2017年12月22日星期五

采访安妮案:死亡率,葬礼等等

道格拉斯克莱门特发表了一个“安妮·凯斯访谈”,副标题是“普林斯顿经济学家关于南非艾滋病成本、美国‘绝望之死’和经济学中的女性”,该区域(来自Minneapolis Federal储备,2017年12月12日)

关于“绝望死亡”和美国中年白人死亡率上升:
"We found that suicide rates were rising. That opened another door: What about mortality in general? That’s when we found that mortality among whites in middle age was actually increasing. That came as a surprise to us, so we tried it out on friends of ours at medical schools. We thought this result must be known to them, or others, but it came as a surprise to basically everyone we showed these results to.
“所以我们深入研究后发现,并不是心脏病在增加,也不是癌症在增加。结果显示,自杀、酗酒导致的肝脏死亡率和药物过量增加最多,我们将这些因素合并为我们所说的“绝望死亡”。因为对我们来说,这一切都像是自杀;要么用枪迅速杀人要么用毒品和酒精慢慢杀人. ...从白人、非西班牙裔的角度来看,这是一个狭窄的人口统计,是的,但它贯穿了整个中年时期。这种情况发生在20多岁、30多岁、40多岁和50多岁的人群中. ...受打击的群体是学历低于学士学位的人,更确切地说,是高中或更低学历的人。这些群体的死亡风险最高。
"None of that would’ve come to light if we had continued to make progress against heart disease in the U.S. Unlike other rich countries where mortality rates from heart disease are falling, they flat-lined in the U.S. We don’t really understand why. Some people are saying, `We’ve been telling you for two decades that you’re all getting fat and that eventually obesity will catch up with you.' But that’s a little bit premature, we think, because in Britain, the obesity rates are almost as high as they are in the U.S., and yet their heart disease rates continue to fall. So it’s something of a mystery. If heart disease progress had continued, it would’ve overwhelmed the increases we’ve seen in drugs and alcohol and suicide. But given that it’s flat-lined, it’s allowed those deaths to actually cause mortality rates to rise. We don’t fully have a picture of why this has happened even though the National Institutes of Health are spending $30 billion annually on health research and as a country we are spending $3 trillion a year on health care.
我们决定的是,部分死亡率转变可能是由于美国人民在没有B.A的情况下的情况。正在找到自己。......我们认为人们滥用酒精或毒品,或者如果他们的生活进展顺利,那就拿起枪。我们认为要了解实际发生的事情,我们将不得不及时到达20世纪70年代。这是20世纪70年代早期,当它变得越来越少,而且少于高中学位的人可能会达到就职培训和福利的工作阶梯,以及潜在的中产阶级生活。我们认为这并不是巧合,即美国男子的中位数工资并没有自1972年以来已经成长。可用的机会变得越来越少,这意味着男人变得越来越少。......

“所以你有一个脆弱的家庭生活,没有前景的工作,和你一起把这些变化也发生在美国的人们,虽然他们不报告自己减少宗教,不太可能报告属于“遗产”教会我们的青春,而不是他们搬到更多的福音派教会,它们更以个人为导向。过去帮助社区里的人们的那种支柱已经消失了。这可能是自杀的完美配方. ...

"Coming to the policy part of this, we think that, while it’s not an easy thing to do, it’s relatively easy to turn off the taps for the prescription opioids, which are out of control. I think that a consensus is building for this, despite a lot of push-back from medical doctors who will say, `You come to my clinic, you look at these people who are in horrible pain and you tell me not to prescribe them something that can actually relieve their pain.' Well, we understand there’s a place for prescription opioids, but we think that they’re not currently being prescribed at an appropriate level. The fact that at current levels, every adult in the U.S. could be taking opioids around the clock for three weeks is more than probably makes any sense at all.
“但当处方阿片类药物变得过于昂贵,或当水龙头被关掉时,这并不能完全解决问题。”大脑中同样的受体也会对海洛因产生反应,海洛因现在从墨西哥来了,而且很纯也很便宜。毒品贩子不想和内陆城市的贩毒团伙纠缠不清,但他们会把毒品运到缅因州和印第安纳州的农村地区,这也使得鸦片类毒品的非法危机更加严重。谈论毒品就像试图射击一个移动的目标。2010年,它是处方阿片类药物;现在是海洛因和芬太尼。”
当南非家庭因丧葬费用而变得贫穷时

“在夸祖鲁 - 纳塔尔的这一部分,也在开普敦外的开普镇,我们还有一个现场网站,葬礼非常昂贵。...在祖鲁兰的这一部分,可能是唯一蓬勃发展的业务funeral business. ... When a baby dies, or a child at a very young age, there would be a traditional funeral. You would wrap them in a blanket and put them in the ground, and there’d be cookies and tea. When poor people died in old age, they would have an old-age funeral policy that would pay for their funerals; they pay in every month a little bit of money, and that takes care of funeral expenses.
“但当人们在中年时开始死于艾滋病时,他们没有葬礼保险来支付费用。但是,不管他们的身份是什么,家里人都觉得有必要把他们埋起来。对男人来说,你会杀一头牛。这是一个非常昂贵的提议。对女人来说,你可以宰杀一只山羊——虽然不那么贵,但仍然是一大笔钱。从四面八方来的大家庭会有食物,他们想住多久就住多久。而且只要它们想留下来,你就得喂它们。
"It was also impossible for local areas to say, `OK, we’re going to make a pact in this local area: No one has an expensive funeral,' because your family who is coming all the way from Johannesburg, they didn’t buy into that. They wanted to come and have this enormous party. It was very important to be able to do that. ... And if you couldn’t afford to bury your dead according to the status of that person, you would borrow money, and as a last resort you would borrow from a money lender at uxorious rates.
“这样一来,这些家庭就会陷入困境,因为他们无法还清为葬礼支付的贷款。我们可以记录这些家庭中发生的更糟糕的事情的程度,无论孩子们是否挨饿,孩子们是否上学,人们是否报告了比家中某人死亡所造成的更多的心理压力。在那些借钱的家庭中,情况很快变得更糟。”
妇女在学术经济学和尖锐的肘部问题中陈述
“当我去参加其他学科的研讨班时,研讨班的主要目的往往不是为了得分,也不是为了把演讲者钉在黑板上。我认为女性通常不会像男性那样回应。很明显,有些女人会。有一个分布给两性. ...
"I think that women in economics oftentimes find that government work is one in which there’s more teamwork and their skills are fully recognized. A lot of women go into government instead of academia because when they look around they think, this is actually an environment that seems pretty healthy. And I think that it’s not the case that economics is altogether a healthy discipline for women.
“我的第一次研究生学位在公共政策中,以及我在我学习数学和经济学的本科,以及在公共政策学校,我从未感受到一个歧视的丝毫。但是我开始博士学位。在经济学中,很明显。那是很久以前,但从那一天到今天,我觉得如果我想听到,我必须愿意进来并准备搭配锋利的肘部。“