TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bil Davenhal: Vaše zdravlje zavisi od toga gde živite
Filmed:
Readability: 3.2
940,322 views
Mesto života: utiče na veše zdravlje podjednako kao ishrana ili geni, ali ono nije deo vaših medicinskih podataka. na TEDMED konferenciji, Bil Devenhal pokazuje kako zanemareni vladini geo-podaci (od lokalnih podataka o infarktu do informacija o opasnim deponijama) mogu da se kombinuju sa mobilnim GPS aplikacijama kako bi doktori bili u toku. Nazovite to "geo-medicinom".
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
Da li geografske informacije
00:18
make you healthy?
1
3000
4000
mogu da učine da budete zdravi?
00:22
In 2001 I got hit by a train.
2
7000
4000
2001. me je udario voz.
00:26
My train was a heart attack.
3
11000
3000
Moj voz je bio infarkt.
00:29
I found myself in a hospital
4
14000
2000
Našao sam se u bolnici
00:31
in an intensive-care ward,
5
16000
2000
na odeljenju intenzivne nege,
00:33
recuperating from emergency surgery.
6
18000
3000
oporavljao sam se od hitne operacije.
00:36
And I suddenly realized something:
7
21000
2000
Odjednom sam shvatio nešto:
00:38
that I was completely in the dark.
8
23000
3000
potpuno sam bio u mraku.
00:41
I started asking my questions, "Well, why me?"
9
26000
2000
Počeo sam da se pitam, "Zašto ja?"
00:43
"Why now?" "Why here?"
10
28000
2000
"Zašto sada?" "Zašto ovde?"
00:45
"Could my doctor have warned me?"
11
30000
3000
"Da li je moj doktor mogao da me upozori?"
00:48
So, what I want to do here in the few minutes I have with you
12
33000
3000
Ono što želim ovde da uradim u ovih nekoliko minuta koje imam sa vama
00:51
is really talk about what is the formula for life and good health.
13
36000
5000
je da zaista pričam o tome koja je formula za život i dobro zdravlje.
00:56
Genetics, lifestyle and environment.
14
41000
3000
Genetika, način života i okruženje.
00:59
That's going to sort of contain our risks,
15
44000
2000
Tu se nalaze rizici
01:01
and if we manage those risks
16
46000
2000
i ako prevaziđemo te rizike
01:03
we're going to live a good life and a good healthy life.
17
48000
3000
živećemo dobar život, dobar zdrav život.
01:06
Well, I understand the genetics and lifestyle part.
18
51000
4000
Razumem deo o genetici i životnom stilu.
01:10
And you know why I understand that?
19
55000
2000
A znate li zašto to razumem?
01:12
Because my physicians constantly
20
57000
3000
Jer mi moji lekari stalno
01:15
ask me questions about this.
21
60000
2000
postavljaju pitanja u vezi s tim.
01:17
Have you ever had to fill out those long,
22
62000
2000
Da li ste ikada morali da popunjavate one dugačke,
01:19
legal-size forms in your doctor's office?
23
64000
3000
formulare kod svog lekara?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
24
67000
3000
Mislim, ako imate sreće onda ih popunite i više puta, je l'?
01:25
(Laughter)
25
70000
1000
(smeh)
01:26
Do it over and over again. And they ask you questions
26
71000
2000
Opet i opet. Tu vas pitaju
01:28
about your lifestyle and your family history,
27
73000
3000
o načinu života i porodičnoj istoriji,
01:31
your medication history, your surgical history,
28
76000
4000
istoriji uzimanja lekova, istoriji operacija,
01:35
your allergy history ... did I forget any history?
29
80000
4000
istoriji alergija... jesam zaboravio neku istoriju?
01:39
But this part of the equation I didn't really get,
30
84000
4000
Ali ovaj deo jednačine baš ne razumem.
01:43
and I don't think my physicians
31
88000
3000
A mislim da ni moji doktori
01:46
really get this part of the equation.
32
91000
2000
baš ne razumeju taj deo jednačine.
01:48
What does that mean, my environment?
33
93000
3000
Šta ovo znači, moje okruženje?
01:51
Well, it can mean a lot of things.
34
96000
2000
Pa, može da znači mnogo stvari.
01:53
This is my life. These are my life places.
35
98000
3000
Ovo je moj život. Ovo su mesta mog života.
01:56
We all have these.
36
101000
2000
Svi imamo ovo.
01:58
While I'm talking I'd like you to also be thinking about:
37
103000
3000
Dok pričam, želeo bih da razmislite o tome
02:01
How many places have you lived?
38
106000
3000
na koliko ste sve mesta živeli.
02:04
Just think about that, you know, wander through
39
109000
2000
Samo promislite, znate, prođite kroz
02:06
your life thinking about this.
40
111000
2000
život misleći na ovo.
02:08
And you realize that you spend it in a variety of different places.
41
113000
4000
I shvatićete da ga provodite na raznim mestima.
02:12
You spend it at rest and you spend it at work.
42
117000
2000
Provodite ga na odmoru i na poslu.
02:14
And if you're like me, you're in an airplane a good portion of your time
43
119000
3000
A ako ste kao ja, onda ste u avionu dobar deo svog vremena,
02:17
traveling some place.
44
122000
2000
putujući na neko mesto.
02:19
So, it's not really simple
45
124000
2000
Dakle, nije tako jednostavno
02:21
when somebody asks you, "Where do you live, where do you work,
46
126000
2000
kad vas neko pita, "Gde živite, gde radite,
02:23
and where do you spend all your time?
47
128000
2000
i gde provodite svo svoje vreme?
02:25
And where do you expose yourselves to risks
48
130000
3000
I gde se izlažete rizicima
02:28
that maybe perhaps you don't even see?"
49
133000
4000
koje verovatno ni ne vidite?"
02:32
Well, when I have done this on myself,
50
137000
2000
Pa, kada sam ovo radio na sebi,
02:34
I always come to the conclusion
51
139000
2000
uvek sam dolazio do zaključka
02:36
that I spend about 75 percent of my time
52
141000
4000
da oko 75% svog vremena provodim
02:40
relatively in a small number of places.
53
145000
3000
na relativno malom broju mesta.
02:43
And I don't wander far from that place
54
148000
2000
I većinu svog vremena ne idem
02:45
for a majority of my time,
55
150000
2000
daleko od tog mesta,
02:47
even though I'm an extensive global trekker.
56
152000
5000
iako sam veliki putnik po svetu.
02:52
Now, I'm going to take you on a little journey here.
57
157000
2000
Sada ću vas povesti na kratak put.
02:54
I started off in Scranton, Pennsylvania.
58
159000
2000
Počeo sam u Skrantonu, u Pensilvaniji.
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
59
161000
3000
Ne znam da li neko dolazi iz severoistočne Pensilvanije.
02:59
but this is where I spent my first 19 years
60
164000
3000
Ovde sam proveo svojih prvih 19 godina
03:02
with my little young lungs.
61
167000
2000
sa svojim malim, mladim plućima.
03:04
You know, breathing high concentrations here
62
169000
3000
Znate, udisao sam velike količine
03:07
of sulfur dioxide, carbon dioxide
63
172000
2000
sumpor-dioksida, ugljen-dioksida,
03:09
and methane gas,
64
174000
2000
metana,
03:11
in unequal quantities -- 19 years of this.
65
176000
3000
u nejednakim količinama - 19 godina toga.
03:14
And if you've been in that part of the country,
66
179000
2000
Ako ste bili u tom delu zemlje,
03:16
this is what those piles of burning, smoldering coal waste look like.
67
181000
4000
ovako izgledaju te gomile otpada od uglja koji se puši i gori.
03:20
So then I decided to leave that part of the world,
68
185000
3000
Onda sam odlučio da napustim taj deo sveta.
03:23
and I was going to go to the mid-west.
69
188000
3000
I da odem u srednji zapad.
03:26
OK, so I ended up in Louisville, Kentucky.
70
191000
3000
Ok, dakle završio sam u Luivilu, Kentaki.
03:29
Well, I decided to be neighbors to a place called Rubbertown.
71
194000
4000
Odlučio sam da budem u komšiluku mesta koje se zove Rabertaun (Rubbertown, "grad gume").
03:33
They manufacture plastics. They use large quantities chloroprene
72
198000
3000
Oni proizvode plastiku. Koriste velike količine hloroprena
03:36
and benzene.
73
201000
2000
i benzena.
03:38
Okay, I spent 25 years, in my middle-age lungs now,
74
203000
5000
OK, proveo sam 25 godina, sada sa svojim sredovečnim plućima,
03:43
breathing various concentrations of that.
75
208000
3000
udišući razne koncentracije toga.
03:46
And on a clear day it always looked like this, so you never saw it.
76
211000
4000
Po vedrom danu uvek je ovako izgledalo, tako da ih niste nikada videli.
03:50
It was insidious and it was really happening.
77
215000
3000
Bilo je podmuklo i zaista se dešavalo.
03:53
Then I decided I had to get really smart,
78
218000
2000
Potom sam odlučio da moram da se opametim
03:55
I would take this job in the West Coast.
79
220000
3000
i prihvatio sam posao na zapadnoj obali.
03:58
And I moved to Redlands California.
80
223000
3000
Preselio sam se u Redlends, Kaliforniju.
04:01
Very nice, and there
81
226000
2000
Veoma lepo i tamo
04:03
my older, senior lungs, as I like to call them,
82
228000
4000
moja starija, seniorska pluća, kako volim da ih zovem,
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
83
232000
6000
napunio sam posebnom materijom, ugljen dioksidom, i veoma visokim dozama ozona.
04:13
Okay? Almost like the highest in the nation.
84
238000
2000
OK? Skoro je najviše u naciji.
04:15
Alright, this is what it looks like on a good day.
85
240000
2000
Dobro, ovako to izgleda kad je dobar dan.
04:17
If you've been there, you know what I'm talking about.
86
242000
3000
Ako ste bili tamo, znate o čemu pričam.
04:20
So, what's wrong with this picture?
87
245000
3000
Dakle, šta ne valja na ovoj slici?
04:23
Well, the picture is, there is a huge gap here.
88
248000
2000
Pa, na slici je velika praznina.
04:25
The one thing that never happens in my doctor's office:
89
250000
4000
Jedina stvar koja se nikada ne dešava kod mog doktora:
04:29
They never ask me about my place history.
90
254000
3000
nikada me ne pitaju za moju istoriju mesta.
04:32
No doctor, can I remember, ever asking me,
91
257000
3000
Ne sećam se da me je ijedan doktor pitao
04:35
"Where have you lived?"
92
260000
2000
"Gde ste živeli?"
04:37
They haven't asked me what kind of the quality
93
262000
2000
Nisu me pitali kakvog kvaliteta je
04:39
of the drinking water that I put in my mouth
94
264000
2000
pijaća voda koju sam stavljao u usta,
04:41
or the food that I ingest into my stomach.
95
266000
4000
ili hrana koju sam vario u stomaku.
04:45
They really don't do that. It's missing.
96
270000
3000
Oni zapravo to ne rade. To nedostaje.
04:48
Look at the kind of data that's available.
97
273000
3000
Pogledajte vrstu podataka koja je dostupna.
04:51
This data's from all over the world --
98
276000
2000
Ovo su podaci sa svih strana sveta -
04:53
countries spend billions of dollars investing in this kind of research.
99
278000
4000
zemlje troše milijarde dolara na ovakva istraživanja.
04:57
Now, I've circled the places where I've been.
100
282000
3000
Zaokružio sam mesta na kojima sam bio.
05:00
Well, by design, if I wanted to have a heart attack
101
285000
3000
Recimo, da sam želeo da imam infarkt
05:03
I'd been in the right places. Right?
102
288000
5000
bio sam na pravim mestima. Zar ne?
05:08
So, how many people are in the white?
103
293000
2000
Koliko ljudi je u belom delu?
05:10
How many people in the room have spent the majority of their life
104
295000
2000
Koliko ljudi iz ove sobe je provelo većinu svog života
05:12
in the white space?
105
297000
3000
u belim mestima?
05:15
Anybody? Boy you're lucky.
106
300000
2000
Bilo ko? Čoveče, vi ste srećnici.
05:17
How many have spent it in the red places?
107
302000
3000
Koliko vas je provelo u crvenim mestima?
05:20
Oh, not so lucky.
108
305000
2000
O, vi niste tako srećni.
05:22
There are thousands of these kinds of maps
109
307000
3000
Postoje hiljade ovakvih mapa
05:25
that are displayed in atlases
110
310000
2000
koje su izložene u atlasima
05:27
all over the world.
111
312000
2000
širom sveta.
05:29
They give us some sense of what's going
112
314000
2000
One nam daju neku ideju o tome
05:31
to be our train wreck.
113
316000
3000
šta će biti naš sudar vozova.
05:34
But none of that's in my medical record.
114
319000
2000
Ali ništa od toga se ne nalazi u mom medicinskom kartonu.
05:36
And it's not in yours either.
115
321000
2000
Niti u vašem.
05:38
So, here's my friend Paul.
116
323000
2000
Evo ga moj prijatelj Pol.
05:40
He's a colleague. He allowed his cell phone to be tracked
117
325000
4000
On je kolega. Dozvolio je da mu prate mobilni telefon
05:44
every two hours, 24/7,
118
329000
3000
na svaka dva sata, 24h 7 dana u nedelji,
05:47
365 days out of the year
119
332000
2000
365 dana u godini,
05:49
for the last two years, everywhere he went.
120
334000
3000
poslednje dve godine, gde god da je išao.
05:52
And you can see he's been to a few places around the United States.
121
337000
4000
Možete videti da je bio na nekoliko mesta u Sjedinjenim Državama.
05:56
And this is where he has spent most of his time.
122
341000
4000
A ovde je proveo većinu svog vremena.
06:00
If you really studied that you might have some clues
123
345000
3000
Da stvarno proučite ovo imali biste neku ideju
06:03
as to what Paul likes to do.
124
348000
3000
o tome šta Pol voli da radi.
06:06
Anybody got any clues? Ski. Right.
125
351000
3000
Ima li neko ideju? Skijanje. Tako je.
06:09
We can zoom in here, and we suddenly see
126
354000
3000
Možemo zumirati ovde i odjednom vidimo
06:12
that now we see where Paul has really spent a majority of his time.
127
357000
4000
gde je stvarno Pol proveo većinu svog vremena.
06:16
And all of those black dots are all of the
128
361000
4000
Sve ove crne tačke obeležavaju
06:20
toxic release inventories
129
365000
2000
mesta otrovnog otpada
06:22
that are monitored by the EPA.
130
367000
2000
koje prati Agencija za zaštitu okoline (EPA).
06:24
Did you know that data existed?
131
369000
3000
Da li ste znali da ti podaci postoje?
06:27
For every community in the United States,
132
372000
2000
Za svaku zajednicu u Americi,
06:29
you could have your own personalized map of that.
133
374000
4000
možete dobiti svoju ličnu mapu toga.
06:33
So, our cell phones can now build a place history.
134
378000
3000
Dakle, naši mobilni telefoni mogu da prave istoriju mesta.
06:36
This is how Paul did it. He did it with his iPhone.
135
381000
3000
Ovako je Pol to uradio. Koristio je iPhone.
06:39
This might be what we end up with.
136
384000
2000
Možda ćemo ovo imati na kraju.
06:41
This is what the physician would have
137
386000
3000
Ovo bi doktor imao
06:44
in front of him and her when we enter that exam room
138
389000
3000
pred sobom kada uđemo u ordinaciju,
06:47
instead of just the pink slip that said I paid at the counter. Right?
139
392000
4000
umesto samo rozog papira koji govori da smo platili račun. Je l' tako?
06:51
This could be my little assessment.
140
396000
2000
Ovo može biti moja mala procena.
06:53
And he looks at that and he says,
141
398000
2000
I on gleda u to i kaže,
06:55
"Whoa Bill,
142
400000
2000
"Opa, Bil,
06:57
I suggest that maybe you not decide,
143
402000
3000
predlažem da možda ne odlučiš,
07:00
just because you're out here in beautiful California,
144
405000
2000
samo zato što si ovde u prelepoj Kaliforniji,
07:02
and it's warm every day,
145
407000
2000
i toplo je svakog dana
07:04
that you get out and run at six o'clock at night.
146
409000
3000
da izađeš i trčiš svako veče u 6 sati.
07:07
I'd suggest that that's a bad idea Bill,
147
412000
3000
Rekao bih da je to loša ideja, Bil
07:10
because of this report."
148
415000
3000
zbog ovog izveštaja."
07:13
What I'd like to leave you for are two prescriptions.
149
418000
4000
Želim da vas ostavim sa dva recepta.
07:17
Okay, number one is, we must teach physicians
150
422000
2000
Ok, prvi je da moramo naučiti lekare
07:19
about the value of geographical information.
151
424000
4000
o vrednosti geografskih informacija.
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
152
428000
4000
To se zove geomedicina. U ovom trenutku postoji nekoliko programa u svetu
07:27
that are focused on this.
153
432000
2000
koji su fokusirani na ovo.
07:29
And they're in the early stages of development.
154
434000
3000
Nalaze se u ranim fazama razvoja.
07:32
These programs need to be supported,
155
437000
3000
Te programe treba podržati.
07:35
and we need to teach our future
156
440000
2000
I trebalo bi da naučimo naše
07:37
doctors of the world
157
442000
2000
buduće doktore u svetu
07:39
the importance of some of the information
158
444000
2000
koliko su važne neke od informacija
07:41
I've shared here with you today.
159
446000
2000
koje sam podelio sa vama danas.
07:43
The second thing we need to do
160
448000
2000
Druga stvar koju bi trebalo da uradimo
07:45
is while we're spending billions and billions
161
450000
2000
je da, dok trošimo milijarde i milijarde
07:47
of dollars all over the world
162
452000
3000
dolara širom sveta
07:50
building an electronic health record,
163
455000
2000
praveći elektronske medicinske kartone,
07:52
we make sure we put a place history
164
457000
2000
da se pobrinemo da uvrstimo istoriju mesta
07:54
inside that medical record.
165
459000
3000
u te medicinske kartone.
07:57
It not only will be important for the physician;
166
462000
3000
To neće biti važno samo za lekare;
08:00
it will be important for the researchers
167
465000
2000
biće važno za istraživače
08:02
that now will have huge samples to draw upon.
168
467000
4000
koji će sada imati ogromne uzorke.
08:06
But it will also be useful for us.
169
471000
2000
A biće korisno i za nas.
08:08
I could have made the decision, if I had this information,
170
473000
4000
Da sam imao ove informacije, mogao sam da odlučim
08:12
not to move to the ozone capital
171
477000
3000
da se ne preselim u ozonsku prestonicu
08:15
of the United States, couldn't I? I could make that decision.
172
480000
3000
Sjedinjenih Država. Zar ne? Mogao sam tako da odlučim.
08:18
Or I could negotiate with my employer
173
483000
2000
Ili sam mogao da pregovaram sa poslodavcem
08:20
to make that decision
174
485000
2000
da donese odluku koja je
08:22
in the best interest of myself and my company.
175
487000
6000
u najboljem interesu za mene i kompaniju.
08:28
With that, I would like to just say that Jack Lord said
176
493000
3000
Ovim želim da kažem da je Džek Lord to
08:31
this almost 10 years ago.
177
496000
3000
rekao pre skoro 10 godina.
08:34
Just look at that for a minute.
178
499000
2000
Samo kratko pogledajte to.
08:36
That was what the conclusion
179
501000
2000
To je bio zaključak
08:38
of the Dartmouth Atlas of Healthcare was about,
180
503000
3000
Atlasa o zdravstvenoj zaštiti u Dartmutu,
08:41
was saying that we can explain the geographic variations
181
506000
3000
koji govori da možemo objasniti geografke varijacije
08:44
that occur in disease, in illness, in wellness,
182
509000
4000
koje se javljaju u bolestima, zarazama, zdravlju
08:48
and how our healthcare system actually operates.
183
513000
3000
i kako naš zdravstveni sistem stvarno funkcioniše.
08:51
That was what he was talking about
184
516000
2000
O tome je govorio
08:53
on that quote.
185
518000
2000
u tom citatu.
08:55
And I would say he got it right almost a decade ago.
186
520000
4000
rekao bih da je pogodio, skoro pre deset godina.
08:59
So, I'd very much like to see us begin to
187
524000
2000
Želeo bih da počnemo da prihvatamo
09:01
really seize this as an opportunity to get this into our medical records.
188
526000
4000
ovu priliku da uvrstimo ovo u naše medicinske kartone.
09:05
So with that, I'll leave you that
189
530000
2000
Ostavljam vas sa time
09:07
in my particular view of view of health:
190
532000
4000
da je u mom pogledu na zdravlje
09:11
Geography always matters.
191
536000
2000
geografija uvek bitna.
09:13
And I believe that geographic information
192
538000
2000
I verujem da geografke informacije
09:15
can make both you and me very healthy. Thank you.
193
540000
2000
mogu da i vas i mene učine veoma zdravim. Hvala vam.
09:17
(Applause)
194
542000
3000
(aplauz)
ABOUT THE SPEAKER
Bill Davenhall - Health and human services expertBill Davenhall wants to improve physicians' diagnostic techniques by collecting each patient's geographic and environmental data, and merging it with their medical records.
Why you should listen
Bill Davenhall has spent three decades creating useful intelligence out of what seems ordinary demographic and geographic data. In the '70s he built the first geo-demographic models that helped some of America’s most well-known franchises expand across the nation; in the '80s he founded a start-up market research company that developed the first national database of estimates for the demand of healthcare services.
Davenhall leads the health and human services marketing team at ESRI, the largest geographic information system (GIS) software developer in the world.
Bill Davenhall | Speaker | TED.com