TED英语演讲集：Your health depends on where you live 所居之地影响健康[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?"

地理环境是否 能使你身体更健康？ 2001年我被一列车撞到。 我的心脏受到了损害。 醒来时我发现自己在医院 的一个加护病房里， 正从急救手术中恢复过来。 我突然意识到： 自己完全被蒙在鼓里。 我开始问自己：“为什么是我？” 为什么是现在？为什么在这儿？ “我的医生能否事先告诫我？”

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，在接下来的几分钟，我想与你们分享的是 一个健康的生命应由什么构成。 遗传基因，生活方式和环境。 也就是说这些是我们将面对的风险因素， 如果我们处理好这些风险 我们的生活将会更健康更美好。 当然 ，我了解基因和生活方式这两方面。 那你们知道我为什么了解吗？ 因为我的内科医生不断地 询问这些方面的情况。

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?

你是否在医生的办公处填写过， 那些标准大小规格的表格？ 我是说，你们已幸运地做过多次这样的事，对吗？ （笑声） 一次又一次的重复。然后他们还要询问 你的生活方式，你的家庭史 你的药物治疗史，你的外科史 你的过敏史，恩...我还忘了其他的什么历史吗？

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?

但是对于这个部分，我并不是真正的知道。 而且我也不认为我的医生 真正的了解了这部分的信息。 我的环境意味着什么？ 实际上，它意味着很多事情。 这是我的生活。它们是我生活的地方。 我们每个人都拥有的。 我希望在我演讲时，你们都想想 你们在多少个地方生活过？

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.

在你的生活中时不时 想想这个问题。 你会意识到，你的生命在很多不同的地方度过。 你在不同的地方休息和工作。 如果是像我类的人，旅途过程中你将花相当一部分的时间 在机场这个地方。 所以，我们总是很难回答类似的问题 你在哪儿生活？你在哪儿工作？ 你在哪儿度过你的时光？ 你在哪儿陷入那些 你甚至未意识到的危机之中？ 当我向自己发问时 我总能得出以下结论 我生命中大约75%的时间 都集中在几个地方度过。 大部分的时间 我不会远离它们， 即使我是一位满世界跑的旅行者。

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.

现在，我将带你们踏上我的几段旅途。 我从宾夕法尼亚的斯克兰顿出发。 我不知道现场是否有人来自宾西法尼亚州东北部。 但是这是我与我年轻活力的肺 一起呆了19年的地方。 在这里，我伴随着高浓度的 二氧化硫，二氧化碳 和甲烷 一起度过了我生命中的19年。 如果你也曾在这个地方住过， 你就会了解它们都是产生于就像这些一堆堆正在燃烧的煤渣。

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，我决定离开那个地方。 然后打算迁到中西部。 现在我在肯塔基州的路易斯维尔定居。 我打算成为橡胶镇的邻居。 这个镇生产塑料。生产过程中使用大量的氯丁二烯 和苯。 就这样，我带着我那步入中年的肺 呼吸着充满氯丁二烯和奔的空气又生活了25年。 在晴朗的天气里它显得那样的干净漂亮，你从不会发现这些毒气存在。 但它却是真真实实的潜在地发生了。

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.

然后我决定了我必须变得聪明， 我要在西海岸从事这个工作。 然后我又搬到了加利福尼亚州的瑞德兰兹。 我带着年长的 肺（我喜欢这样称呼它们）生活在那里 之后我又发现了一些小问题，二氧化碳，臭氧的浓度非常高。 甚至是整个国家最高点的。 这个地方天气好的时候就像这样。 如果你住过那里，你就会了解我正在说的。

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.

现在看看，这副图片存在什么问题？ 是的，在图片的这里，有个巨大的空隙。 在我医生的办公室从未发生过的一件事就是： 他们从未问过我的居住地情况。 我记得从未有过任何一个医生问过我： 你曾经在什么地方居住过？ 他们没有问过我 我饮用的水质量如何？ 或者我食用的食物的质量又如何？ 他们从未那样做过。 看看这组数据。 这组数据是世界各国投入数亿美元 做此类研究所得出的。

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.

现在，我圈出了我们研究过的地方。 现在，我必须在一些地方呆过 我才能得心脏病，对吗？ 所以，有多少人住在白色的这些地方？ 在坐的有多少人在这些白色地方 度过了你生命中的大部分时间？ 有吗？这个先生你很幸运。 又有多少人居住在这些红色区域？ 看来不是很幸运。 有成千上万副类似的图片， 在世界各地的 地图册中展示出来。 他们提醒我们 发生火车碰撞后将会发生什么。 但是在我的医疗记录中没有任何相关的记录。 相信你们的也没有。

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.

这是我的一位朋友Paul， 是我同事，在过去的两年里，他将其移动电话设置为可以被追踪的 365天，每天 两个小时， 不管他到哪个地方。 你可以看到他到过了美国的几个地方， 在这里他度过了大部分的时间。 如果你认真的观察这些地方，你可能从中猜出 Paul的爱好是什么。 有人知道吗？是的，就是滑雪。 我们聚焦这儿，我们马上会发现 在这些地方Paul度过了相当一部分的时光。 所有这些黑点 都是由EPA监测出的有毒气排放 记录的地方。

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.

你们知道有这类数据存在吗？ 在美国的各个社区， 你们都可以领取属于你们自己的地图册。 所以，我们的手机现在帮助建立我们的居住史。 这就是Paul用他的iPhone 所做的. 这可能即使我们最终想要达到的效果。

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."

当我们进入到治疗室时， 这个将呈现给我们的医生 而不是在柜台领取的那张表，对吗？ 这个是我自己一个小猜测 他可能看着那个然后说 “喔~Bill， 你居住， 你居住在美丽的加利福尼亚 每天都那么的温暖， 可能你决定每天晚上6点出去跑步， 但是从这组数据中看出 这将不会是个好主意。”

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.

今天我将留给你们是这样的两个处方： 第一个：我们必须让我们的医生 了解到地理信息的价值所在。 全世界正在做的研究 其中一半项目都在关注。 这些研究都处于起步阶段， 都需要得到支持。 然后我们需要告诉我们未来全世界范围内的 医生们， 今天我与你们 一起分享的这些信息的重要性。

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.

第二件事我们需要做的是： 当世界各地投入 亿万美元 去建立一个电子化的健康记录时， 我们必须确定将居住史 记录在内。 它不仅对医生显得很重要， 为研究者也同样重要。 对此，我们可以举出大量的例子。 同样对于我们自己也非常有用。 如果我们拥有了这些信息， 无需到美国的臭氧中心就可以得出结论。 我可以吗？是的，我可以。 基于我自己和我公司的最大利益， 或者我可以与我的雇主谈判 做出决定。

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，我可以说出Jack Lord 差不多十年前说过的话。 花一分钟的时间看这， 这是Dartmouth保健地图册 所得到的结论。 从中我们可以解释 在身体处于生病抑或是健康时地理区域的变化。 还有我们的保健系统又是怎么实际运行的。 这就是他在引用此数据时 所要阐述的。 我要说在10年前他就正确的认识到了。 所以，我将非常欣喜的看到 我们能真正的抓住这个机会将居住史也涵盖在医疗记录中。 所以我将带给你们 我个人对健康的看法： 就是地理总是问题所在。 而且我坚信了解地理信息 将会使你和我更加健康。谢谢！ （鼓掌）

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