TEDMED 2015
Mary Bassett: Why your doctor should care about social justice
玛丽·巴塞特: 你的医生为什么应该在意社会公正
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1980年代，在津巴布韦，Mary Bassett亲眼目睹了艾滋病的传播。她帮忙建立诊所，治疗和教育当地人，以应对致命病毒。但是回首过去，她为没能对深层问题敲响警钟感到遗憾：植根于世界政治和经济组织的结构性的不平等，让边缘化人群更加脆弱的不平等。同样的结构性问题也存在于当今的美国，作为纽约市保健专员，Bassett正在利用所有机会去为保健平等集结支持，对种族歧视大胆反对。“对倡导变革，我们不需要拥有所有答案，”她说，“我们只需勇气”。
Mary Bassett - New York City Health Commissioner
Mary Bassett is fighting what may be the greatest stumbling block to equitable health care in the US: institutional racism. Full bio
Mary Bassett is fighting what may be the greatest stumbling block to equitable health care in the US: institutional racism. Full bio
Double-click the English transcript below to play the video.
00:12
When I moved to Harare in 1985,
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当我1985年搬到哈拉雷时
00:16
social justice was at the core
of Zimbabwe's national health policy.
of Zimbabwe's national health policy.
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社会公正问题
是津巴布韦国家健康政策的核心
是津巴布韦国家健康政策的核心
00:20
The new government emerged
from a long war of independence
from a long war of independence
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新政府摆脱了长期的独立战争后
00:24
and immediately proclaimed
a socialist agenda:
a socialist agenda:
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立即公布了一项社会主义政策：
00:27
health care services, primary education
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使健康医疗服务与初等教育
00:30
became essentially free.
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成为基本免费项目
00:32
A massive expansion
of rural health centers
of rural health centers
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大规模的农村卫生服务中心
00:36
placed roughly 80 percent
of the population
of the population
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使得80%的人口
00:39
less than a two-hour walk
from these facilities,
from these facilities,
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步行两小时以内便可抵达
00:42
a truly remarkable accomplishment.
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这是一个真正非凡的进步
00:45
In 1980, the year of independence,
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在1980津巴布韦独立年
00:48
25 percent of Zimbabwean children
were fully immunized.
were fully immunized.
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25%的孩童进行了常规免疫接种
00:52
By 1990, a mere decade later,
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到1990，仅仅十年之后
00:55
this proportion stood at 80 percent.
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这一比例上升到80%
00:58
I felt tremendously privileged
to be part of this transformation,
to be part of this transformation,
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我十分荣幸
能参与这次转变，这场革命中
01:04
a revolution.
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01:05
The excitement,
the camaraderie, was palpable.
the camaraderie, was palpable.
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兴奋之情和同志友爱都十分真切
01:10
Working side by side
with brilliant Zimbabweans --
with brilliant Zimbabweans --
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与杰出的津巴布韦人民，
科学家，医生，活动家
科学家，医生，活动家
01:13
scientists, doctors, activists --
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肩并肩工作
01:16
I felt connected not only
to an African independence movement,
to an African independence movement,
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我感到参与的不仅是一个非洲独立运动
01:21
but to a global progressive
public health movement.
public health movement.
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更是一场进步的全球公众健康运动
01:26
But there were daunting challenges.
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我也面临过一些令人畏缩的困难
01:30
Zimbabwe reported its first AIDS case
in 1985, the year I arrived.
in 1985, the year I arrived.
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在1985年，我到达的那一年，
津巴布韦报告了第一例艾滋病。
津巴布韦报告了第一例艾滋病。
01:35
I had taken care of a few patients
with AIDS in the early 1980s,
with AIDS in the early 1980s,
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我在1980年代初
照料过几个艾滋病人
照料过几个艾滋病人
01:39
when I did my medical training
at Harlem Hospital, but --
at Harlem Hospital, but --
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当时我在Harlem医院
接受医学培训，但是…
接受医学培训，但是…
01:44
we had no idea
what lay in store for Africa.
what lay in store for Africa.
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我们完全想不到
会在非洲遇到什么
会在非洲遇到什么
01:49
Infection rate stood at about
two percent in my early days there.
two percent in my early days there.
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我刚到那里的时候
感染率大约2%
感染率大约2%
01:53
These would soar
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这一比例迅速增大
01:55
to one out of every four adults
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当我17年后离开哈拉雷的时候
01:58
by the time I left Harare 17 years later.
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每四名成人就有一名感染
02:02
By the mid-1990s,
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到20世纪90年代中期
02:04
I'd told hundreds of people
in the prime of life
in the prime of life
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我告诉过数百个
朝气蓬勃的年轻人
朝气蓬勃的年轻人
02:08
that they were HIV-positive.
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他们的艾滋病病毒检验呈阳性。
02:10
I saw colleagues and friends die,
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我目睹同事和朋友们死去
02:13
my students, hospital patients, die.
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我的学生和医院病人
也因此死亡
也因此死亡
02:18
In response, my colleagues and I
set up a clinic.
set up a clinic.
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面对这种情况
我和同事开办了一家诊所
我和同事开办了一家诊所
02:22
We did condom demonstrations.
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我们演示如何使用避孕套
02:24
We launched school education
and workplace interventions.
and workplace interventions.
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我们在学校教育和工作场所进行宣传
02:30
We did research. We counseled
the partners of infected men
the partners of infected men
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我们开展研究
我们为艾滋病感染人员伴侣
我们为艾滋病感染人员伴侣
提供如何保护自己的建议。
02:34
about how to protect themselves.
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02:36
We worked hard, and at the time,
I believed that I was doing my best.
I believed that I was doing my best.
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我们非常努力做着这一切
我相信当时我已经竭尽全力
我相信当时我已经竭尽全力
02:41
I was providing excellent treatment,
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我提供了最好的治疗措施
02:44
such as it was.
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至少在当时的条件下如此
02:45
But I was not talking
about structural change.
about structural change.
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但是我没有做出建设性地改变
02:51
Former UN Secretary Kofi Annan
has spoken candidly
has spoken candidly
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前联合国秘书长科菲安南
曾经坦白地承认
曾经坦白地承认
02:55
about his personal failure
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是他个人的错误
02:57
leading to the Rwandan genocide.
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导致了卢旺达大屠杀
02:59
In 1994, he was head
of the UN peacekeeping department.
of the UN peacekeeping department.
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在1994年，
他是联合国维和部门的领导
他是联合国维和部门的领导
03:03
At a 10-year memorial for the genocide,
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在大屠杀十年纪念仪式上
03:06
he reflected, "I believed at the time
I was doing my best,
I was doing my best,
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他回忆说
当时我相信我已经竭尽所能
当时我相信我已经竭尽所能
03:10
but I realized after the genocide
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但是大屠杀之后我才意识到
03:12
that there was more
I could and should have done
I could and should have done
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还有很多是我可以做并且应该做的
03:16
to sound the alarm and rally support."
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去敲响警钟，去寻求支持
03:22
The AIDS epidemic caught
the health community unprepared,
the health community unprepared,
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艾滋病的爆发使医疗团体措手不及
03:27
and today, when the World
Health Organization estimates
Health Organization estimates
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世界卫生组织估计
03:30
that 39 million people
have lost their lives to this disease,
have lost their lives to this disease,
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当今有三千九百万人死于这一疾病
03:35
I'm not alone in feeling
remorse and regret
remorse and regret
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许多人同我一样
因为没能更早地阻止这一切
因为没能更早地阻止这一切
03:40
at not having done more earlier.
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而感到悔恨和惋惜
03:43
But while living in Zimbabwe,
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但当我生活在津巴布韦时
03:46
I didn't see my role
as an advocacy or a political one.
as an advocacy or a political one.
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并没有意识到自己是倡导者或政治人士
03:50
I was there for my technical skills,
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我本以为是因为自己的
医疗知识前去那里的
医疗知识前去那里的
03:52
both my clinical and my research
epidemiology skills.
epidemiology skills.
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是因为我的临床和传染病研究
03:57
And in my mind, my job
was to take care of patients
was to take care of patients
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我一直觉得 我的工作是照顾病人
04:02
and to do research to better understand
the population patterns of transmission,
the population patterns of transmission,
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通过研究来更好地理解传染的人口特征
04:07
and I hoped that we'd slow
the spread of the virus.
the spread of the virus.
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我希望可以减缓病毒的传播速度
04:11
I was aware that socially marginalized
populations were at disproportionate risk
populations were at disproportionate risk
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我意识到社会边缘群体
感染并死于艾滋病的比例
感染并死于艾滋病的比例
04:16
of getting and dying of AIDS.
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出奇的高
04:18
And on the sugar plantations,
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在蔗糖种植园
04:20
which really more closely
resembled feudal fiefdoms
resembled feudal fiefdoms
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这类相比于现代企业
更近似于封建领地的地方
04:24
than any modern enterprise,
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04:26
60 percent of pregnant women
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60%的孕妇
04:29
tested HIV-positive.
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艾滋病病毒测试呈阳性
04:32
I worked to show how getting infected
was not a moral failure
was not a moral failure
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我的工作是向人们展示
被感染并不是道德沦丧
被感染并不是道德沦丧
04:36
but instead related
to a culture of male superiority,
to a culture of male superiority,
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而是与男权意识有关
04:40
to forced migrant labor
and to colonialism.
and to colonialism.
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与强迫外来劳工和殖民主义有关。
04:43
Whites were largely unscathed.
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白人大部分都安然无恙
04:46
As health professionals,
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作为医疗专家
04:48
our tools were pitifully weak:
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我们的手段令人遗憾的无力：
04:52
imploring people to change
their individual behaviors,
their individual behaviors,
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恳求人们改变他们的个人行为
04:56
use condoms, reduce number of partners.
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使用避孕套，减少伴侣数目
04:58
Infection rates climbed,
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感染率还是攀升
05:02
and when treatment
became available in the West,
became available in the West,
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作为我们对抗病毒
05:06
treatment that remains
our most potent weapon
our most potent weapon
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最有效的武器
05:08
against this virus,
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当治疗在西方已经可行的时候
05:10
it was unaffordable
to the public sector across Africa.
to the public sector across Africa.
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对于整个非洲公共部门，
治疗是负担不起的
治疗是负担不起的
05:14
I didn't speak out
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我没有大胆地说出
05:16
about the unequal access
to these life-saving drugs
to these life-saving drugs
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对挽救生命药品获取的不平等
05:21
or about the underlying
economic and political systems
economic and political systems
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或者潜在经济和政治系统中的问题
05:24
that were driving infection rates
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是导致如此大面积人群中
05:27
in such huge swaths of the population.
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感染率居高不下的驱动力
05:33
I rationalized my silence
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我为我的沉默找了借口
05:35
by reminding myself
that I was a guest in the country,
that I was a guest in the country,
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提醒自己我只是这个国家的访客
05:38
that sounding the alarm
could even get me kicked out,
could even get me kicked out,
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敲响警钟可能会被驱逐出境
05:41
keep me from doing good work,
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让我无法做好工作
05:43
taking care of my patients,
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照料我的病人
05:45
doing much-needed research.
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做迫切需要的研究
05:48
So I didn't speak out
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所以我没有
05:49
about the government's
early stance on AIDS.
early stance on AIDS.
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对政府早期的艾滋政策大胆直言
05:53
I didn't voice my concerns loudly enough.
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我表达我的担忧不够大声
05:57
Many doctors, health professionals,
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许多医生，保健工作者
06:00
may think I did nothing wrong.
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可能会觉得我没有做错
06:03
Our pact with our patients,
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我们对于病人的承诺
06:05
the Hippocratic Oath and its variants,
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就如希波克拉底誓言和它的不同版本
06:08
is about the sanctity
of the patient-doctor relationship.
of the patient-doctor relationship.
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是神圣不可侵犯的医患关系
06:13
And I did everything I could
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我对我的每一个病人
06:17
for each and every patient of mine.
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竭尽所能
06:22
But I knew
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但是我知道
06:24
that epidemics emerge
along the fissures of our society,
along the fissures of our society,
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伴随着我们社会分裂产生的传染病
06:28
reflecting not only biology,
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反映的不单是生物学现象
06:30
but more importantly
patterns of marginalization, exclusion,
patterns of marginalization, exclusion,
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更重要的是边缘化，不包容，种族歧视，
06:35
discrimination related to race,
gender, sexuality, class and more.
gender, sexuality, class and more.
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性别歧视，阶级歧视的现象
06:42
It was true of AIDS.
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对于艾滋病如此
06:44
It was true just recently of Ebola.
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对于最近的埃博拉如此
06:48
Medical anthropologists
such as Paul Farmer,
such as Paul Farmer,
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医疗人类学家，
例如保罗·法玛尔
例如保罗·法玛尔
06:51
who worked on AIDS in Haiti,
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在海地从事艾滋病工作
06:53
call this structural violence:
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称之为结构性暴力：
06:56
structural because inequities are embedded
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结构性，因为不平等植根于
07:00
in the political and economic
organization of our social world,
organization of our social world,
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我们社会环境的政治和经济组织
07:05
often in ways that are invisible
to those with privilege and power;
to those with privilege and power;
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经常为特权和政权阶层所无视；
07:11
and violence because its impact --
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暴力，因为它的影响
07:14
premature deaths,
suffering, illness -- is violent.
suffering, illness -- is violent.
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比如早逝，苦难，疾病，是暴力的
07:21
We do little for our patients
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我们为病患做到很少
07:24
if we fail to recognize
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如果我们没有意识到
07:26
these social injustices.
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这些社会不公正
07:28
Sounding the alarm is the first step
towards doing public health right,
towards doing public health right,
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敲响警钟是向正确方向
引导公众保健的第一步，
引导公众保健的第一步，
07:35
and it's how we may rally support
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这是我们寻求支持的方式，
07:38
to break through
and create real change together.
and create real change together.
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一起去突围，去创造真正改变的方式
07:43
So these days, I'm not staying quiet.
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所以现如今，我没有保持沉默
07:46
I'm speaking up about a lot of things,
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我对很多事大胆直言
07:50
even when it makes listeners
uncomfortable,
uncomfortable,
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尽管让听者感到不适
07:53
even when it makes me uncomfortable.
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尽管让我感到不适
07:57
And a lot of this
is about racial disparities
is about racial disparities
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这其中，很多是关于种族隔离
08:00
and institutionalized racism,
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和有组织的种族主义
08:03
things that we're not supposed
to have in this country anymore,
to have in this country anymore,
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这些不应该发生在这个国家的事情
08:06
certainly not in the practice of medicine
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不应该存在于医疗实践中
08:10
or public health.
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或者公众保健中的事情
08:11
But we have them,
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但是它们确实存在
08:13
and we pay for them in lives cut short.
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我们为此付出缩短生命的代价
08:18
That's why sounding the alarm
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这就是在美国对种族主义
08:21
about the impact of racism on health
in the United States,
in the United States,
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影响保健事业敲响警钟的原因
08:25
the ongoing institutional
and interpersonal violence
and interpersonal violence
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持续地有组织的，人际间的
08:30
that people of color face,
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对有色人种的暴力
08:32
compounded by our tragic legacy
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与我们悲剧性的历史息息相关
08:36
of 250 years of slavery,
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250年的奴隶制度
08:40
90 years of Jim Crow
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90年的种族歧视
08:42
and 60 years of imperfect equality,
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60年的不完善的平等关系
08:46
sounding the alarm about this
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为此敲响警钟
08:49
is central to doing my job right
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是我作为纽约市卫生专员的
08:52
as New York City's Health Commissioner.
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工作重心
08:55
In New York City, premature mortality --
that's death before the age of 65 --
that's death before the age of 65 --
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在纽约市，过早死亡率，
即在65岁之前过世，
即在65岁之前过世，
09:00
is 50 percent higher
for black men than white ones.
for black men than white ones.
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黑人比白人高出50%
09:04
A black woman in 2012
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在2012年，黑人女性
09:07
faced more than 10 times
the risk of dying related to childbirth
the risk of dying related to childbirth
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相比白人女性，面对着多于10倍的
与生育相关的
与生育相关的
09:11
as a white woman.
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死亡风险
09:13
And though we've made enormous strides
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尽管我们在减少婴儿死亡率方面
09:16
in reducing infant mortality rates,
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已经取得了巨大的进步
09:20
a black baby still faces
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黑人婴儿出生后
09:22
nearly three times the risk
of death in its first year of life
of death in its first year of life
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第一年死亡率依旧是白人婴儿的
09:27
as compared to a white baby.
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近三倍
09:31
New York City's not exceptional.
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纽约市并非特例
09:33
These statistics are paralleled
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这些统计数据
09:37
by statistics found
across the United States.
across the United States.
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在美国全境都相类似
09:42
A recent New York Times analysis
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一份最近的纽约时报分析
09:45
reported that there are 1.5 million
missing black men across the country.
missing black men across the country.
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报道全国大概有
一千五百万的失踪黑人男性
一千五百万的失踪黑人男性
09:53
They noted that more than one
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作者指出
09:56
out of every six black men
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25至54岁的黑人男性
09:58
who today should be
between the ages of 25 and 54 years
between the ages of 25 and 54 years
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每六人中，就有至少一人
10:04
have disappeared from daily life,
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从日常生活中消失
10:07
lost either to prison or premature death.
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或因牢狱之灾，或因过早死亡
10:12
There is great injustice
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年轻黑人日常要面对
10:15
in the daily and disproportionate violence
faced by young black men,
faced by young black men,
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不成比例的暴力行为
这是非常不公平的
这是非常不公平的
10:19
the focus of recent protests
under the banner #BlackLivesMatter.
under the banner #BlackLivesMatter.
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这些都存在于最近高举
“黑人生命很重要”标语的抗议中
“黑人生命很重要”标语的抗议中
10:25
But we have to remember
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但是我们需要记住
10:26
that enduring and disparate rates
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在普通医疗的
10:30
and the occurrence and outcome
of common medical conditions --
of common medical conditions --
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现状和结果，
以及持久且奇高的疾病比率，
以及持久且奇高的疾病比率，
10:34
heart disease, cancer, diabetes, HIV --
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心脏病，癌症，糖尿病，艾滋病，
10:37
diseases that may kill slowly and quietly
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那些缓慢地安静地吞噬生命的疾病
10:41
and take even more
black lives prematurely.
black lives prematurely.
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让更多黑人生命过早消逝的疾病
10:46
As the #BlackLivesMatter
movement unfolded,
movement unfolded,
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随着“黑人生命很重要”运动的展开
10:50
I felt frustrated and angry
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我感到受挫和愠怒
10:54
that the medical community
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医疗团体
10:55
has been reluctant
to even use the word "racism"
to even use the word "racism"
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在研究和工作中，
甚至对“种族主义”一词的使用
甚至对“种族主义”一词的使用
11:00
in our research and our work.
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都犹豫不决
11:02
You've probably felt something
every time I've said it.
every time I've said it.
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我每次说它时，
你大概已经有所感觉
你大概已经有所感觉
11:06
Our medical students
held die-ins in their white coats,
held die-ins in their white coats,
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医学学生身着白袍，
以死抗议生化武器
以死抗议生化武器
11:09
but the medical community
has largely stood by passively
has largely stood by passively
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但是医疗团体面对
持续的种族歧视
持续的种族歧视
11:13
as ongoing discrimination
continues to affect
continues to affect
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对疾病状况和死亡率的影响
11:17
the disease profile and mortality.
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很大程度上袖手旁观
11:20
And I worry
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我很担心
11:21
that the trend towards personalized
and precision medicine,
and precision medicine,
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趋向个人化和准确化的药物
11:26
looking for biological or genetic targets
to better tailor treatment,
to better tailor treatment,
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找寻生物和基因目标
以更好的设计疗法
以更好的设计疗法
11:31
may inadvertently cause us
to lose sight of the big picture,
to lose sight of the big picture,
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可能会不经意地
使我们不能着眼大局
使我们不能着眼大局
11:36
that it is the daily context,
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而这正是日常生活的场景
11:39
where a person lives, grows,
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一个人的生活，成长，
11:42
works, loves,
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工作，相爱的地方
11:45
that most importantly
determines population health,
determines population health,
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重要地影响着群体健康
11:50
and for too many of us, poor health.
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对我们很多人来说，健康不良
11:54
As health professionals in our daily work,
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在日常生活着，作为保健工作者
11:58
whether in the clinic or doing research,
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无论在诊所里，还是做研究时
12:01
we are witness to great injustice:
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我们都是巨大不公正的目击者：
12:05
the homeless person
who is unable to follow medical advice
who is unable to follow medical advice
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流浪者，无法遵从医嘱，
12:08
because he has more pressing priorities;
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因他要优先考虑更加紧迫之事；
12:11
the transgender youth
who is contemplating suicide
who is contemplating suicide
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年轻的变性人，计划自杀，
12:16
because our society is just so harsh;
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因我们的社会太过无情；
12:18
the single mother who has been made
to feel that she is responsible
to feel that she is responsible
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单身母亲，被迫使感到需要对她孩子的
12:23
for the poor health of her child.
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健康不良负责。
12:26
Our role as health professionals
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作为保健工作者，
我们的角色
我们的角色
12:29
is not just to treat our patients
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不只是治疗我们的病人
12:33
but to sound the alarm
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更是敲响警钟
12:35
and advocate for change.
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主张变革
12:39
Rightfully or not,
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且不论合理与否
12:41
our societal position
gives our voices great credibility,
gives our voices great credibility,
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我们的社会岗位
让我们的声音更加可信
让我们的声音更加可信
12:45
and we shouldn't waste that.
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而我们不应该浪费它
12:48
I regret not speaking up in Zimbabwe,
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我对在津巴布韦没能坦率表达
感到后悔
感到后悔
12:52
and I've promised myself
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我已经对自己承诺
12:54
that as New York City's
Health Commissioner,
Health Commissioner,
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作为纽约市保健专员
12:57
I will use every opportunity I have
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我将会利用拥有的所有机会
13:01
to sound the alarm
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去敲响警钟
13:03
and rally support for health equity.
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去为保健平等寻求支持
13:06
I will speak out against racism,
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我将对种族歧视直言反对
13:09
and I hope you will join me,
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我也希望你们能够加入我
13:11
and I will join you
when you speak out against sexism
when you speak out against sexism
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而我也会加入你们，
当你们为性别歧视，
当你们为性别歧视，
13:14
or any other form of inequality.
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或者任何一种不平等，
直言反对之时
直言反对之时
13:17
It's time for us to rise up
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是时候让我们起来反抗了
13:21
and collectively speak up
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共同地对结构性不平等
13:24
about structural inequality.
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大胆直言
13:27
We don't have to have all the answers
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对倡导变革，我们不需要
13:30
to call for change.
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拥有所有答案
13:33
We just need courage.
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我们只需勇气
13:36
The health of our patients,
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我们病患的健康
13:39
the health of us all, depends on it.
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我们自身的健康，全赖于此
13:43
(Applause)
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（鼓掌）
ABOUT THE SPEAKER
Mary Bassett - New York City Health CommissionerMary Bassett is fighting what may be the greatest stumbling block to equitable health care in the US: institutional racism.
Why you should listen
New York City Public Health Commissioner Mary Bassett has been a health activist since her Radcliffe days of volunteering at a Black Panther Clinic. She began her career on the medical faculty at the University of Zimbabwe, a position she held for 17 years. The valuable lessons she learned in Harare, including the development of one of the first HIV awareness programs, gave her a unique perspective in tackling community health challenges for New York City’s diverse populations. She has led the charge to nudge healthier behaviors, including pushing for higher cigarette taxes and banning artificial trans fats in restaurants.
In her current role, she has called for the medical community’s deeper engagement in the #BlackLivesMatter movement and efforts to tackle institutional racism.
Mary Bassett | Speaker | TED.com