替多伦多的健康把把脉：城市健康在进步

多伦多社区基金Toronto Community Foundation 刚于10月发表一年一度的社区研究报告Toronto’s Vital Signs Report，分析多伦多生活质素的趋势和社会的议题，跟城市人的身心健康，息息相关。The report is a snapshot of the trends and issues affecting the quality of life in our city, critical to the well-being of Toronto and its residents.

Vital signs生命征象, 或称生命体征，本身是医学术语，人体基本生理功能的表现，医疗人员在进行医疗时，为了评估病人基本的生理状况，在身体检查时，必须检查的基本功能，范围很广泛，通常包括了体温、心跳、脉搏、血压、呼吸次数等。Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions, such as the rate of their breathing, their body temperature or their heartbeat.报告的标题借用医学比喻，替多伦多这个城市在经济、就业、工作、安全、保健等重要的生活质素资料，既有诊断之义，也有配方之效。

简言之，Vital sign is measurement that shows that something is alive.The report is widely used by residents, businesses, community organizations, universities, colleges and government departments. In addition, it is a model now being used for strategic planning by cities around the world.

我们尝试从这份239页报告书当中，引述一些重要的数据和观察，例如 ：
人 口 方 面 的 老 化 趋 势 和 移 民 聚 居 NEW IMMIGRANTS :
By 2031, there will be about twice as many seniors as youth in the GTA.
In 2011, close to half of the GTA's seniors (48%) lived in Toronto.
By 2031, almost 80% of Toronto residents will likely be immigrants or children of immigrant parents.
In 2012, the GTA Region will welcome about 85,000 international immigrants.
8 out of 10 immigrants arriving in the Region are identified as minorities.
经 济 上 脆 弱 的 环 节 WHERE IS TORONTO ECONOMICALLY VULNERABLE?
The City's capital funds can support only 20% of the overall $14.8 billion budget.
By 2025, almost 60% of Toronto neighbourhoods could be low-income.
Neighbourhoods with incomes more than 40% below average could comprise 30% of all neighbourhoods (compared to 1% in 1970).
医 疗 和 健 康 --穷 人 常 患 的 疾 病HEALTH AND WELLNESS ：
Most newcomers arrive in Toronto healthier than the average Canadian, but many become less healthy as they live here longer.
The combination of homelessness, mental illness, addictions and poverty create a "perfect storm" of serious illness and early death for Toronto's marginalized.
The poorest 20% of Canadians (compared to the wealthiest 20%) have more than double the rate of diabetes and heart disease, and a 60% higher rate of suffering from two or more chronic diseases.

安 全 问 题 SAFETY CONCERN :
The numbers tell us Toronto is getting safer, but do Torontonians feel safer?
The number of homicides in 2011 was the lowest in 12 years, but increasing levels of gun violence in the summer of 2012 alarmed many city residents.
Almost 4 in 10 respondents to the Toronto Police survey said they were concerned about gang activity in their schools.

年 青 人 和 移 民 工作 就 业 困 难 WORK AND UNEMPLOYMENT:
The creation of new jobs isn't keeping up with a rising population.
The youth unemployment rate in the Toronto Region remained above 17% in 2011.
Visible minorities and immigrants are highly overrepresented in entry-level work, which offers low pay and little opportunity to advance.
Immigrant unemployment levels continue to be substantially higher than for those born in Canada

多伦多虽然有以上种种值得关注的社会趋势和生活质素下降的忧虑，报告书整体的评价，还算是中规中矩，不过不失的：So how are we doing ? Not too bad…not too bad at all.
平心而论，这份报告书既看到多伦多生活实况成功的一面，也未有忽略现实中引以为忧的另一面：城市健康呈现退步的征兆，并且期望各方尽快对症下药。

多伦多其中最大的隐忧是中产阶层人数的消减，和贫富悬殊距离的扩大。There is increasing evidence that Toronto's prosperity is not being spread across the population, with new Canadians and young people, who suffer from high unemployment rates, doing the worst.
Toronto Star《多伦多星报》10月2日的社论VITAL SIGNS : ‘Not too bad’ not good enough ，特别指出这方面的趋势和长远隐忧 :

Toronto’s middle-income areas are shrinking and at risk of disappearing. According to University of Toronto researchers, almost 60 per cent of the city’s neighbourhoods could be low-income by 2025. That depressing trend would take a heavy toll on the city’s overall well-being.
再者，多伦多人均入息分布很不平均，多伦多工商局认为只算仅仅合格，比不上其他加拿大城市区域 : According to the Toronto Board of Trade, the GTA is the only Canadian metropolitan area to receive a C grade on income distribution.

报告书反映多伦多坚尼系数的增长，贫穷人数上升，健全情况在全球24个大都城市中心，从15年前排第7，跌到第16 ： The Gini coefficient has not changed since 2010, but ranking against 24 global centres has slipped to sixteenth, from seventh out of 15 a year ago.

吉尼系数（Gini coefficient），或译作基尼指数， 往往用来判断收入分配公平程度的指标，是比例数值，在0和1之间 ，Lorenz curve劳伦茨曲线的弧度越小 ，基尼系数也越小；反之，收入分配越趋向不平等，那么基尼系数也越大。The Gini coefficient is commonly used to measures the inequality among values of a frequency distribution, for example levels of income or wealth. A Gini coefficient of zero expresses perfect equality where all values are the same, for example, where everyone has an exactly equal income. Gini coefficient in this report is the measure in a community of the deviation from perfectly equitably shared income.

《星报》也同意报告书这个严重的社会现象，需要把脉之余，找寻良方妙药：A troubling finding is that Toronto has emerged as one of the least equitable centres in Canada. We are at risk of becoming a winner-take-all city, with profound consequences for all of us. 赢家全赢，非城市之福。

最后，社论也作出一些建议，供大家参考：
So, what is to be done? Much depends on action at the federal and provincial levels. There’s immense benefit to the poor in making affordable housing more available, providing more child care, increased welfare funding and creating special public health programs aimed at addressing the severe and growing needs of this vulnerable population.