What Americans agree on when it comes to health | Rebecca Onie

翻译人员: jacks peng 校对人员: Tianji (Homer) Li

Today, we are a country divided,

今天，我们是个分裂的国家，

or at least that's what we're told.

或者至少这是我们被告知的。

We are torn apart by immigration, education, guns

我们被移民，教育， 枪支和医疗保健

and health care.

弄得四分五裂。

Health care is ugly and it is loud,

医疗保健是丑陋和喧嚣的，

so loud that it threatens to drown out everything else.

喧嚣到淹没其他一切。

(Voice-over) Protesters: Health care is a human right! Fight, fight, fight!

抗议者：医保是人权！战斗，战斗，战斗！

抗议者：嘿，吼，奥巴马医保必须得走。

Protesters: Hey hey! Ho ho! Obamacare has got to go!

Rebecca Onie: But what if underneath all the noise,

但如果在噪声之下，

we're not divided?

我们没有分裂？

What if the things that we don't ask about

如果我们没有问的问题

are the things that we most agree upon?

是我们最广泛同意一致的事情呢？

It turns out that when we ask the right questions,

其实当我们问正确的问题时，

the answers are startling,

答案是惊人的，

because we agree, not on health care, but on something more important:

因为我们意见一致的，并非在医保上， 而是在更为重要的事情上：

we agree on health.

我们在健康问题上一致。

For 20 years, I've been obsessed with one question:

20多年来，我一直着迷于一个问题：

What do we, what do all of us need in order to be healthy?

我们需要怎样，我们所有人 需要什么才能保持健康？

As a college student in 1995,

1995年我还是个大学生时，

I spent months talking to physicians at a chaotic hospital in Boston,

我花了几个月的时间和波士顿 一家混乱医院的医生交谈，

asking them, "What's the one thing your patients most need to be healthy?"

问他们：“你的病人保持健康 最需要的一件事是什么？”

They shared the same story again and again,

他们分享了同样的故事一次又一次，

one that I've heard hundreds of variations of since.

自那之后，我听到了上百个 不同版本的变化。

They say, "Every day I see a patient with an asthma exacerbation,

他们说：“每天我看到哮喘的病人，

and I prescribe a controller medication.

就给他们开控制药物。

But I know she is living in a mold-infested apartment.

但我知道她住在一间 人满为患的公寓里。

Or I see a kid with an ear infection, and I prescribe antibiotics,

或者我看到一个耳朵感染的孩子， 我给他开了抗生素，

but I know there is no food at home.

我知道他家里缺乏食物。

And I don't ask about those issues, because there's nothing I can do."

我并不会问这些问题， 因为我无能为力。”

Now, it seemed that it shouldn't be so complicated

现在，看起来设计个医生的访问

to design a doctor's visit around what people actually need to be healthy.

去了解人们要保持健康需要什么并不复杂。

So I created Health Leads,

所以我创建了健康领导者，

an organization enabling thousands of physicians and other caregivers

用这个组织让成千上万 的医生和其他护理人员

to ask their patients,

去询问他们病人，

"What do you need to be healthy?"

“你需要什么来保持健康？”

and then prescribe those things --

然后给他们开这些东西——

fruits and vegetables, heat in the winter,

水果和蔬菜，冬天供暖，

electricity to refrigerate their medication --

制冷保鲜药物的电力——

and we then navigated patients to those resources

然后我们引导病人到他们社区

in their communities.

的这些资源。

The model works.

这个模式有效。

A Mass General Hospital study found that navigating patients to essential resources

麻省总医院的一项研究发现， 将病人引导到必要的资源

is associated with improvements in blood pressure and cholesterol levels

与血压和胆固醇水平的 改善相关，

similar to introducing a new drug,

相当于引入新药物的效果，

but without all the side effects.

而且没有任何副作用。

So two decades later, what's changed?

那么20年后，什么改变了？

It's now widely recognized that just 20 percent of health outcomes

现在人们普遍认为只有20%的健康结果

are tied to medical care,

跟医疗保健相关，

whereas up to 70 percent are tied to healthy behaviors

而高达70%与健康行为

and what's called the social determinants of health --

和被称为社会决定因素 联系在一起——

basically, everything that happens to us for that vast majority of time

基本上，我们绝大多数 时间发生的一切

when we're not in the doctor's office

都不在医生的办公室

or the hospital.

或者医院中。

Health care executives now routinely remind us

卫生保健主管们现在 经常提醒我们，

that our zip code matters more than our genetic code.

我们的邮政编码比我们的 遗传密码更重要。

And one health care publication even recently had the audacity

最近有一份卫生保健 出版物大胆地

to describe the social determinants of health

将健康的社会决定因素描述为

as "the feel-good buzzword of the year."

“年度让人感觉良好的流行词”。

Now, there's been some action, too.

现在，人们也已经有所行动。

Over the past decade, six major health care providers and insurers

在过去几十年，6家主要医疗保健 提供商和保险公司

have committed over 600 million dollars

已经投入超过6亿美元

到可负担得起的住房，

to affordable housing,

recognizing that it reduces infant mortality

意识到它可以减低 婴儿死亡率

and increases life expectancy.

并增加预期寿命。

But let's be honest.

但让我们坦诚说。

Is our 3.5 trillion dollar health care system

我们那3.5万亿医药保健系统

fundamentally designed to create health?

根本上是为了创造健康吗？

Absolutely not.

绝对不是。

Take access to healthy food.

拿获取健康食品来讲。

Not long ago, a teenage boy shows up at a hospital in Baltimore,

不久前，一个十多岁的小孩 出现在巴尔的摩一家医院，

losing weight.

身体消瘦。

Just as his doctors are huddled up figuring out which metabolic panels

就在医生聚在一起想要搞清楚 要进行哪些代谢功能检验

and blood tests to run,

和血液测试时，

one of my colleagues asks out loud,

我一个同事大声询问，

"Do you think he might be hungry?"

“你们认为他可能是饿了吗？”

It turned out that this kid had been kicked out of his housing

原来结果是这个孩子 被赶出了他的房子

and literally hadn't had a meal in weeks.

并且几周没吃过饭了。

He said he was "... so relieved that somebody finally asked me."

他说他“终于放心了， 有人问我了”

Somehow, we've created a health care system

曾经，我们创建了 一个医疗保健系统，

where asking a patient "Are you hungry?"

这个系统中会询问 病人：“你饿了吗？”

is so far outside the bounds of what counts as health care

这个问题目前不在医疗 保健的范畴之内，

that we mostly fail or forget to ask altogether;

以致我们大部分都不会或忘记发问；

where doctors lament a hospital's "no third sandwich policy,"

那里医生会哀叹医院 “没有第三块三明治政策，”

meaning that if you're a hungry patient in the ER,

意味着如果你是个急症室的 饥肠辘辘的病人，

you can have only two free sandwiches,

你只能有两块免费的三明治，

but as many MRIs as the doctor orders;

但遵循医嘱的核磁共振成像可没少；

where, in 2016 in the state of Texas,

2016年的德克萨斯州，

they spent 1.2 billion dollars on the medical costs of malnutrition

他们在营养不良的医疗上 花费了12亿美元

instead of on access to healthy food;

而不是提供健康的食物；

where a Centers for Medicare and Medicaid Services program

医疗保险和医疗补助服务中心

对饥饿的病人分门别类，

stratifies hungry patients,

so that some get access to food and some get information about food,

这样一些人可以获得食物， 一些人则获得食物的信息，

with the justification that doing nothing for hungry patients

不为饥饿病人做任何事情的理由

is standard and usual care in this country.

是这个国家标准和 通常的护理方式。

And that's just food.

而且这还只是食物。

The same is true for housing, electricity ...

同样的情况也存在于居住，电力…

The bottom line is, health care may be changing,

不论怎样，医疗保健可能在改变，

but not by enough and certainly not fast enough.

但还不够而且显然不够快速。

We ask the wrong questions of our doctors, of our patients,

我们对我们对医生， 我们的病人，

but also of our citizens.

还有我们的公民问了错误的问题。

We ask about and argue about health care,

我们询问并争论医疗保健问题，

but how do voters think about health?

但选民们是如何思考健康的呢？

No one could tell us the answer to that question,

没人能够告诉我们 这个问题的答案，

so we launched a new initiative

于是我们采取了新行动

and hired a polling firm to ask voters across the country:

去雇佣一个投票公司询问 全国选民的意见：

What do you need to be healthy?

你需要什么来保持健康？

What was so striking about this was that no one has any clue

最令人震惊的是没人知道

what we are talking about in health care.

我们在医疗保健方面谈的是什么。

Voters do not think the social determinants of health

选民们并不认为健康的社会决定因素

is a feel-good phrase.

是个让人感觉良好的说法。

They actually hate it.

他们其实讨厌它。

"What uneducated person came up with that language?"

“哪个没受过教育的人想出这个词语？”

one of the voters said.

其中一个投票者说。

Or my favorite was the guy who said,

或者我最喜欢的那个说：

"You're killing me."

“你让我感觉太糟了。”

But when you strip away all the ridiculousness

但当你抽掉我们关于 医疗保健语言中

of our language in health care,

那些荒谬之处后，

we know exactly what creates health.

我们确实知道什么构建了健康。

So take Charlotte, North Carolina.

就拿北卡罗来纳州的夏洛特来说。

We had two focus groups,

我们有两个焦点小组，

one of African American Democratic women and one of white Republican women.

一个非裔美国民主党女性和 一个白人共和党女性。

And we asked them, "If you had a hundred dollars,

我们问他们，“如果你有100美元，

how would you spend it to buy health in your community?

你会如何在你的社区中购买健康？”

Turns out, they agree nearly to the last percentage point.

结果，她们的意见基本非常一致。

First, they agree that health care only sort of impacts health.

首先，她们认为医疗保健 只是影响健康的一种。

So they choose to spend the majority of their dollars

所以她们选择把大部分钱花在

outside of hospitals and clinics.

非医院和诊所方面。

And second, they agree on what creates health,

其次，她们对构建健康的因素一致，

spending 19 percent on affordable housing

花19%的钱用于支付住房

还有大约25%花在获取健康食物上面。

and about 25 percent on access to healthy food.

So I am sure you are thinking, "This has got to be a fluke."

我确定你们在想，“这侥幸获得罢了”

But it's not.

但并不是这样。

White and Latino male swing voters in Seattle,

西雅图的白人和拉丁裔 男性中间选民，

white and African American Democratic voters in Cleveland,

克利弗兰的白人和 非裔美国民主党选民，

white male Republicans in Dallas,

达拉斯的白人男性共和党人，

low-income white Democrats in Hendersonville, North Carolina:

北卡罗来纳州亨德逊维尔的 低收入白民主党人，

their answers are strikingly similar,

他们的答案惊人地相似，

with all of them choosing to spend more money

她们都选择把更多的钱

on healthy food and safe housing

花在健康食物和安全居住上面，

than they would on hospitals and health centers.

而非医院和健康中心上。

When you ask the right questions,

当你问了正确的问题，

it becomes pretty clear:

这就变得非常清楚：

we may be fractured on health care in this country,

我们可能在这个国家的 医疗保健上支离破碎，

but we are unified on health.

但我们在健康方面是一致的。

The thing that I've been struggling with is why.

我一直在纠结的是为什么。

Why do we agree on health?

为什么我们在健康方面意见一致？

We agree on health because it is common sense.

我们对健康意见一致 是因为这是常识。

We all know that the things we need to get healthy --

我们全都知道对我们健康重要的东西——

medicine and medical care --

药物和医疗保健——

are not the things we need to be healthy,

不是我们保持健康需要的东西，

to not get sick in the first place.

是一开始就不生病。

But we also agree because of common experience.

但因为共同的经验我们也同意。

In a study of 5,000 patients,

在对5千位病人的一项研究中，

24 percent of the patients with commercial health insurance --

24%的病人有商业医疗保险——

meaning, they had a job --

这意味着，他们有工作——

still ran out of food or struggled to find housing or transportation

但他们仍然缺乏食物或者 很难找到住房或者交通

or other essential resources.

或者其他重要的资源。

Twenty-four percent.

24%。

And we saw the same thing in our focus groups.

我们也在我们的焦点小组中 看到同样的事情。

Nearly every voter knew what it meant to struggle,

几乎每个投票人都知道 挣扎意味着什么，

either themselves or their families

不是他们自己就是他们家人

or their neighbors.

或者他们的邻居。

One of those white Republican women in Charlotte was a waitress

其中一位夏洛特的白人 共和党女性服务员

struggling to stay awake with an enormous Big Gulp soda.

用一大杯苏打水努力保持清醒。

She just looked exhausted.

她看起来精疲力尽。

And she was.

她确实如此。

She told us that she worked two jobs

她告诉我们她打两份工作

but still could not afford a membership to the Y,

但仍然无法负担得起Y的会员，

but it was OK that she couldn't go to the gym, she said,

但她说，不能去健身房，这没问题，

because she also could not afford gas

因为她也支付不起油费，

and walked 10 miles to and from work

每天走10英里路

every single day.

上下班。

Listening to her, I felt this familiar panic rise in me,

听着她的描述，我感到熟悉 的恐慌在我心中升起，

the residue of my own childhood.

来自我童年的阴影。

When I was 10 years old,

当我10岁时，

my father lay on the living room floor

我父亲躺在客厅的地板上，

in the grips of one of his many depressions.

被抑郁笼罩着。

As I crouched next to him, he told me that he wanted to kill himself.

当我蹲在他旁边时， 他告诉我他想自杀。

My father lived,

我父亲活下来了，

but he struggled to work.

但他苦于工作。

And my family survived,

我的家人幸存下来，

but we teetered,

但我们摇摇欲坠，

down one paycheck,

靠着一份薪水，

relying on my mom's schoolteacher salary.

依赖我母亲学校的工资度日。

Even as a little kid, I knew we lived in the shadow

即便是个小孩，我知道 我们生活在

of financial and emotional collapse.

经济和情感奔溃的阴影中。

This is really hard to say,

这真的难以启齿，

because it's taken me 25 years to be honest with myself

因为我花了25年的时间 来对自己坦诚

that this is why I do this work:

这就是我做这个工作的原因：

knowing that my father needed health care to recover,

知道我父亲需要 医疗保健来恢复，

but to be healthy, my family needed something else,

但要保持健康，我家人 还需要其他东西，

we needed a decent income;

我们需要一份体面的收入；

and knowing, as so many do more than I,

还知道，就如很多人更能体会的，

that panic when the basics threaten to slip away.

那种对基本的东西 要溜走时的恐慌。

To the voters in our focus groups, the solutions were straightforward.

对我们焦点小组的选民来说， 解决方案很简单。

As one of those white Republican women in Charlotte said,

就像夏洛特的一位白人 共和党女性说的，

"Instead of putting all this money into health care,

“与其把所有钱都投在医疗保健，

put it into affordable housing.

不如投一些到可负担的住房中。

You know, like, take it and distribute it differently."

就像，拿着它，用不同的 方式来分配它。”

It turns out that when you have the right language

结果表明当你有了 正确的沟通语言，

and you ask the right questions,

你问了正确的问题，

the answers become remarkably clear

答案变得明显清楚

and unanimous.

和一致。

What we know is that, despite all the noise,

我们知道的是，尽管有 所有这些噪音，

the plan for health care in this country

这个国家的医疗保健计划

is that there is no plan.

就是没有一个计划。

But we have something more powerful than any politician's bill,

但我们有比任何政治家的法案、

any candidate's platform,

任何候选人平台、

any think tank's policy statement.

任何智囊团的政策声明 更强大的东西，

We have our common sense and our common experience.

我们有我们的常识 和我们的共同经历。

So I ask, if you are a health care executive:

所以我问，如果你是 医疗保健主管：

Do you know how many of your patients run out of food

你知道你有多少病人缺乏食物

or struggle to pay the rent at the end of the month?

或者月底付不起租金吗？

Is that data on your scorecard,

这个数据在不在你的计分卡上，

shaping your business and your bonuses?

影响你的事业和奖金？

If you are a politician:

如果你是个政治家：

Will you continue to fight on the scorched earth of health care,

你会继续在医疗保健的 焦土上作战，

or will you act on what your voters,

还是你会为你的选民的 利益采取行动，

what Democratic and Republican voters alike,

为那些民主党和共和党 选民共同的，

already know,

已经知道的，

which is that good wages, healthy food and safe housing

即体面的薪水，健康的食物和 安全的居住环境

are health?

就是健康而行动？

And for the rest of us, for the citizens of this country:

对于我们其他人来说， 对于这个国家的公民来说：

Will we demand accountability to what we know to be true,

我们是否会要求对我们 所知的事实负责，

which is that our common sense,

那就是我们的常识，

our common experience,

我们的共同经历，

makes us the experts in what it takes to be healthy?

让我们成为健康专家？

This moment, as it turns out,

这一刻，事实证明，

is not about changing minds.

这无关改变思想。

It is about something more powerful.

这事关更强大的事情。

It is about changing the questions we ask

这事关改变我们问的问题

and quieting the noise to hear each other's answers.

和安静地听彼此的答案。

It is about the radical possibility that we the patients,

这事关根治的可能性， 我们病人，

we the physicians, we the caregivers,

我们医生，我们护理人员，

we the health care executives

我们医疗健康主管

and yes, even we the people,

还有甚至我们人民，

that we agree.

我们所一致同意的。

And it is now time --

现在是时候了——

in fact, long overdue --

其实，早该了——

for us to marshal the courage

让我们鼓起勇气

to hear those answers and to act upon them.

倾听这些答案并付诸行动。

Thank you.

谢谢。

(Applause)

（鼓掌，呐喊）