TEDMED 2009
Bill Davenhall: Your health depends on where you live
ビル・ダベンホール：健康はあなたの住む場所次第
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あなたの住む場所は遺伝や食習慣と同じようにあなたの健康に大きな影響を与えます。しかしそれはカルテには載っていません。TEDMEDでビル・ダベンホールは地理データ（心臓発作レートから有害廃棄物の情報まで）がどのように携帯電話のGPSと組み合わさり、医者たちにその情報を与えれるかを説明します。それを“地理医学”と呼びます。
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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地理情報はあなたを
00:18
make you healthy?
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健康にできるのでしょうか
00:22
In 2001 I got hit by a train.
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2001年 私は心臓発作という
00:26
My train was a heart attack.
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列車にはねられました
00:29
I found myself in a hospital
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気がつくと
00:31
in an intensive-care ward,
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集中治療病棟にいて
00:33
recuperating from emergency surgery.
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緊急手術からの回復中でした
00:36
And I suddenly realized something:
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私には
00:38
that I was completely in the dark.
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何がなんだかわかりませんでした
00:41
I started asking my questions, "Well, why me?"
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自分に問いました "なんで私が?"
00:43
"Why now?" "Why here?"
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"なぜ今?" "なぜここなのか?"
00:45
"Could my doctor have warned me?"
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"医者は警告できなかったのか?"
00:48
So, what I want to do here in the few minutes I have with you
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今日は｢健康な人生の秘訣｣について
00:51
is really talk about what is the formula for life and good health.
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お話ししたいと思います
00:56
Genetics, lifestyle and environment.
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遺伝 生活習慣 環境
00:59
That's going to sort of contain our risks,
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これらが持つリスクに
01:01
and if we manage those risks
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うまく対処できれば
01:03
we're going to live a good life and a good healthy life.
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健康的で素敵な人生を過ごせるでしょう
01:06
Well, I understand the genetics and lifestyle part.
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遺伝や生活習慣というのは良く分かります
01:10
And you know why I understand that?
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なぜかというと
01:12
Because my physicians constantly
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医者はいつもこればかり
01:15
ask me questions about this.
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聞いてくるからです
01:17
Have you ever had to fill out those long,
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病院であの長い記入用紙に
01:19
legal-size forms in your doctor's office?
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記入しなければいけなかったことはありませんか?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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運が良ければ そんな機会に度々恵まれますね
01:25
(Laughter)
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(笑い声)
01:26
Do it over and over again. And they ask you questions
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その度に同じことを何度も...
01:28
about your lifestyle and your family history,
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そして あなたの生活習慣 家族の病気歴
01:31
your medication history, your surgical history,
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処方歴 手術歴 アレルギー歴などについて
01:35
your allergy history ... did I forget any history?
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質問してきます
01:39
But this part of the equation I didn't really get,
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しかし 環境ということに関しては
01:43
and I don't think my physicians
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私も医者も
01:46
really get this part of the equation.
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よく理解できていないと思います
01:48
What does that mean, my environment?
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環境とはどういう意味でしょう?
01:51
Well, it can mean a lot of things.
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いろんな捉え方がありそうです
01:53
This is my life. These are my life places.
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これは私の人生で これらは生活空間です
01:56
We all have these.
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みなさんも同じですね
01:58
While I'm talking I'd like you to also be thinking about:
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今まで何か所くらい異なる場所で
02:01
How many places have you lived?
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生活をしたことがありますか?
02:04
Just think about that, you know, wander through
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考えてみてください
02:06
your life thinking about this.
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振り返ると意外に多くの場所で
02:08
And you realize that you spend it in a variety of different places.
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時間を過ごしているのがわかります
02:12
You spend it at rest and you spend it at work.
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仕事でも それ以外でもね
02:14
And if you're like me, you're in an airplane a good portion of your time
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私のような人なら かなりの時間を
02:17
traveling some place.
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移動の飛行機の中で過ごしているでしょう
02:19
So, it's not really simple
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そう 生活や仕事の場を
02:21
when somebody asks you, "Where do you live, where do you work,
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尋ねる質問は
02:23
and where do you spend all your time?
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意外と複雑なんです
02:25
And where do you expose yourselves to risks
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そして何処で目に見えないリスクに
02:28
that maybe perhaps you don't even see?"
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身をさらしているのでしょうか
02:32
Well, when I have done this on myself,
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私の場合
02:34
I always come to the conclusion
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人生の約75パーセントを
02:36
that I spend about 75 percent of my time
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ある一定の場所で過ごし
02:40
relatively in a small number of places.
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ほどんどの時間を
02:43
And I don't wander far from that place
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そこから離れずに生活している―
02:45
for a majority of my time,
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という結果になります
02:47
even though I'm an extensive global trekker.
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これでも私は世界中を回る旅人なんですけどね
02:52
Now, I'm going to take you on a little journey here.
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こちらをご覧ください
02:54
I started off in Scranton, Pennsylvania.
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ペンシルバニア州 スクラントンから始まりました
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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ここに同郷の人がいるかわかりませんが
02:59
but this is where I spent my first 19 years
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ここで私の若い肺は
03:02
with my little young lungs.
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19年間を過ごしました
03:04
You know, breathing high concentrations here
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高濃度の二酸化硫黄
03:07
of sulfur dioxide, carbon dioxide
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二酸化炭素やメタンガスを
03:09
and methane gas,
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不特定量 吸い続けました
03:11
in unequal quantities -- 19 years of this.
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19年の間ずっとです
03:14
And if you've been in that part of the country,
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ここに行ったことがあれば ご存知でしょうが
03:16
this is what those piles of burning, smoldering coal waste look like.
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これは燃えくすぶる石炭廃棄物の山の様子なのです
03:20
So then I decided to leave that part of the world,
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私はこの地域を去り
03:23
and I was going to go to the mid-west.
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中西部に移動し
03:26
OK, so I ended up in Louisville, Kentucky.
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ケンタッキー州 ルイビルに住むことになり
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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ラバータウンという地域の近くに落ち着きました
03:33
They manufacture plastics. They use large quantities chloroprene
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そこはプラスチックを生産していて
03:36
and benzene.
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大量のクロロプレンやベンゼンを使用します
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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ここでは25年間 中年期の肺で過ごし
03:43
breathing various concentrations of that.
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それらの化学物質が濃縮された空気を吸っていました
03:46
And on a clear day it always looked like this, so you never saw it.
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晴れた日はいつもこんな感じで 目には見えませんが
03:50
It was insidious and it was really happening.
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少しずつ しかし確実に蝕まれていたのです
03:53
Then I decided I had to get really smart,
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そして極めつけに
03:55
I would take this job in the West Coast.
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西海岸での仕事を選び
03:58
And I moved to Redlands California.
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カルフォルニア州 レッドランズに越しました
04:01
Very nice, and there
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いい感じです
04:03
my older, senior lungs, as I like to call them,
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そこでは私の年老いた肺を
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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粒子状物質 二酸化炭素 高濃度のオゾンで満たしたのです
04:13
Okay? Almost like the highest in the nation.
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国で最も高濃度のオゾンです
04:15
Alright, this is what it looks like on a good day.
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天気が良くても この眺めです
04:17
If you've been there, you know what I'm talking about.
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ここにいた人ならわかりますよね?
04:20
So, what's wrong with this picture?
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コレのどこが問題なんでしょう?
04:23
Well, the picture is, there is a huge gap here.
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実は大きく欠落しているモノがあります
04:25
The one thing that never happens in my doctor's office:
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ソレは病院では起こることのないことです
04:29
They never ask me about my place history.
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"どこで暮らしたことがあるか?"
04:32
No doctor, can I remember, ever asking me,
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と尋ねてきた医者は
04:35
"Where have you lived?"
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誰ひとりいません
04:37
They haven't asked me what kind of the quality
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どのような質の水
04:39
of the drinking water that I put in my mouth
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食べ物などを摂取していたか
04:41
or the food that I ingest into my stomach.
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そういうことは全くと言っていいほど
04:45
They really don't do that. It's missing.
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聞いてきません
04:48
Look at the kind of data that's available.
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このデータを見てください
04:51
This data's from all over the world --
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これは世界中から集められたもので
04:53
countries spend billions of dollars investing in this kind of research.
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多くの国が このような研究に何十億ドルも投資しています
04:57
Now, I've circled the places where I've been.
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私が住んだ所にマルをつけてみました
05:00
Well, by design, if I wanted to have a heart attack
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どうやら私がいた所は
05:03
I'd been in the right places. Right?
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心臓発作の要因には もってこいの場所だったようです
05:08
So, how many people are in the white?
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白のスペースで
05:10
How many people in the room have spent the majority of their life
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人生の大部分を
05:12
in the white space?
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過ごした人はどれくらいいます?
05:15
Anybody? Boy you're lucky.
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ラッキーですね
05:17
How many have spent it in the red places?
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赤のスペースにいた人は?
05:20
Oh, not so lucky.
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うーん よくないですね
05:22
There are thousands of these kinds of maps
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世界中にある地図帳には
05:25
that are displayed in atlases
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このようなマップが
05:27
all over the world.
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いくつも記載されています
05:29
They give us some sense of what's going
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これらは病気の要因への
05:31
to be our train wreck.
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ヒントを与えてくれます
05:34
But none of that's in my medical record.
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しかし私たちのカルテには
05:36
And it's not in yours either.
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一切こういったものがないのです
05:38
So, here's my friend Paul.
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同僚のポールは
05:40
He's a colleague. He allowed his cell phone to be tracked
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この2年間 彼の携帯電話を年中
05:44
every two hours, 24/7,
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２時間ごとに追跡させ
05:47
365 days out of the year
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彼が訪れた場所を
05:49
for the last two years, everywhere he went.
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全て記録させたのです
05:52
And you can see he's been to a few places around the United States.
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彼が国内の数か所に行ったことがわかりますね
05:56
And this is where he has spent most of his time.
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これは彼が最も時間を過ごしたところです
06:00
If you really studied that you might have some clues
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よく見ると ポールの趣味はなにか?
06:03
as to what Paul likes to do.
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というヒントが隠れています
06:06
Anybody got any clues? Ski. Right.
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わかりますか? そう! スキーです!
06:09
We can zoom in here, and we suddenly see
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さらに拡大すると
06:12
that now we see where Paul has really spent a majority of his time.
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彼が過ごした場所の詳細がわかります
06:16
And all of those black dots are all of the
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この黒の点は 米国環境保護庁によって
06:20
toxic release inventories
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確認された
06:22
that are monitored by the EPA.
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有害物質の排出場所を意味します
06:24
Did you know that data existed?
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こういうデータがあること ご存じでしたか?
06:27
For every community in the United States,
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合衆国では どのコミュニティーでも
06:29
you could have your own personalized map of that.
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この個人用マップを作ることができるのです
06:33
So, our cell phones can now build a place history.
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これで所在地歴は携帯電話で作れます
06:36
This is how Paul did it. He did it with his iPhone.
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ポールが彼のアイフォーンでやったようにね
06:39
This might be what we end up with.
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診察室に入ると
06:41
This is what the physician would have
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このマップを持った医者が
06:44
in front of him and her when we enter that exam room
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イスに座って待っている
06:47
instead of just the pink slip that said I paid at the counter. Right?
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こういった風になるのではないでしょうか？
06:51
This could be my little assessment.
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そして医者は
06:53
And he looks at that and he says,
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それを見て こう言うでしょう
06:55
"Whoa Bill,
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"ビルさん！
06:57
I suggest that maybe you not decide,
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いつも暖かくこの美しい
07:00
just because you're out here in beautiful California,
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カルフォルニアにいるからって
07:02
and it's warm every day,
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午後6時に
07:04
that you get out and run at six o'clock at night.
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ジョギングをするのは
07:07
I'd suggest that that's a bad idea Bill,
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このレポートの結果上
07:10
because of this report."
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お勧めできませんね "
07:13
What I'd like to leave you for are two prescriptions.
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みなさんには２つの課題を託したいと思います
07:17
Okay, number one is, we must teach physicians
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ひとつ目は 私たちの医者に
07:19
about the value of geographical information.
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地理情報の大切さを教えることです
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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それは地理医学と呼ばれ 世界中で複数の計画が
07:27
that are focused on this.
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現在取り組まれています
07:29
And they're in the early stages of development.
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まだ発展初期段階にあり
07:32
These programs need to be supported,
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サポートを必要としています
07:35
and we need to teach our future
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そして今日みなさんに
07:37
doctors of the world
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お話しした内容の大切さを
07:39
the importance of some of the information
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未来の医者たちに
07:41
I've shared here with you today.
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教えなければいけません
07:43
The second thing we need to do
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ふたつ目には
07:45
is while we're spending billions and billions
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何十億ドルもの資金を
07:47
of dollars all over the world
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電子カルテの作成に費やすと同時に
07:50
building an electronic health record,
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この所在地歴を
07:52
we make sure we put a place history
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カルテの中に
07:54
inside that medical record.
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確実に入れることです
07:57
It not only will be important for the physician;
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これは医者だけでなく
08:00
it will be important for the researchers
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研究者にも
08:02
that now will have huge samples to draw upon.
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重要なことで 私たちにとっても
08:06
But it will also be useful for us.
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役に立つことなのです
08:08
I could have made the decision, if I had this information,
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もしこのことを知っていたら
08:12
not to move to the ozone capital
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アメリカのオゾン首都には
08:15
of the United States, couldn't I? I could make that decision.
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引っ越さなかったかもしれませんし
08:18
Or I could negotiate with my employer
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上司と移動についての―
08:20
to make that decision
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交渉も
08:22
in the best interest of myself and my company.
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可能になるかもしれません 会社と私自身のためにもね
08:28
With that, I would like to just say that Jack Lord said
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ジャック ロードは
08:31
this almost 10 years ago.
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"地理は医療の鍵である"
08:34
Just look at that for a minute.
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そう言いました
08:36
That was what the conclusion
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これは
08:38
of the Dartmouth Atlas of Healthcare was about,
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ダートマス アトラスの結論で
08:41
was saying that we can explain the geographic variations
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地理の変動は
08:44
that occur in disease, in illness, in wellness,
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病気や健康状態 健康管理システムに
08:48
and how our healthcare system actually operates.
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大きく影響するということを
08:51
That was what he was talking about
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あの言葉の中で
08:53
on that quote.
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言っていたのです
08:55
And I would say he got it right almost a decade ago.
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彼は10年も前から分かっていたのです
08:59
So, I'd very much like to see us begin to
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私は この地理情報が
09:01
really seize this as an opportunity to get this into our medical records.
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私たちのカルテに入るチャンスをつかんで欲しいのです
09:05
So with that, I'll leave you that
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この私なりの見解を
09:07
in my particular view of view of health:
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みなさんに託したいと思います
09:11
Geography always matters.
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地理情報はとても重要で
09:13
And I believe that geographic information
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私たちをより健康にできる
09:15
can make both you and me very healthy. Thank you.
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そう信じています ありがとう
09:17
(Applause)
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(拍手)
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