TED英語演講集：Your health depends on where you live 所居之地影響健康[中英字幕]

Can geographic information make you healthy? In 2001 I got hit by a train. My train was a heart attack. I found myself in a hospital in an intensive-care ward, recuperating from emergency surgery. And I suddenly realized something: that I was completely in the dark. I started asking my questions, "Well, why me?" "Why now?" "Why here?" "Could my doctor have warned me?"

地理環(huán)境是否 能使你身體更健康？ 2001年我被一列車撞到。 我的心臟受到了損害。 醒來時(shí)我發(fā)現(xiàn)自己在醫(yī)院 的一個(gè)加護(hù)病房里， 正從急救手術(shù)中恢復(fù)過來。 我突然意識(shí)到： 自己完全被蒙在鼓里。 我開始問自己：“為什么是我？” 為什么是現(xiàn)在？為什么在這兒？ “我的醫(yī)生能否事先告誡我？”

So, what I want to do here in the few minutes I have with you is really talk about what is the formula for life and good health. Genetics, lifestyle and environment. That's going to sort of contain our risks, and if we manage those risks we're going to live a good life and a good healthy life. Well, I understand the genetics and lifestyle part. And you know why I understand that? Because my physicians constantly ask me questions about this.

所以，在接下來的幾分鐘，我想與你們分享的是 一個(gè)健康的生命應(yīng)由什么構(gòu)成。 遺傳基因，生活方式和環(huán)境。 也就是說這些是我們將面對(duì)的風(fēng)險(xiǎn)因素， 如果我們處理好這些風(fēng)險(xiǎn) 我們的生活將會(huì)更健康更美好。 當(dāng)然 ，我了解基因和生活方式這兩方面。 那你們知道我為什么了解嗎？ 因?yàn)槲业膬?nèi)科醫(yī)生不斷地 詢問這些方面的情況。

Have you ever had to fill out those long, legal-size forms in your doctor's office? I mean, if you're lucky enough you get to do it more than once, right? (Laughter) Do it over and over again. And they ask you questions about your lifestyle and your family history, your medication history, your surgical history, your allergy history ... did I forget any history?

你是否在醫(yī)生的辦公處填寫過， 那些標(biāo)準(zhǔn)大小規(guī)格的表格？ 我是說，你們已幸運(yùn)地做過多次這樣的事，對(duì)嗎？ （笑聲） 一次又一次的重復(fù)。然后他們還要詢問 你的生活方式，你的家庭史 你的藥物治療史，你的外科史 你的過敏史，恩...我還忘了其他的什么歷史嗎？

But this part of the equation I didn't really get, and I don't think my physicians really get this part of the equation. What does that mean, my environment? Well, it can mean a lot of things. This is my life. These are my life places. We all have these. While I'm talking I'd like you to also be thinking about: How many places have you lived?

但是對(duì)于這個(gè)部分，我并不是真正的知道。 而且我也不認(rèn)為我的醫(yī)生 真正的了解了這部分的信息。 我的環(huán)境意味著什么？ 實(shí)際上，它意味著很多事情。 這是我的生活。它們是我生活的地方。 我們每個(gè)人都擁有的。 我希望在我演講時(shí)，你們都想想 你們?cè)诙嗌賯€(gè)地方生活過？

Just think about that, you know, wander through your life thinking about this. And you realize that you spend it in a variety of different places. You spend it at rest and you spend it at work. And if you're like me, you're in an airplane a good portion of your time traveling some place. So, it's not really simple when somebody asks you, "Where do you live, where do you work, and where do you spend all your time? And where do you expose yourselves to risks that maybe perhaps you don't even see?" Well, when I have done this on myself, I always come to the conclusion that I spend about 75 percent of my time relatively in a small number of places. And I don't wander far from that place for a majority of my time, even though I'm an extensive global trekker.

在你的生活中時(shí)不時(shí) 想想這個(gè)問題。 你會(huì)意識(shí)到，你的生命在很多不同的地方度過。 你在不同的地方休息和工作。 如果是像我類的人，旅途過程中你將花相當(dāng)一部分的時(shí)間 在機(jī)場(chǎng)這個(gè)地方。 所以，我們總是很難回答類似的問題 你在哪兒生活？你在哪兒工作？ 你在哪兒度過你的時(shí)光？ 你在哪兒陷入那些 你甚至未意識(shí)到的危機(jī)之中？ 當(dāng)我向自己發(fā)問時(shí) 我總能得出以下結(jié)論 我生命中大約75%的時(shí)間 都集中在幾個(gè)地方度過。 大部分的時(shí)間 我不會(huì)遠(yuǎn)離它們， 即使我是一位滿世界跑的旅行者。

Now, I'm going to take you on a little journey here. I started off in Scranton, Pennsylvania. I don't know if anybody might hail from northeastern Pennsylvania, but this is where I spent my first 19 years with my little young lungs. You know, breathing high concentrations here of sulfur dioxide, carbon dioxide and methane gas, in unequal quantities -- 19 years of this. And if you've been in that part of the country, this is what those piles of burning, smoldering coal waste look like.

現(xiàn)在，我將帶你們踏上我的幾段旅途。 我從賓夕法尼亞的斯克蘭頓出發(fā)。 我不知道現(xiàn)場(chǎng)是否有人來自賓西法尼亞州東北部。 但是這是我與我年輕活力的肺 一起呆了19年的地方。 在這里，我伴隨著高濃度的 二氧化硫，二氧化碳 和甲烷 一起度過了我生命中的19年。 如果你也曾在這個(gè)地方住過， 你就會(huì)了解它們都是產(chǎn)生于就像這些一堆堆正在燃燒的煤渣。

So then I decided to leave that part of the world, and I was going to go to the mid-west. OK, so I ended up in Louisville, Kentucky. Well, I decided to be neighbors to a place called Rubbertown. They manufacture plastics. They use large quantities chloroprene and benzene. Okay, I spent 25 years, in my middle-age lungs now, breathing various concentrations of that. And on a clear day it always looked like this, so you never saw it. It was insidious and it was really happening.

所以，我決定離開那個(gè)地方。 然后打算遷到中西部。 現(xiàn)在我在肯塔基州的路易斯維爾定居。 我打算成為橡膠鎮(zhèn)的鄰居。 這個(gè)鎮(zhèn)生產(chǎn)塑料。生產(chǎn)過程中使用大量的氯丁二烯 和苯。 就這樣，我?guī)е夷遣饺胫心甑姆?呼吸著充滿氯丁二烯和奔的空氣又生活了25年。 在晴朗的天氣里它顯得那樣的干凈漂亮，你從不會(huì)發(fā)現(xiàn)這些毒氣存在。 但它卻是真真實(shí)實(shí)的潛在地發(fā)生了。

Then I decided I had to get really smart, I would take this job in the West Coast. And I moved to Redlands California. Very nice, and there my older, senior lungs, as I like to call them, I filled with particulate matter, carbon dioxide and very high doses of ozone. Okay? Almost like the highest in the nation. Alright, this is what it looks like on a good day. If you've been there, you know what I'm talking about.

然后我決定了我必須變得聰明， 我要在西海岸從事這個(gè)工作。 然后我又搬到了加利福尼亞州的瑞德蘭茲。 我?guī)е觊L的 肺（我喜歡這樣稱呼它們）生活在那里 之后我又發(fā)現(xiàn)了一些小問題，二氧化碳，臭氧的濃度非常高。 甚至是整個(gè)國家最高點(diǎn)的。 這個(gè)地方天氣好的時(shí)候就像這樣。 如果你住過那里，你就會(huì)了解我正在說的。

So, what's wrong with this picture? Well, the picture is, there is a huge gap here. The one thing that never happens in my doctor's office: They never ask me about my place history. No doctor, can I remember, ever asking me, "Where have you lived?" They haven't asked me what kind of the quality of the drinking water that I put in my mouth or the food that I ingest into my stomach. They really don't do that. It's missing. Look at the kind of data that's available. This data's from all over the world -- countries spend billions of dollars investing in this kind of research.

現(xiàn)在看看，這副圖片存在什么問題？ 是的，在圖片的這里，有個(gè)巨大的空隙。 在我醫(yī)生的辦公室從未發(fā)生過的一件事就是： 他們從未問過我的居住地情況。 我記得從未有過任何一個(gè)醫(yī)生問過我： 你曾經(jīng)在什么地方居住過？ 他們沒有問過我 我飲用的水質(zhì)量如何？ 或者我食用的食物的質(zhì)量又如何？ 他們從未那樣做過。 看看這組數(shù)據(jù)。 這組數(shù)據(jù)是世界各國投入數(shù)億美元 做此類研究所得出的。

Now, I've circled the places where I've been. Well, by design, if I wanted to have a heart attack I'd been in the right places. Right? So, how many people are in the white? How many people in the room have spent the majority of their life in the white space? Anybody? Boy you're lucky. How many have spent it in the red places? Oh, not so lucky. There are thousands of these kinds of maps that are displayed in atlases all over the world. They give us some sense of what's going to be our train wreck. But none of that's in my medical record. And it's not in yours either.

現(xiàn)在，我圈出了我們研究過的地方。 現(xiàn)在，我必須在一些地方呆過 我才能得心臟病，對(duì)嗎？ 所以，有多少人住在白色的這些地方？ 在坐的有多少人在這些白色地方 度過了你生命中的大部分時(shí)間？ 有嗎？這個(gè)先生你很幸運(yùn)。 又有多少人居住在這些紅色區(qū)域？ 看來不是很幸運(yùn)。 有成千上萬副類似的圖片， 在世界各地的 地圖冊(cè)中展示出來。 他們提醒我們 發(fā)生火車碰撞后將會(huì)發(fā)生什么。 但是在我的醫(yī)療記錄中沒有任何相關(guān)的記錄。 相信你們的也沒有。

So, here's my friend Paul. He's a colleague. He allowed his cell phone to be tracked every two hours, 24/7, 365 days out of the year for the last two years, everywhere he went. And you can see he's been to a few places around the United States. And this is where he has spent most of his time. If you really studied that you might have some clues as to what Paul likes to do. Anybody got any clues? Ski. Right. We can zoom in here, and we suddenly see that now we see where Paul has really spent a majority of his time. And all of those black dots are all of the toxic release inventories that are monitored by the EPA.

這是我的一位朋友Paul， 是我同事，在過去的兩年里，他將其移動(dòng)電話設(shè)置為可以被追蹤的 365天，每天 兩個(gè)小時(shí)， 不管他到哪個(gè)地方。 你可以看到他到過了美國的幾個(gè)地方， 在這里他度過了大部分的時(shí)間。 如果你認(rèn)真的觀察這些地方，你可能從中猜出 Paul的愛好是什么。 有人知道嗎？是的，就是滑雪。 我們聚焦這兒，我們馬上會(huì)發(fā)現(xiàn) 在這些地方Paul度過了相當(dāng)一部分的時(shí)光。 所有這些黑點(diǎn) 都是由EPA監(jiān)測(cè)出的有毒氣排放 記錄的地方。

Did you know that data existed? For every community in the United States, you could have your own personalized map of that. So, our cell phones can now build a place history. This is how Paul did it. He did it with his iPhone. This might be what we end up with.

你們知道有這類數(shù)據(jù)存在嗎？ 在美國的各個(gè)社區(qū)， 你們都可以領(lǐng)取屬于你們自己的地圖冊(cè)。 所以，我們的手機(jī)現(xiàn)在幫助建立我們的居住史。 這就是Paul用他的iPhone 所做的. 這可能即使我們最終想要達(dá)到的效果。

This is what the physician would have in front of him and her when we enter that exam room instead of just the pink slip that said I paid at the counter. Right? This could be my little assessment. And he looks at that and he says, "Whoa Bill, I suggest that maybe you not decide, just because you're out here in beautiful California, and it's warm every day, that you get out and run at six o'clock at night. I'd suggest that that's a bad idea Bill, because of this report."

當(dāng)我們進(jìn)入到治療室時(shí)， 這個(gè)將呈現(xiàn)給我們的醫(yī)生 而不是在柜臺(tái)領(lǐng)取的那張表，對(duì)嗎？ 這個(gè)是我自己一個(gè)小猜測(cè) 他可能看著那個(gè)然后說 “喔~Bill， 你居住， 你居住在美麗的加利福尼亞 每天都那么的溫暖， 可能你決定每天晚上6點(diǎn)出去跑步， 但是從這組數(shù)據(jù)中看出 這將不會(huì)是個(gè)好主意。”

What I'd like to leave you for are two prescriptions. Okay, number one is, we must teach physicians about the value of geographical information. It's called geomedicine. There are about a half a dozen programs in the world right now that are focused on this. And they're in the early stages of development. These programs need to be supported, and we need to teach our future doctors of the world the importance of some of the information I've shared here with you today.

今天我將留給你們是這樣的兩個(gè)處方： 第一個(gè)：我們必須讓我們的醫(yī)生 了解到地理信息的價(jià)值所在。 全世界正在做的研究 其中一半項(xiàng)目都在關(guān)注。 這些研究都處于起步階段， 都需要得到支持。 然后我們需要告訴我們未來全世界范圍內(nèi)的 醫(yī)生們， 今天我與你們 一起分享的這些信息的重要性。

The second thing we need to do is while we're spending billions and billions of dollars all over the world building an electronic health record, we make sure we put a place history inside that medical record. It not only will be important for the physician; it will be important for the researchers that now will have huge samples to draw upon. But it will also be useful for us. I could have made the decision, if I had this information, not to move to the ozone capital of the United States, couldn't I? I could make that decision. Or I could negotiate with my employer to make that decision in the best interest of myself and my company.

第二件事我們需要做的是： 當(dāng)世界各地投入 億萬美元 去建立一個(gè)電子化的健康記錄時(shí)， 我們必須確定將居住史 記錄在內(nèi)。 它不僅對(duì)醫(yī)生顯得很重要， 為研究者也同樣重要。 對(duì)此，我們可以舉出大量的例子。 同樣對(duì)于我們自己也非常有用。 如果我們擁有了這些信息， 無需到美國的臭氧中心就可以得出結(jié)論。 我可以嗎？是的，我可以。 基于我自己和我公司的最大利益， 或者我可以與我的雇主談判 做出決定。

With that, I would like to just say that Jack Lord said this almost 10 years ago. Just look at that for a minute. That was what the conclusion of the Dartmouth Atlas of Healthcare was about, was saying that we can explain the geographic variations that occur in disease, in illness, in wellness, and how our healthcare system actually operates. That was what he was talking about on that quote. And I would say he got it right almost a decade ago. So, I'd very much like to see us begin to really seize this as an opportunity to get this into our medical records. So with that, I'll leave you that in my particular view of view of health: Geography always matters. And I believe that geographic information can make both you and me very healthy. Thank you. (Applause)

有了那些，我可以說出Jack Lord 差不多十年前說過的話。 花一分鐘的時(shí)間看這， 這是Dartmouth保健地圖冊(cè) 所得到的結(jié)論。 從中我們可以解釋 在身體處于生病抑或是健康時(shí)地理區(qū)域的變化。 還有我們的保健系統(tǒng)又是怎么實(shí)際運(yùn)行的。 這就是他在引用此數(shù)據(jù)時(shí) 所要闡述的。 我要說在10年前他就正確的認(rèn)識(shí)到了。 所以，我將非常欣喜的看到 我們能真正的抓住這個(gè)機(jī)會(huì)將居住史也涵蓋在醫(yī)療記錄中。 所以我將帶給你們 我個(gè)人對(duì)健康的看法： 就是地理總是問題所在。 而且我堅(jiān)信了解地理信息 將會(huì)使你和我更加健康。謝謝！ （鼓掌）

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