ABOUT THE SPEAKER
Rishi Manchanda - Physician
Rishi Manchanda is an "upstreamist." A physician and public health innovator, he aims to reinvigorate primary care by teaching doctors to think about—and treat—the social and environmental conditions that often underly sickness.

Why you should listen

For a decade, Rishi Manchanda has worked as a doctor in South Central Los Angeles, treating patients who live and work in harsh conditions. He has worked at the Venice Family Clinic, one of the largest free clinics in the United States. He was the first director of social medicine at the St. John’s Well Child and Family Center in Compton, where he and his team provided high quality primary care to low-income families in the area. Currently, he is the medical director of a veterans’ clinic within the Greater Los Angeles Healthcare System, which he refers to as an “intensive caring unit.” He tells the National Health Corps Services, “The moment when a patient switches from despair to hopefulness is the greatest part of my service.” 

Manchanda is the author of the TED Book The Upstream Doctors, in which he looks at how health begins at home and in the workplace, with the social and environmental factors of our everyday lives. He shows how the future of our healthcare system depends on “upstreamists,” the doctors, nurses and other healthcare practitioners who look for the root cause of illness rather than just treating the symptoms.

Manchanda is the president and founder of Health Begins, a social network that teaches and empowers clinicians to improve health where it begins—in patients’ home and work environments. He also founded RxDemocracy, a nonpartisan coalition created to register voters in healthcare clinics. He serves on the board of the National Physicians Alliance, as well as on the board of Physicians for Social Responsibility in Los Angeles.

More profile about the speaker
Rishi Manchanda | Speaker | TED.com
TEDSalon NY2014

Rishi Manchanda: What makes us get sick? Look upstream

Rishi Manchanda: 疾病从何而来?从源头找起。

Filmed:
1,843,333 views

Rishi Manchanda已经在洛杉矶中南部以医生的身份工作了10年,在那儿他开始意识到:他的工作不只是治疗一位患者的症状,而也是追根溯源,找到引发他们疾病的诱因——像糟糕的饮食,有压力的工作,缺乏新鲜空气的环境等“逆流而上”的因素。这是一份对医生们关注病人在诊室外生活的强有力呼吁。
- Physician
Rishi Manchanda is an "upstreamist." A physician and public health innovator, he aims to reinvigorate primary care by teaching doctors to think about—and treat—the social and environmental conditions that often underly sickness. Full bio

Double-click the English transcript below to play the video.

做医生的十年以来,
00:12
For over a decade as a doctor医生,
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00:14
I've cared照顾 for homeless无家可归 veterans老兵,
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我治疗过流浪的老兵,
00:17
for working-class工人阶级 families家庭.
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也治疗过工薪阶层的家庭。
00:19
I've cared照顾 for people who
live生活 and work in conditions条件
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我治疗过那些生活或工作在
艰苦条件中的人们,
00:23
that can be hard, if not harsh苛刻,
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00:25
and that work has led me to believe
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这些工作经历让我坚信,
00:27
that we need a fundamentally从根本上 different不同 way
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我们需要一种新的视角
00:29
of looking at healthcare卫生保健.
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来看待医疗。
00:31
We simply只是 need a healthcare卫生保健 system系统
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我们真正需要的医疗卫生系统,
00:33
that moves移动 beyond just looking at the symptoms症状
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是一个不只把患者接到诊所里,
00:35
that bring带来 people into clinics诊所,
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诊断他们的症状,
而是能够从源头上,
00:36
but instead代替 actually其实 is able能够 to look
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关注和改善人们的健康。
00:39
and improve提高 health健康 where it begins开始.
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00:42
And where health健康 begins开始
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健康问题不是
00:43
is not in the four walls墙壁 of a doctor's医生 office办公室,
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从医生的办公室里开始的,
而是源自我们生活和
00:46
but where we live生活
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00:48
and where we work,
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工作的地方,
源自于跟我们的衣食住行
息息相关的地方,
00:50
where we eat, sleep睡觉, learn学习 and play,
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那些我们花费大半生所生活的地方。
00:53
where we spend the majority多数 of our lives生活.
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那么,这个全新的医疗卫生系统
是怎样的呢?
00:56
So what does this different不同
approach途径 to healthcare卫生保健 look like,
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00:59
an approach途径 that can improve提高 health健康 where it begins开始?
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什么样的方式可以从源头上
改善我们的健康?
01:02
To illustrate说明 this, I'll tell you about Veronica维罗尼卡.
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为了阐明这个问题,让我来和你们
说说Veronica的故事。
01:06
Veronica维罗尼卡 was the 17th patient患者
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Veronica是我某天在
洛杉矶南中心诊所接待的
01:08
out of my 26-patient-患者 day
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26位患者中的第17位。
01:10
at that clinic诊所 in South Central中央 Los洛杉矶 Angeles洛杉矶.
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她来我们诊所是因为患有慢性头痛。
01:13
She came来了 into our clinic诊所 with a chronic慢性 headache头痛.
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这头痛已持续好几年了,
01:15
This headache头痛 had been going on
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她这个特殊的病例
01:16
for a number of years年份, and this particular特定 episode插曲
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01:18
was very, very troubling令人不安.
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非常棘手。
01:21
In fact事实, three weeks before she came来了 to visit访问 us
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事实上,在她第一次来
拜访我们的三周前,
01:23
for the first time, she went to an
emergency room房间 in Los洛杉矶 Angeles洛杉矶.
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她去过了洛杉矶的一处急诊室。
01:27
The emergency room房间 doctors医生 said,
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急诊室的医生说,
“我们对你做了些测试,Veronica.
01:29
"We've我们已经 run some tests测试, Veronica维罗尼卡.
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结果很正常,
你可以先吃些头疼药,
01:31
The results结果 are normal正常, so
here's这里的 some pain疼痛 medication药物治疗,
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01:34
and follow跟随 up with a primary care关心 doctor医生,
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服用后跟基础护理医师进行反馈,
01:36
but if the pain疼痛 persists仍然存在 or if it worsens恶化,
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但如果疼痛持续或变严重,
那就再回来找我们。”
01:38
then come on back."
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01:40
Veronica维罗尼卡 followed其次 those standard标准 instructions说明
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Veronica遵循了这些常规的医疗指示,
之后她又回急诊室来了。
01:43
and she went back.
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01:45
She went back not just once一旦, but twice两次 more.
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她回来不止一次,而是两次。
01:48
In the three weeks before Veronica维罗尼卡 met会见 us,
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在Veronica与我们见面前的三周里,
01:50
she went to the emergency room房间 three times.
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她已经去过三次急诊室。
她来来回回地跑,
01:52
She went back and forth向前,
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反复进出医院和诊所,
01:54
in and out of hospitals医院 and clinics诊所,
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就像她在过去几年间所做的一样,
01:56
just like she had doneDONE in years年份 past过去,
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01:58
trying to seek寻求 relief浮雕 but still coming未来 up short.
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她试着寻找解决头疼的方法,
但仍以失败告终。
02:01
Veronica维罗尼卡 came来了 to our clinic诊所,
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最后,Veronica来到我们的诊所,
02:03
and despite尽管 all these encounters遭遇
with healthcare卫生保健 professionals专业人士,
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尽管之前尝试了各种专业医疗手段,
02:06
Veronica维罗尼卡 was still sick生病.
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她的病却扔没有好转。
02:09
When she came来了 to our clinic诊所, though虽然,
we tried试着 a different不同 approach途径.
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但当她来我们诊所的时候,
我们尝试了一种不同的方法。
02:12
Our approach途径 started开始 with our medical assistant助理,
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我们首先得到了医疗助理的帮助,
02:15
someone有人 who had a GED-levelGED级 training训练
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她受过GED专业训练
(持有普通教育发展证书),
02:17
but knew知道 the community社区.
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而且熟悉我们所在的社区。
02:18
Our medical assistant助理 asked some routine常规 questions问题.
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我们的医疗助理问了一些常规问题。
02:21
She asked, "What's your chief首席 complaint抱怨?"
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她问:“你的主要症状是什么?”
02:23
"Headache头痛."
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——“头疼。”
“让我们来测一些重要指标”——
02:25
"Let's get your vital重要 signs迹象" —
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也就是量一量血压,测一测心律,
02:27
measure测量 your blood血液 pressure压力 and your heart rate,
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但也让我们问些同样重要的问题吧,
02:29
but let's also ask something equally一样 as vital重要
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02:31
to Veronica维罗尼卡 and a lot of patients耐心 like her
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许多像Veronica一样,
居住在洛杉矶南部的病人
02:33
in South Los洛杉矶 Angeles洛杉矶.
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都会面临的问题。
“Veronica,你能告诉我们你住在哪吗?
02:35
"Veronica维罗尼卡, can you tell me about where you live生活?
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02:38
Specifically特别, about your housing住房 conditions条件?
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特别说明下你的居住条件,好吗?
02:39
Do you have mold模子? Do you have water leaks泄漏?
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家里有发霉吗,有漏水吗?
02:42
Do you have roaches蟑螂 in your home?"
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有蟑螂吗?”
结果,Veronica对其中三个问题的回答
是肯定的:
02:44
Turns out, Veronica维罗尼卡 said yes
to three of those things:
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有蟑螂,房屋漏水,已经发霉。
02:46
roaches蟑螂, water leaks泄漏, mold模子.
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我拿到了那份记录,
从头至尾又看了一遍,
02:49
I received收到 that chart图表 in hand, reviewed回顾 it,
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我推开了门,
02:52
and I turned转身 the handle处理 on the door
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然后进了房间。
02:53
and I entered进入 the room房间.
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你们要知道,Veronica,
02:55
You should understand理解 that Veronica维罗尼卡,
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02:57
like a lot of patients耐心 that I have
the privilege特权 of caring爱心 for,
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像我有幸接诊过的大多数病人一样,
是一位端庄的女性,一个强大的存在,
02:59
is a dignified凝重 person, a formidable强大 presence存在,
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她的人格比生命更宏大。
03:02
a personality个性 that's larger than life,
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03:04
but here she was
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但此时此刻她在我的
体检台上,
却经历着超出常人的痛苦。
03:05
doubled翻倍 over in pain疼痛 sitting坐在 on my exam考试 table.
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03:08
Her head, clearly明确地 throbbing悸动, was resting休息 in her hands.
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她抱着头,正忍受着阵阵抽痛。
然后,她抬起了头。
03:12
She lifted取消 her head up,
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我看到了她的脸,说了声你好,
03:14
and I saw her face面对, said hello你好,
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接着我马上意识到
03:17
and then I immediately立即 noticed注意到 something
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她的鼻梁有些不对劲,
03:18
across横过 the bridge of her nose鼻子,
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03:20
a crease in her skin皮肤.
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那里的皮肤有褶皱。
在医学上,我们称之为“变应性鼻炎”。
03:22
In medicine医学, we call that crease the allergic过敏的 salute礼炮.
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它通常见于有慢性过敏的孩子身上。
03:25
It's usually平时 seen看到 among其中 children孩子
who have chronic慢性 allergies过敏.
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03:28
It comes from chronically长期地 rubbing
one's那些 nose鼻子 up and down,
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孩子为了摆脱过敏症状,
03:31
trying to get rid摆脱 of those allergy过敏 symptoms症状,
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长期地上下摩擦鼻子从而致病。
03:33
and yet然而, here was Veronica维罗尼卡, a grown长大的 woman女人,
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但现在,这发生在Veronica——
一位成年女性身上,
03:35
with the same相同 telltale揭秘 sign标志 of allergies过敏.
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她的身上出现了同样的过敏现象。
在之后的几分钟里,
我问了Veronica一些问题,
03:38
A few少数 minutes分钟 later后来, in asking
Veronica维罗尼卡 some questions问题,
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为她做体检,听她讲述病情,
03:41
and examining检查 her and listening to her,
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03:43
I said, "Veronica维罗尼卡, I think I know what you have.
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我说:“Veronica,
我想我知道是怎么回事了。
我觉得是慢性过敏,
03:46
I think you have chronic慢性 allergies过敏,
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03:48
and I think you have migraine偏头痛
headaches头痛 and some sinus congestion拥塞,
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我猜你还伴有偏头痛和鼻窦充血,
03:50
and I think all of those are
related有关 to where you live生活."
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而这些,在我看来
都和你住的地方有关。”
03:53
She looked看着 a little bit relieved安心,
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她看上去稍稍宽慰了些,
因为这是她第一次得到了确诊,
03:55
because for the first time, she had a diagnosis诊断,
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03:57
but I said, "Veronica维罗尼卡, now let's
talk about your treatment治疗.
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但我说:“好,Veronica,
现在让我们来谈谈你的治疗方案。
03:59
We're going to order订购 some
medications药物治疗 for your symptoms症状,
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我们将会为你的症状开些药,
但如果可以的话,
我想为你介绍一位专家。”
04:03
but I also want to refer参考 you to
a specialist专家, if that's okay."
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时至今日,在洛杉矶中南部
04:06
Now, specialists专家 are a little hard to find
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04:09
in South Central中央 Los洛杉矶 Angeles洛杉矶,
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已经很难找到专家了,
04:11
so she gave me this look, like, "Really?"
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于是,她看着我,
就像在说:“真的吗?”
04:13
And I said, "Veronica维罗尼卡, actually其实,
the specialist专家 I'm talking about
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而我回答道:“事实上,Veronica,
我说的专家
04:16
is someone有人 I call a community社区 health健康 worker工人,
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是一位社区卫生工作者,
如果方便的话,
04:18
someone有人 who, if it's okay with you,
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他可以到你家里来,
04:20
can come to your home
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04:21
and try to understand理解 what's going on
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试着找出房子漏水、发霉的原因,
04:22
with those water leaks泄漏 and that mold模子,
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试着帮你解决这些房屋问题,
04:24
trying to help you manage管理 those conditions条件 in your housing住房 that I think are causing造成 your symptoms症状,
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我觉得正是这些导致了你的症状,
如果你觉得有必要,那位专家也许
04:28
and if required需要, that specialist专家 might威力 refer参考 you
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04:30
to another另一个 specialist专家 that we
call a public上市 interest利益 lawyer律师,
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会为你引荐另一位专家,
我们称之为公益律师,
04:32
because it might威力 be that your landlord房东
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因为,也许你的健康问题要归咎于
04:34
isn't making制造 the fixes修复 he's required需要 to make."
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你的房东不愿意掏钱修缮房屋。”
Veronica在几个月后回来了。
04:37
Veronica维罗尼卡 came来了 back in a few少数 months个月 later后来.
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她对整个治疗计划感到满意。
04:39
She agreed同意 to all of those treatment治疗 plans计划.
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04:42
She told us that her symptoms症状
had improved改善 by 90 percent百分.
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她告诉我们,
她的症状已经改善了90%。
04:45
She was spending开支 more time at work
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她可以花更多的时间
04:47
and with her family家庭 and less time
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在工作和家庭上了,
04:49
shuttling穿梭 back and forth向前 between之间
the emergency rooms客房 of Los洛杉矶 Angeles洛杉矶.
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也省下了在洛杉矶的
急诊室来回奔波的时间。
Veronica的生活得到了显著改善。
04:54
Veronica维罗尼卡 had improved改善 remarkably异常.
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04:56
Her sons儿子, one of whom had asthma哮喘,
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她还有一个患哮喘的儿子,
04:58
were no longer as sick生病 as they used to be.
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他们病情都得到了缓解。
05:00
She had gotten得到 better, and not coincidentally巧合,
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她的病好多了,同时,理所当然的,
05:02
Veronica's维罗尼卡的 home was better too.
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她的居住环境也变好了。
05:06
What was it about this different不同 approach途径 we tried试着
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我们所尝试的这种
05:08
that led to better care关心,
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改善医疗的方式,
更少去急诊室,却可以更健康,
这说明了什么呢?
05:11
fewer visits访问 to the E.R., better health健康?
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其实很简单,这始于最初那个问题:
05:15
Well, quite相当 simply只是, it started开始 with that question:
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05:17
"Veronica维罗尼卡, where do you live生活?"
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“Veronica,你住在哪儿?”
但更重要的是,我们建立了一个机制,
05:20
But more importantly重要的, it was that we put in place地点
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05:22
a system系统 that allowed允许 us to routinely常规 ask questions问题
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通过一些例行的提问,
05:25
to Veronica维罗尼卡 and hundreds数以百计 more like her
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对Veronica,和几百名像她一样
05:27
about the conditions条件 that mattered要紧
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生活在那个社区的人的
居住环境加以关注,
05:29
in her community社区, about where health健康,
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05:31
and unfortunately不幸 sometimes有时 illness疾病, do begin开始
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而那里才是南洛杉矶这样的
地区健康问题
甚至是疾病的根源所在。
05:34
in places地方 like South L.A.
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05:35
In that community社区, substandard等外 housing住房
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在这样的社区,劣质的房屋,
05:38
and food餐饮 insecurity不安全 are the major重大的 conditions条件
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食品安全问题可能是我们诊所
05:39
that we as a clinic诊所 had to be aware知道的 of,
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应该关注的主要问题。
05:41
but in other communities社区 it could be
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但在其他社区,问题可能是
05:43
transportation运输 barriers障碍, obesity肥胖,
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交通拥堵、肥胖、
没有公园、枪支暴力。
05:45
access访问 to parks公园, gun violence暴力.
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05:48
The important重要 thing is, we put in place地点 a system系统
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重要的是,我们建立的机制
05:50
that worked工作,
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奏效了,
——我把它称为“逆流机制“
(upstream approach)。
05:52
and it's an approach途径 that I call an upstream上游 approach途径.
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05:54
It's a term术语 many许多 of you are familiar with.
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你们中许多人可能都熟悉。
05:56
It comes from a parable寓言 that's very common共同
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它来自一个在公共卫生领域里
05:58
in the public上市 health健康 community社区.
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非常著名的寓言故事。
这是一则有关”三个朋友“的寓言。
06:00
This is a parable寓言 of three friends朋友.
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假设有3个朋友来到河边,
06:03
Imagine想像 that you're one of these three friends朋友
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你是其中之一。
06:05
who come to a river.
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河边景色优美,
但却被一个孩子的哭声打破了,
06:07
It's a beautiful美丽 scene现场, but it's
shattered破灭 by the cries哭声 of a child儿童,
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实际是上好几个孩子
都掉进了河里,亟待营救。
06:10
and actually其实 several一些 children孩子,
in need of rescue拯救 in the water.
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06:13
So you do hopefully希望 what everybody每个人 would do.
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所以你们本能的做了此刻该做的事。
你和朋友们径直跳入河中。
06:15
You jump right in along沿 with your friends朋友.
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第一个朋友说,我去救那些
06:17
The first friend朋友 says, I'm going to rescue拯救 those
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06:18
who are about to drown,
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快要淹死的孩子、
那些濒临落下瀑布的孩子。
06:20
those at most risk风险 of falling落下 over the waterfall瀑布.
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第二个朋友说,
那我去造只筏子。
06:22
The second第二 friends朋友 says,
I'm going to build建立 a raft.
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06:24
I'm going to make sure that fewer people
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来确保更少的孩子
会漂到瀑布边缘。
06:25
need to end结束 up at the waterfall's瀑布的 edge边缘.
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我们用它来把更多的孩子
06:27
Let's usher招待员 more people to safety安全
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06:28
by building建造 this raft,
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送到安全地带,
06:29
coordinating协调 those branches分支机构 together一起.
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把树枝绑起来(造只筏子)就好。
06:31
Over time, they're successful成功, but not really,
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时间一分一秒过去,
他们成功救起一些人,
06:34
as much as they want to be.
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但还没达到预期的数量。
06:35
More people slip through通过, and they finally最后 look up
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激流把更多人冲走了,
当他们终于抬起头时,
06:37
and they see that their third第三 friend朋友
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却发现第三个朋友
不见了踪影。
06:38
is nowhere无处 to be seen看到.
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他们最终发现了她。
06:39
They finally最后 spot her.
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她在水里,她游得越来越远,
06:41
She's in the water. She's swimming游泳的 away from them
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逆流而上,沿途救起孩子们,
06:43
upstream上游, rescuing营救 children孩子 as she goes,
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然后他们朝她喊:“你要去哪?
06:45
and they shout to her, "Where are you going?
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06:47
There are children孩子 here to save保存."
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这儿有这么多孩子等待救援。”
她回答道:
06:48
And she says back,
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“我要去找出
06:50
"I'm going to find out
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06:51
who or what is throwing投掷 these children孩子 in the water."
176
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是谁或什么原因,
让这些孩子掉进了水里。”
在医疗卫生中心,
我们有第一个朋友——
06:55
In healthcare卫生保健, we have that first friend朋友
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我们有专家,
06:58
we have the specialist专家,
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有创伤外科医师,
有负责重症监护的护士,
06:59
we have the trauma外伤 surgeon外科医生, the ICUICU nurse护士,
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07:01
the E.R. doctors医生.
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还有急诊医生。
07:02
We have those people that are vital重要 rescuers救援人员,
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我们有这些必要的救援者,
07:05
people you want to be there
when you're in dire可怕的 straits海峡.
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他们是你处于水深火热中时,
最需要的人。
07:08
We also know that we have the second第二 friend朋友
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我们也知道,我们有第二个朋友——
07:11
we have that raft-builder筏建设者.
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我们有木筏建造者。
07:12
That's the primary care关心 clinician临床医生,
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基础护理临床医生,
07:14
people on the care关心 team球队 who are there
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医疗团队中治疗你的
07:16
to manage管理 your chronic慢性 conditions条件,
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慢性疾病症状的人,
07:18
your diabetes糖尿病, your hypertension高血压,
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监护你的糖尿病、高血压,
他们每年为你进行体检,
07:19
there to give you your annual全年 checkups体检,
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07:21
there to make sure your vaccines疫苗 are up to date日期,
190
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确保你接种了最新的疫苗,
07:23
but also there to make sure that you have
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他们同时也确保你有一只木筏,
07:25
a raft to sit on and usher招待员 yourself你自己 to safety安全.
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可以随时送你去安全地带的人。
但与此同时,
很重要也十分必要的是,
07:28
But while that's also vital重要 and very necessary必要,
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被我们忽视了的,那第三个朋友。
07:30
what we're missing失踪 is that third第三 friend朋友.
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我们并没有足够的那种”逆流而上者“。
07:32
We don't have enough足够 of that upstreamistupstreamist.
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逆流而上者是健康护理专家,
07:34
The upstreamistsupstreamists are the health健康 care关心 professionals专业人士
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07:36
who know that health健康 does begin开始
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他们知道健康来自于我们
07:38
where we live生活 and work and play,
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工作、生活、娱乐的地方。
07:40
but beyond that awareness意识, is able能够 to mobilize动员
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但他们不仅要能意识到这一点,
07:42
the resources资源 to create创建 the system系统
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还得有能力调集资源,
在他们的诊所里、医院里
07:45
in their clinics诊所 and in their hospitals医院
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建立起一套系统,
07:46
that really does start开始 to approach途径 that,
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这样才能真正地接近源头,
把病人和他们需要的资源联系起来
07:50
to connect people to the resources资源 they need
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2002
07:52
outside the four walls墙壁 of the clinic诊所.
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——那些资源可能并不在诊所里。
现在你也许会问,
07:54
Now you might威力 ask, and it's
a very obvious明显 question
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1668
07:56
that a lot of colleagues同事 in medicine医学 ask:
206
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2655
也是许多从医的同事显然会问的问题:
07:59
"Doctors医生 and nurses护士 thinking思维
about transportation运输 and housing住房?
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3146
“医生和护士还要考虑
交通和住房的问题?
08:02
Shouldn't不能 we just provide提供 pills and procedures程序
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2310
难道我们不应该只是提供药片和处方
并且确保自己专注于手头的工作吗?”
08:04
and just make sure we focus焦点 on the task任务 at hand?"
209
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1732
诚然,拯救处于瀑布边缘的人
08:06
Certainly当然, rescuing营救 people at the water's水的 edge边缘
210
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2846
08:09
is important重要 enough足够 work.
211
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3117
是足够重要的工作了。
谁还有时间干别的?
08:12
Who has the time?
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但我会说,即使这样,
如果我们有科学的方法做指导,
08:13
I would argue争论, though虽然, that if we
were to use science科学 as our guide指南,
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2891
08:16
that we would find an upstream上游
approach途径 is absolutely绝对 necessary必要.
214
484616
2733
就会发现逆流而上寻找根源
是绝对必要的。
科学家现在已经了解,
08:19
Scientists科学家们 now know that
215
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1755
我们每个人都置身其中的
这个工作和
08:21
the living活的 and working加工 conditions条件 that we all
216
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2250
08:23
are part部分 of
217
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1636
生活环境,
08:24
have more than twice两次 the impact碰撞 on our health健康
218
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2390
对我们健康的影响,是我们自身
基因编码的两倍还要多,
08:27
than does our genetic遗传 code,
219
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2127
而我们的工作生活处境,
08:29
and living活的 and working加工 conditions条件,
220
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1333
08:30
the structures结构 of our environments环境,
221
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环境结构组成,
08:32
the ways方法 in which哪一个 our social社会 fabric is woven编织 together一起,
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我们的社会网络联结的方式,
以及它们对我们行为的影响,
08:35
and the impact碰撞 those have on our behaviors行为,
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2182
08:37
all together一起, those have more than five times
224
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2313
这些全部加起来,比医院
和医生开出的
08:40
the impact碰撞 on our health健康
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965
08:41
than do all the pills and procedures程序
226
509155
2009
所有处方和药物
对我们健康的影响的五倍还多。
08:43
administered管理 by doctors医生 and hospitals医院 combined结合.
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2049
08:45
All together一起, living活的 and working加工 conditions条件
228
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这些所有的,生活和工作条件,
08:48
account帐户 for 60 percent百分 of preventable预防的 death死亡.
229
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在可预防的死亡中占了60%。
我给你们举个例子吧。
08:52
Let me give you an example of what this feels感觉 like.
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1580
我们假设有一个公司,科技创业公司,
08:54
Let's say there was a company公司, a tech高科技 startup启动
231
522060
2603
08:56
that came来了 to you and said, "We have a great product产品.
232
524663
1901
对你说:“我们有了个伟大的产品,
08:58
It's going to lower降低 your risk风险
of death死亡 from heart disease疾病."
233
526564
2824
可以降低你因心脏病死亡的风险。”
那么,你可能会愿意为他们公司投资,
09:01
Now, you might威力 be likely容易 to invest投资
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1901
开发这么一种新药物或者医疗设备。
09:03
if that product产品 was a drug药物 or a device设备,
235
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3184
但如果他们的产品是一座公园呢?
09:06
but what if that product产品 was a park公园?
236
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2738
在英国有一项研究,
09:09
A study研究 in the U.K.,
237
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1556
——一项里程碑式的研究,
09:10
a landmark里程碑 study研究 that reviewed回顾 the records记录
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2084
调查了4000万英国居民,
09:12
of over 40 million百万 residents居民 in the U.K.,
239
540851
3341
通过控制诸多因素,
09:16
looked看着 at several一些 variables变量,
240
544192
1828
关注了若干变量,最后得出结论:
09:18
controlled受控 for a lot of factors因素, and found发现 that
241
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2567
当我们试图控制、调节心脏病的风险时,
09:20
when trying to adjust调整 the risk风险 of heart disease疾病,
242
548587
4083
患者在绿色空间中生活
对其有极大的影响。
09:24
one's那些 exposure曝光 to green绿色
space空间 was a powerful强大 influence影响.
243
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3031
你越靠近绿色空间
09:27
The closer接近 you were to green绿色 space空间,
244
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1879
——像公园和树木,
09:29
to parks公园 and trees树木,
245
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1342
你犯心脏病的概率就越小。
09:30
the lower降低 your chance机会 of heart disease疾病,
246
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1495
09:32
and that stayed true真正 for rich丰富 and for poor较差的.
247
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而这一点,对穷人和富人都一样适用。
这一研究,证实了我在
公共健康领域的朋友
09:35
That study研究 illustrates说明 what my friends朋友 in public上市 health健康
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2320
09:37
often经常 say these days:
249
565544
1498
近来常说的话:
一个人的邮政编码,
09:39
that one's那些 zip压缩 code matters事项 more
250
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2068
比他的基因编码更重要。
09:41
than your genetic遗传 code.
251
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1676
我们也知道,邮政编码(地理位置)
09:42
We're also learning学习 that zip压缩 code
252
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1449
实际上也在塑造我们的基因编码。
09:44
is actually其实 shaping成型 our genetic遗传 code.
253
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2435
09:46
The science科学 of epigenetics表观遗传学 looks容貌
at those molecular分子 mechanisms机制,
254
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3217
表观遗传学家观察了分子机制,
——我们的DNA逐一组合起来的
复杂的方式,
09:49
those intricate错综复杂 ways方法 in which哪一个
our DNA脱氧核糖核酸 is literally按照字面 shaped成形,
255
577887
3033
基因的激活和休眠,
09:52
genes基因 turned转身 on and off
256
580920
1568
是基于所暴露的环境,
09:54
based基于 on the exposures曝光 to the environment环境,
257
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2194
09:56
to where we live生活 and to where we work.
258
584682
2744
基于我们生活和工作的地方。
所以显而易见的是,这些因素
09:59
So it's clear明确 that these factors因素,
259
587426
1857
这些逆流而上的问题,确实重要。
10:01
these upstream上游 issues问题, do matter.
260
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2083
10:03
They matter to our health健康,
261
591366
1703
它们关乎我们的健康,
因此我们的医疗卫生人员
应该在这方面有所作为。
10:05
and therefore因此 our healthcare卫生保健 professionals专业人士
should do something about it.
262
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2493
然而,Veronica也问了我一个
10:07
And yet然而, Veronica维罗尼卡 asked me
263
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1768
也许是最值得注意的问题,
10:09
perhaps也许 the most compelling引人注目 question
264
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959
这问题被问过很多次了。
10:10
I've been asked in a long time.
265
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1408
10:11
In that follow-up跟进 visit访问, she said,
266
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2138
在那次随访中,她说:
“为什么之前那些医生
10:13
"Why did none没有 of my doctors医生
267
601835
2152
10:15
ask about my home before?
268
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2878
从未问过我的住房情况?
10:18
In those visits访问 to the emergency room房间,
269
606865
2204
我去急诊室的时候,
10:21
I had two CAT scans扫描,
270
609069
1801
做过2次CAT扫描,
10:22
I had a needle placed放置 in the lower降低 part部分 of my back
271
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1957
他们还在我背部下方插了根针
10:24
to collect搜集 spinal fluid流体,
272
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1530
收集脊髓液,
还做了一大堆血液测试。
10:26
I had nearly几乎 a dozen blood血液 tests测试.
273
614357
1474
10:27
I went back and forth向前, I saw
all sorts排序 of people in healthcare卫生保健,
274
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2654
我来来回回地跑,
找过医疗卫生中心所有类别的医师,
却没有任何人询问过我的住宅情况。“
10:30
and no one asked about my home."
275
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4285
坦率地说,这是因为在医疗卫生中心,
10:34
The honest诚实 answer回答 is that in healthcare卫生保健,
276
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1738
在治疗病症时,我们通常不将
10:36
we often经常 treat对待 symptoms症状 without addressing解决
277
624508
1695
10:38
the conditions条件 that make you sick生病 in the first place地点.
278
626203
3120
导致你生病的环境因素放在首位考虑。
有很多因素导致了这一现象,
说三个主要的,
10:41
And there are many许多 reasons原因 for that, but the big three
279
629323
1844
10:43
are first, we don't pay工资 for that.
280
631167
4600
排在第一的是,这么做不赚钱。
10:47
In healthcare卫生保健, we often经常 pay工资
for volume and not value.
281
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3385
在医疗卫生中心,我们通常
根据”数量“而非”质量“来支付报酬。
10:51
We pay工资 doctors医生 and hospitals医院 usually平时
282
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1788
我们根据医院和医生
提供服务的次数来付钱,
10:52
for the number of services服务 they provide提供,
283
640940
1980
而不是取决于他们使你变得多健康。
10:54
but not necessarily一定 on how healthy健康 they make you.
284
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3299
这导致了第二个现象,我叫它
10:58
That leads引线 to a second第二 phenomenon现象 that I call
285
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2311
在医疗卫生系统里,关于逆流问题的
11:00
the "don't ask, don't tell" approach途径
286
648530
1380
11:01
to upstream上游 issues问题 in healthcare卫生保健.
287
649910
2574
”别问,别说“倾向。
我们不问你住在哪儿,在哪儿工作,
11:04
We don't ask about where you
live生活 and where you work,
288
652484
1744
因为如果那儿有问题,
11:06
because if there's a problem问题 there,
289
654228
1225
11:07
we don't know what to tell you.
290
655453
2896
我们都不知道该如何解释。
医生不是不知道这些问题有多重要。
11:10
It's not that doctors医生 don't know
these are important重要 issues问题.
291
658349
2820
11:13
In a recent最近 survey调查 doneDONE in the U.S. among其中 physicians医师,
292
661169
1871
在最近一次对美国医生进行的调查中,
11:15
over 1,000 physicians医师,
293
663040
1891
超过1000位受访医生中
11:16
80 percent百分 of them actually其实 said that
294
664931
1812
80%的人确实表示,
他们知道患者的”上游问题“
11:18
they know that their patients'耐心' upstream上游 problems问题
295
666743
1698
11:20
are as important重要 as their health健康 issues问题,
296
668441
1887
和他们的健康问题一样重要,
11:22
as their medical problems问题,
297
670328
1692
和医疗问题一样重要。
11:24
and yet然而 despite尽管 that widespread广泛 awareness意识
298
672020
2361
然而,尽管对上游问题的
11:26
of the importance重要性 of upstream上游 issues问题,
299
674381
1934
重要性有着普遍共识,
11:28
only one in five doctors医生 said they had
300
676315
2273
只有五分之一的医生说
11:30
any sense of confidence置信度 to address地址 those issues问题,
301
678588
2865
他们有自信能解决这些问题,
从源头上改善患者健康。
11:33
to improve提高 health健康 where it begins开始.
302
681453
1848
在了解患者的生活,
11:35
There's this gap间隙 between之间 knowing会心
303
683301
1542
11:36
that patients'耐心' lives生活, the context上下文
of where they live生活 and work,
304
684843
2429
他们居住、工作的环境,
遇到的问题,
11:39
matters事项, and the ability能力 to do something about it
305
687272
2808
以及我们现有的医疗系统
做提供的帮助,
11:42
in the systems系统 in which哪一个 we work.
306
690080
1777
这二者之间的供求严重不匹配。
11:43
This is a huge巨大 problem问题 right now,
307
691857
2334
现在,这已经成为一个大问题了,
因为这将人们引向了
下一个问题,那就是:
11:46
because it leads引线 them to this next下一个 question, which哪一个 is,
308
694191
2148
”谁应该对此负责?“
11:48
whose谁的 responsibility责任 is it?
309
696339
1587
而这就将我带到了第三点,
11:49
And that brings带来 me to that third第三 point,
310
697926
1709
11:51
that third第三 answer回答 to Veronica's维罗尼卡的 compelling引人注目 question.
311
699635
3274
Veronica那个引人注目的问题的
第三个答案。
导致我们困境的一部分原因,
11:54
Part部分 of the reason原因 that we have this conundrum难题
312
702909
1586
11:56
is because there are not nearly几乎 enough足够 upstreamistsupstreamists
313
704495
3755
是因为在医疗系统中没有足够的
逆流而上者。
12:00
in the healthcare卫生保健 system系统.
314
708250
2045
我们没有足够多的那种”第三位朋友“,
12:02
There are not nearly几乎 enough足够 of that third第三 friend朋友,
315
710295
1900
12:04
that person who is going to find out
316
712195
1764
那位要去找出
是谁或什么原因,
让这些孩子掉进了水里的人。
12:05
who or what is throwing投掷 those kids孩子 in the water.
317
713959
2857
12:08
Now, there are many许多 upstreamistsupstreamists,
318
716816
1705
现在,出现了许多逆流而上者,
12:10
and I've had the privilege特权 of meeting会议 many许多 of them,
319
718521
2441
我有幸可以在洛杉矶
12:12
in Los洛杉矶 Angeles洛杉矶 and in other parts部分 of the country国家
320
720962
2627
或国内其他地区,
以及世界各地见到他们,
12:15
and around the world世界,
321
723589
1768
12:17
and it's important重要 to note注意 that upstreamistsupstreamists
322
725357
2428
值得指出的是,逆流而上者,
可能是医生,但并不一定是。
12:19
sometimes有时 are doctors医生, but they need not be.
323
727785
2537
他们也可以是护士、
别的卫生工作者、
12:22
They can be nurses护士, other clinicians临床医生,
324
730322
2193
护理管理者、社会工作者。
12:24
care关心 managers经理, social社会 workers工人.
325
732515
2008
逆流而上者不需要
12:26
It's not so important重要 what specific具体 degree
326
734523
1952
有什么特定的头衔。
12:28
upstreamistsupstreamists have at the end结束 of their name名称.
327
736475
1799
12:30
What's more important重要 is that they all seem似乎
328
738274
1756
更重要的是他们都具备
12:32
to share分享 the same相同 ability能力 to implement实行 a process处理
329
740030
4425
相同的能力,可以去推动
医疗系统改革的过程,
12:36
that transforms变换 their assistance帮助,
330
744455
1789
改变他们医学实践的方式。
12:38
transforms变换 the way they practice实践 medicine医学.
331
746244
2346
这一过程十分简单,
12:40
That process处理 is a quite相当 simple简单 process处理.
332
748590
1586
12:42
It's one, two and three.
333
750176
2373
它就是:一,二,三。
第一步,他们坐下来,说
12:44
First, they sit down and they say,
334
752549
1651
12:46
let's identify鉴定 the clinical临床 problem问题
335
754200
2024
“让我们从一群特定患者中找出
12:48
among其中 a certain某些 set of patients耐心.
336
756224
1343
共同存在的临床问题。”
比如说,
12:49
Let's say, for instance,
337
757567
1743
“让我们试着去帮助那些
12:51
let's try to help children孩子
338
759310
1934
12:53
who are bouncing蹦蹦 in and out of the hospital醫院
339
761244
1804
反复进出医院的
12:55
with asthma哮喘.
340
763048
2082
哮喘儿童。
一旦抓住了问题的实质,
他们就进入“第二步”,
12:57
After identifying识别 the problem问题, they
then move移动 on to that second第二 step,
341
765130
2511
12:59
and they say, let's identify鉴定 the root cause原因.
342
767641
2739
然后他们说,
“让我们找到问题的根源。”
好,问题根源分析,在医疗卫生领域,
13:02
Now, a root cause原因 analysis分析, in healthcare卫生保健,
343
770380
3791
他们经常会说,
“好吧,让我们看看你的基因,
13:06
usually平时 says, well, let's look at your genes基因,
344
774171
1715
再让我们看看你的生活方式如何。
13:07
let's look at how you're behaving行为.
345
775886
2458
也许你吃得不够健康。
13:10
Maybe you're not eating healthy健康 enough足够.
346
778344
2080
赶紧改善饮食吧!”
13:12
Eat healthier健康.
347
780424
1016
这是一种过于简化的
13:13
It's a pretty漂亮 simplistic简单化
348
781440
1395
13:14
approach途径 to root cause原因 analyses分析.
349
782835
1406
分析根源的方法。
13:16
It turns out, it doesn't really work
350
784241
1665
事实上,如果我们只把自己的视野
限制于此,
这种治疗就起不到什么作用。
13:17
when we just limit限制 ourselves我们自己 that worldview世界观.
351
785906
2464
逆流而上者做的
问题根源分析是这样的:
13:20
The root cause原因 analysis分析 that an upstreamistupstreamist brings带来
352
788370
2101
13:22
to the table is to say, let's look at the living活的
353
790471
1937
“让我们看看你生活和
13:24
and the working加工 conditions条件 in your life.
354
792408
3352
工作的环境怎么样。”
13:27
Perhaps也许, for children孩子 with asthma哮喘,
355
795760
2082
也许,对患有哮喘的孩子们来说,
13:29
it's what's happening事件 in their home,
356
797842
1608
可能是他们家里有什么问题,
或他们住的离高速公路比较近,
那里空气污染严重,
13:31
or perhaps也许 they live生活 close to a
freeway高速公路 with major重大的 air空气 pollution污染
357
799450
2936
13:34
that triggers触发器 their asthma哮喘.
358
802386
1824
会引发他们的哮喘。
也许这正是我们应该
调集资源去解决的,
13:36
And perhaps也许 that's what we should
mobilize动员 our resources资源 to address地址,
359
804210
2620
因为那第三个元素,
这个过程中的“第三步”,
13:38
because that third第三 element元件,
that third第三 part部分 of the process处理,
360
806830
2373
13:41
is that next下一个 critical危急 part部分 of what upstreamistsupstreamists do.
361
809203
2531
也就是逆流而上者将要采取的
关键步骤。
他们调集资源来设计一个解决方案,
13:43
They mobilize动员 the resources资源 to create创建 a solution,
362
811734
2239
不仅仅是在临床医学系统,
13:45
both within the clinical临床 system系统,
363
813973
1721
还要从公共卫生系统,
13:47
and then by bringing使 in people from public上市 health健康,
364
815694
2336
13:50
from other sectors行业, lawyers律师,
365
818030
1342
从其他领域,找律师等等,
任何一个愿意出一份力的人,
13:51
whoever is willing愿意 to play ball,
366
819372
1947
13:53
let's bring带来 in to create创建 a solution that makes品牌 sense,
367
821319
2083
把他们都集中到一起,
设计一个有效的解决方案,
13:55
to take those patients耐心 who
actually其实 have clinical临床 problems问题
368
823402
2810
去找出病人的问题根源,
13:58
and address地址 their root causes原因 together一起
369
826212
2183
将他们与需要的资源连接起来,
14:00
by linking链接 them to the resources资源 you need.
370
828395
2542
从而合力解决医疗中的根源问题。
对我来说,很显然,
逆流而上者做出的
14:02
It's clear明确 to me that there are so many许多 stories故事
371
830937
1777
14:04
of upstreamistsupstreamists who are doing remarkable卓越 things.
372
832714
2486
引人注目的成就数不胜数。
14:07
The problem问题 is that there's just not
nearly几乎 enough足够 of them out there.
373
835200
2660
问题是,
这样的逆流而上者还是不够多。
经过估算,我们认为医疗卫生系统中
14:09
By some estimates估计, we need one upstreamistupstreamist
374
837860
2583
14:12
for every一切 20 to 30 clinicians临床医生
in the healthcare卫生保健 system系统.
375
840443
2946
每20到30位患者就需要一位逆流而上者。
例如,在美国,这意味着
14:15
In the U.S., for instance, that would mean
376
843389
1255
14:16
that we need 25,000 upstreamistsupstreamists
377
844644
2096
到2020年时我们将需要25000个
14:18
by the year 2020.
378
846740
3467
逆流而上者。
但我们现在只有几千个逆流而上者,
数来数去只有这么多,
14:22
But we only have a few少数 thousand upstreamistsupstreamists
out there right now, by all accounts账户,
379
850207
4110
这就是为何,
几年前我和我的同事会说:
14:26
and that's why, a few少数 years年份 ago, my colleagues同事 and I
380
854317
2553
14:28
said, you know what, we need to train培养
381
856870
1917
你们知道吗,我们需要训练和培养
14:30
and make more upstreamistsupstreamists.
382
858787
1973
更多的逆流而上者。
所以我们决定发起一个叫
14:32
So we decided决定 to start开始 an organization组织
383
860760
1706
14:34
called Health健康 Begins开始,
384
862466
2218
”健康起航”(Health Begins)的组织,
14:36
and Health健康 Begins开始 simply只是 does that:
385
864684
1746
任务很简单:
我们训练逆流而上者。
14:38
We train培养 upstreamistsupstreamists.
386
866430
960
我们有很多种衡量自己成就的方式,
14:39
And there are a lot of measures措施
that we use for our success成功,
387
867390
1938
但我们最关注的是
14:41
but the main主要 thing that we're interested有兴趣 in
388
869328
1361
14:42
is making制造 sure that we're changing改变
389
870689
1912
确保我们在改变
医疗领域的信心,
14:44
the sense of confidence置信度,
390
872601
1539
也就是改变临床医师中的
“别问,别说”现象。
14:46
that "don't ask, don't tell" metric among其中 clinicians临床医生.
391
874140
1905
14:48
We're trying to make sure that clinicians临床医生,
392
876045
2299
我们正在试着让医师
及他们所在的医疗卫生系统,
14:50
and therefore因此 their systems系统 that they work in
393
878344
1940
14:52
have the ability能力, the confidence置信度
394
880284
2295
有能力和自信,
14:54
to address地址 the problems问题 in the living活的
395
882579
2675
去找出那些来自我们的
生活、工作环境里的问题。
14:57
and working加工 conditions条件 in our lives生活.
396
885254
3007
我们正在我们的工作中,
15:00
We're seeing眼看 nearly几乎 a tripling三倍
397
888261
1979
见证着三倍于那样的自信。
15:02
of that confidence置信度 in our work.
398
890240
1581
这是个非凡的成就,
15:03
It's remarkable卓越,
399
891821
1303
15:05
but I'll tell you the most compelling引人注目 part部分
400
893124
1914
但我要说,与逆流而上者共事,
15:07
of what it means手段 to be working加工
401
895038
1569
将他们的力量聚集起来
15:08
with upstreamistsupstreamists to gather收集 them together一起.
402
896607
4483
所蕴含的意义是最鼓舞人心的部分。
最令人兴奋的是,每天、每周,
15:13
What is most compelling引人注目 is that every一切 day,
403
901090
2323
15:15
every一切 week, I hear stories故事 just like Veronica's维罗尼卡的.
404
903413
3771
我都会听到像Veronica一样的故事。
有很多和Veronica相似的故事,
15:19
There are stories故事 out there of Veronica维罗尼卡
405
907184
2478
15:21
and many许多 more like her,
406
909662
1919
甚至越来越多,
15:23
people who are coming未来 to the healthcare卫生保健 system系统
407
911581
1881
那些前来医疗卫生中心的人们
正实际地体验着
15:25
and getting得到 a glimpse一瞥 of what it feels感觉 like
408
913462
1378
15:26
to be part部分 of something that works作品,
409
914840
2560
我们的工作成果,
这个医疗卫生系统
不再来来回回地折腾你,
15:29
a health健康 care关心 system系统 that stops停止
bouncing蹦蹦 you back and forth向前
410
917400
2473
15:31
but actually其实 improves提高 your health健康,
411
919873
1821
而是能够实际改善你的健康,
倾听你的故事,
15:33
listens监听 to you who you are,
412
921694
1127
15:34
addresses地址 the context上下文 of your life,
413
922821
2303
了解你的生活经历,
无论你是富人,还是穷人,或者中产阶级。
15:37
whether是否 you're rich丰富 or poor较差的 or middle中间 class.
414
925124
4365
这些故事令人印象深刻,是因为
15:41
These stories故事 are compelling引人注目 because
415
929489
1655
15:43
not only do they tell us that we're this close
416
931144
1980
它们不仅让我们知道了我们的工作
15:45
to getting得到 the healthcare卫生保健 system系统 that we want,
417
933124
2586
已经如此接近理想的医疗系统,
还让我们知道了要如何实现这个目标。
15:47
but that there's something
that we can all do to get there.
418
935710
2749
15:50
Doctors医生 and nurses护士 can get better at asking
419
938459
1862
医护人员通过询问患者的生活情况,
15:52
about the context上下文 of patients'耐心' lives生活,
420
940321
1844
可以更好地为他们服务,
不仅仅因为更好的问诊态度,
15:54
not simply只是 because it's better bedside床头 manner方式,
421
942165
2511
坦率地说,
还因为这代表着更高水准的医疗方式。
15:56
but frankly坦率地说, because it's a better standard标准 of care关心.
422
944676
3082
15:59
Healthcare卫生保健 systems系统 and payers纳税人
423
947758
2342
医疗卫生系统和纳税人可以共同
16:02
can start开始 to bring带来 in public上市 health健康 agencies机构
424
950100
2790
建立相关的公共卫生机构和部门,
16:04
and departments部门 and say,
425
952890
1415
然后说:
让我们共享数据。
16:06
let's look at our data数据 together一起.
426
954305
1538
看看能否从患者的生活数据上
找出一些端倪,
16:07
Let's see if we can discover发现 some patterns模式
in our data数据 about our patients'耐心' lives生活
427
955843
3526
从而诊断出上游的诱因,
16:11
and see if we can identify鉴定 an upstream上游 cause原因,
428
959369
2471
然后,同样重要的,能否调整社会资源
16:13
and then, as importantly重要的, can we align对齐 the resources资源
429
961840
2561
16:16
to be able能够 to address地址 them?
430
964401
2336
来解决这些问题?
医学院校,护理学校,
16:18
Medical schools学校, nursing看护 schools学校,
431
966737
1394
所有医疗卫生专业教育项目
16:20
all sorts排序 of health健康 professional专业的 education教育 programs程式
432
968131
2296
都能够通过训练新一代的
逆流而上者来帮助我们。
16:22
can help by training训练 the
next下一个 generation of upstreamistsupstreamists.
433
970427
3756
我们也很确定,这些学校
16:26
We can also make sure that these schools学校
434
974183
1755
16:27
certify证明 a backbone骨干 of the upstream上游 approach途径,
435
975938
3228
将成为“逆流机制”的中坚力量,
16:31
and that's the community社区 health健康 worker工人.
436
979166
2195
那将是一个先进卫生工作者的群体。
我们的医疗卫生系统里
需要很多这样的人,
16:33
We need many许多 more of them
in the healthcare卫生保健 system系统
437
981361
1519
16:34
if we're truly going to have it be effective有效,
438
982880
2353
——如果我们确实想让它变得更高效,
16:37
to move移动 from a sickcaresickcare system系统
439
985233
1507
让它从一个“只关心病痛”的系统,
16:38
to a healthcare卫生保健 system系统.
440
986740
1498
转变成一个“关注健康”的系统。
16:40
But finally最后, and perhaps也许 most importantly重要的,
441
988238
2048
但最终,也许是最重要的是:
16:42
what do we do? What do we do as patients耐心?
442
990286
2559
我们能做些什么?
作为患者该应该怎么做?
16:44
We can start开始 by simply只是 going to our doctors医生
443
992845
2265
很简单,当我们到诊所时,
16:47
and our nurses护士, to our clinics诊所,
444
995110
1709
面对我们的医生、护士,
16:48
and asking, "Is there something in where I live生活
445
996819
2332
我们可以问:“我居住和工作的地方
16:51
and where I work that I should be aware知道的 of?"
446
999151
2343
有没有什么值得注意的?”
是否存在一些被我忽视的
影响我健康的细节?
16:53
Are there barriers障碍 to health健康 that I'm just not aware知道的 of,
447
1001494
2848
16:56
and more importantly重要的, if there are barriers障碍
448
1004342
1958
而更重要的是,
如果真的存在一些问题,
我已经察觉到了,然后找到医生说:
16:58
that I'm surfacing堆焊, if I'm coming未来 to you
449
1006300
1981
17:00
and I'm saying I think have a problem问题 with
450
1008281
2119
我觉得我的公寓或者办公环境
17:02
my apartment公寓 or at my workplace职场
451
1010400
2103
可能有些问题,
或者我家附近交通不便,
17:04
or I don't have access访问 to transportation运输,
452
1012503
2196
17:06
or there's a park公园 that's way too far,
453
1014699
1631
或是,那个公园离我家太远,
17:08
so sorry doctor医生, I can't take your advice忠告
454
1016330
1860
抱歉,医生,
我无法听从你的建议,
17:10
to go and jog慢跑,
455
1018190
2086
每天去公园慢跑。
17:12
if those problems问题 exist存在,
456
1020276
1881
如果这些问题真的存在,
17:14
then doctor医生, are you willing愿意 to listen?
457
1022157
3296
那么,医生,你愿意去倾听吗?
我们能彼此配合
17:17
And what can we do together一起
458
1025453
1413
17:18
to improve提高 my health健康 where it begins开始?
459
1026866
2570
从根源上改善我的健康吗?
如果我们都能做到这些,
17:21
If we're all able能够 to do this work,
460
1029436
2444
17:23
doctors医生 and healthcare卫生保健 systems系统,
461
1031880
1539
从医生,到医疗系统,
17:25
payers纳税人, and all of us together一起,
462
1033419
2080
到纳税人,我们所有人一起,
就能实现一种不同以往的健康状况。
17:27
we'll realize实现 something about health健康.
463
1035499
2194
17:29
Health健康 is not just a personal个人
responsibility责任 or phenomenon现象.
464
1037693
3422
健康不仅是患者个人的责任或现象。
健康是共同利益。
17:33
Health健康 is a common共同 good.
465
1041115
3502
它来自我们的个人生活投资,
17:36
It comes from our personal个人 investment投资 in knowing会心
466
1044617
1918
17:38
that our lives生活 matter,
467
1046535
2281
要认识到:生活是不能将就的,
17:40
the context上下文 of where we live生活 and where we work,
468
1048816
2128
我们居住与工作的环境、
饮食、睡眠…它们都很重要,
17:42
eat, and sleep睡觉, matter,
469
1050944
1736
17:44
and that what we do for ourselves我们自己,
470
1052680
1624
而这些我们为自己做的事,
17:46
we also should do for those
471
1054304
2120
同样也应该为那些
生活和工作环境
17:48
whose谁的 living活的 and working加工 conditions条件
472
1056424
2016
相对比较艰苦的人去做。
17:50
again, can be hard, if not harsh苛刻.
473
1058440
2618
17:53
We can all invest投资 in making制造 sure that we improve提高
474
1061058
2486
当然,我们都可以寄希望于
17:55
the allocation分配 of resources资源 upstream上游,
475
1063544
2250
能提升”上游“资源的分配。
17:57
but at the same相同 time work together一起
476
1065794
2183
但同时,我们可以协同合作,
17:59
and show显示 that we can move移动 healthcare卫生保健
477
1067977
2733
来证明,我们能让医疗卫生系统
”逆流而上“地
18:02
upstream上游.
478
1070710
2037
解决问题。
我们可以从根源上改善健康。
18:04
We can improve提高 health健康 where it begins开始.
479
1072747
3073
18:07
Thank you.
480
1075820
2027
谢谢。
(掌声)
18:09
(Applause掌声)
481
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2554
Translated by Twisted Meadows
Reviewed by Min Wang

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ABOUT THE SPEAKER
Rishi Manchanda - Physician
Rishi Manchanda is an "upstreamist." A physician and public health innovator, he aims to reinvigorate primary care by teaching doctors to think about—and treat—the social and environmental conditions that often underly sickness.

Why you should listen

For a decade, Rishi Manchanda has worked as a doctor in South Central Los Angeles, treating patients who live and work in harsh conditions. He has worked at the Venice Family Clinic, one of the largest free clinics in the United States. He was the first director of social medicine at the St. John’s Well Child and Family Center in Compton, where he and his team provided high quality primary care to low-income families in the area. Currently, he is the medical director of a veterans’ clinic within the Greater Los Angeles Healthcare System, which he refers to as an “intensive caring unit.” He tells the National Health Corps Services, “The moment when a patient switches from despair to hopefulness is the greatest part of my service.” 

Manchanda is the author of the TED Book The Upstream Doctors, in which he looks at how health begins at home and in the workplace, with the social and environmental factors of our everyday lives. He shows how the future of our healthcare system depends on “upstreamists,” the doctors, nurses and other healthcare practitioners who look for the root cause of illness rather than just treating the symptoms.

Manchanda is the president and founder of Health Begins, a social network that teaches and empowers clinicians to improve health where it begins—in patients’ home and work environments. He also founded RxDemocracy, a nonpartisan coalition created to register voters in healthcare clinics. He serves on the board of the National Physicians Alliance, as well as on the board of Physicians for Social Responsibility in Los Angeles.

More profile about the speaker
Rishi Manchanda | Speaker | TED.com