TEDMED 2012
Rebecca Onie: What if our health care system kept us healthy?
罗贝卡·欧尼：如果我们的健康保证系统让我们保持健康会怎么样？
Filmed:
Readability: 4.3
1,230,915 views
罗贝卡·欧尼问了大胆的问题：如果等候室是一个促进日常健康的地方会怎么样？如果医生在冬天可以开食物，住房，供暖会怎么样？在TEDMED他介绍了健康领导，一个就在做这些的组织——并且通过建立一个像大学运动队一样精英和专注的志愿者基地而实现的。
Rebecca Onie - Health services innovator
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Rebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems. Full bio
Double-click the English transcript below to play the video.
00:16
So my freshman year of college
0
500
1444
在我大学第一年的时候，
00:17
I signed up for an internship in the housing unit
1
1944
2750
我就在波士顿法律系统的住房部
00:20
at Greater Boston Legal Services.
2
4694
2200
得到了一个实习机会。
00:22
Showed up the first day
3
6894
1653
当我第一天上班
00:24
ready to make coffee and photocopies,
4
8547
2316
准备喝点咖啡，复印东西的时候，
00:26
but was paired with this righteous, deeply inspired attorney
5
10863
4582
我就和Jeff Purcell这个
00:31
named Jeff Purcell,
6
15445
1469
有正义感的律师组成了一组，
00:32
who thrust me onto the front lines
7
16914
2465
他把我从第一天起
00:35
from the very first day.
8
19379
2000
就推到了前线。
00:37
And over the course of nine months
9
21379
1765
在9个月里，
00:39
I had the chance
10
23144
1013
我有机会
00:40
to have dozens of conversations
11
24157
1772
和波士顿低收入家庭
00:41
with low-income families in Boston
12
25929
2784
有许多对话，
00:44
who would come in presenting with housing issues,
13
28713
3116
他们和我谈起住房问题，
00:47
but always had an underlying health issue.
14
31829
3284
但这些问题都有一个潜在的卫生问题。
00:51
So I had a client who came in,
15
35113
2232
我有一个客户跟我说，
00:53
about to be evicted because he hasn't paid his rent.
16
37345
2318
他马上就要被驱逐出住所因为他付不起房租。
00:55
But he hasn't paid his rent, of course,
17
39663
2288
当然他没有付房租，
00:57
because he's paying for his HIV medication
18
41951
2494
不过是因为他要支付艾滋病治疗费用
01:00
and just can't afford both.
19
44445
2200
所以他没法付起两样钱。
01:02
We had moms who would come in,
20
46645
1351
我们的客户中有妈妈，
01:03
daughter has asthma,
21
47996
1383
说她们的女儿有哮喘，
01:05
wakes up covered in cockroaches every morning.
22
49379
2885
每天早上身上爬满蟑螂。
01:08
And one of our litigation strategies
23
52264
1973
所以我们的一个诉讼手段就是
01:10
was actually to send me into the home of these clients
24
54237
2775
把我送到这些人家里
01:12
with these large glass bottles.
25
57012
2133
带着大玻璃瓶。
01:15
And I would collect the cockroaches,
26
59145
2000
然后我用大玻璃瓶来收集这些蟑螂，
01:17
hot glue-gun them to this poster board
27
61145
3018
把他们封起来，
01:20
that we'd bring to court for our cases.
28
64163
2032
然后带到法院。
01:22
And we always won
29
66195
1278
我们总赢
01:23
because the judges were just so grossed out.
30
67473
2722
因为法官法官自己感到恶心。
01:26
Far more effective, I have to say,
31
70195
2149
我想说，这方法
01:28
than anything I later learned in law school.
32
72344
2851
比我在法学院以后学的所有东西都管用。
01:31
But over the course of these nine months,
33
75195
2550
但在那九个月里，
01:33
I grew frustrated with feeling
34
77745
1851
我觉得我们的工作已经太迟了，
01:35
like we were intervening too far downstream
35
79596
2966
并且我被这种感觉所折磨，
01:38
in the lives of our clients --
36
82562
2517
那些人
01:40
that by the time they came to us,
37
85079
1532
到我们这里的时候，
01:42
they were already in crisis.
38
86611
2168
他们已经在危机当中。
01:44
And at the end of my freshman year of college,
39
88779
2816
所以在我大一结束的时候，
01:47
I read an article about the work
40
91595
1684
我读到了关于
01:49
that Dr. Barry Zuckerman was doing
41
93279
1782
巴里·扎克曼博士的工作
01:50
as Chair of Pediatrics
42
95061
2136
他在当儿科主任
01:53
at Boston Medical Center.
43
97197
1400
在波士顿医疗中心。
01:54
And his first hire was a legal services attorney
44
98597
3067
他的第一个工作就是
01:57
to represent the patients.
45
101664
1882
作为律师代表病人。
01:59
So I called Barry,
46
103546
1515
所以我打电话给巴里博士，
02:00
and with his blessing, in October 1995
47
105061
2603
并且在他的帮助下，在1995年十月，
02:03
walked into the waiting room
48
107664
2065
我走进了波士顿医疗中心的
02:05
of the pediatrics clinic at Boston Medical Center.
49
109729
2866
儿科诊所等候室。
02:08
I'll never forget,
50
112595
1333
我永远不会忘记
02:09
the TVs played this endless reel of cartoons.
51
113928
2884
那里的电视不断地播放卡通。
02:12
And the exhaustion of mothers
52
116812
2934
还有母亲的劳累，
02:15
who had taken two, three, sometimes four buses
53
119746
3532
他们也许已经做了2回，3回，有时4回的公交车
02:19
to bring their child to the doctor
54
123278
1932
就为了带她们的孩子来看以上，
02:21
was just palpable.
55
125210
1884
这经历现在我都印象很深。
02:22
The doctors, it seemed,
56
127094
1248
然而，医生似乎
02:24
never really had enough time for all the patients,
57
128342
1519
永远没有足够的时间来看这些病人，
02:25
try as they might.
58
129861
1250
尽管他们很努力。
02:27
And over the course of six months,
59
131111
1218
在6个月里，
02:28
I would corner them in the hallway
60
132329
1681
我在走廊拐角看到他们
02:29
and ask them a sort of naive but fundamental question:
61
134010
3901
问他们一个很简单但基础的问题，
02:33
"If you had unlimited resources,
62
137911
2485
“如果你有无限的组员，
02:36
what's the one thing you would give your patients?"
63
140396
3315
你最想给这些病人什么？”
02:39
And I heard the same story again and again,
64
143711
2700
我听到相同的答复，
02:42
a story we've heard hundreds of times since then.
65
146411
2950
这个答复我已经听到数百遍了。
02:45
They said, "Every day we have patients that come into the clinic --
66
149361
3565
他们说：“每天我们都有病人，
02:48
child has an ear infection,
67
152926
1701
对于耳朵感染的孩子，
02:50
I prescribe antibiotics.
68
154627
1933
我给他们开抗生素。
02:52
But the real issue is there's no food at home.
69
156560
2833
但真正的问题是他们家没有食物。
02:55
The real issue
70
159393
1501
真正的问题是
02:56
is that child is living with 12 other people
71
160894
2234
这个孩子在一个两居室里
02:59
in a two-bedroom apartment.
72
163128
1498
和12个人同居。
03:00
And I don't even ask about those issues
73
164626
1850
所以我甚至就不问这些了
03:02
because there's nothing I can do.
74
166476
2751
因为我什么也做不了。
03:05
I have 13 minutes with each patient.
75
169227
1838
对于一个病人我有13分钟。
03:06
Patients are piling up in the clinic waiting room.
76
171065
2569
病人在诊所等候室堆积。
03:09
I have no idea where the nearest food pantry is.
77
173634
2685
我不知道哪里能弄到吃的，
03:12
And I don't even have any help."
78
176319
2348
我也没有帮助。”
03:14
In that clinic, even today,
79
178667
1200
在那个诊所，每天，
03:15
there are two social workers
80
179867
1686
有两个社会工作者
03:17
for 24,000 pediatric patients,
81
181553
2731
来应对24000个儿童病人，
03:20
which is better than a lot of the clinics out there.
82
184284
2852
这也比其他诊所要强得多。
03:23
So Health Leads was born of these conversations --
83
187136
3031
所以健康领导项目就在这些对话中产生了——
03:26
a simple model
84
190167
1184
一个简单的模型，
03:27
where doctors and nurses
85
191351
1515
在其中医生和护士
03:28
can prescribe nutritious food,
86
192866
2218
可以像开药一样开食物，
03:30
heat in the winter
87
195084
1302
在冬天开供暖
03:32
and other basic resources for their patients
88
196386
2582
以及给病人开其他基本资源
03:34
the same way they prescribe medication.
89
198968
2551
和开药是一模一样的。
03:37
Patients then take their prescriptions
90
201519
1981
然后病人拿着他们的厨房
03:39
to our desk in the clinic waiting room
91
203500
2467
到我们在诊所等候室的桌子前
03:41
where we have a core of well-trained college student advocates
92
205967
3817
在这里我们有训练有素的大学生志愿者
03:45
who work side by side with these families
93
209784
2452
来和这些家庭共同工作
03:48
to connect them out
94
212236
1299
把他们和已有的资源
03:49
to the existing landscape of community resources.
95
213535
3216
连接起来。
03:52
So we began with a card table in the clinic waiting room --
96
216751
3549
所以我们以一个小桌子作为开始——
03:56
totally lemonade stand style.
97
220300
2150
就像一个柠檬汁柜台那样。
03:58
But today we have a thousand college student advocates
98
222450
3320
但现在我们有1000个大学生，
04:01
who are working to connect nearly 9,000 patients and their families
99
225770
4300
来把尽9000患者和家庭
04:05
with the resources that they need to be healthy.
100
230070
3201
和资源联系起来让他们健康。
04:09
So 18 months ago
101
233271
1516
所以18个月前，
04:10
I got this email that changed my life.
102
234787
2785
我收到了一封改变我一生的邮件。
04:13
And the email was from Dr. Jack Geiger,
103
237572
2415
这个邮件是从杰克·盖格博士发来的，
04:15
who had written to congratulate me on Health Leads
104
239987
2984
他祝贺我在健康领导项目上取得的成功
04:18
and to share, as he said,
105
242971
1299
并且像他所说，和我分享
04:20
a bit of historical context.
106
244270
2636
一些历史背景。
04:22
In 1965 Dr. Geiger founded
107
246906
2950
在1965年，盖格博士建立了
04:25
one of the first two community health centers in this country,
108
249856
3014
这个国家两个最早的社区健康中心的一个，
04:28
in a brutally poor area in the Mississippi Delta.
109
252870
3151
在密西西比三角洲最贫穷的地方。
04:31
And so many of his patients came in
110
256021
2516
然后有太多营养不良的病人
04:34
presenting with malnutrition
111
258537
2150
进来
04:36
that be began prescribing food for them.
112
260687
2484
使得他开始给他们开食物。
04:39
And they would take these prescriptions to the local supermarket,
113
263171
3251
然后他们把这些处方带到当地超市，
04:42
which would fill them
114
266422
1098
然后超市提供食物
04:43
and then charge the pharmacy budget of the clinic.
115
267520
2818
并从诊所的药物预算中拿钱。
04:46
And when the Office of Economic Opportunity in Washington, D.C. --
116
270338
2883
当华盛顿特区的经济机会办公室
04:49
which was funding Geiger's clinic --
117
273221
1835
——这个办公室在自助盖格的诊所——
04:50
found out about this,
118
275056
1199
发现这个的时候，
04:52
they were furious.
119
276255
1200
他们很生气。
04:53
And they sent this bureaucrat down
120
277455
1749
并且当他们拍官员
04:55
to tell Geiger that he was expected to use their dollars
121
279204
2951
告诉盖格用这些钱
04:58
for medical care --
122
282155
1466
来提供医疗服务的时候——
04:59
to which Geiger famously and logically responded,
123
283621
3400
盖格发表了著名且有逻辑的回应，
05:02
"The last time I checked my textbooks,
124
287021
2425
“最近一次我看我的教科书的时候，
05:05
the specific therapy for malnutrition was food."
125
289446
4359
书上说营养不良的疗法就是食物。”
05:09
(Laughter)
126
293805
1284
（笑声）
05:10
So when I got this email from Dr. Geiger,
127
295089
2699
所以当我收到盖格的邮件的时候，
05:13
I knew I was supposed to be proud
128
297788
2366
我知道我应该为是这个历史的一部分
05:16
to be part of this history.
129
300154
1667
而感到自豪。
05:17
But the truth is
130
301821
1216
但事实上，
05:18
I was devastated.
131
303037
1992
我很沮丧。
05:20
Here we are,
132
305029
1341
现在是这个情况，
05:22
45 years after Geiger has prescribed food for his patients,
133
306370
3985
当盖格给病人开食物45年后，
05:26
and I have doctors telling me,
134
310355
2015
有医生告诉我，
05:28
"On those issues, we practice a 'don't ask, don't tell' policy."
135
312370
4067
“在那些问题上，我们保持”不许问，不许说“的政策。”
05:32
Forty-five years after Geiger,
136
316437
2433
45年后，
05:34
Health Leads has to reinvent
137
318870
1551
健康领导必须要重新发明
05:36
the prescription for basic resources.
138
320421
2835
开基本资源的处方。
05:39
So I have spent hours upon hours
139
323256
3165
所以我花了很多小时，
05:42
trying to make sense of this weird Groundhog Day.
140
326421
3334
来尝试途理解这个奇怪的土拨鼠节。
05:45
How is it that if for decades
141
329755
2534
我们为什么
05:48
we had a pretty straightforward tool for keeping patients,
142
332289
2769
在几十年前就有一个很直接的手段来让我们的病人
05:50
and especially low-income patients, healthy,
143
335058
2597
特别是低收入病人健康，
05:53
that we didn't use it?
144
337655
1901
但不用？
05:55
If we know what it takes to have a healthcare system
145
339556
3099
如果我们知道什么组成一个健康保障系统，
05:58
rather than a sick-care system,
146
342655
2499
而不是一个疾病治疗系统，
06:01
why don't we just do it?
147
345154
2033
我们为什么不做？
06:03
These questions, in my mind,
148
347187
2234
我认为，这些问题
06:05
are not hard because the answers are complicated,
149
349421
3066
不是因为答案很复杂而变得很难，
06:08
they are hard because they require that we be honest with ourselves.
150
352487
5134
而是因为我们需要对我们自己诚实。
06:13
My belief is that it's almost too painful
151
357621
3100
我的观点是这太痛苦了
06:16
to articulate our aspirations for our healthcare system,
152
360721
3229
来说出来我们对健康系统的渴望，
06:19
or even admit that we have any at all.
153
363950
2738
或者甚至承认我们有一个健康系统。
06:22
Because if we did,
154
366688
1167
因为如果我们这么做，
06:23
they would be so removed
155
367855
1616
那些健康系统就会里
06:25
from our current reality.
156
369471
2186
我们的现实太远了。
06:27
But that doesn't change my belief
157
371657
2963
但这不会改变我的观点：
06:30
that all of us, deep inside,
158
374620
2918
我们所有人在内心深处
06:33
here in this room and across this country,
159
377538
3567
在这个房间里和国家里，
06:37
share a similar set of desires.
160
381105
2916
有一些相同的渴望。
06:39
That if we are honest with ourselves
161
384021
2133
我们如果诚实对待我们自己，
06:42
and listen quietly,
162
386154
2301
仔细倾听，
06:44
that we all harbor
163
388455
1816
我们有
06:46
one fiercely held aspiration for our healthcare:
164
390271
4200
一个强烈的渴望，对于我们的健康系统：
06:50
that it keep us healthy.
165
394471
2100
就是它让我们健康。
06:52
This aspiration that our healthcare keep us healthy
166
396571
3317
这个渴望
06:55
is an enormously powerful one.
167
399888
2400
是一个很强有力的渴望。
06:58
And the way I think about this
168
402288
2617
我是这么认为的：
07:00
is that healthcare is like any other system.
169
404905
2184
健康系统和其他所有系统一样。
07:02
It's just a set of choices that people make.
170
407089
2566
只是人们做的一系列选择。
07:05
What if we decided
171
409655
1801
如果我们决定
07:07
to make a different set of choices?
172
411456
2416
做出一套不同的选择会怎么样呢？
07:09
What if we decided to take all the parts of healthcare
173
413872
3032
如果我们决定吧所有
07:12
that have drifted away from us
174
416904
1802
离我们现实越来越远的部分拿出来
07:14
and stand firm and say, "No.
175
418706
2466
然后坚定地说
07:17
These things are ours.
176
421172
1967
“不，这些是我们的。
07:19
They will be used for our purposes.
177
423139
1999
这些要为我们所用。
07:21
They will be used to realize
178
425138
2024
这些要用来实现我们的
07:23
our aspiration"?
179
427162
1931
希望”又会怎么样呢？
07:24
What if everything we needed
180
429093
1750
如果所有我们需要的
07:26
to realize our aspiration for healthcare
181
430843
2145
来实现我们的渴望
07:28
was right there in front of us
182
432988
1583
就在我们前方
07:30
just waiting to be claimed?
183
434571
1884
等着我们去得到又会怎么样呢？
07:32
So that's where Health Leads began.
184
436455
2050
所以这就是健康领导的起点。
07:34
We started with the prescription pad --
185
438505
1684
我们从处方板开始——
07:36
a very ordinary piece of paper --
186
440189
2399
一个很普通的值——
07:38
and we asked, not what do patients need to get healthy --
187
442588
3968
然后我们不问病人需要什么来变得健康
07:42
antibiotics, an inhaler, medication --
188
446556
3018
——抗生素，呼吸器，药物——
07:45
but what do patients need to be healthy,
189
449574
2783
而是病人需要什么来保持健康，
07:48
to not get sick in the first place?
190
452357
2547
从根本上就不生病？
07:50
And we chose to use the prescription
191
454904
1851
所以我们选择
07:52
for that purpose.
192
456755
1782
以这个目的来开处方。
07:54
So just a few miles from here
193
458537
1202
所以就在几英里外
07:55
at Children's National Medical Center,
194
459739
1784
在儿童国家健康中心，
07:57
when patients come into the doctor's office,
195
461523
2266
当病人进入医生办公室是，
07:59
they're asked a few questions.
196
463789
1685
他们被问到一些问题。
08:01
They're asked, "Are you running out of food at the end of the month?
197
465474
2664
他们被问到：“你在月底还有吃的吗？
08:04
Do you have safe housing?"
198
468138
1566
你有健康的住房吗？"
08:05
And when the doctor begins the visit,
199
469704
2069
并且当医生开始走访，
08:07
she knows height, weight, is there food at home,
200
471773
2833
她知道是否家里有食物，
08:10
is the family living in a shelter.
201
474606
1616
是否有住所。
08:12
And that not only leads to a better set of clinical choices,
202
476222
2884
这不仅导致了更好的临床选择，
08:15
but the doctor can also prescribe those resources for the patient,
203
479106
4050
更能让医生给病人开这些资源，
08:19
using Health Leads like any other sub-specialty referral.
204
483156
3666
在健康领导的指引下。
08:22
The problem is,
205
486822
2233
问题是，
08:24
once you get a taste of what it's like
206
489055
2199
一旦你知道怎样
08:27
to realize your aspiration for healthcare,
207
491254
2235
实现你对健康系统的愿望，
08:29
you want more.
208
493489
1518
你就想要更多。
08:30
So we thought,
209
495007
763
所以我们想，
08:31
if we can get individual doctors
210
495770
1601
如果我们能让医生个人
08:33
to prescribe these basic resources for their patients,
211
497371
3217
来开这些基本资源，
08:36
could we get an entire healthcare system
212
500588
2717
我们能让整个健康系统
08:39
to shift its presumption?
213
503305
2752
改变吗？
08:41
And we gave it a shot.
214
506057
1247
现在我们在做这个工作。
08:43
So now at Harlem Hospital Center
215
507304
1435
在哈雷姆医疗中心，
08:44
when patients come in with an elevated body mass index,
216
508739
3786
当身高体重指数过高的病人进来时，
08:48
the electronic medical record
217
512525
1864
电子医疗系统
08:50
automatically generates a prescription for Health Leads.
218
514389
3800
自动为健康领导开除处方。
08:54
And our volunteers can then work with them
219
518189
1466
然后我们的志愿者就可以和他们一起工作
08:55
to connect patients to healthy food and excercise programs
220
519655
3217
来把病人和食物及健身项目联系起来
08:58
in their communities.
221
522872
1432
这全在他们的社区里。
09:00
We've created a presumption
222
524304
1134
我们提出了一个新的概念
09:01
that if you're a patient at that hospital
223
525438
1567
就是如果你是一个
09:02
with an elevated BMI,
224
527005
1550
身高体重指数过高的病人，
09:04
the four walls of the doctor's office
225
528555
2234
那么医生办公室
09:06
probably aren't going to give you everything
226
530789
1852
也许不能给你所有
09:08
you need to be healthy.
227
532641
1182
你需要来保持健康的东西。
09:09
You need more.
228
533823
1400
你需要更多。
09:11
So on the one hand,
229
535223
681
所以与方面，
09:11
this is just a basic recoding
230
535904
1697
这只是一个
09:13
of the electronic medical record.
231
537601
1705
电子医疗基础记录。
09:15
And on the other hand,
232
539306
1718
但另一方面，
09:16
it's a radical transformation
233
541024
1649
这是一个
09:18
of the electronic medical record
234
542673
2168
电子医疗记录的根本的改变
09:20
from a static repository of diagnostic information
235
544841
3882
从静止诊断信息
09:24
to a health promotion tool.
236
548723
2834
到健康促进工具。
09:27
In the private sector,
237
551557
1117
在私人领域，
09:28
when you squeeze that kind of additional value
238
552674
2620
当你把这些额外价值
09:31
out of a fixed-cost investment,
239
555294
1747
从一个固定成本投资中挤出来，
09:32
it's called a billion-dollar company.
240
557041
2600
这是一个十亿美元公司的做法。
09:35
But in my world,
241
559641
1381
但在我的世界里，
09:36
it's called reduced obesity and diabetes.
242
561022
3401
这是减少肥胖和糖尿病的方法。
09:40
It's called healthcare --
243
564423
1883
这是健康保障
09:42
a system where doctors can prescribe solutions
244
566306
2983
——一个系统其中医生可以
09:45
to improve health,
245
569289
1550
开出解决方案来促进健康，
09:46
not just manage disease.
246
570839
2149
而不只是治疗疾病。
09:48
Same thing in the clinic waiting room.
247
572988
1534
同样的事发生在诊所等候室里。
09:50
So every day in this country
248
574522
1617
每天在这个国家
09:52
three million patients
249
576139
1500
三百万病人
09:53
pass through about 150,000 clinic waiting rooms in this country.
250
577639
4494
从150000个等候室里走过。
09:58
And what do they do when they're there?
251
582144
1973
他们在那里做什么？
10:00
They sit, they watch the goldfish in the fish tank,
252
584117
3450
他们坐着，看着鱼缸里的金鱼，
10:03
they read extremely old copies
253
587567
2483
读着很旧的
10:05
of Good Housekeeping magazine.
254
590050
2283
杂志。
10:08
But mostly we all just sit there forever, waiting.
255
592333
3233
但通常我们只是坐在那里，等候。
10:11
How did we get here
256
595566
1351
我们怎样实现
10:12
where we devote hundreds of acres and thousands of hours
257
596917
3349
我们付出几百英里几千小时
10:16
to waiting?
258
600266
1783
等待？
10:17
What if we had a waiting room
259
602049
1217
如果我们有一个等候室
10:19
where you don't just sit when you're sick,
260
603266
2101
在其中你不仅仅坐着，
10:21
but where you go to get healthy.
261
605367
1866
而是在那里就变得健康会怎样？
10:23
If airports can become shopping malls
262
607233
2517
如果机场可以变成商场，
10:25
and McDonald's can become playgrounds,
263
609750
2966
麦当劳可以变成操场，
10:28
surely we can reinvent the clinic waiting room.
264
612716
3433
当然我们可以重新创造等候室。
10:32
And that's what Health Leads has tried to do,
265
616149
2034
这就是健康领导在做的，
10:34
to reclaim that real estate and that time
266
618183
2283
重新利用那片地和时间
10:36
and to use it as a gateway
267
620466
1432
并且把它做成一个过道
10:37
to connect patients
268
621898
1052
来连接病人
10:38
to the resources they need to be healthy.
269
622950
2767
和让他们健康的资源。
10:41
So it's a brutal winter in the Northeast,
270
625717
1516
在东北部寒冷的冬天，
10:43
your kid has asthma, your heat just got turned off,
271
627233
2467
你的孩子有哮喘，但你却没有暖气，
10:45
and of course you're in the waiting room of the ER,
272
629700
2167
当然你在等候室里，
10:47
because the cold air triggered your child's asthma.
273
631867
2532
因为外面的冷风会让你的孩子咳嗽。
10:50
But what if instead of waiting for hours anxiously,
274
634399
2917
但如果不是在等候室里焦急的等几个小时，
10:53
the waiting room became the place
275
637316
2200
而是让等候室变成一个平台
10:55
where Health Leads turned your heat back on?
276
639516
2484
利用这个平台健康领导能让你的暖气重新工作会怎样呢？
10:57
And of course all of this requires
277
642000
1618
当然这需要
10:59
a broader workforce.
278
643618
1948
很多的劳动力。
11:01
But if we're creative, we already have that too.
279
645566
3167
但如果我们有创意，我们已经有了。
11:04
We know that our doctors and nurses
280
648733
2386
我们知道我们的医生和护士
11:07
and even social workers
281
651119
1347
甚至社会工作者
11:08
aren't enough,
282
652466
1468
的力量并不够，
11:09
that the ticking minutes of health care
283
653934
1649
医疗护理的时间
11:11
are too constraining.
284
655583
1418
还太有限。
11:12
Health just takes more time.
285
657001
2049
健康需要更多时间。
11:14
It requires a non-clinical army
286
659050
2799
它需要一个非临床的队伍
11:17
of community health workers and case managers
287
661849
2684
这个队伍由社区健康工作者和特例经理
11:20
and many others.
288
664533
1616
以及其他许多的人组成。
11:22
What if a small part of that next healthcare workforce
289
666149
3150
如果一小部分队伍
11:25
were the 11 million college students in this country?
290
669299
3701
是1100万大学生又会怎么样呢？
11:28
Unencumbered by clinical responsibilities,
291
673000
2766
不受临床责任所限，
11:31
unwilling to take no for an answer
292
675766
2602
不想从那些想压迫病人
11:34
from those bureaucracies
293
678368
1582
的官员口中
11:35
that tend to crush patients,
294
679950
1933
得到不行的答案，
11:37
and with an unparalleled ability
295
681883
1950
并且具备无可匹敌的
11:39
for information retrieval
296
683833
1452
信息收集能力
11:41
honed through years of using Google.
297
685285
2981
且被不断从用谷歌中加强。
11:44
Now lest you think it improbable
298
688266
2533
现在免得你认为
11:46
that a college volunteer
299
690799
1617
一个大学志愿者可以
11:48
can make this kind of commitment,
300
692416
1783
做出这种工作是不可能的，
11:50
I have two words for you:
301
694199
1567
我有两个词给你：
11:51
March Madness.
302
695766
2351
三月疯狂。
11:54
The average NCAA Division I men's basketball player
303
698117
3967
平均一个美国顶级大学生篮球联赛球员
11:57
dedicates 39 hours a week to his sport.
304
702084
3265
每周付出39小时在运动中。
12:01
Now we may think that's good or bad,
305
705349
2152
现在不过我们认为这时好时坏，
12:03
but in either case it's real.
306
707501
2682
这是事实。
12:06
And Health Leads is based on the presumption
307
710183
2185
并且健康领导是基于这样一个事实：
12:08
that for too long
308
712368
1382
已经有太长时间，
12:09
we have asked too little of our college students
309
713750
2550
我们关于学生问的太少了
12:12
when it comes to real impact in vulnerable communities.
310
716300
3765
当谈及脆弱社区的实际影响。
12:15
College sports teams say,
311
720065
1353
高校运动队说，
12:17
"We're going to take dozens of hours
312
721418
2065
“我们要花几十个小时
12:19
at some field across campus at some ungodly hour of the morning
313
723483
3884
在一些校园里的地方，在一些不虔诚的小时，在早上，
12:23
and we're going to measure your performance, and your team's performance,
314
727367
2816
我们要去衡量你的表现和你的团队的表现，
12:26
and if you don't measure up or you don't show up,
315
730183
2166
如果你不来衡量或者不来了，
12:28
we're going to cut you off the team.
316
732349
1450
我们就要把你淘汰。
12:29
But we'll make huge investments
317
733799
1888
但我们会投资大量的钱
12:31
in your training and development,
318
735687
1212
用于你的训练和发展，
12:32
and we'll give you an extraordinary community of peers."
319
736899
3418
并且我们会给你很出色的队友。”
12:36
And people line up out the door
320
740317
1815
门外排队的人
12:38
just for the chance to be part of it.
321
742132
2785
只是为了成为它的一部分。
12:40
So our feeling is,
322
744917
1217
所以我们的感觉就是，
12:42
if it's good enough for the rugby team,
323
746134
1483
如果它对于橄榄球队很好，
12:43
it's good enough for health and poverty.
324
747617
2115
他也对健康和贫困很好。
12:45
Health Leads too recruits competitively,
325
749732
3268
健康领导也用一个很苛刻的条件选拔志愿者，
12:48
trains intensively,
326
753000
1481
给予高强度的训练，
12:50
coaches professionally,
327
754481
1969
专业的训练，
12:52
demands significant time,
328
756450
1949
需要大量的时间，
12:54
builds a cohesive team
329
758399
1367
来筑造一个有凝聚力的团队
12:55
and measures results --
330
759766
1484
并且检测结果 — —
12:57
a kind of Teach for America for healthcare.
331
761250
2683
类似一个为美国而教学的健康保障。
12:59
Now in the top 10 cities in the U.S.
332
763933
2100
现在，在美国的10个
13:01
with the largest number of Medicaid patients,
333
766033
2319
医疗补助患者最多的城市，
13:04
each of those has at least 20,000 college students.
334
768352
3214
每一个人拥有至少 20000 名高校学生。
13:07
New York alone has half a million college students.
335
771566
3201
纽约一个州就有50万大学生。
13:10
And this isn't just a sort of short-term workforce
336
774767
3049
这不只是一种短期的劳动力
13:13
to connect patients to basic resources,
337
777816
2250
来进行把病人和基本资源连接的工作，
13:15
it's a next generation healthcare leadership pipeline
338
780066
3601
它是下一代医疗保健领导的通道
13:19
who've spent two, three, four years
339
783667
2450
那些花了二、 三、 四年
13:22
in the clinic waiting room
340
786117
1501
在诊所等候室
13:23
talking to patients about their most basic health needs.
341
787618
3984
给病人谈论他们最基本的卫生需求的人。
13:27
And they leave with the conviction,
342
791602
1749
他们带着决心离开，
13:29
the ability and the efficacy
343
793351
1832
能力和效率
13:31
to realize our most basic aspirations for health care.
344
795183
3783
来实现我们对卫生保健的最基本愿望。
13:34
And the thing is, there's thousands of these folks already out there.
345
798966
3018
所以，成千上万的人已经到了。
13:37
So Mia Lozada is Chief Resident of Internal Medicine
346
801984
3817
米亚洛是UCSF健康中心
13:41
at UCSF Medical Center,
347
805801
1415
的内科负责人，
13:43
but for three years as an undergraduate
348
807216
2333
但作为在本科的三年里
13:45
she was a Health Leads volunteer
349
809549
1633
她是健康领导的志愿者
13:47
in the clinic waiting room at Boston Medical Center.
350
811182
3002
在波士顿医疗中心诊所等候室工作。
13:50
Mia says, "When my classmates write a prescription,
351
814184
3715
米亚说，"如果我的同学们开了处方，
13:53
they think their work is done.
352
817899
2018
他们就认为他们的工作已经完成了。
13:55
When I write a prescription,
353
819917
1716
当我写了药，
13:57
I think, can the family read the prescription?
354
821633
2267
我认为，家庭可以理解这个处方吗？
13:59
Do they have transportation to the pharmacy?
355
823900
2183
他们能到药房吗？
14:01
Do they have food to take with the prescription?
356
826083
2450
他们有吃的吗？
14:04
Do they have insurance to fill the prescription?
357
828533
2250
他们有保险吗？
14:06
Those are the questions I learned at Health Leads,
358
830783
2683
这些是我在健康领导中学到的，
14:09
not in medical school."
359
833466
1750
而不是在医学院。"
14:11
Now none of these solutions --
360
835216
1984
现在没有任何这些解决方案 — —
14:13
the prescription pad, the electronic medical record,
361
837200
2970
药方，电子医疗记录，
14:16
the waiting room,
362
840170
1147
等候室，
14:17
the army of college students --
363
841317
1168
大学生队伍——
14:18
are perfect.
364
842485
1183
是完美的。
14:19
But they are ours for the taking --
365
843668
2500
但他们是我们的责任 — —
14:22
simple examples
366
846168
1332
简单的例子
14:23
of the vast under-utilized healthcare resources
367
847500
3501
关于大量未充分利用医疗资源的
14:26
that, if we reclaimed and redeployed,
368
851001
2915
如果我们回收和重新调配，
14:29
could realize our most basic aspiration
369
853916
3417
可以实现我们最基本的愿望
14:33
of healthcare.
370
857333
1784
卫生保健。
14:35
So I had been at Legal Services for about nine months
371
859117
3216
所以我一直在约九个月的法律服务
14:38
when this idea of Health Leads started percolating in my mind.
372
862333
2733
当这个健康领导项目被我想时。
14:40
And I knew I had to tell Jeff Purcell, my attorney,
373
865066
2934
我知道我不得不告诉我的律师，杰夫 · 珀塞尔
14:43
that I needed to leave.
374
868000
1419
我需要离开。
14:45
And I was so nervous,
375
869419
963
我很紧张，
14:46
because I thought he was going to be disappointed in me
376
870382
2534
因为我以为他要将对我失望
14:48
for abandoning our clients for some crazy idea.
377
872916
3050
因为我放弃我们的客户而进行一些疯狂的想法。
14:51
And I sat down with him and I said,
378
875966
1984
他坐下，我说，
14:53
"Jeff, I have this idea
379
877950
1883
"杰夫，我有这种想法
14:55
that we could mobilize college students
380
879833
2419
我们可以调动大学生
14:58
to address patients' most basic health needs."
381
882252
2934
来解决病人最基本的健康需要。”
15:01
And I'll be honest,
382
885186
1581
我是诚实的
15:02
all I wanted was for him to not be angry at me.
383
886767
3299
我只是他不是生我的气。
15:05
But he said this,
384
890066
1467
但他表示，这一点，
15:07
"Rebecca, when you have a vision,
385
891533
3348
"罗贝卡，当你有一个远景
15:10
you have an obligation to realize that vision.
386
894881
3851
你就有义务要实现这一理想。
15:14
You must pursue that vision."
387
898732
3101
你必须追求这一愿景。"
15:17
And I have to say, I was like "Whoa.
388
901833
3266
我不得不说，我就像"哇。
15:20
That's a lot of pressure."
389
905099
2017
这压力很大。”
15:23
I just wanted a blessing,
390
907116
1399
我只想要祝福，
15:24
I didn't want some kind of mandate.
391
908515
1551
我不想要命令。
15:25
But the truth is
392
910066
1567
但事实是
15:27
I've spent every waking minute nearly since then
393
911633
2783
自那时以来我几乎花了醒着的每一分钟
15:30
chasing that vision.
394
914416
1784
追求这一愿景。
15:32
I believe that we all have a vision
395
916200
3182
我相信我们都有一个关于
15:35
for healthcare in this country.
396
919382
1901
这个国家医疗保健的远景。
15:37
I believe that at the end of the day
397
921283
2199
我相信，在一天结束时
15:39
when we measure our healthcare,
398
923482
1834
当我们来衡量我们的卫生保健，
15:41
it will not be by the diseases cured,
399
925316
2816
标准不是被治好的疾病，
15:44
but by the diseases prevented.
400
928132
2518
而是被预防的疾病。
15:46
It will not be by the excellence of our technologies
401
930650
3017
标准不是我们的技术有多好，
15:49
or the sophistication of our specialists,
402
933667
2500
或者我们专家有多专业，
15:52
but by how rarely we needed them.
403
936167
2799
而是我们多么不需要他们。
15:54
And most of all,
404
938966
1484
最重要的是，
15:56
I believe that when we measure healthcare,
405
940450
2517
我认为当我们见此的健康保障是，
15:58
it will be, not by what the system was,
406
942967
2683
标准不是这个系统是什么，
16:01
but by what we chose it to be.
407
945650
2766
而是我们让它变成什么。
16:04
Thank you.
408
948416
1067
谢谢。
16:05
(Applause)
409
949483
10250
（掌声）
16:15
Thank you.
410
959733
1267
谢谢。
16:16
(Applause)
411
961008
9323
（掌声）
ABOUT THE SPEAKER
Rebecca Onie - Health services innovatorRebecca Onie is the founder of Health Leads, a program that connects patients to basic care and resources, such as food and housing, that are the root cause of many health problems.
Why you should listen
In 1996, as a sophomore in college, Rebecca Onie had a realization: The health care system in the United States was not set up to diagnose nor treat the socioeconomic issues that lead to poor health, and that health care providers are not given tools to address basic problems like nutrition and housing.
So, while still a sophomore, she co-founded Health Leads, a program that assists low-income patients and their families to access food, heat, and other basic resources they need to be healthy. With the additional insight that college volunteers could be recruited and trained into an elite group just like a college sport team, she found the people and skills needed to produce such an audacious idea. Since then it has grown tremendously, and now operates in Baltimore, Boston, Chicago, New York, Providence, and Washington, DC, and in the last year assisted over 8,800 patients.
In 2009, Rebecca was awarded a MacArthur “Genius” Fellowship.
Photo: Courtesy of the John D. & Catherine T. MacArthur Foundation
Rebecca Onie | Speaker | TED.com