TED2016
Joseph Ravenell: How barbershops can keep men healthy
約瑟夫 · 羅芙奧: 理髮店怎樣促進健康
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理髮店是黑人的安樂窩，是一個能進行坦誠的對話、充滿信任的地方，也是如約瑟夫 · 羅芙奧醫生所說的：一個談論健康話題的地方。他把當地的理髮店變成一個談論對黑人影響越發嚴重的疾病（如高血壓）的地方。這是一個可以廣泛應用的解決問題新方法。「你的理髮店在哪？」他說，「在人們受到獨特問題的困擾時，能提供獨特的解決方案的地方在哪裡？」
Joseph Ravenell - Physician and men’s health advocate
Using unexpected channels like the pulpit and the barber’s chair, Dr. Joseph Ravenell delivers basic health care information to an at-risk demographic -- African-American men. Full bio
Using unexpected channels like the pulpit and the barber’s chair, Dr. Joseph Ravenell delivers basic health care information to an at-risk demographic -- African-American men. Full bio
Double-click the English transcript below to play the video.
00:14
What do you see?
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你看到什麼？
00:17
Most of you see a barbershop,
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多數人看到的是理髮店，
00:20
but I see an opportunity:
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但是我見到一個機會：
00:23
an opportunity for health,
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一個促進健康的機會，
00:26
an opportunity for health equity.
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一個促進人人都可以
享受健康的機會。
享受健康的機會。
00:30
For black men, the barbershop
is not just a place
is not just a place
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對黑人來說，理髪店不單只是
00:33
where you get your hair cut
or your beard trimmed.
or your beard trimmed.
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你剪頭髮或剃鬍子的地方。
00:37
No, it's much more than that.
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它有更重大的意義。
00:40
Historically, the barbershop
has been a safe haven for black men.
has been a safe haven for black men.
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自古理髪店就是黑人的安樂窩。
00:45
It's a place where we go for friendship,
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那裡是可以結交朋友，
00:48
solidarity and solace.
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大家團結一致和互相安慰的地方。
00:52
It's a place where we go
to get away from the stress
to get away from the stress
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在那裡我們可以遠離
工作的折磨，
00:55
of the grind of work
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00:58
and sometimes home life.
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避開家庭的壓力。
01:02
It's a place where we don't have to worry
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我們在那裡不用擔心
01:04
about how we're being perceived
by the outside world.
by the outside world.
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外界怎樣看待我們。
01:08
It's a place where we don't
feel threatened,
feel threatened,
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不怕受到別人脅迫，
01:11
or threatening.
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或者覺得身處險境。
01:15
It's a place of loyalty and trust.
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那是一個充滿忠誠和信任的地方。
01:18
For that reason,
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因此，
01:20
it's one of the few places
where we can fearlessly be ourselves
where we can fearlessly be ourselves
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那裡是我們少數可以自在做自己，
無憂無慮地聊天的地方。
01:24
and just ... talk.
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01:28
The talk, the shop talk, the conversation,
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聊天、傾行話、閒扯，
01:31
that is the essence
of the black barbershop.
of the black barbershop.
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都是黑人理髮店的精髓。
01:35
I can remember going to the barbershop
with my dad as a kid.
with my dad as a kid.
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我記得少時跟爸爸到理髮店。
01:39
We went to Mr. Mike's barbershop
every other Saturday.
every other Saturday.
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每隔一個星期六，
我們到麥克的理髪店。
我們到麥克的理髪店。
01:43
And like clockwork,
the same group of men would be there
the same group of men would be there
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好像發條鐘錶一樣，每次到那裡
都是同一批男子，
01:47
every time we went,
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01:48
either waiting on their favorite barber
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他們要不是在等自己喜愛的理髮師，
01:51
or just soaking up the atmosphere.
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就是純來感受這裡的氣氛。
01:55
I can remember the jovial greeting
that warmly welcomed us
that warmly welcomed us
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我記得每次我們來到小店
都會受到愉快親切的歡迎。
01:59
every time we went.
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02:01
"Hey Rev," they would say to my dad.
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「嗨，老牧！」
他們會這樣和我爸說話。
他們會這樣和我爸說話。
02:05
He's a local pastor,
and they treated him like a celebrity.
and they treated him like a celebrity.
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爸爸是當地的牧師，
他們待他如名人。
他們待他如名人。
02:09
"Hey young fella, how you doing?"
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「嗨，年輕人，你好嗎？」
02:12
they would say to me,
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他們就是這樣對我說話，
02:13
making me feel just as special.
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讓我覺得自己
就跟爸爸一樣與眾不同。
就跟爸爸一樣與眾不同。
02:17
I remember the range
of the conversations was immense.
of the conversations was immense.
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我記得他們的話題很廣泛。
02:22
The men would talk about politics
and sports and music
and sports and music
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他們會談論政治、體育、音樂
02:27
and world news, national news,
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和世界新聞、國內新聞，
02:30
neighborhood news.
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本地新聞。
02:33
There was some talk about women
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有時談到女人
02:36
and what it was like to be
a black man in America.
a black man in America.
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和美國黑人的生存現狀。
02:40
But many times they also
talked about health.
talked about health.
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但是很多時候
他們談論關於健康的話題，
他們談論關於健康的話題，
02:45
The conversations about health
were lengthy and deep.
were lengthy and deep.
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而且花很長時間深入交談。
02:49
The men often recounted
their doctor's recommendations
their doctor's recommendations
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他們常常詳細地敍述醫生的建議，
02:52
to cut salt in their diet
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例如減鹽飲食、
02:54
or to eat less fried foods
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少吃煎炸食物、
02:57
or to stop smoking
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戒菸、
02:59
or to reduce stress.
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減壓。
03:01
They talked about the different ways
you could reduce stress,
you could reduce stress,
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他們談論減壓的不同方法，
03:05
like simplifying one's love life --
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例如過簡單的愛情生活——
03:08
(Laughter)
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（笑聲）
03:12
all ways to treat high blood pressure.
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各種治療高血壓的方法。
03:17
There's a lot of talk about
high blood pressure in the barbershop.
high blood pressure in the barbershop.
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理髮店裡有很多關於高血壓的談話。
03:22
That's because almost 40 percent
of black men have it.
of black men have it.
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因為四成的黑人男士患有高血壓。
03:28
That means that almost
every single black man
every single black man
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這意味著幾乎每一個黑人
03:32
either has high blood pressure
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不是自己有高血壓，
03:34
or knows a black man who has it.
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就是認識另一個患有高血壓的黑人。
03:37
Sometimes, those conversations
in the barbershop
in the barbershop
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有時這些人在理髮店的對話
03:41
would be about what happens
when high blood pressure
when high blood pressure
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會講到當人們不重視高血壓
03:43
is not adequately addressed.
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會發生什麼事。
03:47
"Say, did you hear about Jimmy?
He had a stroke."
He had a stroke."
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「你有沒有聽到吉米的消息？
他中風了。」
他中風了。」
03:53
"Did you hear about Eddie?
He died last week.
He died last week.
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「你聽說艾迪的事情沒？
他上星期去世了，
他上星期去世了，
03:57
Massive heart attack.
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因為嚴重的心臟病發。
03:59
He was 50."
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他才 50 歲。」
04:02
More black men die from high blood
pressure than from anything else,
pressure than from anything else,
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黑人高血壓死亡率要高於其他疾病，
04:06
even though decades of medical wisdom
and science have demonstrated
and science have demonstrated
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雖然數十年來醫學的
智慧和科學已經證明
智慧和科學已經證明
04:11
that death from high blood pressure
can be prevented
can be prevented
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及時的診斷加上適當的治療
可以預防病人死於高血壓。
可以預防病人死於高血壓。
04:14
with timely diagnosis
and appropriate treatment.
and appropriate treatment.
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04:19
So why is high blood pressure
so differentially deadly for black men?
so differentially deadly for black men?
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為什麼高血壓對黑人特別致命？
04:24
Because too often, high blood pressure
is either untreated
is either untreated
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這是因為黑人常常不是沒有看醫生
04:28
or under-treated in black men,
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就是沒有接受足夠的治療，
04:31
in part because of our lower engagement
with the primary healthcare system.
with the primary healthcare system.
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部分的原因是我們很少參與健保。
04:36
Black men, in particular
those with high blood pressure,
those with high blood pressure,
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尤其是那些患高血壓的黑人
04:40
are less likely to have
a primary care doctor
a primary care doctor
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比起其他群體更可能沒有家庭醫生。
04:42
than other groups.
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04:44
But why?
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但是為什麼？
04:46
Some of our earliest research
on black men's health
on black men's health
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我們有一些早期關於
黑人健康狀況的調查，
黑人健康狀況的調查，
04:49
revealed that for many, the doctor's
office is associated with fear,
office is associated with fear,
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表明對於很多黑人來說，
診所都讓人聯想到恐懼、
診所都讓人聯想到恐懼、
04:55
mistrust,
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缺乏信任、
04:57
disrespect,
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不受尊重、
04:59
and unnecessary unpleasantness.
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還有不愉快。
05:03
The doctor's office is only a place
that you go when you don't feel well.
that you go when you don't feel well.
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診所只是在你感到不適時
要去的地方。
要去的地方。
05:07
And when you do go,
you might wait for hours
you might wait for hours
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你真的去了那裡，可能要等很久，
05:11
only to get the run-around
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只聽到一輪託詞，
05:13
and to be evaluated by
a stoic figure in a white coat
a stoic figure in a white coat
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然後接受一個面無表情、
穿著白袍的醫生看診，
穿著白袍的醫生看診，
05:18
who only has 10 minutes to give you
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他只給你 10 分鐘時間看病，
05:20
and who doesn't value the talk.
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而且並不重視你們之間的對話。
05:25
So it's no wonder that some men
don't want to be bothered
don't want to be bothered
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所以難怪有些人懶得麻煩，
05:28
and skip going to the doctor altogether,
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根本不去看醫生，
05:32
especially if they feel fine.
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尤其是他們感覺精神不錯的時候。
05:35
But herein lies the problem.
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但是這裡存在一個問題。
05:38
You can feel just fine
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即使你的高血壓威脅著
你重要器官的時候，
你重要器官的時候，
05:40
while high blood pressure ravages
your most vital organs.
your most vital organs.
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你也不會感覺不適。
05:46
This is Denny Moe,
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這是丹尼 · 默，
05:49
owner of Denny Moe's
Superstar Barbershop in Harlem.
Superstar Barbershop in Harlem.
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紐約哈林區「丹尼 · 默
超級明星理髮店」的店主。
超級明星理髮店」的店主。
05:53
I've been lucky enough to have Denny
as my barber for the last eight years.
as my barber for the last eight years.
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最近八年，我都很幸運地
有丹尼做我的理髮師。
有丹尼做我的理髮師。
05:58
He said to me once,
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他有一次跟我說：
06:00
"Hey Doc, you know,
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「嗨，醫生，你知道嗎，
06:02
lots of black men trust their barbers
more than they trust their doctors."
more than they trust their doctors."
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比起相信自己的醫生，
很多黑人更相信自己的理髮師。」
很多黑人更相信自己的理髮師。」
06:07
This was stunning to me,
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這一開始真的讓我很驚訝，
06:09
at first,
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06:11
but not so much when you think about it.
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但當你仔細想想的時候
好像就是這樣。
好像就是這樣。
06:14
Black men have been with their
current barbers
current barbers
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平均而言，黑人和他們的
理髮師認識的時間，
理髮師認識的時間，
06:17
on average as long
as I've been with Denny,
as I've been with Denny,
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就和我和丹尼認識的時間一樣長，
06:19
about eight years.
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就是差不多八年。
06:21
And black men see their barbers
about every two weeks.
about every two weeks.
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而且黑人差不多每兩週理一次髮。
06:26
Not only do you trust your barber
with your look and with your style,
with your look and with your style,
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你不僅相信髮型師能夠
照顧好你的髮型和外貌，
照顧好你的髮型和外貌，
06:31
but you also trust him with your secrets
and sometimes your life.
and sometimes your life.
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你還願意和他分享你的秘密，
甚至有時以生命信任他。
甚至有時以生命信任他。
06:37
Denny, like many barbers,
is more than just an artist,
is more than just an artist,
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和很多髮型師一樣，
丹尼不僅僅是一個藝術家，
丹尼不僅僅是一個藝術家，
06:40
a businessman and confidant.
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一個商人和知己。
06:43
He's a leader and a passionate advocate
for the well-being of his community.
for the well-being of his community.
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他還是一個促進社區健康的
領袖和熱情的倡導者。
領袖和熱情的倡導者。
06:50
The very first time I walked
into Denny Moe's shop,
into Denny Moe's shop,
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我第一次走進丹尼的店時，
06:53
he wasn't just cutting hair.
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他不僅在理髮，
06:56
He was also orchestrating
a voter registration drive
a voter registration drive
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他還在為他的顧客和社區發聲
而安排選民登記運動。
而安排選民登記運動。
07:00
to give a voice to his customers
and his community.
and his community.
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07:06
With this kind of activism,
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因為黑人理髮店的典型特徵
是這種積極精神和社區投資，
是這種積極精神和社區投資，
07:09
and community investment
that typifies the black barbershop,
that typifies the black barbershop,
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07:13
of course the barbershop
is a perfect place
is a perfect place
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難怪理髮店會成為談論高血壓
07:17
to talk about high blood pressure and
other health concerns in the community.
other health concerns in the community.
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及社區其他健康問題的首選場所。
07:21
First, the barbershop is not
a medical setting,
a medical setting,
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首先，理髮店不是醫療環境，
07:26
and so it doesn't have
all the negative psychological baggage
all the negative psychological baggage
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所以不會給人帶來負面的心理負擔。
07:29
that comes along with that.
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07:31
When you're in a barbershop,
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當你在理髮店的時候，
07:33
you're in your territory,
and you're among friends
and you're among friends
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你在自己的地盤，
有知道你的過去和艱辛，
及健康風險的朋友陪伴。
及健康風險的朋友陪伴。
07:36
who share your history,
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07:39
your struggle and your health risks.
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07:43
Second, because the barbershop
is a place of connection,
is a place of connection,
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第二，因為理髮店是個充滿
聯繫、忠誠和信任的地方，
聯繫、忠誠和信任的地方，
07:47
loyalty and trust,
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07:49
it's a place where you're more open
to have a conversation about health
to have a conversation about health
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在這裡你能更輕鬆地談論健康話題，
07:53
and especially about high blood pressure.
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尤其是高血壓。
07:56
After all,
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畢竟，有關高血壓的談話
有所有店裡閒聊的要素：
有所有店裡閒聊的要素：
07:57
conversations about high blood pressure
have all the elements of great shop talk:
have all the elements of great shop talk:
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08:03
stress and high blood pressure,
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壓力和高血壓，
08:05
food and high blood pressure,
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食物和高血壓，
08:08
relationships and high blood pressure,
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人際交往和高血壓，
08:10
and yes, what it's like
to be a black man in America
to be a black man in America
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噢還有，在美國
當黑人的感受和高血壓。
當黑人的感受和高血壓。
08:14
and high blood pressure.
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08:17
But you can do more than just talk
about high blood pressure
about high blood pressure
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但是在理髮店裡你不僅能
談論高血壓，你還能做更多。
談論高血壓，你還能做更多。
08:20
in the barbershop.
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08:22
You can concretely take action.
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你能採取具體的行動。
08:25
Here we have an opportunity to partner
with the Denny Moe's of the world
with the Denny Moe's of the world
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現在我們有一個和世界上
其他丹尼 · 默合夥的機會，
其他丹尼 · 默合夥的機會，
08:30
and empower communities
to address the health inequities
to address the health inequities
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去啟發社區重視
其獨特的健康不平等問題。
其獨特的健康不平等問題。
08:34
that uniquely affect it.
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08:37
When high blood pressure screening
expanded from clinics and hospitals
expanded from clinics and hospitals
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在 1960 及 1970 年代，
當高血壓篩檢從診所和醫院
擴大到社區時，
擴大到社區時，
08:40
to communities in the 1960s and '70s,
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08:43
black physicians like
Dr. Eli Saunders in Baltimore
Dr. Eli Saunders in Baltimore
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像巴爾的摩的伊利 · 桑德斯
和新奧爾良的肯斯 · 芬迪南德
和新奧爾良的肯斯 · 芬迪南德
08:47
and Dr. Keith Ferdinand in New Orleans
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這樣的黑人醫生，
08:49
were at the forefront of bringing
health promotion to community hubs
health promotion to community hubs
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把提倡健康活動帶到城市中
黑人街區的社區中心前線。
黑人街區的社區中心前線。
08:53
in urban black neighborhoods.
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08:56
These pioneers paved the way
for my professional journey
for my professional journey
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這些先驅為我專注於
理髮店和健康關係的專業道路奠基，
理髮店和健康關係的專業道路奠基，
09:00
with barbershops and health,
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09:02
which began in Chicago in medical school.
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這事業開始於芝加哥的醫學院。
09:07
The very first research project
that I worked on as a medical student
that I worked on as a medical student
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作為醫學生，
我進行的第一個研究計劃
我進行的第一個研究計劃
09:10
was to help design
healthcare interventions
healthcare interventions
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就是去協助設計能吸引到
黑人的醫保創新。
黑人的醫保創新。
09:13
that would appeal to black men.
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09:16
We conducted about a dozen focus groups
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我們對 12 組焦點團體做實驗，
其中有各個階層的黑人，
其中有各個階層的黑人，
09:19
with a broad cross-section of black men,
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09:23
and we learned that for them,
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我們從中學到了很多，
09:25
being healthy was as much about
being perceived as healthy
being perceived as healthy
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身體健康既是各項指標正常，
09:29
as it was about feeling healthy,
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也是心裡感覺到健康，
09:31
and that feeling good
went hand in hand with looking good.
went hand in hand with looking good.
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而且感覺愉快和外表好看
是緊密聯繫的。
是緊密聯繫的。
09:38
This work led to the development
of Project Brotherhood,
of Project Brotherhood,
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這個研究促進了
「黑人兄弟診所」組織的發展，
「黑人兄弟診所」組織的發展，
09:41
a community clinic founded
by Dr. Eric Whitaker
by Dr. Eric Whitaker
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由艾力克 · 維塔克醫生開辦，
09:44
that provided tailored
healthcare to black men.
healthcare to black men.
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為專為黑人打造的社區醫療診所。
09:48
Part of this tailored care
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這個醫療的一部分包括
09:50
involved having a barber on the premises
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有駐診理髮師給來看病的人
09:53
to reward the men who came
for needed healthcare
for needed healthcare
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一次免費的理髮服務，
09:57
with a free haircut,
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09:59
to let the men know that we, too,
valued how they looked
valued how they looked
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這讓他們知道
我們既重視他們的外貌，
我們既重視他們的外貌，
10:03
as well as how they felt,
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也重視他們的感覺，
10:05
and that what was important to them
was also important to us.
was also important to us.
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對他們而言很重要的東西，
我們同樣看重。
我們同樣看重。
10:10
But while there's only one
Project Brotherhood,
Project Brotherhood,
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儘管只有一個
「黑人兄弟診所」組織，
「黑人兄弟診所」組織，
10:13
there are thousands of black barbershops
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卻有上千個將促進健康和理髮
結合的黑人理髮店，
結合的黑人理髮店，
10:16
where the intersection of health
and haircuts can be cultivated.
and haircuts can be cultivated.
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10:22
The next stop on my journey
was Dallas, Texas,
was Dallas, Texas,
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然後我的促進健康專業旅程
到了德州的達拉斯，
到了德州的達拉斯，
10:26
where we learned that barbers
were not only willing
were not only willing
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我們在那裡了解到理髮師不僅願意，
10:29
but fully able to roll up
their sleeves and participate
their sleeves and participate
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還有足夠的能力捲起袖子親身參與，
10:33
in delivering needed health services
to improve the health of their customers
to improve the health of their customers
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為他們的顧客和社區提供必要的
醫療服務，以促進他們的健康。
醫療服務，以促進他們的健康。
10:38
and their community.
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10:40
We teamed up with an amazing
cadre of black barbers
cadre of black barbers
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我們和一群優秀的黑人理髮師合作，
10:44
and taught them how
to measure blood pressure
to measure blood pressure
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教會他們怎樣測量血壓，
10:46
and how to counsel their customers
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怎樣與顧客商談，
並把他們轉到診所，
並把他們轉到診所，
10:48
and refer them to doctors
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10:50
to help manage high blood pressure.
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以控制和治療高血壓。
10:52
The barbers were not only willing to do it
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這些理髮師不僅願意這樣做，
10:55
but they were damn good at it.
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他們還做得超好。
10:57
Over a three-year period,
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三年以來，
10:59
the barbers measured
thousands of blood pressures
thousands of blood pressures
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這群理髮師測量了上千人的血壓，
11:02
resulting in hundreds of black men
being referred to doctors
being referred to doctors
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讓數百位黑人轉到診所
11:07
for medical care
of their high blood pressure.
of their high blood pressure.
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接受高血壓的治療。
11:11
These barber-doctor partnerships
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這種理髮師和醫生的結合方式
11:14
resulted in a 20 percent increase
in the number of men
in the number of men
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讓血壓控制在標準值內的
人數增長了 20%，
人數增長了 20%，
11:18
who were able to achieve
target blood pressure levels
target blood pressure levels
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11:21
and a three-point drop, on average,
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平均每個參與者的血壓
也都下降了很多。
也都下降了很多。
11:23
in the blood pressure of each participant.
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11:26
If we were to extrapolate
that three point drop
that three point drop
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假如我們能讓美國每個患有
高血壓的黑人的血壓都下降很多，
高血壓的黑人的血壓都下降很多，
11:29
to every single black man
with high blood pressure in America,
with high blood pressure in America,
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11:32
we would prevent 800 heart attacks,
500 strokes and 900 deaths
500 strokes and 900 deaths
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就能防止 800 人次的心臟病，
500 人次的中風
500 人次的中風
和 900 人次因為
高血壓造成的死亡，
高血壓造成的死亡，
11:39
from high blood pressure
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11:40
in just one year.
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在短短一年內達到。
11:44
And our experience with barbershops
has been no different in New York City,
has been no different in New York City,
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我的旅程最近到了紐約州，
我們與理髮店的合作同樣成功。
我們與理髮店的合作同樣成功。
11:49
where my journey has currently led me.
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11:51
With an incredible team
of diverse research assistants,
of diverse research assistants,
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我們優秀的隊伍有不同的研究助理，
11:55
community health workers and volunteers,
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社區醫療工作者和志工，
11:58
we've been able to partner
with over 200 barbershops
with over 200 barbershops
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我們已經和超過 200 家理髮店
及其他值得信任的社區場所合作，
及其他值得信任的社區場所合作，
12:02
and other trusted community venues
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12:04
to reach over 7,000 older black men.
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惠及超過 7000 個年老的黑人。
12:08
And we've offered high blood pressure
screening and counseling
screening and counseling
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我們還為每一個人提供
高血壓檢測和建議。
高血壓檢測和建議。
12:11
to each and every one of them.
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12:13
Thanks to Denny Moe
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感謝丹尼 · 默
12:15
and the myriad other barbers
and community leaders
and community leaders
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和無數的理髮師及社區領袖，
12:19
who shared the vision of opportunity
and empowerment
and empowerment
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他們共同懷有幫助社區發展的
機會和賦權的願景，
機會和賦權的願景，
12:24
to make a difference in their communities,
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12:26
we've been able to not only
lower blood pressure
lower blood pressure
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我們不僅能幫助參與者降低血壓，
12:29
in our participants,
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12:31
but we've also been able to impact
other health indicators.
other health indicators.
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我們也能夠引入其他的健康指數。
12:38
So what do you see?
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那麼你們現在看到什麼？
12:41
What is your barbershop?
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你的理髮店在哪裡？
12:45
Where is that place for you
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在人們受到獨特問題的困擾時，
能提供獨特解決方案的地方在哪裡？
能提供獨特解決方案的地方在哪裡？
12:49
where people who are affected
by a unique problem
by a unique problem
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12:53
can meet a unique solution?
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12:57
When you find that place,
see the opportunity.
see the opportunity.
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當你能找到那個地方時，
便能看到機會。
便能看到機會。
13:02
Thank you.
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謝謝。
13:03
(Applause)
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（掌聲）
ABOUT THE SPEAKER
Joseph Ravenell - Physician and men’s health advocateUsing unexpected channels like the pulpit and the barber’s chair, Dr. Joseph Ravenell delivers basic health care information to an at-risk demographic -- African-American men.
Why you should listen
Colorectal cancer and hypertension are the two leading causes of death among African-American males over 50, and yet these men remain underserved by basic diagnostic procedures such as blood pressure checks or cancer screening. By tapping the members of the African-American community most often trusted by men -- barbers and religious leaders -- Joseph Ravenell hopes to change that.
Working with New York University's Men's Health Initiative, Ravenell studies and implements community-based strategies to diagnose and treat these preventable and potentially deadly diseases, offering blood pressure readings at barbershops and health education at churches and mosques.
Joseph Ravenell | Speaker | TED.com