TED Salon Optum
Rebecca Onie: What Americans agree on when it comes to health
雷貝嘉奧尼: 美國人在健康方面的一致看法
Filmed:
Readability: 4.1
1,706,025 views
雷貝嘉奧尼說：我們可能沒有我們所想像的那麼分裂——至少對健康的看法是如此。她直接穿過噪音，分享研究的結果，說明即使經濟、政治、或種族分裂，美國人對於需要如何變得健康其實有一致的看法。她請求健康照護提供者及病人把焦點放在「什麼讓我們健康」，而非「什麼激怒我們」。
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.
00:12
Today, we are a country divided,
0
984
2658
現今，我們是個分裂的國家，
00:15
or at least that's what we're told.
1
3666
1892
或者，至少我們聽到的是這樣。
00:18
We are torn apart
by immigration, education, guns
by immigration, education, guns
2
6065
5128
我們被移民、教育、槍枝，
以及健康照護拆得四分五裂。
00:23
and health care.
3
11217
1357
00:25
Health care is ugly and it is loud,
4
13038
2825
健康照護很醜惡，
且它的聲音很大，
且它的聲音很大，
00:28
so loud that it threatens
to drown out everything else.
to drown out everything else.
5
16432
4151
大到幾乎可以蓋過
所有其他的聲音。
所有其他的聲音。
00:32
(Voice-over) Protesters: Health care
is a human right! Fight, fight, fight!
is a human right! Fight, fight, fight!
6
20607
3580
（旁白）抗議者：健康照護
是人權！拼啊，拼啊，拼啊！
是人權！拼啊，拼啊，拼啊！
抗議者：嘿嘿！喔喔！
歐巴馬照護不能留！
歐巴馬照護不能留！
00:36
Protesters: Hey hey! Ho ho!
Obamacare has got to go!
Obamacare has got to go!
7
24211
3702
00:41
Rebecca Onie: But what if
underneath all the noise,
underneath all the noise,
8
29009
2448
雷貝嘉奧尼：但，如果
在所有這些噪音的背後，
在所有這些噪音的背後，
00:43
we're not divided?
9
31481
1714
我們其實並沒有分裂呢？
00:45
What if the things that we don't ask about
10
33219
2657
如果我們不過問的事物
00:47
are the things that we most agree upon?
11
35900
2348
就是我們最一致同意的事物呢？
00:50
It turns out that when we ask
the right questions,
the right questions,
12
38822
2663
結果發現，當我們問對問題，
00:53
the answers are startling,
13
41509
2469
答案是很驚人的，
00:56
because we agree, not on health care,
but on something more important:
but on something more important:
14
44002
5971
因為在健康照護上
我們並沒有一致看法，
我們並沒有一致看法，
但在更重要的地方卻有：
01:01
we agree on health.
15
49997
1723
我們對健康的看法一致。
01:04
For 20 years, I've been obsessed
with one question:
with one question:
16
52627
3644
二十年來，我一直
對一個問題很著迷：
對一個問題很著迷：
01:08
What do we, what do all of us need
in order to be healthy?
in order to be healthy?
17
56295
4115
我們所有人需要什麼，
才能夠保持健康？
才能夠保持健康？
01:13
As a college student in 1995,
18
61043
2050
1995 年，我讀大學時，
花了數個月時間，
花了數個月時間，
01:15
I spent months talking to physicians
at a chaotic hospital in Boston,
at a chaotic hospital in Boston,
19
63117
4741
在波士頓一間混亂的醫院，
和該院的醫生談，
和該院的醫生談，
01:19
asking them, "What's the one thing
your patients most need to be healthy?"
your patients most need to be healthy?"
20
67882
5016
我問他們：「你的病人
最需要什麼，才能夠保持健康？」
最需要什麼，才能夠保持健康？」
01:25
They shared the same story
again and again,
again and again,
21
73709
2513
他們一次又一次跟我說相同的故事，
01:28
one that I've heard hundreds
of variations of since.
of variations of since.
22
76246
3301
從那之後，我聽過
這故事的數百種版本。
這故事的數百種版本。
01:32
They say, "Every day I see a patient
with an asthma exacerbation,
with an asthma exacerbation,
23
80143
3313
他們說：「每天，當我看了
一名哮喘急性發作的病人，
一名哮喘急性發作的病人，
01:35
and I prescribe a controller medication.
24
83480
2596
我就會控制性藥物的處方給他。
01:38
But I know she is living
in a mold-infested apartment.
in a mold-infested apartment.
25
86100
3162
但我知道她住在
有大量黴菌的公寓裡。
有大量黴菌的公寓裡。
01:41
Or I see a kid with an ear infection,
and I prescribe antibiotics,
and I prescribe antibiotics,
26
89860
4296
或者，我看了一個耳朵感染的
孩子，開了抗生素給他，
孩子，開了抗生素給他，
01:46
but I know there is no food at home.
27
94180
2038
但我知道他家中沒有食物。
01:48
And I don't ask about those issues,
because there's nothing I can do."
because there's nothing I can do."
28
96702
3854
我不會去問那些議題，
因為我幫不上忙。」
因為我幫不上忙。」
01:53
Now, it seemed that it shouldn't
be so complicated
be so complicated
29
101586
2429
要根據人們真正的健康需求
01:56
to design a doctor's visit around
what people actually need to be healthy.
what people actually need to be healthy.
30
104039
4362
來設計一種醫生拜訪，
似乎不是太難的事。
似乎不是太難的事。
02:00
So I created Health Leads,
31
108925
1346
所以我創立了
「Health Leads」這個組織，
「Health Leads」這個組織，
02:02
an organization enabling thousands
of physicians and other caregivers
of physicians and other caregivers
32
110295
4785
它讓數千名醫生與其他照護者
02:07
to ask their patients,
33
115104
1762
能夠問他們的的病人：
02:08
"What do you need to be healthy?"
34
116890
1924
「你需要什麼才能保持健康？」
02:10
and then prescribe those things --
35
118838
2468
接著針對他們的答案來開處方——
02:13
fruits and vegetables, heat in the winter,
36
121330
3216
水果、蔬菜、冬天的暖氣、
02:16
electricity to refrigerate
their medication --
their medication --
37
124570
3265
冰箱需要的電力，
這些是他們的藥——
這些是他們的藥——
02:19
and we then navigated
patients to those resources
patients to those resources
38
127859
3359
接著我們指引病人
在他們的的社區中
在他們的的社區中
02:23
in their communities.
39
131242
1535
取得那些資源。
這個模型行得通。
02:25
The model works.
40
133584
1156
02:26
A Mass General Hospital study found that
navigating patients to essential resources
navigating patients to essential resources
41
134764
4785
麻省總醫院有一項研究發現，
指引病人取得必要資源，
指引病人取得必要資源，
02:31
is associated with improvements
in blood pressure and cholesterol levels
in blood pressure and cholesterol levels
42
139573
4427
會改善他們的血壓及膽固醇，
02:36
similar to introducing a new drug,
43
144024
2833
就類似使用新藥，
02:38
but without all the side effects.
44
146881
1864
只差沒有那些副作用。
02:41
So two decades later, what's changed?
45
149817
3243
二十年後，什麼改變了？
02:45
It's now widely recognized
that just 20 percent of health outcomes
that just 20 percent of health outcomes
46
153084
3985
現在已經廣為認定，
只有 20% 的健康結果
和醫療照護有關，
和醫療照護有關，
02:49
are tied to medical care,
47
157093
2000
02:51
whereas up to 70 percent
are tied to healthy behaviors
are tied to healthy behaviors
48
159117
5060
而高達 70% 來自健康的行為
02:56
and what's called the social
determinants of health --
determinants of health --
49
164201
3475
和所謂的「健康的社會決定因素」，
02:59
basically, everything that happens to us
for that vast majority of time
for that vast majority of time
50
167700
4115
基本上就是絕大部分
不在醫生辦公室或醫院裡。
03:03
when we're not in the doctor's office
51
171839
2003
03:05
or the hospital.
52
173866
1540
03:08
Health care executives
now routinely remind us
now routinely remind us
53
176509
2406
健康照護執行者經常提醒我們
03:10
that our zip code matters more
than our genetic code.
than our genetic code.
54
178939
3478
郵遞區號比基因編碼更重要。
03:14
And one health care publication
even recently had the audacity
even recently had the audacity
55
182441
3779
近期甚至有一本
健康照護刊物大膽地
健康照護刊物大膽地
03:18
to describe the social
determinants of health
determinants of health
56
186244
2179
將健康的社會決定因素描述為
「年度感覺良好的行話」。
「年度感覺良好的行話」。
03:20
as "the feel-good buzzword of the year."
57
188447
2554
03:23
Now, there's been some action, too.
58
191785
1691
一直也有些行動。
03:25
Over the past decade, six major
health care providers and insurers
health care providers and insurers
59
193500
3879
在過去十年間，六間大型
健康照護提供者和保險業者
健康照護提供者和保險業者
03:29
have committed over 600 million dollars
60
197403
2626
提撥了超過六億美金
03:32
to affordable housing,
61
200053
1701
用來協助提供可負擔住房，
03:33
recognizing that it reduces
infant mortality
infant mortality
62
201778
3975
因為知道可負擔住房
能減低嬰兒的死亡率，
能減低嬰兒的死亡率，
03:37
and increases life expectancy.
63
205777
2372
並延長壽命。
03:41
But let's be honest.
64
209055
1707
但，老實說，
03:42
Is our 3.5 trillion dollar
health care system
health care system
65
210786
4486
我們的 3.5 兆美金健康照護體制
03:47
fundamentally designed to create health?
66
215296
2354
基本上不就是設計來
創造健康的嗎？
創造健康的嗎？
03:50
Absolutely not.
67
218317
1508
絕對不是。
03:52
Take access to healthy food.
68
220468
1968
以健康食物的取得管道為例。
03:54
Not long ago, a teenage boy shows up
at a hospital in Baltimore,
at a hospital in Baltimore,
69
222952
4164
不久前，一位青少年去
巴爾的摩的一間醫院看病，
巴爾的摩的一間醫院看病，
03:59
losing weight.
70
227140
1519
他體重減輕很多。
04:00
Just as his doctors are huddled up
figuring out which metabolic panels
figuring out which metabolic panels
71
228683
3932
當他的醫生們在討論要採用
哪些新陳代謝檢驗套組
以及血液檢測時，
以及血液檢測時，
04:04
and blood tests to run,
72
232639
2082
04:06
one of my colleagues asks out loud,
73
234745
2339
我有一位同事大聲問：
04:09
"Do you think he might be hungry?"
74
237108
2083
「你們覺得他會不會是餓了？」
04:12
It turned out that this kid
had been kicked out of his housing
had been kicked out of his housing
75
240314
2919
結果發現這個孩子被趕出住房，
04:15
and literally hadn't had a meal in weeks.
76
243257
2587
數個星期沒有吃正餐。
04:18
He said he was "... so relieved
that somebody finally asked me."
that somebody finally asked me."
77
246900
4112
他說他「鬆了一口氣，
因為終於有人問我了。」
因為終於有人問我了。」
04:24
Somehow, we've created
a health care system
a health care system
78
252269
2473
不知怎麼的，在我們
創造的健康照護體制中，
創造的健康照護體制中，
04:26
where asking a patient "Are you hungry?"
79
254766
2876
問病人「你餓不餓？」
04:29
is so far outside the bounds
of what counts as health care
of what counts as health care
80
257666
3971
竟然遠超出健康照護的範圍，
04:33
that we mostly fail or forget
to ask altogether;
to ask altogether;
81
261661
3358
我們幾乎沒有或是忘了問這個問題；
04:37
where doctors lament a hospital's
"no third sandwich policy,"
"no third sandwich policy,"
82
265708
4858
讓醫生們很感慨的就是醫院的
「不給第三個三明治政策」，
「不給第三個三明治政策」，
04:42
meaning that if you're
a hungry patient in the ER,
a hungry patient in the ER,
83
270590
2870
意思就是，如果你是
急診室的病人且你餓了，
急診室的病人且你餓了，
04:45
you can have only two free sandwiches,
84
273484
2811
你只能拿到兩個免費的三明治，
04:48
but as many MRIs as the doctor orders;
85
276319
2717
但只要醫生囑付，
做多少次核磁共振都行；
做多少次核磁共振都行；
04:52
where, in 2016 in the state of Texas,
86
280186
3113
2016 年，在德州，
04:55
they spent 1.2 billion dollars
on the medical costs of malnutrition
on the medical costs of malnutrition
87
283323
5459
有十二億美金被花在
營養失調的醫療成本上，
05:00
instead of on access to healthy food;
88
288806
2555
而不是花在取得
健康食物的管道上；
健康食物的管道上；
05:03
where a Centers for Medicare
and Medicaid Services program
and Medicaid Services program
89
291385
3715
聯邦醫療保險和聯邦醫療
輔助計劃服務中心有一個方案
輔助計劃服務中心有一個方案
05:07
stratifies hungry patients,
90
295124
2423
會將飢餓的病人分階級，
05:09
so that some get access to food
and some get information about food,
and some get information about food,
91
297571
5225
有些人得到食物，
有些人得到食物的相關資訊，
05:14
with the justification that
doing nothing for hungry patients
doing nothing for hungry patients
92
302820
3132
對飢餓患者無所作為
是我國合理、標準與常規的護理。
05:17
is standard and usual care
in this country.
in this country.
93
305976
2889
05:21
And that's just food.
94
309649
1227
那只是食物方面。
05:22
The same is true
for housing, electricity ...
for housing, electricity ...
95
310900
2719
住房、電力等等也一樣……
05:25
The bottom line is,
health care may be changing,
health care may be changing,
96
313643
3447
說到底，健康照護也許在改變，
05:29
but not by enough
and certainly not fast enough.
and certainly not fast enough.
97
317114
3181
但程度不夠大，速度也不夠快。
05:33
We ask the wrong questions
of our doctors, of our patients,
of our doctors, of our patients,
98
321418
3941
我們不只問錯了醫生及病人的問題，
05:37
but also of our citizens.
99
325383
2024
公民的也錯了。
05:40
We ask about and argue about health care,
100
328423
2870
我們詢問、爭論「健康照護」，
05:43
but how do voters think about health?
101
331317
1935
但選民對「健康」的看法呢？
05:46
No one could tell us
the answer to that question,
the answer to that question,
102
334042
3085
沒有人能告訴我們
那個問題的答案，
那個問題的答案，
05:49
so we launched a new initiative
103
337151
1947
所以我們推出了一項新計畫，
05:51
and hired a polling firm
to ask voters across the country:
to ask voters across the country:
104
339122
3371
僱用民調公司來問我國的選民：
05:54
What do you need to be healthy?
105
342517
1891
你需要什麼才健康？
05:58
What was so striking about this
was that no one has any clue
was that no one has any clue
106
346893
5290
很令人驚訝的是，
對於我們在健康照護中所談的東西，
06:04
what we are talking about in health care.
107
352207
2452
沒有人有任何頭緒。
06:07
Voters do not think
the social determinants of health
the social determinants of health
108
355135
2936
選民不認為
「健康的社會決定因素」是個好詞，
「健康的社會決定因素」是個好詞，
06:10
is a feel-good phrase.
109
358095
1613
06:12
They actually hate it.
110
360097
1623
反而很討厭它。
06:14
"What uneducated person
came up with that language?"
came up with that language?"
111
362265
2904
「是哪個沒受過教育的人
想出那個用語的？」
想出那個用語的？」
06:17
one of the voters said.
112
365193
1875
這是其中一名選民說的。
06:19
Or my favorite was the guy who said,
113
367092
2039
我最愛的則是這個傢伙的說法：
06:21
"You're killing me."
114
369155
1417
「敗給你了。」
06:23
But when you strip away
all the ridiculousness
all the ridiculousness
115
371842
2597
但，當你把荒謬的健康照護用語
06:26
of our language in health care,
116
374463
1878
先擱在一旁，
06:28
we know exactly what creates health.
117
376365
2247
就清楚知道什麼創造健康。
06:31
So take Charlotte, North Carolina.
118
379165
2304
以北卡羅萊納州的夏洛特為例。
06:33
We had two focus groups,
119
381493
1487
我們有兩個焦點小組，
06:35
one of African American Democratic women
and one of white Republican women.
and one of white Republican women.
120
383004
4201
一組是民主黨的非裔美國女性，
另一組是共和黨的白人女性。
另一組是共和黨的白人女性。
06:39
And we asked them,
"If you had a hundred dollars,
"If you had a hundred dollars,
121
387229
2821
我們問他們：「如果你有一百元，
06:42
how would you spend it
to buy health in your community?
to buy health in your community?
122
390074
3115
在你的社區中，你會
怎麼用它來買到健康？」
怎麼用它來買到健康？」
06:45
Turns out, they agree
nearly to the last percentage point.
nearly to the last percentage point.
123
393672
4170
結果發現他們看法幾乎完全一致。
06:50
First, they agree that health care
only sort of impacts health.
only sort of impacts health.
124
398537
4080
首先，他們都認為健康照護
只對健康有部分影響。
只對健康有部分影響。
06:54
So they choose to spend
the majority of their dollars
the majority of their dollars
125
402641
2545
所以他們選擇將大部分的錢花在
06:57
outside of hospitals and clinics.
126
405210
1823
醫院和診所以外的地方。
06:59
And second, they agree
on what creates health,
on what creates health,
127
407632
3136
第二，對於什麼能創造健康，
他們的意見也一致，
他們的意見也一致，
07:02
spending 19 percent on affordable housing
128
410792
2225
19% 的錢花在可負擔的住房上，
07:05
and about 25 percent
on access to healthy food.
on access to healthy food.
129
413041
2897
約 25% 的錢花在
取得健康食物的管道上。
取得健康食物的管道上。
07:08
So I am sure you are thinking,
"This has got to be a fluke."
"This has got to be a fluke."
130
416868
3496
我相信你們現在在想
「這一定是僥倖碰對的」。
「這一定是僥倖碰對的」。
07:12
But it's not.
131
420388
1191
但並不是。
07:14
White and Latino male
swing voters in Seattle,
swing voters in Seattle,
132
422112
3431
西雅圖的白種
和拉丁裔男性中間選民、
和拉丁裔男性中間選民、
07:17
white and African American
Democratic voters in Cleveland,
Democratic voters in Cleveland,
133
425567
3891
克里夫蘭的民主黨
白種和非裔選民、
白種和非裔選民、
07:21
white male Republicans in Dallas,
134
429482
2629
達拉斯的共和黨白種男性、
07:24
low-income white Democrats
in Hendersonville, North Carolina:
in Hendersonville, North Carolina:
135
432135
4435
北卡羅萊納州亨德森維爾的
民主黨低收入白種人：
民主黨低收入白種人：
07:28
their answers are strikingly similar,
136
436594
2243
他們的答案都非常相似，
07:31
with all of them choosing
to spend more money
to spend more money
137
439498
2297
他們全都選擇把比較多的錢
07:33
on healthy food and safe housing
138
441819
2576
花在健康食物和安全住房上，
07:36
than they would on hospitals
and health centers.
and health centers.
139
444419
2825
高於花在醫院和健康中心的錢。
07:40
When you ask the right questions,
140
448430
2248
當你問對了問題，
07:42
it becomes pretty clear:
141
450702
1741
就能很清楚地知道：
07:44
we may be fractured
on health care in this country,
on health care in this country,
142
452974
3483
在美國，我們或許
對健康照護的意見分歧，
對健康照護的意見分歧，
07:48
but we are unified on health.
143
456481
2160
但我們對健康的意見是一致的。
07:51
The thing that I've been
struggling with is why.
struggling with is why.
144
459839
3160
我一直在絞盡腦汁思考為什麼。
07:55
Why do we agree on health?
145
463023
1849
為什麼我們對健康的意見一致？
07:57
We agree on health
because it is common sense.
because it is common sense.
146
465712
3157
我們對健康的意見一致，
是因為它是常識。
是因為它是常識。
08:01
We all know that the things
we need to get healthy --
we need to get healthy --
147
469270
3232
我們都知道我們要
「變健康」所需要的東西——
「變健康」所需要的東西——
08:04
medicine and medical care --
148
472526
2234
藥物和醫療照護——
08:06
are not the things we need to be healthy,
149
474784
2594
並不等於我們要
「保持健康」所需要的東西，
「保持健康」所需要的東西，
08:09
to not get sick in the first place.
150
477402
2077
也就是根本就不要生病。
08:12
But we also agree because
of common experience.
of common experience.
151
480255
3136
我們對健康的意見一致，
也是因為共同經驗。
也是因為共同經驗。
08:15
In a study of 5,000 patients,
152
483966
2638
有一項針對五千名病人
做的研究指出，
做的研究指出，
08:18
24 percent of the patients
with commercial health insurance --
with commercial health insurance --
153
486628
4284
24% 有商業健康保險的病人——
08:22
meaning, they had a job --
154
490936
1810
也就是有工作的病人——
08:24
still ran out of food or struggled
to find housing or transportation
to find housing or transportation
155
492770
4717
仍然會沒有食物
或很難取得住房、交通工具，
08:29
or other essential resources.
156
497511
2007
或其他必要資源。
08:31
Twenty-four percent.
157
499542
1515
24%。
08:33
And we saw the same thing
in our focus groups.
in our focus groups.
158
501505
2344
在我們的焦點小組中
也有相同的發現。
也有相同的發現。
08:35
Nearly every voter knew
what it meant to struggle,
what it meant to struggle,
159
503873
3748
幾乎每位選民都知道
艱困是怎樣的感覺，
艱困是怎樣的感覺，
08:39
either themselves or their families
160
507645
2745
也許是發生在自己身上、
家人身上，或鄰居身上。
家人身上，或鄰居身上。
08:42
or their neighbors.
161
510414
1278
08:44
One of those white Republican
women in Charlotte was a waitress
women in Charlotte was a waitress
162
512674
3960
夏洛特的一位共和黨白種女服務生
08:49
struggling to stay awake
with an enormous Big Gulp soda.
with an enormous Big Gulp soda.
163
517443
4113
幾乎無法保持清醒，
要靠巨量杯的汽水幫忙。
要靠巨量杯的汽水幫忙。
08:53
She just looked exhausted.
164
521580
1983
她看起來累壞了。
08:56
And she was.
165
524160
1587
她的確累壞了。
08:57
She told us that she worked two jobs
166
525771
1977
她告訴我們，她有兩份工作，
08:59
but still could not afford
a membership to the Y,
a membership to the Y,
167
527772
2989
但仍然無法負擔 YMCA 的會籍，
09:02
but it was OK that she couldn't go
to the gym, she said,
to the gym, she said,
168
530785
3089
但她說，她不能上健身房沒關係，
09:05
because she also could not afford gas
169
533898
2687
因為她也負擔不起油錢，
09:08
and walked 10 miles to and from work
170
536609
2731
所以上班來回各要走十英哩路，
09:11
every single day.
171
539364
1500
天天用走的。
09:14
Listening to her, I felt
this familiar panic rise in me,
this familiar panic rise in me,
172
542212
4093
聽她說時，我感到我內在
出現了一種熟悉的恐慌，
出現了一種熟悉的恐慌，
09:18
the residue of my own childhood.
173
546948
2438
是我童年的殘留下來的。
09:22
When I was 10 years old,
174
550441
1594
當我十歲時，
09:24
my father lay on the living room floor
175
552059
2574
我爸爸躺在客廳地板上，
09:26
in the grips of one
of his many depressions.
of his many depressions.
176
554657
3111
他常常憂鬱症發作，
這是其中一次。
這是其中一次。
09:30
As I crouched next to him, he told me
that he wanted to kill himself.
that he wanted to kill himself.
177
558435
3913
我蹲在他身邊時，
他告訴我他想要自殺。
他告訴我他想要自殺。
09:37
My father lived,
178
565721
2083
我爸爸活下來了，
09:39
but he struggled to work.
179
567828
1550
但他很難找到工作。
09:41
And my family survived,
180
569939
1593
我的家庭存活下來了，
但我們過得很辛苦，
但我們過得很辛苦，
09:43
but we teetered,
181
571556
1708
09:45
down one paycheck,
182
573288
1477
只靠我媽媽當老師的一份薪水養家。
09:46
relying on my mom's schoolteacher salary.
183
574789
2958
09:49
Even as a little kid, I knew
we lived in the shadow
we lived in the shadow
184
577771
4021
即使我當時很小，我也知道
我們住在財務和情緒崩潰的陰影下。
09:53
of financial and emotional collapse.
185
581816
2610
09:57
This is really hard to say,
186
585482
2238
這真的很難說出來，
09:59
because it's taken me 25 years
to be honest with myself
to be honest with myself
187
587744
3929
因為我花了二十五年的時間，
才誠實面對自己，
才誠實面對自己，
10:03
that this is why I do this work:
188
591697
2292
承認這是我從事這項工作的原因。
10:07
knowing that my father
needed health care to recover,
needed health care to recover,
189
595100
3342
我知道爸爸需要健康照護才能復元，
10:10
but to be healthy, my family
needed something else,
needed something else,
190
598466
3562
但我的家庭還需要別的才健康。
10:14
we needed a decent income;
191
602052
2330
我知道我們需要夠用的收入；
10:16
and knowing, as so many do more than I,
192
604406
3237
還知道，很多人比我更熟悉的，
那可能失去基本飽暖的恐慌感。
10:19
that panic when the basics
threaten to slip away.
threaten to slip away.
193
607667
3332
10:24
To the voters in our focus groups,
the solutions were straightforward.
the solutions were straightforward.
194
612378
4184
對我們焦點小組中的選民來說，
解決方案是很直觀的。
解決方案是很直觀的。
10:28
As one of those white Republican
women in Charlotte said,
women in Charlotte said,
195
616586
3256
有一位夏洛特的
共和黨白種女性說：
共和黨白種女性說：
10:31
"Instead of putting all this money
into health care,
into health care,
196
619866
2716
「別把所有的錢用在健康照護上，
10:34
put it into affordable housing.
197
622606
1828
把錢改用在可負擔住房上。
10:36
You know, like, take it
and distribute it differently."
and distribute it differently."
198
624458
3687
你知道的，用不同的方式
來分配錢的使用。」
來分配錢的使用。」
10:41
It turns out that when you have
the right language
the right language
199
629201
2651
結果發現，只要你用對了用語
10:43
and you ask the right questions,
200
631876
2392
並問對了問題，
10:46
the answers become remarkably clear
201
634292
2613
答案就非常清楚且全體一致。
10:48
and unanimous.
202
636929
1245
10:53
What we know is that,
despite all the noise,
despite all the noise,
203
641055
5180
我們知道的是，
儘管有許多噪音，
10:58
the plan for health care in this country
204
646259
3148
這個國家中的健康照護計畫
11:01
is that there is no plan.
205
649431
1580
就是沒有計畫。
11:03
But we have something more powerful
than any politician's bill,
than any politician's bill,
206
651880
4296
但我們有更強大的東西，
勝過任何政客的法案、
勝過任何政客的法案、
11:08
any candidate's platform,
207
656200
2763
任何候選人的平台、
11:10
any think tank's policy statement.
208
658987
2659
任何智囊團的政策聲明。
11:13
We have our common sense
and our common experience.
and our common experience.
209
661670
3528
我們有我們的常識以及共同經驗。
11:18
So I ask, if you are
a health care executive:
a health care executive:
210
666057
4091
所以，如果你是健康照護
執行者，我想問：
執行者，我想問：
11:22
Do you know how many
of your patients run out of food
of your patients run out of food
211
670172
2704
你是否知道你的病人中
有多少人沒有食物？
有多少人沒有食物？
11:24
or struggle to pay the rent
at the end of the month?
at the end of the month?
212
672900
2906
或為了月底付不出房租而苦？
11:27
Is that data on your scorecard,
213
675830
2376
你的事業和你的獎金所參考的
11:30
shaping your business and your bonuses?
214
678230
2789
計分卡上有那些資料嗎？
11:33
If you are a politician:
215
681796
1920
如果你是政治人物：
11:35
Will you continue to fight
on the scorched earth of health care,
on the scorched earth of health care,
216
683740
4279
你會在健康照護的
焦土上努力奮鬥嗎？
焦土上努力奮鬥嗎？
11:40
or will you act on what your voters,
217
688043
2445
或者你會依選民
來決定採取什麼行動？
來決定採取什麼行動？
11:42
what Democratic
and Republican voters alike,
and Republican voters alike,
218
690512
2890
民主黨和共和黨的選民同樣，
11:45
already know,
219
693426
1391
他們已經知道
11:46
which is that good wages,
healthy food and safe housing
healthy food and safe housing
220
694841
3352
好的薪水、健康的食物，
和安全的住房就是健康。
11:50
are health?
221
698217
1165
11:51
And for the rest of us,
for the citizens of this country:
for the citizens of this country:
222
699997
4110
至於其餘的人，我國的公民們：
11:56
Will we demand accountability
to what we know to be true,
to what we know to be true,
223
704131
4326
我們能否要求對已知的事實究責？
12:00
which is that our common sense,
224
708481
2186
也就是我們的常識
12:02
our common experience,
225
710691
1820
以及我們的共同經驗
12:04
makes us the experts
in what it takes to be healthy?
in what it takes to be healthy?
226
712535
3391
讓我們成為專家，
知道健康需要什麼。
知道健康需要什麼。
12:09
This moment, as it turns out,
227
717123
2632
事實證明，此時，
12:11
is not about changing minds.
228
719779
2098
重點不在於改變想法。
12:14
It is about something more powerful.
229
722632
2157
重點在於更強大的東西。
12:17
It is about changing the questions we ask
230
725205
2574
重點在於改變我們所問的問題
12:19
and quieting the noise
to hear each other's answers.
to hear each other's answers.
231
727803
3927
以及讓噪音安靜下來，
才能聽見彼此的答案。
才能聽見彼此的答案。
12:24
It is about the radical possibility
that we the patients,
that we the patients,
232
732659
3918
重點在於，很有可能我們病人、
12:28
we the physicians, we the caregivers,
233
736601
2457
我們醫生、我們照護者、
12:31
we the health care executives
234
739082
1416
我們健康照謢執行者，
還有我們人民，
還有我們人民，
12:32
and yes, even we the people,
235
740522
2064
12:34
that we agree.
236
742610
1403
其實意見一致。
12:36
And it is now time --
237
744642
1890
現在是時候了——
12:38
in fact, long overdue --
238
746556
1951
事實上，早就該做了——
12:40
for us to marshal the courage
239
748531
2154
我們應該要引領有勇氣的人，
12:43
to hear those answers
and to act upon them.
and to act upon them.
240
751409
3231
去聽見那些答案，
並採取相應的行動。
並採取相應的行動。
12:47
Thank you.
241
755058
1182
謝謝。
12:48
(Applause)
242
756264
4119
（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