ABOUT THE SPEAKER
Nadine Burke Harris - Pediatrician
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.

Why you should listen

Pediatrician Nadine Burke Harris noticed a disturbing trend as she treated children in an underserved neighborhood in San Francisco: that many of the kids who came to see her had experienced childhood trauma. She began studying how childhood exposure to adverse events affects brain development, as well as a person’s health as an adult.

Understanding this powerful correlation, Burke Harris became the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for medical interventions to counteract the damaging impact of stress. Her goal: to change the standard of pediatric practice, across demographics.

More profile about the speaker
Nadine Burke Harris | Speaker | TED.com
TEDMED 2014

Nadine Burke Harris: How childhood trauma affects health across a lifetime

娜汀‧哈里斯: 童年創傷如何影響一生健康

Filmed:
6,760,359 views

童年創傷不是一件長大就能解決的事。兒科醫生娜汀‧哈里斯 (Nadine Burke Harris) 解釋虐待、忽視、和父母精神健康不良或有藥物或飲酒問題,都會影響兒童的大腦發展。童年經歷影響終身,在高壓環境下長大的兒童比他人得到心肺疾病的比例高三倍。這是一位慷慨激昂的兒科醫生祈求眾人面對、預防和治療心理創傷的演講。
- Pediatrician
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma. Full bio

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

00:12
In the mid-'中-'90s,
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90 年代中期,
00:14
the CDCCDC and Kaiser凱澤 PermanentePermanente的
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疾病防治中心和凱薩醫療機構
00:17
discovered發現 an exposure曝光
that dramatically顯著 increased增加 the risk風險
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發現暴露於某種物質,
會使死亡風險劇增。
00:21
for seven out of 10 of the leading領導
causes原因 of death死亡 in the United聯合的 States狀態.
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在美國,它占主要死亡原因的 70%。
00:27
In high doses劑量, it affects影響
brain development發展,
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暴露於高劑量時,會影響大腦發育、
00:30
the immune免疫的 system系統, hormonal激素 systems系統,
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免疫系統、激素系統、
00:34
and even the way our DNA脫氧核糖核酸
is read and transcribed轉錄.
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甚至影響 DNA 讀取和轉錄方式。
00:38
Folks鄉親 who are exposed裸露 in very high doses劑量
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暴露在高劑量下的人們,
00:42
have triple三倍 the lifetime一生 risk風險
of heart disease疾病 and lung cancer癌症
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有 3 倍風險患上心臟病和肺癌。
00:46
and a 20-year-年 difference區別
in life expectancy期待.
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預期壽命減少 20 年。
00:52
And yet然而, doctors醫生 today今天 are not trained熟練
in routine常規 screening篩查 or treatment治療.
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但現時醫生未接受相關培訓,
對其進行常規檢查或治療。
00:58
Now, the exposure曝光 I'm talking about is
not a pesticide農藥 or a packaging打包 chemical化學.
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這種病因指的不是農藥
或包裝上的化學物質,
01:03
It's childhood童年 trauma外傷.
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而是童年創傷。
01:07
Okay. What kind of trauma外傷
am I talking about here?
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到底是哪種創傷呢?
01:09
I'm not talking about failing失敗 a test測試
or losing失去 a basketball籃球 game遊戲.
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不是考試不合格或輸掉籃球賽。
01:14
I am talking about threats威脅
that are so severe嚴重 or pervasive無處不在
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那種危害極其嚴重、無孔不入,
01:18
that they literally按照字面 get under our skin皮膚
and change更改 our physiology生理:
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以致深入骨髓,改變了我們的生理:
01:23
things like abuse濫用 or neglect忽略,
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例如虐待、忽視,
01:25
or growing生長 up with a parent
who struggles鬥爭 with mental心理 illness疾病
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或童年受到患有精神病的父母影響,
01:29
or substance物質 dependence依賴.
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或父母患物質依賴症。
01:32
Now, for a long time,
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很長一段時間裡,
01:33
I viewed觀看 these things in the way
I was trained熟練 to view視圖 them,
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我看待這些事的方式受教育影響,
01:36
either as a social社會 problem問題 --
refer參考 to social社會 services服務 --
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將其視為社會問題,
交由社會服務解決,
01:40
or as a mental心理 health健康 problem問題 --
refer參考 to mental心理 health健康 services服務.
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或視為心理健康問題,
運用心理健康服務。
01:46
And then something happened發生
to make me rethink反思 my entire整個 approach途徑.
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但有一件事,
重塑了我整個思維方式。
醫院實習結束後,
01:51
When I finished my residency住院醫師,
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01:53
I wanted to go someplace某個地方
where I felt really needed需要,
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我想去一個真正需要我的地方,
01:57
someplace某個地方 where I could make a difference區別.
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一個我能有所作為的地方。
所以我去了
加利福尼亞太平洋醫療中心,
02:00
So I came來了 to work for
California加州 Pacific和平的 Medical Center中央,
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02:03
one of the best最好 private私人的 hospitals醫院
in Northern北方 California加州,
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北加最好的私立醫院之一,
我們合作
在舊金山灣景區開了家診所,
02:07
and together一起, we opened打開 a clinic診所
in Bayview-Hunters灣景獵人 Point,
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那是舊金山最窮、
社區服務最差的區。
02:12
one of the poorest最窮, most underserved缺醫少藥
neighborhoods社區 in San Francisco弗朗西斯科.
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02:16
Now, prior to that point,
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在這之前,
整個灣景區只有一位兒科醫生,
02:18
there had been only
one pediatrician兒科醫師 in all of Bayview灣景
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02:21
to serve服務 more than 10,000 children孩子,
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負責一萬多名兒童的醫療,
02:24
so we hung a shingle卵石, and we were able能夠
to provide提供 top-quality頂級品質 care關心
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於是我們開始掛牌營業,
提供最優質的服務,
02:29
regardless而不管 of ability能力 to pay工資.
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不論病人能否支付費用。
02:31
It was so cool. We targeted針對
the typical典型 health健康 disparities差距:
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這很有意義,
我們旨在減少常見醫療服務的差距:
02:35
access訪問 to care關心, immunization免疫接種 rates利率,
asthma哮喘 hospitalization住院治療 rates利率,
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如:看護服務、
疫苗接種率、哮喘住院率,
02:40
and we hit擊中 all of our numbers數字.
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每項我們都達標了,
02:42
We felt very proud驕傲 of ourselves我們自己.
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我們感到很自豪。
02:45
But then I started開始 noticing注意到
a disturbing煩擾的 trend趨勢.
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但我注意到一個讓人憂心的趨勢。
02:48
A lot of kids孩子 were being存在
referred簡稱 to me for ADHD多動症,
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很多孩子被診斷患有
「過動症」交給我,
02:52
or Attention注意 Deficit赤字
Hyperactivity肺熱 Disorder紊亂,
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或稱:「注意力不足過動症」。
02:55
but when I actually其實 did
a thorough徹底 history歷史 and physical物理,
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但我給他們做
全面病史和身體檢查後,
03:00
what I found發現 was that
for most of my patients耐心,
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發現大部分病人,
03:03
I couldn't不能 make a diagnosis診斷 of ADHD多動症.
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我難以斷定是過動症。
03:07
Most of the kids孩子 I was seeing眼看
had experienced有經驗的 such這樣 severe嚴重 trauma外傷
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這些孩子多數受過嚴重的創傷,
03:13
that it felt like something else其他
was going on.
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讓我覺得另有起因。
03:16
Somehow不知何故 I was missing失踪 something important重要.
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我莫名地感覺遺漏了一個重要因素。
03:21
Now, before I did my residency住院醫師,
I did a master's碩士 degree in public上市 health健康,
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實習之前,
我取得過公共衛生碩士學位,
03:25
and one of the things that they teach you
in public上市 health健康 school學校
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在學校裡,我學到的一點是:
03:28
is that if you're a doctor醫生
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如果你是個醫生
03:30
and you see 100 kids孩子
that all drink from the same相同 well,
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看到 100 個孩子喝了同一口井的水,
其中 98 個得了腹瀉,
03:34
and 98 of them develop發展 diarrhea腹瀉,
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你可以直接開張處方,
03:37
you can go ahead
and write that prescription處方
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03:39
for dose劑量 after dose劑量
after dose劑量 of antibiotics抗生素,
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一劑又一劑的抗生素,
03:44
or you can walk步行 over and say,
"What the hell地獄 is in this well?"
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或問:「這井裡到底有什麼鬼東西?」
03:50
So I began開始 reading everything that
I could get my hands on
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於是,我開始查閱
手上所有相關文獻,
03:53
about how exposure曝光 to adversity逆境
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研究長期暴露在逆境下
03:56
affects影響 the developing發展 brains大腦
and bodies身體 of children孩子.
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對成長期間的小孩
有何身心健康影響。
03:59
And then one day,
my colleague同事 walked into my office辦公室,
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有一天,我同事走進辦公室,說:
04:03
and he said, "Dr博士. Burke伯克,
have you seen看到 this?"
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「柏醫生,妳看過這個嗎?」
04:09
In his hand was a copy複製
of a research研究 study研究
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他手裡是一份研究報告,
04:13
called the Adverse不利的 Childhood童年
Experiences經驗 Study研究.
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名字是《童年不良經驗研究》。
04:16
That day changed my clinical臨床 practice實踐
and ultimately最終 my career事業.
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那一天,改變了我的醫療方法,
最終改變了我的職業生涯。
04:24
The Adverse不利的 Childhood童年 Experiences經驗 Study研究
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童年不良經歷研究
04:26
is something that everybody每個人
needs需求 to know about.
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是大家都需要了解的東西。
它由凱薩醫療機構的文醫生 (Vince Felitti) 和
疾控中心的安達醫生 (Bob Anda) 聯手完成。
04:30
It was doneDONE by Dr博士. Vince文斯 FelittiFelitti at Kaiser凱澤
and Dr博士. Bob短發 Anda安達 at the CDCCDC,
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04:35
and together一起, they asked 17,500 adults成年人
about their history歷史 of exposure曝光
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他們詢問了 17500 名成年人,
了解他們的「童年不良經驗」,
簡稱 ACE。
04:43
to what they called "adverse不利的
childhood童年 experiences經驗," or ACEs的ACE.
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04:49
Those include包括 physical物理, emotional情緒化,
or sexual有性 abuse濫用;
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包括身心上的不良經歷及性虐待;
04:53
physical物理 or emotional情緒化 neglect忽略;
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生理或情感忽略;
04:56
parental父母 mental心理 illness疾病,
substance物質 dependence依賴, incarceration監禁;
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父母患精神疾病、物質依賴或入獄;
05:00
parental父母 separation分割 or divorce離婚;
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父母分居或離婚;
05:02
or domestic國內 violence暴力.
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或家庭暴力。
05:05
For every一切 yes, you would get
a point on your ACE高手 score得分了.
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每經歷一種,ACE 指數就加 1。
05:09
And then what they did
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接著,
05:11
was they correlated相關 these ACE高手 scores分數
against反對 health健康 outcomes結果.
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他們把 ACE 指數
與健康現狀聯系起來。
05:17
What they found發現 was striking引人注目.
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他們得出驚人的結果。
05:19
Two things:
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其中有兩點:
05:21
Number one, ACEs的ACE are incredibly令人難以置信 common共同.
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一是 ACE 非常普遍。
05:25
Sixty-seven六十七 percent百分 of the population人口
had at least最小 one ACE高手,
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67% 的人有至少一個 ACE,
05:32
and 12.6 percent百分, one in eight,
had four or more ACEs的ACE.
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12.6%,即八分之一的人
有 4 個以上的 ACE。
05:38
The second第二 thing that they found發現
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二是:
05:41
was that there was
a dose-response劑量 - 響應 relationship關係
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ACE 經歷的多少與
健康狀況有關係:
05:44
between之間 ACEs的ACE and health健康 outcomes結果:
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05:49
the higher更高 your ACE高手 score得分了,
the worse更差 your health健康 outcomes結果.
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ACE 指數越高,
健康現狀越差。
05:53
For a person with an ACE高手 score得分了
of four or more,
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ACE 指數為 4 或更高的人,
05:56
their relative相對的 risk風險 of chronic慢性
obstructive阻礙 pulmonary肺的 disease疾病
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患慢性阻塞性肺疾病的相對機率,
06:00
was two and a half times that
of someone有人 with an ACE高手 score得分了 of zero.
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是指數爲 0 的人的 2.5 倍。
06:05
For hepatitis肝炎, it was also
two and a half times.
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患肝炎的機率也是 2.5 倍。
06:08
For depression蕭條, it was
four and a half times.
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患憂鬱症的機率是 4.5 倍。
06:11
For suicidality自殺, it was 12 times.
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自殺傾向則是 12 倍。
06:15
A person with an ACE高手 score得分了
of seven or more
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ACE 指數為 7 或以上的人
06:18
had triple三倍 the lifetime一生 risk風險
of lung cancer癌症
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患肺癌的終身風險為 3 倍,
06:23
and three and a half times the risk風險
of ischemic缺血 heart disease疾病,
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患冠心病的終身風險為 3.5 倍,
06:27
the number one killer兇手
in the United聯合的 States狀態 of America美國.
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這疾病是美國頭號殺手。
06:31
Well, of course課程 this makes品牌 sense.
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這當然說得通,
06:34
Some people looked看著 at this data數據
and they said, "Come on.
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有些人看了這些數據會說:
06:38
You have a rough childhood童年,
you're more likely容易 to drink and smoke抽煙
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「如果你有個痛苦的童年,
你抽煙喝酒的機率更高,
06:43
and do all these things
that are going to ruin廢墟 your health健康.
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會做些毀掉健康的行為。
06:46
This isn't science科學.
This is just bad behavior行為."
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這不是科學,只是不健康行爲。」
06:50
It turns out this is exactly究竟
where the science科學 comes in.
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但這正是其科學性的所在。
06:55
We now understand理解
better than we ever have before
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現在我們比以前更清楚地知道,
07:00
how exposure曝光 to early adversity逆境
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童年遭遇不良經歷,
07:03
affects影響 the developing發展 brains大腦
and bodies身體 of children孩子.
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會影響兒童的身體及大腦發育,
07:06
It affects影響 areas like
the nucleus accumbens,
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它對腦部伏核産生影響,
07:09
the pleasure樂趣 and reward獎勵
center中央 of the brain
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這是大腦對快樂和獎勵的處理中心,
07:12
that is implicated牽連
in substance物質 dependence依賴.
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它與物質依賴有關。
07:14
It inhibits抑制 the prefrontal前額葉 cortex皮質,
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不良經歷會抑制前額皮質,
07:17
which哪一個 is necessary必要 for impulse衝動 control控制
and executive行政人員 function功能,
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這個部位對衝動控制
和行動力有影響,
07:21
a critical危急 area for learning學習.
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對學習能力有決定性影響。
07:23
And on MRIMRI scans掃描,
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在核磁共振掃描上,
07:25
we see measurable可測量 differences分歧
in the amygdala杏仁核,
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會發現杏仁核有明顯的差異,
它是大腦的恐懼反應中心。
07:29
the brain's大腦的 fear恐懼 response響應 center中央.
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07:32
So there are real真實 neurologic神經 reasons原因
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因此,從神經學而言
07:35
why folks鄉親 exposed裸露
to high doses劑量 of adversity逆境
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遭遇較多不良經歷的人,
07:39
are more likely容易 to engage從事
in high-risk高風險 behavior行為,
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做出高風險行為的機率更大,
07:42
and that's important重要 to know.
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了解這一點很重要。
07:44
But it turns out that even if you don't
engage從事 in any high-risk高風險 behavior行為,
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但事實上,即使你不做高風險行爲,
07:50
you're still more likely容易
to develop發展 heart disease疾病 or cancer癌症.
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你依然容易患上心臟病或者癌症。
07:56
The reason原因 for this has to do with
the hypothalamic下丘腦pituitary垂體adrenal腎上腺 axis,
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這點跟
下丘腦—垂體—腎上腺軸有關,
它是大腦和身體的應激反應系統。
08:02
the brain's大腦的 and body's身體的
stress強調 response響應 system系統
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08:05
that governs共治 our fight-or-flight戰鬥或逃跑 response響應.
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影響著我們「戰還是逃」的決定。
08:09
How does it work?
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這是怎麼運作的呢?
08:11
Well, imagine想像 you're walking步行
in the forest森林 and you see a bear.
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想像一下, 你在森林中看見一隻熊。
你的下丘腦會瞬間發送信號到腦垂體,
08:15
Immediately立即, your hypothalamus下丘腦
sends發送 a signal信號 to your pituitary垂體,
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腦垂體向腎上腺發信號,
08:19
which哪一個 sends發送 a signal信號
to your adrenal腎上腺 gland that says,
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「釋放應激激素!腎上腺素!皮質醇!」
08:22
"Release發布 stress強調 hormones激素!
Adrenaline腎上腺素! Cortisol皮質醇!"
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08:25
And so your heart starts啟動 to pound,
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然後你開始心跳加快,
瞳孔放大,呼吸道大開,
08:28
Your pupils學生 dilate膨脹, your airways航空公司 open打開 up,
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08:30
and you are ready準備 to either
fight鬥爭 that bear or run from the bear.
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你已經做好準備,
跟這只熊抗擊或逃跑。
08:36
And that is wonderful精彩
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這非常重要,
08:38
if you're in a forest森林
and there's a bear.
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如果你在森林中,而那裡有隻熊。
08:42
(Laughter笑聲)
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(笑)
08:45
But the problem問題 is what happens發生
when the bear comes home every一切 night,
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但問題是,
如果這只熊每天都來騷擾你,
08:50
and this system系統 is activated活性
over and over and over again,
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這個應激系統
一而再再而三地啓動,
08:56
and it goes from being存在
adaptive自適應, or life-saving救生,
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它從一種適應性或救命的系統,,
09:00
to maladaptive不適應, or health-damaging損害健康.
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變成適應不良或有損健康的系統。
09:04
Children孩子 are especially特別 sensitive敏感
to this repeated重複 stress強調 activation激活,
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兒童對這種反復的應激激活很敏感,
09:10
because their brains大腦 and bodies身體
are just developing發展.
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因爲他們的大腦和身體
都還在發育階段,
09:14
High doses劑量 of adversity逆境 not only affect影響
brain structure結構體 and function功能,
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大量的逆境
不單損傷他們的大腦結構和功能,
09:20
they affect影響 the developing發展 immune免疫的 system系統,
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還會影響發育中的免疫系統、
09:23
developing發展 hormonal激素 systems系統,
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激素系統,
09:26
and even the way our DNA脫氧核糖核酸
is read and transcribed轉錄.
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甚至影響 DNA 的讀取和轉錄方式。
09:32
So for me, this information信息
threw my old training訓練 out the window窗口,
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對我而言,
這個發現顛覆了我以前的認知,
09:37
because when we understand理解
the mechanism機制 of a disease疾病,
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因爲當我們明白了一種疾病的機制,
09:41
when we know not only
which哪一個 pathways途徑 are disrupted破壞, but how,
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知道了被干擾的路徑及方式,
09:45
then as doctors醫生, it is our job工作
to use this science科學
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作爲醫生,我們理應運用科學
09:50
for prevention預防 and treatment治療.
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去預防和治療這種疾病。
09:53
That's what we do.
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是職責所在。
09:54
So in San Francisco弗朗西斯科, we created創建
the Center中央 for Youth青年 Wellness健康
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於是,我們在舊金山
創立了青少年健康中心,
用以預防、檢查並治癒
因 ACE 及有害壓力所造成的影響。
09:58
to prevent避免, screen屏幕 and heal癒合 the impacts影響
of ACEs的ACE and toxic有毒的 stress強調.
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我們開始對每個孩子做檢查,
作為常規體檢的一部分,
10:04
We started開始 simply只是 with routine常規 screening篩查
of every一切 one of our kids孩子
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10:09
at their regular定期 physical物理,
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10:10
because I know that if my patient患者
has an ACE高手 score得分了 of 4,
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因爲我知道
如果病人有 4 分的 ACE 值,
她患肝炎或慢性阻塞性肺病
機率是 2.5 倍,
10:15
she's two and a half times as likely容易
to develop發展 hepatitis肝炎 or COPD慢性阻塞性肺病,
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10:19
she's four and half times as likely容易
to become成為 depressed鬱悶,
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4.5 倍的機率患憂鬱,
10:22
and she's 12 times as likely容易
to attempt嘗試 to take her own擁有 life
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12 倍的機率選擇自殺,
比那些 ACE 為 0 的人而言。
10:26
as my patient患者 with zero ACEs的ACE.
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10:29
I know that when she's in my exam考試 room房間.
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當她在檢查室裡,我就知道了。
10:32
For our patients耐心 who do screen屏幕 positive,
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檢查結果呈陽性的患者,
10:35
we have a multidisciplinary多學科 treatment治療 team球隊
that works作品 to reduce減少 the dose劑量 of adversity逆境
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我們有支多學科的團隊,
致力於降低逆境的影響。
10:40
and treat對待 symptoms症狀 using運用 best最好 practices做法,
including包含 home visits訪問, care關心 coordination協調,
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運用最好的療法,
包括家訪、協調護理、
10:46
mental心理 health健康 care關心, nutrition營養,
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心理保健及營養均衡、
全面干預措施,
以及藥物治療,有必要的話。
10:50
holistic整體 interventions干預措施, and yes,
medication藥物治療 when necessary必要.
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同時我們也向家長普及
ACE 和有害壓力的危害。
10:54
But we also educate教育 parents父母
about the impacts影響 of ACEs的ACE and toxic有毒的 stress強調
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10:59
the same相同 way you would for covering覆蓋
electrical電動 outlets網點, or lead poisoning中毒,
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這危害可與觸電或鉛中毒相提並論。
同時我們調整對哮喘患者
和糖尿病患者的護理,
11:05
and we tailor裁縫 the care關心
of our asthmatics哮喘 and our diabetics糖尿病
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11:09
in a way that recognizes識別 that they may可能
need more aggressive侵略性 treatment治療,
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意識到他們可能需要更積極的治療,
11:13
given特定 the changes變化 to their hormonal激素
and immune免疫的 systems系統.
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因為他們的荷爾蒙
和免疫系統受到了影響。
11:17
So the other thing that happens發生
when you understand理解 this science科學
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知道這個科學道理後,
11:22
is that you want to shout it
from the rooftops屋頂,
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你會想要廣而告之,
11:25
because this isn't just an issue問題
for kids孩子 in Bayview灣景.
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因爲這不僅是灣景區孩子們的問題。
11:29
I figured想通 the minute分鐘
that everybody每個人 else其他 heard聽說 about this,
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我以為每個人明白這道理後,
11:33
it would be routine常規 screening篩查,
multi-disciplinary多學科 treatment治療 teams球隊,
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相關檢查會變為常規,
多學科團隊會組成,
11:36
and it would be a race種族 to the most
effective有效 clinical臨床 treatment治療 protocols協議.
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大家爭先尋找有效治療方案。
11:41
Yeah. That did not happen發生.
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但這些都沒有發生。
11:45
And that was a huge巨大 learning學習 for me.
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對我而言,這是個大教訓。
11:48
What I had thought of as simply只是
best最好 clinical臨床 practice實踐
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我簡單地認為
找到最好的治療方法就能解決。
11:53
I now understand理解 to be a movement運動.
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現在我明白了,這是一場運動。
11:57
In the words of Dr博士. Robert羅伯特 Block,
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如美國兒科學會的前會長
羅伯特博士所說:
11:59
the former前任的 President主席
of the American美國 Academy學院 of Pediatrics兒科,
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「不良的童年經歷
12:03
"Adverse不利的 childhood童年 experiences經驗
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12:06
are the single greatest最大
unaddressed未解決 public上市 health健康 threat威脅
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是現時我國唯一一個最大的
未解決的公共健康威脅。」
12:11
facing面對 our nation國家 today今天."
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12:13
And for a lot of people,
that's a terrifying可怕的 prospect展望.
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對於大多數人而言,
這個前景並不樂觀。
這個問題的範圍和規模似乎太大了,
12:18
The scope範圍 and scale規模 of the problem問題
seems似乎 so large that it feels感覺 overwhelming壓倒
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以至讓人感覺這難以解決。
12:24
to think about how we might威力 approach途徑 it.
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但於我而言,那正是希望之所在,
12:26
But for me, that's actually其實
where the hopes希望 lies,
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12:31
because when we have the right framework骨架,
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因爲當我們有正確的框架,
12:33
when we recognize認識 this to be
a public上市 health健康 crisis危機,
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並意識到這是個公眾健康危機,
我們就可以開始運用合適的工具
去找出解決辦法。
12:38
then we can begin開始 to use the right
tool工具 kit套件 to come up with solutions解決方案.
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12:43
From tobacco煙草 to lead poisoning中毒
to HIVHIV/AIDS艾滋病,
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例如煙草、鉛中毒、愛滋病,
12:47
the United聯合的 States狀態 actually其實 has
quite相當 a strong強大 track跟踪 record記錄
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美國在解決公共健康問題方面,
實際上保持了良好的記錄,
12:52
with addressing解決 public上市 health健康 problems問題,
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12:55
but replicating複製 those successes成功
with ACEs的ACE and toxic有毒的 stress強調
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若要在 ACE
和有害壓力方面也成功,
13:01
is going to take determination決心
and commitment承諾,
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將需要決心和承諾,
13:05
and when I look at what
our nation's國家 response響應 has been so far,
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基於現時我看到民眾對此的反響,
13:09
I wonder奇蹟,
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我想知道,
爲什麽我們沒有
更嚴肅地看待這個問題?
13:11
why haven't沒有 we taken採取 this more seriously認真地?
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13:15
You know, at first I thought
that we marginalized邊緣化 the issue問題
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起初我以為我們忽略了這個問題,
13:19
because it doesn't apply應用 to us.
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以為它和我們無關,
13:21
That's an issue問題 for those kids孩子
in those neighborhoods社區.
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那只是鄰居家孩子的問題。
13:24
Which哪一個 is weird奇怪的, because the data數據
doesn't bear that out.
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這很奇怪,
因爲數據不支持這個說法。
13:28
The original原版的 ACEs的ACE study研究
was doneDONE in a population人口
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在最早的 ACE 研究中,
13:32
that was 70 percent百分 Caucasian高加索,
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白種人占 70%,
13:35
70 percent百分 college-educated受過大學教育.
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受過大學教育的占 70%。
13:38
But then, the more I talked to folks鄉親,
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但我愈向人們談論此問題,
13:42
I'm beginning開始 to think that maybe
I had it completely全然 backwards向後.
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我愈認為我可能本末倒置了。
13:47
If I were to ask
how many許多 people in this room房間
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若我問在座各位有多少人
13:53
grew成長 up with a family家庭 member會員
who suffered遭遇 from mental心理 illness疾病,
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與患有心理疾病的家人一起長大,
我打賭有幾個人會舉起手。
13:57
I bet賭注 a few少數 hands would go up.
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14:00
And then if I were to ask how many許多 folks鄉親
had a parent who maybe drank too much,
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若我問有多少人的父母經常喝醉酒,
14:05
or who really believed相信 that
if you spare備用 the rod竿, you spoil溺愛 the child兒童,
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或認為你不打孩子就是溺愛他們,
14:11
I bet賭注 a few少數 more hands would go up.
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我打賭會有更多人舉起手。
14:14
Even in this room房間, this is an issue問題
that touches觸摸 many許多 of us,
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即使是在這個會場,
這個問題也影響了很多人,
14:19
and I am beginning開始 to believe
that we marginalize邊緣化 the issue問題
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我開始認為,我們忽視這個問題
14:22
because it does apply應用 to us.
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正因爲它影響著我們。
14:25
Maybe it's easier更輕鬆 to see
in other zip壓縮 codes代碼
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或許作為旁觀者更易看清,
因爲我們寧願生病,
也不想面對這個問題。
14:28
because we don't want to look at it.
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14:31
We'd星期三 rather be sick生病.
222
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14:34
Fortunately幸好, scientific科學 advances進步
and, frankly坦率地說, economic經濟 realities現實
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幸運的是,科學的進步以及
坦率地說,經濟現實
14:40
make that option選項 less viable可行 every一切 day.
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逐漸使我們變得難以忽視它。
14:45
The science科學 is clear明確:
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科學道理很明確:
14:48
Early adversity逆境 dramatically顯著 affects影響
health健康 across橫過 a lifetime一生.
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童年逆境對健康
有著終身性的巨大影響。
14:54
Today今天, we are beginning開始 to understand理解
how to interrupt打斷 the progression級數
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現在我們開始了解如何阻止其發展,
14:58
from early adversity逆境
to disease疾病 and early death死亡,
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從童年逆境發展到疾病和過早死亡,
15:03
and 30 years年份 from now,
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現在開始未來 30 年裡,
15:05
the child兒童 who has a high ACE高手 score得分了
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ACE 指數過高的小孩,
15:08
and whose誰的 behavioral行為的 symptoms症狀
go unrecognized無法識別,
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若其行為症狀無法確認,
15:11
whose誰的 asthma哮喘 management管理
is not connected連接的,
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哮喘治療未與 ACE 關聯,
15:13
and who goes on to develop發展
high blood血液 pressure壓力
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逐漸發展成爲高血壓,
15:17
and early heart disease疾病 or cancer癌症
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或是早期心臟病或癌症,
15:20
will be just as anomalous異常的
as a six-month6個月 mortality死亡 from HIVHIV/AIDS艾滋病.
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這將和患愛滋病六個月
就死亡一樣異常。
15:25
People will look at that situation情況
and say, "What the heck赫克 happened發生 there?"
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對此,人們會問:
「到底發生了什麼?」
15:30
This is treatable可治療.
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這是可以治癒的。
15:32
This is beatable不可戰勝的.
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可以戰勝的。
15:35
The single most important重要 thing
that we need today今天
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現在我們需要做最重要的一件事是
15:39
is the courage勇氣 to look
this problem問題 in the face面對
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勇於直接面對這個問題,
15:43
and say, this is real真實
and this is all of us.
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接受這就是現實,
它和我們息息相關。
15:48
I believe that we are the movement運動.
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我認為我們就是這項運動的關鍵。
15:53
Thank you.
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謝謝。
15:54
(Applause掌聲)
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(掌聲)
Translated by Marssi Draw
Reviewed by Regina Chu

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ABOUT THE SPEAKER
Nadine Burke Harris - Pediatrician
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.

Why you should listen

Pediatrician Nadine Burke Harris noticed a disturbing trend as she treated children in an underserved neighborhood in San Francisco: that many of the kids who came to see her had experienced childhood trauma. She began studying how childhood exposure to adverse events affects brain development, as well as a person’s health as an adult.

Understanding this powerful correlation, Burke Harris became the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for medical interventions to counteract the damaging impact of stress. Her goal: to change the standard of pediatric practice, across demographics.

More profile about the speaker
Nadine Burke Harris | Speaker | TED.com