Liu Guoen: Peking University Boya Distinguished Professor and Deputy Director of the Department of Economics and Management; Dean of the Peking University Global Health Development Research Institute; Peking University National Development Research Institute Changjiang Scholar Distinguished Professor and Director of the Academic Committee. He taught at the University of Southern California and the University of North Carolina at Chapel Hill. He is currently the Chinese convener of the "China-US Health Track Two Dialogue", an economist representative of the National New Coronary Pneumonia Expert Group, and a member of the National Medical Reform Expert Advisory Committee of the State Council. Served as the chairman of the Chinese Society of Economics in the United States

　　Recently, a kindergarten in Changxing County, Zhejiang Province launched an epidemic prevention and control knowledge education activity to teach children to wear masks correctly.

　　How the sudden global impact of the new crown epidemic in 2020 will change the development trajectory of various countries is a major issue that people are paying close attention to. How might the epidemic affect China's emerging "dual-cycle" economic development pattern? What is the role of medical and health needs for economic development? How should anti-epidemic measures make a scientific trade-off between safeguarding health and safeguarding the economy? Recently, Peking University Liu Guoen, Distinguished Professor of Boya and Dean of the Institute of Global Health Development of Peking University, gave a special lecture on economic development and public health related issues under the impact of the new crown epidemic. In this issue, we will compile and publish the content of the lectures for readers. --editor

　　1 Globalization brings opportunities and challenges to mankind

　　In 2001, the World Health Organization initiated a project and entrusted the famous economist Jeffrey Sachs of Columbia University to take the lead, leading dozens of top economists and medical scientists around the world to complete a landmark report: "Macroeconomics and health". The executive summary of the report pointed out that technology and politics have brought the world together more closely than ever before, and the benefits of globalization are enormous. This is due to the increasing sharing of ideas, culture, life-saving technologies and effective production processes.

　　However, the benefits of globalization are still being tested. Part of the reason is that these benefits have not yet benefited hundreds of millions of poor people in the world, and part of the reason is that globalization has brought new challenges. Unrest in one region of the world can quickly spread to other regions through terrorism and armed conflict, and the environment is deteriorating. Or infectious diseases spread rapidly across the globe. The outbreak of the global new crown epidemic this year has made the world realize that the warnings of the World Health Organization 20 years ago were not unfounded.

　　In fact, calculations based on publicly available data show that in the 2,000 years of human development, human wars have claimed 450 million lives, and conflicts between humans and microorganisms have caused 467 million deaths, which is not inferior to the same period. The lethality of human weapons. What is the impact and cost of the new crown virus on humans? Although the epidemic is still spreading around the world, in terms of its impact so far, it has been the most serious attack on humans by microbes since the Spanish flu in 1918.

　　As of December 23, 78 million people have been diagnosed with the new coronavirus globally, with an infection rate of 10,000 per million residents. The lowest infection rate is in Southeast Asia represented by China, followed by Africa, and North America, South America, and Europe are the most serious. The global number of deaths from the new crown is 1.73 million, and the average death rate is 222/100 million residents. Its distribution of severity and infection rate is highly consistent, and the regional clustering characteristics are obvious: it is still the lowest in Southeast Asia, led by China, followed by Africa, North America and Europe. The most serious.

　　From a global perspective, why are the differences in anti-epidemic effectiveness in different regions so significant? The reason is that although it is extremely complicated, the epidemic is still ongoing, and it is too early to conclude, it can be understood from at least three aspects.

　　First, the central government's administrative decision-making and strict control of anti-epidemic measures, as well as the top-down implementation of local governments at all levels.

　　Second, the trade-off relationship between the value of life and the quality of life in the cultural genes of the people of various countries critically determines people's personal behavior and community actions in cooperation with the government's anti-epidemic measures.

　　One of the core characteristics of Chinese culture is the supremacy of life. As the saying goes, "Stay in the green hills, not afraid of not having firewood", is the best interpretation of this culture. China's anti-epidemic can achieve such a significant stage result, the strict control measures implemented by governments at all levels in a timely manner and the high degree of integration of people's life-first culture should play a decisive role.

　　Compared with Chinese culture, the most different feature of Western culture is probably the reciprocity between freedom of life and the value of life, that is, the so-called "freedom or death" culture.

　　Extreme adventure should be the main portrayal of this culture. In 2017, the world's top rock climber and young American Alex Honnold climbed the 884-meter-high, nearly 90-degree Emirates Rock in Yosemite, USA with his bare hands, setting an unprecedented and most dangerous rock climbing creation. When the reporter asked him if he had the fear of dying at any time, he replied: "The length of human life is limited. If life ends on the rock climbing that day, its value is not less than the death of an advanced age."

　　Third, differences in the forces of nature may also have varying degrees of impact, including the types of COVID-19 strains in various regions and differences in the genetic structure of the immune systems of different ethnic groups.

　　2 Why does the new crown epidemic have such a big impact on the economy

　　The impact of the new crown epidemic on the social economy is reflected in many aspects. We will focus on its impact on the economy. In 2020, global GDP is expected to fall back 4.4% from 2019. China's GDP is expected to achieve a growth of 2% to 2.5% this year, which is the best performer among the world's major economies. However, from a vertical perspective, compared with the average level of economic growth in the past 40 years, the economic growth rate in the year of the pandemic is also facing a huge challenge of falling by nearly 70%, which is unprecedented. So why is the impact of the new crown epidemic on the macroeconomics of countries so great?

　　If we compare the traditional economic crisis in the past, it may be able to help us understand this problem better. In most cases, traditional economic crises occur mainly because of problems with the economic structure itself. Firstly, weak demand and insufficient consumption make the supplied products unsalable, unemployment rises, and income declines further, thus forming a vicious circle of crisis cycles. The impact of the new crown epidemic is different. From the demand side, in order to reduce the risk of infection, residents choose home activities, which objectively reduces demand and consumption. At the same time, when the epidemic is serious, in order to comply with the relevant government anti-epidemic regulations, the supply side has to suspend work and production. For the already reduced economic activities, it is tantamount to "make up for it" by itself. Several empirical studies at home and abroad have shown that the degree of macroeconomic downturn caused by the new crown epidemic is much more affected on the supply side than on the demand side, which is rare in traditional economic crises.

　　We can also observe further from another angle. In this year's study, Harvard University's famous economist Haji Chaiti applied real big data from the United States to compare and analyze the differences in the impact of this year's new crown epidemic and the 2008 financial crisis on the US economy. In the 2008 financial crisis, consumption of durable consumer goods dropped by 58.6%; consumption of non-durable consumer goods dropped by 44.3%; consumption of services was not affected.

　　The difference is that the negative impact of the new crown epidemic on consumer durables this year is only 19.5%, and the consumption of non-durable consumer goods has fallen by only 13.3%; the most negative impact is service industry consumption, which has dropped by as much as 67.2%. Because most of the service provision requires interaction between people to complete. This research has prompted extremely important information for us to formulate economic recovery policy measures.

　　3 The proportion of health care in the macro economy continues to rise

　　In recent years, China's economic development mode is undergoing structural transformation and upgrading. This summer, the country’s main reasons for proposing a "dual cycle" economic growth model should include two aspects: On the one hand, the relationship between China's economy and the world economy has entered a new stage. With the continuous expansion of China's economic scale, the relative size of the international market and the gradual decline in demand capacity, the export-oriented growth method in the past will inevitably face increasing market pressure and will inevitably need to expand new product markets. On the other hand, the industrial structure of the Chinese economy is constantly changing. The most notable feature is that the service industry accounts for more than 50%, reaching 54% in 2019. Compared with tangible goods, the service industry is less able to conduct international trade. This is the second reason why China's sustained economic growth needs to expand domestic demand transformation.

　　In short, I think the core essence of the "double cycle" model is not to reduce the scale of the external market. On the contrary, the Chinese economy needs to increase efforts to develop and explore domestic market demand with great potential while continuously maintaining international market demand. This will not only create a larger market for the supply side, but more importantly, it will also be able to better improve and satisfy The needs of people in pursuit of a better life.

　　There is no doubt that the current per capita GDP in China is only 10,000 US dollars, and the future domestic demand growth potential of residents is indeed very huge. Of course, the demand potential is not equal to the actual demand. How to change the potential to the actual level depends on many conditions that promote growth. Among them, three conditions are particularly important: First, the majority of rural residents can participate in the real urbanization process. The second is to further reform the income distribution system. At present, the gap between China's per capita GDP and per capita disposable income is not small. With reference to the standards of developed countries, and by further promoting the reform of the taxation system for labor income, there is still considerable room for improvement in the disposable income of Chinese residents. The third is to continue to advance and improve the national social security system and medical security system, which is also a source of further boosting China's domestic demand.

　　Inspecting the consumption structure of residents also helps to better understand the conditions for expanding domestic demand. According to the statistics released by the National Bureau of Statistics in recent years, the consumption structure of Chinese residents is divided into 8 categories: tobacco and alcohol, housing, transportation, education, culture, medical care, clothing, daily necessities and others. From 2015 to 2019, although the absolute value of each item is increasing, the relative growth of each item is different. Among them, the proportion of tobacco, alcohol and clothing consumption in income is declining; the proportion of housing and medical care expenditure in income is increasing. Because residence has both consumption attributes and investment attributes. If housing is not considered, among the eight major items of national consumption, only the relative expenditure on health care has continued to rise during the observations from 2015 to 2019.

　　Accordingly, can we understand health care as a sunrise market for China's economic growth in the future? The five-year observation period in China may be too short, and I am afraid that it cannot be asserted as a long-term trend. However, related studies in Europe and the United States may provide us with a more reliable reference basis. Robert Fogel, a Nobel Prize economist at the University of Chicago, tracked the changes in the consumption structure of American residents during the 120 years from 1875 to 1995. He found that among the seven consumption expenditures of food, clothing, housing, medical care, education, leisure and others, the growth of the consumption of food, clothing and housing was lower than the growth of income over the same period; while the growth of health care, education, leisure and others It exceeds the income growth over the same period. Among them, the relative growth rate of medical consumption is the highest, and the corresponding income elasticity is 1.6.

　　From a macroeconomic perspective, it is an indisputable fact that the growth rate of the medical market is higher than the economic growth rate in almost all countries. In 1970, the medical and health care in developed countries accounted for 5% to 6% of the macro economy. After the new century, most developed countries accounted for more than 10%. From the late 1970s to the present in China, the proportion of medical and health care in the macro-economy has also been rising. Why is the growth rate of the medical market always faster than the economic growth rate? Whether it is good or bad, different people have different opinions, and all walks of life are arguing. Nevertheless, there is a certain consensus on the decisive reasons for the rapid growth, including the accelerating aging, the innovation of medical technology, and the institutionalized development of national medical insurance.

　　4 Anti-epidemic measures can be more precise and effective with the help of scientific methods

　　Through the unremitting efforts of nearly 10 years of medical reform, China has eliminated the gap between urban and rural medical insurance from the system in 2019, and achieved the national universal basic medical insurance goal of urban and rural integration, which is a feat.

　　At the same time, even greater challenges are coming. In 2019, at the national level, the income of the medical insurance fund is close to 2452.0 billion, the expenditure is 2.0854 billion, and there is a balance of more than 366.6 billion. However, from 2018 to 2019, the per capita financing of resident medical insurance has increased by 12.7%, while the per capita expenditure on medical insurance has increased by 18%. Therefore, the reform of the medical insurance payment system is imperative. The main line of the payment reform mainly revolves around two major issues: what to buy and how to buy.

　　In terms of applicable theories and scientific methods, pharmacoeconomics has a great use. In fact, in the adjustment process of the National Medical Insurance Catalogue for the two-year period from 2019 to 2020, the strength of pharmacoeconomics experts did analyze and calculate through the principle of "cost-benefit" and played a very critical role.

　　So far, more than 1.73 million people have died of new crowns worldwide. Calculated in the first 11 months of this year, this is equivalent to an average of more than 5,000 deaths per day. This is a serious threat to human life and health and is close to the top 6 deaths from diseases in the world. While the new crown attacked humanity, other disease killers did not soften their hands because of sympathy for humans. For example, the number one killer cardiovascular disease takes the lives of more than 48,000 people every day; the second biggest killer is tumors, which causes more than 26,000 people to die every day in the world. What's more serious is that these non-communicable disease killers are not a special situation in 2020, and they will threaten human life and health for a long time. Therefore, while continuing to strengthen the prevention and control of the new crown epidemic, it is more necessary for everyone to work together to effectively allocate limited medical and health resources and do a long-term response to normalized chronic disease prevention and control.

　　As humans’ understanding of the new coronavirus becomes more and more comprehensive, can we further improve the effective accuracy of anti-epidemic measures? The answer is yes. One of the entry points is to identify the risk of the new coronavirus at the individual level, so as to study and carry out "targeted" prevention and control work based on personal risks, especially through non-pharmaceutical personal interventions, which should be more cost-effective. The prevention and control effect.

　　According to the current publicly and independently published scientific research at home and abroad, the risk and severity of death faced by patients with new crowns in various countries are almost all highly consistent and closely related to age. In Italy, for example, patients with new crowns over 80 years of age have a risk of death as high as 20%. However, as long as the age drops by 10 years, the mortality rate is significantly reduced by 7 percentage points; the risk of death for patients with new crowns between 60 and 70 years old is greatly reduced by more than three times, or 3.5%; the risk of death at 50 years old is reduced to 1%, if it is For patients under 30, the risk of death is only 0.2% to 0.3%, which is equivalent to the risk of death from a conventional pandemic.

　　In addition, the Nobel Prize winner Professor Bent Holmstrom of the Massachusetts Institute of Technology in the United States issued a paper in October this year, analyzing why the new crown virus is particularly serious in winter. The main reason is not the change of temperature and humidity, but the lighter ultraviolet radiation causes the virus to be more active in winter and thus more spreading.

　　The vulnerability of coronavirus to ultraviolet exposure is a scientific common sense, but its attention and application level is still very low. This reminds people that in addition to developing new anti-epidemic technologies such as vaccines, they can also learn from existing technologies and recognitions.

　　Excavating knowledge areas, including better use of current related drugs and ultraviolet technology, may be more cost-effective. (Organized by Zhang Haohua)