TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall: A súa saúde depende de onde vostede vive
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O lugar onde vostede vive impacta na súa saúde tanto coma o fan a dieta e os xenes, pero non é parte do seu expediente médico. No TEDMED, Bill Davenhall amosa como os xeo-datos gobernamentais examinados (dende os índices dos ataques ao corazón locais ata a información dos vertedoiros tóxicos) pódense combinar coas aplicacións GPS móbiles para manter aos médicos ao día. Chamémolo "xeomedicina".
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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Pode a información xeográfica
00:18
make you healthy?
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facer que estean sans?
00:22
In 2001 I got hit by a train.
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No 2001 atropeloume un tren.
00:26
My train was a heart attack.
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O meu tren foi un ataque ao corazón.
00:29
I found myself in a hospital
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Atopeime nun hospital,
00:31
in an intensive-care ward,
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na unidade de coidados intensivos,
00:33
recuperating from emergency surgery.
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para reporme dunha cirurxía de urxencia.
00:36
And I suddenly realized something:
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De súpeto decateime de algo:
00:38
that I was completely in the dark.
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estaba completamente ás escuras.
00:41
I started asking my questions, "Well, why me?"
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Comezaron as preguntas,
"Ben, por que a min?"
"Ben, por que a min?"
00:43
"Why now?" "Why here?"
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"Por que agora?" "Por que aquí?"
00:45
"Could my doctor have warned me?"
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"Puido o meu médico terme advertido?"
00:48
So, what I want to do here in the few minutes I have with you
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Ben, o que quero facer aquí con vostedes
00:51
is really talk about what is the formula for life and good health.
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é falar da fórmula da vida e da boa saúde:
00:56
Genetics, lifestyle and environment.
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Xenética, estilo de vida e medio ambiente.
00:59
That's going to sort of contain our risks,
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Iso vai refrear algo os nosos riscos,
01:01
and if we manage those risks
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e se controlamos eses riscos,
01:03
we're going to live a good life and a good healthy life.
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imos vivir unha vida boa e saudable.
01:06
Well, I understand the genetics and lifestyle part.
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Ben, entendo a parte da xenética
e do estilo de vida.
e do estilo de vida.
01:10
And you know why I understand that?
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E saben por que o entendo?
01:12
Because my physicians constantly
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Porque os meus médicos están seguido
01:15
ask me questions about this.
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preguntándome sobre isto.
01:17
Have you ever had to fill out those long,
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Nunca tiveron que cubrir eses longos
01:19
legal-size forms in your doctor's office?
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impresos oficiais na consulta do médico?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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Tiveron a sorte de facelo máis dunha vez?
01:25
(Laughter)
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(Risas)
01:26
Do it over and over again. And they ask you questions
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De facelo unha e outra vez?
E pregúntanlles
E pregúntanlles
01:28
about your lifestyle and your family history,
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polo estilo de vida
e o historial familiar,
e o historial familiar,
01:31
your medication history, your surgical history,
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historial de medicación,
historial de cirurxías,
historial de cirurxías,
01:35
your allergy history ... did I forget any history?
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historial de alerxias... esquecín algún?
01:39
But this part of the equation I didn't really get,
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Pero esta parte da ecuación
non a entendín realmente
non a entendín realmente
01:43
and I don't think my physicians
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e tampouco creo que os meus médicos
01:46
really get this part of the equation.
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a entendan realmente.
01:48
What does that mean, my environment?
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Que significa iso, o meu medio ambiente?
01:51
Well, it can mean a lot of things.
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Ben, pode significar moitas cousas.
01:53
This is my life. These are my life places.
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Esta é a miña vida, estes os meus sitios.
01:56
We all have these.
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Todos temos os lugares da nosa vida.
01:58
While I'm talking I'd like you to also be thinking about:
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Mentres falo, gustaríame
que pensasen tamén:
que pensasen tamén:
02:01
How many places have you lived?
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En cantos lugares viviron?
02:04
Just think about that, you know, wander through
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Pénseno, percorran a súa vida,
02:06
your life thinking about this.
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pensen nisto.
02:08
And you realize that you spend it in a variety of different places.
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Verán que estiveron
en moitos lugares distintos,
en moitos lugares distintos,
02:12
You spend it at rest and you spend it at work.
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tanto para descansar como para traballar.
02:14
And if you're like me, you're in an airplane a good portion of your time
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E se son coma min,
botan unha boa parte da vida nun avión
botan unha boa parte da vida nun avión
02:17
traveling some place.
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viaxando a algures.
02:19
So, it's not really simple
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Entón, non é tan simple
cando lles preguntan
cando lles preguntan
02:21
when somebody asks you, "Where do you live, where do you work,
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"Onde vive, onde traballa
02:23
and where do you spend all your time?
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e onde pasa o tempo?
02:25
And where do you expose yourselves to risks
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E onde se expón a riscos
02:28
that maybe perhaps you don't even see?"
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que quizais nin vexa?”
02:32
Well, when I have done this on myself,
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Ben, cando me fago esa pregunta,
02:34
I always come to the conclusion
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sempre chego á conclusión
02:36
that I spend about 75 percent of my time
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de que paso ao redor do 75% do tempo
02:40
relatively in a small number of places.
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máis ben nun número pequeno de sitios,
02:43
And I don't wander far from that place
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e non deambulo moi lonxe deles
02:45
for a majority of my time,
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a maior parte do tempo,
02:47
even though I'm an extensive global trekker.
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aínda que son un viaxeiro empedernido.
02:52
Now, I'm going to take you on a little journey here.
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Agora, imos facer aquí unha pequena viaxe.
02:54
I started off in Scranton, Pennsylvania.
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Comecei en Scranton, Pensilvania.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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Non sei se hai alguén aquí
do nordeste de Pensilvania.
do nordeste de Pensilvania.
02:59
but this is where I spent my first 19 years
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Aquí pasei os meus primeiros 19 anos
03:02
with my little young lungs.
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cos meus pulmonciños novos.
03:04
You know, breathing high concentrations here
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Xa saben, respirando altas concentracións
03:07
of sulfur dioxide, carbon dioxide
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de dióxido de xofre, dióxido de carbono
03:09
and methane gas,
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e metano,
03:11
in unequal quantities -- 19 years of this.
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en cantidades diversas... así 19 anos!
03:14
And if you've been in that part of the country,
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E se estiveron nesta parte do país,
03:16
this is what those piles of burning, smoldering coal waste look like.
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este é o aspecto desas moreas
de queima latente de residuos de carbón.
de queima latente de residuos de carbón.
03:20
So then I decided to leave that part of the world,
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Despois decidín abandonar
esa parte do mundo
esa parte do mundo
03:23
and I was going to go to the mid-west.
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e fun cara ao medio oeste.
03:26
OK, so I ended up in Louisville, Kentucky.
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E acabei en Louisville, Kentucky.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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Ben, decidín residir en Rubbertown.
03:33
They manufacture plastics. They use large quantities chloroprene
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Alí fabrican plástico.
Empregan grandes cantidades de cloropreno
Empregan grandes cantidades de cloropreno
03:36
and benzene.
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e benceno.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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Pasei alí 25 anos
cuns pulmóns de mediana idade,
cuns pulmóns de mediana idade,
03:43
breathing various concentrations of that.
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respirando distintas concentracións diso.
03:46
And on a clear day it always looked like this, so you never saw it.
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E nun día claro sempre era así,
nunca chegabas a velo.
nunca chegabas a velo.
03:50
It was insidious and it was really happening.
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Era traizoeiro, pero era un feito
que estaba a ocorrer.
que estaba a ocorrer.
03:53
Then I decided I had to get really smart,
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Entón decidín actuar intelixentemente,
03:55
I would take this job in the West Coast.
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aceptaría este traballo na costa oeste.
03:58
And I moved to Redlands California.
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E mudeime para Redlands, en California.
04:01
Very nice, and there
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Moi bonito, e alí
04:03
my older, senior lungs, as I like to call them,
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enchín os meus pulmóns máis vellos,
séniors, como me gusta chamarlles,
séniors, como me gusta chamarlles,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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de partículas diminutas,
dióxido de carbono e altas doses de ozono.
dióxido de carbono e altas doses de ozono.
04:13
Okay? Almost like the highest in the nation.
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Vale? Case como as máis altas do país.
04:15
Alright, this is what it looks like on a good day.
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Ben, esta é a pinta nun bo día.
04:17
If you've been there, you know what I'm talking about.
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Se teñen estado alí, saben do que falo.
04:20
So, what's wrong with this picture?
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Entón, cal é o problema desta imaxe?
04:23
Well, the picture is, there is a huge gap here.
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Ben, a imaxe é, hai un oco grande aquí.
04:25
The one thing that never happens in my doctor's office:
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O único que non ocorre nunca
na consulta do médico:
na consulta do médico:
04:29
They never ask me about my place history.
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Xamais me preguntan
polo meu historial de lugares.
polo meu historial de lugares.
04:32
No doctor, can I remember, ever asking me,
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Non lembro que ningún médico
me preguntase nunca,
me preguntase nunca,
04:35
"Where have you lived?"
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"Onde viviu?"
04:37
They haven't asked me what kind of the quality
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Nunca me preguntaron pola calidade
04:39
of the drinking water that I put in my mouth
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da auga que levaba á boca
04:41
or the food that I ingest into my stomach.
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ou da comida que metía no estómago.
04:45
They really don't do that. It's missing.
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Non fan iso. E deberían.
04:48
Look at the kind of data that's available.
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Reparen no tipo de datos dispoñibles.
04:51
This data's from all over the world --
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Estes datos son de todo o mundo
04:53
countries spend billions of dollars investing in this kind of research.
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–os países invisten miles de millóns
de dólares neste tipo de investigación.
de dólares neste tipo de investigación.
04:57
Now, I've circled the places where I've been.
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Aquí están marcados
os sitios nos que estiven.
os sitios nos que estiven.
05:00
Well, by design, if I wanted to have a heart attack
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A propósito, se eu quixese ter
un ataque ao corazón
un ataque ao corazón
05:03
I'd been in the right places. Right?
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estiven nos lugares correctos, non si?
05:08
So, how many people are in the white?
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Cantos de vostedes están no branco?
05:10
How many people in the room have spent the majority of their life
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Cantos desta sala viviron
a maior parte da súa vida
a maior parte da súa vida
05:12
in the white space?
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no espazo branco?
05:15
Anybody? Boy you're lucky.
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Alguén? Rapaz, que sorte tes!
05:17
How many have spent it in the red places?
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Cantos viviron nos sitios en vermello?
05:20
Oh, not so lucky.
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Oh, non son tan afortunados!
05:22
There are thousands of these kinds of maps
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Hai milleiros de mapas coma estes
05:25
that are displayed in atlases
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expostos en atlas
05:27
all over the world.
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por todo o mundo.
05:29
They give us some sense of what's going
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Dannos idea do que vai ser
05:31
to be our train wreck.
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o noso desastre.
05:34
But none of that's in my medical record.
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Pero nada disto aparece
no meu historial médico.
no meu historial médico.
05:36
And it's not in yours either.
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E no seu tampouco.
05:38
So, here's my friend Paul.
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Este é o meu amigo Paul.
05:40
He's a colleague. He allowed his cell phone to be tracked
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É un colega.
Permitiu que rastrexaran o seu móbil
Permitiu que rastrexaran o seu móbil
05:44
every two hours, 24/7,
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cada dúas horas, día e noite,
05:47
365 days out of the year
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os 365 días do ano
05:49
for the last two years, everywhere he went.
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nos 2 últimos anos, onde queira que fose.
05:52
And you can see he's been to a few places around the United States.
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E pódese ver que estivo
en poucos sitios dos Estados Unidos.
en poucos sitios dos Estados Unidos.
05:56
And this is where he has spent most of his time.
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Estivo aquí a maior parte do tempo.
06:00
If you really studied that you might have some clues
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Se realmente estudan iso,
poderán ter algunhas pistas
poderán ter algunhas pistas
06:03
as to what Paul likes to do.
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do que lle gusta facer a Paul.
06:06
Anybody got any clues? Ski. Right.
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Alguén ten idea? Esquiar. Correcto.
06:09
We can zoom in here, and we suddenly see
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Podemos ampliar aquí e de súpeto vemos
06:12
that now we see where Paul has really spent a majority of his time.
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onde pasou Paul a maior parte do tempo.
06:16
And all of those black dots are all of the
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E todos eses puntos negros
06:20
toxic release inventories
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son os inventarios de emisións tóxicas
06:22
that are monitored by the EPA.
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monitorizados pola EPA.
06:24
Did you know that data existed?
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Sabían que existía esa información?
06:27
For every community in the United States,
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Para cada comunidade dos Estados Unidos,
06:29
you could have your own personalized map of that.
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poderían ter o seu mapa personalizado.
06:33
So, our cell phones can now build a place history.
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Agora os nosos móbiles
poden construír un historial de lugares.
poden construír un historial de lugares.
06:36
This is how Paul did it. He did it with his iPhone.
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Iso é o que fixo Paul.
Fíxoo co seu iPhone.
Fíxoo co seu iPhone.
06:39
This might be what we end up with.
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Este podería ser o resultado acadado.
06:41
This is what the physician would have
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Isto é o que o/a médico/a tería diante
06:44
in front of him and her when we enter that exam room
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cando entrásemos na súa consulta
06:47
instead of just the pink slip that said I paid at the counter. Right?
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en vez de só o xustificante rosa
de que xa pagamos no mostrador.
de que xa pagamos no mostrador.
06:51
This could be my little assessment.
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Esta podería ser a miña breve valoración.
06:53
And he looks at that and he says,
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E el mira para ela e di,
06:55
"Whoa Bill,
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“Oe Bill,
06:57
I suggest that maybe you not decide,
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aconsélloche que talvez non deberías,
07:00
just because you're out here in beautiful California,
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aínda que andas por esta bela California
07:02
and it's warm every day,
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e vai calor todos os días,
07:04
that you get out and run at six o'clock at night.
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saír correr ás 6 da tarde.
07:07
I'd suggest that that's a bad idea Bill,
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Eu diría que é unha mala idea, Bill,
07:10
because of this report."
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debido a este informe".
07:13
What I'd like to leave you for are two prescriptions.
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Gustaríame deixarlles dúas receitas.
07:17
Okay, number one is, we must teach physicians
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A primeira é
que debemos ensinar aos médicos
que debemos ensinar aos médicos
07:19
about the value of geographical information.
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o valor da información xeográfica.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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Chámase xeomedicina.
Hai ao redor de media ducia de programas
Hai ao redor de media ducia de programas
07:27
that are focused on this.
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no mundo que se centran nela.
07:29
And they're in the early stages of development.
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E están nas primeiras etapas
de desenvolvemento.
de desenvolvemento.
07:32
These programs need to be supported,
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Estes programas precisan patrocinio,
07:35
and we need to teach our future
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e necesitamos ensinarlles aos futuros
07:37
doctors of the world
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doutores do mundo
07:39
the importance of some of the information
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a importancia de parte da información
07:41
I've shared here with you today.
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que hoxe compartín aquí con vostedes.
07:43
The second thing we need to do
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O segundo que hai que facer
07:45
is while we're spending billions and billions
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é, mentres se gastan miles de millóns
07:47
of dollars all over the world
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de dólares en todo o mundo
07:50
building an electronic health record,
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construíndo
unha historia clínica electrónica,
unha historia clínica electrónica,
07:52
we make sure we put a place history
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asegurarnos de poñer
un historial de lugares
un historial de lugares
07:54
inside that medical record.
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dentro dese historial médico.
07:57
It not only will be important for the physician;
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Non será importante só para os médicos;
08:00
it will be important for the researchers
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serao tamén para os investigadores
08:02
that now will have huge samples to draw upon.
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que terán moitas mostras en que se basear.
08:06
But it will also be useful for us.
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Pero tamén será útil para nós.
08:08
I could have made the decision, if I had this information,
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Se tivese esta información,
eu podería decidir
eu podería decidir
08:12
not to move to the ozone capital
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non mudarme á capital do ozono
08:15
of the United States, couldn't I? I could make that decision.
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dos Estados Unidos, non si?
Puiden tomar esa decisión.
Puiden tomar esa decisión.
08:18
Or I could negotiate with my employer
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Ou podería negociar co meu empregador
08:20
to make that decision
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tomar esa decisión
08:22
in the best interest of myself and my company.
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no meu interese e no da miña empresa.
Con iso, gustaríame dicir só que Jack Lord
08:28
With that, I would like to just say that Jack Lord said
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dixo isto hai case 10 anos.
08:31
this almost 10 years ago.
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[A xeografía é o destino da medicina]
08:34
Just look at that for a minute.
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Soamente miren iso un minuto.
08:36
That was what the conclusion
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Esa foi a conclusión
08:38
of the Dartmouth Atlas of Healthcare was about,
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do Atlas do Sistema Sanitario de Dartmouth
08:41
was saying that we can explain the geographic variations
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cando dicía que se poden explicar
as variacións xeográficas
as variacións xeográficas
08:44
that occur in disease, in illness, in wellness,
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existentes nas doenzas,
nas enfermidades, no benestar,
nas enfermidades, no benestar,
08:48
and how our healthcare system actually operates.
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e como se xestiona realmente
o noso sistema sanitario.
o noso sistema sanitario.
08:51
That was what he was talking about
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Diso era do que falaba
08:53
on that quote.
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nesa cita.
08:55
And I would say he got it right almost a decade ago.
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E eu diría que acertou
hai case unha década.
hai case unha década.
08:59
So, I'd very much like to see us begin to
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Así que me encantaría ver que comezamos
09:01
really seize this as an opportunity to get this into our medical records.
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a ver isto como unha oportunidade de ter
esa información nos historiais médicos.
esa información nos historiais médicos.
09:05
So with that, I'll leave you that
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Así pois, gustaríame deixarlles
09:07
in my particular view of view of health:
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a miña opinión particular sobre a saúde:
09:11
Geography always matters.
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A xeografía sempre importa.
09:13
And I believe that geographic information
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E penso que a información xeográfica
09:15
can make both you and me very healthy. Thank you.
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pode facer que vostedes e mais eu
esteamos máis sans. Grazas
esteamos máis sans. Grazas
09:17
(Applause)
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(Aplausos)
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