TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall: Sanatatea ta depinde de locul in care traiesti
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Locul in care traiesti : Are acelasi impact asupra sanatatii precum o au dieta si genele, dar acesta nu face parte din datele tale medicale. La TEDMED, Bill Davenhall demonstreaza cum datele guvernamentale geografice trecute cu vederea (de la zonele in care au loc cele mai multe atacuri de cord la locurile in care se arunca deseurile toxice) pot fi tinute sub observatie cu ajutorul aplicatiilor GPS de pe telefoanele mobile. Numiti-o "geo-medicina"
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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Pot informatiile geografice
00:18
make you healthy?
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sa va faca sanatosi?
00:22
In 2001 I got hit by a train.
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In 2001 am fost lovit de "un tren"
00:26
My train was a heart attack.
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Trenul meu s-a numit "atac de cord".
00:29
I found myself in a hospital
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M-am trezit intr-un spital
00:31
in an intensive-care ward,
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la terapie intensiva,
00:33
recuperating from emergency surgery.
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recuperandu-ma dupa operatia de urgenta.
00:36
And I suddenly realized something:
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Si mi-am dat seama pe moment de ceva:
00:38
that I was completely in the dark.
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ca nu intelegeam nimic.
00:41
I started asking my questions, "Well, why me?"
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Am inceput sa ma intreb "De ce eu ?"
00:43
"Why now?" "Why here?"
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"De ce acum?" "De ce aici?"
00:45
"Could my doctor have warned me?"
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"Ar fi putut doctorul meu sa ma previna de acest lucru?"
00:48
So, what I want to do here in the few minutes I have with you
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Deci, ce doresc sa fac in putinele minute pe care le am la dispozitie
00:51
is really talk about what is the formula for life and good health.
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este sa vorbesc despre formula vietii si a sanatatii.
00:56
Genetics, lifestyle and environment.
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Genetica, modul de viata si mediul.
00:59
That's going to sort of contain our risks,
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Acestea au riscurile aferente,
01:01
and if we manage those risks
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si daca reusim sa evitam aceste riscuri
01:03
we're going to live a good life and a good healthy life.
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o sa ducem o viata buna si o viata sanatoasa.
01:06
Well, I understand the genetics and lifestyle part.
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Ei bine, inteleg partea cu genetica si stilul de viata.
01:10
And you know why I understand that?
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Si stiti de ce o inteleg?
01:12
Because my physicians constantly
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Pentru ca doctorii mei
01:15
ask me questions about this.
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ma intreaba mereu despre ea.
01:17
Have you ever had to fill out those long,
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Ati completat vreodata formularele acelea lungi,
01:19
legal-size forms in your doctor's office?
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din cabinetul doctorului?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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Vreau sa zic ca, daca esti destul de norocos, apuci sa faci asta de mai multe ori, nu?
01:25
(Laughter)
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(Rasete)
01:26
Do it over and over again. And they ask you questions
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Le completezi incontinuu. Si ei te intreaba
01:28
about your lifestyle and your family history,
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despre modul de viata, despre antecedentele medicale ale familiei,
01:31
your medication history, your surgical history,
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despre ce medicamente ai luat, daca ai fost operat,
01:35
your allergy history ... did I forget any history?
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daca esti alergic... am uitat ceva?
01:39
But this part of the equation I didn't really get,
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Dar partea aceasta a ecuatiei nu am prea inteles-o.
01:43
and I don't think my physicians
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Si cred ca nici doctorii
01:46
really get this part of the equation.
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nu o inteleg.
01:48
What does that mean, my environment?
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Ce inseamna cu adevarat mediul inconjurator?
01:51
Well, it can mean a lot of things.
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Poate insemna mai multe lucruri.
01:53
This is my life. These are my life places.
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Asta e viata mea. Aici sunt locurile unde am trait.
01:56
We all have these.
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Cu totii le avem.
01:58
While I'm talking I'd like you to also be thinking about:
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In timp ce eu va vorbesc, as dori ca voi sa va ganditi
02:01
How many places have you lived?
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in cate locuri ati trait?
02:04
Just think about that, you know, wander through
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Ganditi-va un moment, aduceti-va aminte
02:06
your life thinking about this.
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de locurile in care ati trait.
02:08
And you realize that you spend it in a variety of different places.
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Si o sa va dati seama ca va traiti viata in multe locuri diferite.
02:12
You spend it at rest and you spend it at work.
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Va petreceti viata odihnindu-va si muncind.
02:14
And if you're like me, you're in an airplane a good portion of your time
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Si daca sunteti ca mine, petreceti mult timp in avion
02:17
traveling some place.
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calatorind undeva.
02:19
So, it's not really simple
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Deci, nu e chiar simplu
02:21
when somebody asks you, "Where do you live, where do you work,
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cand cineva te intreaba "Unde locuiesti, unde muncesti,
02:23
and where do you spend all your time?
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si unde iti petreci timpul?
02:25
And where do you expose yourselves to risks
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Si unde va expuneti riscurilor
02:28
that maybe perhaps you don't even see?"
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fara sa va dati seama?
02:32
Well, when I have done this on myself,
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Ei bine, cand am facut acest experiment,
02:34
I always come to the conclusion
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am ajuns la concluzia
02:36
that I spend about 75 percent of my time
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ca petrec cam 75% din timpul meu
02:40
relatively in a small number of places.
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intr-un numar relativ mic de locuri.
02:43
And I don't wander far from that place
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Si de obicei stau cam in aceeasi zona
02:45
for a majority of my time,
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o mare majoritate a timpului,
02:47
even though I'm an extensive global trekker.
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desi sunt un calator inrait.
02:52
Now, I'm going to take you on a little journey here.
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Acum, o sa va iau intr-o mica calatorie.
02:54
I started off in Scranton, Pennsylvania.
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Am inceput in Scranton Pennsylvania.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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Nu stiu daca se trage careva din nord-estul Pennsylvaniei.
02:59
but this is where I spent my first 19 years
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Dar aici am petrecut primii mei 19 ani
03:02
with my little young lungs.
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cu tinerii mei plamani.
03:04
You know, breathing high concentrations here
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Am inhalat aici concentratii ridicate
03:07
of sulfur dioxide, carbon dioxide
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de dioxid de sulf, dioxid de carbon
03:09
and methane gas,
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si gaz metan,
03:11
in unequal quantities -- 19 years of this.
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in cantitati inegale -- 19 ani am facut asta.
03:14
And if you've been in that part of the country,
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Si daca ati fost vreodata in aceasta parte a tarii,
03:16
this is what those piles of burning, smoldering coal waste look like.
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asa arata aceste gramezi de deseuri miniere care inca ard mocnit.
03:20
So then I decided to leave that part of the world,
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Dupa o vreme, am decis sa plec din aceasta zona.
03:23
and I was going to go to the mid-west.
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As fi vrut sa ma duc in vestul mijlociu.
03:26
OK, so I ended up in Louisville, Kentucky.
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Asa ca am ajuns in Louisville Kentucky.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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Ei bine, am decis sa fiu vecin cu un loc numit Rubbertown (Orasul de cauciuc)
03:33
They manufacture plastics. They use large quantities chloroprene
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Acolo se produc materiale plastice. Foloseau cantitati mari de cloropren
03:36
and benzene.
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si benzen.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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Ei bine, am petrecut 25 de ani, cu plamanii mei de varsta mijlocie,
03:43
breathing various concentrations of that.
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inhaland diferite concentratii din aceste substante.
03:46
And on a clear day it always looked like this, so you never saw it.
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Intr-o zi senina intotdeauna arata asa, deci nu o puteai vedea niciodata.
03:50
It was insidious and it was really happening.
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Era de nevazut, dar chiar se intampla.
03:53
Then I decided I had to get really smart,
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Apoi am decis ca e timpul sa ma destept,
03:55
I would take this job in the West Coast.
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Am acceptat o slujba pe coasta de vest.
03:58
And I moved to Redlands California.
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Si m-am mutat in Redlands California.
04:01
Very nice, and there
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Foarte frumos, si acolo
04:03
my older, senior lungs, as I like to call them,
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pe batranii mei plamani, cum imi place sa ii numesc,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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I-am umplut cu dioxid de carbon si cu doze foarte mari de ozon.
04:13
Okay? Almost like the highest in the nation.
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Da? Aproape cea mai mare concentratie din tara.
04:15
Alright, this is what it looks like on a good day.
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In regula. Asa arata intr-o zi buna.
04:17
If you've been there, you know what I'm talking about.
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Daca ati fost acolo, stiti despre ce vorbesc.
04:20
So, what's wrong with this picture?
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Deci, ce e in neregula cu povestea mea?
04:23
Well, the picture is, there is a huge gap here.
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Ei bine, exista o mare discrepanta.
04:25
The one thing that never happens in my doctor's office:
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Singurul lucru care nu se intampla niciodata in biroul doctorului meu:
04:29
They never ask me about my place history.
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Nimeni nu ma intreaba despre locurile in care am mai locuit.
04:32
No doctor, can I remember, ever asking me,
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Nici un doctor, din cate imi amintesc, nu m-a intrebat,
04:35
"Where have you lived?"
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"Unde ai locuit?"
04:37
They haven't asked me what kind of the quality
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Nu m-au intrebat daca e de calitate
04:39
of the drinking water that I put in my mouth
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apa pe care o beau,
04:41
or the food that I ingest into my stomach.
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sau mancarea pe care o mananc.
04:45
They really don't do that. It's missing.
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Nici un doctor nu pune aceste intrebari. Lipseste.
04:48
Look at the kind of data that's available.
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Uitati-va la datele disponibile.
04:51
This data's from all over the world --
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Aceste date sunt de peste tot din lume--
04:53
countries spend billions of dollars investing in this kind of research.
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tarile cheltuiesc miliarde de dolari investind in acest mod de cercetare.
04:57
Now, I've circled the places where I've been.
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Am incercuit locurile in care am fost.
05:00
Well, by design, if I wanted to have a heart attack
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Dupa cum se vede aici, daca as fi dorit un atac de cord
05:03
I'd been in the right places. Right?
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am fost in locurile potrivite, Nu-i asa?
05:08
So, how many people are in the white?
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Cati dintre dumneavoastra sunt in zona alba?
05:10
How many people in the room have spent the majority of their life
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Cati dintre cei din sala si-au petrecut mare parte din viata
05:12
in the white space?
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in spatiile albe?
05:15
Anybody? Boy you're lucky.
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Cineva? Esti norocos.
05:17
How many have spent it in the red places?
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Cati si-au petrecut viata in locurile rosii?
05:20
Oh, not so lucky.
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Oh, nu chiar asa de norocosi.
05:22
There are thousands of these kinds of maps
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Sunt mii de astfel de harti
05:25
that are displayed in atlases
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in atlase
05:27
all over the world.
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din toata lumea.
05:29
They give us some sense of what's going
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Acestea ne arata cam cum o sa fie
05:31
to be our train wreck.
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accidentul nostru.
05:34
But none of that's in my medical record.
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Dar aceasta informatie nu se afla in dosarul meu medical.
05:36
And it's not in yours either.
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Si nici in al vostru.
05:38
So, here's my friend Paul.
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Acesta e amicul meu Paul.
05:40
He's a colleague. He allowed his cell phone to be tracked
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E un coleg. Si-a dat acceptul ca telefonul lui sa fie monitorizat
05:44
every two hours, 24/7,
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la fiecare doua ore, in fiecare ora din zi,
05:47
365 days out of the year
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365 de zile pe an,
05:49
for the last two years, everywhere he went.
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in ultimii doi ani, oriunde s-ar fi dus.
05:52
And you can see he's been to a few places around the United States.
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Si dupa cum vedeti a fost in cateva locuri din Statele Unite.
05:56
And this is where he has spent most of his time.
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Si aici si-a petrecut cea mai mare parte a timpului.
06:00
If you really studied that you might have some clues
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Daca v-ati uita cu atentie, v-ati da seama
06:03
as to what Paul likes to do.
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de ceea ce ii place lui Paul sa faca.
06:06
Anybody got any clues? Ski. Right.
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Si-a dat cineva seama? Sa schieze. Da.
06:09
We can zoom in here, and we suddenly see
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Daca ne uitam atent aici, ne dam seama imediat
06:12
that now we see where Paul has really spent a majority of his time.
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unde a petrecut Paul o buna parte din timpul sau.
06:16
And all of those black dots are all of the
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Toate acele puncte negre reprezinta
06:20
toxic release inventories
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zonele toxice
06:22
that are monitored by the EPA.
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care sunt monitorizate de EPA.
06:24
Did you know that data existed?
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Stiati ca exista aceste informatii?
06:27
For every community in the United States,
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Pentru fiecare comunitate din Statele Unite,
06:29
you could have your own personalized map of that.
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ati putea avea o harta personalizata cu aceste informatii.
06:33
So, our cell phones can now build a place history.
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Telefoanele noastre mobile pot aduna date despre locurile vizitate.
06:36
This is how Paul did it. He did it with his iPhone.
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Asa a facut Paul. A facut-o cu ajutorul iPhone-ului sau.
06:39
This might be what we end up with.
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S-ar putea ca acesta sa fie viitorul.
06:41
This is what the physician would have
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Doctorul sa aiba aceasta informatie
06:44
in front of him and her when we enter that exam room
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in fata lui sau a ei cand am intra in cabinet
06:47
instead of just the pink slip that said I paid at the counter. Right?
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in locul acelei chitante roz care arata ca ai platit la casierie, Nu?
06:51
This could be my little assessment.
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Aceasta ar putea sa fie mica mea evaluare.
06:53
And he looks at that and he says,
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Si el s-ar uita la ea si ar spune,
06:55
"Whoa Bill,
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"Oo Bill,
06:57
I suggest that maybe you not decide,
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Ti-as sugera, sa nu te decizi,
07:00
just because you're out here in beautiful California,
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doar pentru ca esti aici in California,
07:02
and it's warm every day,
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si e cald in fiecare zi
07:04
that you get out and run at six o'clock at night.
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sa iesi sa alergi la ora sase seara.
07:07
I'd suggest that that's a bad idea Bill,
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Iti zic ca e o idee proasta Bill,
07:10
because of this report."
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din cauza acestui raport."
07:13
What I'd like to leave you for are two prescriptions.
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As dori sa inchei cu doua doleante.
07:17
Okay, number one is, we must teach physicians
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Prima e, trebuie sa-i invatam pe doctori
07:19
about the value of geographical information.
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despre valoarea informatiilor geografice.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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Se numeste geomedicina. Sunt in jur de sase programe in lume la ora actuala
07:27
that are focused on this.
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care se axeaza pe asta.
07:29
And they're in the early stages of development.
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Si sunt in stadiu incipient de dezvoltare.
07:32
These programs need to be supported,
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Aceste programe trebuie sa fie sustinute.
07:35
and we need to teach our future
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Si trebuie sa-i invatam pe viitorii
07:37
doctors of the world
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doctori ai lumii
07:39
the importance of some of the information
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despre importanta acestor informatii
07:41
I've shared here with you today.
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pe care le-am impartasit cu voi astazi.
07:43
The second thing we need to do
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Al doilea lucru pe care trebuie sa il facem
07:45
is while we're spending billions and billions
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este ca in timp ce noi cheltuim miliarde si miliarde
07:47
of dollars all over the world
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de dolari peste tot in lume
07:50
building an electronic health record,
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ca sa contruim o arhiva electronica a sanatatii,
07:52
we make sure we put a place history
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sa ne asiguram ca punem si o istorie a locurilor vizitate
07:54
inside that medical record.
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in acea arhiva medicala.
07:57
It not only will be important for the physician;
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O sa fie important nu doar pentru doctori;
08:00
it will be important for the researchers
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ci si pentru cercetatorii
08:02
that now will have huge samples to draw upon.
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care o sa aiba multe exemple dupa care sa se ia.
08:06
But it will also be useful for us.
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Dar o sa ne fie si noua folositor.
08:08
I could have made the decision, if I had this information,
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As fi putut lua decizia, daca as fi avut aceste informatii
08:12
not to move to the ozone capital
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sa nu ma mut in capitala ozonului
08:15
of the United States, couldn't I? I could make that decision.
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a Statelor Unite. Nu-i asa? As fi putut lua aceasta decizie.
08:18
Or I could negotiate with my employer
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Sau as fi putut negocia cu angajatorul meu
08:20
to make that decision
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sa iau deciza
08:22
in the best interest of myself and my company.
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care mi-ar fi convenit mie si companiei mele.
08:28
With that, I would like to just say that Jack Lord said
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In incheiere as vrea sa va spun ce a zis Jack Lord
08:31
this almost 10 years ago.
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acum aproape 10 ani.
08:34
Just look at that for a minute.
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Uitati-va aici pentru un minut.
08:36
That was what the conclusion
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Aceasta a fost concluzia
08:38
of the Dartmouth Atlas of Healthcare was about,
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Dartmouth Atlas of Healthcare,
08:41
was saying that we can explain the geographic variations
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care zice ca ne putem explica variatiile georgrafice
08:44
that occur in disease, in illness, in wellness,
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care influenteaza boliile si afectiuniile, starea buna de sanatate
08:48
and how our healthcare system actually operates.
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si cum actioneaza sistemul de asistenta medicala cu adevarat.
08:51
That was what he was talking about
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Despre asta vorbea el
08:53
on that quote.
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in acel citat.
08:55
And I would say he got it right almost a decade ago.
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Si pot spune ca a avut dreptate acum un deceniu.
08:59
So, I'd very much like to see us begin to
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Mi-ar placea sa incepem sa
09:01
really seize this as an opportunity to get this into our medical records.
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ne dam seama de aceasta oportunitate, sa facem asta o parte din arhiva noastra medicala.
09:05
So with that, I'll leave you that
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Si cu aceasta inchei spunandu-va
09:07
in my particular view of view of health:
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punctul meu personal de vedere in ceea ce priveste sanatatea,
09:11
Geography always matters.
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geografia intotdeauna conteaza.
09:13
And I believe that geographic information
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Si cred ca informatiile geografice
09:15
can make both you and me very healthy. Thank you.
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ne pot face si pe mine si pe voi foarte sanatosi. Va multumesc.
09:17
(Applause)
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(Aplauze)
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