TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall: Sinu tervis sõltub sinu elukohast
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Koht, kus sa elad mõjutab sinu tervist sama palju kui su dieet ja geenid, kuid seda ei ole kirjas sinu tervisekaardil. Bill Davenhall rääkis TEDMED-il, kuivõrd valitsuse geoandmeid (alates kohalikest südamerabanduste määradest kuni toksiliste jäätmete mahapaneku koha infoni) saab ühendada GPS rakendustega, et hoida arstide teadlikkust. Kutsuge seda "geomeditsiiniks".
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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Kas geograafilise asukoha informatsioon
00:18
make you healthy?
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saab muuta sind terveks?
00:22
In 2001 I got hit by a train.
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2001 aastal sain löögi rongilt.
00:26
My train was a heart attack.
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Selleks rongiks oli infarkt
00:29
I found myself in a hospital
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Leidsin end haiglast
00:31
in an intensive-care ward,
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intensiivravi osakonnast,
00:33
recuperating from emergency surgery.
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taastumas erakorralisest operatsioonist.
00:36
And I suddenly realized something:
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Ootamatult taipasin,
00:38
that I was completely in the dark.
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et olin täielikus teadmatuses.
00:41
I started asking my questions, "Well, why me?"
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Küsisin endalt, "Miks mina?"
00:43
"Why now?" "Why here?"
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"Miks nüüd?", "Miks siin?"
00:45
"Could my doctor have warned me?"
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"Kas minu arst oleks saanud mind hoiatada?"
00:48
So, what I want to do here in the few minutes I have with you
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Ma sooviksin teile rääkida nende minutite jooksul,
00:51
is really talk about what is the formula for life and good health.
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mis on elu ja hea tervise valem.
00:56
Genetics, lifestyle and environment.
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Geneetika, elustiil ja keskkond.
00:59
That's going to sort of contain our risks,
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Need sisaldavad omamoodi meie riske
01:01
and if we manage those risks
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ja kui suudame toime tulla nende riskidega,
01:03
we're going to live a good life and a good healthy life.
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siis saab meil olema hea elu ning hea tervisega elu.
01:06
Well, I understand the genetics and lifestyle part.
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Ma saan aru geneetika ja elustiili mõjust.
01:10
And you know why I understand that?
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Kas teate, miks?
01:12
Because my physicians constantly
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Kuna minu arstid küsivad pidevalt
01:15
ask me questions about this.
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selle kohta küsimusi.
01:17
Have you ever had to fill out those long,
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Kas olete kunagi pidanud täitma
01:19
legal-size forms in your doctor's office?
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pikki juriidilisi ankeete oma arsti kabinetis?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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Kui teil veab, siis saate neid täita rohkem kui ainult üks kord.
01:25
(Laughter)
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(Naer)
01:26
Do it over and over again. And they ask you questions
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Te täidate neid ikka ja jälle. Need küsivad teie
01:28
about your lifestyle and your family history,
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elustiili, perekonna ajaloo,
01:31
your medication history, your surgical history,
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ravimite ajaloo, kirurgilise ajaloo,
01:35
your allergy history ... did I forget any history?
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allergiate ajaloo kohta .... kas unustasin mainida mõnda ajalugu?
01:39
But this part of the equation I didn't really get,
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Kuid sellest võrrandi osast ei saanud ma päris aru.
01:43
and I don't think my physicians
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Arvan, et isegi minu arstid
01:46
really get this part of the equation.
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ei mõista seda võrrandi osa.
01:48
What does that mean, my environment?
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Mida see tähendab - minu keskkond?
01:51
Well, it can mean a lot of things.
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See võib tähendada nii mõndagi.
01:53
This is my life. These are my life places.
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See on minu elu. Need on minu elukohad.
01:56
We all have these.
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Meil kõigil on need olemas
01:58
While I'm talking I'd like you to also be thinking about:
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Samal ajal kui ma räägin, soovin, et mõtleksite
02:01
How many places have you lived?
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kui mitmes kohas olete teie elanud?
02:04
Just think about that, you know, wander through
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Lihtsalt mõelge sellele, rännake läbi oma elu
02:06
your life thinking about this.
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sellele mõeldes.
02:08
And you realize that you spend it in a variety of different places.
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Mõistate, et olete veetnud oma elu mitmetes erinevates paikades.
02:12
You spend it at rest and you spend it at work.
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Veedate oma elu puhates ja tööl olles.
02:14
And if you're like me, you're in an airplane a good portion of your time
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Ja kui te olete minu sarnane, siis veedate märkimisväärse osa oma ajast lennukis
02:17
traveling some place.
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kuhugi reisides.
02:19
So, it's not really simple
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Niisiis, ei ole just lihtne,
02:21
when somebody asks you, "Where do you live, where do you work,
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kui keegi küsib sinult, "Kus sa elad?", "Kus sa töötad?"
02:23
and where do you spend all your time?
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ja "Kus sa veedad kogu oma aja?"
02:25
And where do you expose yourselves to risks
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"Kus sa paljastad end riskidele,
02:28
that maybe perhaps you don't even see?"
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mida sa võib-olla isegi tähele ei pane?"
02:32
Well, when I have done this on myself,
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Kui ma olen ennast analüüsinud,
02:34
I always come to the conclusion
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olen alati jõudnud järeldusele,
02:36
that I spend about 75 percent of my time
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et 75% oma ajast olen
02:40
relatively in a small number of places.
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veetnud suhteliselt vähestes kohtades.
02:43
And I don't wander far from that place
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Enamiku oma ajast ma ei rända
02:45
for a majority of my time,
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kaugele sellest kohast,
02:47
even though I'm an extensive global trekker.
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kuigi olen ka ulatuslik maailmarändur
02:52
Now, I'm going to take you on a little journey here.
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Viin teid ühele rännakule.
02:54
I started off in Scranton, Pennsylvania.
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Ma alustasin Scranton´is Pennsylvanias.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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Ma ei tea, kas keegi võiks hõigata, kes on Kirde-Pennsylvaniast,
02:59
but this is where I spent my first 19 years
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kuid seal veetsin ma oma esimesed 19 aastat
03:02
with my little young lungs.
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oma väikeste noorte kopsudega.
03:04
You know, breathing high concentrations here
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Hingates sisse suure kontsertatsiooniga erinevates kogustes
03:07
of sulfur dioxide, carbon dioxide
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vääveldioksiidi, süsinikdioksiidi
03:09
and methane gas,
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ja metaangaasi
03:11
in unequal quantities -- 19 years of this.
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-- 19 aasta jooksul.
03:14
And if you've been in that part of the country,
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Kui te olete viibinud selles riigi osas,
03:16
this is what those piles of burning, smoldering coal waste look like.
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siis nii näevad välja põlevad, hõõguvad söejäätmete hunnikud.
03:20
So then I decided to leave that part of the world,
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Siis otsustasin lahkuda sellest maailmajaost
03:23
and I was going to go to the mid-west.
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ja ma kolisin kesk-läände.
03:26
OK, so I ended up in Louisville, Kentucky.
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OK, nii ma sattusin Louisville'i Kentucky's.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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Otsustasin olla naaber kohale, mille nimeks on Kummilinn (Rubbertown)
03:33
They manufacture plastics. They use large quantities chloroprene
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Nad toodavad plastikut. Nad kasutavad suurtes kogustes nitriili
03:36
and benzene.
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ja benseene.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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OK, seal ma veetsin 25 aast, täites oma keskealisi kopse
03:43
breathing various concentrations of that.
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mitmekesise kontsentrantsiooniga.
03:46
And on a clear day it always looked like this, so you never saw it.
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Selgel päeval nägi see koht välja selline, sa ei näinud seda iial.
03:50
It was insidious and it was really happening.
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See oli salakaval ning tegelikult toimumas.
03:53
Then I decided I had to get really smart,
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Siis otsustasin teha targa otsuse
03:55
I would take this job in the West Coast.
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ja võtsin vastu töö läänerannikul
03:58
And I moved to Redlands California.
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ning kolisin Redlands´i Californias.
04:01
Very nice, and there
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Väga ilus,
04:03
my older, senior lungs, as I like to call them,
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seal täitsin oma vanemaid kopse
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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tahkete osakestega, süsihappegaasiga ning väga suure annuse osooniga.
04:13
Okay? Almost like the highest in the nation.
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OK? Peaaegu kõrgeim kogu riigis.
04:15
Alright, this is what it looks like on a good day.
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Sellisena paistab see ilusal päeval.
04:17
If you've been there, you know what I'm talking about.
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Kui te olete olnud seal, siis teate millest ma räägin.
04:20
So, what's wrong with this picture?
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Mis on sellel kuvandil valesti?
04:23
Well, the picture is, there is a huge gap here.
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Siin on üks suur lünk.
04:25
The one thing that never happens in my doctor's office:
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Üks asi, mis iialgi minu arsti kabinetis ei juhtu:
04:29
They never ask me about my place history.
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nad ei küsi iialgi minu geograafilist ajalugu.
04:32
No doctor, can I remember, ever asking me,
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Mitte ükski arst, keda mäletan, ei küsinud minult
04:35
"Where have you lived?"
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"Kus sa oled elanud?"
04:37
They haven't asked me what kind of the quality
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Nad ei küsinud,
04:39
of the drinking water that I put in my mouth
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millise kvaliteediga vett ma joon
04:41
or the food that I ingest into my stomach.
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või millise toiduga täidan oma kõhtu.
04:45
They really don't do that. It's missing.
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Nad ei tee seda. See on puudu.
04:48
Look at the kind of data that's available.
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Vaadake millised andmed on kättesaadavad.
04:51
This data's from all over the world --
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Need andmed on pärit üle maailma --
04:53
countries spend billions of dollars investing in this kind of research.
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riigid investeerivad sellistesse uuringutesse miljardeid dollareid.
04:57
Now, I've circled the places where I've been.
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Tegin ringid ümber paikadele, kus ma olen olnud.
05:00
Well, by design, if I wanted to have a heart attack
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Kui ma oleksin tahtnud saada infarkti,
05:03
I'd been in the right places. Right?
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olen olnud õigetes kohtades. Eks ju?
05:08
So, how many people are in the white?
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Kui paljud teist on tulnud valgelt alalt?
05:10
How many people in the room have spent the majority of their life
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Kui paljud ruumis olevaist inimestest on veetnud enamiku oma elust
05:12
in the white space?
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valgel alal?
05:15
Anybody? Boy you're lucky.
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Keegi? Teil on vedanud.
05:17
How many have spent it in the red places?
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Kui paljud on veetnud enamiku oma elust punasel alal?
05:20
Oh, not so lucky.
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Oh, teil ei ole nii vedanud.
05:22
There are thousands of these kinds of maps
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Üle maailma on olemas
05:25
that are displayed in atlases
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tuhandeid selliseid kaarte,
05:27
all over the world.
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mis on kuvatud atlastes.
05:29
They give us some sense of what's going
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Need annavad meile arusaamise, mis saab olema
05:31
to be our train wreck.
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meie tulevane rongiõnnetus.
05:34
But none of that's in my medical record.
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Kuid mitte ükski neist ei ole minu tervisekaardil
05:36
And it's not in yours either.
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ja samuti mitte sinu omal.
05:38
So, here's my friend Paul.
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See on minu sõber Paul.
05:40
He's a colleague. He allowed his cell phone to be tracked
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Ta on kolleeg. Ta lubas oma mobiili jälgida
05:44
every two hours, 24/7,
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iga kahe tunni järel 24/7,
05:47
365 days out of the year
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365 päeva aastas,
05:49
for the last two years, everywhere he went.
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viimase kahe aasta jooksul, kõikjal kuhu ta läks.
05:52
And you can see he's been to a few places around the United States.
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Nagu näha, on ta viibinud erinevais paigus USA-s.
05:56
And this is where he has spent most of his time.
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Siin on ta veetnud enamuse oma ajast.
06:00
If you really studied that you might have some clues
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Kui te uuriksite seda lähemalt, oleks teil mõned vihjed,
06:03
as to what Paul likes to do.
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millega Paulile meeldib tegeleda.
06:06
Anybody got any clues? Ski. Right.
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Keegi leidis vihjeid? Suusatamine. Õige.
06:09
We can zoom in here, and we suddenly see
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Kui suurendame seda, siis näeme,
06:12
that now we see where Paul has really spent a majority of his time.
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kus Paul on veetnud enamiku oma ajast.
06:16
And all of those black dots are all of the
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Kõik mustad täpikesed tähistavad
06:20
toxic release inventories
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mürgiseid heitmeid,
06:22
that are monitored by the EPA.
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mida jälgib keskkonnakaitseagentuur.
06:24
Did you know that data existed?
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Kas teadsite, et sellised andmed on olemas?
06:27
For every community in the United States,
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Igal kogukonnal USA-s
06:29
you could have your own personalized map of that.
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võiks olla selline individuaalne kaart.
06:33
So, our cell phones can now build a place history.
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Meie telefonid saavad koostada asukoha ajalugu.
06:36
This is how Paul did it. He did it with his iPhone.
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Paul tegi seda oma iPhone-ga
06:39
This might be what we end up with.
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See võiks olla meie tulem.
06:41
This is what the physician would have
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Sisenedes arsti kabinetti, oleks
06:44
in front of him and her when we enter that exam room
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arstil ees selline ülevaatlik kaart,
06:47
instead of just the pink slip that said I paid at the counter. Right?
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mitte roosa lipik, mis tõendab, et olen visiidi eest tasunud.
06:51
This could be my little assessment.
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See võiks olla minu väike hinnang.
06:53
And he looks at that and he says,
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Arst vaataks seda ja ütleks
06:55
"Whoa Bill,
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"Vau Bill,
06:57
I suggest that maybe you not decide,
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ma soovitaks, et sa võib-olla ei otsustaks
07:00
just because you're out here in beautiful California,
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minna välja jooksma kell 6 õhtul,
07:02
and it's warm every day,
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kuigi sa oled looduskaunis Californias
07:04
that you get out and run at six o'clock at night.
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ning siin on soe iga päev.
07:07
I'd suggest that that's a bad idea Bill,
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Lähtuvalt sellest raportist arvan,
07:10
because of this report."
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et see on halb idee."
07:13
What I'd like to leave you for are two prescriptions.
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Ma sooviksin teile jätta kaks retsepti.
07:17
Okay, number one is, we must teach physicians
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Esiteks, me peame õpetama oma arste
07:19
about the value of geographical information.
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hindama geograafiise informatsiooni väärtust.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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Seda kutsutakse geomeditsiiniks. Maailmas on umbes pool tosinat programmi,
07:27
that are focused on this.
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mis sellele keskenduvad.
07:29
And they're in the early stages of development.
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Need projektid on varajases arengustaadiumis.
07:32
These programs need to be supported,
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Neid programme on vaja toetada,
07:35
and we need to teach our future
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ja meil tuleb õpetada homsetele
07:37
doctors of the world
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maailma arstidele
07:39
the importance of some of the information
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sellise informatsiooni olulisust,
07:41
I've shared here with you today.
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mida olen teiega täna jaganud.
07:43
The second thing we need to do
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Teiseks asjaks, mida on meil vaja teha
07:45
is while we're spending billions and billions
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samal ajal, kui me kulutame miljardeid
07:47
of dollars all over the world
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dollareid üle maailma
07:50
building an electronic health record,
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ehitamaks elektroonilist tervisekaarti,
07:52
we make sure we put a place history
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on vaja tagada,
07:54
inside that medical record.
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et see sisaldaks ka asukoha ajalugu.
07:57
It not only will be important for the physician;
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See ei ole oluline vaid arstile,
08:00
it will be important for the researchers
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vaid ka teaduritele,
08:02
that now will have huge samples to draw upon.
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kellel nüüd on suur näidiste kogum, millest lähtuda.
08:06
But it will also be useful for us.
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Kuid sellest on ka kasu meile endile.
08:08
I could have made the decision, if I had this information,
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Ma oleksin saanud teha otsuse mitte kolida USA osooni pealinna,
08:12
not to move to the ozone capital
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kui mul oleks olnud selline informatsioon
08:15
of the United States, couldn't I? I could make that decision.
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Ma saaksin teha sellise otsuse.
08:18
Or I could negotiate with my employer
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Ma saaksin pidada läbirääkimisi oma tööandjaga
08:20
to make that decision
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sellise otsuse tegemisel,
08:22
in the best interest of myself and my company.
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silmas pidades nii enese kui ka ettevõtte huve
08:28
With that, I would like to just say that Jack Lord said
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Sellega sooviksin vaid öelda, mida ütles Jack Lord
08:31
this almost 10 years ago.
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peaaegu 10 aastat tagasi.
08:34
Just look at that for a minute.
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Vaadake seda üks minut.
08:36
That was what the conclusion
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See oli see, mida kujutab endast
08:38
of the Dartmouth Atlas of Healthcare was about,
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Darthmouthi tervishoiu atlase kokkuvõte.
08:41
was saying that we can explain the geographic variations
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See ütles, et saame kirjeldada geograafilisi erinevusi,
08:44
that occur in disease, in illness, in wellness,
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mis esinevad tõvedes, haigustes, heaolus
08:48
and how our healthcare system actually operates.
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ning kuidas tervishoiusüsteem tegelikult toimib.
08:51
That was what he was talking about
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See on see, millest
08:53
on that quote.
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ta oma tsitaadis rääkis.
08:55
And I would say he got it right almost a decade ago.
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Ma võin öelda, et ta tabas seda peaaegu dekaad tagasi.
08:59
So, I'd very much like to see us begin to
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Mulle meeldiks väga, kui me haaraksime
09:01
really seize this as an opportunity to get this into our medical records.
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võimalusest saada see informatsioon oma tervisekaartidele.
09:05
So with that, I'll leave you that
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Jätan teile
09:07
in my particular view of view of health:
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oma konkreetse vaate tervise kohta:
09:11
Geography always matters.
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geograafia omab alati tähtust.
09:13
And I believe that geographic information
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Ja ma usun, et geograafiline informatsioon
09:15
can make both you and me very healthy. Thank you.
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võib teha sind ja mind terveks. Aitäh.
09:17
(Applause)
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(Aplaus)
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