TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall: Vaše zdravie závisí na tom kde žijete.
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To kde žijete ovplyvňuje vaše zdravie rovnako ako diéta a vaše gény, ale nie je to v žiadnych vašich zdravotných záznamoch. V TEDMED, Bill Dovenhall ukazuje ako je možné vládou prehliadané geo-dáta (od percenta miestnych infarktov k informáciám o počte toxických skládok) spojiť s mobilnými GPS aplikáciami poskytujúc tak doktorom dodatočné informácie. Nazvime to "geo-medicína".
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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Môžu vás zemepisné informácie
00:18
make you healthy?
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uzdraviť?
00:22
In 2001 I got hit by a train.
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V roku 2001 ma zrazil vlak.
00:26
My train was a heart attack.
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Ten vlak bol infarkt.
00:29
I found myself in a hospital
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Ocitol som sa v nemocnici
00:31
in an intensive-care ward,
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na oddelení intenzívnej starostlivosti,
00:33
recuperating from emergency surgery.
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zotavujúc sa z akútneho zákroku.
00:36
And I suddenly realized something:
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V tom som si niečo uvedomil:
00:38
that I was completely in the dark.
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že som bol v úplnej tme.
00:41
I started asking my questions, "Well, why me?"
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Začal som si klásť otázky, "Prečo práve ja?"
00:43
"Why now?" "Why here?"
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"Prečo teraz?" "Prečo tu?"
00:45
"Could my doctor have warned me?"
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"Mohol ma môj doktor varovať?"
00:48
So, what I want to do here in the few minutes I have with you
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Takže, čo by som chcel za tých pár minút, ktoré tu dnes mám,
00:51
is really talk about what is the formula for life and good health.
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je hovoriť o tom aký je vzorec na život a dobré zdravie.
00:56
Genetics, lifestyle and environment.
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Genetika, životný štýl a prostredie.
00:59
That's going to sort of contain our risks,
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To tak nejak zahŕňa naše riziká
01:01
and if we manage those risks
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a ak sa nám podarí riadiť tieto riziká
01:03
we're going to live a good life and a good healthy life.
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budeme žiť dobrý a zdravý život.
01:06
Well, I understand the genetics and lifestyle part.
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Nuž, chápem tej genetickej a životného štýlu časti.
01:10
And you know why I understand that?
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A viete prečo tomu chápem?
01:12
Because my physicians constantly
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Pretože môj doktor mi neustále
01:15
ask me questions about this.
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kladie otázky ohľadne tohto.
01:17
Have you ever had to fill out those long,
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Už ste niekedy vyplňovali tie dlhé
01:19
legal-size forms in your doctor's office?
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formuláre v ambulancii vášho doktora.
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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Myslím tým, ak máte to šťastie tak to musíte robiť viac než jeden krát, či nie?
01:25
(Laughter)
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(Smiech)
01:26
Do it over and over again. And they ask you questions
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Znova a znova. A pýtajú sa vás otázky
01:28
about your lifestyle and your family history,
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o vašom životnom štýle a vašich predkoch,
01:31
your medication history, your surgical history,
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vašom zdravotnom zázname, chirurgických zákrokoch,
01:35
your allergy history ... did I forget any history?
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alergiách ... zabudol som niečo?
01:39
But this part of the equation I didn't really get,
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Túto časť rovnice som naozaj nepochopil.
01:43
and I don't think my physicians
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A nemyslím si, že môj doktor
01:46
really get this part of the equation.
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v skutočnosti pochopil túto časť rovnice.
01:48
What does that mean, my environment?
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Čo to znamená, moje prostredie?
01:51
Well, it can mean a lot of things.
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Nuž, môže to znamenať veľa vecí.
01:53
This is my life. These are my life places.
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Toto je môj život. Toto sú miesta môjho života.
01:56
We all have these.
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Všetci ich máme.
01:58
While I'm talking I'd like you to also be thinking about:
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Ako tu hovorím, chcem aby ste sa tiež zamysleli nad tým
02:01
How many places have you lived?
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na koľkých miestach ste už žili?
02:04
Just think about that, you know, wander through
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Len sa nad tým zamyslite, viete, prejdite
02:06
your life thinking about this.
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si tak svoj život premýšľajúc o tom.
02:08
And you realize that you spend it in a variety of different places.
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A uvedomíte si, že ste ho prežili na rôznych miestach.
02:12
You spend it at rest and you spend it at work.
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Strávili ste ho oddychom a prácou.
02:14
And if you're like me, you're in an airplane a good portion of your time
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A ak ste ako ja, trávite v lietadle veľkú časť vášho času
02:17
traveling some place.
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cestovaním niekam.
02:19
So, it's not really simple
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Takže to nieje úplne jednoduché
02:21
when somebody asks you, "Where do you live, where do you work,
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keď sa vás niekto opýta, "Kde žiješ, kde pracuješ,
02:23
and where do you spend all your time?
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a kde tráviš všetok svoj čas?
02:25
And where do you expose yourselves to risks
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A kde sa vystavuješ rizikám,
02:28
that maybe perhaps you don't even see?"
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ktoré pravdepodobne ani nevidíš?"
02:32
Well, when I have done this on myself,
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Nuž, keď som to skúšal na sebe,
02:34
I always come to the conclusion
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vždy som došiel k záveru,
02:36
that I spend about 75 percent of my time
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že 75 percent môjho času strávim
02:40
relatively in a small number of places.
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na relatívne malom počte miest.
02:43
And I don't wander far from that place
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A to sa netúlam ďaleko od týchto miest
02:45
for a majority of my time,
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po väčšinu môjho času,
02:47
even though I'm an extensive global trekker.
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aj keď som veľký svetový cestovateľ.
02:52
Now, I'm going to take you on a little journey here.
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Teraz vás tu vezmem na malú cestu.
02:54
I started off in Scranton, Pennsylvania.
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Začal som v Scranton Pensylvánia.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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Neviem či niekto pochádza zo severovýchodnej Pensylvánie.
02:59
but this is where I spent my first 19 years
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Ale tu som strávil mojich prvých 19 rokov
03:02
with my little young lungs.
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s mojimi mladými pľúcami.
03:04
You know, breathing high concentrations here
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Viete, dýchajúc vysoké koncentrácie
03:07
of sulfur dioxide, carbon dioxide
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oxidu siričitého, oxidu uhoľnatého
03:09
and methane gas,
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a metánu,
03:11
in unequal quantities -- 19 years of this.
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v rôznych množstvách -- a to všetko 19 rokov.
03:14
And if you've been in that part of the country,
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A ak ste boli v tej časti krajiny
03:16
this is what those piles of burning, smoldering coal waste look like.
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takto vypadajú tie kopy horiaceho, tlejúceho uhoľného odpadu.
03:20
So then I decided to leave that part of the world,
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Takže potom som sa rozhodol opustiť túto časť sveta.
03:23
and I was going to go to the mid-west.
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A šiel som na stredo-západ.
03:26
OK, so I ended up in Louisville, Kentucky.
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OK, tak som skončil v Luisville v Kentucky.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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Rozhodol som sa byť susedom miestu zvanému Gumové mesto.
03:33
They manufacture plastics. They use large quantities chloroprene
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Vyrábajú tam plasty. Používajú pri tom veľké množstvá chloroprénu
03:36
and benzene.
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a benzénu.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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OK, 25 rokov mojich stredne starých pľúc som strávilo
03:43
breathing various concentrations of that.
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dýchajúc rôzne koncentrácie tohoto.
03:46
And on a clear day it always looked like this, so you never saw it.
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A počas jasného dňa to vždy vypadalo takto, takže to nebolo vidno.
03:50
It was insidious and it was really happening.
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Bolo to zákerné a fakt sa to dialo.
03:53
Then I decided I had to get really smart,
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A potom som sa rozhodol, že musím byť už rozumnejší
03:55
I would take this job in the West Coast.
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a vezmem tú prácu na západnom pobreží.
03:58
And I moved to Redlands California.
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A presťahoval som sa do Redlands v Kalifornii.
04:01
Very nice, and there
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Veľmi pekné, a tam
04:03
my older, senior lungs, as I like to call them,
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moje staršie, seniorské pľuca, ako ich rád nazývam,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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som naplnil časticami oxidu uhoľnatého, a veľkými dávkami ozónu.
04:13
Okay? Almost like the highest in the nation.
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OK? Skoro tie najvyššie v krajine.
04:15
Alright, this is what it looks like on a good day.
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A takto to vypadá v ten lepší deň.
04:17
If you've been there, you know what I'm talking about.
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Ak ste tam boli, tak viete o čom hovorím.
04:20
So, what's wrong with this picture?
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Takže čo je zlé na tomto obrázku?
04:23
Well, the picture is, there is a huge gap here.
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No, samotný obrázok, je tam obrovská medzera.
04:25
The one thing that never happens in my doctor's office:
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Jedna vec ktorá sa nikdy nestane v ambulancii môjho doktora:
04:29
They never ask me about my place history.
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Nikdy sa ma neopýtajú na históriu mojich bydlísk.
04:32
No doctor, can I remember, ever asking me,
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Žiadny doktor, čo si pamätám, sa ma nikdy neopýtal,
04:35
"Where have you lived?"
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"Kde ste bývali?"
04:37
They haven't asked me what kind of the quality
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Neopýtali sa ako kvalitnu
04:39
of the drinking water that I put in my mouth
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pitnú vodu som pil,
04:41
or the food that I ingest into my stomach.
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alebo ako kvalitné jedlo som jedol.
04:45
They really don't do that. It's missing.
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Naozaj to nerobia. Je to chyba.
04:48
Look at the kind of data that's available.
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Pozrite sa na druh dát, ktoré sú k dispozícii.
04:51
This data's from all over the world --
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Tieto dáta sú z celého sveta -
04:53
countries spend billions of dollars investing in this kind of research.
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krajiny investujú miliardy dolárov do podobných výskumov.
04:57
Now, I've circled the places where I've been.
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Teraz, zakrúžkoval som miesta kde som bol.
05:00
Well, by design, if I wanted to have a heart attack
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No schválne, ak by som chcel mať infarkt
05:03
I'd been in the right places. Right?
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bol som na tých správnych miestach. Je tak?
05:08
So, how many people are in the white?
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Takže, schválne, koľko ľudí tu je v tých v bielych miestach?
05:10
How many people in the room have spent the majority of their life
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Koľko ľudí z tejto miestnosti strávilo väčšinu svojho života
05:12
in the white space?
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v bielych miestach?
05:15
Anybody? Boy you're lucky.
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Nikto? Vy máte šťastie.
05:17
How many have spent it in the red places?
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Koľký ho strávili na tých červených miestach.
05:20
Oh, not so lucky.
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Oh, nie tak šťastný.
05:22
There are thousands of these kinds of maps
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Existujú tisícky podobných máp
05:25
that are displayed in atlases
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zobrazených v atlasoch
05:27
all over the world.
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po celom svete.
05:29
They give us some sense of what's going
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Dávajú nám akú takú predstavu toho, čo
05:31
to be our train wreck.
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môže byť naším koncom.
05:34
But none of that's in my medical record.
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Ale nič z toho nieje v mojom zdravotnom zázname.
05:36
And it's not in yours either.
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A ani vo vašom.
05:38
So, here's my friend Paul.
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Tak, tu je môj priateľ Paul.
05:40
He's a colleague. He allowed his cell phone to be tracked
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Je to kolega. Povolil sledovanie svojho mobilu
05:44
every two hours, 24/7,
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každé dve hodiny, 24/7,
05:47
365 days out of the year
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365 dní v roku,
05:49
for the last two years, everywhere he went.
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počas posledných dvoch rokov, kamkoľvek šiel.
05:52
And you can see he's been to a few places around the United States.
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A môžete vidieť, že bol na pár miestach v rámci Spojených štátov.
05:56
And this is where he has spent most of his time.
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A toto sú miesta kde strávil najviac svojho času.
06:00
If you really studied that you might have some clues
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Keby ste to bližšie preskúmali môžete tušiť
06:03
as to what Paul likes to do.
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čo Paul rád robí.
06:06
Anybody got any clues? Ski. Right.
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Má niekto nejaké nápady? Lyžovanie. Správne.
06:09
We can zoom in here, and we suddenly see
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Môžeme sem priblížiť, a zrazu vidíme
06:12
that now we see where Paul has really spent a majority of his time.
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kde Paul skutočne strávil väčšinu svojho času.
06:16
And all of those black dots are all of the
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A všetky tie čierne bodky sú
06:20
toxic release inventories
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výpuste toxického odpadu
06:22
that are monitored by the EPA.
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monitorované EPA (Agentúra ochrany životného prostredia).
06:24
Did you know that data existed?
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Vedeli ste, že také dáta existujú?
06:27
For every community in the United States,
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Pre každú komunitu v Spojených Štátoch
06:29
you could have your own personalized map of that.
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by ste mohli mať svoju osobnú mapu toho.
06:33
So, our cell phones can now build a place history.
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Takže naše mobily môžu teraz vytvoriť históriu pobytu.
06:36
This is how Paul did it. He did it with his iPhone.
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Takto to spravil Paul. Spravil to so svojim iPhonom.
06:39
This might be what we end up with.
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Toto by nám mohlo vzniknúť.
06:41
This is what the physician would have
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Toto je to, čo by mali doktori
06:44
in front of him and her when we enter that exam room
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pred sebou keď vstúpime do ambulancie
06:47
instead of just the pink slip that said I paid at the counter. Right?
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namiesto ružového ústrižku, ktorý hovorí, že som zaplatil na pulte. Je tak?
06:51
This could be my little assessment.
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Toto by mohlo byť moje malé hodnotenie.
06:53
And he looks at that and he says,
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Doktor sa na to pozrie a povie,
06:55
"Whoa Bill,
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"Fíha Bill.
06:57
I suggest that maybe you not decide,
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Myslím, že by ste sa nemali rozhodnúť,
07:00
just because you're out here in beautiful California,
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len preto, že ste tu v prekrásnej Kalifornii
07:02
and it's warm every day,
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a je teplo každý deň,
07:04
that you get out and run at six o'clock at night.
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že večer o šiestej vyjdete von a beháte.
07:07
I'd suggest that that's a bad idea Bill,
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Myslím Bill, že je to zlý nápad,
07:10
because of this report."
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kvôli tejto správe."
07:13
What I'd like to leave you for are two prescriptions.
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Chcel by som vám dať dva recepty.
07:17
Okay, number one is, we must teach physicians
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OK, po prvé, musíme naučiť doktorov
07:19
about the value of geographical information.
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hodnote zemepisných informácii.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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Nazýva sa to geomedicína. Vo svete je asi poltucta programov
07:27
that are focused on this.
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zameraných na toto.
07:29
And they're in the early stages of development.
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A sú v počiatočných fázach vývoja.
07:32
These programs need to be supported,
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Tieto programy potrebujú podporu.
07:35
and we need to teach our future
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Musíme učiť našich budúcich
07:37
doctors of the world
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doktorov na svete
07:39
the importance of some of the information
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doležitosti niektorých informácií
07:41
I've shared here with you today.
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o ktoré som sa tu dnes s vami podelil.
07:43
The second thing we need to do
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Druhú vec, čo musíme spraviť,
07:45
is while we're spending billions and billions
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zatiaľ čo míňame miliardy a miliardy
07:47
of dollars all over the world
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dolárov po celom svete
07:50
building an electronic health record,
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na tvorbu elektronických zdravotných záznamov,
07:52
we make sure we put a place history
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je že zaistíme pridanie histórií miest
07:54
inside that medical record.
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do týchto záznamov.
07:57
It not only will be important for the physician;
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Nebude to dôležité len pre doktorov;
08:00
it will be important for the researchers
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bude to dôležité pre výskumníkov,
08:02
that now will have huge samples to draw upon.
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ktorý budú mať teraz množstvo vzoriek na čerpanie.
08:06
But it will also be useful for us.
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Ale bude to užitočné aj pre nás.
08:08
I could have made the decision, if I had this information,
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Mohol som sa rozhodnúť, majúc túto informáciu,
08:12
not to move to the ozone capital
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nepresťahovať sa do hlavného mesta ozónu
08:15
of the United States, couldn't I? I could make that decision.
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Spojených štátov. Nemohol som? Mohol som sa tak rozhodnúť.
08:18
Or I could negotiate with my employer
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Alebo som mohol vyjednávať s mojim zamestnávateľom,
08:20
to make that decision
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tak aby som spravil toto rozhodnutie
08:22
in the best interest of myself and my company.
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v najlepšom záujme mojom a mojej spoločnosti.
08:28
With that, I would like to just say that Jack Lord said
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K tomu by som chcel len povedal,že Jack Lord to povedal,
08:31
this almost 10 years ago.
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skoro pred desiatimi rokmi.
08:34
Just look at that for a minute.
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Len sa na to pozrite na minútku.
08:36
That was what the conclusion
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To je to o čom bol záver
08:38
of the Dartmouth Atlas of Healthcare was about,
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zdravotnej starostlivosti v Dartmouth Atlase,
08:41
was saying that we can explain the geographic variations
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ktorý hovorí, že je možné vysvetliť zemepisné rozdiely
08:44
that occur in disease, in illness, in wellness,
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ktoré nastávajú pri chorobách, nemociach, uzdravovaní
08:48
and how our healthcare system actually operates.
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a ako náš zdravotný systém vlastne funguje.
08:51
That was what he was talking about
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To je to o čom hovoril
08:53
on that quote.
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v tom citáte.
08:55
And I would say he got it right almost a decade ago.
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A ja by som povedal, že mal pravdu už pred desaťročím.
08:59
So, I'd very much like to see us begin to
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Takže by som nás veľmi rád videl
09:01
really seize this as an opportunity to get this into our medical records.
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chopiť sa tejto príležitosti pridať to do našich zdravotných záznamov.
09:05
So with that, I'll leave you that
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Opustil by som vás s tým, že
09:07
in my particular view of view of health:
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podľa môjho názoru najmä z ohľadom na zdravie,
09:11
Geography always matters.
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geografia hraje vždy rolu.
09:13
And I believe that geographic information
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A verím, že geografické informácie
09:15
can make both you and me very healthy. Thank you.
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môžu oboch, Vás i mňa, urobiť veľmi zdravými. Ďakujem.
09:17
(Applause)
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(Potlesk)
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