A smarter, more precise way to think about public health | Sue Desmond-Hellmann

Prevodilac: Ivana Krivokuća Lektor: Tijana Mihajlović

OK, first, some introductions.

U redu, najpre, malo uvoda.

My mom, Jennie, took this picture.

Moja mama, Dženi, je uslikala ovu sliku.

That's my dad, Frank, in the middle.

To je moj tata, Frenk, u sredini.

And on his left, my sisters:

Sa njegove leve strane su moje sestre:

Mary Catherine, Judith Ann, Theresa Marie.

Meri Ketrin, Džudit En i Tereza Mari.

John Patrick's sitting on his lap and Kevin Michael's on his right.

Džon Patrik sedi u njegovom krilu, a Kevin Majkl je desno od njega.

And in the pale-blue windbreaker,

A u svetlo plavoj vetrovci,

Susan Diane. Me.

Suzan Dajana. Ja.

I loved growing up in a big family.

Volela sam odrastanje u velikoj porodici.

And one of my favorite things was picking names.

Jedna od omiljenih stvari bila mi je biranje imena.

But by the time child number seven came along,

Međutim, do trenutka kada je došlo sedmo dete,

we had nearly run out of middle names.

gotovo da nam je ponestalo srednjih imena.

Dugo je trajalo razmatranje

It was a long deliberation

before we finally settled on Jennifer Bridget.

dok se nismo konačno složili oko Dženifer Bridžet.

Every parent in this audience

Svakom roditelju u ovoj publici

knows the joy and excitement

poznata je radost i uzbuđenje

of picking a new baby's name.

odabira imena za novorođenu bebu.

And I was excited and thrilled

Bila sam uzbuđena i ushićena

to help my mom in that special ceremonial moment.

što pomažem mami u tom posebnom svečanom momentu.

But it's not like that everywhere.

Ipak, nije tako svuda.

I travel a lot and I see a lot.

Mnogo putujem i vidim dosta toga.

But it took me by surprise to learn

Iznenadilo me je saznanje

in an area of Ethiopia,

da u oblasti Etiopije

parents delay picking the names for their new babies

roditelji odlažu biranje imena za svoje novorođene bebe

by a month or more.

mesec dana ili više.

Why delay?

Zašto odlagati?

Why not take advantage of this special ceremonial time?

Zašto ne iskoristiti ovaj poseban svečani trenutak?

Well, they delay because they're afraid.

Pa, odlažu jer se boje.

They're afraid their baby will die.

Boje se da će njihova beba umreti,

And this loss might be a little more bearable without a name.

a taj gubitak bi mogao biti malo podnošljiviji bez imena.

A face without a name might help them feel

Lice bez imena moglo bi pomoći da se osete

just a little less attached.

malčice manje vezano.

Dakle, evo nas u jednom delu sveta -

So here we are in one part of the world --

a time of joy, excitement, dreaming of the future of that child --

vreme radosti, uzbuđenja, sanjarenja o budućnosti deteta -

while in another world,

dok su u drugom svetu

parents are filled with dread,

roditelji ispunjeni strahom

not daring to dream of a future for their child

i ne usuđuju se da sanjaju o budućnosti svog deteta

beyond a few precious weeks.

izvan nekoliko dragocenih nedelja.

How can that be?

Kako to?

How can it be that 2.6 million babies

Kako to da 2,6 miliona beba

die around the world

širom sveta umre

before they're even one month old?

čak i pre nego što napune mesec dana;

2.6 million.

2,6 miliona.

That's the population of Vancouver.

To je stanovništvo Vankuvera.

And the shocking thing is:

Šokantno je to što -

Why?

zašto?

In too many cases, we simply don't know.

U previše slučajeva, jednostavno ne znamo.

Now, I remember recently seeing an updated pie chart.

Sećam se da sam nedavno videla ažurirani kružni grafikon.

And the pie chart was labeled,

Taj kružni grafikon je imao naziv

"Causes of death in children under five worldwide."

„Uzroci smrti dece ispod pet godina širom sveta.“

And there was a pretty big section of that pie chart, about 40 percent --

Tu je bio prilično veliki deo kružnog grafikona, oko 40 procenata -

40 percent was labeled "neonatal."

40 procenata je označeno kao „neonatalni“.

Now, "neonatal" is not a cause of death.

„Neonatalni“ nije uzrok smrti.

Neonatal is simply an adjective,

Neonatalni je jednostavno pridev,

an adjective that means that the child is less than one month old.

pridev koji znači da je dete ima manje od mesec dana.

For me, "neonatal" said: "We have no idea."

Za mene, „neonatalni“ govori: „Nemamo pojma.“

Now, I'm a scientist. I'm a doctor.

E, sad, ja sam naučnik. Ja sam doktor.

I want to fix things.

Želim da popravim stvari.

But you can't fix what you can't define.

Međutim, ne možete popraviti ono što ne možete definisati.

So our first step in restoring the dreams of those parents

Stoga naš prvi korak u obnavljanju snova tih roditelja

is to answer the question:

predstavlja nalaženje odgovora na pitanje

Why are babies dying?

zašto bebe umiru.

So today, I want to talk about a new approach,

Zato danas želim da govorim o novom pristupu,

an approach that I feel

o pristupu za koji smatram

will not only help us know why babies are dying,

da će nam ne samo pomoći da saznamo zašto bebe umiru,

but is beginning to completely transform

već koji počinje da potpuno transformiše

the whole field of global health.

čitavo polje globalnog zdravlja.

It's called "Precision Public Health."

Naziva se „precizno javno zdravlje“.

For me, precision medicine comes from a very special place.

Za mene, precizna medicina proističe sa vrlo posebnog mesta.

I trained as a cancer doctor, an oncologist.

Obrazovala sam se kao lekar za rak, onkolog.

I got into it because I wanted to help people feel better.

Ušla sam u to jer sam želela da pomognem da ljudima bude bolje.

But too often my treatments made them feel worse.

Međutim, previše često im je od mojih tretmana bilo lošije.

I still remember young women being driven to my clinic

Još se sećam mladih žena koje su dovozile u moju kliniku

by their moms --

njihove mame,

adults, who had to be helped into my exam room by their mothers.

odraslih osoba kojima su majke morale da pomažu da dođu do moje ordinacije.

They were so weak

Bile su tako slabe

from the treatment I had given them.

od lečenja koje sam im pružila.

But at the time, in those front lines in the war on cancer,

U to vreme, u tim prvim redovima u ratu protiv raka,

we had few tools.

imali smo nekoliko sredstava.

And the tools we did have couldn't differentiate

Sredstva koja smo imali nisu mogla da razlikuju

between the cancer cells that we wanted to hit hard

ćelije raka koje smo hteli da žestoko napadnemo

and those healthy cells that we wanted to preserve.

od zdravih ćelija koje smo hteli da sačuvamo.

And so the side effects that you're all very familiar with --

Zato su nas nuspojave sa kojima ste svi upoznati -

hair loss, being sick to your stomach,

gubitak kose, mučnine,

having a suppressed immune system, so infection was a constant threat --

potisnut imuni sistem, tako da postoji stalna pretnja od infekcije -

were always surrounding us.

uvek okruživale.

And then I moved to the biotechnology industry.

Zatim sam prešla u industriju biotehnologije.

And I got to work on a new approach for breast cancer patients

Dobila sam da radim na novom pristupu za pacijente sa rakom dojke

that could do a better job of telling the healthy cells

koji bi mogao da bolje razlikuje

zdrave ćelije od nezdravih ćelija ili ćelija raka.

from the unhealthy or cancer cells.

It's a drug called Herceptin.

To je lek pod imenom Herceptin.

And what Herceptin allowed us to do

Herceptin nam je omogućio

is to precisely target HER2-positive breast cancer,

da precizno naciljamo HER2 pozitivni rak dojke,

at the time, the scariest form of breast cancer.

što je u to vreme bila najstrašnija vrsta raka dojke.

And that precision let us hit hard the cancer cells,

Ta preciznost nam je dozvolila da žestoko napadnemo ćelije raka,

while sparing and being more gentle on the normal cells.

dok štedimo normalne ćelije i nežniji smo prema njima.

A huge breakthrough.

Ogromno otkriće.

It felt like a miracle,

Činilo se kao čudo,

so much so that today,

toliko da danas

we're harnessing all those tools --

koristimo sva ta sredstva -

big data, consumer monitoring, gene sequencing and more --

velike podatke, praćenje potrošača, sekvenciranje gena i više od toga -

to tackle a broad variety of diseases.

da bismo se bavili širokim spektrom bolesti.

That's allowing us to target individuals

To nam omogućava da ka pojedincima usmerimo

with the right remedies at the right time.

prave lekove u pravo vreme.

Precision medicine revolutionized cancer therapy.

Precizna medicina je napravila revoluciju u lečenju raka.

Everything changed.

Sve se promenilo

And I want everything to change again.

i želim da se sve promeni ponovo.

So I've been asking myself:

Stoga sam sebi postavila pitanje:

Why should we limit

„Zašto bismo ograničili

this smarter, more precise, better way to tackle diseases

taj pametniji, precizniji i bolji način za bavljenje bolestima

na bogati svet?“

to the rich world?

Now, don't misunderstand me --

Nemojte me pogrešno razumeti -

I'm not talking about bringing expensive medicines like Herceptin

ne govorim o donošenju skupih lekova kao što je Herceptin

to the developing world,

u zemlje u razvoju,

although I'd actually kind of like that.

mada bih zapravo to i volela.

What I am talking about

Ono o čemu govorim je premeštanje

is moving from this precise targeting for individuals

sa ovog preciznog ciljanja za pojedince

to tackle public health problems

da bismo se pozabavili problemima javnog zdravlja

in populations.

u populacijama.

Now, OK, I know probably you're thinking, "She's crazy.

U redu, znam da verovatno mislite:

„Ona je luda. To ne može. To je suviše ambiciozno.“

You can't do that. That's too ambitious."

But here's the thing:

Međutim, evo u čemu je stvar:

we're already doing this in a limited way,

to već radimo na ograničen način

and it's already starting to make a big difference.

i to već ostavlja veliki trag.

So here's what's happening.

Evo šta se dešava.

Now, I told you I trained as a cancer doctor.

Rekla sam vam da sam obučena kao doktor za rak.

But like many, many doctors who trained in San Francisco in the '80s,

Međutim, kao i mnogi doktori obrazovani u San Francisku '80-ih godina,

I also trained as an AIDS doctor.

takođe sam obučena kao doktor za sidu.

It was a terrible time.

Bilo je to užasno vreme.

AIDS was a death sentence.

Sida je bila smrtna presuda.

All my patients died.

Svi moji pacijenti su umrli.

Now, things are better,

Sada su stvari bolje,

but HIV/AIDS remains a terrible global challenge.

ali sida ostaje užasan globalni izazov.

Worldwide, about 17 million women are living with HIV.

Širom sveta, oko 17 miliona žena živi sa HIV virusom.

We know that when these women become pregnant,

Znamo da, kada te žene zatrudne,

they can transfer the virus to their baby.

mogu da prenesu virus na svoju bebu.

We also know in the absence of therapy,

Takođe znamo da, u odsustvu terapije,

half those babies will not survive until the age of two.

polovina tih beba neće doživeti uzrast od dve godine.

But we know that antiretroviral therapy can virtually guarantee

No, znamo da antiretrovirusna terapija može praktično da garantuje

that she will not transmit the virus to the baby.

da neće preneti virus na bebu.

So what do we do?

Pa, šta radimo?

Well, a one-size-fits-all approach, kind of like that blast of chemo,

Pa, pristup koji bi odgovarao svima, nekako poput tog udara hemoterapije,

would mean we test and treat every pregnant woman in the world.

značio bi da testiramo i lečimo svaku trudnicu na svetu.

That would do the job.

To bi obavilo posao.

But it's just not practical.

Međutim, to jednostavno nije praktično.

So instead, we target those areas where HIV rates are the highest.

Umesto toga, možemo ciljati one oblasti gde su stope HIV virusa najviše.

We know in certain countries in sub-Saharan Africa

Znamo da u određenim zemljama u Podsaharskoj Africi

we can test and treat pregnant women where rates are highest.

možemo testirati i lečiti trudnice, gde su stope najviše.

This precision approach to a public health problem

Ovaj precizni pristup problemu javnog zdravlja

has cut by nearly half

skoro upola je smanjio

HIV transmission from mothers to baby

prenošenje HIV virusa sa majki na bebu

in the last five years.

u poslednjih pet godina.

(Applause)

(Aplauz)

Screening pregnant women in certain areas in the developing world

Pregledi trudnih žena u određenim oblastima zemalja u razvoju

is a powerful example

predstavljaju snažan primer

of how precision public health can change things on a big scale.

toga kako precizno javno zdravlje može da promeni stvari na širokom planu.

So ...

Dakle...

How do we do that?

Kako to da uradimo?

We can do that because we know.

Možemo to da uradimo jer znamo.

We know who to target,

Znamo koga da ciljamo,

what to target,

šta da ciljamo,

where to target and how to target.

gde da ciljamo i kako da ciljamo.

And that, for me, are the important elements of precision public health:

To su, za mene, važni elementi preciznog javnog zdravlja:

who, what, where and how.

ko, šta, gde i kako.

But let's go back to the 2.6 million babies

No, vratimo se na 2,6 miliona beba

who die before they're one month old.

koje umru pre nego što napune mesec dana.

Here's the problem: we just don't know.

Evo u čemu je problem - jednostavno ne znamo.

It may seem unbelievable,

Može delovati neverovatno,

but the way we figure out the causes of infant mortality

ali način na koji otkrivamo uzroke mortaliteta novorođenčadi

in those countries with the highest infant mortality

u tim zemljama sa najvećim mortalitetom novorođenčadi

is a conversation with mom.

je kroz razgovor sa majkom.

A health worker asks a mom who has just lost her child,

Zdravstveni radnik pita mamu koja je upravo izgubila dete:

"Was the baby vomiting? Did they have a fever?"

„Da li je beba povraćala? Da li je imala temperaturu?“

And that conversation may take place

A taj razgovor se može odvijati

as long as three months after the baby has died.

čak i tri meseca nakon što je beba umrla.

Now, put yourself in the shoes of that mom.

Stavite se sada u položaj te mame.

It's a heartbreaking, excruciating conversation.

To je uznemirujući, bolan razgovor.

And even worse -- it's not that helpful,

Što je još gore - nije baš od naročite pomoći,

because we might know there was a fever or vomiting,

jer možemo znati da je bilo temperature ili povraćanja,

but we don't know why.

ali ne znamo zašto.

So in the absence of knowing that knowledge,

U odsustvu saznanja o tome,

we cannot prevent that mom, that family,

ne možemo sprečiti da ta majka, ta porodica,

or other families in that community

ili druge porodice u toj zajednici

from suffering the same tragedy.

pretrpe istu tragediju.

But what if we applied a precision public health approach?

Međutim, šta ako bismo primenili pristup preciznog javnog zdravlja?

Let's say, for example,

Recimo, na primer,

we find out in certain areas of Africa

da otkrijemo da u određenim oblastima u Africi

that babies are dying because of a bacterial infection

bebe umiru zbog bakterijske infekcije

transferred from the mother to the baby,

koja se prenosi sa majke na bebu,

known as Group B streptococcus.

poznate kao streptokoke grupe B.

In the absence of treatment, mom has a seven times higher chance

U odsustvu lečenja, mama ima sedam puta veće izglede

that her next baby will die.

da će njena sledeća beba umreti.

Once we define the problem, we can prevent that death

Jednom kada definišemo problem, možemo sprečiti tu smrt

with something as cheap and safe as penicillin.

nečim jeftinim i bezbednim poput penicilina.

We can do that because then we'll know.

Možemo to da uradimo jer tada znamo.

And that's the point:

U tome je poenta -

once we know, we can bring the right interventions

kada saznamo, možemo doneti prave intervencije

to the right population in the right places

u pravu populaciju na prava mesta

to save lives.

da bismo spasili živote.

With this approach, and with these interventions

Ovim pristupom, ovim intervencijama

and others like them,

i drugim poput njih,

I have no doubt

ne sumnjam

that a precision public health approach

da pristup preciznog javnog zdravlja

can help our world achieve our 15-year goal.

može pomoći da naš svet ostvari naš petnaestogodišnji cilj.

And that would translate into a million babies' lives saved

To se pretvara u milion spasenih života beba

every single year.

svake godine.

One million babies every single year.

Milion beba svake godine.

And why would we stop there?

Zašto bismo tu stali?

A much more powerful approach to public health --

Mnogo snažniji pristup javnom zdravlju -

imagine what might be possible.

zamislite šta bi moglo biti moguće.

Why couldn't we more effectively tackle malnutrition?

Zašto se ne bismo efikasnije bavili neuhranjenošću?

Why wouldn't we prevent cervical cancer in women?

Zašto ne bismo sprečili rak grlića materice kod žena?

And why not eradicate malaria?

Zašto da ne iskorenimo malariju?

(Applause)

(Aplauz)

Yes, clap for that!

Da, aplaudirajte tome!

(Applause)

(Aplauz)

So, you know, I live in two different worlds,

Znate, ja živim u dva različita sveta.

one world populated by scientists,

Jedan svet nastanjuju naučnici,

and another world populated by public health professionals.

a drugi svet nastanjuju profesionalci u oblasti javnog zdravlja.

The promise of precision public health

Obećanje preciznog javnog zdravlja

is to bring these two worlds together.

je da se spoje ta dva sveta.

But you know, we all live in two worlds:

Međutim, znate, svi živimo u dva sveta -

the rich world and the poor world.

bogatom i siromašnom svetu.

And what I'm most excited about about precision public health

Ono zbog čega sam najviše uzbuđena u vezi sa preciznim javnim zdravljem

is bridging these two worlds.

je povezivanje ta dva sveta.

Every day in the rich world,

Svakoga dana u bogatom svetu

we're bringing incredible talent and tools --

donosimo neverovatne talente i sredstva -

everything at our disposal --

sve što nam je na raspolaganju -

to precisely target diseases in ways I never imagined

da bismo precizno naciljali bolesti na načine za koje nikada nisam mislila

would be possible.

da će biti mogući.

Surely, we can tap into that kind of talent and tools

Svakako, možemo da iskoristimo takve talente i sredstva

to stop babies dying in the poor world.

da zaustavimo umiranje beba u siromašom svetu.

If we did,

Ako bismo to učinili,

then every parent would have the confidence

tada bi svaki roditelj imao pouzdanje

to name their child the moment that child is born,

da dȃ ime svom detetu onog trenutka kada se to dete rodi,

daring to dream that that child's life will be measured in decades,

usuđujući se da sanja o tome da će se život tog deteta

meriti decenijama, a ne danima.

not days.

Thank you.

Hvala.

(Applause)

(Aplauz)