Why your doctor should care about social justice | Mary Bassett

翻译人员: Yanjia Yang 校对人员: Gu Yu

When I moved to Harare in 1985,

当我1985年搬到哈拉雷时

social justice was at the core of Zimbabwe's national health policy.

社会公正问题 是津巴布韦国家健康政策的核心

The new government emerged from a long war of independence

新政府摆脱了长期的独立战争后

and immediately proclaimed a socialist agenda:

立即公布了一项社会主义政策：

health care services, primary education

使健康医疗服务与初等教育

became essentially free.

成为基本免费项目

A massive expansion of rural health centers

大规模的农村卫生服务中心

placed roughly 80 percent of the population

使得80%的人口

less than a two-hour walk from these facilities,

步行两小时以内便可抵达

a truly remarkable accomplishment.

这是一个真正非凡的进步

In 1980, the year of independence,

在1980津巴布韦独立年

25 percent of Zimbabwean children were fully immunized.

25%的孩童进行了常规免疫接种

By 1990, a mere decade later,

到1990，仅仅十年之后

this proportion stood at 80 percent.

这一比例上升到80%

I felt tremendously privileged to be part of this transformation,

我十分荣幸

能参与这次转变，这场革命中

a revolution.

The excitement, the camaraderie, was palpable.

兴奋之情和同志友爱都十分真切

Working side by side with brilliant Zimbabweans --

与杰出的津巴布韦人民， 科学家，医生，活动家

scientists, doctors, activists --

肩并肩工作

I felt connected not only to an African independence movement,

我感到参与的不仅是一个非洲独立运动

but to a global progressive public health movement.

更是一场进步的全球公众健康运动

But there were daunting challenges.

我也面临过一些令人畏缩的困难

Zimbabwe reported its first AIDS case in 1985, the year I arrived.

在1985年，我到达的那一年， 津巴布韦报告了第一例艾滋病。

I had taken care of a few patients with AIDS in the early 1980s,

我在1980年代初 照料过几个艾滋病人

when I did my medical training at Harlem Hospital, but --

当时我在Harlem医院 接受医学培训，但是…

we had no idea what lay in store for Africa.

我们完全想不到 会在非洲遇到什么

Infection rate stood at about two percent in my early days there.

我刚到那里的时候 感染率大约2%

These would soar

这一比例迅速增大

to one out of every four adults

当我17年后离开哈拉雷的时候

by the time I left Harare 17 years later.

每四名成人就有一名感染

By the mid-1990s,

到20世纪90年代中期

I'd told hundreds of people in the prime of life

我告诉过数百个 朝气蓬勃的年轻人

that they were HIV-positive.

他们的艾滋病病毒检验呈阳性。

I saw colleagues and friends die,

我目睹同事和朋友们死去

my students, hospital patients, die.

我的学生和医院病人 也因此死亡

In response, my colleagues and I set up a clinic.

面对这种情况 我和同事开办了一家诊所

We did condom demonstrations.

我们演示如何使用避孕套

We launched school education and workplace interventions.

我们在学校教育和工作场所进行宣传

We did research. We counseled the partners of infected men

我们开展研究 我们为艾滋病感染人员伴侣

about how to protect themselves.

提供如何保护自己的建议。

We worked hard, and at the time, I believed that I was doing my best.

我们非常努力做着这一切 我相信当时我已经竭尽全力

I was providing excellent treatment,

我提供了最好的治疗措施

such as it was.

至少在当时的条件下如此

But I was not talking about structural change.

但是我没有做出建设性地改变

Former UN Secretary Kofi Annan has spoken candidly

前联合国秘书长科菲安南 曾经坦白地承认

about his personal failure

是他个人的错误

leading to the Rwandan genocide.

导致了卢旺达大屠杀

In 1994, he was head of the UN peacekeeping department.

在1994年， 他是联合国维和部门的领导

At a 10-year memorial for the genocide,

在大屠杀十年纪念仪式上

he reflected, "I believed at the time I was doing my best,

他回忆说 当时我相信我已经竭尽所能

but I realized after the genocide

但是大屠杀之后我才意识到

that there was more I could and should have done

还有很多是我可以做并且应该做的

to sound the alarm and rally support."

去敲响警钟，去寻求支持

The AIDS epidemic caught the health community unprepared,

艾滋病的爆发使医疗团体措手不及

and today, when the World Health Organization estimates

世界卫生组织估计

that 39 million people have lost their lives to this disease,

当今有三千九百万人死于这一疾病

I'm not alone in feeling remorse and regret

许多人同我一样 因为没能更早地阻止这一切

at not having done more earlier.

而感到悔恨和惋惜

But while living in Zimbabwe,

但当我生活在津巴布韦时

I didn't see my role as an advocacy or a political one.

并没有意识到自己是倡导者或政治人士

I was there for my technical skills,

我本以为是因为自己的 医疗知识前去那里的

both my clinical and my research epidemiology skills.

是因为我的临床和传染病研究

And in my mind, my job was to take care of patients

我一直觉得 我的工作是照顾病人

and to do research to better understand the population patterns of transmission,

通过研究来更好地理解传染的人口特征

and I hoped that we'd slow the spread of the virus.

我希望可以减缓病毒的传播速度

I was aware that socially marginalized populations were at disproportionate risk

我意识到社会边缘群体 感染并死于艾滋病的比例

of getting and dying of AIDS.

出奇的高

And on the sugar plantations,

在蔗糖种植园

which really more closely resembled feudal fiefdoms

这类相比于现代企业

更近似于封建领地的地方

than any modern enterprise,

60 percent of pregnant women

60%的孕妇

tested HIV-positive.

艾滋病病毒测试呈阳性

I worked to show how getting infected was not a moral failure

我的工作是向人们展示 被感染并不是道德沦丧

but instead related to a culture of male superiority,

而是与男权意识有关

to forced migrant labor and to colonialism.

与强迫外来劳工和殖民主义有关。

Whites were largely unscathed.

白人大部分都安然无恙

As health professionals,

作为医疗专家

our tools were pitifully weak:

我们的手段令人遗憾的无力：

imploring people to change their individual behaviors,

恳求人们改变他们的个人行为

use condoms, reduce number of partners.

使用避孕套，减少伴侣数目

Infection rates climbed,

感染率还是攀升

and when treatment became available in the West,

作为我们对抗病毒

treatment that remains our most potent weapon

最有效的武器

against this virus,

当治疗在西方已经可行的时候

it was unaffordable to the public sector across Africa.

对于整个非洲公共部门， 治疗是负担不起的

I didn't speak out

我没有大胆地说出

about the unequal access to these life-saving drugs

对挽救生命药品获取的不平等

or about the underlying economic and political systems

或者潜在经济和政治系统中的问题

that were driving infection rates

是导致如此大面积人群中

in such huge swaths of the population.

感染率居高不下的驱动力

I rationalized my silence

我为我的沉默找了借口

by reminding myself that I was a guest in the country,

提醒自己我只是这个国家的访客

that sounding the alarm could even get me kicked out,

敲响警钟可能会被驱逐出境

keep me from doing good work,

让我无法做好工作

taking care of my patients,

照料我的病人

doing much-needed research.

做迫切需要的研究

So I didn't speak out

所以我没有

about the government's early stance on AIDS.

对政府早期的艾滋政策大胆直言

I didn't voice my concerns loudly enough.

我表达我的担忧不够大声

Many doctors, health professionals,

许多医生，保健工作者

may think I did nothing wrong.

可能会觉得我没有做错

Our pact with our patients,

我们对于病人的承诺

the Hippocratic Oath and its variants,

就如希波克拉底誓言和它的不同版本

is about the sanctity of the patient-doctor relationship.

是神圣不可侵犯的医患关系

And I did everything I could

我对我的每一个病人

for each and every patient of mine.

竭尽所能

But I knew

但是我知道

that epidemics emerge along the fissures of our society,

伴随着我们社会分裂产生的传染病

reflecting not only biology,

反映的不单是生物学现象

but more importantly patterns of marginalization, exclusion,

更重要的是边缘化，不包容，种族歧视，

discrimination related to race, gender, sexuality, class and more.

性别歧视，阶级歧视的现象

It was true of AIDS.

对于艾滋病如此

It was true just recently of Ebola.

对于最近的埃博拉如此

Medical anthropologists such as Paul Farmer,

医疗人类学家， 例如保罗·法玛尔

who worked on AIDS in Haiti,

在海地从事艾滋病工作

call this structural violence:

称之为结构性暴力：

structural because inequities are embedded

结构性，因为不平等植根于

in the political and economic organization of our social world,

我们社会环境的政治和经济组织

often in ways that are invisible to those with privilege and power;

经常为特权和政权阶层所无视；

and violence because its impact --

暴力，因为它的影响

premature deaths, suffering, illness -- is violent.

比如早逝，苦难，疾病，是暴力的

We do little for our patients

我们为病患做到很少

if we fail to recognize

如果我们没有意识到

these social injustices.

这些社会不公正

Sounding the alarm is the first step towards doing public health right,

敲响警钟是向正确方向 引导公众保健的第一步，

and it's how we may rally support

这是我们寻求支持的方式，

to break through and create real change together.

一起去突围，去创造真正改变的方式

So these days, I'm not staying quiet.

所以现如今，我没有保持沉默

I'm speaking up about a lot of things,

我对很多事大胆直言

even when it makes listeners uncomfortable,

尽管让听者感到不适

even when it makes me uncomfortable.

尽管让我感到不适

And a lot of this is about racial disparities

这其中，很多是关于种族隔离

and institutionalized racism,

和有组织的种族主义

things that we're not supposed to have in this country anymore,

这些不应该发生在这个国家的事情

certainly not in the practice of medicine

不应该存在于医疗实践中

or public health.

或者公众保健中的事情

But we have them,

但是它们确实存在

and we pay for them in lives cut short.

我们为此付出缩短生命的代价

That's why sounding the alarm

这就是在美国对种族主义

about the impact of racism on health in the United States,

影响保健事业敲响警钟的原因

the ongoing institutional and interpersonal violence

持续地有组织的，人际间的

that people of color face,

对有色人种的暴力

compounded by our tragic legacy

与我们悲剧性的历史息息相关

of 250 years of slavery,

250年的奴隶制度

90 years of Jim Crow

90年的种族歧视

and 60 years of imperfect equality,

60年的不完善的平等关系

sounding the alarm about this

为此敲响警钟

is central to doing my job right

是我作为纽约市卫生专员的

as New York City's Health Commissioner.

工作重心

In New York City, premature mortality -- that's death before the age of 65 --

在纽约市，过早死亡率， 即在65岁之前过世，

is 50 percent higher for black men than white ones.

黑人比白人高出50%

A black woman in 2012

在2012年，黑人女性

faced more than 10 times the risk of dying related to childbirth

相比白人女性，面对着多于10倍的 与生育相关的

as a white woman.

死亡风险

And though we've made enormous strides

尽管我们在减少婴儿死亡率方面

in reducing infant mortality rates,

已经取得了巨大的进步

a black baby still faces

黑人婴儿出生后

nearly three times the risk of death in its first year of life

第一年死亡率依旧是白人婴儿的

as compared to a white baby.

近三倍

New York City's not exceptional.

纽约市并非特例

These statistics are paralleled

这些统计数据

by statistics found across the United States.

在美国全境都相类似

A recent New York Times analysis

一份最近的纽约时报分析

reported that there are 1.5 million missing black men across the country.

报道全国大概有 一千五百万的失踪黑人男性

They noted that more than one

作者指出

out of every six black men

25至54岁的黑人男性

who today should be between the ages of 25 and 54 years

每六人中，就有至少一人

have disappeared from daily life,

从日常生活中消失

lost either to prison or premature death.

或因牢狱之灾，或因过早死亡

There is great injustice

年轻黑人日常要面对

in the daily and disproportionate violence faced by young black men,

不成比例的暴力行为 这是非常不公平的

the focus of recent protests under the banner #BlackLivesMatter.

这些都存在于最近高举 “黑人生命很重要”标语的抗议中

But we have to remember

但是我们需要记住

that enduring and disparate rates

在普通医疗的

and the occurrence and outcome of common medical conditions --

现状和结果， 以及持久且奇高的疾病比率，

heart disease, cancer, diabetes, HIV --

心脏病，癌症，糖尿病，艾滋病，

diseases that may kill slowly and quietly

那些缓慢地安静地吞噬生命的疾病

and take even more black lives prematurely.

让更多黑人生命过早消逝的疾病

As the #BlackLivesMatter movement unfolded,

随着“黑人生命很重要”运动的展开

I felt frustrated and angry

我感到受挫和愠怒

that the medical community

医疗团体

has been reluctant to even use the word "racism"

在研究和工作中， 甚至对“种族主义”一词的使用

in our research and our work.

都犹豫不决

You've probably felt something every time I've said it.

我每次说它时， 你大概已经有所感觉

Our medical students held die-ins in their white coats,

医学学生身着白袍， 以死抗议生化武器

but the medical community has largely stood by passively

但是医疗团体面对 持续的种族歧视

as ongoing discrimination continues to affect

对疾病状况和死亡率的影响

the disease profile and mortality.

很大程度上袖手旁观

And I worry

我很担心

that the trend towards personalized and precision medicine,

趋向个人化和准确化的药物

looking for biological or genetic targets to better tailor treatment,

找寻生物和基因目标 以更好的设计疗法

may inadvertently cause us to lose sight of the big picture,

可能会不经意地 使我们不能着眼大局

that it is the daily context,

而这正是日常生活的场景

where a person lives, grows,

一个人的生活，成长，

works, loves,

工作，相爱的地方

that most importantly determines population health,

重要地影响着群体健康

and for too many of us, poor health.

对我们很多人来说，健康不良

As health professionals in our daily work,

在日常生活着，作为保健工作者

whether in the clinic or doing research,

无论在诊所里，还是做研究时

we are witness to great injustice:

我们都是巨大不公正的目击者：

the homeless person who is unable to follow medical advice

流浪者，无法遵从医嘱，

because he has more pressing priorities;

因他要优先考虑更加紧迫之事；

the transgender youth who is contemplating suicide

年轻的变性人，计划自杀，

because our society is just so harsh;

因我们的社会太过无情；

the single mother who has been made to feel that she is responsible

单身母亲，被迫使感到需要对她孩子的

for the poor health of her child.

健康不良负责。

Our role as health professionals

作为保健工作者， 我们的角色

is not just to treat our patients

不只是治疗我们的病人

but to sound the alarm

更是敲响警钟

and advocate for change.

主张变革

Rightfully or not,

且不论合理与否

our societal position gives our voices great credibility,

我们的社会岗位 让我们的声音更加可信

and we shouldn't waste that.

而我们不应该浪费它

I regret not speaking up in Zimbabwe,

我对在津巴布韦没能坦率表达 感到后悔

and I've promised myself

我已经对自己承诺

that as New York City's Health Commissioner,

作为纽约市保健专员

I will use every opportunity I have

我将会利用拥有的所有机会

to sound the alarm

去敲响警钟

and rally support for health equity.

去为保健平等寻求支持

I will speak out against racism,

我将对种族歧视直言反对

and I hope you will join me,

我也希望你们能够加入我

and I will join you when you speak out against sexism

而我也会加入你们， 当你们为性别歧视，

or any other form of inequality.

或者任何一种不平等， 直言反对之时

It's time for us to rise up

是时候让我们起来反抗了

and collectively speak up

共同地对结构性不平等

about structural inequality.

大胆直言

We don't have to have all the answers

对倡导变革，我们不需要

to call for change.

拥有所有答案

We just need courage.

我们只需勇气

The health of our patients,

我们病患的健康

the health of us all, depends on it.

我们自身的健康，全赖于此

(Applause)

（鼓掌）