We are here today because [the] United Nations have defined goals for the progress of countries. They're called Millennium Development Goals. And the reason I really like these goals is that there are eight of them. And by specifying eight different goals, the United Nations has said that there are so many things needed to change in a country in order to get the good life for people. Look here -- you have to end poverty, education, gender, child and maternal health, control infections, protect the environment and get the good global links between nations in every aspect from aid to trade.
今天我來到這裡, 是因為聯合國 為國家的發展 定了幾個目標, 他們稱之為「千禧發展目標」。 我喜歡這些目標的原因是, 他們分成八個目標。 這八個不同目標是由聯合國所訂定的, 他們認為要讓一個國家 為人民創造更好的生活, 有太多事情 是等著我們去做的。 看看這裡,我們應該終止貧窮、 發展教育、性別平等、 重視孩童與母親的健康、 控制傳染病、保護環境、 讓世界各國維持良好關係, 這些目標包涵了每一個面向, 從援助到貿易都有。
There's a second reason I like these development goals, and that is because each and every one is measured. Take child mortality; the aim here is to reduce child mortality by two-thirds, from 1990 to 2015. That's a four percent reduction per year -- and this, with measuring. That's what makes the difference between political talking like this and really going for the important thing, a better life for people. And what I'm so happy about with this is that we have already documented that there are many countries in Asia, in the Middle East, in Latin America and East Europe that [are] reducing with this rate. And even mighty Brazil is going down with five percent per year, and Turkey with seven percent per year. So there's good news. But then I hear people saying, "There is no progress in Africa. And there's not even statistics on Africa to know what is happening." I'll prove them wrong on both points.
我喜歡這幾個發展目標還有另一個原因, 就是每一個目標都可以加以衡量。 舉孩童死亡率為例, 目標是要在1990年到2050年內, 降低孩童死亡率 達三分之二, 也就是每年要下降4%, 這是可以衡量的。 這就是為什麼政治語言 和實際上為人民創造 更好的生活, 會有那麼大的差別。 我之所以很高興, 是因為我們終於看到, 在亞洲、中東、 拉丁美洲 和東歐的許多國家裡, 這個比率確實在下降。 即使偉大的巴西每年的孩童死亡率也下降了5%, 土耳其則下降了7%, 這真是好消息。 但我聽到有人說:「非洲的情況並沒有改善啊... 我們連非洲的統計數據都看不到, 要怎麼知道發生了什麼事?」 我要來證明這些人錯了。
Come with me to the wonderful world of statistics. I bring you to the webpage, ChildMortality.org, where you can take deaths in children below five years of age for all countries -- it's done by U.N. specialists. And I will take Kenya as an example. Here you see the data. Don't panic -- don't panic now, I'll help you through this. It looks nasty, like in college when you didn't like statistics. But first thing, when you see dots like this, you have to ask yourself: from where do the data come? What is the origin of the data? Is it so that in Kenya, there are doctors and other specialists who write the death certificate at the death of the child and it's sent to the statistical office? No -- low-income countries like Kenya still don't have that level of organization. It exists, but it's not complete because so many deaths occur in the home with the family, and it's not registered. What we rely on is not an incomplete system. We have interviews, we have surveys. And this is highly professional female interviewers who sit down for one hour with a woman and ask her about [her] birth history. How many children did you have? Are they alive? If they died, at what age and what year? And then this is done in a representative sample of thousands of women in the country and put together in what used to be called a demographic health survey report. But these surveys are costly, so they can only be done [in] three- to five-year intervals. But they have good quality. So this is a limitation. And all these colored lines here are results; each color is one survey. But that's too complicated for today, so I'll simplify it for you, and I give you one average point for each survey.
和我一起來看看這些美妙的統計數據, 你可以上這個網頁:ChildMortality.org, 上面有每一個國家 年齡小於五歲的孩童死亡數字, 這是由聯合國的專家所統計出來的, 我就舉肯亞為例子好了。 你看這個資料, 先別緊張,先別緊張,我來告訴你們怎麼看這些數據。 這看起來很恐怖,就像你在大學時 最討厭上的統計課一樣, 但是,當你看到這些點點的時候, 你得先問你自己一個問題: 這些數據是從哪裡來的? 原始數據在哪裡? 在肯亞有沒有 醫生或其他專業人員, 在孩童死去的時候,填寫一張死亡證明, 然後送到統計局去? 沒有,像肯亞這種低收入國家 還沒有這種層級的機構組織, 是有這種組織沒錯,但是缺乏完整的運作功能, 因為有許多孩童是在 家裡死去, 沒有做任何登記。 我們不能信任這種不完整的系統, 我們只能進行訪談,深入調查。 這是一位極為專業的 女性訪問員, 她和一位女士坐在一起一個小時, 詢問對方的生產資料, 你生了幾個小孩? 全都活著嗎? 死掉的孩子是在哪一年、幾歲的時候死去? 這些會成為那個國家裡 成千上萬婦女的代表性樣本, 這些樣本會被蒐集起來, 放進人口健康調查的報告裡。 但這種調查需要很多經費, 所以只能每隔三到五年才能做一次, 但調查的品質很好, 只是經費有些限制。 這些有顏色的線就是調查結果, 每一種顏色代表每一次的調查。 但這樣看起來太複雜了,所以我想要簡化一點, 我就把每一次調查的平均值點出來好了,
This was 1977, 1988, 1992, '97 and 2002. And when the experts in the U.N. have got these surveys in place in their database, then they use advanced mathematical formulas to produce a trend line, and the trend line looks like this. See here -- it's the best fit they can get of this point. But watch out -- they continue the line beyond the last point out into nothing. And they estimated that in 2008, Kenya had per child mortality of 128. And I was sad, because we could see this reversal in Kenya with an increased child mortality in the 90s. It was so tragic. But in June, I got a mail in my inbox from Demographic Health Surveys, and it showed good news from Kenya. I was so happy. This was the estimate of the new survey. Then it just took another three months for [the] U.N. to get it into their server, and on Friday we got the new trend line -- it was down here. Isn't it nice -- isn't it nice, yeah? I was actually, on Friday, sitting in front of my computer, and I saw the death rate fall from 128 to 84 just that morning. So we celebrated.
這是1977年、1988年、 1992年、1997年 和2002年。 當聯合國的專家們 把這些數據放進資料庫, 他們就會用先進的數學公式 來畫出一條趨勢線,像是這一條趨勢線, 看這裡,這是他們畫出來的線, 請你注意看, 他們還把線 往後延伸了, 延伸到未來, 他們估計,在2008年, 肯亞孩童的死亡率是128。 我很難過, 因為我們本來以為, 在90年代肯亞的 孩童死亡率達到高峰後,應該會下降, 但沒有,真的很慘。 但我在六月的時候收到一封電子郵件, 是從人口健康調查局送出的郵件, 我看到了來自肯亞的好消息。 我很高興, 這是新調查做出的估計, 聯合國又花了三個月的時間, 把資料放進電腦裡, 星期五我們才收到新畫出來的趨勢線, 從這裡開始下降了, 很棒吧?這真的很棒,不是嗎? 星期五的時候,我一整個上午都坐在電腦前面, 看著死亡率下降, 從128下降到84, 我們高興地慶祝了起來。
But now, when you have this trend line, how do we measure progress? I'm going into some details here, because [the] U.N. do it like this. They start [in] 1990 -- they measure to 2009. They say, "0.9 percent, no progress." That's unfair. As a professor, I think I have the right to propose something differently. I would say, at least do this -- 10 years is enough to follow the trend. It's two surveys, and you can see what's happening now. They have 2.4 percent. Had I been in the Ministry of Health in Kenya, I may have joined these two points. So what I'm telling you is that we know the child mortality. We have a decent trend. It's coming into some tricky things then when we are measuring MDGs. And the reason here for Africa is especially important, because '90s was a bad decade, not only in Kenya, but across Africa. The HIV epidemic peaked. There was resistance for the old malaria drugs, until we got the new drugs. We got, later, the mosquito netting. And there was socio-economic problems, which are now being solved at a much better scale. So look at the average here -- this is the average for all of sub-Saharan Africa. And [the] U.N. says it's a reduction with 1.8 percent.
但是,當你看到這條趨勢線的時候, 要怎麼樣來衡量進步程度? 我現在來仔細講解 聯合國的作法, 他們是從1990年開始,一直衡量到2009年, 他們發現:「只有0.9%,沒有進步。」 這不合理, 身為一位教授,我認為我有權利提出不同的見解, 我會說,至少要做這個分析, 十年就足以看出趨勢了, 十年裡會有二次調查,你就可以看出實際的狀況, 其實是2.4%。 要是我是肯亞的衛生署長, 我就會把這二個點列入考慮。 我要告訴各位的是, 我們已經知道孩童的死亡率, 我們畫得出一條趨勢線, 但我們在衡量這些千禧發展目標時, 有些陷阱是必須注意的, 尤其是對非洲來說格外重要, 因為90年代是很不好的十年, 不只是肯亞,整個非洲都很不好。 HIV病毒的擴散達到高峰; 瘧疾已對舊的藥物產生抗藥性,直到我們開發出新藥才抑制下來; 我們後來也收到許多蚊帳; 還有一些社會經濟的問題, 現在才改善到較好的狀況。 現在來看看平均數, 這是撒哈拉沙漠以南非洲的平均數, 聯合國說 下降了1.8%。
Now this sounds a little theoretical, but it's not so theoretical. You know, these economists, they love money, they want more and more of it, they want it to grow. So they calculate the percent annual growth rate of [the] economy. We in public health, we hate child death, so we want less and less and less of child deaths. So we calculate the percent reduction per year, but it's sort of the same percentage. If your economy grows with four percent, you ought to reduce child mortality four percent; if it's used well and people are really involved and can get the use of the resources in the way they want it. So is this fair now to measure this over 19 years? An economist would never do that. I have just divided it into two periods. In the 90s, only 1.2 percent, only 1.2 percent. Whereas now, second gear -- it's like Africa had first gear, now they go into second gear. But even this is not a fair representation of Africa, because it's an average, it's an average speed of reduction in Africa.
我現在要講的會讓你以為很理論, 但是並不會, 這些經濟學家, 他們愛錢,他們希望錢愈多愈好,他們喜歡看到成長, 所以他們老是在計算每年的經濟成長率; 但我們這種公共衛生領域的人,我們討厭孩童死亡, 我們希望孩童死亡人數愈少愈好, 所以我們會計算每年的下降比率, 但其實這二種都是同一種比率。 如果經濟成長了4%, 孩童死亡率應該也會下降4%才對, 因為如果經濟成長了, 人們就會有足夠的資源去做他們想做的事。 那你覺得用19年的期間來衡量這個指標合理嗎? 經濟學家就不會這麼做。 我把整個期間分成二個期間來看, 在1990年代,只有1.2%, 只有1.2%。 現在則換到二檔-- 過去的非洲是在一檔, 現在換到了二檔。 但即使如此, 還是不能合理代表非洲的狀況, 因為我們用的是平均數, 也就是說,這是非洲平均的下降速度。
And look here when I take you into my bubble graphs. Still here, child death per 1,000 on that axis. Here we have [the] year. And I'm now giving you a wider picture than the MDG. I start 50 years ago when Africa celebrated independence in most countries. I give you Congo, which was high, Ghana -- lower. And Kenya -- even lower. And what has happened over the years since then? Here we go. You can see, with independence, literacy improved and vaccinations started, smallpox was eradicated, hygiene was improved, and things got better. But then, in the '80s, watch out here. Congo got into civil war, and they leveled off here. Ghana got very ahead, fast. This was the backlash in Kenya, and Ghana bypassed, but then Kenya and Ghana go down together -- still a standstill in Congo. That's where we are today. You can see it doesn't make sense to make an average of this zero improvement and this very fast improvement. Time has come to stop thinking about sub-Saharan Africa as one place. Their countries are so different, and they merit to be recognized in the same way, as we don't talk about Europe as one place. I can tell you that the economy in Greece and Sweden are very different -- everyone knows that. And they are judged, each country, on how they are doing.
我讓你們看看我畫的圖表, 和前面一樣, 這個軸代表的是每千個孩童死亡的人數, 這邊則代表年份。 我要讓你們看看比千禧發展目標更宏觀的圖表, 我從50年前開始記錄, 那時非洲大部分的國家都才剛剛獨立, 例如剛果,死亡率很高, 迦納比較低,肯亞更低一點。 那以後又發生了什麼事?我們來看看, 因為國家獨立了,人民的讀寫能力跟著提升; 人民接種牛痘疫苗,天花逐漸絕跡; 衛生環境也改善了,每一件事都變得更好。 但我們看看這裡,1980年代的時候, 剛果發生了內戰, 所以他們就維持在這個水平線上, 迦納則持續下降, 肯亞稍微往上升一點,然後迦納超越肯亞, 接著肯亞和迦納就一起往下降, 剛果還是維持在那個水平線上。 到今天就是這副模樣。 你們看看,把那些沒有改善的國家 和改善非常快的國家,放在一起平均, 是完全沒有道理的。 現在是該停止 把撒哈拉沙漠以南的非洲視為一個整合區域的時候了, 那裡每個國家都不一樣, 他們不應該再被視為一個區域, 就像我們不會以為歐洲是一個區域一樣。 我可以告訴各位,希臘和瑞典的經濟是完全不同的, 大家都知道這一點, 所以每一個國家的表現,都是被單獨評估的。
So let me show the wider picture. My country, Sweden: 1800, we were up there. What a strange personality disorder we must have, counting the children so meticulously in spite of a high child death rate. It's very strange. It's sort of embarrassing. But we had that habit in Sweden, you know, that we counted all the child deaths, even if we didn't do anything about it. And then, you see, these were famine years. These were bad years, and people got fed up with Sweden. My ancestors moved to the United States. And eventually, soon they started to get better and better here. And here we got better education, and we got health service, and child mortality came down. We never had a war; Sweden was in peace all this time. But look, the rate of lowering in Sweden was not fast. Sweden achieved a low child mortality because we started early. We had primary school actually started in 1842. And then you get that wonderful effect when we got female literacy one generation later. You have to realize that the investments we do in progress are long-term investments. It's not about just five years -- it's long-term investments. And Sweden never reached [the] Millennium Development Goal rate, 3.1 percent when I calculated. So we are off track -- that's what Sweden is. But you don't talk about it so much. We want others to be better than we were, and indeed, others have been better.
所以我們來看看宏觀的圖表, 我的國家,瑞典: 1800年的時候,我們在這上面, 我們國家的個性真的很奇怪, 儘管我們精心統計小孩的出生數字,卻還有這麼高的孩童死亡率, 這真的很奇怪,我都有點不好意思了。 但我們瑞典人就是有這種習慣, 我們會計算孩童的死亡率, 但卻也沒做什麼事來改善這個狀況。 接下來,你們看看,這幾年鬧饑荒, 生活不好過,人們追求自由, 所以我的祖先搬到了美國。 最後,很快地,死亡率下降得愈來愈快, 到了這裡,我們有更好的教育制度、醫療保健, 孩童死亡率就下降到這裡。 瑞典從來沒有發生過戰爭,一直都處於和平狀態, 但是你看,瑞典孩童死亡率 下降的速度 並沒有那麼快, 瑞典之所以會讓孩童死亡率降到這麼低, 只是因為我們起步得很早。 我們的小學教育 是在1842年開始的, 所以在一個世代以後, 我們才看到婦女讀寫能力 大幅度提升所帶來的好處。 各位必須瞭解,為國家進步發展而投入的投資, 將是一段漫長的投資, 不是短短五年的投資, 而是更長遠的投資。 瑞典從來沒有達到千禧發展目標所要求的水準, 我計算了一下,只有3.1%。 所以我們不合格,哈!這就是瑞典。 不過不要告訴別人。 我們希望其他國家能有更好的表現,而其他國家也真的有更好的表現,
Let me show you Thailand, see what a success story, Thailand from the 1960s -- how they went down here and reached almost the same child mortality levels as Sweden. And I'll give you another story -- Egypt, the most hidden, glorious success in public health. Egypt was up here in 1960, higher than Congo. The Nile Delta was a misery for children with diarrheal disease and malaria and a lot of problems. And then they got the Aswan Dam. They got electricity in their homes, they increased education and they got primary health care. And down they went, you know. And they got safer water, they eradicated malaria. And isn't it a success story. Millennium Development Goal rates for child mortality is fully possible. And the good thing is that Ghana today is going with the same rate as Egypt did at its fastest. Kenya is now speeding up. Here we have a problem. We have a severe problem in countries which are at a standstill.
我們來看看泰國, 看看他們成功的故事,泰國從1960年代 下降到這裡, 他們的孩童死亡率幾乎和瑞典一樣。 還有另一個例子,埃及, 他們在公衛領域的成就是最突出的,但也最不為人知。 埃及在1960年代的時候是在這上面, 比剛果還要高, 尼羅河三角洲附近的孩童, 深受腹瀉、瘧疾 和其他疾病困擾。 後來他們建了亞斯望水庫,每個人家裡都有電力, 教育水準提升, 也有了基礎的醫療體系, 所以死亡率就下降了。 他們的飲用水更為清潔,瘧疾也絕跡了, 這真的是一個成功的典範, 讓我們看到千禧發展目標所訂的孩童死亡率, 是完全有可能達到的。 好消息是, 迦納現在也以和埃及一樣快的速度 降低孩童的死亡率; 肯亞正在加速追趕。 但我們有個問題, 有些國家的死亡率仍維持在相同的水準,這是嚴重的問題。
Now, let me now bring you to a wider picture, a wider picture of child mortality. I'm going to show you the relationship between child mortality on this axis here -- this axis here is child mortality -- and here I have the family size. The relationship between child mortality and family size. One, two, three, four children per woman: six, seven, eight children per woman. This is, once again, 1960 -- 50 years ago. Each bubble is a country -- the color, you can see, a continent. The dark blue here is sub-Saharan Africa. And the size of the bubble is the population. And these are the so-called "developing" countries. They had high, or very high, child mortality and family size, six to eight. And the ones over there, they were so-called Western countries. They had low child mortality and small families. What has happened? What I want you [to do] now is to see with your own eyes the relation between fall in child mortality and decrease in family size. I just want not to have any room for doubt -- you have to see that for yourself. This is what happened. Now I start the world. Here we come down with the eradication of smallpox, better education, health service. It got down there -- China comes into the Western box here. And here Brazil is in the Western Box. India is approaching. The first African countries coming into the Western box, and we get a lot a new neighbors. Welcome to a decent life. Come on. We want everyone down there. This is the vision we have, isn't it. And look now, the first African countries here are coming in. There we are today.
現在,我讓各位看看一張更宏觀的圖表, 有關孩童死亡率的圖表, 我要讓各位知道,在這個軸上的 孩童死亡率, 這個軸是孩童死亡率, 和家庭人數多寡之間的關係, 也就是孩童死亡率和家中小孩數之間的關係。 一、二、三、四,這是每位婦女所生的小孩數, 還有人生了六、七、八個小孩。 我們再來看看1960年代, 也就是50年前, 每一個圓點代表一個國家, 顏色則代表該國所處的大陸, 像是深藍色就代表撒哈拉沙漠以南非洲, 圓點的大小代表該國的人口數。 這些是 大家眼中的「開發中國家」, 他們的孩童死亡率非常高, 家中小孩有六到八個。 在這裡的這些國家, 則是一般人眼中的西方國家, 孩童死亡率很低, 小孩人數也很少。 這是怎麼一回事? 我要你們親眼看看 孩童死亡率的下降, 是和家中小孩數減少有關的。 我要你們每一個人 都親眼看看這張圖的變化, 就是這麼一回事。現在,世界在改變, 教育水準提升了, 天花也不見了,教育水準 和醫療體系都提升了, 大家都下降到這裡了,現在中國擠進西方國家框框裡了, 巴西也加入了, 印度就快進來了,有一個非洲國家也進到了這個區塊, 我們一下子多了好多新鄰居, 歡迎大家一起提升生活品質, 來吧!每個人都下來這裡吧! 這是我們的夢想,不是嗎? 看看,首次有非洲國家進到這個區塊了, 這就是現在這個世界的樣子。
There is no such thing as a "Western world" and "developing world." This is the report from [the] U.N., which came out on Friday. It's very good -- "Levels and Trends in Child Mortality" -- except this page. This page is very bad; it's a categorization of countries. It labels "developing countries," -- I can read from the list here -- developing countries: Republic of Korea -- South Korea. Huh? They get Samsung, how can they be [a] developing country? They have here Singapore. They have the lowest child mortality in the world, Singapore. They bypassed Sweden five years ago, and they are labeled a developing country. They have here Qatar. It's the richest country in the world with Al Jazeera. How the heck could they be [a] developing country? This is crap. (Applause) The rest here is good -- the rest is good.
根本沒有什麼 「西方國家」和「開發中國家」的差別。 這一份是聯合國的報告, 星期五才剛出刊的, 這份報告非常棒:「孩童死亡率及其趨勢」, 除了這一頁以外。 這一頁很糟, 它把國家做了分類, 標題是「開發中國家」--我可以把名單讀出來, 開發中國家:南韓... 啊? 他們有三星這種大公司,怎麼可能是開發中國家? 還有,新加坡... 新加坡的孩童死亡率可是全世界最低的耶! 他們在五年前就超越了瑞典, 竟然還只是開發中國家? 卡達也在名單上, 卡達可是全世界最有錢的國家耶...他們還擁有半島電視台耶! 卡達怎麼會是開發中國家? 這簡直胡說八道! (掌聲) 報告的其他部分都很好,都很好。
We have to have a modern concept, which fits to the data. And we have to realize that we are all going to into this, down to here. What is the importance now with the relations here. Look -- even if we look in Africa -- these are the African countries. You can clearly see the relation with falling child mortality and decreasing family size, even within Africa. It's very clear that this is what happens. And a very important piece of research came out on Friday from the Institute of Health Metrics and Evaluation in Seattle showing that almost 50 percent of the fall in child mortality can be attributed to female education. That is, when we get girls in school, we'll get an impact 15 to 20 years later, which is a secular trend which is very strong. That's why we must have that long-term perspective, but we must measure the impact over 10-year periods. It's fully possible to get child mortality down in all of these countries and to get them down in the corner where we all would like to live together.
我們的觀念應該要跟得上時代, 才能讀得懂這些資料。 我們必須瞭解, 所有的國家都應該下降到這個水準, 重要的是要瞭解其中的關係。 看看,即使我們把焦點放在非洲, 這些就是非洲國家, 你還是可以清楚地看到,在孩童死亡率下降的同時, 家中小孩數也在減少, 就算在非洲也一樣, 這是一個很明顯的事實。 西雅圖的健康評估機構在星期五 發表了一篇很重要的研究報告, 他們指出,孩童死亡率之所以下降, 有一半可以歸功於 女性接受教育所帶來的影響。 也就是說,當我們把女孩們送到學校去, 15到20年後,我們就會看到實際的效用發生, 這種影響的效用是很強烈的。 所以我們得把眼光放遠, 至少要以十年 做為衡量的區間。 要讓這些國家的 孩童死亡率下降,是絕對可能的, 他們一定能下降到這個角落, 達到和其他國家一樣的水準。
And of course, lowering child mortality is a matter of utmost importance from humanitarian aspects. It's a decent life for children, we are talking about. But it is also a strategic investment in the future of all mankind, because it's about the environment. We will not be able to manage the environment and avoid the terrible climate crisis if we don't stabilize the world population. Let's be clear about that. And the way to do that, that is to get child mortality down, get access to family planning and behind that drive female education. And that is fully possible. Let's do it.
當然,從人道主義的觀點來看, 孩童死亡率的降低 有其絕對的重要性, 我們所談的, 是要保障孩童基本的生活品質。 這當然也算是我們全體人類 對未來的重要策略性投資, 因為這攸關環境的現況。 如果我們不能控制全世界的人口成長, 我們就無法保有良好的環境, 也就無法避免可怕的氣候變遷, 我們一定得清楚瞭解這一點。 要達到這個目標, 首先我們得降低孩童死亡率,提倡家庭計畫, 而且讓女性接受教育, 我們絕對有可能辦到,就這麼辦吧!
Thank you very much.
謝謝各位!
(Applause)
(掌聲)