TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall: La teva salut depèn del lloc on vius
Filmed:
Readability: 3.2
940,322 views
El lloc on vius afecta la teva salut tant com l'alimentació i els gens, però no forma part dels teus historials mèdics. A TEDMED, Bill Davenhall ens mostra com dades geogràfiques del govern que es passen per alt (des d'índexs locals d'atacs de cor fins a informació sobre abocadors tòxics) poden acoblar-se amb les aplicacions GPS dels mòbils per mantenir els metges informats.
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
La informació geogràfica
00:18
make you healthy?
1
3000
4000
et pot fer tenir una millor salut?
00:22
In 2001 I got hit by a train.
2
7000
4000
L'any 2001 em va envestir un tren.
00:26
My train was a heart attack.
3
11000
3000
El meu tren va ser un atac de cor.
00:29
I found myself in a hospital
4
14000
2000
Vaig trobar-me a la unitat de
00:31
in an intensive-care ward,
5
16000
2000
cures intensives d'un hospital,
00:33
recuperating from emergency surgery.
6
18000
3000
recuperant-me d'una intervenció quirúrgica d'urgència.
00:36
And I suddenly realized something:
7
21000
2000
I, de sobte, em vaig adonar d'una cosa:
00:38
that I was completely in the dark.
8
23000
3000
que no sabia absolutament res.
00:41
I started asking my questions, "Well, why me?"
9
26000
2000
Vaig començar a demanar-me: "Ostres, per què a mi?",
00:43
"Why now?" "Why here?"
10
28000
2000
"Per què ara?", "Per què aquí?"
00:45
"Could my doctor have warned me?"
11
30000
3000
"El meu metge me'n podria haver previngut?"
00:48
So, what I want to do here in the few minutes I have with you
12
33000
3000
Llavors, el que m'agradaria fer aquí aquesta estona que tinc amb vosaltres
00:51
is really talk about what is the formula for life and good health.
13
36000
5000
és parlar de quina és la fórmula de la vida y de la bona salut.
00:56
Genetics, lifestyle and environment.
14
41000
3000
La genética, l'estil de vida i l'entorn.
00:59
That's going to sort of contain our risks,
15
44000
2000
Això d'alguna manera comportarà certs riscos,
01:01
and if we manage those risks
16
46000
2000
i si aconseguim gestionar aquests riscos
01:03
we're going to live a good life and a good healthy life.
17
48000
3000
viurem una bona vida, una vida plena de salut.
01:06
Well, I understand the genetics and lifestyle part.
18
51000
4000
D'acord, entenc la part de la genètica i de l'estil de vida.
01:10
And you know why I understand that?
19
55000
2000
I, sabeu per què entenc aquestes parts?
01:12
Because my physicians constantly
20
57000
3000
Doncs perquè els meus metges
01:15
ask me questions about this.
21
60000
2000
em fan preguntes sobre això constantment.
01:17
Have you ever had to fill out those long,
22
62000
2000
Alguna vegada heu hagut d'emplenar aquests formularis
01:19
legal-size forms in your doctor's office?
23
64000
3000
llarguíssims a la consulta del vostre metge?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
24
67000
3000
Vull dir, si teniu prou sort ho heu fet més d'una vegada, oi?
01:25
(Laughter)
25
70000
1000
(Rialles)
01:26
Do it over and over again. And they ask you questions
26
71000
2000
Una vegada i una altra. I et fan preguntes sobre
01:28
about your lifestyle and your family history,
27
73000
3000
el teu estil de vida i el teu historial familiar,
01:31
your medication history, your surgical history,
28
76000
4000
el teu historial de medicaments, el teu historial quirúrgic,
01:35
your allergy history ... did I forget any history?
29
80000
4000
el teu historial d'al·lèrgies...m'he oblidat d'algun historial?
01:39
But this part of the equation I didn't really get,
30
84000
4000
Però la que no acabo d'entendre és aquesta part de l'equació.
01:43
and I don't think my physicians
31
88000
3000
I crec que ni els meus metges
01:46
really get this part of the equation.
32
91000
2000
l'entenen de veritat.
01:48
What does that mean, my environment?
33
93000
3000
Què vol dir, el meu entorn?
01:51
Well, it can mean a lot of things.
34
96000
2000
Bé, pot voler dir moltes coses.
01:53
This is my life. These are my life places.
35
98000
3000
Aquesta és la meva vida. Aquests són els llocs de la meva vida.
01:56
We all have these.
36
101000
2000
Tots en tenim.
01:58
While I'm talking I'd like you to also be thinking about:
37
103000
3000
Mentre parlo m'agradaria que vosaltres també penséssiu
02:01
How many places have you lived?
38
106000
3000
a quants llocs heu viscut.
02:04
Just think about that, you know, wander through
39
109000
2000
Només penseu-hi, vull dir, repasseu
02:06
your life thinking about this.
40
111000
2000
la vostra vida pensant-hi.
02:08
And you realize that you spend it in a variety of different places.
41
113000
4000
I us adonareu que l'heu passada a diversos llocs.
02:12
You spend it at rest and you spend it at work.
42
117000
2000
O bé l'heu passada descansat o bé l'heu passada a la feina.
02:14
And if you're like me, you're in an airplane a good portion of your time
43
119000
3000
I si sou com jo, heu passat gran part del vostre temps en un avió
02:17
traveling some place.
44
122000
2000
viatjant a algun lloc.
02:19
So, it's not really simple
45
124000
2000
O sigui que en realitat no és fàcil contestar
02:21
when somebody asks you, "Where do you live, where do you work,
46
126000
2000
quan algú et demana: "On vius, on treballes i
02:23
and where do you spend all your time?
47
128000
2000
on passes tot el teu temps?
02:25
And where do you expose yourselves to risks
48
130000
3000
I on us exposeu a riscos?"
02:28
that maybe perhaps you don't even see?"
49
133000
4000
Potser això ni ho veieu.
02:32
Well, when I have done this on myself,
50
137000
2000
Bé, quan vaig fer això jo mateix,
02:34
I always come to the conclusion
51
139000
2000
vaig arribar a la conclusió
02:36
that I spend about 75 percent of my time
52
141000
4000
que passo un 75 per cent del meu temps
02:40
relatively in a small number of places.
53
145000
3000
en un nombre de llocs relativament petit.
02:43
And I don't wander far from that place
54
148000
2000
I no vaig gaire lluny d'aquests llocs
02:45
for a majority of my time,
55
150000
2000
la major part del meu temps,
02:47
even though I'm an extensive global trekker.
56
152000
5000
tot i que sóc un rodamón.
02:52
Now, I'm going to take you on a little journey here.
57
157000
2000
Bé, ara us faré un petit recorregut.
02:54
I started off in Scranton, Pennsylvania.
58
159000
2000
Vaig començar a Scranton, Pennsilvània.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
59
161000
3000
No sé si hi ha algú aquí que vingui del nord-est de Pennsilvània.
02:59
but this is where I spent my first 19 years
60
164000
3000
Però aquí és on vaig passar els meus primers 19 anys
03:02
with my little young lungs.
61
167000
2000
amb els meus joves pulmons.
03:04
You know, breathing high concentrations here
62
169000
3000
És a dir, respirant concentracions elevades
03:07
of sulfur dioxide, carbon dioxide
63
172000
2000
de diòxid de sofre, diòxid de carboni
03:09
and methane gas,
64
174000
2000
i gas metà
03:11
in unequal quantities -- 19 years of this.
65
176000
3000
en quantitats desiguals -- 19 anys d'això.
03:14
And if you've been in that part of the country,
66
179000
2000
I si heu estat en aquella part del país,
03:16
this is what those piles of burning, smoldering coal waste look like.
67
181000
4000
així és com són aquelles piles roents i fumejants de residus de carbó.
03:20
So then I decided to leave that part of the world,
68
185000
3000
Llavors vaig decidir marxar d'aquella part del món.
03:23
and I was going to go to the mid-west.
69
188000
3000
I vaig optar anar cap a l'Oest Mitjà.
03:26
OK, so I ended up in Louisville, Kentucky.
70
191000
3000
O sigui que vaig acabar a Louisville, Kentucky.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
71
194000
4000
Bé, vaig decidir ser veí d'un lloc anomenat Rubbertown.
03:33
They manufacture plastics. They use large quantities chloroprene
72
198000
3000
Hi fabriquen plàstics. Utilitzen grans quantitals de cloroprè
03:36
and benzene.
73
201000
2000
i benzè.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
74
203000
5000
Bé, doncs vaig estar-hi 25 anys, amb els meus pulmons de mitjana edat,
03:43
breathing various concentrations of that.
75
208000
3000
respirant diverses concentracions d'allò.
03:46
And on a clear day it always looked like this, so you never saw it.
76
211000
4000
I un dia clar era sempre així, o sigui que mai no el veies.
03:50
It was insidious and it was really happening.
77
215000
3000
Era insidiós i estava passant de veritat.
03:53
Then I decided I had to get really smart,
78
218000
2000
I llavors vaig pensar que havia de ser llest
03:55
I would take this job in the West Coast.
79
220000
3000
i vaig acceptar una feina a la Costa Oest.
03:58
And I moved to Redlands California.
80
223000
3000
I em vaig traslladar a Redlands, Califòrnia.
04:01
Very nice, and there
81
226000
2000
Molt maco, i allà
04:03
my older, senior lungs, as I like to call them,
82
228000
4000
els meus pulmons de tercera edat, com m'agrada anomenar-los,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
83
232000
6000
es van omplir de partícules en suspensió, diòxid de carboni i concentracions elevades d'ozò.
04:13
Okay? Almost like the highest in the nation.
84
238000
2000
D'acord? Gairebé les més elevades del país.
04:15
Alright, this is what it looks like on a good day.
85
240000
2000
Bé, així es com es veu si fa bon dia.
04:17
If you've been there, you know what I'm talking about.
86
242000
3000
Si hi heu estat, sabeu de què parlo.
04:20
So, what's wrong with this picture?
87
245000
3000
O sigui que, què és el que no funciona en aquesta imatge?
04:23
Well, the picture is, there is a huge gap here.
88
248000
2000
Doncs que hi ha un forat enorme aquí.
04:25
The one thing that never happens in my doctor's office:
89
250000
4000
L´única cosa que mai no passa a la consulta del meu metge:
04:29
They never ask me about my place history.
90
254000
3000
mai no em demanen el meu historal geogràfic.
04:32
No doctor, can I remember, ever asking me,
91
257000
3000
No recordo cap metge que m'hagi preguntat:
04:35
"Where have you lived?"
92
260000
2000
"On has viscut?"
04:37
They haven't asked me what kind of the quality
93
262000
2000
Tampoc no em fan preguntes sobre la qualitat
04:39
of the drinking water that I put in my mouth
94
264000
2000
de l'aigua que bec,
04:41
or the food that I ingest into my stomach.
95
266000
4000
ni sobre el menjar que arriba al meu estòmac.
04:45
They really don't do that. It's missing.
96
270000
3000
Mai no ho demanen.
04:48
Look at the kind of data that's available.
97
273000
3000
Mireu el tipus d'informació que hi ha disponible.
04:51
This data's from all over the world --
98
276000
2000
Aquesta informació arriba d'arreu del món --
04:53
countries spend billions of dollars investing in this kind of research.
99
278000
4000
els països es gasten mils de milions de dòlars invertint en aquest tipus d'investigacions.
04:57
Now, I've circled the places where I've been.
100
282000
3000
Bé, he encerclat els llocs on he estat.
05:00
Well, by design, if I wanted to have a heart attack
101
285000
3000
Bé, pensant'hi bé, si volia tenir un atac de cor
05:03
I'd been in the right places. Right?
102
288000
5000
he estat als millors llocs, oi?
05:08
So, how many people are in the white?
103
293000
2000
D'acord, quants us esteu a les zones blanques?
05:10
How many people in the room have spent the majority of their life
104
295000
2000
Quants dels que sou aquí heu passat la major part de la vostra vida
05:12
in the white space?
105
297000
3000
a les zones blanques?
05:15
Anybody? Boy you're lucky.
106
300000
2000
Ningú? Tens sort, noi.
05:17
How many have spent it in the red places?
107
302000
3000
Quants l'heu passada a les zones vermelles?
05:20
Oh, not so lucky.
108
305000
2000
Bé, no sou tan afortunats.
05:22
There are thousands of these kinds of maps
109
307000
3000
Hi ha milers de mapes com aquest
05:25
that are displayed in atlases
110
310000
2000
exposats en atles
05:27
all over the world.
111
312000
2000
arreu del món.
05:29
They give us some sense of what's going
112
314000
2000
Ens donen una idea de quin
05:31
to be our train wreck.
113
316000
3000
serà el nostre tren.
05:34
But none of that's in my medical record.
114
319000
2000
Però no n'hi ha cap al meu historial mèdic.
05:36
And it's not in yours either.
115
321000
2000
Ni tampoc al vostre.
05:38
So, here's my friend Paul.
116
323000
2000
Bé, aquí hi ha el meu amic Paul.
05:40
He's a colleague. He allowed his cell phone to be tracked
117
325000
4000
És un company. Va permetre que rastrejessin el seu mòbil
05:44
every two hours, 24/7,
118
329000
3000
cada dues hores, 24 hores, 7 dies la setmana,
05:47
365 days out of the year
119
332000
2000
365 dies de l'any,
05:49
for the last two years, everywhere he went.
120
334000
3000
durant els darrers dos anys, allà on anés.
05:52
And you can see he's been to a few places around the United States.
121
337000
4000
I podeu veure que ha anat a diversos llocs dels Estats Units.
05:56
And this is where he has spent most of his time.
122
341000
4000
I aquí és on ha passat la major part del seu temps.
06:00
If you really studied that you might have some clues
123
345000
3000
Si hi feu un cop d'ull podreu fer-vos una idea
06:03
as to what Paul likes to do.
124
348000
3000
del que li agrada fer al Paul.
06:06
Anybody got any clues? Ski. Right.
125
351000
3000
Alguna idea? Esquiar. D'acord.
06:09
We can zoom in here, and we suddenly see
126
354000
3000
Si augmentem aquí, veurem
06:12
that now we see where Paul has really spent a majority of his time.
127
357000
4000
on ha passat de veritat el Paul la major part del seu temps.
06:16
And all of those black dots are all of the
128
361000
4000
I tots aquests punts negres són tots els
06:20
toxic release inventories
129
365000
2000
enregistraments d'emissions de substàncies tòxiques
06:22
that are monitored by the EPA.
130
367000
2000
que l'Agència de Protecció Ambiental supervisa.
06:24
Did you know that data existed?
131
369000
3000
Sabíeu que aquest tipus d'informació existeix?
06:27
For every community in the United States,
132
372000
2000
Per a cada comunitat dels Estats Units,
06:29
you could have your own personalized map of that.
133
374000
4000
podrieu tenir el vostre propi mapa personalitzat.
06:33
So, our cell phones can now build a place history.
134
378000
3000
O sigui que ara els nostres telèfons mòbils poden crear un historial geogràfic.
06:36
This is how Paul did it. He did it with his iPhone.
135
381000
3000
Així és com ho va fer el Paul. Amb el seu iPhone.
06:39
This might be what we end up with.
136
384000
2000
Això és el que n'hauriem d'obtenir.
06:41
This is what the physician would have
137
386000
3000
Això és el que el metge o la metgessa hauria de tenir
06:44
in front of him and her when we enter that exam room
138
389000
3000
al seu davant quan entréssim a la consulta
06:47
instead of just the pink slip that said I paid at the counter. Right?
139
392000
4000
en comptes de només el full rosa que diu que he pagat al mostrador. Sí?
06:51
This could be my little assessment.
140
396000
2000
Aquesta podria ser la meva petita avaluació.
06:53
And he looks at that and he says,
141
398000
2000
I el mira i diu:
06:55
"Whoa Bill,
142
400000
2000
"Ostres, Bill,
06:57
I suggest that maybe you not decide,
143
402000
3000
et suggereixo que potser no decideixis,
07:00
just because you're out here in beautiful California,
144
405000
2000
només perquè vius aquí, a un lloc tan maco com Califòrnia,
07:02
and it's warm every day,
145
407000
2000
i fa calor cada dia
07:04
that you get out and run at six o'clock at night.
146
409000
3000
sortir a córrer a les sis de la tarda.
07:07
I'd suggest that that's a bad idea Bill,
147
412000
3000
Diria que no és gaire bona idea, Bill,
07:10
because of this report."
148
415000
3000
segons el que diu aquest informe".
07:13
What I'd like to leave you for are two prescriptions.
149
418000
4000
El que m'agradaria deixar-vos són dues receptes.
07:17
Okay, number one is, we must teach physicians
150
422000
2000
D'acord, la primera és que hem d'ensenyar els metges
07:19
about the value of geographical information.
151
424000
4000
la importància que té la informació geogràfica.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
152
428000
4000
S'anomena geomedicina. Hi ha uns sis programes al món ara mateix
07:27
that are focused on this.
153
432000
2000
que es centren en això.
07:29
And they're in the early stages of development.
154
434000
3000
I es troben a les primeres fases de desenvolupament.
07:32
These programs need to be supported,
155
437000
3000
Hem de recolzar aquests programes.
07:35
and we need to teach our future
156
440000
2000
I hem d'ensenyar als nostres futurs
07:37
doctors of the world
157
442000
2000
metges del món
07:39
the importance of some of the information
158
444000
2000
la importància de part de la informació
07:41
I've shared here with you today.
159
446000
2000
que he compartit aquí amb vosaltres avui.
07:43
The second thing we need to do
160
448000
2000
La segona cosa que hem de fer
07:45
is while we're spending billions and billions
161
450000
2000
és que mentre gastem mils i mils de milions
07:47
of dollars all over the world
162
452000
3000
de dòlars arreu del món
07:50
building an electronic health record,
163
455000
2000
creant un historial mèdic electrònic,
07:52
we make sure we put a place history
164
457000
2000
ens assegurem que incloem un historial geogràfic
07:54
inside that medical record.
165
459000
3000
dins d'aquest historial mèdic.
07:57
It not only will be important for the physician;
166
462000
3000
No solament serà important pel metge,
08:00
it will be important for the researchers
167
465000
2000
sinó pels investigadors
08:02
that now will have huge samples to draw upon.
168
467000
4000
que tindran a la seva disposició una gran quantitat de mostres sobre les quals estudiar.
08:06
But it will also be useful for us.
169
471000
2000
Però també ens serà útil a nosaltres.
08:08
I could have made the decision, if I had this information,
170
473000
4000
Podria haver decidit, si hagués tingut aquesta informació,
08:12
not to move to the ozone capital
171
477000
3000
no traslladar-me a la capital de l'ozò
08:15
of the United States, couldn't I? I could make that decision.
172
480000
3000
dels Estats Units, oi? Podria haver pres aquesta decisió.
08:18
Or I could negotiate with my employer
173
483000
2000
O podria haver negociat amb el meu cap
08:20
to make that decision
174
485000
2000
a l'hora de prendre aquesta decisió
08:22
in the best interest of myself and my company.
175
487000
6000
pel meu propi interés i el de la meva empresa.
08:28
With that, I would like to just say that Jack Lord said
176
493000
3000
Amb això, només m'agradaria citar allò que Jack Lord va dir
08:31
this almost 10 years ago.
177
496000
3000
fa gairebé 10 anys.
08:34
Just look at that for a minute.
178
499000
2000
Només mireu això un moment.
08:36
That was what the conclusion
179
501000
2000
Això era el que es discutia a les conclusions
08:38
of the Dartmouth Atlas of Healthcare was about,
180
503000
3000
de l'atles de salut de Dartmouth,
08:41
was saying that we can explain the geographic variations
181
506000
3000
dient que no podem explicar les variacions geogràfiques
08:44
that occur in disease, in illness, in wellness,
182
509000
4000
que es verifiquen a les malalties, a les patologies, al benestar
08:48
and how our healthcare system actually operates.
183
513000
3000
i com funciona el nostre sistema sanitari.
08:51
That was what he was talking about
184
516000
2000
Això és el que ell volia dir
08:53
on that quote.
185
518000
2000
en aquesta citació.
08:55
And I would say he got it right almost a decade ago.
186
520000
4000
I jo diria que la va encertar fa quasi deu anys.
08:59
So, I'd very much like to see us begin to
187
524000
2000
O sigui que m'agradaria molt veure'ns començar a
09:01
really seize this as an opportunity to get this into our medical records.
188
526000
4000
aprofitar de veritat aquesta oportunitat per incloure tot això als nostres historials mèdics.
09:05
So with that, I'll leave you that
189
530000
2000
Doncs amb això us deixo, dient que
09:07
in my particular view of view of health:
190
532000
4000
segons la meva manera de veure la salut
09:11
Geography always matters.
191
536000
2000
la geografia sempre compta.
09:13
And I believe that geographic information
192
538000
2000
I crec que la informació geogràfica
09:15
can make both you and me very healthy. Thank you.
193
540000
2000
pot fer que tant vosaltres com jo tinguem una bona salut. Gràcies.
09:17
(Applause)
194
542000
3000
Aplaudiments.
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