ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States.

Why you should listen

Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.

A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.

More profile about the speaker
Elizabeth Howell | Speaker | TED.com
TEDMED 2018

Elizabeth Howell: How we can improve maternal healthcare -- before, during and after pregnancy

伊丽莎白·豪威尔: 我们如何改进孕产妇保健 ——孕前,孕中以及孕后

Filmed:
1,629,987 views

震惊,却真实:美国现在在所有发达国家中有着最高的新生儿母亲死亡率——并且这其中60%都是可以避免的。内科医生伊丽莎白·豪威尔(Elizabeth Howell)明确又紧迫地解释了孕妇死亡率的诱因并给医院和医生们分享了如何使妇女在孕前、孕中以及产后更加安全的方法。
- Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States. Full bio

Double-click the English transcript below to play the video.

00:12
It was chaos混沌 as I got off the elevator电梯.
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当我从电梯里出来的时候
眼前一片混乱。
00:15
I was coming未来 back on duty义务
as a resident居民 physician医师
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作为一名住院医师,
00:18
to cover the labor劳动 and delivery交货 unit单元.
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我正从值班的妇产科部门回来。
00:20
And all I could see was a swarm一群
of doctors医生 and nurses护士
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我所能看见的是待产室里
一大群医生和护士
00:24
hovering徘徊 over a patient患者 in the labor劳动 room房间.
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徘徊在一名病人周围。
00:26
They were all desperately拼命 trying
to save保存 a woman's女人的 life.
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他们正绝望地尝试
挽救一名产妇的生命。
00:29
The patient患者 was in shock休克.
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病人已经休克了。
00:31
She had delivered交付 a healthy健康 baby宝宝 boy男孩
a few少数 hours小时 before I arrived到达.
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她在我到达的几小时之前
生了一名健康的男宝宝。
00:36
Suddenly突然, she collapsed倒塌,
became成为 unresponsive反应 迟钝,
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突然之间,她昏倒了,毫无反应,
00:39
and had profuse丰富的 uterine子宫的 bleeding流血的.
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并且开始血崩。
00:42
By the time I got to the room房间,
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当我到达房间,
00:44
there were multiple doctors医生 and nurses护士,
and the patient患者 was lifeless死气沉沉.
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里面有各种医生和护士,
而病人生命迹象微弱。
00:48
The resuscitation复生 team球队
tried试着 to bring带来 her back to life,
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复苏组尝试使她恢复意识,
00:51
but despite尽管 everyone's大家的 best最好 efforts努力,
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但是尽管每一个人都尽力了,
00:53
she died死亡.
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她还是走了。
00:55
What I remember记得 most about that day
was the father's父亲的 piercing冲孔 cry.
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我对那一天记忆最深刻的
是那位父亲撕心裂肺的哭声。
00:59
It went through通过 my heart
and the heart of everyone大家 on that floor地板.
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那哭声刺激了我的心,
以及那层楼所有人的心。
01:02
This was supposed应该 to be
the happiest最幸福 day of his life,
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那一天本应该是他
生命中最快乐的一天,
01:05
but instead代替 it turned转身 out
to be the worst最差 day.
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但是最后却变成了最糟糕的一天。
01:10
I wish希望 I could say this tragedy悲剧
was an isolated孤立 incident事件,
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我希望我可以说
这场悲剧是一个个案,
01:13
but sadly可悲的是, that's not the case案件.
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但遗憾的是,并不是这样的。
01:16
Every一切 year in the United联合的 States状态,
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在美国,每一年
01:18
somewhere某处 between之间 700 and 900 women妇女 die
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有700至900名妇女
01:21
from a pregnancy-related与怀孕有关 cause原因.
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死于与妊娠相关的原因。
01:23
The shocking触目惊心 part部分 of this story故事
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这个故事令人震惊的部分在于
01:25
is that our maternal母系 mortality死亡 rate
is actually其实 higher更高
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我们的产妇死亡率实际上
01:29
than all other high-income高收入 countries国家,
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高于其他高收入国家,
01:31
and our rates利率 are far worse更差
for women妇女 of color颜色.
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并且这个概率在有色人种
的女性身上更加糟高。
01:35
Our rate of maternal母系 mortality死亡
actually其实 increased增加 over the last decade,
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在过去一个世纪我们的
产妇死亡率实际上增加了,
01:40
while other countries国家 reduced减少 their rates利率.
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与此同时其他国家降低了。
01:43
And the biggest最大 paradox悖论 of all?
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这里最大的悖论是什么?
01:45
We spend more on health健康 care关心
than any other country国家 in the world世界.
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我们在医疗保健上有着
比其他所有国家都要高的花费。
01:50
Well, around the same相同 time in residency住院医师
that this new mother母亲 lost丢失 her life,
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当然,几乎与在住院时
那位新母亲失去生命的同时,
01:54
I became成为 a mother母亲 myself.
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我成为了一名母亲。
01:56
And even with all of my background背景
and training训练 in the field领域,
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尽管我有着这个领域
所有的背景和培训,
02:00
I was taken采取 aback吓了一跳
by how little attention注意 was paid支付
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我仍然对无法保证一个高质量的
02:03
to delivering交付 high-quality高质量
maternal母系 health健康 care关心.
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孕期保健而震惊。
02:06
And I thought about what that meant意味着,
not just for myself
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我思考着这意味着什么,
不仅仅是对于我,
02:09
but for so many许多 other women妇女.
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而是对于许许多多的妇女们。
02:11
Maybe it's because my dad
was a civil国内 rights权利 attorney律师
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也许因为我的父亲
是一名民权律师,
02:15
and my parents父母 were socially社交上 conscious意识
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并且我的父母非常具有社会意识,
02:17
and demanded要求 that we stand up
for what we believe in.
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并且要求我们要坚持自己的信仰。
02:20
Or the fact事实 that my parents父母
were born天生 in Jamaica牙买加,
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或者是因为事实上我的
父母出生在牙买加,
02:22
came来了 to the United联合的 States状态
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移民到了美国,
02:24
and were able能够 to realize实现
the American美国 Dream梦想.
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并且能够实现他们的美国梦。
02:27
Or maybe it was my residency住院医师 training训练,
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又或者是我的住院医师培训,
02:29
where I saw firsthand第一手
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使我直接地看到了
02:31
how poorly不好 so many许多 low-income低收入
women妇女 of color颜色 were treated治疗
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医疗系统是多么恶劣的对待
02:34
by our healthcare卫生保健 system系统.
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许多有色人种的妇女的。
02:36
For whatever随你 the reason原因,
I felt a responsibility责任 to stand up,
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不论是因为哪一个原因,
我感觉到我有责任站出来,
02:40
not just for myself,
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不仅仅为我自己,
02:41
but for all women妇女,
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而且为了所有的女性,
02:43
and especially特别 those marginalized边缘化
by our healthcare卫生保健 system系统.
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尤其是那些被我们
医疗系统所边缘化的。
02:46
And I decided决定 to focus焦点 my career事业
on improving提高 maternal母系 health健康 care关心.
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所以我决定将我职业的重点
放在改善孕产期医疗。
02:52
So what's killing谋杀 mothers母亲?
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那么是什么杀害了母亲们?
02:54
Cardiovascular心血管 disease疾病, hemorrhage出血,
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心血管疾病,大出血,
02:57
high blood血液 pressure压力
causing造成 seizures癫痫发作 and strokes,
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高血压引发癫痫和中风,
03:00
blood血液 clots血块 and infection感染
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血栓和感染
03:01
are some of the major重大的 causes原因
of maternal母系 mortality死亡 in this country国家.
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则是我们国家孕产期
死亡的部分主要原因。
03:05
But a maternal母系 death死亡
is only the tip小费 of the iceberg冰山.
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但是孕产期死亡仅仅是冰山的一角。
03:09
For every一切 death死亡, over a hundred women妇女
suffer遭受 a severe严重 complication并发症
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每一类死亡,超过
100名女性都遭受了
03:14
related有关 to pregnancy怀孕 and childbirth分娩,
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严重的与怀孕和分娩
相关的并发症,
03:16
resulting造成 in over 60,000 women妇女 every一切 year
having one of these events事件.
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导致了每年有超过6万名
女性有其中的一个症状。
03:21
These complications并发症,
called severe严重 maternal母系 morbidity发病率,
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这些并发症,被称为
严重的产妇发病率,
03:24
are on the rise上升 in the United联合的 States状态,
and they're life-altering改变生活.
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在美国呈现上升的趋势,
并且这些并发症会改变人的一生。
03:28
It's estimated预计 that somewhere某处
between之间 1.5 and two percent百分
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据统计,我们国家每年
03:32
of the four million百万 deliveries交付
that occur发生 every一切 year in this country国家
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的四百万次分娩中,
03:35
are associated相关 with one of these events事件.
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有1.5%到2%都与这些症状相关。
03:38
That is five or six women妇女 every一切 hour小时
having a blood血液 clot凝块, a seizure发作, a stroke行程,
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也就是每小时有五到六名女性
患上了血栓,癫痫,中风,
03:44
receiving接收 a blood血液 transfusion,
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接受一次输血,
03:45
having end-organ端器官 damage损伤
such这样 as kidney failure失败,
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患上终末器官损害比如肾衰竭,
03:48
or some other tragic悲惨 event事件.
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或者其它突发症状。
03:52
Now, the part部分 of this story故事
that's frankly坦率地说 unforgivable不可饶恕
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现在,这个情况明显
不能原谅的部分在于
03:55
is the fact事实 that 60 percent百分
of these deaths死亡 and severe严重 complications并发症
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60%的死亡和并发症
04:00
are thought to be preventable预防的.
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被认为是可以避免的。
04:02
When I say 60 percent百分 are preventable预防的,
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当我说60%是可以避免的,
04:04
I mean there are concrete具体 steps脚步
and standard标准 procedures程序
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我的意思是有一些具体步骤
04:08
that we could implement实行
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和标准程序我们可以实行,
04:09
that could prevent避免
these bad outcomes结果 from occurring发生
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以避免这些糟糕的结果出现,
04:12
and save保存 women's女士的 lives生活.
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并且挽救这些女性的生命。
04:14
And it doesn't require要求
fancy幻想 new technology技术.
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而且这并不需要高级的新技术。
04:17
We just have to apply应用 what we know
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我们只是需要将
我们知道的付诸于行动
04:19
and ensure确保 equal等于 standards标准
between之间 hospitals医院.
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并且确保医院之间的同等标准。
04:23
For example, if a pregnant woman女人
in labor劳动 has really high blood血液 pressure压力
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比如说,当一名正在分娩的孕妇
有着非常高的血压
04:27
and we treat对待 her with the right
antihypertensive降压 medication药物治疗
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如果我们及时给她正确的
04:30
in a timely及时 fashion时尚,
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抗高血压药物,
04:32
we can prevent避免 stroke行程.
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我们就可以避免中风。
04:34
If we accurately准确 track跟踪
blood血液 loss失利 during delivery交货,
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如果我们可以准确的观测到
分娩中的血液流失,
04:37
we can detect检测 a hemorrhage出血 sooner
and save保存 a woman's女人的 life.
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我们就会及时察觉到出血
并挽救孕妇的生命。
04:41
We could actually其实 lower降低 the rates利率
of these catastrophic灾难性的 events事件 tomorrow明天,
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那么明天我们就可以从根本上
降低这些灾难性事件发生的概率,
04:46
but it requires要求 that we value
the quality质量 of care关心
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但是这需要我们重视
04:49
we deliver交付 to pregnant women妇女
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孕妇在孕前、孕中和产后
04:50
before, during and after pregnancy怀孕.
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治疗的质量。
04:54
If we raise提高 quality质量 of care关心 universally举世
to what is supposed应该 to be the standard标准,
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如果我们将治疗的质量普遍
提升到我们认为的“标准”,
04:58
we could bring带来 the rates利率 of these deaths死亡
and severe严重 complications并发症 way down.
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就可以将死亡率和
并发症发生率大大降低。
05:03
Well, there is some good news新闻.
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当然了,也有一些好的消息。
05:06
There are some success成功 stories故事.
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有一些成功的案例。
05:08
There are some places地方 that have
actually其实 adopted采用 these standards标准,
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有一些地区已经落实了这些标准,
并且出现了实质性的改变。
05:12
and it's really making制造 a difference区别.
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05:13
A few少数 years年份 ago, the American美国 College学院
of Obstetricians产科 医生 and Gynecologists妇产科
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几年前,美国妇产科学院
05:18
joined加盟 forces军队 with other
healthcare卫生保健 organizations组织,
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联合了其他医疗机构,
05:21
researchers研究人员 like myself
and community社区 organizations组织.
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研究员们,比如我,和社区组织。
05:24
They wanted to implement实行
standard标准 care关心 practices做法
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他们希望在整个国家
的医院和医疗系统里
05:27
in hospitals医院 and health健康 systems系统
throughout始终 the country国家.
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实施标准治疗工作。
05:30
And the vehicle车辆 they're using运用
is a program程序 called
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他们采用的方法则是一个
05:33
the Alliance联盟 for Innovation革新
in Maternal孕 产妇 Health健康, the AIM目标 program程序.
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叫做孕妇保健的联盟创新计划,
即AIM计划。
05:37
Their goal目标 is to lower降低 maternal母系 mortality死亡
and severe严重 maternal母系 morbidity发病率 rates利率
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他们的目标是通过
质量和安全新举措
05:42
through通过 quality质量 and safety安全 initiatives倡议
across横过 the country国家.
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在全国范围内降低孕妇死亡率
和严重产妇并发症发病率。
05:45
The group has developed发达
a number of safety安全 bundles捆绑
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这个组织已经开发了一些安全方案,
05:48
that target目标 some of the most
preventable预防的 causes原因 of a maternal母系 death死亡.
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针对一些最可预防的孕产妇死亡原因。
05:53
The AIM目标 program程序 currently目前
has the potential潜在 to reach达到
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AIM计划现在有覆盖
05:56
over 50 percent百分 of US births出生.
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超过美国百分之五十
出生人数的可能性。
05:59
So what's in a safety安全 bundle?
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那么什么是安全方案?
06:01
Evidence-based基于证据 practices做法,
protocols协议, procedures程序,
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将这些情境作为目标所需要的
循证实践,习惯做法,步骤,
06:04
medications药物治疗, equipment设备
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用药,设备,
06:05
and other items项目 targeting针对
these conditions条件.
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和其他物品。
06:08
Let's take the example
of a hemorrhage出血 bundle.
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以出血的安全方案为例。
06:11
For a hemorrhage出血, you need a cart大车
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在病人出血时,
你需要一个手推车,
06:13
that has everything a doctor医生 or nurse护士
might威力 need in an emergency:
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准备好医生或者护士
可能在急救中会用到的所有东西:
06:17
an IVIV line线, an oxygen mask面具, medications药物治疗,
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静脉注射管线,氧气罩,药物,
06:20
checklists清单, other equipment设备.
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清单,其它仪器。
06:22
Then you need something
to measure测量 blood血液 loss失利:
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然后你需要测量血液流失的仪器:
06:25
sponges海绵 and pads.
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海绵和衬垫。
06:26
And instead代替 of just eyeballing眼球 it,
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医生和护士收集
这些海绵和衬垫,
06:28
the doctors医生 and nurses护士
collect搜集 these sponges海绵 and pads
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称出重量,或者是
用新技术来准确的评估
06:31
and either weigh称重 them
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到底流失了多少血,
06:33
or use newer technology技术 to accurately准确
assess评估 how much blood血液 has been lost丢失.
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而不是一直盯着它们。
06:39
The hemorrhage出血 bundle also includes包括
crises危机 protocols协议 for massive大规模的 transfusions输血
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出血安全方案也包括需要
大量输血时的危险期医疗方案
06:44
and regular定期 trainings培训 and drills演习.
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和常规培训和教学。
06:46
Now, California加州 has been a leader领导
in the use of these types类型 of bundles捆绑,
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现在,加州已经成为应用
这种安全方案的领导者,
06:50
and that's why California加州
saw a 21 percent百分 reduction减少
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这也是为什么加州实施
这种安全方案的第一年,
06:54
in near death死亡 from hemorrhage出血
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医院里因出血而
06:56
among其中 hospitals医院 that implemented实施
this bundle in the first year.
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濒临死亡的人数就降低了21%。
07:00
Yet然而 the use of these bundles捆绑
across横过 the country国家 is spotty参差不齐 or missing失踪.
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但是这些方案在全国范围内的
应用是参差不齐或者不完整的。
07:04
Just like the fact事实 that the use
of evidence-based循证 practices做法
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比如说,即便使用循证实践
07:07
and the emphasis重点 on safety安全
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和对安全的重视,
07:09
differs不同 from one hospital醫院 to the next下一个,
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每一个医院都是不同的,
07:12
quality质量 of care关心 differs不同.
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治疗的质量也不尽相同。
07:14
And quality质量 of care关心 differs不同 greatly非常
for women妇女 of color颜色 in the United联合的 States状态.
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而且对有色人种的女性,
治疗的质量则区别更大。
07:19
Black黑色 women妇女 who deliver交付 in this country国家
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在这个国家,黑人女性分娩时
07:21
are three to four times more likely容易
to suffer遭受 a pregnancy-related与怀孕有关 death死亡
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可能遭受的与妊娠有关的死亡
07:25
than are white白色 women妇女.
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是白人女性的三到四倍。
07:27
This statistic统计 is true真正 for all black黑色 women妇女
who deliver交付 in this country国家,
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这个统计对于所有在这个国家
分娩的黑人女性是真实有效的,
07:31
whether是否 they were born天生
in the United联合的 States状态
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不管他们是出生在美国,
07:33
or born天生 in another另一个 country国家.
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或是出生在其它国家。
07:35
Many许多 want to think that income收入 differences分歧
drive驾驶 these disparities差距,
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很多人愿意相信是因为
收入差异导致了这些不同,
07:39
but it goes beyond class.
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但是这超出了阶级的范畴。
07:41
A black黑色 woman女人 with a college学院 education教育
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一个有着大学学历的黑人女性
07:44
is nearly几乎 twice两次 as likely容易 to die
as compared相比 to a white白色 woman女人
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死亡的可能性是一个
不到高中学历的
07:48
with less than a high school学校 education教育.
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白人女性的两倍。
07:50
And she is two to three times more likely容易
to suffer遭受 a severe严重 pregnancy怀孕 complication并发症
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并且她有两到三倍的
可能在分娩的时候
07:56
with her delivery交货.
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经历严重的妊娠并发症。
07:58
Now, I was always taught to think
that education教育 was our salvation救恩,
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现在,我总是被教导着认为
教育是我们的救世主,
08:02
but in this case案件, it's simply只是 not true真正.
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但是在这种情况下,
这根本不是真的。
08:06
This black-white黑,白 disparity差距
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根据疾病控制中心所说,
08:08
is the largest最大 disparity差距
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黑人-白人的差异
08:10
among其中 all population人口
perinatal围产期 health健康 measures措施,
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在所有人口围产期健康措施中,
08:12
according根据 to the CDCCDC.
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是最大的。
08:14
And these disparities差距
are even more pronounced宣判
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而这些差异在一些城市中
08:17
in some of our cities城市.
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则更加显著。
08:18
For example, in New York纽约 City,
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比如,在纽约,
08:20
a black黑色 woman女人 is eight to 12 times
more likely容易 to die
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黑人妇女因为妊娠
相关原因死亡的概率
08:24
from a pregnancy-related与怀孕有关 cause原因
than is a white白色 woman女人.
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是白人妇女的12倍。
08:28
Now, I think many许多 of you
are probably大概 familiar with
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我想你们大部分人都可能很熟悉
08:31
the heart-wrenching心脏痛心 story故事
of Dr博士. Shalon沙隆 Irving欧文,
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谢纶·欧文博士那令人
撕心裂肺的故事,
08:33
a CDCCDC epidemiologist流行病学家
who died死亡 following以下 childbirth分娩.
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她是一名疾病防治中心
的流行病学家,死于后来的分娩。
08:37
Her story故事 was reported报道
in ProPublicaProPublica and NPR美国国家公共电台
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不到一年前她的故事
08:41
a little less than a year ago.
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被ProPublica和NPR报道。
08:43
Recently最近, I was at a conference会议
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最近,我在一个会议上
08:45
and I had the privilege特权
of hearing听力 her mother母亲 speak说话.
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有幸听到了她母亲的演讲。
08:47
She brought the entire整个 audience听众 to tears眼泪.
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整个观众席都被她的
演讲感动到热泪盈眶。
08:50
Shalon沙隆 was a brilliant辉煌 epidemiologist流行病学家,
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谢纶是一名杰出的流行病学家,
08:53
committed提交 to studying研究
racial种族 and ethnic民族 disparities差距 in health健康.
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立志于研究种族和人种
在医疗方面的差异。
08:56
She was 36 years年份 old,
this was her first baby宝宝,
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她才36岁,那是她的第一个孩子,
08:59
and she was African-American非裔美国人.
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她是一名非裔美国人。
09:02
Now, Shalon沙隆 did have
a complicated复杂 pregnancy怀孕,
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Shalon得了妊娠并发症,
09:05
but she delivered交付 a healthy健康 baby宝宝 girl女孩
and was discharged出院 from the hospital醫院.
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但是她分娩了一名健康
的女孩,然后出院了。
09:09
Three weeks later后来, she died死亡
from complications并发症 of high blood血液 pressure压力.
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三周之后,她死于高血压并发症。
09:14
Shalon沙隆 was seen看到 four or five times
by healthcare卫生保健 professionals专业人士
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谢纶在那三周里
09:19
in those three weeks.
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与医疗专家见了四五次。
09:20
She was not listened听了 to,
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她的话被当作了耳旁风,
09:22
and the severity严重 of her condition条件
was not recognized认可.
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她情况的严重性也没有被认可。
09:27
Now, Shalon's沙隆的 story故事
is just one of many许多 stories故事
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谢纶的故事只是在美国的
09:30
about racial种族 and ethnic民族 disparities差距
in health健康 and health健康 care关心
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众多关于健康和医疗的
09:33
in the United联合的 States状态,
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种族和人种差异故事的其中一个,
09:35
and there's a growing生长 recognition承认
that the social社会 determinants决定因素 of health健康,
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并且越来越多人认可健康的
社会决定因素,
09:39
such这样 as racism种族主义, poverty贫穷, education教育,
segregated隔离 housing住房,
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比如种族,贫穷,教育,隔离住房,
09:44
contribute有助于 to these disparities差距.
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1899
都是导致这些差异的因素。
09:46
But Shalon's沙隆的 story故事 highlights强调
an additional额外 underlying底层 cause原因:
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但是谢纶的故事
使另外一个潜在的因素凸显出来:
09:50
quality质量 of care关心.
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治疗的质量。
09:52
Lack缺乏 of standards标准 in postpartum产后 care关心.
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缺乏产后治疗的标准。
09:55
Shalon沙隆 was seen看到 multiple times
by clinicians临床医生 in those three weeks,
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3288
谢纶在那三周里见了
好几次临床医生,
09:58
and she still died死亡.
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1897
但是她仍然去世了。
10:00
Quality质量 of care关心
in the setting设置 of childbirth分娩
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在美国,妊娠死亡和严重并发症中,
10:03
is an underlying底层 cause原因
of racial种族 and ethnic民族 disparities差距
194
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分娩环境中的治疗质量
10:06
in maternal母系 mortality死亡
and severe严重 maternal母系 morbidity发病率
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是导致种族和人种差异的
10:09
in the United联合的 States状态,
196
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一个潜在因素,
10:10
and it's something we can address地址 now.
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2278
并且这是我们现在
就可以处理的问题。
10:14
Research研究 by our team球队 and others其他
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我们团队的研究员和其他人
10:16
has documented记录 that,
for a variety品种 of reasons原因,
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已经书面记录了这些状况,
因为不同的原因,
10:18
black黑色 women妇女 tend趋向 to deliver交付
in a specific具体 set of hospitals医院,
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黑人女性倾向于在一些
特定的医院进行分娩,
10:22
and those hospitals医院 often经常 have worse更差
outcomes结果 for both black黑色 and white白色 women妇女,
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而不考虑病人的风险因素,
10:26
regardless而不管 of patient患者 risk风险 factors因素.
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这些医院的黑人和白人女性
都时常有更严重的预后不良。
10:29
This is true真正 overall总体 in the United联合的 States状态,
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这样的情况在全美国比比皆是,
10:31
where about three quarters住处
of all black黑色 women妇女
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在美国大约四分之三的黑人女性
10:34
deliver交付 in a specific具体 set of hospitals医院,
205
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2290
在一些特定医院进行分娩,
10:36
while less than one-fifth五分之一 of white白色 women妇女
deliver交付 in those same相同 hospitals医院.
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3778
而同时只有不到五分之一的
白人女性在同样的医院分娩。
10:40
In New York纽约 City, a woman's女人的 risk风险
of having a life-threatening危及生命 complication并发症
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在纽约,一名妇女在一家医院里
进行分娩时患上威胁生命
10:44
during delivery交货
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1159
的并发症的风险
10:46
can be six times higher更高
in one hospital醫院 than another另一个.
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可能是另外一家医院的六倍。
10:49
Not surprisingly出奇, black黑色 women妇女
are more likely容易 to deliver交付
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也难怪,黑人女性在医院
分娩时遇到不良结果
10:53
in hospitals医院 with worse更差 outcomes结果.
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的可能性更大一些。
10:55
In fact事实, differences分歧 in delivery交货 hospital醫院
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事实上,不同分娩医院的区别
10:57
explain说明 nearly几乎 one-half一半
of the black-white黑,白 disparity差距.
213
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解释了接近一半
黑人-白人差异的原因。
11:01
While we must必须 address地址
social社会 determinants决定因素 of health健康
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如果我们要在这个国家
真正实现公平的医疗保健,
11:04
if we're ever going to truly have
equitable公平 health健康 care关心 in this country国家,
215
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3913
我们就必须解决健康
的社会决定因素,
11:08
many许多 of these are deep-seated根深蒂固
and they will take some time to resolve解决.
216
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3739
而这些因素大部分都是根深蒂固的,
解决它们需要一些时间。
11:12
In the meantime与此同时,
we can tackle滑车 quality质量 of care关心.
217
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同时,我们可以处理
治疗质量的问题。
11:15
Providing提供 high-quality高质量 care关心
across横过 the care关心 continuum连续
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在整个连续的治疗中
提供高质量的治疗
11:19
means手段 providing提供 access访问 to safe安全
and reliable可靠 contraception避孕
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3521
意味着在妇女的整个生殖周期
11:22
throughout始终 women's女士的 reproductive生殖 lives生活.
220
670953
2438
提供安全而有保障的避孕。
11:25
Before pregnancy怀孕, it means手段
providing提供 preconception偏见 care关心,
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4728
在孕前,这意味着提供孕前保健,
11:30
so we can manage管理 chronic慢性 illness疾病
and optimize优化 health健康.
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这样我们就可以控制慢性病
并且维持最佳健康状态。
11:34
During pregnancy怀孕, it includes包括
high-quality高质量 prenatal产前 and delivery交货 care关心
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在孕中,它包括了高质量的
产前和分娩治疗,
11:38
so we can produce生产 healthy健康 moms妈妈 and babies婴儿.
224
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2836
让我们可以有健康的
妈妈们和宝宝。
11:41
And finally最后, after pregnancy怀孕, it includes包括
postpartum产后 and inter-pregnancy孕产间 care关心
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最后,在产后,它包括了
产后和怀孕间的治疗,
11:46
so we can set moms妈妈 up
to have a healthy健康 next下一个 baby宝宝
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让我们能够帮妈妈们康复,
为生育下一个健康的宝宝,
11:49
and a healthy健康 life.
227
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1490
和拥有一个健康的生活做准备。
11:51
And it can literally按照字面 spell拼写 the difference区别
between之间 life and death死亡,
228
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它可以从字面上来分辨
生命和死亡的区别,
11:54
as it did in the case案件 of Maria玛丽亚,
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就像玛丽亚的案例中一样,
11:56
who checked检查 into the hospital醫院
after having an elevated提高的 blood血液 pressure压力
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玛丽亚在孕前检查时,
11:59
during a prenatal产前 visit访问.
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发现有高血压之后去了医院检查。
12:01
Maria玛丽亚 was 40, and this
was her second第二 pregnancy怀孕.
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她40岁了,这是她第二次怀孕。
12:05
During Maria's玛丽亚 first pregnancy怀孕
that had happened发生 two years年份 earlier,
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玛丽亚在两年前第一次怀孕时,
12:08
she also didn't feel so well
in the last few少数 weeks of her pregnancy怀孕,
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她在怀孕的最后几周
感觉并不是很好,
12:12
and she had a few少数
elevated提高的 blood血液 pressures压力,
235
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2371
她有一点高血压,
12:14
but nobody没有人 seemed似乎 to pay工资 attention注意.
236
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2323
但是并没有人注意到。
12:16
They just said, "Maria玛丽亚,
don't worry担心, you'll你会 be fine.
237
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2467
大家只是说,
“玛丽亚,别担心,你没事的。
12:19
This is your first pregnancy怀孕.
You're a little nervous紧张."
238
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2695
“这是你第一次怀孕
所以你有一点紧张。”
12:22
But it did not end结束 well
for Maria玛丽亚 last time.
239
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2436
但是情况并没有变好。
12:24
She seized during labor劳动.
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她在分娩时癫痫发作。
12:26
Well, this time her team球队 really listened听了.
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不过这一次她的团队听进去了。
12:29
They asked smart聪明 and probing探测 questions问题.
242
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2417
他们询问了一些巧妙的探索性问题。
12:31
Her doctor医生 counseled劝告 her about
the signs迹象 and symptoms症状 of preeclampsia子 痫 前期
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3904
她的医生和她讨论了
关于子痫前期的迹象和征兆,
12:35
and explained解释 that
if she was not feeling感觉 well,
244
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2236
并且向她解释如果她感到不适,
她需要去医院检查。
12:37
she needed需要 to come in and be seen看到.
245
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12:40
And this time Maria玛丽亚 came来了 in,
246
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1990
然后这一次玛丽亚去了,
12:42
and her doctor医生 immediately立即
sent发送 her to the hospital醫院.
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2616
她的医生立刻将她送去了医院。
12:45
At the hospital醫院, her doctor医生
ordered有序 urgent紧急 lab实验室 tests测试.
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在医院,医生立刻安排了
紧急的实验测试。
12:49
They hooked迷上 her up
to multiple different不同 monitors显示器
249
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2437
为她连上了不同的监控器,
12:51
and paid支付 special特别 attention注意
to her blood血液 pressure压力,
250
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2294
并且认真观察她的血压,
12:54
the fetal heart rate tracing追踪
251
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胎儿心率,
12:55
and gave her IVIV medication药物治疗
to prevent避免 a seizure发作.
252
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3190
并且给她注射静脉
药物来防止痉挛。
12:59
And when Maria's玛丽亚 blood血液 pressure压力 got
so high it put her at risk风险 for a stroke行程,
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当玛丽亚的血压高到
令她有中风的风险时,
13:03
her doctors医生 and nurses护士 jumped跳下 into action行动.
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她的医生和护士立刻行动。
13:05
They repeated重复 her
blood血液 pressure压力 in 15 minutes分钟
255
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2170
他们将她的血压重复了15分钟,
13:07
and declared声明 a hypertensive高血压 emergency.
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2160
然后宣布了高血压急症。
13:10
They gave her the right IVIV medication药物治疗
according根据 to the latest最新 correct正确 protocol协议.
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他们根据最近的正确规程
给了她合适的静脉注射药物。
13:14
They worked工作 smoothly顺利 together一起
as a coordinated协调 team球队
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他们作为一个合作的团队,
工作进展的很顺利,
13:17
and successfully顺利
lowered降低 her blood血液 pressure压力.
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2481
并且成功降低了她的血压。
13:21
As a result结果, what could have been
a tragedy悲剧 became成为 a success成功 story故事.
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结果就是,一个潜在的悲剧
变成了一个成功的故事。
13:25
Maria's玛丽亚 dangerous危险 symptoms症状
were controlled受控,
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玛丽亚危险的征兆被控制住了,
13:27
and she delivered交付 a healthy健康 baby宝宝 girl女孩.
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并且生下了一个健康的女婴。
13:30
And before Maria玛丽亚 was discharged出院
from the hospital醫院,
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然后在玛丽亚出院之前,
13:33
her doctor医生 counseled劝告 her again about
the signs迹象 and symptoms症状 of preeclampsia子 痫 前期,
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她的医生又和她讨论了
子痫前期的迹象和征兆,
13:36
the importance重要性 of having
her blood血液 pressure压力 checked检查,
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特别是产后第一周
13:39
especially特别 in this first week postpartum产后
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2195
检查血压的重要性,
13:41
and gave her education教育 about
postpartum产后 health健康 and what to expect期望.
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4317
并且给了她关于产后健康和
可能出现的情况的说明。
13:46
And in the weeks and months个月 that followed其次,
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2077
然后在接下来的几个月里,
13:48
naturally自然, Maria玛丽亚 had follow-up跟进 visits访问
with her pediatrician儿科医师
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很自然地,玛丽亚和她的儿科医生
进行了几次术后随访
13:51
to check in on her baby's宝宝 health健康.
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来检查宝宝的健康。
13:53
But just as important重要,
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但是一样重要的是,
13:54
she had follow-up跟进 visits访问 with her ob-gyn妇产科
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2672
她也在妇产科进行了术后随访
13:57
to check in on her health健康,
her blood血液 pressure压力,
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来检查她本人的健康和血压,
13:59
and her cares管它 and concerns关注
as a new mother母亲.
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827854
3004
以及作为一名新手妈妈的
谨慎和忧虑。
14:02
This is what high-quality高质量 care关心
across横过 the care关心 continuum连续 looks容貌 like,
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830882
3839
这就是贯穿整个过程的连续性
高质量治疗的样子,
14:06
and this is how it can look.
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这就是它应有的效果。
14:08
If every一切 pregnant woman女人 in every一切 community社区
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如果每一个社区里的每一名孕妇
14:11
received收到 this kind of high-quality高质量 care关心
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都可以接受这种高质量的治疗,
14:14
and delivered交付 at facilities设备 that utilized利用
standard标准 care关心 practices做法,
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842473
3626
并且在使用标准治疗
实践的机构里分娩,
14:18
our maternal母系 mortality死亡 and severe严重
maternal母系 morbidity发病率 rates利率 would plummet铅坠.
280
846123
4202
我们的产妇死亡率和严重的产妇
发病率将会骤然下跌。
14:22
Our international国际 ranking排行
would no longer be an embarrassment困窘.
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850349
3564
我们的国际排名再也
不会让人觉得尴尬。
14:25
But the truth真相 is, we've我们已经 had decades几十年
of unacceptably不可接受 high rates利率
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4819
但是事实是,我们
已经有了几十年的
14:30
of maternal母系 death死亡 and life-threatening危及生命
complications并发症 during delivery交货
283
858780
4746
高产妇死亡率和在分娩时
威胁生命的并发症高发率,
14:35
and decades几十年 of devastating破坏性的 consequences后果
for moms妈妈, babies婴儿 and families家庭,
284
863550
5118
以及几十年来母亲、婴儿
和家庭的毁灭性后果,
14:40
and we have not been moved移动 to action行动.
285
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2142
我们并没有任何实质性行动。
14:43
The recent最近 media媒体 attention注意 on
our poor较差的 performance性能 on maternal母系 mortality死亡
286
871336
3838
最近媒体对我们在
产妇死亡率上表现不佳的关注
14:47
has helped帮助 the public上市 to understand理解:
287
875198
2334
已经帮助公众来了解:
14:49
high-quality高质量 maternal母系 health健康 care关心
is within reach达到.
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877556
3001
高质量的产妇医疗是伸手可及的。
14:52
The question is:
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1205
问题则是:
14:53
Are we as a society社会 ready准备 to value
pregnant women妇女 from every一切 community社区?
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5208
我们的社会是否准备好
从每一个社区开始重视孕妇?
14:59
For my part部分, I'm doing everything I can
to ensure确保 that when we do,
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887042
4671
对我来说,我做了一切来
确保当我们开始做了,
15:03
we have the tools工具 and evidence证据 base基础 ready准备
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3092
我们已经准备好了
技术和证据基础
15:06
to move移动 forward前锋.
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继续前进。
15:09
Thank you.
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谢谢大家。
15:10
(Applause掌声)
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(鼓掌)
Translated by Jingdan Niu
Reviewed by Homer Li

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ABOUT THE SPEAKER
Elizabeth Howell - Maternal health reformer
Elizabeth Howell is working to address maternal mortality in the United States.

Why you should listen

Elizabeth Howell is a physician, researcher and advocate committed to improving the health and well-being of women. She is an expert in quality-of-care and racial and ethnic disparities in maternal and child health. Her research focuses on the intersection between quality-of-care and disparities in maternal and infant mortality and morbidity, as well as postpartum depression and its impact on underserved communities.

A graduate of both Harvard Medical School and the Harvard Kennedy School, Howell is a pioneer in research in health equity. She has conducted extensive research on maternal morbidity and mortality in New York City and the significant racial and ethnic disparities that exist. She is a professor in the Departments of Obstetrics, Gynecology, and Reproductive Sciences and Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai. In addition, as the founding Director of the Blavatnik Family Women's Health Research Institute at Mount Sinai, Howell is building a competitive research program that advances the science of women's health across the life span. She has served on several expert committees for organizations including the National Academy of Medicine, National Institutes of Health, the Joint Commission and the American Congress of Obstetricians and Gynecologists.

More profile about the speaker
Elizabeth Howell | Speaker | TED.com

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