TEDMED 2009
Bill Davenhall: Your health depends on where you live
比爾‧達文霍(Bill Davenhall)：健康本於所居
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你所居住過的地方，和飲食、基因一樣會影響你的健康，但卻往往沒有被列在醫療紀錄上。在TEDMED大會上，達文霍告訴我們，一般人所忽略的政府提供的地理資訊(包含當地的心臟病發機率到有毒廢棄物掩埋場資訊等)可以和GPS設備配合使用，讓醫生得以掌握患者狀況。這就是「地理醫學」。
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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地理資訊
00:18
make you healthy?
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能讓你更健康嗎?
00:22
In 2001 I got hit by a train.
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2001年一輛火車撞上了我，
00:26
My train was a heart attack.
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那輛火車名為心臟病，
00:29
I found myself in a hospital
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我發現自己身處醫院中的
00:31
in an intensive-care ward,
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一間加護病房裡，
00:33
recuperating from emergency surgery.
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剛從急診撿回一命。
00:36
And I suddenly realized something:
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我忽然驚覺到一件事，
00:38
that I was completely in the dark.
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那就是,我對自己的狀況一無所知。
00:41
I started asking my questions, "Well, why me?"
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我開始問自己"為什麼是我?"
00:43
"Why now?" "Why here?"
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"為什麼是現在?","為什麼在這裡?"
00:45
"Could my doctor have warned me?"
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"我的醫生能否提早警告我?"
00:48
So, what I want to do here in the few minutes I have with you
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因此,我想在這裡花幾分鐘時間
00:51
is really talk about what is the formula for life and good health.
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和你們聊聊，何謂生活方程式，以及健康。
00:56
Genetics, lifestyle and environment.
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這個方程式包括基因、生活型態及環境等，
00:59
That's going to sort of contain our risks,
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這些都是風險，
01:01
and if we manage those risks
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如果我們能掌握這些風險，
01:03
we're going to live a good life and a good healthy life.
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我們就能活得好，活得健康。
01:06
Well, I understand the genetics and lifestyle part.
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我瞭解自己的基因和生活型態這部分，
01:10
And you know why I understand that?
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你知道我怎麼知道的嗎?
01:12
Because my physicians constantly
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因為我的內科醫生一直以來
01:15
ask me questions about this.
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都會詢問我這些問題。
01:17
Have you ever had to fill out those long,
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你是否曾在醫生的辦公室裡
01:19
legal-size forms in your doctor's office?
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填寫過那些法定規格的冗長表格呢?
01:22
I mean, if you're lucky enough you get to do it more than once, right?
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我是說，如果你夠幸運的話，還能多填幾次對吧?
01:25
(Laughter)
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(笑聲)
01:26
Do it over and over again. And they ask you questions
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寫了一遍又一遍,表格上問的問題
01:28
about your lifestyle and your family history,
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包含生活型態,家族病史,
01:31
your medication history, your surgical history,
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你的用藥史,手術史,
01:35
your allergy history ... did I forget any history?
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過敏史等...我有漏了什麼史嗎?
01:39
But this part of the equation I didn't really get,
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不過方程式裡有一部份我不是很懂，
01:43
and I don't think my physicians
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我也不認為我的醫生
01:46
really get this part of the equation.
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真正瞭解方程式裡的這個部分，
01:48
What does that mean, my environment?
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也就是，我的生活環境代表什麼?
01:51
Well, it can mean a lot of things.
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我說,它的意義可多了，
01:53
This is my life. These are my life places.
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這是我的生活，還有我居住的地方，
01:56
We all have these.
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我們都有這些。
01:58
While I'm talking I'd like you to also be thinking about:
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我在講的時候,希望你們能想想
02:01
How many places have you lived?
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你們住過多少個地方?
02:04
Just think about that, you know, wander through
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只要想著這點，
02:06
your life thinking about this.
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回顧你的生命歷程，
02:08
And you realize that you spend it in a variety of different places.
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你會發現,你曾待過許多地方，
02:12
You spend it at rest and you spend it at work.
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休息的地方,工作的地方。
02:14
And if you're like me, you're in an airplane a good portion of your time
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若你像我,你會花很多時間搭飛機，
02:17
traveling some place.
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到一些地方旅行。
02:19
So, it's not really simple
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所以,要回答這些問題並不簡單。
02:21
when somebody asks you, "Where do you live, where do you work,
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當有人問"你住哪?在哪工作?
02:23
and where do you spend all your time?
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你平常都待在哪裡?
02:25
And where do you expose yourselves to risks
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你是否將自己暴露於危險的環境之中，
02:28
that maybe perhaps you don't even see?"
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就連你自己也不知道？"
02:32
Well, when I have done this on myself,
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當我自己想這些問題時，
02:34
I always come to the conclusion
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總是得到一個結論，
02:36
that I spend about 75 percent of my time
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我花了大約75%的時間，
02:40
relatively in a small number of places.
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只待在少數幾個地方。
02:43
And I don't wander far from that place
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大部分時間我都不會
02:45
for a majority of my time,
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離這些地方太遠，
02:47
even though I'm an extensive global trekker.
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儘管我經常旅行世界各地。
02:52
Now, I'm going to take you on a little journey here.
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現在,我要帶你們踏上一小段旅程，
02:54
I started off in Scranton, Pennsylvania.
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從賓州的斯克蘭頓出發，
02:56
I don't know if anybody might hail from northeastern Pennsylvania,
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我不知這裡是否有人來自賓州東北部，
02:59
but this is where I spent my first 19 years
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但這是我人生最初19年所待的地方，
03:02
with my little young lungs.
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那時我的肺還很年輕。
03:04
You know, breathing high concentrations here
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我在這裡吞吐高濃度的廢氣，
03:07
of sulfur dioxide, carbon dioxide
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包括二氧化硫,二氧化碳，
03:09
and methane gas,
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以及甲烷，
03:11
in unequal quantities -- 19 years of this.
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每一種廢氣量都不是很平均，但我吸足了19年。
03:14
And if you've been in that part of the country,
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如果你也待過那個地方，
03:16
this is what those piles of burning, smoldering coal waste look like.
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這就是那堆燃燒、悶燒的煤灰廢棄物的樣子。
03:20
So then I decided to leave that part of the world,
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所以,我決定離開那個世界。
03:23
and I was going to go to the mid-west.
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我當時正想去中西部，
03:26
OK, so I ended up in Louisville, Kentucky.
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因此,我在肯塔基州的路易維爾落腳。
03:29
Well, I decided to be neighbors to a place called Rubbertown.
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我住在鄰近一個叫羅柏鎮的地方，
03:33
They manufacture plastics. They use large quantities chloroprene
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那裡生產塑膠,大量使用氯丁二烯，
03:36
and benzene.
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還有苯。
03:38
Okay, I spent 25 years, in my middle-age lungs now,
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然後,我和我中年的肺在這住了25年，
03:43
breathing various concentrations of that.
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每天呼吸那些各式各樣的高濃度化學物質。
03:46
And on a clear day it always looked like this, so you never saw it.
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天晴的日子,看起來總是這樣,因此你從沒發現。
03:50
It was insidious and it was really happening.
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你看不見這些風險,但他們卻無所不在。
03:53
Then I decided I had to get really smart,
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接著我認為自己應該學聰明點，
03:55
I would take this job in the West Coast.
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我應該接下這個西岸的工作。
03:58
And I moved to Redlands California.
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然後我搬到加州瑞得蘭市，
04:01
Very nice, and there
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那裡好極了，
04:03
my older, senior lungs, as I like to call them,
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我那年紀大的肺,我總愛這麼稱呼他，
04:07
I filled with particulate matter, carbon dioxide and very high doses of ozone.
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現在充滿了微粒分子,二氧化碳,以及高濃度的臭氧，
04:13
Okay? Almost like the highest in the nation.
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你知道嗎?幾乎是全國濃度最高的。
04:15
Alright, this is what it looks like on a good day.
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這是那裡天氣好的樣子，
04:17
If you've been there, you know what I'm talking about.
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如果你去過那裡,你就知道我的意思。
04:20
So, what's wrong with this picture?
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所以,這張圖有什麼問題?
04:23
Well, the picture is, there is a huge gap here.
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其實,這張圖還遺漏了一個重點。
04:25
The one thing that never happens in my doctor's office:
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在我的醫生的辦公室裡,有件事從沒發生過，
04:29
They never ask me about my place history.
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他們從不過問我的"居住史"。
04:32
No doctor, can I remember, ever asking me,
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沒有一個醫生,在我的記憶裡,曾經問過我：
04:35
"Where have you lived?"
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"你住過哪裡?"
04:37
They haven't asked me what kind of the quality
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他們從沒問過我關於
04:39
of the drinking water that I put in my mouth
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我所飲用的水的品質，
04:41
or the food that I ingest into my stomach.
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或是我吃的食物的品質。
04:45
They really don't do that. It's missing.
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他們從不過問,這些被遺漏了。
04:48
Look at the kind of data that's available.
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看看眼前這些資料，
04:51
This data's from all over the world --
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這些數據來自全世界--
04:53
countries spend billions of dollars investing in this kind of research.
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各國花了好幾十億美金投入這項研究。
04:57
Now, I've circled the places where I've been.
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現在,我圈出了我曾待過的地方，
05:00
Well, by design, if I wanted to have a heart attack
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簡直像計算好的一樣,如果我想得心臟病，
05:03
I'd been in the right places. Right?
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我都待在了正確的地方,是吧?
05:08
So, how many people are in the white?
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那麼,有多少人住在白色的區域裡?
05:10
How many people in the room have spent the majority of their life
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這個房間裡,有多少人花了大半輩子
05:12
in the white space?
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待在白色的區域裡呢?
05:15
Anybody? Boy you're lucky.
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有人嗎?你們真幸運。
05:17
How many have spent it in the red places?
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有多少人住過紅色的區域呢?
05:20
Oh, not so lucky.
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喔,你們沒那麼幸運。
05:22
There are thousands of these kinds of maps
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像這樣的地圖有上千份，
05:25
that are displayed in atlases
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他們被收錄在地圖集裡，
05:27
all over the world.
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全世界都有。
05:29
They give us some sense of what's going
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這些地圖讓我們知道，
05:31
to be our train wreck.
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撞倒我們的火車可能會是什麼。
05:34
But none of that's in my medical record.
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但這些都不包含在我的醫療記錄裡，
05:36
And it's not in yours either.
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也不在你們的記錄裡。
05:38
So, here's my friend Paul.
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所以,現在來看我的朋友保羅。
05:40
He's a colleague. He allowed his cell phone to be tracked
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他是我的同僚,他同意讓我們追蹤他的手機位址，
05:44
every two hours, 24/7,
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每兩小時追蹤一次,每天24小時,每週7天，
05:47
365 days out of the year
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一年365天全程追蹤。
05:49
for the last two years, everywhere he went.
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過去兩年內,我們把他的所到之處都記錄了下來。
05:52
And you can see he's been to a few places around the United States.
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就像你看到的,他去過美國幾個地方，
05:56
And this is where he has spent most of his time.
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而這裡是他花最多時間待的地方。
06:00
If you really studied that you might have some clues
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如果你仔細觀察,你可能會有些頭緒，
06:03
as to what Paul likes to do.
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發現保羅喜歡從事什麼活動。
06:06
Anybody got any clues? Ski. Right.
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有人發現了什麼嗎?沒錯,是滑雪。
06:09
We can zoom in here, and we suddenly see
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我們把畫面拉近一點,就可以看到
06:12
that now we see where Paul has really spent a majority of his time.
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保羅大部份時間所待的地方。
06:16
And all of those black dots are all of the
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而這些黑點的地方，
06:20
toxic release inventories
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全都是有毒廢棄物的存放地點，
06:22
that are monitored by the EPA.
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這些地點由美國環保局監測。
06:24
Did you know that data existed?
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你知道這些數據的存在嗎?
06:27
For every community in the United States,
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美國的每個社區都有這些資料，
06:29
you could have your own personalized map of that.
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你可以擁有像那樣的個人化地圖。
06:33
So, our cell phones can now build a place history.
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所以,手機可以替我們建立居住史，
06:36
This is how Paul did it. He did it with his iPhone.
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就如同保羅的做法,他用他的iPhone做到了。
06:39
This might be what we end up with.
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這是我們最後會得到的結果，
06:41
This is what the physician would have
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這份資訊也會在我們進入診間時，
06:44
in front of him and her when we enter that exam room
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被放在醫生的面前，
06:47
instead of just the pink slip that said I paid at the counter. Right?
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而不是只有一張要我在櫃台付帳的粉紅色單據,對吧?
06:51
This could be my little assessment.
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以下可能是醫生對我的一點小評估，
06:53
And he looks at that and he says,
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他會看這些資料,然後說：
06:55
"Whoa Bill,
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"喔,比爾，
06:57
I suggest that maybe you not decide,
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我建議你不該這麼做，
07:00
just because you're out here in beautiful California,
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不能因為你在美麗的加州,
07:02
and it's warm every day,
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每天天氣暖和,
07:04
that you get out and run at six o'clock at night.
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就晚上六點出門跑步，
07:07
I'd suggest that that's a bad idea Bill,
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我得說那不是個好主意,比爾,
07:10
because of this report."
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這份報告說得夠清楚了。"
07:13
What I'd like to leave you for are two prescriptions.
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我想要留給你們兩份處方，
07:17
Okay, number one is, we must teach physicians
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好的,首先,我們必須教導醫生，
07:19
about the value of geographical information.
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讓他們重視地理資訊的價值，
07:23
It's called geomedicine. There are about a half a dozen programs in the world right now
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這稱為地理醫學,世界上約有6個計畫，
07:27
that are focused on this.
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正針對這個主題進行研究，
07:29
And they're in the early stages of development.
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他們還處於早期發展階段，
07:32
These programs need to be supported,
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需要各界的支持。
07:35
and we need to teach our future
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我們必須教育
07:37
doctors of the world
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未來世界上的醫生，
07:39
the importance of some of the information
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這些資訊的重要性，
07:41
I've shared here with you today.
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這些我今天都告訴你們了。
07:43
The second thing we need to do
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我們要做的第二件事情，
07:45
is while we're spending billions and billions
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是當我們花了好幾十億美金，
07:47
of dollars all over the world
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在全世界
07:50
building an electronic health record,
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建立電子醫療紀錄的時候，
07:52
we make sure we put a place history
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我們要確定有把居住史
07:54
inside that medical record.
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列入那份醫療紀錄中。
07:57
It not only will be important for the physician;
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這不只對醫生的診療很重要，
08:00
it will be important for the researchers
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對研究人員也很重要，
08:02
that now will have huge samples to draw upon.
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因為他們將有大量可供參考的樣本。
08:06
But it will also be useful for us.
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不過,這對我們也很實用，
08:08
I could have made the decision, if I had this information,
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因為如果我以前有這些資料,我可能會決定
08:12
not to move to the ozone capital
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不搬到美國的臭氧首府，
08:15
of the United States, couldn't I? I could make that decision.
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不是嗎?我可能會那麼決定。
08:18
Or I could negotiate with my employer
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或者我會和我的雇主協調，
08:20
to make that decision
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以做出那樣的決定，
08:22
in the best interest of myself and my company.
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並取得我和公司間的最大利益。
08:28
With that, I would like to just say that Jack Lord said
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因此,我想要說Jack Lord說過的話(地理是醫學的命運主宰)
08:31
this almost 10 years ago.
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這是他將近十年前所說的話。
08:34
Just look at that for a minute.
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再多看一眼，
08:36
That was what the conclusion
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這就是
08:38
of the Dartmouth Atlas of Healthcare was about,
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Dartmouth Atlas保健計畫的結論，
08:41
was saying that we can explain the geographic variations
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就是說,我們可以解釋不同的地理環境
08:44
that occur in disease, in illness, in wellness,
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和疾病、病痛、健康間的關係，
08:48
and how our healthcare system actually operates.
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以及它對於我們醫療系統實際運作的影響。
08:51
That was what he was talking about
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那正是他所說的
08:53
on that quote.
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那句話的含意。
08:55
And I would say he got it right almost a decade ago.
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而我必須說,他在約十年前就瞭解了這一點，
08:59
So, I'd very much like to see us begin to
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因此,我很樂意看到大家開始
09:01
really seize this as an opportunity to get this into our medical records.
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真正地把握這次機會，把居住史加入我們的醫療紀錄中。
09:05
So with that, I'll leave you that
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所以,我最後要告訴你們的，
09:07
in my particular view of view of health:
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是我自己對於健康的一個特別的觀點：
09:11
Geography always matters.
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地理永遠都很重要，
09:13
And I believe that geographic information
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而我相信地理資訊，
09:15
can make both you and me very healthy. Thank you.
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能讓你我都健健康康,謝謝。
09:17
(Applause)
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(掌聲)
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