Steven Johnson: How humanity doubled life expectancy in a century | TED

翻译人员: 宇航 李 校对人员: Yanyan Hong

Here's a classic thought experiment

这是一个经典的思维实验，

that's designed to trick your brain into thinking long-term

旨在欺骗你的大脑，让你从长远考虑，

and getting out of the daily news cycle.

并从日常的新闻循环中脱离出来。

And it goes like this:

就像这样：

if a newspaper came out once a century,

如果说一份报纸一世纪只出版一次，

what would the front page banner headline be?

那么它的头版大标题会是什么呢？

“We defeated the Nazis,” or “landed on the moon,”

“们战胜了纳粹”，还是“成功登月”，

or "built the Internet"?

又或许是“互联网建立”？

I would argue that it would be the story of a single number,

而我认为头版会是 一个关于数字的故事，

maybe the most elemental measure of progress that we have.

或许是我们想要取得进步 最基本的方式，

Life expectancy at birth.

那就是出生时的预期寿命。

The length of time

我们所能预测的

that the average person can expect to live

每一个人的生存寿命

in a given place at a given time.

在给定的时间和地点。

One hundred years ago, as best as we can measure,

一百年以前，尽我们所能权衡，

the average global life expectancy stood somewhere in the mid 30s.

全球人均寿命大约在 35 岁上下。

Today, it's just over 70.

而今，人均寿命则超过了70岁，

So in one century,

因此在一个世纪里，

we doubled global life expectancy.

我们全球人均寿命翻了近一倍。

And to give a sense of what this looks like geographically,

并为了给人一种 像是从地理角度去观察的感觉，

take a look at this image, these maps.

看一看这张图片，这些地图。

This is data courtesy of the great organization,

数据由一个很好的组织提供，

Our World in Data.

叫做“数据看世界（Our World in Data）”。

This is the world in 1950.

这是 1950 年时的世界，

And in blue are the countries where life expectancy is more than 70.

而蓝色区域所指的是 那些人均寿命超过 70 岁的国家。

You can see it's just five countries in northern Europe. That's it.

你可以看到只有北欧 5 个国家 位于蓝色区域，仅此而已。

And in red, these are the countries where life expectancy is below 45.

而那些红色的区域则是 人均寿命低于 45 岁的国家。

It's about a third of the planet.

而这些国家的数量大约 占全球国家总量的三分之一。

So fast-forward to more recent history.

让我们快进到近代，

2015 -- in blue the countries where life expectancy is above 70.

在2015年——图中蓝色区块指的是 人均寿命超过 70 岁的国家。

Look at all that life.

看看所有地区的情况，

And in red, the countries where it's below 45.

而这些红色部分则是 人均寿命低于 45 岁的地区。

There's no red on the map

这张地图上没有红色的区域

because there are no countries where life expectancy is below 45.

那是因为没有任何国家的 人均寿命是低于 45 岁的。

In fact, there are very few where it's below 60.

事实上，地图上很少有国家的 人均寿命是低于 60 岁的，

This is an extraordinary achievement.

这是一项非凡的成就。

And you'll sometimes hear people say

有时候，你会听见一些人说到

that life expectancy and this kind of progress

预期寿命以及我们现在 所取得的这些进步，

is actually just a statistical illusion.

只是统计假象罢了。

That we got better at reducing infant mortality,

我们在降低婴儿死亡率方面做得更好了，

but the rest of our lives are actually not all that different.

但实际上，其余人的预期寿命 并没有和以往有太多的不同。

And it is true that infant mortality has been dramatically reduced

在过去一百年里，

婴儿的死亡率确实大幅下降。

over the last hundred years.

But the story is much richer and more intense than that.

但事情远比这要更加精彩、振奋。

If you take a look at this early infographic

如果你看了早期的信息图，

by the great Victorian statistician

由维多利亚时代伟大的统计学家——

William Farr,

威廉·法尔（William Farr）所绘制——

which is attempting to show mortality rates by age group

它试图显示不同年龄组的死亡率

in London in the early 1840s.

在 19 世纪 40 年代早期的伦敦。

I find something incredibly heroic about this chart.

我从这张图表上 发现了一些非常了不起的东西。

I mean, here's a guy without computers, without the Internet, without Excel,

我是说这个家伙他没有电脑， 没有网，没有办公软件，

trying to do something that is incredibly hard

却尝试着去完成这一极其困难

and incredibly important.

却极其重要的挑战。

He's trying to look at broad patterns in life and death in a great city,

他打算去研究一个大城市 出生与死亡的大致关系，

trying to make sense of what is going on.

并搞明白自己下一步要去做些什么。

And what the chart reveals

这个图表所展现的是

is that there is a tragic amount of death among children,

儿童的死亡数量是极其多的， 这让我们感到悲伤，

not just infants, but five-year-olds and 10-year-olds

而不仅仅是婴儿， 五岁和十岁左右的儿童

are dying at an alarming rate.

也正以令人惊恐的的速度死去。

But almost nobody makes it to 85 or 90.

可没有人几乎没有人 能够活到 85 或 90 岁。

And more than half of the population is dead by the age of 45.

超过半数的人口在 45 岁之前死亡。

How many people in this room are older than 45?

我们这间屋子里 有多少人的年龄是大于 45 岁的？

Right? And think about that: half of you would not be here.

对吧？想想看： 在座一半的人将不会在这儿。

We talk about optimism.

我们演讲的主题是“乐观”，

That is the most fundamental form of good news there is.

我想没有什么比这更好的消息了吧。

(Laughter)

（笑声）

You are not dead. Right?

你们没有死，对吧？

(Laughter)

（笑声）

So I want to stress here

我所要强调的是

that this good news is not uncomplicated.

这个好消息并不简单。

100 years ago, there were less than two billion people on earth.

百年以前，只有不到 20 亿的人类 生活在地球上。

Today there's almost eight billion and counting.

而现在快有 80 亿了， 并且数量在不断增加。

And we have that runaway population growth

我们的人口正在失控似的增长，

not because people started having more babies,

并不是因为出生率提高了，

but rather because people stopped dying and the generations stacked up.

而是因为人类的死亡率下降， 人类数量不断累积增加。

And we have problems like climate change

我们面临着很多问题， 比如说气候变化，

because of these underlying trends as well.

而人口数量增加也是这些问题的诱因。

If we had kept mortality rates where they were in 1920,

如果我们始终保持 1920 年的人类死亡率，

we wouldn't have anywhere near the magnitude

那么我们将永远不会

of the climate crisis we're facing now

面临像现在这么严峻的气候危机，

because there simply wouldn't have been enough people on the planet

因为人类数量少了， 将不会有那么多的人

to emit enough carbon into the atmosphere to make a meaningful difference.

在大气中排放大量的碳， 这将带来很大的改变。

In a weird sense, climate change

从某种奇怪的意义上来讲，气候变化

is the unintended consequence of industrialization

是工业化以及人类寿命延长

and increased longevity.

所带来的意外结果。

So all this extra life is a mixed blessing,

因此，世界上所有其他的生命 都是毁誉参半的，

like any change this momentous.

就像任何重大的改变一样。

But I want to stress not just that we did it,

但我想要强调的 并不仅仅是我们的所作所为，

but I think the more interesting question is how we did it.

我认为更加有趣的是 我们是怎样做到的。

That's what's been obsessing me over the last years,

过去那些年里，这个问题 也困扰了我很久，

that's the investigation I've been on,

这是我一直在进行的调查，

trying to figure out what are the prime movers

我试着去找出导致 这一结果的推动力究竟是什么，

when we see change this momentous.

这种推动力带来了极其重大的改变。

What is really driving that change?

真正推动这种改变的究竟是什么呢？

And I think we should say,

我想我们应该说，

given everything that's happening in the world,

既然事情都已经发生了，

we should point out that, you know,

我们就应该指出这一点，

one of those prime movers, which we should shout from the rooftops,

大家都知道，这其中一种推动力

is vaccines.

就是疫苗。

Right? We doubled --

对吧？我们人多了一倍——

(Applause)

（掌声）

Yes, right?

我说的没错吧？

Thank you.

谢谢。

I did invent vaccines, so I appreciate that.

我发明了疫苗，所以我很感激。

(Laughter)

（笑声）

I mean, for smallpox to polio, influenza, TB and measles, and covid.

我是说从天花到小儿麻痹症， 流感，结核病和麻疹，还有新冠病毒。

I mean, if we celebrated the eradication of smallpox

假如我们以庆祝登月成功的方式

the way we celebrate the moon landing,

来庆祝成功消灭天花这种疾病，

we would have a lot less vaccine hesitancy in the world right now.

那么我们就不会再去犹豫 到底要不要注射疫苗。

But I also think it's a mistake

但是我认为我们不应该

to focus exclusively on the march of science

完全地专注于科学

and the kind of tangible objects,

过于在乎那些可触摸到的事物，

like vaccines and antibiotics or X-rays.

比如说疫苗、抗生素或者 X 光片。

And to explain what I mean by that,

我将通过下面的例子来解释，

I think it's useful to look at the story

我觉得看看这个故事还是挺有用的

of how we conquered one of the most terrifying threats

讲的是人类如何克服 19 世纪最可怕的

of the 19th century.

那些威胁。

Milk.

牛奶。

Now, we think of milk as this kind of emblem of health and vitality,

当今，我们把牛奶当作 一种健康与活力的象征，

but in fact, in the middle of the 19th century,

可实际上，在 19 世纪中叶，

milk was a serious health threat, particularly to children.

牛奶曾为人们视作一种健康威胁， 对于孩子的威胁尤为明显。

We had no mechanical refrigeration

我们那时候没有机械冷藏技术，

and so there was a lot of spoilage problems.

所以那时候牛奶 时常存在变质的问题。

People could get tuberculosis from milk.

喝了牛奶以后，人们还会的肺结核。

They figured out this thing for urban cattle

人们后来从城市的奶牛身上 发现了这种疾病，

where they couldn't feed them grass

因为当时人们没有条件 给奶牛提供草食，

so they would feed them slop from whiskey distilleries --

就只好用威士忌酒厂的泔水喂他们——

instead of grass, brilliant idea --

而不是喂草，真是个高明的主意——

which produced this kind of blue-tinted milk

这也导致了奶牛生产出了 蓝色的奶水，

that was very dangerous, called swill milk.

这种牛奶叫做泔水奶， 是不能用来饮用的。

In 1850,

在 1850 年，

more than half of all the deaths recorded in New York City were young children,

有超过半数的纽约儿童死亡，

many of them killed by contaminated milk.

他们中很多都是因为 喝了这种受到污染才死去的。

And look, I know what you're thinking.

我知道你们在想些什么，

You're thinking, "I know how we solved this problem.

你们在想： “我知道我们是怎样解决这个问题的，

We solved it with science.

我们依靠科学解决了这个问题，

We solved it with chemistry."

我们凭借化学解决了这个问题。”

Right? I mean, the solution is so famous.

是这样的吗？人们采用了 一种很有名的方法去解决。

It's sitting there printed on every carton of milk

这种方法印在了全国每一个杂货店

in every grocery store in the country, right?

每一盒牛奶上，对吧？

Pasteurization.

没错，那就是“巴斯德氏杀菌法”。

But actually, the story of pasteurization is a case study in the limits of science

实际上，“巴斯德氏杀菌法” 是科学局限性的一个研究案例，

because Louis Pasteur came up with his technique for sterilizing milk

因为路易·巴斯德（Louis Pasteur） 在 1865 年发明了

in 1865,

消毒牛奶的方法。

but we didn't actually have pasteurized milk as a standard

直到 1915 年， 巴氏法消毒牛奶

on American grocery stores’ shelves until 1915,

才被美国杂货商店定为上市标准，

a full 50 years later.

这时已经整整过去了 50 年了。

And that's because science and chemistry on its own wasn't enough

因为科学和化学本身并不足以

to make a meaningful change.

促成有意义的改变。

You also needed persuasion.

你还需要去劝说别人。

You had to convince people to drink pasteurized milk,

你必须说服人们喝巴氏消毒牛奶，

you had to convince the dairy industry to make pasteurized milk,

你必须说服乳制工厂 去生产巴氏消毒牛奶，

and that took a whole other cast of characters.

你需要在这其中扮演不同的角色。

It took muckraking journalists.

这需要揭发丑闻的记者，

It took crusading lawmakers.

这需要勇于改革的立法者。

There was a whole subculture of pasteurization activists back then.

那时候有一群 反对巴氏杀菌的激进分子。

Maybe the most unlikely one was a department store magnate

而有一家百货公司的巨头， 绝对不与这些人为伍的公司老板，

named Nathan Straus,

名叫做施特劳斯，

who got obsessed with the pasteurization cause

他对巴氏消毒法情有独钟，

and he funded all these milk depots all around New York City

并资助了纽约市这些 储存巴氏消毒牛奶的仓库。

where pasteurized milk was sold at cost

这里的牛奶将会卖给

to low-income residents so that they would develop a taste for it.

那些低收入的居民， 这样子他们也会养成喝牛奶的习惯。

So in a sense, the way to think about it

从某角度上来讲，我认为

is that Pasteur solved the problem on the level of chemistry,

巴斯德是在化学层面上 解决了这些问题，

but Straus and his allies solved it on the level of society.

而施特劳斯和他们同伴 则在社会层面上去处理问题。

And you need both fronts to effect change on that scale.

你需要在两面都做出改变。

And there's another prime mover that we don't talk about enough,

另外一个因素 则是我们在这方面讨论的还不够，

which seems a little bit unlikely in the context of disruptive innovation,

在颠覆性的创新背景下， 我们似乎不太可能进行充分的讨论研究，

and that is large bureaucratic institutions.

官僚机构限制了我们的研究。

Now, if that seems contradictory to you, I suggest that you flip through the pages

如果这对你来说有点矛盾和突兀， 我建议你去翻翻书，

of any pharmaceutical drug catalog from the early 20th century.

翻翻 20 世纪早期的任何药品目录。

I mean, these things are just a laundry list of deadly poisons,

这上面写的都是一长串的毒物名称，

one after another:

一条接着一条：

arsenic, mercury, belladonna, not to mention all the heroin and cocaine.

砷、汞、颠茄， 更别提海洛因和可卡因了。

A lot of medical historians believe that all-in pharmaceutical drugs

很多研究医学历史的学者 都认为所有的药品

were a net negative in terms of human health

都对人的身体健康有负面的影响

until the invention of antibiotics in the 1940s.

直到 20 世纪 40 年代， 抗生素的发明才消除了这种影响。

That's what life was like.

生活就是这样。

And in 1937, there was this Tennessee pharma startup

在 1937 年，这家田纳西州的制药公司

that hit upon this idea for a new cough syrup,

研发出了一种新兴的咳嗽糖浆，

a cure for strep throat actually, targeted at children.

可用来治疗链球菌性喉炎， 适用于儿童使用。

At the time, there was a new drug called sulfa drugs

当时，有一种新药叫磺胺，

that were kind of a forerunner of antibiotics.

这种药正是抗生素的前身。

But they were generally packaged in this bulky pill format,

可那时，磺胺都只能装在 大个的药丸里面，

very difficult for kids to swallow.

咽下这些药丸对于孩子们来说非常困难。

So a chemist at this startup

因此一位化学家开始了新的尝试

came up with the brilliant idea of dissolving the sulfa drug

他想到了一个绝妙的主意， 让磺胺溶解

in diethylene glycol

在二甘醇里，

and then adding some raspberry flavoring to make it more palatable for the kids.

接着再加入树莓调味剂， 这让孩子们更加容易喝下口。

Seemed like a brilliant idea,

这看似一个绝佳的想法。

except that diethylene glycol is toxic to human beings.

然而二甘醇会 产生对人体有害的毒素，

It's basically antifreeze.

它的毒性基本上和防冻剂差不多。

And so almost immediately, weeks after,

所以几周后，

there were dozens of deaths around the United States

在美国，有很多的孩子 因为喝了这种糟糕的调制药剂

from this terrible concoction,

相继死亡，

and the crazy thing is that putting diethylene glycol in your medicine

更让我们感到诧异的是， 将二甘醇和药物放在一起

was not a problem,

在当时是被允许的，

given the existing regulations of the day.

鉴于那时候的现行法规。

The only thing that the FDA was really interested in

食品及药物管理局当时唯一关注的

was whether you were actually listing

那就是你有没有列出

the ingredients of your potion on the label.

药剂相应的成分标签。

So if you wanted to put antifreeze in your cough syrup,

所以如果你想把 助冻剂和咳嗽糖浆放在一起，

go ahead, as long as you list ingredients on the label.

只要你在药盒上注明就行，

That's what life was like.

生活那时就是这样。

But because of this tragedy, laws were changed.

但正是因为这场悲剧， 国家修改了相应的法律。

And for the first time, the FDA mandated

食品及药物管理局首次要求

the pharma companies show that their drugs were not harmful to consumers,

法尔诺德制药公司证明 他们的药物对消费者无害，

which seems kind of obvious, but somebody had to figure that out.

虽然似乎真相显而易见， 但还是要有人去找答案。

And so what we needed at that point was not just kind of new miracle drugs.

在那个阶段，人们真正需要的 并不仅仅是这么一款特效药，

We needed new institutions.

我们需要新的体系，

We needed new medi-innovations,

我们也需要新的医疗创新，

like three phase trials

像三期试验，

and randomized controlled experiments,

同时还需要进行随机对照试验，

and regulatory bodies, like the FDA,

以及监察机构， 例如食品及药物管理局，

to separate out the fake cures from the real thing.

这些机构能帮助我们 将假药和真药区分开，

And that kind of institutional innovation is going to be increasingly important

这种体系创新正变得愈发重要。

in the decades to come,

在未来的几十年里，

because all around the world right now,

因为在世界的各个角落，

there are well-funded scientists and serious labs that are working

都会有一些受资助的科学家在实验室里

on tackling the problem of aging itself.

注重于攻克这个日益严峻的难题。

I mean, currently the outer boundary of human life

目前，人们生活的外部边界

is somewhere around 110 and 115.

在 110 和 115 之间的某处。

It's very hard to live past that.

这要是在过去，人们是很难活下去的。

But there is serious research out there

但一项严谨的研究表明，

that suggests that we can just blow past that boundary

我是可以越过那条界限的

and live for decades longer, maybe even indefinitely.

并活得更久，甚至永远活下去。

I'm not saying this is going to happen, but it is on the table.

我并不是说这将会发生， 但已经提上日程了。

And the thing about it is, if we did do that,

问题是，如果我们真的做到了，

it would be the most momentous change in the history of our species, right?

这将会成为人类历史上 最重大的改变，对吧？

Initially, it would intensely --

首先，这将会极大程度上——

increase the health inequalities in the world

导致世界健康不平等，

because people could -- only rich people could afford these treatments originally.

因为最初只有富人 才能付得起这些治疗的费用。

It would greatly exacerbate our runaway population growth problem

这将会极大程度上加剧 人口失控增长的问题，

and it would fundamentally alter the definition of the arc of a human life.

它将从根本上改变 人们生活轨迹的定义。

And when you ask people, do you think we should mess around with immortality,

而当你问人们， 问他们是否追求永生，

ordinary people, most of them say no.

绝大多数的普通人都会说不。

But the problem is we don't have collectively

但问题是，我们整体上并不具有

a decision-making body that can help us wrestle with changes this immense.

一个能帮助我们应对 如此巨大变化的决策机构。

We're like the FDA back in 1930,

我们就像 1930 年的食品及药物管理局，

like, go ahead and make your immortality pill.

寻求制造出永生药的办法。

Just make sure the ingredients are right on the label.

我们只要确认 标签上的成分都正确就行，

That's where we are.

这就是我们在干的事情。

So the kinds of innovations we need are going to be on the level of oversight

因此，我们所需要的创新 是在监督层面上

and decision making,

以及决策层面上的。

and I think we can make these innovations if we if we work at it.

如果我们致力于此， 我认为我们可以实现创新。

Now, we all realize that regulatory overreach is a problem.

现在，我们都意识到、 过度管制是存在问题的。

So we're going to have to design decision-making bodies

我们必须得建立决策机构，

that are both sensitive to the dangers and the unintended consequences,

这种决策机构会对 危险和意外后果保持敏感，

but also genuinely open to the possibilities.

但也要真正接受各种可能性。

But to my mind, we should be focusing less on extending life indefinitely

但在我看来， 我们不应该过于关注如何延长寿命，

and more on reducing the gaps that remain in health outcomes

而应该着重缩小世界各国 在健康产出方面

here and around the world.

所存在的差距。

I mean, just look at what we've lived through in the past year and a half.

我是说，看看我们在过去 一年半的时间里经历了些什么。

On average, white Americans lost one year of expected life in 2020,

在 2020 年，白人的平均预期寿命 相较于前年减少了一年，

thanks largely to covid.

很大程度上都归咎于新冠疫情，

African Americans lost three years.

而美国黑人则减少了三年的寿命。

And we should be focusing on reducing the gap

我们应该着重去缩小差距，

between what we call health span and lifespan.

缩小我们所说的寿命之间的差距。

The amount of time that we spend

我们所花费的时间

that is fundamentally healthy and full capacity.

从根本上来将， 正是健康、充分的产能。

I think we all agree that these are problems

我想大家都认同我的说法：这些问题

that are worth solving

是值得解决的，

and we have the tools at our disposal right now to solve them.

而且我们现在也有 解决这些问题的工具。

If the first great revolution in human health

如果说人类健康第一次伟大的革命

was extending the overall average human life,

是延长人类平均寿命的话，

the second should be about closing the gaps.

那么第二次革命则将是 缩小寿命差距。

Thank you very much.

非常感谢。

(Applause)

（掌声）