TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall: Vaše zdravlje ovisi o tome gdje živite
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Mjesto života: utječe na vaše zdravlje podjednako kao ishrana ili geni, ali ono nije dio vaših medicinskih podataka. Na TEDMED konferenciji, Bill Davenhall pokazuje kako se zanemareni vladini geo-podaci (od lokalnih podataka o infarktu do informacija o opasnim deponijima) mogu kombinirati s mobilnim GPS aplikacijama kako bi doktori bili u tijeku. Nazovite to "geo-medicinom".
Bill Davenhall - Health and human services expert
Bill Davenhall wants to improve physicians' diagnostic techniques by collecting each patient's geographic and environmental data, and merging it with their medical records. Full bio
Bill Davenhall wants to improve physicians' diagnostic techniques by collecting each patient's geographic and environmental data, and merging it with their medical records. Full bio
Double-click the English transcript below to play the video.
00:15
Can geographic information
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Mogu li vas geografske informacije
00:18
make you healthy?
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učiniti zdravim?
00:22
In 2001 I got hit by a train.
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2001. me udario vlak.
00:26
My train was a heart attack.
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Moj vlak je bio infarkt.
00:29
I found myself in a hospital
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Našao sam se u bolnici
00:31
in an intensive-care ward,
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na odjelu intenzivne njege,
00:33
recuperating from emergency surgery.
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oporavljao sam se od hitne operacije.
00:36
And I suddenly realized something:
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Odjednom sam shvatio nešto:
00:38
that I was completely in the dark.
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potpuno sam bio u mraku.
00:41
I started asking my questions, "Well, why me?"
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Počeo sam se pitat, "Zašto ja?"
00:43
"Why now?" "Why here?"
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"Zašto sada?" "Zašto ovdje?"
00:45
"Could my doctor have warned me?"
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"Je li me moj doktor mogao upozorit?"
00:48
So, what I want to do here in the few minutes I have with you
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Ono što želim ovdje učiniti u ovih nekoliko minuta koje imam s vama je
00:51
is really talk about what is the formula for life and good health.
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da zaista pričam o tome koja je formula za život i dobro zdravlje.
00:56
Genetics, lifestyle and environment.
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Genetika, način života i okruženje.
00:59
That's going to sort of contain our risks,
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Tu se nalaze rizici i
01:01
and if we manage those risks
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ako upravljamo tim rizicima
01:03
we're going to live a good life and a good healthy life.
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živjet ćemo dobar život, dobar zdrav život.
01:06
Well, I understand the genetics and lifestyle part.
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Razumijem dio o genetici i životnom stilu.
01:10
And you know why I understand that?
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A znate li zašto to razumijem?
01:12
Because my physicians constantly
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Jer mi moji liječnici stalno postavljaju
01:15
ask me questions about this.
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pitanja u vezi s tim.
01:17
Have you ever had to fill out those long,
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Jeste li ikada morali popuniti one dugačke,
01:19
legal-size forms in your doctor's office?
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formulare kod liječnika?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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Mislim, ako imate sreće onda ih ispunite i više puta, točno?
01:25
(Laughter)
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(Smijeh)
01:26
Do it over and over again. And they ask you questions
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Opet i opet. Tu vas pitaju
01:28
about your lifestyle and your family history,
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o načinu života i obiteljskoj povijesti,
01:31
your medication history, your surgical history,
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povijesti uzimanja lijekova, povijesti operacija,
01:35
your allergy history ... did I forget any history?
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povijesti alergija... Jesam li zaboravio neku povijest?
01:39
But this part of the equation I didn't really get,
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Ali ovaj dio jednadžbe baš ne razumijem.
01:43
and I don't think my physicians
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A mislim da ni moji doktori
01:46
really get this part of the equation.
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baš ne razumiju taj dio jednadžbe.
01:48
What does that mean, my environment?
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Što ovo znači, moje okruženje?
01:51
Well, it can mean a lot of things.
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Pa, može značiti mnogo stvari.
01:53
This is my life. These are my life places.
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Ovo je moj život. Ovo su mjesta mog života.
01:56
We all have these.
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Svi imamo ovo.
01:58
While I'm talking I'd like you to also be thinking about:
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Dok pričam, želio bih da razmislite o tome
02:01
How many places have you lived?
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na koliko ste sve mjesta živjeli?
02:04
Just think about that, you know, wander through
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Samo promislite, znate, prođite kroz
02:06
your life thinking about this.
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život misleći na to.
02:08
And you realize that you spend it in a variety of different places.
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I shvatite da ga provodite na raznim mjestima.
02:12
You spend it at rest and you spend it at work.
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Provodite ga na odmoru i na poslu.
02:14
And if you're like me, you're in an airplane a good portion of your time
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A ako ste kao ja, onda ste u avionu dobar dio svog vremena,
02:17
traveling some place.
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putujući na neko mjesto.
02:19
So, it's not really simple
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Dakle, nije tako jednostavno
02:21
when somebody asks you, "Where do you live, where do you work,
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kad vas netko pita, "Gdje živite, gdje radite,
02:23
and where do you spend all your time?
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i gdje provodite sve svoje vrijeme?
02:25
And where do you expose yourselves to risks
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I gdje se izlažete rizicima
02:28
that maybe perhaps you don't even see?"
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koje vjerojatno ni ne vidite?"
02:32
Well, when I have done this on myself,
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Pa, kada sam ovo radio na sebi,
02:34
I always come to the conclusion
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uvijek sam dolazio do zaključka
02:36
that I spend about 75 percent of my time
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da oko 75 posto svog vremena
02:40
relatively in a small number of places.
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provodim na relativno malom broju mjesta.
02:43
And I don't wander far from that place
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I ne idem daleko od tog mjesta,
02:45
for a majority of my time,
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većinu svog vremena,
02:47
even though I'm an extensive global trekker.
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iako sam veliki putnik po svijetu.
02:52
Now, I'm going to take you on a little journey here.
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Sada ću vas povesti na kratak put.
02:54
I started off in Scranton, Pennsylvania.
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Počeo sam u Scrantonu u Pennsylvaniji.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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Ne znam dolazi li netko iz sjeveroistočne Pennsylvanije.
02:59
but this is where I spent my first 19 years
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Ovdje sam proveo svojih prvih 19 godina
03:02
with my little young lungs.
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sa svojim malim, mladim plućima.
03:04
You know, breathing high concentrations here
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Znate, udisao sam velike količine
03:07
of sulfur dioxide, carbon dioxide
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sumpornog dioksida, ugljičnog dioksida,
03:09
and methane gas,
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metana,
03:11
in unequal quantities -- 19 years of this.
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u nejednakim količinama -- 19 godina toga.
03:14
And if you've been in that part of the country,
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Ako ste bili u tom dijelu zemlje,
03:16
this is what those piles of burning, smoldering coal waste look like.
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ovako izgledaju te gomile otpada od ugljena koji se puši i gori.
03:20
So then I decided to leave that part of the world,
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Onda sam odlučio napustiti taj dio svijeta.
03:23
and I was going to go to the mid-west.
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I otići u srednji zapad.
03:26
OK, so I ended up in Louisville, Kentucky.
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OK, dakle završio sam u Louisville, Kentucky.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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Odlučio sam biti u susjedstvu mjesta koje se zove Rubbertown, "grad gume".
03:33
They manufacture plastics. They use large quantities chloroprene
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Oni proizvode plastiku. Koriste velike količine kloroprena
03:36
and benzene.
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i benzena.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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OK, proveo sam 25 godina, sada sa svojim sredovječnim plućima,
03:43
breathing various concentrations of that.
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udišući razne koncentracije toga.
03:46
And on a clear day it always looked like this, so you never saw it.
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Po vedrom danu uvijek je ovako izgledalo, tako da ih niste nikada vidjeli.
03:50
It was insidious and it was really happening.
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Bilo je podmuklo i zaista se događalo.
03:53
Then I decided I had to get really smart,
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Potom sam odlučio kako se moram opametit
03:55
I would take this job in the West Coast.
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i prihvatio sam posao na zapadnoj obali.
03:58
And I moved to Redlands California.
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Preselio sam se u Redlands, Kaliforniju.
04:01
Very nice, and there
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Jako lijepo i tamo sam
04:03
my older, senior lungs, as I like to call them,
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svoja starija, seniorska pluća, kako ih voli zvati,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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napunio posebnom materijom, ugljičnim dioksidom, i veoma visokim dozama ozona.
04:13
Okay? Almost like the highest in the nation.
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OK? Skoro je najviša u naciji.
04:15
Alright, this is what it looks like on a good day.
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Dobro, ovako to izgleda kad je dobar dan.
04:17
If you've been there, you know what I'm talking about.
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Ako ste bili tamo, znate o čemu pričam.
04:20
So, what's wrong with this picture?
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Dakle, što ne valja na ovoj slici?
04:23
Well, the picture is, there is a huge gap here.
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Pa, na slici je velika praznina.
04:25
The one thing that never happens in my doctor's office:
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Jedina stvar koja se nikada ne događa kod mog doktora:
04:29
They never ask me about my place history.
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nikada me ne pitaju za moju povijest mjesta.
04:32
No doctor, can I remember, ever asking me,
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Ne sjećam se da me je ijedan doktor pitao
04:35
"Where have you lived?"
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"Gdje ste živjeli?"
04:37
They haven't asked me what kind of the quality
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Nisu me pitali kakve kvalitete
04:39
of the drinking water that I put in my mouth
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je pitka voda koju sam stavljao u usta,
04:41
or the food that I ingest into my stomach.
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ili hrana koju sam vario u trbuhu.
04:45
They really don't do that. It's missing.
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Oni zapravo to ne rade. To nedostaje.
04:48
Look at the kind of data that's available.
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Pogledajte vrstu podataka koja je dostupna.
04:51
This data's from all over the world --
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Ovo su podaci sa svih strana svijeta --
04:53
countries spend billions of dollars investing in this kind of research.
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zemlje troše milijarde dolara na ovakva istraživanja.
04:57
Now, I've circled the places where I've been.
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Zaokružio sam mjesta na kojima sam bio.
05:00
Well, by design, if I wanted to have a heart attack
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Recimo, da sam želio imati infarkt
05:03
I'd been in the right places. Right?
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bio sam na pravim mjestima. Zar ne?
05:08
So, how many people are in the white?
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Koliko ljudi je u bijelom dijelu?
05:10
How many people in the room have spent the majority of their life
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Koliko ljudi iz ove sobe je provelo većinu svog života
05:12
in the white space?
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u bijelim mjestima?
05:15
Anybody? Boy you're lucky.
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Bilo tko? Čovječe, vi ste sretnici.
05:17
How many have spent it in the red places?
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Koliko vas je provelo u crvenim mjestima?
05:20
Oh, not so lucky.
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O, vi niste tako sretni.
05:22
There are thousands of these kinds of maps
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Postoje tisuće ovakvih mapa
05:25
that are displayed in atlases
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koje su izložene u atlasima
05:27
all over the world.
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diljem svijeta.
05:29
They give us some sense of what's going
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One nam daju neku ideju o tome što će
05:31
to be our train wreck.
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biti naš sudar vlakova.
05:34
But none of that's in my medical record.
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Ali ništa od toga nema u mom medicinskom kartonu.
05:36
And it's not in yours either.
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Niti u vašem.
05:38
So, here's my friend Paul.
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Evo ga moj prijatelj Paul.
05:40
He's a colleague. He allowed his cell phone to be tracked
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On je kolega. Dozvolio je da mu prate mobilni telefon
05:44
every two hours, 24/7,
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na svaka dva sata, 24 sata, 7 dana u tjednu,
05:47
365 days out of the year
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365 dana u godini,
05:49
for the last two years, everywhere he went.
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posljednje dvije godine, gdje god je išao.
05:52
And you can see he's been to a few places around the United States.
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Možete vidjeti kako je bio na nekoliko mjesta u Sjedinjenim Državama.
05:56
And this is where he has spent most of his time.
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A ovdje je proveo većinu svog vremena.
06:00
If you really studied that you might have some clues
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Ako stvarno proučite ovo imali biste neku ideju
06:03
as to what Paul likes to do.
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o tome što Paul voli raditi.
06:06
Anybody got any clues? Ski. Right.
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Ima li netko ideju? Skijanje. Tako je.
06:09
We can zoom in here, and we suddenly see
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Možemo zumirati ovdje i odjednom vidimo
06:12
that now we see where Paul has really spent a majority of his time.
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gdje je stvarno Paul proveo većinu svog vremena.
06:16
And all of those black dots are all of the
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Sve ove crne točke obilježavaju mjesta
06:20
toxic release inventories
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otrovnog otpada
06:22
that are monitored by the EPA.
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koje prati Agencija za zaštitu okoliša (EPA).
06:24
Did you know that data existed?
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Jeste li znali da ti podaci postoje?
06:27
For every community in the United States,
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Za svaku zajednicu u Americi,
06:29
you could have your own personalized map of that.
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možete dobiti svoju osobnu kartu toga.
06:33
So, our cell phones can now build a place history.
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Dakle, naši mobilni telefoni mogu stvarati povijest mjesta.
06:36
This is how Paul did it. He did it with his iPhone.
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Ovako je Paul to učinio. Koristio je iPhone.
06:39
This might be what we end up with.
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Možda ćemo ovo imati na kraju.
06:41
This is what the physician would have
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Ovo bi doktor imao
06:44
in front of him and her when we enter that exam room
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pred sobom kada uđemo u ordinaciju,
06:47
instead of just the pink slip that said I paid at the counter. Right?
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umjesto samo rozog papira koji govori da smo platili račun. Točno?
06:51
This could be my little assessment.
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Ovo može biti moja mala procjena.
06:53
And he looks at that and he says,
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I on gleda u to i kaže,
06:55
"Whoa Bill,
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"Opa, Bill,
06:57
I suggest that maybe you not decide,
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predlažem da možda ne doneseš odluku,
07:00
just because you're out here in beautiful California,
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samo zato što si ovdje u prelijepoj Kaliforniji,
07:02
and it's warm every day,
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i toplo je svakog dana
07:04
that you get out and run at six o'clock at night.
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da izađeš i trčiš svaku večer u 6 sati.
07:07
I'd suggest that that's a bad idea Bill,
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Rekao bih da je to loša ideja ,
07:10
because of this report."
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Bill zbog ovog izvješća."
07:13
What I'd like to leave you for are two prescriptions.
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Želim vas ostaviti s dva recepta.
07:17
Okay, number one is, we must teach physicians
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OK, prvi je da moramo naučiti liječnike
07:19
about the value of geographical information.
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o vrijednosti geografskih informacija.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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To se zove geomedicina. U ovom trenutku postoji nekoliko programa u svijetu
07:27
that are focused on this.
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koji su fokusirani na ovo.
07:29
And they're in the early stages of development.
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Nalaze se u ranim fazama razvoja.
07:32
These programs need to be supported,
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Te programe treba podržati.
07:35
and we need to teach our future
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I trebalo bi naučiti naše buduće
07:37
doctors of the world
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doktore u svijetu
07:39
the importance of some of the information
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koliko su važne neke od informacija
07:41
I've shared here with you today.
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koje sam podijelio s vama danas.
07:43
The second thing we need to do
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Druga stvar koju bi trebali učiniti je da,
07:45
is while we're spending billions and billions
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dok trošimo milijarde i milijarde
07:47
of dollars all over the world
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dolara diljem svijeta
07:50
building an electronic health record,
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praveći elektronske medicinske kartone,
07:52
we make sure we put a place history
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pobrinuti se uvrstiti povijest mjesta
07:54
inside that medical record.
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u te medicinske kartone.
07:57
It not only will be important for the physician;
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To neće biti važno samo za liječnike;
08:00
it will be important for the researchers
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bit će važno za istraživače
08:02
that now will have huge samples to draw upon.
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koji će sada imati ogromne uzorke.
08:06
But it will also be useful for us.
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A bit će korisno i za nas.
08:08
I could have made the decision, if I had this information,
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Da sam imao ove informacije,
08:12
not to move to the ozone capital
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mogao sam odlučiti da se ne preselim u ozonsku prijestolnicu
08:15
of the United States, couldn't I? I could make that decision.
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Sjedinjenih Država. Zar ne? Mogao sam tako odlučiti.
08:18
Or I could negotiate with my employer
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Ili sam mogao pregovarati s poslodavcem
08:20
to make that decision
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da donese odluku
08:22
in the best interest of myself and my company.
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koja je u najboljem interesu za mene i kompaniju.
08:28
With that, I would like to just say that Jack Lord said
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Ovim želim reći kako je Jack Lord to rekao
08:31
this almost 10 years ago.
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prije skoro 10 godina.
08:34
Just look at that for a minute.
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Samo kratko pogledajte to.
08:36
That was what the conclusion
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To je bio zaključak
08:38
of the Dartmouth Atlas of Healthcare was about,
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Atlasa o zdravstvenoj zaštiti u Dartmouthu,
08:41
was saying that we can explain the geographic variations
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koji govori kako možemo objasniti geografske varijacije
08:44
that occur in disease, in illness, in wellness,
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koje se javljaju u bolestima, zarazama, zdravlju
08:48
and how our healthcare system actually operates.
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i kako naš zdravstveni sustav stvarno funkcionira.
08:51
That was what he was talking about
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O tome je govorio
08:53
on that quote.
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u tom citatu.
08:55
And I would say he got it right almost a decade ago.
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Rekao bih da je pogodio, skoro prije deset godina.
08:59
So, I'd very much like to see us begin to
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Želio bih da počnemo
09:01
really seize this as an opportunity to get this into our medical records.
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prihvaćati ovu priliku da uvrstimo ovo u naše medicinske kartone.
09:05
So with that, I'll leave you that
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Ostavljam vas s time
09:07
in my particular view of view of health:
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kako je u mom pogledu na zdravlje
09:11
Geography always matters.
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geografija uvijek bitna.
09:13
And I believe that geographic information
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I vjerujem kako geografske informacije
09:15
can make both you and me very healthy. Thank you.
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mogu i vas i mene učiniti vrlo zdravim. Hvala vam.
09:17
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Bill Davenhall - Health and human services expertBill Davenhall wants to improve physicians' diagnostic techniques by collecting each patient's geographic and environmental data, and merging it with their medical records.
Why you should listen
Bill Davenhall has spent three decades creating useful intelligence out of what seems ordinary demographic and geographic data. In the '70s he built the first geo-demographic models that helped some of America’s most well-known franchises expand across the nation; in the '80s he founded a start-up market research company that developed the first national database of estimates for the demand of healthcare services.
Davenhall leads the health and human services marketing team at ESRI, the largest geographic information system (GIS) software developer in the world.
Bill Davenhall | Speaker | TED.com