Race and life expectancy

人種與預(yù)期壽命

Black lives longer

黑人的壽命在增長(zhǎng)

The life-expectancy gap between black and white Americans has steadily declined

美國(guó)黑人和白人之間的預(yù)期壽命差距一直在穩(wěn)步縮小

BACK IN 1980 when Harlem was still a byword for poverty, criminality and the decline of New York City, black men in the neighbourhood had a worse chance of living to the age of 65 than men in Bangladesh did. At that time Harlem’s residents—almost all of them black, and many of them poor—died of heart disease at double the rate of whites. They died of liver cirrhosis, brought on by alcoholism or hepatitis, at ten times the rate of whites. And they were 14 times likelier to be murdered. Today the prominent corner of Malcolm X Boulevard and West 125th Street houses a Whole Foods, an upmarket grocery chain, and life expectancy is up to 76.2 years. That is still five years behind the rest of the city, but the gap is no longer so egregious.

早在1980年，哈萊姆區(qū)還是貧窮、犯罪和紐約市衰落的代名詞，當(dāng)時(shí)，該社區(qū)的黑人男性比孟加拉國(guó)男性活到65歲的機(jī)會(huì)更低。那時(shí)，哈萊姆區(qū)的居民——幾乎都是黑人，而且很多都很窮——死于心臟病的比率是白人的兩倍。他們死于肝硬化，由酒精中毒或肝炎引起，死亡率是白人的十倍。他們被謀殺的可能性是其他人的14倍。如今，馬爾科姆·艾克斯大道(Malcolm X Boulevard)和西125街(West 125 Street)的顯眼的角落里，坐落著一家高檔食品連鎖企業(yè)全食超市(Whole Foods)，這里人均壽命高達(dá)76.2歲。這仍比倫敦金融城其他地區(qū)落后5年，但差距已不再那么大。

詞匯

Byword/綽號(hào)；笑柄

Cirrhosis/ ?硬化；[內(nèi)科] 肝硬化

Hepatitis/肝炎

Egregious/驚人的；過(guò)分的；惡名昭彰的

The case of Harlem exemplifies a remarkable trend in American public health that is seldom noticed: the persistent gap in life expectancy between whites and blacks has closed substantially, and is now at its narrowest ever. In 1900, the earliest date for which the Centres for Disease Control and Prevention (CDC) publishes statistics, the life expectancy for black boys at birth was 32.5—14.1 years shorter than for white boys. Put another way, the typical black boy had 30% less life to live. Incremental progress, however fitful, was made for the next century, but epidemics of crack, HIV and urban violence threatened to reverse it. By 1993, a peak year for violent crime, the life-expectancy gap between black and white men had widened again by nearly three years, to 8.5 years.

哈萊姆區(qū)是美國(guó)公共衛(wèi)生領(lǐng)域人少為關(guān)心但卻有著的衛(wèi)生狀況顯著改善趨勢(shì)的例證:白人和黑人預(yù)期壽命的持續(xù)差距已大幅縮小，目前正處于歷史上最接近的水平。1900年，美國(guó)疾病控制與預(yù)防中心(CDC)最早發(fā)布統(tǒng)計(jì)數(shù)據(jù)，黑人男孩出生時(shí)的預(yù)期壽命比白人男孩短32.5-14.1歲。換句話說(shuō)，典型的黑人男孩的壽命要少30%。盡管下個(gè)世紀(jì)取得了斷斷續(xù)續(xù)的漸進(jìn)進(jìn)展，但【】、艾滋病毒和城市暴力的流行有可能扭轉(zhuǎn)這一趨勢(shì)。到1993年，暴力犯罪的高發(fā)年，黑人和白人男性的預(yù)期壽命差距又?jǐn)U大了近三年，達(dá)到8.5歲。

詞匯

Persistent/堅(jiān)持的；持久穩(wěn)固的

Incremental/增加的，增值的

Fitful/一陣陣的；斷斷續(xù)續(xù)的

?

But then it began a sustained, steady fall. In 2011 the black-white gap had narrowed to 4.4 years for men (5.7% less) and just 3.1 years (3.8% less) for women. Though progress then levelled off until 2016, the most recent year available from the CDC, the trend is stable and not reversing.

但隨后年齡差開(kāi)始了持續(xù)穩(wěn)定的縮小。2011年，黑人和白人的年齡差距縮小到男性4.4歲(減少5.7%)，女性3.1歲(減少3.8%)。盡管直到2016年(疾控中心可提供的最近一年)，年齡差才縮小趨于平穩(wěn)，而且這一趨勢(shì)是穩(wěn)定的，不會(huì)逆轉(zhuǎn)。

?

The downward trajectory can be explained by several simultaneous phenomena, not all of them cheerful. Among the elderly, more of whom die after all than the rest, the narrowing is due to mortality from heart disease and cancer declining faster for blacks than for whites. But for premature deaths, racial gaps—especially between black and white men—have also narrowed because of substantially reduced mortality from homicide, the result of the great crime decline, and HIV, the result of improved medical therapies. Yet the emergence of the opioid epidemic, which kills whites at higher rates than other races, has also hastened the racial convergence.

下降趨勢(shì)可以用幾個(gè)同時(shí)出現(xiàn)的現(xiàn)象來(lái)解釋?zhuān)⒎撬鞋F(xiàn)象都是值得鼓舞的。在老年人中，死于心臟病和癌癥的黑人死亡率比白人下降得更快。但就過(guò)早死亡而言，種族差距——尤其是黑人和白人男性之間的差距——也在縮小，因?yàn)樗麣?dǎo)致的死亡率大幅下降，這是犯罪率大幅下降的結(jié)果，而艾滋病病毒(HIV)則是醫(yī)療療法改善的結(jié)果。然而，【】類(lèi)藥物的流行也加快縮短了人種壽命的差距——與其他種族相比，白人的死亡率更高（這里指有錢(qián)的白人，花錢(qián)買(mǎi)【】類(lèi)藥物，濫嗑藥，然后死的快）。

詞匯

Trajectory/ ?軌道，軌線

Mortality/死亡數(shù)，死亡率

Homicide/過(guò)失殺人；殺人犯

Convergence/收斂；會(huì)聚

Criminologists still do not know why violent crime and homicides began to decline in the mid-1990s. A wide array of theories have been proposed: the eroding appeal of crack cocaine, mass incarceration actually working as intended, legalisation of abortion, less lead poisoning of children and the improving economy. But the public-health consequences are abundantly clear, particularly for black men who were and remain the most frequent victims of murder. Patrick Sharkey and Michael Friedson, two sociologists, conducted a thought experiment showing that life expectancy for black men would have been 0.8 years lower if homicide rates had persisted at their levels in 1991. That is a remarkably large health effect—on the order of entirely eliminating obesity among black men. The authors calculate that 17% of the narrowing of the life-expectancy gap for black and white men between 1991 and 2014 could be explained by the unexpected halving of the murder rate over that period.

犯罪學(xué)家仍然不知道為什么暴力犯罪和兇殺案在20世紀(jì)90年代中期開(kāi)始下降。人們提出了一系列廣泛的理論:高純度【】吸引力的下降、大規(guī)模監(jiān)禁實(shí)際上起到了預(yù)期的效果、【】合法化、兒童鉛中毒減少以及經(jīng)濟(jì)狀況的改善。但是公共健康改善的結(jié)果是顯著的，尤其是對(duì)黑人男性來(lái)說(shuō)，他們過(guò)去是，現(xiàn)在仍然是最頻繁的謀殺受害者。帕特里克·夏基(Patrick Sharkey)和邁克爾·弗里德森(Michael Friedson)是兩位社會(huì)學(xué)家，他們進(jìn)行了一項(xiàng)思想實(shí)驗(yàn)，結(jié)果表明，如果謀殺率維持在1991年的水平，黑人男性的預(yù)期壽命會(huì)低0.8年。這對(duì)完全消除黑人男性肥胖的進(jìn)程有著顯著的健康方面影響（我這真的不懂為啥要扯上肥胖率）。作者計(jì)算，1991年至2014年間，黑人和白人男性預(yù)期壽命差距的縮小有17%可以用這段時(shí)間謀殺率出人意料地減半來(lái)解釋。

Considerable improvement in the treatment of HIV has also decreased premature deaths for black men, who were hammered by the epidemic. An estimated 42% of the 1.1m Americans living with HIV today are black, triple their share of the population. At the peak of the epidemic, around 1994, the virus was killing blacks at an age-adjusted rate of nearly 60 per 100,000—or three times the rate at which opioid overdoses killed whites in 2017. Though blacks still make up a majority of Americans killed by HIV, the overall rates of death have plummeted to around 10 per 100,000.

艾滋病毒治療的顯著改善也減少了黑人男性的過(guò)早死亡，他們?cè)?jīng)深受艾滋病的打擊。據(jù)估計(jì)，目前美國(guó)110萬(wàn)艾滋病毒攜帶者中有42%是黑人，是其人口比例的三倍。在1994年左右的疫情高峰期，該病毒以每10萬(wàn)人中近60人的年齡調(diào)整率殺死黑人，是2017年【】類(lèi)藥物過(guò)量殺死白人的三倍。盡管黑人仍然占死于艾滋病毒的美國(guó)人的大多數(shù)，但總體死亡率已降至每10萬(wàn)人中有10人左右。

詞匯

age-adjusted rate/標(biāo)化率（age-adjusted?mortality?rate?/年齡調(diào)整死亡率）

?

At the same time as lifespans have been increasing for blacks, prospects for whites, especially the non-elderly, have sagged. This is mainly because of the rapid increase in deaths from drug overdoses, opioids chief among them. Death rates for whites caused by all drugs more than quadrupled from 1999 to 2017, and are now 32% higher than for blacks. Historically drug epidemics have disproportionately hit non-white Americans. But of the 47,600 people killed by opioids in 2017, 37,100 were white. Opioid addiction, suicide and overdose-related deaths all affect whites at much higher rates than blacks. Some of the reason for this may, ironically enough, lie in racial discrimination.

與此同時(shí)，隨著黑人的壽命不斷延長(zhǎng)，而白人，尤其是非老年人的預(yù)期壽命在下降。這主要是由于藥物過(guò)量導(dǎo)致的死亡人數(shù)迅速增加，【】類(lèi)藥物是其中的主要原因。從1999年到2017年，所有【】導(dǎo)致的白人死亡率翻了兩番多，現(xiàn)在比黑人高32%。從歷史上看，【】流行對(duì)非白人美國(guó)人的打擊是不成比例的。但在2017年死于【】類(lèi)藥物的47600人中，有37100人是白人。【】類(lèi)藥物成癮、自殺和過(guò)量相關(guān)死亡對(duì)白人的影響都比黑人高得多。具有諷刺意味的是，其中一些原因可能在于種族歧視。

詞匯

Sag./ 下垂，下降

Quadrupled/翻了兩番；變成四倍的

?

A life-saving bias

偏見(jiàn)，卻是在拯救生命

About three in four heroin addictions began with a legitimate prescription. The hotspots of the opioid crisis—the tri-state meeting of Ohio, Kentucky and West Virginia as well as rural New England—where blizzards of pills were later followed by a rise in overdose deaths, are much whiter than the rest of the country. “It is consistent with pretty different rates of prescribing opioids. We supplied it very differently to whites versus blacks in these areas,” says Ellen Meara, a health economist at Dartmouth College. “But we also know that there’s a lot of racial discrimination in our health-care system.”

大約四分之三的【】成癮者都是從合法處方開(kāi)始的?！尽款?lèi)藥物危機(jī)的熱點(diǎn)地區(qū)——俄亥俄州、肯塔基州和西弗吉尼亞州這三個(gè)問(wèn)題點(diǎn)，以及新英格蘭的農(nóng)村地區(qū)——在那里，暴風(fēng)雪似的藥物泛濫過(guò)后，藥物過(guò)量服用的死亡率上升，比國(guó)家其他地方更顯蒼白（可怕）?！斑@與處方【】類(lèi)藥物的比例相當(dāng)不同”。達(dá)特茅斯學(xué)院(Dartmouth College)的健康經(jīng)濟(jì)學(xué)家艾倫?米拉(Ellen Meara)表示:“在這些地區(qū)，我們向B人和H人提供的藥方非常不同（給B人提供【】類(lèi)藥物，H人提供其他的，【】類(lèi)藥物貴，但是有很好的止痛效果，但是會(huì)成癮）。”“……”

詞匯

Blizzard/暴風(fēng)雪，大風(fēng)雪；大打擊

Versus/對(duì)；與...相對(duì)；對(duì)抗

Wherever they lived, blacks were less likely to obtain legal opioids in the first place. A study of pain-related visits to emergency departments between 1993 and 2005—a period that overlaps with the run-up to the crisis—shows that whites were substantially more likely to obtain an opioid prescription, even after controlling for the reported severity of pain and other factors. A wealth of studies have found similar effects. Doctors are also much more likely to stop prescribing opioids for blacks after detecting illicit drug use. In the case of opioids, racial bias probably saved lives.

無(wú)論他們住在哪里，H人首先獲得合法【】類(lèi)藥物的可能性就更小。一項(xiàng)關(guān)于1993年至2005年間急診部門(mén)疼痛相關(guān)就診的研究表明，即使在控制了疼痛的嚴(yán)重程度和其他因素后，B人也更有可能獲得【】類(lèi)藥物處方。大量的研究也發(fā)現(xiàn)了類(lèi)似的效果。在發(fā)現(xiàn)非法使用【】后，醫(yī)生也更有可能停止給H人開(kāi)【】類(lèi)藥物的處方。就【】類(lèi)藥物而言，種族偏見(jiàn)可能挽救了生命。

Despite improvements in the racial gap, inequality in life expectancy by class and income still remains. The CDC has begun publishing estimates of life expectancy at the census-tract (or neighbourhood) level. Life expectancy at the 90th percentile is 83.1 years compared with 73.1 years at the 10th. In Chicago, census tracts a few miles apart can differ in average life expectancies by two decades. The estimates are quite closely related to measures of income and poverty: a simple regression shows that a five-percentage-point increase in the poverty rate is associated with a one-year decline in life expectancy.

盡管種族差距有所改善，但按階級(jí)和收入劃分的預(yù)期壽命不平等仍然存在。美國(guó)疾病控制與預(yù)防中心(CDC)已開(kāi)始發(fā)布人口普查(或鄰近地區(qū))水平的預(yù)期壽命估計(jì)值。有90%左右的人群的預(yù)期壽命為83.1歲，而剩下10%的預(yù)期壽命為73.1歲。在芝加哥，相隔幾英里的人口普查區(qū)域平均預(yù)期壽命可能相差20年。這些估計(jì)數(shù)字與收入和貧困的衡量指標(biāo)密切相關(guān):簡(jiǎn)單的回歸統(tǒng)計(jì)顯示，貧困率上升5個(gè)百分點(diǎn)與預(yù)期壽命下降1年有關(guān)。

詞匯

Census/人口普查，人口調(diào)查

Research by Raj Chetty, an economist, and his colleagues shows that the income gap in life expectancy has been growing even as the racial one has been declining. So has the education gap. Although people have long assumed that higher socioeconomic status bought better health, that was not as true for blacks as it was for whites, says Arline Geronimus, a public-health professor at the University of Michigan. Now that is changing. “The convergence is due to more affluent, educated blacks living longer while less-affluent, less-educated whites are not living as long. It shouldn’t be interpreted as though we’ve made great strides,” she says. Even so, the improvements for black men run counter to the drumbeat of pessimism about race in America. Black lives are longer.

經(jīng)濟(jì)學(xué)家Raj Chetty和他的同事們的研究表明，盡管種族差異一直在下降，預(yù)期壽命影響成分之一——收入差距卻一直在擴(kuò)大。教育差距也是如此。密歇根大學(xué)公共衛(wèi)生教授Arline Geronimus說(shuō)，盡管人們長(zhǎng)期以來(lái)一直認(rèn)為社會(huì)經(jīng)濟(jì)地位越高，健康狀況就越好，但事實(shí)并非如此?，F(xiàn)在這種情況正在改變?！斑@種趨同是因?yàn)楦辉！⑹芙逃潭雀叩腍人壽命更長(zhǎng)，而不那么富裕、受教育程度較低的B人壽命則沒(méi)有那么長(zhǎng)。這不應(yīng)該被理解為我們已經(jīng)取得了巨大的進(jìn)步，”她說(shuō)。盡管如此，H人男性的進(jìn)步與美國(guó)狹隘悲觀的種族偏見(jiàn)背道而馳。黑人的壽命更長(zhǎng)。

詞匯

run counter/違背