TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bil Davenhal: Vaše zdravlje zavisi od vašeg mjesta življenja.
Filmed:
Readability: 3.2
940,322 views
Gdje živite: To utiče na vaše zdravlje u istoj mjeri koliko dijete i geni, ali taj podatak ne ulazi u vaše medicinske nalaze. U TEDMED-u, Bil Davenhal pokazuje kako se nedovoljno prostudirani geo-podaci vlade (od omjera lokalnih srčanih udara do informacija o mjestima istovara toksičnih otpada) mogu povezati sa mobilnim GPS aplikacijam u svrhu boljeg informisanja samih doktora. Zovite to ''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
0
0
3000
Mogu li vas geografske informacije
00:18
make you healthy?
1
3000
4000
načiniti zdravim?
00:22
In 2001 I got hit by a train.
2
7000
4000
2001. mene je udario voz.
00:26
My train was a heart attack.
3
11000
3000
Moj voz je bio srčani udar.
00:29
I found myself in a hospital
4
14000
2000
Našao sam se u bolnici
00:31
in an intensive-care ward,
5
16000
2000
na odjelu intenzivne njege,
00:33
recuperating from emergency surgery.
6
18000
3000
oporavljajući se od hitne operacije.
00:36
And I suddenly realized something:
7
21000
2000
I iznenada sam shvatio:
00:38
that I was completely in the dark.
8
23000
3000
bio sam u potpunosti neinformisan.
00:41
I started asking my questions, "Well, why me?"
9
26000
2000
Počeo sam postavljati svoja pitanja, ''Pa, zašto ja?''
00:43
"Why now?" "Why here?"
10
28000
2000
''Zašto sada?'' ''Zašto ovdje?''
00:45
"Could my doctor have warned me?"
11
30000
3000
''Da li me je moj doktor mogao upozoriti?''
00:48
So, what I want to do here in the few minutes I have with you
12
33000
3000
Zato, ono što ja želim uraditi u par minuta koje imam sa vama
00:51
is really talk about what is the formula for life and good health.
13
36000
5000
jeste da govorim o formuli za život i dobro zdravlje.
00:56
Genetics, lifestyle and environment.
14
41000
3000
Genetika, stil življenja i okruženje.
00:59
That's going to sort of contain our risks,
15
44000
2000
U njima će se, na neki način, sadržavati naši rizici
01:01
and if we manage those risks
16
46000
2000
i ako mi kontrolišemo te rizike
01:03
we're going to live a good life and a good healthy life.
17
48000
3000
imat ćemo dobar i veoma zdrav život.
01:06
Well, I understand the genetics and lifestyle part.
18
51000
4000
Naime, ja se razumijem u dio koji se odnosi na genetiku i način življenja.
01:10
And you know why I understand that?
19
55000
2000
I znate li zašto se u to razumijem?
01:12
Because my physicians constantly
20
57000
3000
Zato što su mi moji doktori konstantno
01:15
ask me questions about this.
21
60000
2000
postavljali pitanja o tome.
01:17
Have you ever had to fill out those long,
22
62000
2000
Da li ste ikada morali popopunjavati one duge
01:19
legal-size forms in your doctor's office?
23
64000
3000
formulare, veličine zakonskih formulara, u ordinaciji vašeg doktora?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
24
67000
3000
Milsim, ako ste dovoljno sretni taj će te proces ponoviti više puta, zar ne?
01:25
(Laughter)
25
70000
1000
(Smijeh)
01:26
Do it over and over again. And they ask you questions
26
71000
2000
Popunite ih nekoliko puta. I oni vas pitaju
01:28
about your lifestyle and your family history,
27
73000
3000
o vašem načinu življenja i porodičnoj istoriji,
01:31
your medication history, your surgical history,
28
76000
4000
o vašoj istoriji konzumiranja lijekova, vašoj istoriji operacija,
01:35
your allergy history ... did I forget any history?
29
80000
4000
vašoj istoriji alergija ... da li sam zaboravio neku istoriju?
01:39
But this part of the equation I didn't really get,
30
84000
4000
Ali ovaj dio jednačine ni ja nisam u potpunosti shvatio.
01:43
and I don't think my physicians
31
88000
3000
I mislim da ni moji doktori
01:46
really get this part of the equation.
32
91000
2000
ustvari ne razumiju ovaj dio jednačine.
01:48
What does that mean, my environment?
33
93000
3000
Šta to znači, moje okruženje?
01:51
Well, it can mean a lot of things.
34
96000
2000
Pa, to može značiti mnogo toga.
01:53
This is my life. These are my life places.
35
98000
3000
Ovo je moj život. Ovo su moja mjesta u životu.
01:56
We all have these.
36
101000
2000
Mi ih svi imamo.
01:58
While I'm talking I'd like you to also be thinking about:
37
103000
3000
Dok ja pričam, želio bih da i vi također razmišljate o broju mjesta
02:01
How many places have you lived?
38
106000
3000
u kojima ste boravili.
02:04
Just think about that, you know, wander through
39
109000
2000
Samo mislite o tome, hoću reći, lutajte kroz
02:06
your life thinking about this.
40
111000
2000
svoj život razmišljajući o ovome.
02:08
And you realize that you spend it in a variety of different places.
41
113000
4000
I shvatiti ćete da ste ga proveli na raznim i različitim mjestima.
02:12
You spend it at rest and you spend it at work.
42
117000
2000
Proveli ste ga u odmaranju i na poslu.
02:14
And if you're like me, you're in an airplane a good portion of your time
43
119000
3000
I ako ste poput mene, dobar dio svog vremena provodite u avionu
02:17
traveling some place.
44
122000
2000
putujući negdje.
02:19
So, it's not really simple
45
124000
2000
Tako da to nije uopšte toliko jednostavno
02:21
when somebody asks you, "Where do you live, where do you work,
46
126000
2000
kada vas neko pita, ''Gdje živite, gdje radite,
02:23
and where do you spend all your time?
47
128000
2000
i gdje provodite svo vaše vrijeme?
02:25
And where do you expose yourselves to risks
48
130000
3000
I gdje se izlažete rizicima
02:28
that maybe perhaps you don't even see?"
49
133000
4000
koje možda i ne vidite?''
02:32
Well, when I have done this on myself,
50
137000
2000
Pa, kada sam ja ovo uradio na sebi,
02:34
I always come to the conclusion
51
139000
2000
uvijek sam dolazio do zaključka
02:36
that I spend about 75 percent of my time
52
141000
4000
da provodim oko 75 posto svog vremena
02:40
relatively in a small number of places.
53
145000
3000
na relativno malom broju mjesta.
02:43
And I don't wander far from that place
54
148000
2000
I ne lutam daleko od tog mjesta
02:45
for a majority of my time,
55
150000
2000
veći dio svog vremena,
02:47
even though I'm an extensive global trekker.
56
152000
5000
iako sam veoma globalno prostran putnik.
02:52
Now, I'm going to take you on a little journey here.
57
157000
2000
Sada ću vas povesti na malo putovanje.
02:54
I started off in Scranton, Pennsylvania.
58
159000
2000
Ja sam počeo u Skrentonu, u Pensilvaniji
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
59
161000
3000
Ne znam da li možda neko dolazi iz sjeverno-istočne Pensilvanije.
02:59
but this is where I spent my first 19 years
60
164000
3000
Ali ovdje sam proveo svojih prvih 19 godina
03:02
with my little young lungs.
61
167000
2000
sa svojim malim i mladim plućima.
03:04
You know, breathing high concentrations here
62
169000
3000
Znate, udišući velike koncentracije
03:07
of sulfur dioxide, carbon dioxide
63
172000
2000
sulfor dioksida, karbon dioksida
03:09
and methane gas,
64
174000
2000
i metan gasa,
03:11
in unequal quantities -- 19 years of this.
65
176000
3000
u nejednakim količinama - 19 godina ovoga.
03:14
And if you've been in that part of the country,
66
179000
2000
I ako ste bili u tom dijelu države,
03:16
this is what those piles of burning, smoldering coal waste look like.
67
181000
4000
ovo je kako te gomile sagorjevajućeg, tinjajućeg otpada uglja izgledaju.
03:20
So then I decided to leave that part of the world,
68
185000
3000
Tako da sam tada odlučio napustiti taj dio svijeta.
03:23
and I was going to go to the mid-west.
69
188000
3000
I planirao sam otići na srednji-zapad.
03:26
OK, so I ended up in Louisville, Kentucky.
70
191000
3000
Uredu, i tako sam završio u Luivilu, u Kentakiju.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
71
194000
4000
Onda sam odlučio biti susjed sa mjestom zvanim Rabertaun.
03:33
They manufacture plastics. They use large quantities chloroprene
72
198000
3000
Oni proizvode plastiku. Koriste velike količine kloroprena
03:36
and benzene.
73
201000
2000
i benzena.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
74
203000
5000
Uredu, proveo sam 25 godina, sa svojim plućima sada srednjih godina
03:43
breathing various concentrations of that.
75
208000
3000
udišući razne koncentracije toga.
03:46
And on a clear day it always looked like this, so you never saw it.
76
211000
4000
I na vedar dan uvijek je izgledalo ovako, tako da to nikad niste vidjeli.
03:50
It was insidious and it was really happening.
77
215000
3000
To je bilo podmuklo i zaista se događalo.
03:53
Then I decided I had to get really smart,
78
218000
2000
I onda sam odlučio da moram postati veoma pametan,
03:55
I would take this job in the West Coast.
79
220000
3000
i da ću prihvatiti ovaj posao na zapadnoj obali.
03:58
And I moved to Redlands California.
80
223000
3000
Tako sam se preselio u Redlands u Kaliforniji.
04:01
Very nice, and there
81
226000
2000
Veoma fino, i tamo sam
04:03
my older, senior lungs, as I like to call them,
82
228000
4000
moja starija, seniorska pluća, kako ih ja volim zvati,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
83
232000
6000
napunio česticama supstanci, karbon dioksidom i veoma visokim količinama ozona.
04:13
Okay? Almost like the highest in the nation.
84
238000
2000
U redu? Skoro sa najvećim nivoom u naciji.
04:15
Alright, this is what it looks like on a good day.
85
240000
2000
Eh sada, ovako ono izgleda na dobar dan.
04:17
If you've been there, you know what I'm talking about.
86
242000
3000
Ako ste bili tamo onda znate o čemu govorim.
04:20
So, what's wrong with this picture?
87
245000
3000
Prema tome, šta nije uredu sa ovom slikom?
04:23
Well, the picture is, there is a huge gap here.
88
248000
2000
Pa, slika je, ovdje ima velika praznina.
04:25
The one thing that never happens in my doctor's office:
89
250000
4000
Jedna stvar koja se nikada ne događa u kancelariji mog doktora je:
04:29
They never ask me about my place history.
90
254000
3000
nikada me ne pitaju o istoriji mojih mjesta boravka.
04:32
No doctor, can I remember, ever asking me,
91
257000
3000
Niti jedan doktor, koliko se mogu sjetiti, me nije pitao
04:35
"Where have you lived?"
92
260000
2000
''Gdje ste živjeli?''
04:37
They haven't asked me what kind of the quality
93
262000
2000
Nisu me pitali o kvalitetu
04:39
of the drinking water that I put in my mouth
94
264000
2000
pitke vode koju stavljam u svoja usta,
04:41
or the food that I ingest into my stomach.
95
266000
4000
ili hrane koju unosim u stomak.
04:45
They really don't do that. It's missing.
96
270000
3000
Oni to stvarno ne rade. To nedostaje.
04:48
Look at the kind of data that's available.
97
273000
3000
Pogledajte vrste podataka koje su dostupne.
04:51
This data's from all over the world --
98
276000
2000
Ovi podaci su iz svih dijelova svijeta -
04:53
countries spend billions of dollars investing in this kind of research.
99
278000
4000
zemlje troše milijarde dolara ulažući ih u ove vrste istraživanja.
04:57
Now, I've circled the places where I've been.
100
282000
3000
Ja sam zaokružio mjesta gdje sam bio.
05:00
Well, by design, if I wanted to have a heart attack
101
285000
3000
Tako da, prema dizajnu, ako sam želio da imam srčani udar
05:03
I'd been in the right places. Right?
102
288000
5000
onda sam bio na pravim mjestima. Zar ne?
05:08
So, how many people are in the white?
103
293000
2000
Prema tome, koliko ljudi je u bijelom?
05:10
How many people in the room have spent the majority of their life
104
295000
2000
Koliko ljudi u prostoriji su proveli veći dio svojih života
05:12
in the white space?
105
297000
3000
u bijelim mjestima?
05:15
Anybody? Boy you're lucky.
106
300000
2000
Iko? Kako ste samo sretni.
05:17
How many have spent it in the red places?
107
302000
3000
Koliko vas je provelo vremena u crvenim mjestima?
05:20
Oh, not so lucky.
108
305000
2000
Oh, ne baš toliko sretni.
05:22
There are thousands of these kinds of maps
109
307000
3000
Postoje hiljade ovakvih karti
05:25
that are displayed in atlases
110
310000
2000
koje su prikazane u atlasima
05:27
all over the world.
111
312000
2000
po cijelom svijetu.
05:29
They give us some sense of what's going
112
314000
2000
Oni nam daju neki smisao o tome šta će
05:31
to be our train wreck.
113
316000
3000
biti naš sudar sa vozom.
05:34
But none of that's in my medical record.
114
319000
2000
Ali ništa od toga nije u mom medicinskom kartonu.
05:36
And it's not in yours either.
115
321000
2000
I nije ni u vašem.
05:38
So, here's my friend Paul.
116
323000
2000
Ovo je moj prijatelj Pol.
05:40
He's a colleague. He allowed his cell phone to be tracked
117
325000
4000
On je moj kolega. On je dozvolio da mu prate mobilni telefon
05:44
every two hours, 24/7,
118
329000
3000
svaka dva sata, 24 sata u sedmici,
05:47
365 days out of the year
119
332000
2000
365 dana u godini,
05:49
for the last two years, everywhere he went.
120
334000
3000
u posljednje dvije godine, gdje god da je išao.
05:52
And you can see he's been to a few places around the United States.
121
337000
4000
I možete vidjeti da je bio na nekoliko mjesta po cijelim Ujedinjenim Državama.
05:56
And this is where he has spent most of his time.
122
341000
4000
I ovdje je provodio veći dio svog vremena.
06:00
If you really studied that you might have some clues
123
345000
3000
Ako to usitinu prostudirate možda će te shvatiti
06:03
as to what Paul likes to do.
124
348000
3000
šta to Pol voli raditi.
06:06
Anybody got any clues? Ski. Right.
125
351000
3000
Da li iko ima neku ideju? Skijanje. Tako je.
06:09
We can zoom in here, and we suddenly see
126
354000
3000
Možemo ovdje zumirati, i iznenada uviđamo
06:12
that now we see where Paul has really spent a majority of his time.
127
357000
4000
da sada primjećujemo gdje je Pol zaista provodio veći dio svog vremena.
06:16
And all of those black dots are all of the
128
361000
4000
I sve te crne tačke su mjesta
06:20
toxic release inventories
129
365000
2000
oslobađanja toksičkih zaliha
06:22
that are monitored by the EPA.
130
367000
2000
koje nadgleda EPA (Agencija za Zaštitu Okoline).
06:24
Did you know that data existed?
131
369000
3000
Jeste li znali da ti podaci postoje?
06:27
For every community in the United States,
132
372000
2000
Za svaku zajednicu u Sjedinjenim Američkim Državama,
06:29
you could have your own personalized map of that.
133
374000
4000
mogli biste imati istu, ali svoju ličnu mapu.
06:33
So, our cell phones can now build a place history.
134
378000
3000
Tako da sada, naši mobilni telefoni, mogu izgraditi mjesto u istoriji.
06:36
This is how Paul did it. He did it with his iPhone.
135
381000
3000
Ovo je način na koji je to Pol uradio. On je to izvršio sa svojim iPhone-om.
06:39
This might be what we end up with.
136
384000
2000
Ovo može biti ono s čime ćemo završiti.
06:41
This is what the physician would have
137
386000
3000
Ovo je ono što će doktori imati
06:44
in front of him and her when we enter that exam room
138
389000
3000
ispred sebe kada uđemo u tu ordinaciju
06:47
instead of just the pink slip that said I paid at the counter. Right?
139
392000
4000
umjesto same otpusnice koja govori kako smo platili na šalteru. Zar ne?
06:51
This could be my little assessment.
140
396000
2000
Ovo bi mogla biti moja mala procjena.
06:53
And he looks at that and he says,
141
398000
2000
I on pogleda u to i kaže,
06:55
"Whoa Bill,
142
400000
2000
''Uh Bil,
06:57
I suggest that maybe you not decide,
143
402000
3000
ja predlažem da možda ne odlučuješ,
07:00
just because you're out here in beautiful California,
144
405000
2000
samo zbog toga što si ovdje u prelijepoj Kaliforniji
07:02
and it's warm every day,
145
407000
2000
i zbog toga što je toplo svakog dana
07:04
that you get out and run at six o'clock at night.
146
409000
3000
da izađeš trčati u šest sati navečer.
07:07
I'd suggest that that's a bad idea Bill,
147
412000
3000
Ja to smatram kao lošu ideju Bil,
07:10
because of this report."
148
415000
3000
uzimajući u obzir ovaj izvještaj.''
07:13
What I'd like to leave you for are two prescriptions.
149
418000
4000
Ono s čime bih ja vas htio ostaviti su dva recepta.
07:17
Okay, number one is, we must teach physicians
150
422000
2000
Ok, broj jedan je taj da moramo naučiti doktore
07:19
about the value of geographical information.
151
424000
4000
o vrijednosti geografskih informacija.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
152
428000
4000
To se zove geomedicina. Trenutno postoji otprilike šest programa u svijetu
07:27
that are focused on this.
153
432000
2000
koji su fokusirani na ovo.
07:29
And they're in the early stages of development.
154
434000
3000
I oni se nalaze u ranim fazama razvoja.
07:32
These programs need to be supported,
155
437000
3000
Ovi programi moraju biti podržani.
07:35
and we need to teach our future
156
440000
2000
I mi moramo naučiti naše buduće
07:37
doctors of the world
157
442000
2000
doktore svijeta
07:39
the importance of some of the information
158
444000
2000
važnosti nekih informacija
07:41
I've shared here with you today.
159
446000
2000
koje sam podijelio ovdje s vama danas.
07:43
The second thing we need to do
160
448000
2000
Druga stvar koju moramo uraditi
07:45
is while we're spending billions and billions
161
450000
2000
jeste da, dok trošimo milijarde i milijarde
07:47
of dollars all over the world
162
452000
3000
dolara po cijelom svijetu
07:50
building an electronic health record,
163
455000
2000
na izradu elektonskih zdravstvenih podataka,
07:52
we make sure we put a place history
164
457000
2000
mi moramo da stavimo istoriju mjesta boravka
07:54
inside that medical record.
165
459000
3000
unutar naših zdravstvenih podataka.
07:57
It not only will be important for the physician;
166
462000
3000
To neće biti bitno samo za doktore;
08:00
it will be important for the researchers
167
465000
2000
to će biti bitno za istraživače
08:02
that now will have huge samples to draw upon.
168
467000
4000
koji će sada imati mnoštvo uzoraka koje mogu iskoristiti.
08:06
But it will also be useful for us.
169
471000
2000
Ali to će također biti korisno za nas.
08:08
I could have made the decision, if I had this information,
170
473000
4000
Mogao sam donijeti odluku, da sam imao ovu informaciju,
08:12
not to move to the ozone capital
171
477000
3000
da se ne preselim u glavni ozonski grad
08:15
of the United States, couldn't I? I could make that decision.
172
480000
3000
Sjedinjenih Američkih Država. Zar nisam? Mogao sam donijeti tu odluku.
08:18
Or I could negotiate with my employer
173
483000
2000
Ili sam mogao pregovarati sa svojim uposlenikom
08:20
to make that decision
174
485000
2000
da donesem odluku
08:22
in the best interest of myself and my company.
175
487000
6000
koja je u mom najboljem interesu kao i interesu same kompanije.
08:28
With that, I would like to just say that Jack Lord said
176
493000
3000
Sa time, volio bih dodati kako je Džek Lord ovo rekao
08:31
this almost 10 years ago.
177
496000
3000
prije skoro 10 godina.
08:34
Just look at that for a minute.
178
499000
2000
Samo pogledajte to na trenutak.
08:36
That was what the conclusion
179
501000
2000
To je bio zaključak
08:38
of the Dartmouth Atlas of Healthcare was about,
180
503000
3000
samog Dartmut Atlas-a Zdravstvene skrbi,
08:41
was saying that we can explain the geographic variations
181
506000
3000
gdje su takođe govorili kako možemo objasniti geografske varijacije
08:44
that occur in disease, in illness, in wellness,
182
509000
4000
koje se pojavljuju u bolestima, oboljenjima, zdravlju,
08:48
and how our healthcare system actually operates.
183
513000
3000
i kako naš sistem zdravstvene skrbi, ustvari, funkcioniše.
08:51
That was what he was talking about
184
516000
2000
On je o tome pričao
08:53
on that quote.
185
518000
2000
u tom citatu.
08:55
And I would say he got it right almost a decade ago.
186
520000
4000
I mogu reći da je pogodio i to skoro prije 10 godina.
08:59
So, I'd very much like to see us begin to
187
524000
2000
Tako da bih ja volio veoma mnogo da mi
09:01
really seize this as an opportunity to get this into our medical records.
188
526000
4000
ovo vidimo kao našu priliku kako bi te podatke uvrstili u naš zdravstveni karton.
09:05
So with that, I'll leave you that
189
530000
2000
Prema tome, ja ću vas ostaviti sa tezom
09:07
in my particular view of view of health:
190
532000
4000
da je, po mom ličnom mišljenju o zdravlju,
09:11
Geography always matters.
191
536000
2000
geografija uvijek bitna.
09:13
And I believe that geographic information
192
538000
2000
I ja vjerujem da geografske informacije
09:15
can make both you and me very healthy. Thank you.
193
540000
2000
mogu vas kao i mene načiniti veoma zdravim. Hvala vam.
09:17
(Applause)
194
542000
3000
(Aplauz)
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