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您的政府是否关心出生在本国的宝宝?

本文提供一种新的方法,针对在保护公民健康权的义务方面,向政府问责。本文基于联合国最忌们的人权文章之一,主要材料数据来源于世界卫生组织,联合国儿童基金会,世界银行和国际货币基金组织。这种方法可供评估政府的工作,拯救了孩子们的生命或是莫不关心。

A newborn baby delivered by US Navy doctors.
一个新的生命降生在美国海军医生的手中。美国与它的发达程度相比较拥有最差的婴儿死亡率和最差的医疗制度,但是他们拍了世界上最出色的宝宝的照片。来源Suzanne M. Day, Wikimedia.

我提供的工具是一张略显复杂的图表,但将会在以下逐步解释。在阅读逐步深入之前,您可以试着点击下面图表的按钮,随着鼠标浏览。您或许会快速明白大意,以免阅读本文的剩余:

经济发展和婴儿死亡率的互相关系。
经济发展和婴儿死亡率的互相关系。

大量的记者、通讯员、研究者、政治家和人权保护组织意图问责世界各国政府对于人权遵守和侵犯。不幸的是,他们往往依赖于一种被截肢式的人权观念:他们专注于公民和政治权利,比如言论自由、宗教信仰自由和法治。经济与社会权通常受限制于歧视及难情援助。他们几乎从不问责政府理应负责保障最基础的服务如健康、教育、消除贫困等。

This attempt to hold governments accountable with regards to the right to health is based on the International Covenant on Economic, Social and Cultural Rights, one of the most fundamental UN human rights text, so far ratified by 164 countries. This treaty states: "The steps to be taken by the States Parties to the present Covenant to achieve the full realization of [the right to health] shall include those necessary for […] the reduction […] of infant mortality" (article 12.2). Another article stipulates that each state takes steps "to the maximum of its available resources" "with a view to achieving progressively the full realization of the rights" (article 2.1).

At least for recent years, we have got very good data about infant mortality for most countries in the world; the infant mortality rate (IMR) is defined as the number of babies which die in their first year of life out of 1000 babies born alive. The most reliable source is Child Mortality Estimates (CME Info), a website operate by the UN Inter-agency Group for Child Mortality Estimation jointly operated by UNICEF, WHO, the World Bank and the UN Population Division. When no figures are available from CME Info, other sources were used; for more details, refer to the information provided by the interactive charts below.

How can we evaluate the "available resources" of each country? Since this criterion is mentioned in each fundamental human rights text with regards to the obligations of the state to achieve the full realization of the economic and social rights, this question is fundamental. Most experts agree that the best way of measuring the standard of living in a country is GDP per capita purchasing power parity (GDP PC PPP, or simply "GDP" in this article). Large scale projects by the World Bank, the IMF and many other international organizations and academics provide reliable data for this indicator. The interactive charts below provide more detailed information.

On the chart below, each dot represents one country; countries which massively export oil or other mining products are not shown, for reasons which will be explained below. The x-axis represents GDP on some kind of logarithmic scale (actually the logarithm of GDP plus a constant in order to get a symmetric distribution). The y-axis represents infant mortality rate (IMR). If your mouse hovers above one of the dots, you will get more information about the country it represents.

经济发展和婴儿死亡率的互相关系。
经济发展和婴儿死亡率的互相关系。

At the first glance it becomes obvious that there is a very strong relationship between IMR and GDP. No low-income country has come even near the values of IMR which the industrialized countries can offer to their citizens. All countries with a GDP below 1000$ have got an IMR above 40‰. All the countries below 3000$ have got an IMR above 30‰. Conversely, all the countries above a GDP of 30,000$ have got an IMR below 6‰. This clearly shows that in the long term, economic development will certainly lead to fewer babies dying in their first year of life, and it is the only way of achieving this objective.

The red diagonal line represents the line which fits best into the cloud of dots; it was calculated using a method called linear regression. In technical terms, this is the line for which the sum of the squares of the vertical distances between the line and the various points is minimal. It allows us to calculate the average IMR which we would expect for a certain GDP level, based on the IMR achieved by the various countries for their respective level of GDP. If a country is significantly below the line, it provides a better-than-average survival chance for the babies born there. If a country is significantly above the line, we can consider that its achievements in the field of health care are questionable, unless we find another explanation for its poor performance.

The chart below shows all the countries, including those massively exporting oil and mining products which are displayed as circles whereas other countries are discs. Major countries and some other countries with interesting characteristics are singled out for a quick overview.

经济发展和婴儿死亡率的互相关系。
经济发展和婴儿死亡率的互相关系。

One glance at the chart shows why countries which massively export oil or mining products have been excluded from the first chart and from the calculation of the red line representing the average infant mortality for a given GDP level. Except for Norway, none of them have got a better-than-average healthcare system. The country which is closest to the average line in 2015 is Libya, but this is due to the fact that it saw its GDP break down after the uprising and NATO intervention, whereas its health care system was apparently not affected to the same extent. Before 2011, Libya was in the middle of other Middle Eastern oil states, way above the line. Another article to come will try to come up with an explanation of this "oil curse".

The following chart shows just a few major countries. Using the button "Select countries", you can add the countries you are interested in. With the button "Change the period", you can display any year between 1950 and 2015. By just hovering with the mouse above one of the countries, you will get the most important information about the corresponding country: the infant mortality, in per thousand and as a percentage of the average infant mortality for the corresponding GDP level, and also the number of babies which this country has saved through a better-than-average health care system or the number of babies which could have been saved with an average health care system.

经济发展和婴儿死亡率的互相关系。
经济发展和婴儿死亡率的互相关系。

Please spend a few minutes to get some information which you can then spread in order to get the message across that the lives of babies matter. Our academic system and our media don't care. You might be interested in the page of the New York Times dedicated to infant mortality. Unlike many other newspapers, at least they have got a page about this topic, and some articles are really interesting. However, the last article dates back to July… (article written on November 22 2015)

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