TEDMED 2009
Bill Davenhall: Your health depends on where you live
Bill Davenhall：健康本于环境
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住在哪儿如同食物和基因很大程度上影响着你的健康,但是却未成为你医疗记录的一部分.在TEDMED ，Bill Davenhall 将为你展示那些被忽略的官方地理数据，这些数据可以通过手机GPS应用程序帮助建立以供医生了解。我们将其称为地理处方。
Bill Davenhall - Health and human services expert
Bill Davenhall wants to improve physicians' diagnostic techniques by collecting each patient's geographic and environmental data, and merging it with their medical records. Full bio
Bill Davenhall wants to improve physicians' diagnostic techniques by collecting each patient's geographic and environmental data, and merging it with their medical records. Full bio
Double-click the English transcript below to play the video.
00:15
Can geographic information
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地理环境是否
00:18
make you healthy?
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能使你身体更健康？
00:22
In 2001 I got hit by a train.
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2001年我被一列车撞到。
00:26
My train was a heart attack.
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我的心脏受到了损害。
00:29
I found myself in a hospital
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醒来时我发现自己在医院
00:31
in an intensive-care ward,
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的一个加护病房里，
00:33
recuperating from emergency surgery.
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正从急救手术中恢复过来。
00:36
And I suddenly realized something:
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我突然意识到：
00:38
that I was completely in the dark.
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自己完全被蒙在鼓里。
00:41
I started asking my questions, "Well, why me?"
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我开始问自己：“为什么是我？”
00:43
"Why now?" "Why here?"
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为什么是现在？为什么在这儿？
00:45
"Could my doctor have warned me?"
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“我的医生能否事先告诫我？”
00:48
So, what I want to do here in the few minutes I have with you
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所以，在接下来的几分钟，我想与你们分享的是
00:51
is really talk about what is the formula for life and good health.
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一个健康的生命应由什么构成。
00:56
Genetics, lifestyle and environment.
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遗传基因，生活方式和环境。
00:59
That's going to sort of contain our risks,
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也就是说这些是我们将面对的风险因素，
01:01
and if we manage those risks
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如果我们处理好这些风险
01:03
we're going to live a good life and a good healthy life.
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我们的生活将会更健康更美好。
01:06
Well, I understand the genetics and lifestyle part.
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当然 ，我了解基因和生活方式这两方面。
01:10
And you know why I understand that?
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那你们知道我为什么了解吗？
01:12
Because my physicians constantly
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因为我的内科医生不断地
01:15
ask me questions about this.
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询问这些方面的情况。
01:17
Have you ever had to fill out those long,
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你是否在医生的办公处填写过，
01:19
legal-size forms in your doctor's office?
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那些标准大小规格的表格？
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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我是说，你们已幸运地做过多次这样的事，对吗？
01:25
(Laughter)
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（笑声）
01:26
Do it over and over again. And they ask you questions
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一次又一次的重复。然后他们还要询问
01:28
about your lifestyle and your family history,
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你的生活方式，你的家庭史
01:31
your medication history, your surgical history,
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你的药物治疗史，你的外科史
01:35
your allergy history ... did I forget any history?
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你的过敏史，恩...我还忘了其他的什么历史吗？
01:39
But this part of the equation I didn't really get,
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但是对于这个部分，我并不是真正的知道。
01:43
and I don't think my physicians
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而且我也不认为我的医生
01:46
really get this part of the equation.
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真正的了解了这部分的信息。
01:48
What does that mean, my environment?
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我的环境意味着什么？
01:51
Well, it can mean a lot of things.
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实际上，它意味着很多事情。
01:53
This is my life. These are my life places.
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这是我的生活。它们是我生活的地方。
01:56
We all have these.
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我们每个人都拥有的。
01:58
While I'm talking I'd like you to also be thinking about:
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我希望在我演讲时，你们都想想
02:01
How many places have you lived?
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你们在多少个地方生活过？
02:04
Just think about that, you know, wander through
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在你的生活中时不时
02:06
your life thinking about this.
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想想这个问题。
02:08
And you realize that you spend it in a variety of different places.
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你会意识到，你的生命在很多不同的地方度过。
02:12
You spend it at rest and you spend it at work.
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你在不同的地方休息和工作。
02:14
And if you're like me, you're in an airplane a good portion of your time
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如果是像我类的人，旅途过程中你将花相当一部分的时间
02:17
traveling some place.
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在机场这个地方。
02:19
So, it's not really simple
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所以，我们总是很难回答类似的问题
02:21
when somebody asks you, "Where do you live, where do you work,
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你在哪儿生活？你在哪儿工作？
02:23
and where do you spend all your time?
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你在哪儿度过你的时光？
02:25
And where do you expose yourselves to risks
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你在哪儿陷入那些
02:28
that maybe perhaps you don't even see?"
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你甚至未意识到的危机之中？
02:32
Well, when I have done this on myself,
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当我向自己发问时
02:34
I always come to the conclusion
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我总能得出以下结论
02:36
that I spend about 75 percent of my time
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我生命中大约75%的时间
02:40
relatively in a small number of places.
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都集中在几个地方度过。
02:43
And I don't wander far from that place
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大部分的时间
02:45
for a majority of my time,
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我不会远离它们，
02:47
even though I'm an extensive global trekker.
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即使我是一位满世界跑的旅行者。
02:52
Now, I'm going to take you on a little journey here.
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现在，我将带你们踏上我的几段旅途。
02:54
I started off in Scranton, Pennsylvania.
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我从宾夕法尼亚的斯克兰顿出发。
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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我不知道现场是否有人来自宾西法尼亚州东北部。
02:59
but this is where I spent my first 19 years
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但是这是我与我年轻活力的肺
03:02
with my little young lungs.
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一起呆了19年的地方。
03:04
You know, breathing high concentrations here
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在这里，我伴随着高浓度的
03:07
of sulfur dioxide, carbon dioxide
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二氧化硫，二氧化碳
03:09
and methane gas,
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和甲烷
03:11
in unequal quantities -- 19 years of this.
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一起度过了我生命中的19年。
03:14
And if you've been in that part of the country,
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如果你也曾在这个地方住过，
03:16
this is what those piles of burning, smoldering coal waste look like.
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你就会了解它们都是产生于就像这些一堆堆正在燃烧的煤渣。
03:20
So then I decided to leave that part of the world,
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所以，我决定离开那个地方。
03:23
and I was going to go to the mid-west.
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然后打算迁到中西部。
03:26
OK, so I ended up in Louisville, Kentucky.
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现在我在肯塔基州的路易斯维尔定居。
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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我打算成为橡胶镇的邻居。
03:33
They manufacture plastics. They use large quantities chloroprene
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这个镇生产塑料。生产过程中使用大量的氯丁二烯
03:36
and benzene.
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和苯。
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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就这样，我带着我那步入中年的肺
03:43
breathing various concentrations of that.
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呼吸着充满氯丁二烯和奔的空气又生活了25年。
03:46
And on a clear day it always looked like this, so you never saw it.
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在晴朗的天气里它显得那样的干净漂亮，你从不会发现这些毒气存在。
03:50
It was insidious and it was really happening.
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但它却是真真实实的潜在地发生了。
03:53
Then I decided I had to get really smart,
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然后我决定了我必须变得聪明，
03:55
I would take this job in the West Coast.
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我要在西海岸从事这个工作。
03:58
And I moved to Redlands California.
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然后我又搬到了加利福尼亚州的瑞德兰兹。
04:01
Very nice, and there
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我带着年长的
04:03
my older, senior lungs, as I like to call them,
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肺（我喜欢这样称呼它们）生活在那里
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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之后我又发现了一些小问题，二氧化碳，臭氧的浓度非常高。
04:13
Okay? Almost like the highest in the nation.
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甚至是整个国家最高点的。
04:15
Alright, this is what it looks like on a good day.
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这个地方天气好的时候就像这样。
04:17
If you've been there, you know what I'm talking about.
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如果你住过那里，你就会了解我正在说的。
04:20
So, what's wrong with this picture?
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现在看看，这副图片存在什么问题？
04:23
Well, the picture is, there is a huge gap here.
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是的，在图片的这里，有个巨大的空隙。
04:25
The one thing that never happens in my doctor's office:
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在我医生的办公室从未发生过的一件事就是：
04:29
They never ask me about my place history.
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他们从未问过我的居住地情况。
04:32
No doctor, can I remember, ever asking me,
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我记得从未有过任何一个医生问过我：
04:35
"Where have you lived?"
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你曾经在什么地方居住过？
04:37
They haven't asked me what kind of the quality
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他们没有问过我
04:39
of the drinking water that I put in my mouth
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我饮用的水质量如何？
04:41
or the food that I ingest into my stomach.
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或者我食用的食物的质量又如何？
04:45
They really don't do that. It's missing.
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他们从未那样做过。
04:48
Look at the kind of data that's available.
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看看这组数据。
04:51
This data's from all over the world --
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这组数据是世界各国投入数亿美元
04:53
countries spend billions of dollars investing in this kind of research.
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做此类研究所得出的。
04:57
Now, I've circled the places where I've been.
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现在，我圈出了我们研究过的地方。
05:00
Well, by design, if I wanted to have a heart attack
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现在，我必须在一些地方呆过
05:03
I'd been in the right places. Right?
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我才能得心脏病，对吗？
05:08
So, how many people are in the white?
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所以，有多少人住在白色的这些地方？
05:10
How many people in the room have spent the majority of their life
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在坐的有多少人在这些白色地方
05:12
in the white space?
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度过了你生命中的大部分时间？
05:15
Anybody? Boy you're lucky.
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有吗？这个先生你很幸运。
05:17
How many have spent it in the red places?
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又有多少人居住在这些红色区域？
05:20
Oh, not so lucky.
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看来不是很幸运。
05:22
There are thousands of these kinds of maps
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有成千上万副类似的图片，
05:25
that are displayed in atlases
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在世界各地的
05:27
all over the world.
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地图册中展示出来。
05:29
They give us some sense of what's going
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他们提醒我们
05:31
to be our train wreck.
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发生火车碰撞后将会发生什么。
05:34
But none of that's in my medical record.
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但是在我的医疗记录中没有任何相关的记录。
05:36
And it's not in yours either.
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相信你们的也没有。
05:38
So, here's my friend Paul.
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这是我的一位朋友Paul，
05:40
He's a colleague. He allowed his cell phone to be tracked
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是我同事，在过去的两年里，他将其移动电话设置为可以被追踪的
05:44
every two hours, 24/7,
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365天，每天
05:47
365 days out of the year
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两个小时，
05:49
for the last two years, everywhere he went.
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不管他到哪个地方。
05:52
And you can see he's been to a few places around the United States.
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你可以看到他到过了美国的几个地方，
05:56
And this is where he has spent most of his time.
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在这里他度过了大部分的时间。
06:00
If you really studied that you might have some clues
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如果你认真的观察这些地方，你可能从中猜出
06:03
as to what Paul likes to do.
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Paul的爱好是什么。
06:06
Anybody got any clues? Ski. Right.
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有人知道吗？是的，就是滑雪。
06:09
We can zoom in here, and we suddenly see
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我们聚焦这儿，我们马上会发现
06:12
that now we see where Paul has really spent a majority of his time.
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在这些地方Paul度过了相当一部分的时光。
06:16
And all of those black dots are all of the
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所有这些黑点
06:20
toxic release inventories
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都是由EPA监测出的有毒气排放
06:22
that are monitored by the EPA.
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记录的地方。
06:24
Did you know that data existed?
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你们知道有这类数据存在吗？
06:27
For every community in the United States,
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在美国的各个社区，
06:29
you could have your own personalized map of that.
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你们都可以领取属于你们自己的地图册。
06:33
So, our cell phones can now build a place history.
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所以，我们的手机现在帮助建立我们的居住史。
06:36
This is how Paul did it. He did it with his iPhone.
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这就是Paul用他的iPhone 所做的.
06:39
This might be what we end up with.
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这可能即使我们最终想要达到的效果。
06:41
This is what the physician would have
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当我们进入到治疗室时，
06:44
in front of him and her when we enter that exam room
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这个将呈现给我们的医生
06:47
instead of just the pink slip that said I paid at the counter. Right?
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而不是在柜台领取的那张表，对吗？
06:51
This could be my little assessment.
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这个是我自己一个小猜测
06:53
And he looks at that and he says,
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他可能看着那个然后说
06:55
"Whoa Bill,
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“喔~Bill，
06:57
I suggest that maybe you not decide,
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你居住，
07:00
just because you're out here in beautiful California,
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你居住在美丽的加利福尼亚
07:02
and it's warm every day,
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每天都那么的温暖，
07:04
that you get out and run at six o'clock at night.
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可能你决定每天晚上6点出去跑步，
07:07
I'd suggest that that's a bad idea Bill,
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但是从这组数据中看出
07:10
because of this report."
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这将不会是个好主意。”
07:13
What I'd like to leave you for are two prescriptions.
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今天我将留给你们是这样的两个处方：
07:17
Okay, number one is, we must teach physicians
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第一个：我们必须让我们的医生
07:19
about the value of geographical information.
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了解到地理信息的价值所在。
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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全世界正在做的研究
07:27
that are focused on this.
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其中一半项目都在关注。
07:29
And they're in the early stages of development.
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这些研究都处于起步阶段，
07:32
These programs need to be supported,
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都需要得到支持。
07:35
and we need to teach our future
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然后我们需要告诉我们未来全世界范围内的
07:37
doctors of the world
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医生们，
07:39
the importance of some of the information
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今天我与你们
07:41
I've shared here with you today.
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一起分享的这些信息的重要性。
07:43
The second thing we need to do
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第二件事我们需要做的是：
07:45
is while we're spending billions and billions
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当世界各地投入
07:47
of dollars all over the world
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亿万美元
07:50
building an electronic health record,
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去建立一个电子化的健康记录时，
07:52
we make sure we put a place history
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我们必须确定将居住史
07:54
inside that medical record.
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记录在内。
07:57
It not only will be important for the physician;
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它不仅对医生显得很重要，
08:00
it will be important for the researchers
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为研究者也同样重要。
08:02
that now will have huge samples to draw upon.
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对此，我们可以举出大量的例子。
08:06
But it will also be useful for us.
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同样对于我们自己也非常有用。
08:08
I could have made the decision, if I had this information,
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如果我们拥有了这些信息，
08:12
not to move to the ozone capital
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无需到美国的臭氧中心就可以得出结论。
08:15
of the United States, couldn't I? I could make that decision.
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我可以吗？是的，我可以。
08:18
Or I could negotiate with my employer
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基于我自己和我公司的最大利益，
08:20
to make that decision
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或者我可以与我的雇主谈判
08:22
in the best interest of myself and my company.
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做出决定。
08:28
With that, I would like to just say that Jack Lord said
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有了那些，我可以说出Jack Lord
08:31
this almost 10 years ago.
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差不多十年前说过的话。
08:34
Just look at that for a minute.
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花一分钟的时间看这，
08:36
That was what the conclusion
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这是Dartmouth保健地图册
08:38
of the Dartmouth Atlas of Healthcare was about,
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所得到的结论。
08:41
was saying that we can explain the geographic variations
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从中我们可以解释
08:44
that occur in disease, in illness, in wellness,
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在身体处于生病抑或是健康时地理区域的变化。
08:48
and how our healthcare system actually operates.
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还有我们的保健系统又是怎么实际运行的。
08:51
That was what he was talking about
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这就是他在引用此数据时
08:53
on that quote.
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所要阐述的。
08:55
And I would say he got it right almost a decade ago.
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我要说在10年前他就正确的认识到了。
08:59
So, I'd very much like to see us begin to
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所以，我将非常欣喜的看到
09:01
really seize this as an opportunity to get this into our medical records.
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我们能真正的抓住这个机会将居住史也涵盖在医疗记录中。
09:05
So with that, I'll leave you that
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所以我将带给你们
09:07
in my particular view of view of health:
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我个人对健康的看法：
09:11
Geography always matters.
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就是地理总是问题所在。
09:13
And I believe that geographic information
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而且我坚信了解地理信息
09:15
can make both you and me very healthy. Thank you.
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将会使你和我更加健康。谢谢！
09:17
(Applause)
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（鼓掌）
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