Folch Erik, Hernandez Isabel, Barragan Maribel, Franco-Paredes Carlos
AIDS Internastional Training and Research program, Rollins School of Public Health, Emory University, Atlanta, GA 30303, USA.
Am J Med Sci. 2003 Aug;326(2):66-72. doi: 10.1097/00000441-200308000-00003.
Despite some improvements in the health status of the world during the last few decades, major obstacles remain. Improvements in health outcomes have not been shared equally among countries and poverty is clearly the main reason. Infectious diseases, which remain the major cause of death worldwide, are an incalculable source of human misery and economic loss. In fact, 25% of all deaths and 30% of the global burden of disease are attributed to infectious diseases. Unfortunately, more than 95% of these deaths, most of which are preventable, occur in the developing world, where poverty is widespread. The 3 major infectious disease killers in these countries are HIV/AIDS, tuberculosis, and malaria. The principles of social justice and health as a human right in the developing world have been advocated as the main justification for health assistance from rich to poor countries. Although we do not disagree with this, we argue that a strategy that emphasizes the shared benefit to rich and poor countries would facilitate this process. We propose that the accomplishment of these challenging tasks should be viewed from the perspective of game theory, where the interests of the parties (in this case rich and poor countries) overlap. As the world becomes increasingly integrated, economic development in resource-poor countries will increase the opportunities for richer countries to profit from investment in the developing world. Global health has political and international security implications for the developed world, as well. In view of the current health status of the developing world, we are not playing a game but facing a matter of life and death. "When health is absent, wisdom cannot reveal itself, art cannot become manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied" --Herophilus, 325 BCE (Physician to Alexander the Great). The purpose of this article is to address the relationship between health, poverty, and development in the context of game theory. We will focus on the link between economic inequalities and health outcomes, exclusively concentrating our analysis on the impact of infectious diseases. Subsequently, we will outline the game, the players, and the potential win-win outcomes that may potentially result.
尽管在过去几十年间世界健康状况有了一些改善，但主要障碍依然存在。各国在健康成果改善方面的情况并不均衡，而贫困显然是主要原因。传染病仍是全球主要死因，是人类苦难和经济损失的一个难以估量的来源。事实上，所有死亡病例的25%以及全球疾病负担的30%都归因于传染病。不幸的是，这些死亡病例中超过95%发生在即贫困普遍存在的发展中世界，其中大多数是可以预防的。这些国家的三大传染病杀手是艾滋病毒/艾滋病、结核病和疟疾。发展中世界的社会正义原则以及健康作为一项人权，一直被倡导为富国向穷国提供卫生援助的主要理由。虽然我们对此并无异议，但我们认为，强调富国和穷国共同受益的战略将推动这一进程。我们建议，应从博弈论的角度看待这些具有挑战性任务的完成情况，其中各方（在这种情况下是富国和穷国）的利益存在重叠。随着世界日益一体化，资源匮乏国家的经济发展将增加富裕国家从对发展中世界的投资中获利的机会。全球健康对发达世界也具有政治和国际安全影响。鉴于发展中世界目前的健康状况，我们面临的不是一场博弈，而是生死攸关的问题。“健康缺失时，智慧无法彰显，技艺无法展现，力量无法战斗，财富变得无用，才智无法施展”——公元前325年，希罗菲卢斯（亚历山大大帝的御医）。本文的目的在于在博弈论的背景下探讨健康、贫困与发展之间的关系。我们将重点关注经济不平等与健康成果之间的联系，分析将专门集中于传染病的影响。随后，我们将概述这场博弈、参与者以及可能产生的潜在双赢结果。
