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肥胖症和基础设施 我刚从加拿大、美国、墨西哥旅行归来，带着新鲜的旅途记忆：包括在各个机场办理出入境以及过关安检手续的经历，还有飞行中的一些感受与心得。 大概两年前，我大学时的室友让我说说移居亚洲40年后发现美国最大的变化是什么。我说这太容易了，答案就是肥胖症激增，不仅成年人和儿童中超重的人数显著增加，超重的程度也日益严重。 最近，在争论多年后美国医学会终于认定肥胖为一种疾病。而当年争论的焦点之一就是什么才算肥胖。目前肥胖的定义以体质指数（BMI）为基础，存在一定的争议，因为据此标准，很多骨架较大的瘦身男女也会被认定为肥胖。 除了争论肥胖的症状以外，有关医保覆盖范围以及保费等问题也被广为涉及。 美国医学会作出这一决定，主要是为了鼓励医生主动向患者提示：肥胖可能会导致其他疾病，比如2型糖尿病、心血管病、中风等。 除了肥胖症增多外，我还想指出，美国的第二大变化就是乘机体验的全方位持续性恶化，这既包括空勤和地勤人员服务的及时性和服务态度，也包括机场的基础设施状况。 曾几何时，空中旅行还算是件乐事，充满各种兴奋刺激，一如当年航空公司和度假胜地的广告所言。如今，这些早已变做尘封的记忆，就像档案馆里发黄的老照片。 虽然美国的旅游胜地和度假村还在幸运地保持增长，但前往那里的旅途体验已大不如前。 回想上世纪七十年代我刚到中国旅行时，基础设施建设还比较薄弱，服务态度更差强人意。如果你搭乘国际航班在午饭前或午饭时抵达，那真是痛苦，因为什么也阻挡不了行李员和报关员吃饭、午睡。你能做的只有等待。 不过，那会儿机场的气氛还是挺放松的。有一年秋天，在广州白云机场，我的行李没有出现在露天的行李棚下。我很担心，于是就问行李员借用停在一旁的自行车。 他说：“行”。于是我就骑着车穿过跑道，来到刚刚乘坐过的飞机旁，告诉那儿的行李员我正在找行李。他们很礼貌地请我进行李舱查找，结果没有找到。待确认清楚后，我又骑车回去，向机场报告丢失了行李。 现在，中国机场的设施几乎都是新的，远超美国。行李到达十分迅速，身穿制服的安保人员也至少可以表现出例行公事式的礼貌，而不光是生硬地履行职责。 在这样的新机场，你不可能发现自己正坐在漏水的屋顶下，就像去年我在纽约肯尼迪机场遭遇的那样。 但另一方面，从北京、上海出发的航班经常晚点，往往还没有合理的事先通知或解释。到底是因为空军演习、部级领导包机、商务专机起降、还是目的地暴雨？总是让旅客一头雾水瞎揣测。 尽管如此，改善基础设施毕竟是有所进步的表现。在世界经济论坛关于全球基础设施的排名中，美国排在第25位，落后于多个主要竞争对手。而且问题不仅限于航空领域，还扩展到高速公路、桥梁、给水管道等。 据《财富》撰稿人Sheila Bair介绍，新美国基金会（New America Foundation）和其他很多组织都呼吁成立国家基础设施银行，在不增加长期赤字的前提下为重大基础设施提供资金保障。 希望这些理性的声音有人倾听，并得到行动上的支持。 倘若真能如此，也许可以像美国医学会把肥胖定义为疾病那样，成为开潮流之先的小改变。 从经济产出来说，落后的基础设施会带来巨大的经济损失。而一些研究表明，10亿美元的基础设施投资，可以创造20,000个新就业机会。 |
Obesity and Infrastructure I just returned from a trip to Canada, the U.S. and Mexico with fresh traveller's memories: passing through airports, immigration, customs and security, and the inflight experience. About two years ago, my college roommate asked me to name the single biggest change I had noticed in America since moving to Asia nearly 40 years ago. I said that was an easy question. The answer was the dramatic growth in obesity. Not just the numbers, but the scale of extremely overweight adults and children. Just recently, following years of debate, the American Medical Association formally defined obesity as a disease. Part of the debate was focused on the definition of obesity. There is controversy surrounding the current definition, which is based on Body Mass Index (BMI), because many large-boned but fit people are defined as obese under this system. Apart from the stigma involved, there are huge implications with regard to health insurance coverage, premiums, etc. The main driver behind the AMA's decision was to encourage physicians to pro-actively counsel their patients about the risks associated with obesity, such as Type 2 diabetes, cardiovascular disease, stroke, etc. Apart from obsesity, I would now nominate a second category of dramatic change in America, which is the decline in quality of almost all aspects of the air travel experience. That includes the timeliness of service, service attitudes among airline as well as uniformed airport personnel, and the state of basic airport infrastructure. I remember when air travel used to be fun and imbued with a spirit of excitement and adventure, just like it was portrayed in the airline and destination advertising of the day. Those are now very distant memories, like sepia toned photos in the museum archive. America's tourist destinations and resorts are fortunate to be experiencing continued growth, despite the serious decline in the quality of the "getting there" experience. In my early travels in China in the 1970s, infrastructure was awful and service attitudes even worse. It was a curse to arrive on an incoming international flight which landed before or during lunch hour, because nothing would interrupt the baggage handlers' or customs officers' lunch break and nap. You just had to wait. Still, it was fairly relaxed. At Guangzhou's Baiyun Airport one Fall day, my luggage did not show up in the open-air, covered baggage shed. Worried, I asked one of the baggage handlers if I could borrow his bicycle, which was parked right there. He said "fine", and I rode it across the runway to the jet I'd arrived on, explaining to the baggage handlers there that I was looking for my bag. They politely invited me up into the aircraft's cargo hold. My bag was not there. Satisfied, I bicycled back, and eventually placed a claim for the missing suitcase. Now, China's airport infrastructure, almost all brand new, has leapfrogged America's. Baggage arrives promptly, and uniformed security personnel are at least routinely polite rather than gruff in carrying out their duties. Given such new airports, it is unlikely you'll find yourself seated under a hole in the ceiling leaking big drops of water as I did in New York's JFK Airport last year. On the other hand, departing flights from Beijing and Shanghai are frequently subject to unpredictable delays, which are usually not accompanied by reasonable advance notice or explanations. Is it due to air force exercises, a minister's chartered jet, a business jet, or a rainstorm in the destination city? Passengers are usually left to speculate. Still, improved infrastructure is the foundation of progress. The World Economic Forum ranks the U.S. as 25th in infrastructure worldwide, behind all its major competitors. The challenge is far broader than air transport alone, extending to highways, bridges, water mains, etc. According to Fortune contributor Sheila Bair, the New America Foundation is one of many voices arguing for creation of a National Infrastructure Bank, which could provide significant infrastructure financing without adding to the long-term deficit. Let's hope sensible voices like these get heard and acted upon. If so, it may be like the slight change in tide heralded by the AMA's new definition of obesity as a disease. Outdated infrastructure causes significant losses in economic productivity, and some studies show that $1 billion in infrastructure investment can yield some 20,000 new jobs. |
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