’ investments in those areas.	政府需要提供足够的鼓励措施,来激励首位行动者,而且应该发挥积极作用,提供必要的改进措施或协调私人公司在那些领域的投资。


Structural change is, by definition, innovative.	很明显，结构改变具有创新性。


Developing countries may benefit from the advantage of backwardness by replicating the structural change that has already occurred in higher-income countries.	发展中国家，通过复制高收入国家的结构变化，可能会因此受益于自己的后发优势。


Based on the experiences of successful countries, every developing country has the potential to sustain 8% annual growth (or higher) for several decades, and to become a middle- or even a high-income country in one or two generations.	基于成功国家的经验，每一个发展中国家在几十年里有可能继续保持8%的年增长率(或更高)，在一代或两代里成为中等收入甚至是高收入国家。


The key is to have the right policy framework in place to facilitate private-sector alignment with the country’s comparative advantages, and to benefit from latecomer advantages in the process of structural change.	关键是要有正确的政策框架，促进私营企业与国家的比较优势相一致，在结构变化的过程中受益于后发优势。


Development Aid for Development’s Sake	以发展为目的的发展援助


Almost daily, the United States and Europe brandish threats to impose economic sanctions or cut off development assistance unless some vulnerable government accepts their political strictures.	几乎日复一日，美国和欧洲都在威胁一些弱小国家的政府接受它们的政治束缚，不然就要进行经济制裁或停止发展援助。


The most recent threats are towards the new Hamas-led government in Palestine.	最近一次这样的威胁是针对新当选的以哈马斯为首的巴勒斯坦政府。


Other recent examples include threats vis-à-vis Chad, Ethiopia, Haiti, Kenya, Bolivia, Uganda, and long-standing sanctions against Myanmar.	不久前曾受到过类似威胁的还有乍得、埃塞俄比亚、海地、肯尼亚、玻利维亚、乌干达等国政府，缅甸政府也一直受到西方的长期制裁。


Such tactics are misguided.	这样的策略是错误的。


The use of development aid as a political stick merely deepens the suffering of impoverished and unstable countries, without producing the political objectives sought by donors.	把发展援助作为一种政治武器只会加深不稳定的贫困国家所受的痛苦，而无法实现援助国希望实现的政治目标。


To understand why requires taking a long-term view of geopolitics, particularly the gradual decline of US and European global domination.	了解个中原因需要长期关注地缘政治，特别是美国和欧洲全球霸权的逐步衰落。


Technology and economic development are proliferating across Asia and the developing world, while the spread of literacy and political awareness during the past century made national self-determination by far the dominant ideology of our age, leading to the end of colonialism.	亚洲和发展中世界正在经历技术和经济的快速发展，过去一百年间文化和政治觉悟的迅速普及已经使国家自主成为我们这个时代不可动摇的信念，结束了殖民主义的统治。


Nationalism continues to produce powerful political “antibodies” to American and European meddling in other countries’ internal affairs.	民族主义还催生了反对美国和欧洲强权的“抗体”，不再允许发达国家干涉其它国家的内部事务。


The failure to understand this lies behind repeated US foreign policy debacles in the Middle East, at least since the toppling of the Shah of Iran in 1979.	正是由于对这一点缺乏了解，至少从1979年推翻伊朗王朝后，美国在中东的外交政策就屡遭挫折。


The US naively continues to view the Middle East as an object of manipulation, whether for oil or for other purposes.	美国继续天真地把伊朗当作可以操纵的木偶，无论是出于争夺石油还是别的什么目的。


In the Middle East, the Iraq war is widely interpreted as a war for US control of Persian Gulf oil – a rather plausible view given what we know about the war’s true origins.	在中东地区，大多数人认为美国是为了控制波斯湾石油才发动的伊拉克战争¾这种看法似是而非，因为我们都清楚这场战争的真正缘由。


Only incredible hubris and naiveté could bring US (and UK) leaders to believe that Western troops would be greeted as liberators rather than as occupiers.	错就错在令人难以置信的傲慢和天真使美国（和英国）领导人相信：人们会像迎接救星那样欢迎西方军队，而不会把他们看成占领者。


The politicization of foreign aid reflects the same hubris.	对外援助的政治化同样反映了这种傲慢自大。


Even as the US rhetorically champions democracy in the Middle East, its first response to Hamas’s victory was to demand that the newly elected government return $50 million in US aid.	即便美国一再声称支持中东民主，它对哈马斯获胜的第一反应就是要求新当选的政府归还5000万美元的美国援助。


Hamas’s doctrines are indeed unacceptable for long-term peace, as even some Arab states, such as Egypt, have made clear.	期望长久和平的人的确无法接受哈马斯的宗旨，这一点甚至像埃及这样的阿拉伯国家都有过明确的表示。


But cutting aid is likely to increase turmoil rather than leading to an acceptable long-term compromise between Israel and Palestine.	但取消援助更有可能的结果是加剧混乱，而不是使以色列和巴勒斯坦之间达成能为人所接受的长期妥协。


A newly elected Palestinian government should be treated, at least initially, with legitimacy.	一届新当选的巴勒斯坦政府至少刚开始时理应得到合理的对待。


Later, if it behaves badly by sponsoring terror, policies can change.	今后，如果它支持恐怖，行为恶劣，我们可以改变政策。


An aid cutoff should be a policy of last resort, not a first strike.	取消援助应该是最后采取的非常手段，而不是迎头一击。


Aid cutoffs regularly fail to produce desired political results for at least two reasons.	取消援助一般不会带来预期的政治效果，这里面至少有两个原因。


First, neither the US nor European countries have much standing as legitimate arbiters of “good governance.”	首先，无论是美国还是欧洲国家都没有裁定政府好坏的合法权利。


Rich countries have long meddled, often with their own corruption and incompetence, in the internal affairs of the countries that they now lecture.	富裕国家尽管自己腐败无能，长期以来却一直对其它国家的内政指手画脚。


The US preaches “good governance” in the shadow of an unprovoked war, congressional bribery scandals, and windfalls for politically connected companies like Halliburton.	美国鼓吹“优秀统治”，但自己内部也爆出种种丑闻：无缘无故对别国发动战争、议会发生贿赂事件以及像哈利佰顿（Halliburton）这样与政治有染的公司在一夜之间大发横财。


Second, US and European threats to cut off aid or impose sanctions are in any case far too weak to accomplish much besides undermining already unstable and impoverished countries.	其次，无论从哪个角度来讲，美国和欧洲取消援助或实施制裁的威胁除了给本已贫困潦倒、风雨飘���的国家雪上加霜之外根本起不到其它任何作用。


Consider the recent threats to cut Ethiopia’s aid, which is on the order of $15 per Ethiopian per year – much of it actually paid to US and European consultants.	看一下不久前取消对埃塞俄比亚援助的情况就清楚了：每年每个埃塞俄比亚人从这笔援助中只能得到约15美元¾而且这其中的很大一部分实际上还付给了来自欧美的顾问。


It is sheer fantasy to believe that the threat of an aid cutoff would enable the US and Europe to influence the course of Ethiopia’s complex internal politics.	如果认为威胁取消援助就能改变目前埃塞俄比亚国内复杂的政治走向，简直纯属是天方夜谭。


An aid cutoff to Ethiopia would nonetheless lead to a lot of death among impoverished people, who will lack medicines, improved seeds, and fertilizer.	取消对埃塞俄比亚的援助却能够令大批的穷人丧命，他们缺医少药、也得不到化肥和改良的种子。


Indeed, the track record of on-again-off-again aid is miserable.	事实上，如果援助断断续续，最终的结果会非常可悲。


Stop-and-go aid has left Haiti in an unmitigated downward spiral.	断断续续的援助已经使海地经济陷入下降的通道而无法自拔。


The decade-long sanctions against Myanmar have not restored Aung San Suu Kyi to power, but have deepened the disease burden and extreme poverty in that country.	对缅甸长达10年的制裁不仅没有使昂山素姬重新获得权力，反而加剧了那个国家的极端贫困和疾病负担。


Threatened aid cutoffs in Kenya, Chad, and elsewhere would make desperately bad situations worse.	威胁取消对肯尼亚、乍得和其它地方的援助会使本来已经糟得不能再糟的形势进一步恶化。


None of this is to suggest that the US and Europe should abide every move by every corrupt dictator.	这绝不是说美国和欧洲应该按照腐败独裁者的意愿采取行动。


But realism in international economic affairs requires accepting that official development assistance can help achieve the broad political objectives of stability and democracy only in the long run.	但国际经济事务中的现实主义要求我们必须承认：官方发展援助只有从长远的角度看才有可能实现稳定和民主的广泛政治目标。


The most reliable path to stable democracy is robust and equitable economic progress over an ample period of time.	长期繁荣公正的经济发展是通向民主稳定最为可靠的道路。


The overwhelming standard for supplying official development assistance should therefore be whether official assistance actually promotes economic development.	有鉴于此，提供官方发展援助的关键标准应该是看能否真正促进经济的发展。


As such, it must be reliable, predictable, and directed towards development needs in ways that can be monitored, measured, and evaluated.	因此，发展援助必须可以依靠、可以预测，还必须以可以监管、可以衡量、也可以评价的方式直接满足发展需求。


Can the aid be monitored and measured?	能否实现对援助的管理和衡量？


Is it being stolen?	款项有没有被盗用？


Is it supporting real development needs, such as growing more food, fighting disease, or building transport, energy, and communications infrastructure?	是否支持了真正的发展需求，比如种植更多粮食？ 控制疾病或者建设交通、能源和通讯基础设施？


If development aid can be directed to real needs, then it should be given to poor and unstable countries, knowing that it will save lives, improve economic performance, and thus also improve the long-term prospects for democracy and good governance.	如果发展援助能够满足真正的需要，那么就应该把它提供给不稳定的贫困国家，确保它能够拯救生命、改善经济状况，从而改善实现民主和“优秀统治”的长远前景。


Making the Most of More Aid	最大限度地利用更多援助


PARIS – The effort to eradicate global poverty has never been more intense.	巴黎——消除全球贫困的努力从未如此热烈。


In 2014, for the second consecutive year, official development assistance (ODA) totaled a historic high of $135 billion, according to new OECD data.	经合组织最新数据显示2014年，官方发展援助（ODA）连续第二年达到创纪录的1，350亿美元总额。


This indicates that advanced economies remain committed to promoting global development, despite their own recent problems.	这表明发达经济体仍然致力于促进全球发展，尽管他们自身的经济近来也出现了问题。


Add to this total the substantial spending by China, Arab states, and Latin American countries in the form of investments and loans, and it is clear that flows of ODA toward the developing world have reached unprecedented levels.	再加上中国、阿拉伯国家和拉美国家以投资和贷款形式投入的大笔支出，流向发展中国家的官方发展援助显然已经达到史无前例的金额。


And yet happiness about the headline numbers should not be allowed to obscure opportunities to channel these funds more effectively.	但我们不能让整体数据所带来的幸福感抢走资金有效利用的风头。


Official aid from donor countries has helped to halve extreme poverty and child mortality, and it has driven progress on many other fronts as well.	来自捐助国的官方援助协助降低了半数贫困和儿童死亡率，并带动了其他许多方面的进步。


But it is becoming clear that sustained flows of development aid will not be enough to eradicate extreme poverty by 2030 and implement the new United Nations Sustainable Development Goals, which are to be agreed upon later this year.	但人们已经清楚地看到持续的发展援助并不足以到2030年消除极端贫困，落实将在今年下半年达成的联合国新的可持续发展目标。


The money being spent on aid today could have a substantially greater impact if it were used to mobilize domestic tax flows and private investment in aid-dependent countries.	今天的援助款如果被用于动员国内税收和对援助依赖国进行私人投资，产生的影响将比现在大得多。


This use of ODA can be better captured in the new indicator introduced on April 8 by the OECD: Total Official Support for Development.	经合组合4月8日引入的新指标官方发展援助总额可以更准确地反映官方发展援助。


On average, developing countries raise 17% of their GDP in taxes, compared with 34% in OECD countries.	平均而言，发展中国家税收占GDP的17%，而经合组织国家则占34%的份额。


Some collect as little as 10%.	某些国家税收可能仅占GDP的10%。


Much of the lost tax revenue escapes in illicit flows and ends up abroad.	资金非法逃往国外解释了绝大部分的损失税收。


Africa, for example, loses around $50 billion a year in illicit flows, much more than it receives in development aid.	以非洲为例，每年因非法流动损失的资金约500亿美元，远高于其所得到的发展援助总额。


Enabling developing countries to generate just 1% more of GDP in taxes would mobilize twice as much money as the total amount of ODA – and all of it could be channeled into education, health, security, or cash disbursement schemes.	发展中国家税收增加GDP1%所带来的资金相当于两倍的官方发展援助——而且可以悉数投入教育、卫生、安全或现金支付计划。


The returns from money spent on strengthening tax systems can be staggering.	加强税收体系的资金回报是非常惊人的。


In Kenya, Tax Inspectors Without Borders, a project led by the OECD, found that every dollar spent working with authorities on cracking down on tax avoidance produced $1,290 in increased revenues.	在肯尼亚，由经合组织领导的无国界税收督察项目发现与当局合作打击避税行为每投入1美元，就能带来1，290美元的增量收入。


Similarly, in the Philippines, a half-million dollars provided to support tax reform generated well over $1 billion in additional tax receipts.	同样，在菲律宾，支持税收改革的50万美元带来了超过十亿美元的增量税收。 但今天仅有0.


Yet today, only 0.1% of all development aid, just under $120 million, goes toward supporting tax systems in developing countries.	1%、或不到1. 2亿美元的发展援助被用于支持发展中国家的税收改革。


Development aid, properly channeled, also has the potential to mobilize private investment if it is spent to reduce risk.	发展援助如果得到正确引导用于降低风险，也能对私人投资起带动作用。


Guarantees, soft loans, and equity investments backed by development aid can help attract investors, as has occurred with solar energy projects in Mali and manufacturing plants in Ethiopia.	发展援助支持的担保、软性贷款和股权投资有助于吸引投资者，马里的太阳能项目和埃塞俄比亚的生产企业项目就是实例。


In 2014, then-EU Commissioner for Development Andris Piebalgs reported that grants worth €2.1 billion ($2.2 billion) had “achieved an estimated leverage of €40.7 billion in 226 projects since 2007.”	2014年，时任欧盟发展专员安德里斯·皮尔巴格斯报告总值为21亿欧元（合22亿美元）的拨款“从2007年来已在226个项目中实现了约407亿欧元的杠杆效果。 ”


It is important, too, that aid target the areas where it is most needed.	重要的是援助针对需求最迫切的领域。


Even as aid remained at record levels last year, funds provided to the world’s least-developed countries actually dropped.	虽然去年援助额再创新高，但向世界最不发达国家所提供的资金实际呈下降趋势。


Long-standing programs in better-off countries received greater amounts of money, while a string of poorer candidates were once again overlooked.	相对富裕国家的长期计划获得了更多资金，而一系列贫困国家则再次遭到忽视。


When world leaders meet in Addis Ababa in July for the Financing for Sustainable Development Summit, they must agree to channel aid to those countries with the least access to other sources of finance, the greatest difficulty in attracting investors, and the weakest tax systems.	当世界领导人7月在亚的斯亚贝巴可持续发展融资峰会会晤时，他们必须同意援助那些资金来源最匮乏、吸引投资者最困难、税收体制也最落后的国家。


Vulnerable groups, such as ethnic and religious minorities and indigenous rural populations struggling to break out of poverty, should receive special attention.	种族及宗教少数族裔和力求脱贫的当地农村人口等弱势群体应该得到特别的关注。


The 29 member countries of the OECD’s Development Assistance Committee have committed to reversing the decline in aid to the world’s poorest countries.	经合组织发展援助委员会的29个成员国已承诺扭转全球最贫困国家的援助下降趋势。


These donor countries have also pledged to meet a UN target of spending at least 0.15% of their gross national income on development assistance to the least-developed countries.	上述捐助国还承诺实现至少将本国国民总收入的0. 15%用于向最不发达国家提供发展援助。


Moreover, they have agreed on new rules that should channel more resources on softer terms to the poorest countries, and that implement new safeguards to ensure debt sustainability.	此外，他们还就新规达成一致，以更柔和的条件向最贫困国家划拨资源，并落实确保债务可持续性的全新保障举措。


We are the first generation in human history with the means to pull every person on the planet out of abject poverty.	纵观人类历史，我们这代人第一次有能力让地球上所有人从赤贫当中摆脱。


There is enough money in the world.	实现目标的资金十分充足。


It is critical that we use it more wisely.	关键在于我们如何更明智的利用。


Leave No Refugee Behind	不抛弃任何一名难民


NEW YORK – The world has entered an era in which people are being displaced at an unprecedented rate.	纽约——世界民众流离失所的速度前所未有。


In 2014, conflict and persecution forced 42,500 people a day to flee their homes, nearly quadruple the number from 2010.	2014年，冲突和迫害每天迫使42，500人逃离家园，是2010年的将近4倍。


Almost 60 million people are now forcibly displaced – a crisis unmatched since World War II.	目前近6，000万人被迫流离失所——这是二战后前所未有的危机。


This is unacceptable, but it is not inevitable.	现状不可接受，但却并非无法避免。


In 1945, the world responded to the deadliest conflict in human history by establishing the United Nations.	1945年，人类历史上最致命的冲突促成了联合国的建立。


Today, as heads of UN refugee and development agencies, we call for the world to respond to this monumental upheaval by giving people the tools they need to rebuild their lives.	今天，身为联合国难民及发展机构负责人的我们呼吁世界积极应对目前史无前例的动荡，赋予人们重建生活必不可少的工具。


We believe that the path forward begins with the 2030 Sustainable Development Goals, which the UN, affirming a pledge to “leave no one behind” in the fight against poverty and inequality, adopted unanimously last September.	我们相信前进之路始于2030年可持续发展目标，该目标是联合国为了兑现消除贫困和不平等斗争中“不抛弃任何一名难民”的承诺于去年9月一致通过的。


The international community’s current approach to displacement relies mainly on humanitarian aid, which provides rapid, lifesaving relief while the search for a permanent solution is underway.	国际社会现行的流离失所政策主要依靠人道主义援助，其宗旨是在寻求永久解决方案的过程中提供快速赈济物资以挽救生命。


But solutions are proving more elusive than ever.	但在现实中很难找到解决方案。


Just 1% of refugees were able to return home in 2014. The vast majority of those displaced spend not days or months in exile, but years or decades, even entire lifetimes.	2014年仅有1%的难民得以重返家园，而多数流离失所者不是流亡数天或数月，而是数年或数十年，甚至一生都无法重返家园。


They risk being left behind.	他们面临被抛弃的危险。


Consider Somaya, a third-generation refugee in Kenya.	以肯尼亚第三代难民索玛雅为例。


Decades ago, her grandmother fled to the Hagadera refugee camp to escape the brutal conflict in Somalia.	数十年前，她的祖母逃到哈加德拉难民营以躲避索马里爆发的残酷冲突。


Her mother was born there, and so was she.	她的母亲就出生在那里，她也是。


Neither of them has set foot outside the five-square-mile (13 square kilometers) camp.	她们从未跨出过方圆五平方英里（13平方公里）的难民营半步。


They still live out of her grandmother’s suitcases, waiting for a chance to move on.	她们的生活用品全来自祖母的皮箱，静静等待着离开这里的时机。


Like Somaya, most refugees live in the developing world.	像索玛雅一样，多数难民生活在发展中世界。


And yet, too often, development organizations that could provide refugees with a hand up face insufficient funding and stiff regulations that prevent them from addressing refugees’ needs.	但很多时候，本可以为难民提供帮助的发展组织面临经费不足和规定僵化的困扰，导致难民的需求无法得到满足。


Long-term displacement inflicts profound burdens on people like Somaya.	长期流离失所对索玛雅这样的人造成重负。


Refugees too often face limits on their ability to work and move freely, making it all but impossible to provide for their families or to contribute to their host communities.	难民在太多时候面临工作和行动自由方面的限制，致��其几乎不可能抚养家庭或为所生活的社会提供帮助。


They live in limbo, with no choice but to rely on humanitarian aid.	他们生活在地狱边缘，除依靠人道主义援助外别无选择。


Or they are obliged to seek a living in the informal economy, where they risk falling victim to arrest, sexual exploitation, child labor, or other abuses.	另一种情况是他们被迫在非正规经济中寻找出路，从而可能成为逮捕、性剥削、童工或其他虐待行为的受害者。


Consider another example: Anas, a 13-year-old Syrian refugee in Lebanon.	黎巴嫩13岁的叙利亚难民阿纳斯是另外一个例子。


His family cannot survive without the $5 he earns every day.	他的家人没有他每天所赚的5美元根本无法生存。


So, instead of going to school, he sorts lumps of coal for sale as fuel.	因此，他没有上学，而是拣选煤块作为燃料出售。


Refugees like Anas struggle to exercise precisely those rights – to education, health care, freedom of movement, and access to work, land, and housing – that are essential to escaping poverty.	阿纳斯这样的难民在行使对摆脱贫困必不可少的权利时苦苦挣扎——包括教育、医疗、行动自由、就业、土地和住所。


Fixing this will require political and economic changes that allow the development community to provide more support.	改变现状需要让发展团体提供更多支持的政治和经济变革。


The relationship between development and displacement is clear, and we need to begin to consider these challenges as areas of joint responsibility.	发展和流离失所之间的关系十分明确，我们需要为应对上述挑战共同担责。


Large-scale displacement strains public resources, even in middle-income countries; without sufficient outside help, it can undo years of progress.	大规模流离失所导致公共资源紧张，即使中等收入国家也无法摆脱； 如果外界无法提供足够的援助，它会抵消多年以来的发展成果。


Until the world gives more and better support to host countries and the refugees living there, we can expect to pay ever-larger sums for humanitarian programs that never end.	在世界为难民及其收容国提供更多、更好的支持之前，可以预见支付的人道主义援助永远不会停止、而只会越来越多。


But there is another side to the coin.	但还有硬币的另外一面。


When displaced people are allowed to develop their skills and pursue their aspirations, they create new opportunities for growth.	如果流离失所者被允许学习技能、实现愿望，他们能带来新的发展机遇。


This is why development agencies must have more flexibility to address new cycles of poverty and fragility – wherever they appear – before they spiral out of control.	发展机构因此必须赶在新一轮贫困和脆弱彻底失控前（无论它们出现在何种领域）更加灵活地采取对策。


The time has come to discard the clichéd image of refugees as passive recipients of aid, sitting idly with outstretched hands.	彻底摒弃老套难民形象的时机已经成熟，难民不应再被视为无所事事、伸手乞讨的被动的援助接受者。


If anything, that image reflects circumstances that have been imposed upon refugees and reinforced by the world’s incomplete response.	如果说这种形象反应了什么，那么它所反应的是强加给难民的各国不完全对策下难民的境况。


Refugees are entrepreneurs.	难民是创业者。


They are artists.	他们是艺术家。


They are teachers, engineers, and workers of all types.	他们是教师、工程师和掌握各种技能的劳动者。


They are a rich source of human capital that we are failing to cultivate.	他们是丰富的人力资本源泉，而我们却未能对其善加利用。


The international community can no longer afford to ignore so much potential or to sit by while the most vulnerable are pushed to the margins of society.	国际社会不能再继续对如此的潜能视而不见，或坐视最脆弱的群体被社会边缘化。


As news headlines call attention to the human costs of these tragedies, we must remember that we have the choice to respond with more than just shock.	在新闻头条呼吁关注这些悲剧所造成的人文代价的同时，我们必须牢记我们可以采取除震惊以外的其他对策。


We can reject the economic exclusion of those who live among us but were born somewhere else.	我们可以拒绝对出生在别处、但生活在我们身边的人进行经济排斥。


We can redouble our efforts to seek political solutions to conflict and persecution.	我们可以加倍努力政治解决迫害和冲突。


We can empower humanitarian and development partners to work together from the moment a crisis erupts.	我们可以授权人道主义和发展伙伴，从危机爆发的那一刻就开始合作。


In short, we can honor our pledge to “leave no one behind.”	总而言之，我们可以履行“不抛弃一个难民”的承诺。


Financing the Fight Against Climate Change	为对抗气候变化融资


PARIS – Climate change is already wreaking havoc throughout the developing world.	巴黎—气候变化已给发展中世界造成了严重破坏。


Vietnam, for example, has reported that natural disasters, some of them exacerbated by climate change, have caused annual losses equivalent to 2% of its GDP.	比如，越南报告说，一些自然灾害因为气候变化而加剧，而自然灾害每年造成的损失相当于其GDP的2%。


In agriculture-dependent countries like Ethiopia, longer droughts and more frequent flooding are threatening livelihoods and food supplies.	在埃塞俄比亚等农业国，更长时期的干旱和更频繁的洪水正在威胁牲畜和食品供给。


As the international community gears up for the United Nations Climate Change Conference in Paris in December, identifying and streamlining sources of financing for the fight against climate change must be a top priority.	12月，国际社会将在巴黎召开联合国气候变化会议，确定并梳理对抗气候变化的资金源必须作为重中之重。


Development banks like the French Development Agency (AFD), where I am CEO, are well placed to contribute.	法国开发署（French Development Agency，AFD，由我担任CEO）等开发银行可以做出贡献。


For starters, development banks can finance projects that benefit both development and the environment.	首先，开发银行可以为同时有利于发展和环境的工程提供融资。


Global warming is now a vital factor to consider when planning any development project.	如今，全球变暖已是所有发展项目规划时都要考虑的关键因素。


For example, the effects of climate change can pose critical risks to infrastructure – agricultural irrigation, public transportation, or nearly anything else.	比如，气候变化的影响可能给基础设施——农业灌溉、公共交通和其他几乎所有领域——带来临界风险。


Meanwhile, rising incomes – a goal of any development effort – nearly always means increased consumption of natural resources and energy, resulting in more emissions and further warming.	与此同时，收入的增加——发展项目的目标——几乎总是意味着增加自然资源和能源的消费，导致更多排放和进一步变暖。


Such interlocking relationships between global warming and development explain why the French government requires that at least 50% of the funding provided by the AFD be directed toward development projects that also have a positive impact on the environment.	这一全球变暖和发展之间的连锁反应揭示了为何法国政府要求AFD所提供的资金中至少有50%用于能对环境产生积极影响的发展项目。


Examples include wind farms in Ethiopia, better forest management in Madagascar, nationwide climate plans in Indonesia and Vietnam, and clean urban transport in Colombia.	这方面的例子包括埃塞俄比亚的风电场、改善马达加斯加森林管理、印度尼西亚和越南的全国气候规划、哥伦比亚的清洁城市交通等。


Development banks can also play an important role in designing financial tools that allow private investors to contribute to the fight against climate change.	开发银行还可以在设计金融工具、让私人投资者也为对抗气候变化做出贡献方面起到重要作用。


But today’s funding challenge is no longer just about quantity.	但今天的融资挑战已不再是数量。


Though potential sources for climate-friendly development financing now include pension funds, insurance companies, foundations, and sovereign wealth funds, what is often missing are mechanisms to ensure that investments are channeled into well-targeted and effective projects.	尽管潜在的气候友好型发展融资源包括养老基金、保险公司、基金会和主权财富基金，但我们常常忽略确保投资被引导到定位准、效率高的项目的机制。


One solution is “green” (or “climate”) bonds.	一个解决方案是“绿色”（或“气候”）债券。


These instruments have all the characteristics of conventional bonds, but they are backed by investments that contribute to sustainable development or the fight against climate change.	这一工具具有传统债券的所有特征，但它们由有助于可持续发展或对抗气候变化的投资支持。


Until recently, only a few organizations or governments, including the World Bank, the American state of Massachusetts, and the French region of Île de France, issued green bonds, and generally the amounts involved were modest.	到目前为止，只有少数组织或政府（包括世界银行、美国马萨诸塞州和法国的法兰西岛地区）发行了绿色债券，总的来说数量极为有限。


But in the past two years, other players have entered the market, and volumes have skyrocketed.	但在过去两年中，其他行动方也进入了市场，发行量大幅增加。


In 2014, emissions of green bonds exceeded the total in all previous years combined.	2014年，绿色债券的发行量超过了此前所有年份的总和。


Indeed, demand is outstripping supply.	事实上，绿色债券供不应求。


The latest bond offers were all oversubscribed – and the trend is likely to continue.	最近的债券发行都出现了超募——这一趋势有望持续下去。


The insurance industry has committed to double its green investments, to $84 billion, by the end of 2015.	保险业承诺将其绿色投资翻番，到2015年底达到840亿美元。


And in September, three major pension funds from North America and Europe announced plans to increase their holdings in low-carbon investments by more than $31 billion by 2020.	9月，三家来自北美和欧洲的主要养老基金宣布计划到2020年将增加低碳投资持有量增加310亿美元。


As the market for these bonds expands, they must be better labeled and certified.	随着这些债券的市场的扩张，它们必须更好地得到包装和认证。


Today, harmonized standards do not exist.	目前尚不存在协调标准（harmonized standards）。


The quality of the assets backing the bonds depends solely on issuers’ goodwill and technical skills.	支持这些债券的资产质量完全取决于发行者的商誉和技术技能。


Specific guidelines and rating methods need to be developed.	我们需要开发具体的指导原则和评级方法。


In this context, the recent decision by a coalition of institutional investors to measure and disclose the carbon footprint of at least $500 billion in investments is a step forward.	再这样的背景下，最近一系列机构投资者联合决定测量和披露至少5,000亿美元规模投资中的碳足迹，这是一项重大进步。


In September, the AFD issued €1 billion ($1.2 billion) in climate bonds, with one goal being to contribute to the development of concrete quality standards.	9月，AFD发行了1亿欧元气候债券，其目标之一是助力具体质量标准的制定。


With the help of a major agency that rates corporate social responsibility, we were able to provide investors with solid information – and an accountability process – about the portfolio’s direct impact on greenhouse-gas emissions.	在一家公司社会责任评级机构的帮助下，我们得以向投资者提供关于投资组合对温室气体排放的直接影响的具体信息和问责程序。


Indeed, the projects financed by these bonds were required to meet stringent criteria, including a prior analysis of their carbon footprint, proof of a clear and significant impact on climate change, and a design that is aligned with the broader strategies being pursued by local actors and countries.	事实上，通过这些债券融资的工程被要求满足严格的标准，包括事前碳足迹分析、清楚重大气候变化影响证明，以及与本地和国家行动方所追求的更广泛的战略一致的设计。


Climate bonds have the potential to empower countries and institutions as they move toward meeting enforceable commitments to reduce CO2 emissions.	气候债券有望助力国家和机构满足强制性减少二氧化碳排放的承诺。


However, if they are to be effective, they will require clear guidelines and a reliable framework for assessment.	但是，要想气候债券产生效果，就必须有明确的指导原则和可靠的评估框架。


As leaders from countries and institutions from around the world prepare to meet in Paris in December, getting the financing right should be a top priority.	在世界各个国家和机构领导人准备12月巴黎会议的时候，正确地进行融资应该成为重中之重。


What’s Wrong with Evidence-Based Medicine?	基于证据的医学的问题


SEATTLE – Every health-care system balances coverage, quality, and cost – often focusing on one or two at the expense of the others.	西雅图—任何医疗体系都要平衡覆盖度、质量和成本——通常都会集中关注其中之一或之二而牺牲其他。


European systems, for example, tend to focus on coverage and ensure universal access to care; in the United States, by contrast, quality appears to be paramount.	比如，欧洲的医疗体系关注覆盖度、确保所有人都能获得医疗； 与之相反，在美国，质量才是最重要的。


But, whatever one’s view is about the proper priorities, it is clear that the US has room for improvement in all three areas.	但是，不管你认为什么才是最重要的，显然美国在所有三个方面都有改进空间。


Fortunately, efforts are underway to address each of them.	幸运的是，美国已经采取措施改进所有三个领域。


And efforts in the US have implications for other countries as well.	而美国的动作对其他国家也有影响。


The US Patient Protection and Affordable Care Act (the landmark legislation now widely known as “Obamacare”) aims to widen coverage, while so-called accountable care organizations, such as Kaiser Permanente, try to contain costs by aligning the interests of providers and payers.	美国患者保护和平价医疗法（Patient Protection and Affordable Care Act，现被广泛称为“奥巴马医保”的标志性立法）旨在扩大覆盖度，与此同时，凯撒医疗机构（Kaiser Permanente）等所谓的责任医疗组织试图通过协调医疗服务供应商和患者的利益控制成本。


However, efforts to raise quality through the application of evidence-based medicine (EBM) risk ignoring what we know about human cognition and expertise, and may undermine the vital role played by a physician’s expert judgment.	但是，通过应用基于证据的医学（evidence-based medicine，EBM）提高质量的做法有可能忽视我们所知道的的人类认知和专业知识，并且常常不利于医生的专业判断所起到的关键作用。


There are at least three reasons to be wary.	至少有三个理由值得关注。


For starters, EBM is grounded in a fundamental distrust of physicians’ intuition – that is, the rendering of pattern-based judgments that rely on years of experience.	首先，EBM的基础是根本上对医生直觉（即依赖多年经验的基于模式的判断）的不信任。


To be sure, there are good reasons to be skeptical of intuition, given the countless cases in which it has proved to be wrong.	平心而论，怀疑直觉不无道理，因为直觉出错的例子不胜枚举。


But it does not follow that all cases of intuition are flawed or that skilled intuition has no function in healthcare.	但这并不意味着所有直觉都有缺陷，或者技艺高超的医生的直觉在医疗中毫无作用。


Physicians develop expertise over many years, and when they have ample opportunities for feedback about their judgments, their intuitions are valuable, particularly in more complex cases.	医生在多年的时间里打磨专业技能，当获得了足够多的对其判断的反馈机会时，他们就能形成极有价值的直觉，特别是在疑难杂症中。


An experienced physician will evaluate a patient’s vital signs and test results in the context of the patient’s life – for example, whether he is an octogenarian with diabetes and a smoker’s cough, or a three-week premature baby.	有经验的医生可以评估患者的关键信号，并在患者的生命状况测试结果——比如他是否是耄耋之年的糖尿病患者并且还是个烟枪，还是只有三周大的婴儿。


With heuristics, intuition, and experience, an experienced physician can best understand a complicated case and develop a plan.	在启发式、直觉和经验的作用下，有经验的医生能够很好地理解疑难杂症，制定对策。


In fact, an experienced doctor’s conclusions may be more accurate than those provided by EBM.	事实上，有经验的医生的结论可能比EBM所提供的结论更加准确。


That is because EBM, though based on data from randomized trials and rigorous experiments, is designed for situations that approximate the conditions of patients in those tests.	这是因为，尽管EBM基于来自随机试验和严格实验的数据，但它所适用的状况是在这些测试中的病人的近似情况。


The problem is that when the context changes, the trial results become less reliable.	问题在于，当条件变化时，试验结果就不那么可靠了。


In such cases, the physician must determine how close his or her patient’s situation matches that in the relevant studies.	此时，医生必须确定他的患者的状况与相关研究的匹配程度。


If the disease is not as advanced as in the trials, the doctor will have to decide whether to embark on the recommended protocol.	如果病情不如试验中严重，那么医生必须决定是否采取建议方案。


And clinicians may be unsure about which constraints are inviolate.	临床医生可能无法确认哪些约束是不可违反的。


Ultimately, the final judgment is informed by personal experience and pattern recognition, an approach that EBM supporters discount or even disparage.	最终，最后判断要根据EBM支持者抨击甚至蔑视的个人经验和模式识别做出。


A second problem with EBM is that it offers little guidance when a medical condition is evolving.	EBM的第二个问题是它无法对不断演化的医疗环境提供指导。


For example, acute asthma may be the focus of care at one moment, but might shift to the patient’s diabetes later.	比如，急性哮喘可能是某一时刻治疗的中心点，但随后可能转为患者的糖尿病。


EBM guidelines focus on asthma treatment or diabetes, but not both, or even how they may interact and change over time.	EBM指导要么以哮喘治疗为中心，要么以糖尿病为中心，而不可能同时以两者为中心，甚至不关注两者之间的互动和随时间的变化。


Finally, and perhaps most critically, one must ask how clinicians are to make decisions when there are gaps in the EBM knowledge base.	最后——或许也是贵关键的——你必须指导临床医生在EBM知识基础存在空白时怎样做决定。


Doctors often spot trends and develop hypotheses that involve guesswork, and that are validated by trials only later.	医生往往要识别趋势，提出包含猜测因素的假说，他们的假说只有在随后的试验中才能得到证实。


Should doctors therefore ignore observed patterns until the data are in?	医生应该因此忽视观察到的模式等待数据吗？


Indeed, one might wonder how such trials are initiated at all if clinicians do not tentatively explore a problem in the first place.	事实上，你或许会问，如果临床医生不在一开始主动地尝试探索问题，这类试验如何会启动呢？


To insist that all treatment decisions be based on existing best practices stifles this exploration and prevents potential medical breakthroughs.	坚持所有医疗决定都必须基于现有最佳实践会扼杀这一尝试、阻止潜在医学突破。


Advocates of EBM respond that it is the job of researchers to generate the data that are turned into best practices; the clinician’s role is to implement the results.	EBM的支持者反驳说，生产数据并转为最佳实践的工作应该由研究者来完成； 临床医生的作用是实施成果。


But this approach runs counter to medical history, in which advances come only after practitioners notice anomalies, discover flaws in current “best practices,” or improve on existing approaches.	但这一观点与医学史背道而驰。 在医学史中，进展只能在实践者注意到反常、发现现有“最佳实践”漏洞或改进已有方法后发生。


Many medical advances, from ulcer therapies to joint replacement, have evolved through clinician curiosity, not as a result of trials.	从溃疡治疗到关节置换术在内的大量医学进步都来自临床发现而不是试验成果。


Moreover, important sources of EBM have themselves proved to be misleading.	此外，EBM的重要来源本身也被认为有误导性。


The Framingham Heart Study, considered the gold standard in its field, was shown to be flawed, owing to its focus on white males.	被认为所在领域黄金法则的《弗莱明厄姆心脏研究》（Framingham Heart Study）被证明存在漏洞，因为它是以白人男性为中心撰写的。


For example, a key symptom of a heart attack identified by the study (the feeling of “an elephant sitting on my chest”) is found in only 5% of women.	比如，该研究所识别的一个重要的心脏病症状（感到“胸口坐着一头大象”）只在5%的女性身上发生。


As one emergency medicine physician ruefully admitted to us, “I think about all the women I sent home to their deaths because I was following best practices.”	一位急诊医生悲哀地向我们坦承，“我想，在我的病床上去世的女性都是因为我遵守最佳实践而死的。 ”


As we consider a likely future in which physicians adhering to EBM are paid more, we must consider the cognitive limitations and the human cost of unquestioning compliance with so-called “best practices.”	考虑到在未来严守EBM的医生将成为主流，我们必须认识到认知局限和不容置疑地遵守所谓的“最佳实践”的人道成本。


A more effective approach must be to combine EBM with the expertise and intuition of experienced caregivers, and to take the benefits of both.	更有效的方法必须结合EBM和经验丰富的医护人员的专业知识和直觉，兼取其长。


Diagnosis as Public Policy	当诊断成为公共政策


When we think about medical diagnosis, we usually think in terms of science.	每当我们想起医学诊断，我们通常是站在科学的角度。


The conventional (and accurate) wisdom is that diseases are named and classified on the basis of scientific research.	常规（且精确）的公认说法是，根据科学研究来命名并分类疾病。


For example, the roughly decennial revisions of the World Health Organization’s International Classification of Diseases (ICD) partly reflect advances in scientific understanding of diseases and injuries.	举例而言，大约每十年一次的世界卫生组织《国际疾病分类标准》(ICD)的修订就从某一个角度反映了在对疾病和损伤科学性理解方面的进步。


The cataloging and naming of diseases is a condition of scientific research, as well as its product.	疾病的分类和命名是科学研究、同样也是科学成果的条件之一。


Indeed, how are doctors to explain and control disease without a common language for the phenomena that they observe?	的确，如果医生没有一种通用语言来描述他们所观察到的现象，他们怎能解释并控制疾病呢？


The ICD comprehends the entire spectrum of human disease and injury, and its updates reflect the best new knowledge as well as set the stage for the next wave of medical advances.	ICD包含了所有人类疾病和损伤种类，它的更新不仅反映了最新尖端知识，也酝酿了医学进步的下一浪潮。


But the formal classification of diseases has another aspect, one that concerns a variety of important social functions.	但是疾病的正式分类还有另外一个方面，它关系到许多重要社会职能。


It provides a set of disease names and numeric codes for assigning and tracking health-care expenditures and services.	它为分配及追踪健康医疗开销和服务提供了全套疾病名字和数字代码。


Governments, insurance companies, and patients use these names and codes in accounting and budgeting.	政府、保险公司和病人在记账与制定预算时也使用这些名字和代码。


The ICD code also frames eligibility for related social goods like hospital care, medical retirement, claims for disability compensation, hospice care, and home health care, to name a few.	ICD也为诸如医院看护、医疗退休的相关社会产品的可行性制定了框架，呼吁残疾人补贴、收容所看护以及家庭健康看护，在此仅举以上几例。


From the doctor’s perspective, diagnostic classifications like the ICD provide the official language to be used in medical records, discussions with patients and their families, and in billing for services.	从医生角度来说，诸如ICD此类的诊断分类，为他们提供了在医学记录、与病人及其家属的讨论以及为医疗服务开账单时所需使用的官方语言。


For patients, diagnostic classifications provide the framework for understanding their own and others’ disease processes.	对于病人来说，诊断分类有助于他们了解自己与他人病情的进展情况。


Finally, diagnostic classification provides politicians the language for building or dismantling health programs.	最后一点，诊断分类为政治家们提供了建立或撤销一个健康计划的语言。


Clearly, the public and social character of diagnostic classifications of disease extends to private organizations.	显而易见，诊断分类的公共社会性还延伸到了私人组织。


Consider organizations that regulate medical licenses or administer medical emergency relief funds.	想想那些管理医药许可证或管理医药紧急援助基金的组织。


(In the non-medical area, think of business organizations that regulate trade or educational commissions that accredit schools).	（在非医药行业，则想想那些管理贸易的商业组织或对学校进行资格认证的教育委员会）。


Government is hardly alone in creating the formal rules, principles, and guidelines that structure and regulate public life.	政府并非唯一在制定用于构建、管理公共生活的正式条例、原则和方针的机构。


Public policy is defined by the public’s interest in the policy, not who made it.	公共政策的定义由政策中的公共利益，而非它的制定者来决定。


At least in democratic societies, such policies should be accountable to the public, and the classification of diseases, since it serves many of the functions of public policy should be no different.	至少在民主社会，应当向公众解释清楚这样的政策，而疾病分类，由于它应用于公共政策中的诸多职能，也应该如此。


It turns out that psychiatry, in particular, has exhibited leadership and innovation in recognizing the public-policy aspects of diagnostic classification.	然而结果却是，精神病学家诊断分类的公共政策认识性方面，表现出了出众的领导才能与创新意识。


Both the ICD classification of mental disorders, and its American counterpart, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) efforts have taken pains to make diagnostic classification accountable as examples of public policy.	ICD中的心理疾病分类，与它的美国对应物——美国精神病学协会的《美国精神疾病诊断标准》(DSM)一起，已经正在不遗余力向公众像解释公共政策的范例一样地解释诊断分类。


Both organizations have included diverse representation on their working committees, invited input from “outsiders” to the professions and collaborated with related institutions and organizations in preparing their classification revisions.	在工作委员会上，这两个组织都运用了大量的演示陈述，邀请了从“行外人”到专家加入其中，与相关协会及机构合作，为校对分类积极筹备。


In my view, the classification of mental disorders, as a form of public policy making, poses exceptional challenges.	在我看来，作为公共政策制定的形式之一，心理疾病的分类面临着异常艰巨的挑战。


A primary challenge is posed by the nature of mental illness itself.	主要挑战之一就来自心理疾病本身的特性。


Mental illness invades the mind and the self, the same domains where political beliefs and social interests reside.	心理疾病侵扰心灵和本性，那里主宰着政治信仰和社会利益。


The history of world psychiatry is peppered with diagnoses of mental illness based on political dissent.	心理病学的历史穿插着许多由于政治不合而导致的心理疾病诊断。


Public policy concerning mental illness must, therefore, consider carefully the potential for imposing unjustified social and political values on people in the guise of the classification of disease.	因此，关系到心理疾病的公共政策必须仔细考虑可能会以诊断分类的名义出现、强加于人们身上的不公平的社会及政治价值观。


On the other hand, psychiatric public policy must also take into consideration the feeble social and political status of the severely mentally ill.	从另外一方面来说，精神病学方面的公共政策必须考虑到那些心理患疾严重者低微的社会和政治地位。


Public policy concerning the mentally ill should empower, not marginalize.	有关心理疾病的公共政策应该赋予他们权力而不是使他们边缘化。


The latter point, however, is where the current puzzles reside for psychiatric diagnosis as public policy.	然而，接着就是当前存在的对于精神病学作为公共政策的困惑。


As the WHO begins to plan the ICD eleventh edition and the American Psychiatric Association begins to plan the fifth edition of the DSM, one wonders how to ensure additional moral, social, and political accountability in what traditionally have been viewed as the instruments and products of science.	当世界卫生组织开始计划ICD的第十一版，美国精神病学协会开始计划DSM的第五版时，也许有人会想知道如何保证能将那些附加在传统观念中的科学工具和成果上的道德、社会和政治性解释清楚。


Should patients and their families be directly involved in the development of classifications?	病人及其家属也应该被牵涉到分类的发展中来吗？


If so, how?	如果应该，又该如何呢？


If not, how can the needs of scientific credibility and public accountability be met?	如果不应该，又该如何使科学可信度与公众解释性两种需要相满足呢？


While psychiatry may be leading the debate about these problems, other medical specialties cannot be far behind.	当精神病学家也许正引领着关于这些问题的讨论时，其他的医药专家也不可能远远落后。


As scientific progress broadens the range of options regarding health, the trappings of social, political, and moral choice will increasingly infiltrate medical diagnoses.	随着科学进步拓宽了关于健康的选择范围，社会、政治以及道德选择的标志将日益渗入到医疗诊断中。


Debates about reproductive freedom and “cosmetic” enhancements – such as the use of growth hormone to “treat” short stature – already occupy the news.	有关再生育自由和“美容”增高的争论——诸如为治疗身材矮小而使用增长激素——早已充斥满了新闻版。


How will the associated conditions be classified?	如何对这些相关情况进行分类呢？


By whose authority and with what accountability?	以谁的权威性，采取何种解释法？


What social values will be advanced?	社会价值观将迈向何处？


Classifying disease should reflect the best collaborations between science and politics.	对疾病的分类应当反映出科学与政治之间的最佳合作状态。


With thoughtfulness and perseverance, psychiatry’s current deliberations about diagnosis as public policy will provide a road map for the broader medical debates lurking ahead.	经过深思熟虑，秉着坚定不移的态度，精神病学家目前对于诊断作为公共政策的仔细考虑将会为潜藏于前方、更广范围内的医学辩论勾画出一幅路线图。


Dialogue or Disaster	对话还是灾难


Although Hu has been on several “working visits” to Washington, his upcoming trip will be his first official “state visit” since becoming president eight years ago. Given the great importance that China has traditionally attached to formalities, the Chinese government is repeatedly emphasizing that fact – and thus demonstrating its high expectations for the event.	华盛顿——


China has made an enormous effort to manage every detail of the summit.	1月18日，中国国家主席胡锦涛将对美国进行为期4天的访问。


Foreign Minister Yang Jiechi was sent to Washington last week to apply the final touches to the preparations.	此前，胡主席已数次到过华盛顿进行“工作访问”，但此次访问是他成为中国国家主席8年来首次正式“国事访问”。


China also resumed high-level bilateral military exchanges, which it suspended a year ago to protest US arms sales to Taiwan. Robert Gates, the US	中国向来极其重视礼节，因此中国政府一再强调这次是“国事访问”，显示出对此事的极高期待。


Secretary of Defense, was warmly welcomed by Hu and other Chinese leaders days before the Washington summit.	中国对这次访问作了无微不至的准备。 上周，杨洁篪外长赴美，就准备工作与美方做最后的沟通。


He even toured the People’s Liberation Army’s missile corps.	中国还恢复了一年前因抗议美国对台军售而暂停的高级别双边军事交流。 在胡主席访美前夕，美国国防部长盖茨先访问了中国，受到了胡主席和其他中国领导人的热情款待。


Obviously, China wants to cultivate a pleasant atmosphere for Hu’s state visit.	盖茨甚至造访了中国人民解放军二炮司令部。 显然，中国意在为胡主席的国事访问营造和谐氛围。


Most of the meeting’s agenda will be the same as at previous Sino-US summits.	胡主席这次访问的日程与前几次中美峰会无异。


President Barack Obama will likely raise issues such as the bilateral trade imbalance, the Chinese government’s manipulation of the renminbi’s exchange rate, prevention of nuclear proliferation, recent tension on the Korean peninsula, international cooperation on climate change, and China’s poor human rights record.	奥巴马总统所提出的问题可能依然是双边贸易失衡、中国政府操纵人民币汇率、防止核扩散、朝鲜半岛紧张局势、气候变化国际合作以及中国人权状况有待改善等。


Hu’s reactions to Obama will also be familiar.	胡主席对奥巴马总统的回应也不会有多少新意。


China will blame the trade imbalance on America’s ban on high-tech exports to China, deny engaging in currency manipulation, call on the US and its allies in East Asia to negotiate with North Korea without preconditions, insist on China’s entitlement as a developing country to an exemption from emissions caps on CO2, and refute criticism of its human rights record.	中国将把贸易失衡之责推给美国针对中国的高科技出口禁令、否认有汇率操纵行为、敦促美国及其东亚盟友与朝鲜展开不带先决条件的谈判、强调中国作为发展中国家免受CO2排放限制约束的权利，并反驳对中国人权状况的批评。


While neither side is likely to change its current position significantly, a new subject will probably arise at the meeting: China’s growing military power, and its influence on the Asian and Pacific region.	虽然中美双方均不愿意大幅改变当前立场，但此次胡奥峰会仍可能涉及一个新话题：中国军力的提升及其对亚太地区的影响。


Just as China has replaced Japan as the world’s second largest economy, so its military might has grown rapidly in recent years.	中国的经济规模已超过日本，成为世界第二。 其军力近年来亦有了迅速提升。


As a result, the US, as the world’s strongest military power, wants to put bilateral military relations on the upcoming meeting’s agenda, along with bilateral economic relations and international political affairs.	因此，作为世界首席军事强国，美国意欲将双边军事关系提上此次胡奥峰会议程，与双边经济关系和国际政治事务一起讨论。


Gates raised this issue during his recent talks with his Chinese counterpart, Liang Guanglie, proposing a mechanism for “strategic dialogue” between US and Chinese military forces, aimed at avoiding potential conflicts that might be caused by mutual misunderstanding and mistrust.	盖茨在与中国国防部长梁光烈的谈话中谈到了这个问题，提议建立美中军方的“战略对话”机制，以避免双方因互相误解和互不信任而导致冲突。


But Liang did not commit to such a formal arrangement.	但梁光烈并未就此事承诺任何正式安排。


Obama will surely raise the issue again at the upcoming summit.	奥巴马总统必定会在胡主席到访时重提此事。


But China’s attitude towards Sino-US military dialogue remains uncertain.	但中国对中美军事对话的态度依然暧昧。


Despite its resistance to a strategic military dialogue with the US, it seems to crave America’s attention to its growing military might.	中方不愿与美方展开战略军事对话，但似乎很想向美国展示其不断提升的军力。


A few days before Gates’s visit, official Chinese media published a photo of the J-20 Black Eagle, a fifth generation stealth, twin-engine fighter aircraft made in China.	在盖茨到访前几天，中国官方媒体发布了中国自主研发的第五代双引擎歼击机J20黑鹰战机的照片。


The media also reported the development of the Dong Feng 21D ballistic missile, described as an “aircraft carrier killer.”	官方媒体还报道了东风21D弹道导弹的研发进展，称之为“航母杀手”。


From America’s point of view, China’s rapidly growing military power and lack of transparency have become grave concerns.	站在美方的立场上，中国军力的快速增长和缺乏透明度值得引起严重关切。


In recent years, China has become increasingly assertive in its territorial disputes with Japan and other countries around the South China Sea.	近几年来，中国与日本和其他国家在南海主权问题争端上越来越强硬。


Indeed, Chinese leaders claim the South China Sea and the Yellow Sea as “core” national interests and openly express displeasure at the presence of US naval forces in these waters.	事实上，中国领导人宣布南海和黄海是中国的“核心”国家利益，公开谴责美国海军在上述海域出没。


China’s behavior clearly shows its determination to become a regional power – indeed, the only military power in the region.	如此动作清楚地标明，中国已下定决心成为区域军事强国——事实上，是成为该地区唯一的军事力量。


Given the strength and depth of America’s alliances within the Asia-Pacific region, tension between US and Chinese military forces has risen.	而美国与亚太地区有着深厚的盟友关系，因此美中之间的军事关系日渐紧张。


China believes that it has a legitimate right to increase its military power, given its need to protect its expanding economic interests, which include secure sea routes for the transport of energy and other goods.	中国认为提升军力是其的正当权利，因为它需要维护日益扩大的经济利益，比如保证能源和其他商品运输线的安全。


The suspicions of China’s neighbors, and their moves to establish closer military relations with the US, have made the Chinese government increasingly anxious and frustrated.	中国的邻国则对此颇为狐疑，纷纷倒向美国，与之建立起紧密的军事关系，这使中国政府感到越来越焦虑和失望。


At the same time, growing nationalist sentiment has put huge pressure on the government to be more aggressive and confrontational.	而与此同时，中国政府还受到国内日渐增长的民族主义情绪的巨大压力，不得不表现出强硬对峙的姿态。


Putting strategic military dialogue on the US-Sino agenda benefits both sides.	将战略军事对话纳入美中议事日程对双方都有利。


For China, it is a symbol of recognition and respect as a regional military power.	对中国来说，这算是对其作为地区军事力量的认可和尊重。


And, on a practical level, frequent and regular high-level military exchanges between the US and China would greatly increase mutual confidence and trust at a time when their divergent interests might otherwise lead to conflict.	此外，从务实的角度看，美中之间频繁的定期高层军事交流能显著增进互信，否则的话，两国之间的利益分歧可能会导致冲突。


History shows that a rising military power will inevitably clash with an existing military power if they do not have regular, effective dialogue.	历史表明，如果没有定期、有效的对话，新兴军事力量就会免不了要与现存军事力量���生冲突。


In that case, China’s claim to a peaceful rise would ring hollow.	到时中国的和平崛起宣言就会成为空谈。


China, the Asia-Pacific region, and the world would suffer greatly as a result.	中国、亚太地区以及全世界都将因此蒙难。


Did America Really Kill the Trade Talks?	贸易谈判破裂谁之过


It is appalling that the world has decided to blame the United States for the crushing end to five years of global trade talks last month (the so-called “Doha round”).	世界决定将持续五年的全球贸易谈判（即所谓的“多哈回合”）在上月的破裂归罪于美国，这实在令人震惊。


I am the first to admit that the US under President George W. Bush has not covered itself with multilateral glory in recent years.	我第一个承认布什总统领导下的美国在近几年处理多边关系的问题上确实无所建树。


But accuse America of sabotaging the trade talks?	但是指责美国破坏贸易谈判？


Give me a break.	太欲加之罪了吧。


Has anybody noticed that for more than a decade now, US imports have been averaging several hundred billion (thousand million) dollars more than exports?	是否有人注意到十多年以来，美国的进口一直比出口平均高出几千亿美元？


Do people seriously believe that the US has accomplished its majestic trade deficit by shutting its doors to foreign goods?	人们真地认为美国是通过拒绝进口外国商品才实现如此巨大的贸易逆差吗？


On the contrary, through its low tariffs and general lack of import restrictions, the US has turned itself into an international shopping theme park.	正相反，美国通过其低关税和通常极少的进口限制将自身变成了一座购物乐园。


Americans buy more foreign-made refrigerators, cars, clothing, computers – you name it – than anyone else.	美国人比其他任何国家的人都购买了更多外国产的冰箱、汽车、服装和电脑—真可谓不胜枚举。


Happily for world exporters, the same binge mentality that makes a whopping two-thirds of Americans either overweight or obese seems to extend to all their purchasing habits.	让世界各地的出口商欣喜的是，那种让多达三分之二的美国人或超重或肥胖的狂欢心态也延伸到了他们的购物习惯上。


Since the start of this decade, neither recession nor hurricanes nor sky-high oil prices have seemed to dent their appetites.	这个十年以来，不论是经济衰退还是飓风抑或是高企的油价都没能影响美国人的购买欲。


The simple fact is that even if US trade negotiator Susan Schwab had refused to make a single “concession,” and if Europe, Japan, and the big emerging markets had kept their best offers on the table, the US would still remain more open than all but a few small countries.	一个简单的事实是：就算美国的贸易谈判代表Susan Schwab没有做出任何一项让步，就算欧洲、日本和其他大的新兴市场国家把最好的出价摆在台面上，美国仍然会是除少数小国以外的最为开放的市场。


True, in the endgame of the talks, the US caved in to its wealthy and powerful agribusiness lobby.	诚然，在谈判的最后阶段，美国屈服于其富有而强大的农业综合企业的游说。


But that was only after five years of intransigence by Europe’s even more powerful farm lobbies.	但这也仅仅是在领教了欧洲长达五年更为强硬的农业游说后做出的。


And this is not to mention emerging market politicians’ failure to grasp that unilaterally reducing their excessive import restrictions would be a good idea even if rich countries sat on their hands.	更不用说新兴市场国家的政客们没能明白的一点：即便美国袖手旁观，单方面降低他们过度的进口限制也会是个好主意。


What does last month’s trade fiasco mean?	上个月的贸易谈判彻底失败说明了什么？


Old hands know that global trade deals often rise out of the ashes of failed talks.	老手们都知道全球贸易协议往往诞生于谈判破裂的灰烬之中。


Unfortunately, such an outcome seems improbable now, especially since the US is unlikely to rejoin the talks anytime soon.	不幸的是，这样的结果现在似乎不可能出现了，特别是因为美国不大会在短时间内重回谈判桌。


The opposition Democratic Party seems poised to take up growing wage inequality as a central issue in this year’s mid-term US congressional elections and in the 2008 presidential election.	在野的民主党似乎决意将日渐突出的薪资不平等作为今年美国国会中期选举和2008年总统大选的中心议题。


To be sure, we economists have found that globalization appears to have played a far lesser role in growing wage inequality than have technological advances.	确切地说，我们这些经济学家们发现技术进步对薪资不平等的影响似乎远比全球化要大。


Even so, the explosion of exports coming out of low-wage regions like China and India is at least a piece of the puzzle.	即便如此，从中国和印度这样的低工资地区涌来的大量出口商品也是这个谜题的一部分。


The last thing that Bush’s Republicans want is to appear indifferent to the plight of the middle classes.	布什的共和党人最不愿显得对中产阶级的困境漠不关心。


So, unfortunately, even if Europe came to its senses and emerging markets showed greater enthusiasm for liberal trade, we may not see a big global deal until the next decade.	所以，不幸的是，即便欧洲即时醒悟，且新兴市场国家也对自由贸易抱有更大的热情，我们或许还是不能指望在未来十年里会达成大宗的全球性贸易协议。


How bad would that be?	这样的结果会有多糟？


After all, many Asian countries have achieved impressive export-led growth under the current system.	毕竟，在现有体制下许多亚洲国家已经实现了不错的出口主导的经济增长。


And bilateral or regional trade deals can chip away at some of the barriers in the current global system.	双边和地区性的贸易协议可以消除目前全球体制下的一些壁垒。


For example, a fundamental problem is that the nature of global trade is constantly evolving, and existing agreements have only limited capacity to adapt.	例如，一个根本的问题是全球贸易日新月异的特点使得现有的协定调整适应的能力有限。


Services like education, banking, accounting, and insurance account for an ever larger share of global output (now roughly two-thirds), and further expansion requires significant changes in existing agreements.	如教育、银行、会计和保险等服务贸易占全球输出总量的份额越来越大（现在的份额约是三分之二），其份额的进一步扩大需要我们对现有的贸易协定进行重大变更。


Even if Asia has succeeded by relentlessly exporting manufactures, today’s poorest countries, especially in Africa, can realistically export only agriculture and textiles.	即便亚洲通过大量出口工业品而取得了经济成功，当今最贫穷的国家，特别是非洲国家实际上却只能出口农产品和纺织品。


But these are precisely the range of goods that remain most protected under existing agreements.	但这些种类的产品恰恰是在现行的贸易协议中最受保护的。


Bilateral deals can help, but they can also lead to higher trade barriers for everyone else.	双边协定能够在一定程度上应对这一问题，但也可能给协议外的各方造成更高的贸易壁垒。


The current state of affairs is all the more depressing because global economic growth in the past four years has been the fastest since the early 1970’s.	因为全球经济增长在过去的四年里达到自1970年代初以来的新高，所以目前的形势就更加令人沮丧。


Rapidly expanding global trade, combined with an ever-freer and faster exchange of people and ideas, has been a cornerstone of this growth, particularly of the strong productivity gains that underlie it.	全球贸易的快速扩张与空前自由和快速的人员和思想交流相结合，就成为了这种增长的，特别是突出的生产力强劲增长的基石。


Absent further trade agreements, there is a big risk that the pace of globalization will slow, with profound consequences for global poverty and welfare.	没有进一步的贸易协议，全球化的步伐就会面临放慢的风险，而这又将在全球（民众）的贫困和福利方面造成深��的后果。


Outside Africa, the people who will suffer the most are those in countries like Brazil, India, China, and Mexico, whose leaders rightly took on rich-country farm subsidies, but wrongly failed to recognize the profound costs of the developing world’s own import restrictions.	在非洲之外，最受影响的国家将会是巴西、印度、中国和墨西哥等。 其领导人在农业补贴方面和富国谈判是对的，但他们的错误在于未能认识到发展中国家的进口限制造成的高昂成本。


So for now, the world must hope that Americans continue gorging on foreign imports.	就目前而言，全世界都必须希望美国人继续大买特买进口商品。


Wallis Simpson, the controversial US-born Duchess of Windsor, once famously quipped, “You can never be too rich or too thin.”	美国出生的、颇受争议的辛普森温莎公爵夫人曾有一句不无讽刺的妙语：“再富都不够富，再瘦都不够瘦。


Fortunately for everyone, America’s motto nowadays is “You can never be too rich or too large.”	”对所有人而言，幸运的是，美国当今的座右铭是：“再富都不够富，再胖都不嫌胖。


When Americans finally decide to go on an import diet, as they will someday, the world’s hypocrisy over the failed global trade talks will become apparent to all.	”而当美国人最终决定在进口方面有所节制时（这一天终归会到来），这个世界在失败的全球贸易谈判上的虚伪终将暴露无遗。


Did Development Fail in Kenya?	肯尼亚的发展失败了吗？


Nairobi -- A month ago, Kenya fell prey to a sudden burst of post-electoral violence that has left over 1000 dead and hundreds of thousands displaced.	内罗毕—一个月前，肯尼亚在大选后突然爆发了骚乱，造成1000多人失去生命和几十万人无家可归。


The intensity and scale of the violence have stunned the world.	这次骚乱的恶劣程度和规模震惊了整个世界。


Of course, Kenya had lived through tense electoral periods before, and few people who know Africa were blind to the many difficulties the country continued to face.	当然，肯尼亚以前也在大选期间经历过局势的紧张，并且了解非洲的人也不会不知道这个国家依然面临的许多难题。


But things seemed to be going well recently.	但是最近几年情况似乎一直很好。


This year’s campaign was exceptionally peaceful, and millions of citizens voted on December 27 – at times walking and queuing for hours to cast their ballot.	今年的竞选活动也进行得特别和平，有数百万人在12月27日参加了投票，他们花了数小时步行和排队投出了他们的选票。


Perhaps more fundamentally, Kenya was unanimously seen as the “good student” of development, sometimes referred to as a symbol of an African renaissance.	也许更根本的问题在于，肯尼亚一直被公认为发展的“好学生”，甚至有时被认为是非洲复兴的典范。


The “Kenya vision 2030 framework,” a set of ambitious macroeconomic, legal, and constitutional reforms, was being implemented in close partnership with the World Bank.	正在实施的包含了一系列雄心勃勃的宏观经济、法制和宪法改革方案的“肯尼亚2030年远景框架”就是在与世界银行密切合作下进行的。


Cherished by the donor community, Kenya received almost $1 billion of official development assistance in 2006 – up by 250% since 2002.	得益于捐助者的慷慨，肯尼亚在2006年获得大约10亿美元的官方发展援助，比2002年大幅增长了250%。


Its booming horticulture and tourist industries were hailed as models for other African states in their efforts to integrate into world trade.	它繁荣的园艺和旅游业被认为给其他非洲国家融入世界贸易体系提供了典范。


The country’s economic expansion, which averaged 5.5% in the last four years and fuelled the progress of neighboring economies, appeared to prove that vigorous growth is possible in Africa even without mineral or fossil resources.	这个国家在过去四年的经济增长率平均达到5. 5%，并且推动了周边国家经济的发展，似乎证明了在非洲即便没有矿物或化石资源同样也可以取得经济的强劲增长。


Today, this economic miracle is up in the air.	今天，这一经济的奇迹似乎依然还是一件悬而未决的事情。


All is not lost, and there are strong reasons to believe that Kenyans will surmount the current political crisis and put the country back on its promising track.	但是希望并没有完全失去，我们有很大的理由相信肯尼亚能够战胜目前的政治危机并且把这个国家重新推回到有希望的轨道上来。


Nevertheless, as we sit on the brink of the abyss, it is worth re-examining our assumptions that since poverty breeds conflict, socio-economic development must foster political stability and reduce recourse to violence.	然而，当我们处在深渊的边缘时，我们很有必要重新审视我们关于贫穷孕育了冲突，而社会经济的发展必然会促进政治的稳定并且减少了诉诸暴力的想法的臆断。


The first lesson we should draw from this month of civil strife is that development, however well-managed, cannot solve everything.	我们从这个月爆发的内乱中获得的第一个教训就是发展不管管理得多么良好并不能解决一切问题。


Some tensions are deeply ingrained in societies, and peace requires more than any development agency can deliver.	一些紧张关系深深地植根于社会当中，而要获得和平，需要在发展规划之外做出更多其他方面的努力。


Parallel to the growth agenda, there is a specific role for bilateral and multilateral diplomacy to play in support of improved governance.	与发展规划相平行，双边和多边外交在支持更好的国家治理方面也扮演着特殊的角色。


In fact, development itself generates a number of strains on societies that lie at the very roots of conflict.	事实上，发展本身造成了社会上许多的紧张关系，它们都是潜在引发冲突的根源。


Fast-paced changes of identity caused by urbanization, the empowerment of women or exposure to foreign media tend to weaken traditional norms and social networks.	因为城市化所带来的身份的快速变化、妇女权利的提高或者对外国媒体的开放都会弱化传统标准和社会网络。


And, at least initially, economic growth tends to increase inequalities within a country, as some communities or individuals benefit from rising income and others don’t.	并且至少在一开始的阶段，经济的增长会在国家内部 增加 不平等的现象，因为一些群体或个人从更高的收入中获益，而另一些人则没有。


By displacing traditional centers of power, development can nurture collective resentment.	通过传统权力中心的转移，发展会在一些群体中造成怨恨的情绪。


Ethnic manipulation is a small step away, which many political leaders are disposed to take.	种族操纵只是偏离正确方向的一小步，并且是很多政治领导人都喜欢采取的方式。


None of this, however, disproves the link between development and peace, or inverts the correlation.	不过，所有这些都不能证明发展与和平之间的联系是错误的，或者颠倒了它们相互之间的关系。


At both the micro and the macro level, development projects and economic growth can do much to alleviate some of the structural causes of political violence.	不管是在微观还是宏观的层面，发展计划和经济增长都能够大大地减少政治暴力的某些结构性根源。


But development professionals, whose first duty is to “do no harm,” should be more conscious of the complex strains brought upon developing societies.	但是首要任务是“无害”的发展专家应该更加注意发展中国家所面临的复杂的紧张关系。


In Kenya too, this sensitivity has not sufficiently infused our organizations and projects.	在肯尼亚，这种敏感性同样也没有引起我们的机构和计划的足够重视。


Ultimately, the enhanced economic activity that development generates is the only way to reduce inequalities, particularly in a context of rapid demographic growth: it is easier to work on a fairer distribution of a growing pie than of a shrinking one.	从根本上讲，由发展所带来的经济的活跃是减少不平等现象的唯一途径，尤其是在人口快速增长的情况下：在一块越来越大的煎饼上进行更公正的分配总比一块越来越小的煎饼上进行分配要容易得多。


Moreover, fast-paced but ill-distributed economic growth can be accompanied by programs that focus on those who are left behind, thereby mitigating grievances.	此外，面对快速但是分配不公的经济增长，我们也可以实施一些项目关注那些被落在后面的人，从而缓解悲伤的情绪。


It is no coincidence that much of Kenya’s ongoing violence is occurring in the slums of its large cities.	肯尼亚目前的暴力活动大多发生在大城市的贫民区并不是一个巧合。


Had more attention been given to the country’s most glaring inequalities in access to water, shelter, or jobs, this population might not have chosen violence as an instrument of change.	如果能够更多地关注国内在获得水、住所或工作方面巨大的不平等现象，这些人也许不会选择暴力作为寻求改变的方式。


Let us draw the right lessons from Kenya: socio-economic progress remains our best tool to prevent conflict in the long run.	我们应该从肯尼亚发生的事件中吸取的教训是：社会经济发展依然是我们在长期防止冲突的最佳手段。


But the relationship between growth and political stability is subtler and less linear than we like to believe.	但是增长和政治稳定之间的关系比我们所认为的更加微妙并且没有那么直线化。


Development is no miracle solution to violence, and may create its own set of grievances – particularly when done without regard to the abrupt changes it brings to societies.	发展并不是解决暴力问题的灵丹妙药，并且可能会制造它自己的悲伤情绪，尤其是在没有充分考虑它可能给社会带来的突然变化。


Kenya isn’t an illustration of development failing, but of development at work: complex, powerful, and yet fragile.	肯尼亚并不是发展失败的范例，而是发展过程中所出现的现象：复杂、强有力然而脆弱。


Did Humans Invent Modernity?	人类发明了现代性吗？


Fossil remains and genetic data suggest that modern humans come from Africa, and in the last decade anthropologists, archaeologists, linguists, and other scientists have tended to identify our species' biological origin with the origin of modern intelligence.	化石遗迹和遗传讯息显示现代人来自非洲。 在过去的十年里，人类学家、考古学家、语言学家和其他科学家们都试图将我们人类的生物起源与现代智能的起源统一起来。


The idea is quite simple.	这一概念非常简单。


The process that produced our species in Africa granted it a number of advantages - syntactical language, advanced cognition, symbolic thinking - that favored its spread throughout the world and determined its eventual evolutionary success.	我们这个物种在非洲出现的进程赋予了我们一些优势-有句法可循的语言、发达的认知能力和符号思维-正是这些优势使我们能够分布到整个世界并决定了我们最终的进化成功。


If, however, such advantages were dramatic and mainly determined by biological change, we should expect to find them reflected in the material culture produced by these early, anatomically modern populations.	但如果这些优势是显著的，并且主要由生物性变化决定的，那么我们就应该可以发现它们从这些早期的、在解剖学上已可被称为现代人的人口所创造的物质文化中反映出来。


Complex technologies, regional trends in the style and decoration of tools, use of pigments, abstract and representational depiction, burials, grave goods, and personal ornaments are among the more common long-lasting creations that attest to the complex symbolic nature of ethnographically recorded human cultures.	复杂的技术，在工具的设计和装饰方面的地区性特点，颜料的使用，抽象和具象的描画，墓葬，陪葬品和个人装饰物都是常见的持久性创造物。 它们可以证明以人种学的方式记录下来的人类文化所具有的复杂的符号性特点。


Specifically, we should find such archeological evidence at sites in Africa from between 200,000 and 100,000 years ago.	具体而言，我们应该在非洲的遗址上发现这些距今10-20万年之间的考古证据。


But what we see instead is a gradual emergence of behavioral innovations in and outside Africa between 300,000 and 20,000 years ago.	但我们真正发现的却是在非洲及其以外的地点逐步出现的，距今20-30万年的行为创新。


Moreover, anatomically modern populations shared a number of these innovations with Neanderthals, which many anthropologists and geneticists consider a different species, or a human type inherently incapable of reaching our cognitive level.	另外，解剖学上的现代人与穴居人有一些共同的行为创新。 而许多人类学家和遗传学家都认为穴居人是一个不同的种群，或是一种在先天就达不到我们的认知能力的人类。


For example, elongated stone blades are found not only at Neanderthal sites in Europe and the Near East, but also at sites inhabited by Moderns in the Near East and Africa since at least 100,000 years ago.	例如，延长了的石刃不仅仅在欧洲和近东的穴居人遗址出土，还在近东和非洲距今至少10万年的现代人遗址上被发现。


Blade technologies then disappeared and reappeared cyclically in these areas, and in some regions, such as Australia, they only appeared a few thousand years ago.	然后制刃的技术在这些地点上周期性地消失和再出现。 在某些地区（如澳大利亚），这些技术直到几千年前才出现。


Similarly, standardized tools produced by both Neanderthals and Moderns appeared 80,000 years ago.	同样，穴居人和现代人所制造的标准化工具出现在8万年前。


Pigments, probably used in symbolic activities such as tattooing or body painting, are found at Southern African sites since 300,000 years, but also at contemporaneous and more recent Neanderthal sites in Europe.	可能用于纹身和人体绘画一类符号活动的颜料不仅仅在距今30万年的南非遗址上被发现，它们也出现在同时期和更近期的欧洲穴居人遗址上。


The intentional character and symbolic significance of burials prior to 30,000 years ago, especially those of Neanderthals, remain the subject of intense debate.	距今3万年前以前的墓葬，特别是穴居人墓葬的目的性特点和象征意义仍然是激烈争论的主题。


But there is enough evidence to believe that both anatomically modern humans and Neanderthals began burying their dead 100,000 years ago - and probably before, as suggested by the recent dating at 160,000 years of a Neanderthal burial site at Tabun, Israel.	但有足够的证据使我们相信解剖学意义上的现代人和穴居人在10万年前-或更早以前，就开始埋葬死者。 最近在以色列Tabun发现的距今16万年的穴居人墓葬就证明了这一点。


To be sure, sophisticated bone tools, such as harpoons, spear points, and awls, seem to have appeared in Africa 90,000 years ago, much earlier than in the rest of the world.	固然，如鱼叉、矛和尖钻一类的复杂骨器似乎在9万年以前就在非洲出现了，这比世界的其它地方都要出现得早。


This also applies to such artifacts of modern humans as personal ornaments, with recently discovered shell beads dated at 75,000 years ago.	同样的情况还有现代人用于个人装饰的器物，特别是最近发现的距今75000年前的贝壳珠链。


But these innovations do not seem to have been widespread.	但这些革新似乎并没有广为流传。


Bone tools and beads are virtually absent from sites in Africa and the Near East inhabited by modern humans beginning 100,000 years ago, and few abstract engravings on bone and on fragments of ochre are found at African sites dated to 75,000 years ago.	在非洲和近东的距今10万年以来的现代人遗址上并没有发现骨器和珠链。 在距今75000年前的非洲遗址上也极少发现雕刻在骨片和赭石碎片上的图案。


Depictions of animals, human beings, and other natural features do not occur in the three records - Africa, Europe, and the Near East - before 40,000-30,000 years ago, and they appear much later in some areas than others.	对动物、人类和其它自然特征的描画并没有出现在4万至3万年前之前的非洲、欧洲和近东的考古记录中。 它们在各地出现的时间也早晚不一。


In sum, certain behavioral innovations seem to appear in Africa between 10,000 and 30,000 years before Neanderthals express them.	总而言之，某些行为创新似乎在穴居人的集中展示之前就已经在距今1-3万年前的非洲出现了。


But I doubt that this gap is evidence of different cognitive abilities.	但我不能确信这一间隙就是不同认知能力的证据。


After all, it took 7,000 years for agriculture to arrive in England from the Near East, and nobody would argue that the cognitive abilities of Mesolithic hunter-gatherers from England were inferior to those of early agriculturalists.	毕竟，农业经历了7000年的时间才从近东传到英格兰，但没有人会认为中石器时代的英格兰狩猎-采集者的认知能力会不如早期的农耕者。


This suggests that the trajectory of we "moderns" in our transformations since the end of the Ice Age has varied enormously in material culture.	这说明我们"现代人"自冰期结束以来的变化轨迹在物质文化方面有着巨大的不同。


Future archaeologists would do well not to seek an explanation of this variation in terms of visible differences in our skeletal biology!	未来的考古学家不应通过我们在骨骼生物学上的差异来寻求对这种不同的解释。


"Modern" behavior may have appeared in different regions and among different groups of humans, much as would happen later in history with the inventions of agriculture, writing, and transport.	"现代"行为可能在不同地区的不同人类群体中出现，正如农业、书写和交通的发明在较晚的历史时期出现一样。


More fundamentally, behavior is certainly a significant component in determining a species' adaptation, geographic range, and mate-recognition system - all of which contribute to the maintenance of species boundaries.	更根本的一点是行为的确在决定一个物种的适应性、地理范围和同伴识别系统方面至关重要-这些因素都有助于维护物种的界限。


But this does not imply that modern behavior must have developed in a single species.	但这并不意味着现代行为一定是在单一物种中发展起来的。


Very close species may have similar behavioral systems and, in the case of our close predecessors, the shared features probably included many traits we have preferred to consider the monopoly of our species, including symbolic behavior.	非常相似的物种可能有着相近的行为系统。 就与我们最相似的祖先而言，这些共有的特点可能包括了许多如符号行为在内的，一直被我们认为是人类所独有的特性。


The most important implication of believing that cultural modernity emerged in more than one species is that it largely eliminates the dichotomy that Western thought has traditionally detected between the natural world and human culture.	相信文化现代性出现在不止一种物种当中的重要意义在于它在很大程度上终结了那种在探究自然世界与人类文明的关系方面的传统两分法似的西方思维。


The archaeology of early modern and Neanderthal populations suggests that we are not the chosen people who received from God the light, the divine mandate to go forth, multiply, and eliminate their subhuman neighbors.	对于早期的现代人和穴居人的考古发现说明我们并不是唯一受上帝青睐，沐浴智慧之光，奉圣谕进化、繁衍并淘汰了类人邻居的那一群人。


This is a liberating, as well as a humbling, prospect.	这一发现令人释怀同时也让人感到卑微。


If the fact that we are the only human species left on earth is the result of an historical accident rather than Darwinian competition, we can open our minds and accept that we share some of our "culture" with both our living and no longer living relatives.	如果我们作为地球上硕果仅存的人类种群是历史展的意外而非达尔文物竞天择的结果，那么我们就能以开放的心态接受我们与一些现存的和已灭绝的亲缘物种共有某些"文化"的现实。


Our modernity is probably a part of their legacy as well.	我们的现代性极可能也是他们遗产的一部分。


Digital Globalization and the Developing World	数字全球化与发展中世界


BERKELEY – Globalization is entering a new era, defined not only by cross-border flows of goods and capital, but also, and increasingly, by flows of data and information.	伯克利—全球化正在进入新时代，其特征不仅包括跨境商品和资本流，也包括日益增加的数据和信息流。


This shift would seem to favor the advanced economies, whose industries are at the frontier in employing digital technologies in their products and operations.	这一转变似乎有利于发达经济体，这些经济提的各个产业在运用数字技术于产品和经营方面位于前沿位置。


Will developing countries be left behind?	发展中国家会远远落后吗？


For decades, vying for the world’s low-cost manufacturing business seemed to be the most promising way for low-income countries to climb the development ladder.	几十年来，争夺全球低成本制造业务似乎是低收入国家在发展阶梯向上攀爬的不二法门。 全球商品贸易占世界GDP之比从1985年的13.


Global trade in goods rose from 13.8% of world GDP in 1985 ($2 trillion) to 26.6% of GDP ($16 trillion) in 2007.	8%（2万亿美元）上升到2007年的26. 6%（16万亿美元）。


Propelled by demand and outsourcing from advanced economies, emerging markets won a growing share of the soaring trade in goods; by 2014, they accounted for more than half of global trade flows.	受来自发达经济体的需求和外包的驱动，新兴市场在蒸蒸日上的商品贸易中所占比重日益增加； 到2014年，它们已经贡献了一大半的全球贸易流。


Since the Great Recession, however, growth in global merchandise trade has stalled, mainly owing to anemic demand in the world’s major economies and plummeting commodity prices.	但是，自大衰退以来，全球商业贸易增长陷入了停滞，主要原因是世界主要经济体需求萎靡和大宗商品价格暴跌。


But deeper structural changes are also playing a role.	但更深层次的结构变化也在起作用。


Many companies are simplifying and shortening their supply chains.	许多公司正在简化和收缩供应链。


For a range of goods, automation means that production location and outsourcing decisions no longer depend primarily on labor costs.	对于很多商品，自动化意味着生产地和外包决定不再主要取决于劳动力成本。


Quality of talent, infrastructure, energy costs, and speed to market are assuming greater weight in such decisions.	人才质量、基础设施、能源成本和上市速度在这类决定中的权重日益增加。


In the near future, 3D printing could further reduce the need to ship goods across long distances.	在不久的将来，3D打印将进一步降低商品长途航运的需要。


If trade in global goods has indeed peaked relative to global GDP, it will be harder for poor countries in Africa, Latin America, and Asia to develop by becoming the world’s next workshops.	如果全球商品贸易相对全球GDP的水平确实已经见顶，那么对于非洲、拉丁美洲和亚洲的穷国来说，成为下一个世界工厂的更加困难了。


But globalization itself is not in retreat.	但全球化本身并没有退缩。


While global goods trade has stalled and cross-border financial flows have fallen sharply since 2007, flows of digital information have surged: Cross-border bandwidth use has grown 45-fold over the past decade, circulating ideas, intellectual content, and innovation around the world.	尽管自2007年以来，全球商品贸易陷入了停滞跨境金融流大幅下降，但数字信息流大幅增加：过去十年中跨境带宽增加了45倍，将思想、知识内容和创新传向全世界。


New research from the McKinsey Global Institute (MGI) finds that cross-border flows of goods, services, finance, people, and data during this period increased world GDP by roughly 10% – roughly an additional $7.8 trillion in 2014 alone.	麦肯锡全球研究所（MGI）的新研究发现，在此期间，商品、服务、金融、人员和数据的跨境流动将世界GDP推高了10%左右——光是在2014年，就增加了7. 8万亿美元。


Data flows accounted for an estimated $2.8 trillion of this gain, exerting a larger impact than global goods trade – a remarkable finding, given that the world’s trade networks developed over centuries while cross-border data flows were nascent just 15 years ago.	数据流贡献了其中大约2. 8万亿美元，其影响大于全球商品贸易——这是一个令人瞩目的发现，因为世界贸易网络已经发展了几百年，而跨境数据流出现只是最近15年的事。


Digitization disrupts everything: the nature of goods changing hands; the universe of potential suppliers and customers; the method of delivery, and the capital and scale required to operate globally.	数字化破坏一切：换手的商品的性质； 潜在供应商和客户范围；


It expands opportunities for more types of firms, individuals, and countries to participate in the global economy.	交货方法； 以及全球经营所需要的资本和规模。


It also gives countries and companies everywhere an opportunity to redefine their comparative and competitive advantage.	数字化为更多类型的企业、个体和国家扩大了参与全球经济的机会。


For example, while the United States may have been at a disadvantage in a world where low labor costs were paramount in global manufacturing value chains, digital globalization plays directly to its strengths in technology and innovation.	数字化还让世界各地的国家和公司有机会重新定义比较和竞争优势。 比如，在低劳动力成本是全球制造业价值链最重要的因素的情况下��美国在世界一直处于劣势，但数字全球化让它在技术和创新方面获得了直接优势。


On its face, this shift to digital globalization would seem to work against developing countries that have large pools of low-cost labor but inadequate infrastructure and education systems.	表面上看，数字全球化的趋势似乎不利于拥有大量低成本劳动力但基础设施和教育体系不足的发展中国家。


Advanced economies dominate MGI’s latest Connectedness Index, which ranks countries on both inflows and outflows of goods, services, finance, people, and data relative to their size and share in each type of global flow.	发达经济体主导着MGI最新的连通性指数（Connectedness Index，对各国就商品、服务、金融、人员和数据的流入和流出量相对于它们在每一类流动上的规模和比重进行排名）。


These flows are disproportionately concentrated among a small set of countries, including the US, the United Kingdom, Germany, and Singapore, with huge gaps between the leaders and laggards.	这些流动严重向一小撮国家集中，包括美国、英国、德国和新加坡，领先者和落后者之间差距巨大。


China is the only emerging economy to have made it to the top ten on the index.	中国是在这一指数上跻身前十的唯一一个新兴经济体。


Yet digital flows offer developing countries new ways of engaging with the global economy.	但数字流给发展中国家带来了参与全球经济的新途径。


The near-zero marginal costs of digital communications and transactions create new possibilities for conducting cross-border business on a massive scale.	接近于零的数字通讯和交易边际成本给大规模跨境商务创造了新的可能性。


Alibaba, Amazon, eBay, Flipkart, and Rakuten are turning millions of small enterprises around the world into “micro-multinational” exporters.	阿里巴巴、亚马逊、eBay、Flipkart和Rakuten正在把全世界数百万小企业转变为“微型跨国”出口商。


Companies based in developing countries can overcome local market constraints and connect with customers, suppliers, financing, and talent worldwide.	位于发展中国家的公司可以克服地方市场约束，与全世界客户、供应商、资金和人才互联互通。


Twelve percent of global goods trade is already conducted in ecommerce channels.	已有12%的全球商品贸易通过电子商务渠道进行。


Moreover, a country need not develop its own Silicon Valley to benefit.	此外，一国不需要发展自己的硅谷就能受益。


Countries on the periphery of the network of global data flows can benefit more than countries in the center.	全球数据流网络外围国家可以获得比核心国家更大的收益。