Gary Slutkin: Let's treat violence like a contagious disease

翻译人员: lin piao 校对人员: Tina Zhao

I'm a physician trained in infectious diseases,

我是一名治疗传染性疾病的医生。

and following my training,

学业结束以后，

I moved to Somalia

我从旧金山

from San Francisco.

去了索马里。

And my goodbye greeting

当时旧金山综合医院

from the chief of infectious diseases

传染科主任

at San Francisco General was,

送给我的离别致辞是

"Gary, this is the biggest mistake you'll ever make."

”加里，这是你一生中最错误的决定。“

But I landed in a refugee situation

我在难民营落脚，

that had a million refugees in 40 camps,

那里有40个难民营收容了100万难民。

and there were six of us doctors.

却只有我们6个医生。

There were many epidemics there.

流行病随处可见。

My responsibilities were largely related to

我的职责主要是针对

tuberculosis,

肺结核

and then we got struck by an epidemic of cholera.

和令人震惊的流行性霍乱。

So it was the spread of tuberculosis

我负责阻止肺结核

and the spread of cholera

和霍乱的

that I was responsible for inhibiting.

大幅扩散。

And in order to do this work, we, of course,

为了让工作得以顺利进行，

because of the limitation in health workers,

我们数量有限的医护人员

had to recruit refugees to be a specialized

不得不从难民中招人来

new category of health worker.

特训成医护人员。

Following three years of work in Somalia,

在索马里工作了三年以后，

I got picked up by the World Health Organization,

我被世界卫生组织选中

and got assigned to the epidemics of AIDS.

从事防治艾滋病流行的工作。

My primary responsibility was Uganda,

我的主要工作是在乌干达。

but also I worked in Rwanda and Burundi

我也在卢旺达、布隆迪、

and Zaire, now Congo,

扎伊尔、刚果、

Tanzania, Malawi, and several other countries.

坦桑尼亚、马拉维和其他几个国家工作过。

And my last assignment there was to run a unit

我最后一个任务是负责一个

called intervention development,

叫干预发展的机构。

which was responsible for designing interventions.

这个机构主要负责干预治疗的设计工作。

After 10 years of working overseas,

10年的海外工作

I was exhausted.

令我身心疲惫。

I really had very little left.

我几乎身无分文。

I had been traveling to one country after another.

常年的四处奔波，

I was emotionally feeling very isolated.

令我倍感孤独无助。

I wanted to come home.

我想回家歇歇。

I'd seen a lot of death,

我看过太多的死亡，

in particular epidemic death,

尤其是流行病造成的死亡。

and epidemic death has a different feel to it.

流行病死亡给人的感受是不一样的，

It's full of panic and fear,

它令人触目惊心。

and I'd heard the women wailing and crying

我听多了沙漠里女人的

in the desert.

恸哭和哀吟。

And I wanted to come home and take a break

我很想回家歇歇

and maybe start over.

也许重新开始。

I was not aware of any epidemic problems

在美国，我没发现任何流行病的

in America.

问题。

In fact, I wasn't aware of any problems in America.

实际上，我没觉得美国有任何问题。

In fact -- seriously.

真的。

And in fact I would visit friends of mine,

我去看望我的一些朋友时

and I noticed that they had water

我看到他们有水

that came right into their homes.

水直接在家里就可以喝到。

How many of you have such a situation?

你们中多少人家里是这种情况？

(Laughter)

（笑声）

And some of them, many of them actually,

有些朋友，其实是很多朋友，

had water that came into more than one room.

可以在家里的不同房间直接喝到水。

And I noticed that they would move

我还发现他们在家里安装了

this little thermoregulatory device

小巧的调温装置，

to change the temperature in their home

可以一度一度地或者两度两度地调解

by one degree or two degrees.

家里的室内温度。

And now I do that.

我家现在也是这样。

And I really didn't know what I would do,

所以我不知道我该做什么好。

but friends of mine began telling me

我的一个朋友告诉关于

about children shooting other children with guns.

青少年之间的枪击事件。

And I asked the question,

我就想

what are you doing about it?

你该做什么来阻止这样的事件？

What are you in America doing about it?

你在美国该做什么来阻止这样的事件？

And there were two essential explanations

大家都知道主要有两种方案

or ideas that were prevalent.

或者说办法。

And one was punishment.

一个是惩罚。

And this I had heard about before.

我以前就听说过的方法。

We who had worked in behavior

我们以前研究行为学的

knew that punishment was something that was discussed

知道惩罚是经常被探讨的方法。

but also that it was highly overvalued.

但它也是个被高估的方法。

It was not a main driver of behavior,

它不是行为的主要驱动力，

nor was it a main driver of behavior change.

也不是行为改变的主要驱动力。

And besides that, it reminded me

而且，它让我意识到

of ancient epidemics

过去的流行病

that were previously completely misunderstood

就曾经被完全曲解。

because the science hadn't been there before,

当时的科学没有普及到

epidemics of plague

瘟疫、

or typhus or leprosy,

斑疹伤寒和麻风病（疫区）。

where the prevalent ideas were that there were

所以当时大家普遍认为

bad people or bad humors or bad air,

疫区的人差、环境差、空气差。

and widows were dragged around the moat,

寡妇们被拖到护城河。

and dungeons were part of the solution.

（拖进）地牢甚至是解决（流行病）的方法之一。

The other explanation or, in a way,

另一种方案，或者说，

the solution suggested,

解决方法是

is please fix all of these things:

请改善所有的设施：

the schools, the community, the homes, the families,

学校、公共场所、私人住处、各个家庭，以及

everything.

所有的东西。

And I'd heard this before as well.

我也同样知道这个方法。

I'd called this the "everything" theory,

我把这叫做“凡事”理论。

or EOE: Everything On Earth.

或者说EOE:世上万物。

But we'd also realized

但是我们也认识到

in treating other processes and problems

在治疗流行病的过程中

that sometimes you don't need to treat everything.

有时候你并不需要改变所有的东西。

And so the sense that I had

所以我的感觉是

was there was a giant gap here.

人们的认识上有一个鸿沟。

The problem of violence was stuck,

暴力问题（的解决）陷入僵局。

and this has historically been the case

这历来都是

in many other issues.

其他重大问题的特点。

Diarrheal diseases had been stuck.

腹泻病（的治疗）曾陷入僵局。

Malaria had been stuck.

疟疾（的治疗）也曾陷入僵局。

Frequently, a strategy has to be rethought.

通常情况下，一个治疗方案必需进行反思。

It's not as if I had any idea what it would look like,

不是说我知道应该怎么做，

but there was a sense that we would have to do

我是觉得我们需要

something with new categories of workers

和一种全新类别的工作者一起来解决这个问题。

and something having to do with behavior change

这样的新方案应该可以改变人们的行为，

and something having to do with public education.

这样的新方案应该用公共教育的方式来实行。

But I began to ask questions

我开始提出问题，

and search out the usual things

研究我以前探讨过的

that I had been exploring before,

一些常见指标。

like, what do the maps look like?

比如说，分布图是什么样的？

What do the graphs look like?

图表是什么样的？

What does the data look like?

数据又是什么样的？

And the maps of violence

那么在美国大部分的城市，

in most U.S. cities

暴力事件的分布图

looked like this.

就象这个。

There was clustering.

是丛集分布的。

This reminded me of clustering that we'd seen also

这让我意识到我们以前见过的

in infectious epidemics,

流行传染病就是丛集分布的。

for example cholera.

比如说霍乱。

And then we looked at the maps,

我们观察曲线图发现

and the maps showed this typical wave

曲线图里有这样的典型曲线。

upon wave upon wave,

一个波形叠着一个波形的分布。

because all epidemics

因为所有的流行病

are combinations of many epidemics.

都合并着其他流行病而生。

And it also looked like infectious epidemics.

而暴力事件的曲线图和流行病的曲线图也很相似。

And then we asked the question,

然后我们就问了，

well what really predicts a case of violence?

怎样预警暴力案件呢？

And it turns out that the greatest predictor

结果我们发现对一个暴力事件的

of a case of violence is a preceding case of violence.

最好预警就是上一次的暴力事件。

Which also sounds like, if there is a case of flu,

这就跟流感疫情相似，

someone gave someone a case of flu, or a cold,

就象某人把流感，或者感冒传给别人，

or the greatest risk factor of tuberculosis

最大的罹患因素就是

is having been exposed to tuberculosis.

结核病的接触史。

And so we see that violence is, in a way,

我们发现暴力事件，在某种程度上，

behaving like a contagious disease.

很象传染病的爆发。

We're aware of this anyway

其实，我们

even in our common experiences

在日常生活中

or our newspaper stories

或者媒体的报道中都可以了解到

of the spread of violence from fights

争吵中的暴力会蔓延成

or in gang wars or in civil wars

帮派斗争，内战，

or even in genocides.

甚至蔓延成为种族屠杀。

And so there's good news about this, though,

有个好消息，就是，

because there's a way to reverse epidemics,

我们知道治疗传染病的方式。

and there's really only three things that are done

只要做好三件事就可以

to reverse epidemics,

阻止传染病的发生。

and the first of it is interrupting transmission.

第一点就是切断传播途径。

In order to interrupt transmission,

为了切断传播途径，

you need to detect and find first cases.

我们需要找到第一个案例。

In other words, for T.B. you have to find somebody

就是说，如果是结核病，你必须要找到

who has active T.B. who is infecting other people.

谁有活动性结核病菌，谁会把结核病传染给别人。

Make sense?

对吧？

And there's special workers for doing that.

我们有专业人员来做这个工作。

For this particular problem,

对这样特定的问题，

we designed a new category of worker

我们设计出新类别的工作者。

who, like a SARS worker

就象（寻找）非典（传染源）的工作者，

or someone looking for bird flu,

（寻找）禽流感（传染源）的工作者，

might find first cases.

去找到首例患病者。

In this case, it's someone who's very angry

在这个（暴力事件的）案例里，起因是有人

because someone looked at his girlfriend

因为别人偷看了他的女朋友

or owes him money,

或者别人欠了他的钱而动怒。

and you can find workers and train them

你可以找到一些人，训练他们成为

into these specialized categories.

特殊类型的工作者。

And the second thing to do, of course,

第二点呢，当然就是

is to prevent further spread,

防止扩散。

that means to find who else has been exposed,

就是说，要找到谁有可能被牵涉进去。

but may not be spreading so much right now

虽然他可能不会很快被牵涉，

like someone with a smaller case of T.B.,

就像在结核病传染的小型案例里一样。

or someone who is just hanging out in the neighborhoods,

哪怕那个人不过是到那个地区转了一圈

but in the same group,

但是在一个圈子里（活动）。

and then they need to be, in a way,

那么这些人就需要，以某种方式，

managed as well,

被好好管理。

particular to the specific disease process.

就象处理某些特殊疾病的过程一样。

And then the third part, the shifting the norms,

那么第三点就是，恢复到正常。

and that means a whole bunch of community activities,

就是说整个社区活动的

remodeling, public education,

重组和公共教育。

and then you've got what you might call

然后你可以做到所谓的

group immunity.

“群体免疫”。

And that combination of factors

这几个因素的结合

is how the AIDS epidemic in Uganda

使我们当初成功地阻止了

was very successfully reversed.

艾滋病在乌干达的扩散。

And so what we decided to do in the year 2000

在2000年我们决定尝试

is kind of put this together in a way

把这些因素结合起来。

by hiring in new categories of workers,

首先我们采用了一些新类型的工作者，

the first being violence interruptors.

作为第一批暴力阻止者。

And then we would put all of this into place

然后我们把（我上面提到的）三个因素全部运用到

in one neighborhood

某个社区，

in what was the worst police district

美国国内的

in the United States at the time.

某个治安差的地区。

So violence interruptors hired from the same group,

暴力阻止者是从（动怒者）同一个圈子里选出来的，

credibility, trust, access,

有信誉、值得信任、能接近（动怒者），

just like the health workers in Somalia,

就象在索马里的那些（在难民营受训的）医护工作者一样。

but designed for a different category,

只不过他们为不同的目的而工作。

and trained in persuasion,

他们受训学习如何劝说别人，

cooling people down, buying time, reframing.

让（动怒者）息怒，和他们一起消磨时间，转变他的态度。

And then another category of worker,

还有其他类别的员工，

the outreach workers, to keep people

外展员工，是在某种程度上

in a way on therapy for six to 24 months.

让动怒者接受6到24个月的心理辅导。

Just like T.B., but the object is behavior change.

就象结核病的治疗，只不过这次是行为上的改变。

And then a bunch of community activities

然后呢，一些社区活动就会

for changing norms.

恢复正常。

Now our first experiment of this

我们首次实验结果

resulted in a 67-percent drop

显示在芝加哥西加费尔德地区，

in shootings and killings

枪击案和枪杀案

in the West Garfield neighborhood of Chicago.

减少了67％。

(Applause)

（掌声）

And this was a beautiful thing

这对一个社区来说，

for the neighborhood itself,

是一件非常好的事。

first 50 or 60 days, then 90 days,

刚开始坚持了50天，或60天，然后是90天，

and then there was unfortunately another shooting

在接下来的90天里，

in another 90 days,

那里仅发生了一件不幸的枪击事件。

and the moms were hanging out in the afternoon.

那些社区里的妈妈们开始在下午一起出来散步，

They were using parks they weren't using before.

他们开始利用他们以前不曾利用的公园。

The sun was out. Everybody was happy.

太阳出来了。每个人都很高兴。

But of course, the funders said, "Wait a second,

但当然了，有些捐款人说，“等等，

do it again."

你再做一次。”

And so we had to then, fortunately,

所以呢，我们幸运地

get the funds to repeat this experience,

拿到了资金来重复这个实验。

and this is one of the next four neighborhoods

在其他四个实验社区中的一个社区

that had a 45-percent drop in shootings and killings.

枪杀案和凶杀案减少了45％。

And since that time, this has been replicated

从那时开始，这个实验已经被重复了

20 times.

20次。

There have been independent evaluations

我们的实验被独立评估过。

supported by the Justice Department

这个评估是由司法部门和

and by the CDC and performed by Johns Hopkins

疾病预防控制中心支持，由约翰霍普金斯大学来实行的。

that have shown 30-to-50-percent and 40-to-70-percent

评估结果显示我们的实验把枪击案和杀人案

reductions in shootings and killings

减少到了30－50％ 和40－60％。

using this new method.

这是采用（我上面提到的）新方法做到的。

In fact, there have been three independent

实际上，我们的工作目前为止已经通过了三次独立

evaluations of this now.

评估。

Now we've gotten a lot of attention as a result of this,

也因此受到了很多人的瞩目。

including being featured on

其中包括

The New York Times' Sunday magazine cover story.

《纽约时报》周日杂志的封面特别推荐。

The Economist in 2009

2009年的《经济学家》杂志

said this is "the approach that will come to prominence."

报道说，我们的工作是“卓越的尝试“。

And even a movie was made around our work.

甚至有一部电影是围绕我们的工作来拍摄的。

[The Interrupters]

［中断］

However, not so fast,

但是，先不要急，

because a lot of people did not agree

因为很多人还不同意

with this way of going about it.

我们的做法。

We got a lot of criticism,

我们受到了很多的批评，

a lot of opposition,

很多的反对意见，

and a lot of opponents.

很多的敌对态度。

In other words, what do you mean, health problem?

（他们问），（你说这是）健康问题，是什么意思？

What do you mean, epidemic?

（你说这是）流行病，是什么意思？

What do you mean, no bad guys?

（你说)他们不是很坏的人，是什么意思？

And there's whole industries designed

社会上已经有了

for managing bad people.

管理坏人的方案。

What do you mean, hiring people

你说的雇用有（不良）背景的人，

who have backgrounds?

是什么意思？

My business friends said,

我的商业界朋友说，

"Gary, you're being criticized tremendously.

”格里，你的工作受到了严厉地批评，

You must be doing something right."

你一定是做了正确的事！“

(Laughter)

（笑声）

My musician friends added the word "dude."

我的音乐家朋友还加了一个词儿”伙计“。

So anyway, additionally,

事实上，

there was still this problem,

暴力问题确实还是存在。

and we were getting highly criticized as well

我们的工作受到了另一种严厉批评

for not dealing with all of these other problems.

因为我们的工作无法处理所有的其他问题。

Yet we were able to manage malaria

目前为止，我们能控制疟疾，

and reduce HIV and reduce diarrheal diseases

减少艾滋病和腹泻的发病，

in places with awful economies

在那些贫困的

without healing the economy.

没有经济复苏的地区。

So what's actually happened is,

所以实际上，

although there is still some opposition,

尽管有一些反对意见，

the movement is clearly growing.

很明显大家都行动起来了。

Many of the major cities in the U.S.,

美国的很多大城市，

including New York City and Baltimore

包括纽约和巴的摩尔

and Kansas City,

和堪萨斯城。

their health departments are running this now.

他们的卫生部门在开展着类似的工作。

Chicago and New Orleans, the health departments

芝加哥和新奥尔良的卫生部门

are having a very large role in this.

在这样的工作中发挥着巨大的作用。

This is being embraced more by law enforcement

执法部门比几年前更加

than it had been years ago.

接受我们的工作。

Trauma centers and hospitals

创伤中心和医院

are doing their part in stepping up.

也在不断跟进。

And the U.S. Conference of Mayors

美国市长联席会议

has endorsed not only the approach

已经核准不仅要开展类似的工作

but the specific model.

而且要作为特别模式来做。

Where there's really been uptake even faster

也有一些行动更加迅速的

is in the international environment,

国际组织。

where there's a 55-percent drop

在波多黎各的第一个试点区域，

in the first neighborhood in Puerto Rico,

犯罪率减少了55％。

where interruptions are just beginning in Honduras,

在洪都拉斯切断（犯罪）工作正在着手进行。

where the strategy has been applied in Kenya

在肯亚最近的选举活动中，我们的工作模式

for the recent elections,

已经被列入计划。

and where there have been 500 interruptions in Iraq.

伊拉克已经完成了500次切断犯罪的工作。

So violence is responding as a disease

暴力事件可以当作疾病来对待，

even as it behaves as a disease.

它的表现形式就象一个疾病的表现形式。

So the theory, in a way,

我们的理论，某种意义上说，

is kind of being validated by the treatment.

是在处理过程中得到了验证的。

And recently, the Institute of Medicine

最近，医学研究中心

came out with a workshop report

提出了一个研究报告

which went through some of the data,

提供了包括了神经科学方面的

including the neuroscience,

一些数据

on how this problem is really transmitted.

来解释暴力是如何传播的。

So I think this is good news,

我认为这个是好消息，

because it allows us an opportunity

因为这些研究让我们有机会

to come out of the Middle Ages,

走出以往的

which is where I feel this field has been.

中世纪般的陈旧思维。

It gives us an opportunity to consider the possibility

这些研究给我们重新考虑

of replacing some of these prisons

把一些监狱变成

with playgrounds or parks,

儿童游乐场和公园的可能性。

and to consider the possibility

重新考虑

of converting our neighborhoods into neighborhoods,

把我们的社区变成

and to allow there to be a new strategy,

采用新模式

a new set of methods, a new set of workers:

新方法，新类型的工作者的社区。

science, in a way, replacing morality.

用科学的方法来替代道德的方法。

And moving away from emotions

控制住情绪

is the most important part of the solution

是解决问题中最重要的一部分。

to science as a more important part of the solution.

用科学的方法来解决是更加重要的。

So I didn't mean to come up with this at all.

我不是说所有的问题最终都能用我们的方法来解决。

It was a matter of,

重要的是，

I wanted actually a break,

我想要有个突破，

and we looked at maps, we looked at graphs,

让我们能够看着分布图，看着图表，

we asked some questions

提出一些问题，

and tried some tools

然后尽量采用

that actually have been used many times before

以前在其他方面运用过很多次的

for other things.

方法。

For myself, I tried to get away from

对我自己来说，我曾试图从

infectious diseases,

感染性疾病中脱身。

and I didn't.

可是我没有。

Thank you.

谢谢大家！

(Applause)

（掌声）