Health Risks
健康威胁
understandable
[1] Opinion polls repeatedly tell us that the only thing Americans worry about more than the environment is their health. This is entirely understandable, for health is obviously preferable to illness. What makes today's preoccupation with health slightly surprising is that Americans are far healthier now than they have ever been. Many diseases that once struck terror into hearts have either been completely eliminated or brought under control. Although AIDS is a notable exception, few new mass killers have come along to replace the ones that have been eliminated.
民意调查一再告诉我们，美国人最为担心的就是他们的健康，其次才是环境问题。这是完全可以理解的，因为身体健康显然比生病要好。美国人现在对健康如此关注，是有点令人吃惊，因为他们目前比以往任何时候都要健康得多。许多曾令人恐惧的疾病现在或者已经彻底根除，或者已得到控制。尽管艾滋病是个显著的例外，但是现在几乎没有什么新的能置许多人于死地的疾病出现，以取代那些已被根除的疾病。
[2] Nonetheless, health and the various threats to it remain everyone's permanent concern. After all, more than half of us (57 percent) will die from either heart disease or cancer, if current trends continue.
然而，健康以及对健康的各种威胁，仍然是人们永久关注的问题。毕竟，如果目前的趋势无法制止的话，我们中将有不止一半（57％）的人将死于心脏病或是癌症。
[3] One major problem with any comparison of health risks—especially life-threatening ones—is that they differ enormously in their immediacy. For instance, AIDS—if you get it—will probably be fatal after a number of years. Cancer induced by smoking or exposure to radiation, on the other hand, may take 20 to 30 years before its catastrophic effects show up . In making choices about health risks, therefore, it is important to bear in mind the likely time lag between taking a risk and suffering its consequences.
将威胁健康的危险，特别是致命的危险，进行比较时，有一个主要的问题，就是这些危险的紧迫性有很大差异。例如艾滋病，如果你染上的话，很可能几年后就死亡。然而，由吸烟或辐射诱发的癌症，也许要经过20至30年的时间其灾难性的后果才会出现。因此，在对健康的各种危险做出选择时，务必要考虑进行冒险与承受其后果之间的时间间隔。
[4] Those with a mind to "live for today" are apt to be indifferent to health risks that have a very long incubation period. Although this is short-sighted, it does make sense to discount long-term risks more than short-term ones. After all, when virtually any of us is confronted with the choice of doing something likely to kill us today versus doing something likely to kill us in two decades, the choice is going to be the lesser of the two evils .
那些一心要“今朝有酒今朝醉”的人们，往往对潜伏期较长的危害不放在心上。尽管这是一种目光短浅的行为，但不理会滞后期长的危险，重视近期危险还是有道理的。毕竟，如果我们真的面临选择，是去做今天就可能使我们丧命的事，还是去做20年后才可能使我们丧命的事，我们往往会两害相比取其轻。
[5] One commonly used measure to deal with such problems is a concept called years of potential life lost (YPLL). The idea is that for a 25-year-old, doing something that will kill him in 5 years is much more "costly" than doing something that will kill him in 40 years. Both may involve the same element of risk—the same probability of eventually dying from that activity—but a risk that may cause immediate damage is much more costly than one for which the piper needn't be paid for a long time . In the first case, he will have his normal life span cut short by about 45 years; in the latter case, the deficit is about 5 years . Thinking about matters in this light inevitably causes a reassessment of many of the threats to health. For instance, heart disease is the single largest killer of Americans, way in front of cancer or strokes. However, heart disease tends to strike the elderly in much greater proportions than younger people. Cancer, by contrast, kills fewer people but tends to strike somewhat earlier than heart disease. Hence, more YPLLs are lost to cancer than to heart disease—despite the greater incidence of fatal heart cases. Specifically, cancers claim about 25 percent more YPLLs than heart disease (if we define the YPLL as a year of life lost before age 65).
对待这类问题有种常用的计算方法，就是考虑可能少活的年数（YPLL）。其意思是，对一个25岁的人来说，去做一件使自己五年后丧生的事要比做一件40年后丧生的事“代价高昂”得多。二者同样都具有危险因素——即最终因从事某事而导致死亡的可能性相同——但是，会马上引起伤害的危险，要比一个很长时间不需付出代价的危险要昂贵得多。在第一种情形下，他的正常寿命减少了约45年，而在第二种情形下，减少了约5年。从这种角度看问题必然会对威胁健康的许多因素进行重新评估。例如，心脏病是夺去美国人性命的头号杀手，远远超过癌症或中风。然而，老年人患心脏病的比例大大超出了年轻人。相比之下，癌症的死亡人数虽然要少于心脏病的死亡人数，但患癌症的人比较年轻。所以，尽管心脏病死亡率要大，但癌症损失的YPLL要比心脏病多。具体来讲，与心脏病相比，癌症让人大约多损失了25％的YPLL（如果我们将YPLL定义为65岁以前寿命缩短的年头）。
[6] The concept of YPLLs has an important, if controversial, influence on issues in health care economics. It is frequently argued that money devoted to medical research on curing diseases should be divided upon the basis of the number of lives lost to each disease. Thus, some critics of the massive levels of funding devoted to AIDS research claim that—compared to killers such as heart disease and cancer—AIDS receives a disproportionately high support. That criticism fails to consider the fact that AIDS, by virtue of striking people principally in their 20s and 30s, generates far more YPLLs than the bare figure of 20,000 deaths per year, bad as that is, might suggest. Put differently, finding a cure for AIDS would be likely to add about 25-30 years to the life of each potential victim. Finding a cure for heart disease, although it might save far more lives, would probably add only another 5-10 years to the life of its average victim.
YPLL这一概念，尽管人们对它还有争议，却对保健经济学有着重要影响。人们经常争辩说，用于医学研究攻克疾病的资金应该按每种疾病死亡人数的多少来分配。因此，一些人士抨击将大量资金用于艾滋病研究。他们认为与其他致命的疾病如心脏病和癌症相比，艾滋病得到了不成比例的高额资助。该批评没有考虑到这样一个事实：由于艾滋病的主要受害者为二三十岁的年轻人，尽管每年只造成20,000人死亡——该数字本身也不小了——但是艾滋病引起的YPLL要大得多，远比简单的死亡人数更值得我们重视。换句话说，到艾滋病的方法，将可能增加每位潜在的艾滋病患者25至30年的寿命。到心脏病的方法，虽然可能拯救更多人的生命，但对每位受害者来说只能增加平均5到10年的寿命。
[7] The assessment of the seriousness of a risk changes, depending upon whether we ask how many lives it claims or how many YPLLs it involves. Some of the differences are quite striking. For instance, accidental deaths appear relatively insignificant compared to cancer and heart disease when we just count the deaths caused. But once we look at the number of lost years, accidents loom into first place among the killers of Americans. These data show that we need to ask not only how large a risk is but also when it becomes payable. Other things being equal, the sooner a risk causes damage or death, the more that risk is to be avoided. (788 words)
对一种危险的严重程度的估算会有差异，这要看我们是关注它所引起的死亡人数还是它所导致的YPLL的多少。有些差异很令人吃惊。比如，如果我们只算引起的死亡人数的话，与癌症和心脏病相比，意外死亡就显得无足轻重。然而，一旦我们关注所损失的YPLL，意外事故却赫然位居美国杀手榜的榜首。这些数据显示，我们不仅要探究危险程度的大小，而且要探究危险什么时候要我们付出代价。在其他因素都相等的情况下，危险所导致的损害或死亡来得越快，人们就越应该回避这种危险。