TEDMED 2012
Rebecca Onie: What if our health care system kept us healthy?
Rebecca Onie: 如果健保制度真的讓我們健康？
Filmed:
Readability: 4.3
1,230,915 views
Rebecca Onie問觀眾幾個大膽的問題：假使診療室成為能幫助我們增進健康的場所？假使醫生可以開食物、住屋或冬天的暖氣當處方？在TEDMED，Rebecca向大家介紹「導向健康組織」，他們正在做以上這些事情，並建立像大學運動校隊般的菁英健保志工團隊。
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
我大一的時候
00:17
I signed up for an internship in the housing unit
1
1944
2750
申請成為大波士頓法律援助處的實習生
00:20
at Greater Boston Legal Services.
2
4694
2200
在住宅部門
00:22
Showed up the first day
3
6894
1653
第一天上工時
00:24
ready to make coffee and photocopies,
4
8547
2316
我準備好要幫大家煮咖啡、影印
00:26
but was paired with this righteous, deeply inspired attorney
5
10863
4582
卻被分配與一位充滿正義感與啟發性的律師共事
00:31
named Jeff Purcell,
6
15445
1469
他是Jeff Purcell
00:32
who thrust me onto the front lines
7
16914
2465
他在我實習的第一天
00:35
from the very first day.
8
19379
2000
便將我丟到工作前線
00:37
And over the course of nine months
9
21379
1765
而在之後的九個月中
00:39
I had the chance
10
23144
1013
我有機會
00:40
to have dozens of conversations
11
24157
1772
跟許多波士頓低收入的家庭
00:41
with low-income families in Boston
12
25929
2784
有許多會談
00:44
who would come in presenting with housing issues,
13
28713
3116
他們來我們這裡，通常是因為許多關於居住的問題
00:47
but always had an underlying health issue.
14
31829
3284
但潛藏其中，總有與健康相關的問題
00:51
So I had a client who came in,
15
35113
2232
我有一個客戶
00:53
about to be evicted because he hasn't paid his rent.
16
37345
2318
他因長期沒付房租，即將被逐出房屋
00:55
But he hasn't paid his rent, of course,
17
39663
2288
但他一直沒付房租
00:57
because he's paying for his HIV medication
18
41951
2494
是因為他必須支付愛滋病的醫藥費
01:00
and just can't afford both.
19
44445
2200
所以無法負荷兩者加起來的支出
01:02
We had moms who would come in,
20
46645
1351
也有許多母親來我們這裡
01:03
daughter has asthma,
21
47996
1383
女兒有氣喘病
01:05
wakes up covered in cockroaches every morning.
22
49379
2885
卻每天早晨在蟑螂堆中起床
01:08
And one of our litigation strategies
23
52264
1973
我們訴訟的策略之一
01:10
was actually to send me into the home of these clients
24
54237
2775
是派我去這些客戶的家裡
01:12
with these large glass bottles.
25
57012
2133
用大玻璃瓶
01:15
And I would collect the cockroaches,
26
59145
2000
蒐集這些蟑螂
01:17
hot glue-gun them to this poster board
27
61145
3018
用熱熔膠把蟑螂黏在海報板上
01:20
that we'd bring to court for our cases.
28
64163
2032
再帶到法庭打官司
01:22
And we always won
29
66195
1278
而我們總能贏得這些案件
01:23
because the judges were just so grossed out.
30
67473
2722
因為法官看了這些都覺得很噁心
01:26
Far more effective, I have to say,
31
70195
2149
這方法，我必須承認
01:28
than anything I later learned in law school.
32
72344
2851
比我日後在法學院所學的都還要有效
01:31
But over the course of these nine months,
33
75195
2550
但是在這九個月中
01:33
I grew frustrated with feeling
34
77745
1851
我越來越感到挫敗
01:35
like we were intervening too far downstream
35
79596
2966
因為在客戶的生活中
01:38
in the lives of our clients --
36
82562
2517
我們出手相助的時機總是太晚
01:40
that by the time they came to us,
37
85079
1532
當他們來尋求幫助時
01:42
they were already in crisis.
38
86611
2168
他們的生活早已陷入危機
01:44
And at the end of my freshman year of college,
39
88779
2816
當我大一那年即將結束時
01:47
I read an article about the work
40
91595
1684
我讀到一篇文章
01:49
that Dr. Barry Zuckerman was doing
41
93279
1782
是有關Barry Zuckerman博士的工作
01:50
as Chair of Pediatrics
42
95061
2136
他是小兒科主任
01:53
at Boston Medical Center.
43
97197
1400
在波士頓醫療中心工作
01:54
And his first hire was a legal services attorney
44
98597
3067
而他的第一份工作是當律師
01:57
to represent the patients.
45
101664
1882
為病患辯護
01:59
So I called Barry,
46
103546
1515
我打電話給Barry
02:00
and with his blessing, in October 1995
47
105061
2603
並在他的幫助之下，於1995年10月
02:03
walked into the waiting room
48
107664
2065
走進波士頓醫療中心
02:05
of the pediatrics clinic at Boston Medical Center.
49
109729
2866
小兒科的候診室
02:08
I'll never forget,
50
112595
1333
我永遠不會忘記
02:09
the TVs played this endless reel of cartoons.
51
113928
2884
他們的電視上不斷播放卡通
02:12
And the exhaustion of mothers
52
116812
2934
而那些筋疲力竭的母親們
02:15
who had taken two, three, sometimes four buses
53
119746
3532
有些已經轉了2、3次，甚至是4次的公車
02:19
to bring their child to the doctor
54
123278
1932
才能帶她的小孩來看醫生
02:21
was just palpable.
55
125210
1884
她們的疲憊真實的如可觸見
02:22
The doctors, it seemed,
56
127094
1248
那些醫生
02:24
never really had enough time for all the patients,
57
128342
1519
看似永遠沒有足夠時間來看所有的病患
02:25
try as they might.
58
129861
1250
儘管他們很努力
02:27
And over the course of six months,
59
131111
1218
而接下來的六個月
02:28
I would corner them in the hallway
60
132329
1681
我常在走廊上攔下這些醫生
02:29
and ask them a sort of naive but fundamental question:
61
134010
3901
問他們一個看似天真但卻很基本的問題：
02:33
"If you had unlimited resources,
62
137911
2485
「如果你有無限的資源
02:36
what's the one thing you would give your patients?"
63
140396
3315
你會給你的病患什麼？」
02:39
And I heard the same story again and again,
64
143711
2700
同樣的回答一次又一次的出現
02:42
a story we've heard hundreds of times since then.
65
146411
2950
我們大概聽了一百遍這樣的故事
02:45
They said, "Every day we have patients that come into the clinic --
66
149361
3565
他們說："我們每天有許多病患來求診
02:48
child has an ear infection,
67
152926
1701
像耳朵感染的小孩
02:50
I prescribe antibiotics.
68
154627
1933
我會開抗生素
02:52
But the real issue is there's no food at home.
69
156560
2833
但是最大的問題是他們家中沒有食物
02:55
The real issue
70
159393
1501
真正的問題
02:56
is that child is living with 12 other people
71
160894
2234
是這小孩與其他12個人一起
02:59
in a two-bedroom apartment.
72
163128
1498
住在一間只有兩個臥房的公寓
03:00
And I don't even ask about those issues
73
164626
1850
而我對於這樣的事卻不願多問
03:02
because there's nothing I can do.
74
166476
2751
因為我也束手無策
03:05
I have 13 minutes with each patient.
75
169227
1838
我與每位病患有13分鐘的診療時間
03:06
Patients are piling up in the clinic waiting room.
76
171065
2569
候診室塞滿病人
03:09
I have no idea where the nearest food pantry is.
77
173634
2685
我不曉得最近的救濟中心在哪
03:12
And I don't even have any help."
78
176319
2348
也沒有人能幫我。"
03:14
In that clinic, even today,
79
178667
1200
即便今日，在那間醫療中心
03:15
there are two social workers
80
179867
1686
只有2位社工
03:17
for 24,000 pediatric patients,
81
181553
2731
卻要處理2萬4千位小兒科病人
03:20
which is better than a lot of the clinics out there.
82
184284
2852
但這狀況已經比其他的醫療中心好了
03:23
So Health Leads was born of these conversations --
83
187136
3031
「導向健康組織(Heath Leads)」從這些會談中誕生
03:26
a simple model
84
190167
1184
運用簡單的模式
03:27
where doctors and nurses
85
191351
1515
讓醫生和護士
03:28
can prescribe nutritious food,
86
192866
2218
能開營養的食物
03:30
heat in the winter
87
195084
1302
冬天的暖氣
03:32
and other basic resources for their patients
88
196386
2582
和其他基本的生活資源給病患
03:34
the same way they prescribe medication.
89
198968
2551
就像他們開其他藥方一樣
03:37
Patients then take their prescriptions
90
201519
1981
病患拿著這些處方籤
03:39
to our desk in the clinic waiting room
91
203500
2467
來我們位於候診室的櫃台
03:41
where we have a core of well-trained college student advocates
92
205967
3817
在這我們有一群訓練優良的大學生
03:45
who work side by side with these families
93
209784
2452
可以從旁協助這些家庭
03:48
to connect them out
94
212236
1299
幫他們向外聯繫
03:49
to the existing landscape of community resources.
95
213535
3216
取得社區現有的資源
03:52
So we began with a card table in the clinic waiting room --
96
216751
3549
一開始我們在診療室設立了一個簡單的櫃台
03:56
totally lemonade stand style.
97
220300
2150
就像賣檸檬汁的攤販那樣
03:58
But today we have a thousand college student advocates
98
222450
3320
但如今我們已有1千名支持這項行動的大學生
04:01
who are working to connect nearly 9,000 patients and their families
99
225770
4300
他們幫忙9千個病患和其家庭
04:05
with the resources that they need to be healthy.
100
230070
3201
幫忙取得他們維持健康所需的資源
04:09
So 18 months ago
101
233271
1516
18個月前
04:10
I got this email that changed my life.
102
234787
2785
我收到一封改變我人生的電郵
04:13
And the email was from Dr. Jack Geiger,
103
237572
2415
是Jack Geiger博士寄給我的
04:15
who had written to congratulate me on Health Leads
104
239987
2984
他寫來恭賀我和導向健康組織
04:18
and to share, as he said,
105
242971
1299
並且分享，如同他說的
04:20
a bit of historical context.
106
244270
2636
一些歷史脈絡
04:22
In 1965 Dr. Geiger founded
107
246906
2950
1965年，Geiger博士創立
04:25
one of the first two community health centers in this country,
108
249856
3014
那時全國唯二社區健康中心的其中一個
04:28
in a brutally poor area in the Mississippi Delta.
109
252870
3151
位於密西西比三角洲，是極為貧窮的地區
04:31
And so many of his patients came in
110
256021
2516
博士有許多前來求診的病患
04:34
presenting with malnutrition
111
258537
2150
呈現營養不良的問題
04:36
that be began prescribing food for them.
112
260687
2484
於是他開始開食物給病患當藥方
04:39
And they would take these prescriptions to the local supermarket,
113
263171
3251
病人將這些處方籤拿去當地超市
04:42
which would fill them
114
266422
1098
取得他們所需的食物
04:43
and then charge the pharmacy budget of the clinic.
115
267520
2818
超市則向診所支取這些費用
04:46
And when the Office of Economic Opportunity in Washington, D.C. --
116
270338
2883
當華府的職業訓練部
04:49
which was funding Geiger's clinic --
117
273221
1835
--他們當時資助Geiger的診所--
04:50
found out about this,
118
275056
1199
發現這件事後
04:52
they were furious.
119
276255
1200
他們十分不高興
04:53
And they sent this bureaucrat down
120
277455
1749
派官員告訴Geiger
04:55
to tell Geiger that he was expected to use their dollars
121
279204
2951
他們期待將這些資助的費用
04:58
for medical care --
122
282155
1466
花在醫療保健上
04:59
to which Geiger famously and logically responded,
123
283621
3400
Geiger的回應出名且有邏輯：
05:02
"The last time I checked my textbooks,
124
287021
2425
"上回我查課本的時候
05:05
the specific therapy for malnutrition was food."
125
289446
4359
針對改善營養不良，最好的解藥就是食物。"
05:09
(Laughter)
126
293805
1284
(笑聲)
05:10
So when I got this email from Dr. Geiger,
127
295089
2699
因此當我收到Geiger博士的這封電郵
05:13
I knew I was supposed to be proud
128
297788
2366
我知道我身為這段歷史的一份子
05:16
to be part of this history.
129
300154
1667
應該感到驕傲
05:17
But the truth is
130
301821
1216
但事實上
05:18
I was devastated.
131
303037
1992
我卻感到挫敗
05:20
Here we are,
132
305029
1341
我們現在
05:22
45 years after Geiger has prescribed food for his patients,
133
306370
3985
離Geiger開食物給他的病人當藥方已經45年
05:26
and I have doctors telling me,
134
310355
2015
卻仍有醫生告訴我
05:28
"On those issues, we practice a 'don't ask, don't tell' policy."
135
312370
4067
"面對這些問題
我們奉行「不問、不說」的原則"
我們奉行「不問、不說」的原則"
05:32
Forty-five years after Geiger,
136
316437
2433
在Geiger開始這項行動的45年後
05:34
Health Leads has to reinvent
137
318870
1551
導向健康組織必須重新創造
05:36
the prescription for basic resources.
138
320421
2835
給予病人基本生活資源的的藥方
05:39
So I have spent hours upon hours
139
323256
3165
我花了好多時間
05:42
trying to make sense of this weird Groundhog Day.
140
326421
3334
試圖了解這個怪異的迴圈
05:45
How is it that if for decades
141
329755
2534
為什麼這幾十年來
05:48
we had a pretty straightforward tool for keeping patients,
142
332289
2769
我們一直有非常直接的方法讓病患健康
05:50
and especially low-income patients, healthy,
143
335058
2597
特別是低收入戶的患者
05:53
that we didn't use it?
144
337655
1901
我們卻從不使用？
05:55
If we know what it takes to have a healthcare system
145
339556
3099
如果我們知道要如何成立「健保」系統
05:58
rather than a sick-care system,
146
342655
2499
而不是「病保」系統
06:01
why don't we just do it?
147
345154
2033
為什麼我們不做呢？
06:03
These questions, in my mind,
148
347187
2234
在我心中，這些問題
06:05
are not hard because the answers are complicated,
149
349421
3066
並不因為答案很複雜而困難
06:08
they are hard because they require that we be honest with ourselves.
150
352487
5134
它們是如此困難，
是因為它需要我們誠實的面對自己
是因為它需要我們誠實的面對自己
06:13
My belief is that it's almost too painful
151
357621
3100
我認為這是一件極為痛苦的事
06:16
to articulate our aspirations for our healthcare system,
152
360721
3229
以致我們無法表達對健保制度的期望
06:19
or even admit that we have any at all.
153
363950
2738
或甚至承認有任何期待
06:22
Because if we did,
154
366688
1167
因為如果我們這麼做
06:23
they would be so removed
155
367855
1616
它們將看似遙不可及
06:25
from our current reality.
156
369471
2186
不可能存在現實生活中
06:27
But that doesn't change my belief
157
371657
2963
但這並不能改變我的信念
06:30
that all of us, deep inside,
158
374620
2918
我認為每個人在心深處
06:33
here in this room and across this country,
159
377538
3567
在這間大廳和整個國家
06:37
share a similar set of desires.
160
381105
2916
都有相同的渴望
06:39
That if we are honest with ourselves
161
384021
2133
如果我們能誠實的面對自己
06:42
and listen quietly,
162
386154
2301
並安靜的傾聽
06:44
that we all harbor
163
388455
1816
我們便能懷抱
06:46
one fiercely held aspiration for our healthcare:
164
390271
4200
對健保制度的熱切期望：
06:50
that it keep us healthy.
165
394471
2100
它幫我們保持健康
06:52
This aspiration that our healthcare keep us healthy
166
396571
3317
認為健保制度能讓人們健康的期待
06:55
is an enormously powerful one.
167
399888
2400
是非常強大有影響力的
06:58
And the way I think about this
168
402288
2617
我是這麼認為:
07:00
is that healthcare is like any other system.
169
404905
2184
健保制度跟其它制度一樣
07:02
It's just a set of choices that people make.
170
407089
2566
它只是一系列人們的選擇
07:05
What if we decided
171
409655
1801
如果我們決定
07:07
to make a different set of choices?
172
411456
2416
做出不同的選擇，將會如何?
07:09
What if we decided to take all the parts of healthcare
173
413872
3032
如果我們決定不讓健保制度
07:12
that have drifted away from us
174
416904
1802
拿走對我們有助益的部分
07:14
and stand firm and say, "No.
175
418706
2466
並且堅決的說："不
07:17
These things are ours.
176
421172
1967
這些都是屬於我們的
07:19
They will be used for our purposes.
177
423139
1999
它們會幫助我們達成目標
07:21
They will be used to realize
178
425138
2024
它們會被使用並實現
07:23
our aspiration"?
179
427162
1931
我們的期望"
07:24
What if everything we needed
180
429093
1750
所有能讓我們實現
07:26
to realize our aspiration for healthcare
181
430843
2145
對健保制度期望的要件
07:28
was right there in front of us
182
432988
1583
會不會就在我們面前
07:30
just waiting to be claimed?
183
434571
1884
等待被使用？
07:32
So that's where Health Leads began.
184
436455
2050
這就是導向健康組織的開端
07:34
We started with the prescription pad --
185
438505
1684
我們從處方籤著手
07:36
a very ordinary piece of paper --
186
440189
2399
一張非常平凡的紙
07:38
and we asked, not what do patients need to get healthy --
187
442588
3968
我們不問病患要怎麼做才能健康
07:42
antibiotics, an inhaler, medication --
188
446556
3018
不是抗生素、吸入劑、藥物治療
07:45
but what do patients need to be healthy,
189
449574
2783
而是問病患需要什麼才能保持健康
07:48
to not get sick in the first place?
190
452357
2547
讓他們一開始就不會生病
07:50
And we chose to use the prescription
191
454904
1851
而我們選擇使用的藥方
07:52
for that purpose.
192
456755
1782
專為這個目的
07:54
So just a few miles from here
193
458537
1202
離這裡幾哩遠的地方
07:55
at Children's National Medical Center,
194
459739
1784
在國家兒童醫療中心
07:57
when patients come into the doctor's office,
195
461523
2266
當病人來到醫生辦公室
07:59
they're asked a few questions.
196
463789
1685
他們會被問幾個問題
08:01
They're asked, "Are you running out of food at the end of the month?
197
465474
2664
"你的食物夠不夠每月所需？
08:04
Do you have safe housing?"
198
468138
1566
你有安全的住處嗎？"
08:05
And when the doctor begins the visit,
199
469704
2069
因此當醫生診療時
08:07
she knows height, weight, is there food at home,
200
471773
2833
他知道病人的身高、體重、家裡存糧的狀況
08:10
is the family living in a shelter.
201
474606
1616
他的家庭是否住在安全的地方
08:12
And that not only leads to a better set of clinical choices,
202
476222
2884
這些問題不只讓診療結果更好
08:15
but the doctor can also prescribe those resources for the patient,
203
479106
4050
醫生也能開給病患他們所需的資源
08:19
using Health Leads like any other sub-specialty referral.
204
483156
3666
藉由導向健康或其他組織的幫助
08:22
The problem is,
205
486822
2233
問題是
08:24
once you get a taste of what it's like
206
489055
2199
當你嚐到
08:27
to realize your aspiration for healthcare,
207
491254
2235
實現對健保制度的期望的滋味
08:29
you want more.
208
493489
1518
你會想要更多
08:30
So we thought,
209
495007
763
因此我們想:
08:31
if we can get individual doctors
210
495770
1601
如果我們可以讓每位醫生
08:33
to prescribe these basic resources for their patients,
211
497371
3217
開基本的生活資源給患者
08:36
could we get an entire healthcare system
212
500588
2717
我們是否能讓整個健保制度
08:39
to shift its presumption?
213
503305
2752
改變它先入為主的態度?
08:41
And we gave it a shot.
214
506057
1247
所以我們決定一試
08:43
So now at Harlem Hospital Center
215
507304
1435
現在，哈林醫學中心
08:44
when patients come in with an elevated body mass index,
216
508739
3786
當前來的病患測出有過高身體質量指數(BMI)時
08:48
the electronic medical record
217
512525
1864
電子醫療記錄
08:50
automatically generates a prescription for Health Leads.
218
514389
3800
自動產生處方給導向健康組織
08:54
And our volunteers can then work with them
219
518189
1466
而我們的志工即可協助
08:55
to connect patients to healthy food and excercise programs
220
519655
3217
讓病患取得他們的社區中
08:58
in their communities.
221
522872
1432
健康飲食與運動計畫
09:00
We've created a presumption
222
524304
1134
我們創造出這個假設:
09:01
that if you're a patient at that hospital
223
525438
1567
如果你去醫院
09:02
with an elevated BMI,
224
527005
1550
身體質量指數很高
09:04
the four walls of the doctor's office
225
528555
2234
在醫院裡
09:06
probably aren't going to give you everything
226
530789
1852
你可能無法得到你需要的
09:08
you need to be healthy.
227
532641
1182
你需要健康
09:09
You need more.
228
533823
1400
你需要更多
09:11
So on the one hand,
229
535223
681
所以一方面
09:11
this is just a basic recoding
230
535904
1697
這只是基本重新設計
09:13
of the electronic medical record.
231
537601
1705
電子醫療的記錄程式
09:15
And on the other hand,
232
539306
1718
另一方面
09:16
it's a radical transformation
233
541024
1649
這是大規模的改變
09:18
of the electronic medical record
234
542673
2168
對電子醫療記錄而言
09:20
from a static repository of diagnostic information
235
544841
3882
從靜態儲存診斷記錄
09:24
to a health promotion tool.
236
548723
2834
變成推廣健康的工具
09:27
In the private sector,
237
551557
1117
在私營部門
09:28
when you squeeze that kind of additional value
238
552674
2620
當你從固定成本的投資中
09:31
out of a fixed-cost investment,
239
555294
1747
找出這樣的附加價值
09:32
it's called a billion-dollar company.
240
557041
2600
這被稱做高盈利公司
09:35
But in my world,
241
559641
1381
但在我的世界裡
09:36
it's called reduced obesity and diabetes.
242
561022
3401
這被稱做減少肥胖和糖尿病
09:40
It's called healthcare --
243
564423
1883
這就是健保
09:42
a system where doctors can prescribe solutions
244
566306
2983
讓醫生能開好處方的系統
09:45
to improve health,
245
569289
1550
讓病人改善健康
09:46
not just manage disease.
246
570839
2149
不只是控制病情
09:48
Same thing in the clinic waiting room.
247
572988
1534
在醫院的候診室也是如此
09:50
So every day in this country
248
574522
1617
在這個國家裡，每一天
09:52
three million patients
249
576139
1500
3百萬名病人
09:53
pass through about 150,000 clinic waiting rooms in this country.
250
577639
4494
會先待在15萬的候診室
09:58
And what do they do when they're there?
251
582144
1973
他們在那裡要做什麼呢？
10:00
They sit, they watch the goldfish in the fish tank,
252
584117
3450
他們坐著，看水族箱裡的金魚
10:03
they read extremely old copies
253
587567
2483
他們讀好久以前的
10:05
of Good Housekeeping magazine.
254
590050
2283
居家生活雜誌
10:08
But mostly we all just sit there forever, waiting.
255
592333
3233
但我們大多就在那永無止盡的等待
10:11
How did we get here
256
595566
1351
我們怎麼會這樣
10:12
where we devote hundreds of acres and thousands of hours
257
596917
3349
致力花了很多空間與時間
10:16
to waiting?
258
600266
1783
只為了等待？
10:17
What if we had a waiting room
259
602049
1217
如果我們可以有一個候診室
10:19
where you don't just sit when you're sick,
260
603266
2101
不只是生病時去那坐著
10:21
but where you go to get healthy.
261
605367
1866
而是去那裡恢復健康
10:23
If airports can become shopping malls
262
607233
2517
如果機場可以變成購物中心
10:25
and McDonald's can become playgrounds,
263
609750
2966
麥當勞變成遊樂場
10:28
surely we can reinvent the clinic waiting room.
264
612716
3433
我們也可以重新設計候診室
10:32
And that's what Health Leads has tried to do,
265
616149
2034
而這就是導向健康組織試圖做的事
10:34
to reclaim that real estate and that time
266
618183
2283
重新審視空間與時間
10:36
and to use it as a gateway
267
620466
1432
將之利用成為一種
10:37
to connect patients
268
621898
1052
幫助病人的途徑
10:38
to the resources they need to be healthy.
269
622950
2767
讓他們得到能恢復健康的物資
10:41
So it's a brutal winter in the Northeast,
270
625717
1516
今年美國東北的冬天很冷
10:43
your kid has asthma, your heat just got turned off,
271
627233
2467
你的孩子有氣喘，你沒有暖氣
10:45
and of course you're in the waiting room of the ER,
272
629700
2167
你當然前往急診室的候診室
10:47
because the cold air triggered your child's asthma.
273
631867
2532
因為冷空氣導致你小孩氣喘
10:50
But what if instead of waiting for hours anxiously,
274
634399
2917
但假使與其在那花幾個小時焦急的等待
10:53
the waiting room became the place
275
637316
2200
候診室成為
10:55
where Health Leads turned your heat back on?
276
639516
2484
導向健康組織幫你讓暖氣重新運作的地方?
10:57
And of course all of this requires
277
642000
1618
當然這些都需要
10:59
a broader workforce.
278
643618
1948
更多的人力
11:01
But if we're creative, we already have that too.
279
645566
3167
但如果我們夠有創意，我們早已擁有這些
11:04
We know that our doctors and nurses
280
648733
2386
我們知道我們的醫生和護士
11:07
and even social workers
281
651119
1347
甚至社工
11:08
aren't enough,
282
652466
1468
都仍不夠
11:09
that the ticking minutes of health care
283
653934
1649
時間緊迫的健保制度
11:11
are too constraining.
284
655583
1418
設限太多
11:12
Health just takes more time.
285
657001
2049
健康需要我們花更多的時間
11:14
It requires a non-clinical army
286
659050
2799
需要非診所的團體
11:17
of community health workers and case managers
287
661849
2684
社區健康工作者和個案負責人
11:20
and many others.
288
664533
1616
還有許多其他的人力
11:22
What if a small part of that next healthcare workforce
289
666149
3150
那如果下代健保一部分人力來自
11:25
were the 11 million college students in this country?
290
669299
3701
我國1億1的大學生呢?
11:28
Unencumbered by clinical responsibilities,
291
673000
2766
不受醫療系統的限制
11:31
unwilling to take no for an answer
292
675766
2602
不願意向政府機構
11:34
from those bureaucracies
293
678368
1582
那些無法幫助病人的政策
11:35
that tend to crush patients,
294
679950
1933
低頭與妥協
11:37
and with an unparalleled ability
295
681883
1950
大學生擁有前所未有的能力
11:39
for information retrieval
296
683833
1452
能取得資料
11:41
honed through years of using Google.
297
685285
2981
因著這幾年來使用google的經驗
11:44
Now lest you think it improbable
298
688266
2533
現在，如果你覺得這不可能
11:46
that a college volunteer
299
690799
1617
一個大學志工
11:48
can make this kind of commitment,
300
692416
1783
可以委身這樣的託付
11:50
I have two words for you:
301
694199
1567
我有4個字給你：
11:51
March Madness.
302
695766
2351
三月瘋狂(美國大學籃球聯賽賽季)
11:54
The average NCAA Division I men's basketball player
303
698117
3967
美國體育協會的一級男子籃球競賽中
11:57
dedicates 39 hours a week to his sport.
304
702084
3265
籃球員每週花39小時做訓練
12:01
Now we may think that's good or bad,
305
705349
2152
不論你覺得是好是壞
12:03
but in either case it's real.
306
707501
2682
這是確實發生的事情
12:06
And Health Leads is based on the presumption
307
710183
2185
導向健康組織認為
12:08
that for too long
308
712368
1382
已經太久
12:09
we have asked too little of our college students
309
713750
2550
我們對大學生的要求太少
12:12
when it comes to real impact in vulnerable communities.
310
716300
3765
我們需要大學生對脆弱的社群發揮影響力
12:15
College sports teams say,
311
720065
1353
大學球隊會說：
12:17
"We're going to take dozens of hours
312
721418
2065
"我們要花很多小時
12:19
at some field across campus at some ungodly hour of the morning
313
723483
3884
在離校園很遠的地方，在討厭的清晨
12:23
and we're going to measure your performance, and your team's performance,
314
727367
2816
我們要考核你和你隊伍的表現
12:26
and if you don't measure up or you don't show up,
315
730183
2166
如果你表現不夠好或是你沒出現
12:28
we're going to cut you off the team.
316
732349
1450
我們會把你踢出球隊
12:29
But we'll make huge investments
317
733799
1888
但是我們會高額投資
12:31
in your training and development,
318
735687
1212
在你的訓練和發展上
12:32
and we'll give you an extraordinary community of peers."
319
736899
3418
我們也會給你優良的隊員"
12:36
And people line up out the door
320
740317
1815
而人們總是在門外大排長龍
12:38
just for the chance to be part of it.
321
742132
2785
只想要成為球隊的一份子
12:40
So our feeling is,
322
744917
1217
因此我們認為
12:42
if it's good enough for the rugby team,
323
746134
1483
如果大學生願意參加橄欖球隊
12:43
it's good enough for health and poverty.
324
747617
2115
他們也會願意幫助健康或窮困
12:45
Health Leads too recruits competitively,
325
749732
3268
導向健康的招募像球隊一樣充滿競爭性
12:48
trains intensively,
326
753000
1481
高強度訓練
12:50
coaches professionally,
327
754481
1969
並有專業指導
12:52
demands significant time,
328
756450
1949
需要花一段時間
12:54
builds a cohesive team
329
758399
1367
來建立凝聚力高的團隊
12:55
and measures results --
330
759766
1484
並驗收成效
12:57
a kind of Teach for America for healthcare.
331
761250
2683
像是「為美國而教」的健保版
(大學畢業生到偏遠、窮困地區教書)
(大學畢業生到偏遠、窮困地區教書)
12:59
Now in the top 10 cities in the U.S.
332
763933
2100
現在於美國
13:01
with the largest number of Medicaid patients,
333
766033
2319
十個最多的病人需要醫療補助的城市中
13:04
each of those has at least 20,000 college students.
334
768352
3214
各個至少有2萬名大學生
13:07
New York alone has half a million college students.
335
771566
3201
僅紐約就有50萬
13:10
And this isn't just a sort of short-term workforce
336
774767
3049
這不是短期的勞動力
13:13
to connect patients to basic resources,
337
777816
2250
為了幫病人取得基本資源
13:15
it's a next generation healthcare leadership pipeline
338
780066
3601
這是培養下一代健保領導者的管道
13:19
who've spent two, three, four years
339
783667
2450
他們花了2、3、4年
13:22
in the clinic waiting room
340
786117
1501
在候診室裡
13:23
talking to patients about their most basic health needs.
341
787618
3984
與病人協談有關他們最基本的保健需求
13:27
And they leave with the conviction,
342
791602
1749
而他們離開時會有信念
13:29
the ability and the efficacy
343
793351
1832
能力和功效
13:31
to realize our most basic aspirations for health care.
344
795183
3783
來完成我們對健保最基本的期望
13:34
And the thing is, there's thousands of these folks already out there.
345
798966
3018
事實上，我們已經有成千上萬委身此事的大學生
13:37
So Mia Lozada is Chief Resident of Internal Medicine
346
801984
3817
Mia Lozada是內科住院總醫師
13:41
at UCSF Medical Center,
347
805801
1415
在加州大學舊金山分校的醫學中心
13:43
but for three years as an undergraduate
348
807216
2333
但她還是大學生時，她花了三年
13:45
she was a Health Leads volunteer
349
809549
1633
擔任導向健康組織的志工
13:47
in the clinic waiting room at Boston Medical Center.
350
811182
3002
在波士頓醫學中心的候診室
13:50
Mia says, "When my classmates write a prescription,
351
814184
3715
Mia說："當我的醫學院同學開了處方
13:53
they think their work is done.
352
817899
2018
他們認為他們的工作已結束
13:55
When I write a prescription,
353
819917
1716
當我開處方時
13:57
I think, can the family read the prescription?
354
821633
2267
我會想，這個家庭讀得懂這個處方嗎？
13:59
Do they have transportation to the pharmacy?
355
823900
2183
他們有辦法通車到藥房嗎？
14:01
Do they have food to take with the prescription?
356
826083
2450
他們有可以搭配療程的食物嗎？
14:04
Do they have insurance to fill the prescription?
357
828533
2250
他們有保險可以支付這張藥單嗎？
14:06
Those are the questions I learned at Health Leads,
358
830783
2683
這些問題都是我在導向健康工作時學到的
14:09
not in medical school."
359
833466
1750
不是在醫學院"
14:11
Now none of these solutions --
360
835216
1984
目前這些解決方式：
14:13
the prescription pad, the electronic medical record,
361
837200
2970
處方籤、電子醫療記錄
14:16
the waiting room,
362
840170
1147
候診室
14:17
the army of college students --
363
841317
1168
或大學生志工
14:18
are perfect.
364
842485
1183
都仍不完善
14:19
But they are ours for the taking --
365
843668
2500
但只要我們願意，這些都能改善
14:22
simple examples
366
846168
1332
舉個簡單的例子
14:23
of the vast under-utilized healthcare resources
367
847500
3501
這些大量少被使用的健保資源
14:26
that, if we reclaimed and redeployed,
368
851001
2915
如果我們重新使用與配置
14:29
could realize our most basic aspiration
369
853916
3417
即可實現我們對健保
14:33
of healthcare.
370
857333
1784
最基本的渴望
14:35
So I had been at Legal Services for about nine months
371
859117
3216
當我在法律機構工作9個月後
14:38
when this idea of Health Leads started percolating in my mind.
372
862333
2733
成立導向健康組織的概念在我心中逐漸成型時
14:40
And I knew I had to tell Jeff Purcell, my attorney,
373
865066
2934
我知道我必須告訴Jeff Purcell，我的上司
14:43
that I needed to leave.
374
868000
1419
我必須離開
14:45
And I was so nervous,
375
869419
963
我當時非常緊張
14:46
because I thought he was going to be disappointed in me
376
870382
2534
覺得他會對我感到失望
14:48
for abandoning our clients for some crazy idea.
377
872916
3050
因為我為了瘋狂的想法拋棄我們的客戶
14:51
And I sat down with him and I said,
378
875966
1984
我們倆坐下商量，我說
14:53
"Jeff, I have this idea
379
877950
1883
"Jeff，我有個想法
14:55
that we could mobilize college students
380
879833
2419
我們可以動員大學生
14:58
to address patients' most basic health needs."
381
882252
2934
讓他們向社會宣導病患最基本的健康需求"
15:01
And I'll be honest,
382
885186
1581
我誠實的告訴你
15:02
all I wanted was for him to not be angry at me.
383
886767
3299
我當時只希望上司不要對我生氣
15:05
But he said this,
384
890066
1467
但他卻這麼說
15:07
"Rebecca, when you have a vision,
385
891533
3348
"Rebecca，當你有這樣的遠見
15:10
you have an obligation to realize that vision.
386
894881
3851
你有義務去實行它
15:14
You must pursue that vision."
387
898732
3101
你必須追求這個夢想"
15:17
And I have to say, I was like "Whoa.
388
901833
3266
我得說，我當時覺得
15:20
That's a lot of pressure."
389
905099
2017
"哇！這個壓力真大"
15:23
I just wanted a blessing,
390
907116
1399
我本來只希望得到他的祝福
15:24
I didn't want some kind of mandate.
391
908515
1551
我不想被命令
15:25
But the truth is
392
910066
1567
但事實上
15:27
I've spent every waking minute nearly since then
393
911633
2783
自那時起，我花了所有的心力
15:30
chasing that vision.
394
914416
1784
追求我的目標
15:32
I believe that we all have a vision
395
916200
3182
我相信我們對這國家的健保制度
15:35
for healthcare in this country.
396
919382
1901
都有一個目標
15:37
I believe that at the end of the day
397
921283
2199
我相信，最後
15:39
when we measure our healthcare,
398
923482
1834
當我們衡量健保的重要性
15:41
it will not be by the diseases cured,
399
925316
2816
不是用治癒疾病的數量
15:44
but by the diseases prevented.
400
928132
2518
而是用避免疾病的數量
15:46
It will not be by the excellence of our technologies
401
930650
3017
也不是用科技的發達
15:49
or the sophistication of our specialists,
402
933667
2500
或是專家專精的程度
15:52
but by how rarely we needed them.
403
936167
2799
而是以我們不用倚賴他們的程度來算
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
我相信當我們估算健保的重要性時
15:58
it will be, not by what the system was,
406
942967
2683
將不會根據這個制度以往的樣子
16:01
but by what we chose it to be.
407
945650
2766
而是我們決定它成為的樣子
16:04
Thank you.
408
948416
1067
謝謝
16:05
(Applause)
409
949483
10250
(掌聲)
16:15
Thank you.
410
959733
1267
謝謝
16:16
(Applause)
411
961008
9323
(掌聲)
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