TEDTalks2010---Bill Davenhall：健康本于环境

Bill Davenhall :Your health depends on where you live

Can geographic information make you healthy? In 2001 I got hit by a train. My train was a heart attack. I found myself in a hospital in an intensive-care ward, recuperating from emergency surgery. And I suddenly realized something: that I was completely in the dark. I started asking my questions, "Well, why me?" "Why now?" "Why here?" "Could my doctor have warned me?"


So, what I want to do here in the few minutes I have with you is really talk about what is the formula for life, and good health. Genetics, lifestyle and environment. That's going to sort of contain our risks, and if we manage those risks we're going to live a good life, and a good healthy life. Well, I understand the genetics and lifestyle part. And you know why I understand that? Because my physicians constantly ask me questions about this.


Have you ever had to fill out those long, legal-size forms in your doctor's office? I mean, if you're lucky enough you get to do it more than once, right? (Laughter) Do it over and over again. And they ask you questions about your lifestyle and your family history, your medication history, your surgical history, your allergy history ... did I forget any history?


But this part of the equation I didn't really get. And I don't think my physicians really get this part of the equation. What does that mean, my environment? Well, it can mean a lot of things. This is my life. These are my life places. We all have these. While I'm talking I'd like you to also be thinking about how many places have you lived?


Just think about that, you know, wander through your life thinking about this. And you realize that you spend it in a variety of different places. You spend it at rest and you spend it at work. And if you're like me, you're in an airplane a good portion of your time traveling some place. So, it's not really simple when somebody asks you, "Where do you live, where do you work, and where do you spend all your time? And where do you expose yourselves to risks that maybe perhaps you don't even see?" Well, when I have done this on myself, I always come to the conclusion that I spend about 75 percent of my time relatively in a small number of places. And I don't wander far from that place for a majority of my time, even though I'm an extensive global trekker.


Now, I'm going to take you on a little journey here. I started off in Scranton Pennsylvania. I don't know if anybody might hail from northeastern Pennsylvania. But this is where I spent my first 19 years with my little young lungs. You know, breathing high concentrations here of sulfur dioxide, carbon dioxide and methane gas, in unequal quantities -- 19 years of this. And if you've been in that part of the country, this is what those piles of burning, smoldering coal waste look like.


So, then I decided to leave that part of the world. And I was going to go to the mid-west. Okay, so, I ended up in Louisville Kentucky. Well, I decided to be neighbors to a place called Rubbertown. They manufacture plastics. They use large quantities chloroprene and benzene. Okay, I spent 25 years, in my middle-age lungs now, breathing various concentrations of that. And on a clear day it always looked like this, so you never saw it. It was insidious and it was really happening.


And then I decided I had to get really smart, I would take this job in the west coast. And I moved to Redlands California. Very nice, and there my older, senior lungs, as I like to call them, I filled with particulate matter, carbon dioxide, and very high does of ozone. Okay? Almost like the highest in the nation. Alright, this is what it looks like on a good day. If you've been there, you know what I'm talking about.


So, what's wrong with this picture? Well, the picture is, there is a huge gap here. The one thing that never happens in my doctor's office: They never ask me about my place history. No doctor, can I remember, ever asking me, "Where have you lived?" They haven't asked me what kind of the quality of the drinking water that I put in my mouth, or the food that I ingest into my stomach. They really don't do that. It's missing. Look at the kind of data that is available. This data is from all over the world -- countries spend billions of dollars investing in this kind of research.


Now, I've circled the places where I've been. Well, by design, if I wanted to have a heart attack I'd been in the right places. Right? So, how many people are in the white? How many people in the room have spent the majority of their life in the white space? Anybody? Boy you're lucky. How many have spent it in the red places? Oh, not so lucky. There are thousands of these kinds of maps that are displayed in atlases all over the world. They give us some sense of what's going to be our train wreck. But none of that is in my medical record. And it's not in yours either.


So, here is my friend Paul. He's a colleague. He allowed his cell phone to be tracked every two hours, 24/7, 365 days out of the year, for the last two years, everywhere he went. And you can see he's been to a few places around the United States. And this is where he has spent most of his time. If you really studied that you might have some clues as to what Paul likes to do. Anybody got any clues? Skiing. Right. We can zoom in here, and we suddenly see that now we see where Paul has really spent a majority of his time. And all of those black dots are all of the toxic release inventories that are monitored by the EPA.


Did you know that data existed? For every community in the United States, you could have your own personalized map of that. So, our cellphones can now build a place history. This is how Paul did it. He did it with his iPhone. This might be what we end up with.


This is what the physician would have in front of him and her when we enter that exam room instead of just the pink slip that said I paid at the counter. Right? This could be my little assessment. And he looks at that and he says, "Whoa Bill, I suggest that maybe you not decide, just because you're out here in beautiful California, and it's warm every day that you get out and run at six o'clock at night. I'd suggest that that's a bad idea Bill, because of this report."


What I'd like to leave you for are two prescriptions. Okay, number one is, we must teach physicians about the value of geographical information. It's called geomedicine. There are about a half a dozen programs in the world right now that are focused on this. And they're in the early stages of development. These programs need to be supported. And we need to teach our future doctors of the world the importance of some of the information I've shared here with you today.


The second thing we need to do is while we're spending billions and billions of dollars all over the world building an electronic health record, we make sure we put a place history inside that medical record. It not only will be important for the physician; it will be important for the researchers that now will have huge samples to draw upon. But it will also be useful for us. I could have made the decision, if I had this information not to move to the ozone capital of the United States. Couldn't I? I could make that decision. Or I could negotiate with my employer to make that decision in the best interest of myself and my company.

With that, I would like to just say that Jack Lord said this almost 10 years ago. Just look at that for a minute. That was what the conclusion of the Dartmouth Atlas of Healthcare was about, with saying that we can explain the geographic variations that occur in disease, in illness, in wellness, and how our healthcare system actually operates. That was what he was talking about on that quote. And I would say he got it right almost a decade ago. So, I'd very much like to see us begin to really seize this as an opportunity to get this into our medical records. So, with that I'll leave you that in my particular view of view of health, geography always matters. And I believe that geographic information can make both you and me very healthy. Thank you. (Applause)




Bill Davenhall談健康取決於你居住的地方


地理資訊能夠讓你保持健康嗎？2001年時，我被火車撞了；撞我的火車是心臟病。我發現自己在醫院的加護病房中，剛進行完緊急手術。我突然意識到某些事情：我完全在黑暗中，一片茫然。我開始問一些問題，「為什麼是我？為什麼是現在？為什麼在這裡？醫生不能先警告我一下嗎？」


因此，在這與你們共處的這幾分鐘內，我想做的是，確實談談關於生活、良好健康、遺傳、生活方式、和環境的公式是什麼。可以這麼說，我們要控制這些風險；如果我們管理好這些風險，就能生活美滿，並擁有良好健康。嗯，我瞭解關於遺傳和生活方式這部分，你知道我為什麼瞭解嗎？因為我的醫生不斷問我像這樣的問題。


你曾經在你醫生的辦公室中，填寫過這些冗長的、像法律文件般的表格嗎？我是指，如果你夠「幸運」，而不只一次得這樣做，對嗎？(笑聲)一遍又一遍的做。他們問你一些問題，關於你的生活方式和家族史、你的用藥史、手術史、過敏史…我還漏說了什麼嗎？


但是，我還沒有真正得到這部分的公式（環境），我也不認為我的醫生真的得到了這部分的公式。我的環境，那指的是什麼？嗯，這可以表示很多東西。這是我的生命，這是我生命中的地方，這是我們每個人都擁有的。當我在說這些時，希望你也可以思考一下，你住過多少地方？


試著想看看，你知道，讓思緒在你的生命歷程漫遊一下，想想這個問題。你會瞭解到，你將生命花在各種不同的地方；你把它花在休息、花在工作。如果你像我一樣，就會花一大部分時間在飛機上，到某些地方旅行。因此，這不是很容易，當有人問你，「你住哪兒？在哪裡工作？所有時間都花在什麼地方？你是在什麼地方將自己置於險境中？或許，甚至連自己也不知道？」當我這麼問自己時，我總是得到一個結論：就是我大約花費 75 % 的時間，在相較之下少數的幾個地方。我不會遠離那些我大部分時間所在的地方，即使我是一位足跡踏遍全球的旅者。


現在，我要帶你們做一趟小小旅程－從賓州的斯克蘭頓出發。我不知道是否有來自賓州東北部的人，但這就是我生命最初的19年，還有我「年少」的肺部所處的地方。你知道，呼吸這裡高濃度的二氧化硫、二氧化碳、和甲烷氣體，這些不等量的氣體－19年都是如此。如果你去過美國的那部份地區，這就是大量燃燒及悶燒的煤廢氣看起來的樣子。

所以，我決定離開那部分的世界，我要到中西部去。Okay，最後我到了肯塔基州的路易斯維爾。嗯，我決定在鄰近一個叫Rubbertown的地方落腳。他們生產塑膠製品，使用大量的氯丁二烯還有苯。Okay，我花了25年，用我「中年」的肺部呼吸這些不同濃度的氣體。在好天氣時，它總是看起來像這樣，所以你不會看到這些污染。這是潛伏的，但確實存在的污染。


然後，我決定必須得真正聰明點，我要接下在西岸的工作。我搬到加州的雷德蘭茲，那兒非常好。還有我老了的、年紀大了的肺，這是我一向對它的稱呼。充滿了顆粒物、二氧化碳、和非常高量的臭氧，Okay？幾乎可說是全國最高的。這就是它在好天氣時看起來的樣子。如果你曾去過那裡，你會瞭解我所說的。


那麼，這張圖有什麼問題？這張圖跟實際上有很大的差距。有件事永遠不會發生在我醫生的辦公室中：他們從來不問我曾待過地方的歷史。記憶中，沒有任何醫生曾問過我，「你曾住過哪些地方？」他們不曾問過我，我喝進嘴裡的水品質如何，或吃進胃裡的食物品質如何？他們的確沒有這麼做，這些都被遺漏了。看看這些我搜集的資料，這資料來自世界各地，許多國家花費數十億美元投資於這種研究。


現在，我圈出我曾待過的地方；像設計好的一樣，如果我想得到心臟病，我一直在最佳地點。對嗎？有多少人住在白色的地方？這演講廳中，有多少人一生大多生活在白色的地點？有任何人嗎？你是個幸運的傢伙。有多少人生活在紅色的地方？哦，你就沒有那麼幸運了。有數以千計像這樣的地圖，顯示在世界各地的地圖集中。這讓我們意識到，什麼將會成為我們的「火車事故」（比喻疾病的發生）。但這些在我的病歷中都沒有記錄，你們的病歷中也不會有。


這是我的朋友保羅，他是我的一位同事。他答應讓他的手機被追蹤，每兩個小時追蹤一次，每天24小時，每週7天，一年365天全程追蹤。在過去兩年裡，不管他去哪裡都會被追蹤。你可以看到，他在美國境內少數幾個地方活動，這是他度過大部分時間的地方。如果你確實研究一下，可能會得到一些關於保羅喜歡做什麼的線索。有人得到任何線索嗎？滑雪，沒錯。我們可以放大這裡，突然看到－現在我們看到保羅確實待了大部分時間的地方。所有這些黑點，都是毒物排釋放清冊上列的儲存地點，由美國環保局監測中。


你知道這些資料的存在嗎？對於美國的每個社區，都可以有像這樣的個人化地圖。因此，我們的手機可以建構一個地方的歷史；這就是保羅所做的，他用他的iPhone做到了。這可能是我們最終所進行的方向。


這就是在我們進入檢查室時候，醫生面前會有的資料，而不只是張粉紅單據，寫著要我在櫃檯付帳，對嗎？對我的小小評估可能像這樣：醫生看著那個說：「喔，比爾，我建議，也許你不該這麼做…僅因為你是在這美麗的加州，每天氣候都很溫暖，你就在晚上六點出去跑步。我建議你，這樣做不太好，比爾，因為這份報告上寫的」。

我想留給你們的是兩份處方。Okay，第一個是，我們必需教導醫生關於地理資訊的價值，這就是所謂的「地理醫學」。目前世界上大約有六個計畫著眼於這一方面，它們還在早期發展階段，我們必需支援這些計畫，我們必需教育全世界未來的醫生，關於這些資訊的重要性，就是我今天在此與你們分享的這些。


我們需要做的第二件事，就是當我們花費數十億又數十億美元，在世界各地建立電子健康記錄，我們要確保把地方環境的歷史，放入這些醫療記錄中。它不僅對醫生是重要的，對研究人員也是重要的。這將使我們有大量的樣本可以利用，它也將對我們大有益處。如果我有這種資料，早就可以決定不要搬到美國的臭氧之都，不是嗎？我可以作出這樣的決定。或者我可以與我的雇主商量，來作出那樣的決定－在對我和我公司都最有利的情況下。


因此，我想要說的是，Jack Lord曾說過，這幾乎是10年前的事了，看看這句話，只要一下：（「地理是醫學的命運主宰」－醫學博士Jack Lord）；這就是結論，也是Dartmouth Atlas保健計畫正進行的部份。就是說，我們可以解釋地理變異，它存在於病痛、疾病、健康、以及我們保健系統的實際運作之中；這就是括弧中他所說的意思。他在將近十年前就正確瞭解到這一點。所以，我非常希望看到我們能真正抓住這個契機，在我們的醫療記錄加入地理資訊。因此，我將留給你們我對健康的獨特觀點：地理永遠都是很重要的。我相信這樣的地理資訊，將可使我們都非常健康。謝謝(掌聲)


翻譯：洪曉慧


編輯：劉契良


簡繁轉換：陳盈


後製：洪曉慧


字幕影片後制：謝旻均