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

翻译人员: Yini Yao 校对人员: Haoliang Chen

OK, first, some introductions.

大家好。首先，我想先介绍一下我的家庭。

My mom, Jennie, took this picture.

这张照片是我母亲珍妮拍的。

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

照片正中的是我父亲，弗兰克。

And on his left, my sisters:

在他的左侧的是我的姐妹：

Mary Catherine, Judith Ann, Theresa Marie.

玛丽·凯瑟琳，朱迪·安，特蕾莎·玛瑞。

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

被他抱在膝上的是约翰·帕特里克， 而坐在父亲右侧的是凯文·迈克尔。

And in the pale-blue windbreaker,

而那个穿着浅蓝色冲锋衣的小孩

Susan Diane. Me.

就是我，苏珊·黛安。

I loved growing up in a big family.

在这样一个大家庭里成长是非常幸福的。

And one of my favorite things was picking names.

小时候我的爱好之一就是帮忙取名字。

But by the time child number seven came along,

但当家中迎来第七个孩子时，

we had nearly run out of middle names.

我们能用的中间名已经基本上全用过了。

It was a long deliberation

最后全家经过几番讨论后决定，

before we finally settled on Jennifer Bridget.

我的小妹妹的名字为詹妮弗·布丽奇特。

Every parent in this audience

在座的各位中一定有已经为人父母的，

knows the joy and excitement

你们一定了解在新生儿诞生之初

of picking a new baby's name.

为它取名时的激动和喜悦。

And I was excited and thrilled

而我在那重要的纪念性时刻

to help my mom in that special ceremonial moment.

协助母亲的时候感到激动不已。

But it's not like that everywhere.

但并不是所有家庭都能如此幸福。

I travel a lot and I see a lot.

我四处游历，也见闻颇丰。

But it took me by surprise to learn

但是在埃塞俄比亚的所见所闻

in an area of Ethiopia,

还是让我感到非常意外。

parents delay picking the names for their new babies

那里的父母会推迟给新生儿取名

by a month or more.

长达一个月甚至更久。

Why delay?

他们为什么要推迟？

Why not take advantage of this special ceremonial time?

为什么不趁着这一重要的纪念性时刻为孩子命名？

Well, they delay because they're afraid.

他们推迟，是因为害怕，

They're afraid their baby will die.

他们害怕他们的孩子活不了多久。

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

没有取名字，或许能让死去孩子的父母更好受一点。

A face without a name might help them feel

一张没有名字的脸或许能够

让他们的丧子之痛不那么刻骨铭心。

just a little less attached.

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

我们所处的世界这端，

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

对于新生命的到来如此热切，激动，充满希望。

while in another world,

但在世界另一端，

parents are filled with dread,

那些同为父母的人，却总是满怀忧虑，

not daring to dream of a future for their child

他们甚至不敢去奢望孩子的未来

beyond a few precious weeks.

哪怕这“未来”的定义，仅仅是未来几周。

How can that be?

为什么会这样？

How can it be that 2.6 million babies

为什么全球范围内

会有260万的新生儿

die around the world

before they're even one month old?

在未满月就已夭折？

2.6 million.

260万

That's the population of Vancouver.

那可是温哥华的人口总数。

And the shocking thing is:

而最令人痛心的是：

Why?

为什么？

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

在发生了这么多悲剧后，我们仍旧一无所知。

Now, I remember recently seeing an updated pie chart.

我最近看过一张扇形统计图，

And the pie chart was labeled,

这张图是关于

"Causes of death in children under five worldwide."

全球五岁以下儿童死亡原因的统计。

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

扇形图中很大的一部分，大约有40%，

40 percent was labeled "neonatal."

40%的死亡原因标注为“新生的”。

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

“新生的”并不能算致死原因。

Neonatal is simply an adjective,

它仅仅是一个形容词，

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

形容那些尚未满月的婴儿。

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

在我看来，“新生的”意为“我们一无所知”。

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

而我作为一名科学家，一名医生，

I want to fix things.

我想弥补这些不幸。

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

但是对于我们甚至都无法定义的对象，修补谈何容易。

So our first step in restoring the dreams of those parents

所以为了找回那些父母的梦想，

is to answer the question:

首先我们必须回答这个至关重要的问题：

Why are babies dying?

为什么新生儿们还在不断夭折呢？

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

今天，我想要谈论一种新的解决方案。

an approach that I feel

这一方案在我看来

will not only help us know why babies are dying,

将不仅能揭开婴儿早夭的原因，

but is beginning to completely transform

更是将全面改善

the whole field of global health.

全人类健康的现状。

It's called "Precision Public Health."

这一方案叫作 “精准公共卫生”。

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

对我来说，精准医疗的起点不同寻常。

I trained as a cancer doctor, an oncologist.

我曾作为一名癌症医师，一名肿瘤学家接受专业训练。

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

我进入这一领域是因为我想要帮助人们减轻痛苦，

But too often my treatments made them feel worse.

但常常事与愿违，我的治疗往往让他们更加痛苦。

I still remember young women being driven to my clinic

我至今仍记得那些年轻女孩坐着母亲的车

by their moms --

来到我的诊所求医，

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

即使她们已是成年人，

却仍要在母亲的帮助下才能走进检测室。

They were so weak

她们非常虚弱

from the treatment I had given them.

而正是我的治疗方案让她们如此虚弱。

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

可是当时，在与癌症抗争的前线，

we had few tools.

我们别无选择。

And the tools we did have couldn't differentiate

而我们仅有的化疗手段无法区别

between the cancer cells that we wanted to hit hard

我们意在消灭的癌细胞

and those healthy cells that we wanted to preserve.

和那些我们想要保护的健康细胞。

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

而化疗的副作用你们早已耳熟能详：

hair loss, being sick to your stomach,

脱发掉发，恶心反胃，

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

免疫系统遭抑制，因此感染的威胁无处不在

were always surrounding us.

一直潜伏在我们的周围。

And then I moved to the biotechnology industry.

之后我将工作重心转到了生物科技产业。

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

同时我仍立志寻找新的治疗乳腺癌的方法，

that could do a better job of telling the healthy cells

新方法必须能够更好地将健康的细胞

from the unhealthy or cancer cells.

与非健康细胞或癌细胞区分开。

It's a drug called Herceptin.

这是一种叫做赫赛汀（Herceptin)的药物。

And what Herceptin allowed us to do

赫赛汀使得我们能够

is to precisely target HER2-positive breast cancer,

精确地锁定HER2阳性乳腺癌细胞，

at the time, the scariest form of breast cancer.

这是当时最为棘手的乳腺癌。

And that precision let us hit hard the cancer cells,

而这样的精确度，使我们强有力地攻击癌细胞，

while sparing and being more gentle on the normal cells.

同时不影响到正常的细胞。

A huge breakthrough.

这是一项创举。

It felt like a miracle,

简直像是一种奇迹，

so much so that today,

这样的奇迹在如今不胜枚举。

we're harnessing all those tools --

如今我们使用着各种工具，

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

大数据，患者监控，基因序列等等，

to tackle a broad variety of diseases.

来应对各种疾病。

That's allowing us to target individuals

这使得我们可以针对不同的患者

with the right remedies at the right time.

在恰当的时间对症下药。

Precision medicine revolutionized cancer therapy.

“精准医疗” 在癌症治疗领域掀起了一场革命。

Everything changed.

它改变了一切。

And I want everything to change again.

而我希望这一切能够再一次改变。

So I've been asking myself:

因此我不断地问自己：

Why should we limit

为什么我们要将

this smarter, more precise, better way to tackle diseases

这一更为先进，更为准确，更好的治疗疾病的方法

to the rich world?

限制在富人阶层？

Now, don't misunderstand me --

不要误解我的话，

I'm not talking about bringing expensive medicines like Herceptin

我并不是在宣扬将诸如赫赛汀这样昂贵的药品

to the developing world,

带入第三世界，

although I'd actually kind of like that.

虽然其实这也不失为一个好主意

What I am talking about

但我想要传递的

is moving from this precise targeting for individuals

是将这些为个体客制化的医疗服务

to tackle public health problems

向大范围公共卫生的范畴推进

in populations.

不是以个人为单位 是以总人口为单位

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

我知道你们可能会认为

“你疯了，你不能那么做。那代价太大了。“

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

But here's the thing:

但事实是：

we're already doing this in a limited way,

尽管受到种种制约，我们已经开始实施这一计划，

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

而且它已经开始产生显著的效果。

So here's what's happening.

我来告诉你们它究竟改变了什么

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

我刚才说了，我所受的是癌症医生的专业训练。

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

然而像许多在上世纪八十年代的旧金山地区受教育的医生一样，

I also trained as an AIDS doctor.

我所受的专业培训也包含了艾滋病治疗。

It was a terrible time.

那是段艰难岁月。

AIDS was a death sentence.

艾滋病就是死亡的代名词。

All my patients died.

我所有的病人都死了。

Now, things are better,

尽管现在情况有所好转，

but HIV/AIDS remains a terrible global challenge.

但艾滋病毒和艾滋病仍然是可怕的全球性难题。

Worldwide, about 17 million women are living with HIV.

如今在世界范围内，有大约1700万的女性是艾滋病毒携带者。

We know that when these women become pregnant,

我们知道一旦这些女性怀孕，

they can transfer the virus to their baby.

她们所携带的艾滋病毒很可能会传染给她们的孩子。

We also know in the absence of therapy,

我们也很清楚地知道，由于医疗条件的不足，

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

那些孩子中有半数活不过两岁。

But we know that antiretroviral therapy can virtually guarantee

可我们也了解到抗逆转录病毒治疗几乎能够确保

that she will not transmit the virus to the baby.

艾滋病毒携带的母体不会将病毒传染给婴儿。

So what do we do?

所以我们该怎么做？

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

我们将采取一种通用的治疗方法，

有点类似一种大范围的化疗，

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

为此我们必须要检测和治疗世界上每一位孕妇。

That would do the job.

这样就能达成目标。

But it's just not practical.

可这显然是不现实的。

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

所以作为替代，我们针对那些艾滋病高发的地区。

We know in certain countries in sub-Saharan Africa

在撒哈拉以南的非洲国家，

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

我们可以在艾滋病高发的地区检测和治疗孕妇。

This precision approach to a public health problem

这一针对公共健康问题的精确手段

has cut by nearly half

在近五年内

HIV transmission from mothers to baby

成功地将艾滋病毒的母婴传播率

in the last five years.

削减了将近一半。

(Applause)

（掌声）

Screening pregnant women in certain areas in the developing world

对于第三世界中特定地区的孕妇进行筛查

is a powerful example

充分展示了

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

精准公共卫生能够如何大范围地改善现状。

So ...

所以

How do we do that?

我们将如何达成这一步？

We can do that because we know.

我们之所以能够实现是因为我们清楚。

We know who to target,

我们清楚该锁定哪一类人群，

what to target,

该锁定哪一项疾病，

where to target and how to target.

在什么环境进行锁定，以及如何进行锁定。

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

在我看来，这些都是精准公共卫生中最为重要的要素。

who, what, where and how.

什么人，什么疾病，什么地点，以及怎么做。

But let's go back to the 2.6 million babies

现在让我们再回到260万早夭的婴儿

who die before they're one month old.

他们夭折时都尚未满月。

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

其中最大的问题在于：我们一无所知。

It may seem unbelievable,

这听起来可能非常荒谬，

但是在那些婴儿早夭率居高不下的地区

but the way we figure out the causes of infant mortality

in those countries with the highest infant mortality

我们探求其根本原因的途径

仅仅是通过与那些母亲对话

is a conversation with mom.

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

一位卫生工作者向一位刚失去自己孩子的母亲提问，

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

”孩子过世前是否呕吐，是否有发烧？“

And that conversation may take place

而这一段对话也许就发生在

as long as three months after the baby has died.

孩子夭折后仅仅三个月内

Now, put yourself in the shoes of that mom.

请在座各位站在那位母亲的角度想想，

It's a heartbreaking, excruciating conversation.

这是一场多么令人心碎与备受折磨的对话

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

更糟的是，它对于我们的研究并没有多少帮助。

because we might know there was a fever or vomiting,

因为即便我们得知孩子有发烧或呕吐的症状，

but we don't know why.

我们仍然不知道症状背后的根本原因。

So in the absence of knowing that knowledge,

因此由于缺少对此类事件的认知，

we cannot prevent that mom, that family,

我们对于如何帮助那位母亲和她的家庭

or other families in that community

乃至别的家庭免受同样的悲剧

from suffering the same tragedy.

仍然束手无策。

But what if we applied a precision public health approach?

但是假如我们能够在这些地区尝试精准公共卫生呢？

Let's say, for example,

比如说，

we find out in certain areas of Africa

我们发现在非洲的某些地区中，

that babies are dying because of a bacterial infection

某种细菌感染导致了婴儿的夭折，

transferred from the mother to the baby,

而这种感染是由母体传给婴儿的，

known as Group B streptococcus.

这种细菌，我们称之为B群链球菌。

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

由于治疗条件的缺失，

这位母亲下一个孩子的死亡率将提高七倍。

that her next baby will die.

Once we define the problem, we can prevent that death

一旦找出问题根源所在，我们就能用像青霉素一样

with something as cheap and safe as penicillin.

相对便宜且安全的治疗手段来避免这类死亡。

We can do that because then we'll know.

我们能这么做是因为我们知道了原因，

And that's the point:

而接下来的便是重中之重：

once we know, we can bring the right interventions

一旦我们弄清楚，我们就能在正确的地点

to the right population in the right places

向正确的人群对症下药

to save lives.

从而达到治病救人的目的

With this approach, and with these interventions

通过这种医疗尝试和这些介入治疗

and others like them,

以及其他类似手段，

I have no doubt

我坚信

that a precision public health approach

精准公共卫生方案

can help our world achieve our 15-year goal.

能够帮助我们实现“15年目标”

And that would translate into a million babies' lives saved

这一进步每一年

都能挽救近100万婴儿的生命。

every single year.

One million babies every single year.

每年挽救一百万个婴儿。

And why would we stop there?

同时我们绝不会止步于此，

A much more powerful approach to public health --

随后将是在公共卫生领域更为强有力的尝试。

imagine what might be possible.

请大家想象一下它所可能带来的无限可能。

Why couldn't we more effectively tackle malnutrition?

营养不良将不再是问题。

Why wouldn't we prevent cervical cancer in women?

宫颈癌也将不再是问题。

And why not eradicate malaria?

疟疾的根除将同样不再是问题。

(Applause)

（掌声）

Yes, clap for that!

没错，请为这一切鼓掌！

(Applause)

（掌声）

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

现在你们能了解到，我所生活的两个不同的世界，

one world populated by scientists,

其中一个都是科学家，

and another world populated by public health professionals.

另一个则都是公共卫生领域的专家。

The promise of precision public health

精准公共卫生成功的关键

is to bring these two worlds together.

就在于它们的相互融合。

But you know, we all live in two worlds:

但同时你们也要明白，我们都活在另外两个世界中：

the rich world and the poor world.

富人的世界和穷人的世界。

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

而在这两个相距甚远的世界之间架起桥梁

is bridging these two worlds.

则是我对于精准公共卫生制度最为激动的部分。

Every day in the rich world,

就像在富人世界的每一天里，

we're bringing incredible talent and tools --

我们都以我们的需求为转移

everything at our disposal --

调动出色的人才和工具

to precisely target diseases in ways I never imagined

来以我从未想过的方式

would be possible.

精确地锁定疾病。

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

当然，我们可以深入地去挖掘相关领域的人才和工具

to stop babies dying in the poor world.

来阻止在贫困世界中婴儿的夭亡。

If we did,

如果我们真能够做到，

then every parent would have the confidence

那么每一位父母都将能够拥有

to name their child the moment that child is born,

在他们的孩子出生的那一刻就给予他们名字的信心，

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

更能有勇气以数十年为单位去希冀孩子的未来，

not days.

而不是仅仅以天数去衡量婴儿的寿命。

Thank you.

谢谢。

(Applause)

（掌声）