来源：《卫报》
原文刊登日期：2021年5月4日
A 30-year-old American is three times more likely to die at that age than his or her European peers. In fact, Americans do worse at just about every age. To make matters more grim, the American disadvantage is growing over time.
一个30岁的美国人在这个年龄死亡的可能性是欧洲同龄人的三倍。事实上，美国人几乎在每个年龄阶段都死亡率更高。更糟糕的是，随着时间的推移，美国的劣势越来越大。
In 2017, for example, higher American mortality translated into roughly 401,000 excess deaths – deaths that would not have occurred if the US had Europe’s lower age-specific death rates.
例如，2017年，美国较高的死亡率意味着大约40.1万例额外死亡——如果美国有欧洲较低的年龄细分死亡率，这些死亡就不会发生。
There have been many efforts to account for the US mortality disadvantage. There is no single answer, but three factors stand out. First, death rates from drug overdose are much higher in the US than in Europe and have risen sharply in the 21st century. Second is the rapid rise in the proportion of American adults who are obese. In 2016, 40% of American adults were obese, a larger proportion than in Europe. Higher levels of obesity in the US may account for 55% of its shortfall in life expectancy relative to other rich countries. Third, the US stands out among wealthy countries for not offering universal healthcare insurance. One analysis suggests that the absence of universal healthcare resulted in 45,000 excess deaths at ages 18-64 in 2005.
人们做了很多努力来解释美国死亡率高的原因。没有单一的答案，但有三个因素很突出。首先，美国服药过量的死亡率远高于欧洲，并且在21世纪急剧上升。其次是美国成年人肥胖率的快速上升。2016年，40%的美国成年人患有肥胖症，这一比例高于欧洲。与其他富裕国家相比，美国预期寿命低成因的55%可能是由较高的肥胖水平造成的。第三，美国是富裕国家中少有的没有全民医保的国家。一项分析表明，2005年，由于缺乏全民医保，18-64岁的人多死亡4.5万人。
Why does the US perform so poorly in these realms? We would argue that a lack of federal oversight and regulation, powerful lobbying structure, and deindustrialization of American jobs combine to create an annual tsunami of excess deaths.
为什么美国在这些领域表现如此糟糕？我们认为，缺乏联邦监督和监管、强大的游说体系以及美国就业岗位的去工业化，这些因素加在一起，每年都造成了一场死亡人数过多的海啸。
Both supply and demand factors are involved in the increasing number of US deaths from drug overdose. Large pharmaceutical companies marketed pain relievers without adequate federal oversight of their safety claims in the 1990s, fueling overdoses of prescription opioids. Big pharma’s lobbying power protected their sales campaigns. Although restrictions were eventually put in place, the damage had been done. Illegal use of opiates grew dramatically, especially among people in economically depressed areas and with lower levels of schooling.
美国因药物过量而死亡的人数不断增加，其中既有供给因素，也有需求因素。上世纪90年代，大型制药公司在销售止痛药时，联邦政府没有对其安全声明进行足够的监管，导致处方阿片类药物的过量使用。大型制药公司的游说力量保护了他们的销售活动。尽管最终出台了限制措施，但损害已经造成。阿片类药物的非法使用急剧增加，特别是在经济萧条地区和教育水平较低的人群中。
Noting that this increase coincided with increases in mortality from suicide and alcohol-related deaths, the economists Anne Case and Angus Deaton have argued that American society is suffering from a growing tide of despair. They argue that one of the main drivers is de-industrialization, which eliminated millions of well-paying jobs for people who did not attend college. This is the group with the largest increase in premature mortality during the 21st century.
经济学家安妮·凯斯和安格斯·迪顿指出，药物过量死亡人数的增长与自杀和酗酒导致的死亡率上升同时发生。他们认为，美国社会正遭受着日益高涨的绝望情绪，主要的驱动因素之一是去工业化，这让数百万没有上过大学的人失去了高薪工作。他们是21世纪早死率增长最快的群体。
The prevalence of cardiovascular diseases and many cancers, the principal killers in wealthy countries, is unusually high in the US. Heart disease, a type of cardiovascular disease and America’s number one cause of death for decades, is strongly linked to lifestyle factors such as obesity. Although the connection between obesity and health risks is well known, consumer preferences for unhealthy food are strong. Not just because humans are biologically vulnerable to sweets and fats, but because major food producers and distributors are incentivized to turn this weakness into profit.
心血管疾病和许多癌症是富裕国家的主要死因，但在美国，它们的发病率异常高。心脏病是一种心血管疾病，几十年来一直是美国人的头号死因，与肥胖等生活方式因素密切相关。虽然肥胖和健康风险之间的联系是众所周知的，但消费者对不健康食品的偏好是强烈的。这不仅是因为人类在生理上容易受到甜食和脂肪的伤害，还因为主要的食品生产商和经销商受到激励，将人的弱点转化为利润。