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

譯者: Lilian Chiu 審譯者: Helen Chang

Here's a classic thought experiment

以下是個經典的思想實驗， 其設計的目的是

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

要騙你的大腦去做遠程思考，

and getting out of the daily news cycle.

脫離每日新聞的循環。

And it goes like this:

內容是這樣的：

if a newspaper came out once a century,

如果報紙是一世紀才發行一份，

what would the front page banner headline be?

頭版頭條新聞會是什麼？

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

「我們打敗了納粹」、 「登陸月球」，或「網路誕生」？

or "built the Internet"?

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

我認為，頭條會是 關於一個數字的報導，

maybe the most elemental measure of progress that we have.

也許是我們測量進步用的指標 當中最根本的一個。

Life expectancy at birth.

出生時的預期壽命。

The length of time

在給定地點和時間的 條件下，一般人可以

that the average person can expect to live

in a given place at a given time.

預期自己會活多長的時間。

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

一百年前，根據我們能做到的測量，

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

全球平均壽命是三十五歲左右。

Today, it's just over 70.

現今，超過七十歲。

So in one century,

所以，只花了一世紀，

we doubled global life expectancy.

我們就將全球預期壽命加倍了。

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

用地理的方式來看看預期壽命，

可以參考這張圖，這些地圖。

take a look at this image, these maps.

This is data courtesy of the great organization,

感謝《用資料看我們的世界》 這個很棒的組織提供的資料。

Our World in Data.

This is the world in 1950.

這是 1950 年的世界。

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

藍色標示的是預期壽命 超過七十歲的國家。

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

各位可以看到，就只有 北歐五個國家而已。

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

紅色標示的是預期壽命 低於四十五歲的國家。

It's about a third of the planet.

大約佔地球的三分之一。

So fast-forward to more recent history.

快轉一下，

到更近期的歷史，2015 年，

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

預期壽命超過七十歲的藍色國家。

Look at all that life.

看看那些壽命。

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

還有低於四十五歲的紅色國家。

There's no red on the map

地圖上沒有紅色，因為各國的 預期壽命皆高於四十五歲。

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

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

事實上，連低於 六十歲的國家都沒幾個。

This is an extraordinary achievement.

這是非常不凡的成就。

And you'll sometimes hear people say

有時候會聽到有人說，

that life expectancy and this kind of progress

預期壽命和這種進步 其實只是統計上的幻覺。

is actually just a statistical illusion.

That we got better at reducing infant mortality,

我們只是更能降低嬰兒的死亡率，

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

但其他人的生命沒有太大的不同。

And it is true that infant mortality has been dramatically reduced

的確，在過去一百年間，

嬰兒死亡率大大減低了。

over the last hundred years.

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

但實情比那樣的說法 還要豐富、緊張許多，

If you take a look at this early infographic

請看看這張早期的資訊圖表，

by the great Victorian statistician

其作者是維多利亞時代的 偉大統計學家威廉·法爾，

William Farr,

which is attempting to show mortality rates by age group

這張圖想要呈現出 1840 年代初倫敦

in London in the early 1840s.

不同年齡層的死亡率。

I find something incredibly heroic about this chart.

我認為這張圖有非常了不起的地方。

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

這個傢伙沒有電腦，

沒有網路，沒有試算表，

trying to do something that is incredibly hard

卻試著去做非常困難 但非常重要的事。

and incredibly important.

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

他在試圖研究大城市中的 整體生死模式，

trying to make sense of what is going on.

試圖合理解釋發生的現象。

And what the chart reveals

這張圖揭露出

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

兒童的死亡人數多到可說 很悲慘，不只是嬰兒，

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

還有五歲孩子和十歲孩子， 死亡率都很讓人擔憂。

are dying at an alarming rate.

But almost nobody makes it to 85 or 90.

幾乎沒有人以活到 八十五歲或九十歲。

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

且有一半以上的人口

活不過四十五歲。

How many people in this room are older than 45?

在座有多少人超過四十五歲？

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

對吧？想想看，你們 有一半都不會在這了。

We talk about optimism.

我們會說樂觀主義。

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

那就是好消息的 最基本形式。（笑聲）

(Laughter)

You are not dead. Right?

你沒死，對吧？（笑聲）

(Laughter)

So I want to stress here

在此我想要強調

that this good news is not uncomplicated.

這種好消息並不簡單。

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

一百年前，

地球上只有不到二十億人。

現在有近八十億，且還在增加中。

Today there's almost eight billion and counting.

And we have that runaway population growth

人口成長失控，

not because people started having more babies,

並不是因為大家開始生比較孩子，

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

而是因為大家不再死亡，

多個世代疊加起來。

And we have problems like climate change

還有像氣候變遷這些問題，

because of these underlying trends as well.

也是這些背後的趨勢所造成。

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

如果我們一直維持著 1920 年的死亡率，

we wouldn't have anywhere near the magnitude

我們根本不會遇到現在 面臨的嚴重氣候危機，

of the climate crisis we're facing now

因為地球上的這些人數所排放到

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

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

大氣中的碳量根本 不足以造成什麼差別。

In a weird sense, climate change

在某種奇怪的意義上，氣候變遷

is the unintended consequence of industrialization

是工業化和越來越長壽的

未預期結果。

and increased longevity.

所以，這些多出來的壽命

So all this extra life is a mixed blessing,

和所有如此重大的改變一樣， 都是種混雜的福氣。

like any change this momentous.

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

但，

我想強調的不只是我們做到了，

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

我認為更有趣的問題是， 我們怎麼做到的？

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

這是我過去幾年間著迷的 主題，我都在研究這些，

that's the investigation I've been on,

我試圖想要找出是哪些主要因子 在推動如此重大的改變。

trying to figure out what are the prime movers

when we see change this momentous.

What is really driving that change?

是什麼在驅動這改變？

And I think we should say,

我想，應該可以說， 以世界的狀況而言，

given everything that's happening in the world,

我們應該要點出，

we should point out that, you know,

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

其中一個主要的推動因子， 我們應該到屋頂大喊出來，

is vaccines.

就是疫苗。

Right? We doubled --

對吧？我們加倍了—— （掌聲）沒錯，對吧？

(Applause)

Yes, right?

Thank you.

謝謝。疫苗不是我發明的， 所以很謝謝掌聲。

I did invent vaccines, so I appreciate that.

(Laughter)

（笑聲）

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

我的意思是，從天花， 到小兒麻痺、流感、

肺結核、麻疹，和新冠肺炎，

I mean, if we celebrated the eradication of smallpox

如果我們用慶祝登月的方式

the way we celebrate the moon landing,

來慶祝天花的根除，

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

現在世界上對疫苗的 疑慮就會少很多。

But I also think it's a mistake

但我也認為不應該只關注

to focus exclusively on the march of science

科學的進展以及實質的物體，

and the kind of tangible objects,

like vaccines and antibiotics or X-rays.

比如疫苗、抗生素，或 X 光。

And to explain what I mean by that,

為了解釋我的意思，

I think it's useful to look at the story

我認為可以先了解

這個故事：我們如何克服

of how we conquered one of the most terrifying threats

十九世紀最駭人的威脅之一。

of the 19th century.

Milk.

牛奶。

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

我們認為牛奶是健康和活力的象徵。

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

但事實，在十九世紀中，牛奶 對健康的威脅很大，特別是孩子。

milk was a serious health threat, particularly to children.

We had no mechanical refrigeration

我們沒有機械式的冷凍， 所以會有很多變質的問題。

and so there was a lot of spoilage problems.

People could get tuberculosis from milk.

牛奶會讓人染上結核病。

They figured out this thing for urban cattle

他們發現了這件事， 不能餵都市的牛吃草，

where they couldn't feed them grass

so they would feed them slop from whiskey distilleries --

所以他們餵牛吃威士忌 釀酒廠來的流體食物——

instead of grass, brilliant idea --

取代草，很聰明的點子——

which produced this kind of blue-tinted milk

會擠出很危險的藍色 牛奶，稱為餿牛奶。

that was very dangerous, called swill milk.

In 1850,

1850 年，

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

根據記錄，紐約市的死者 有一半以上是孩童，

many of them killed by contaminated milk.

許多是因為受污染的牛奶而死。

And look, I know what you're thinking.

我知道你們在想：

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

「我知道我們是怎麼解決 這個問題的。用科學！

We solved it with science.

We solved it with chemistry."

用化學來解決！」

Right? I mean, the solution is so famous.

對吧？解決方法很有名。

It's sitting there printed on every carton of milk

就在那裡，印在全國每一間雜貨店的

in every grocery store in the country, right?

每一盒牛奶上：巴氏殺菌。

Pasteurization.

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

但其實，巴氏殺菌的故事

是在科學限度內的個案研究，

because Louis Pasteur came up with his technique for sterilizing milk

因為路易斯·巴斯德想出這種

牛奶殺菌技巧的時間是 1865 年，

in 1865,

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

但殺菌的牛奶直到 1915 年

on American grocery stores’ shelves until 1915,

才成為美國雜貨店架上的標準商品，

a full 50 years later.

整整五十年後。

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

那是因為科學和化學

本身並不夠造成有意義的改變。

to make a meaningful change.

You also needed persuasion.

還需要說服力。

You had to convince people to drink pasteurized milk,

你得說服大家

去喝殺菌的牛奶，你得說服 乳業製造殺菌的牛奶，

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

and that took a whole other cast of characters.

做這些事需要的特質全然不同。

It took muckraking journalists.

需要專門爆料的記者。

It took crusading lawmakers.

需要有鬥爭精神的立法者。

There was a whole subculture of pasteurization activists back then.

在當時，殺菌活動家 還有完整的次文化。

Maybe the most unlikely one was a department store magnate

最讓人想不到的可能是

一位百貨業巨擘，內森·史特勞斯，

named Nathan Straus,

who got obsessed with the pasteurization cause

他迷上了這個殺菌的理念，

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

在紐約市各處成立牛奶站，

where pasteurized milk was sold at cost

按成本價將殺菌的牛奶銷售

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

給低收入居民， 讓他們能喜歡上牛奶。

So in a sense, the way to think about it

所以，在某種意義上， 可以想成巴斯德解決了

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

這個問題的化學層面，

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

史特勞斯和他的盟友解決了 這個問題的社會層面。

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

兩個面向都需要， 才能造成大規模的影響。

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

還有一個我們不夠 強調的主要推動因子，

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

在顛覆性創新的情境中 似乎不太可能出現，

and that is large bureaucratic institutions.

那就是大型官僚制度。

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

如果你覺得很矛盾， 我建議你快速翻閱一下任何

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

二十世紀初期的藥品型錄。

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

這些東西只是

一張冗長的致命毒物清單， 一項接著一項：砒霜、

one after another:

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

水銀、顛茄，更不用說 還有海洛英和古柯鹼。

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

許多醫學史學家認為

什麼都有的綜合藥物 對人類健康只有淨負值的影響，

were a net negative in terms of human health

until the invention of antibiotics in the 1940s.

直到 1940 年代 抗生素被發明出來。

That's what life was like.

當時生活就是這樣。

And in 1937, there was this Tennessee pharma startup

1937 年，

有一家田納西州的新興藥品公司，

that hit upon this idea for a new cough syrup,

偶然想出了新咳嗽糖漿的點子，

a cure for strep throat actually, targeted at children.

可以治療鏈球菌性喉炎，

目標對象是孩童。

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

當時，有一種新藥叫做磺胺藥，

that were kind of a forerunner of antibiotics.

算是抗生素的前身。

But they were generally packaged in this bulky pill format,

但它們通常是做成大型藥丸的形式，

very difficult for kids to swallow.

孩童很難吞嚥。

So a chemist at this startup

這間新興公司的一名化學家 想出了一個聰明的點子，

came up with the brilliant idea of dissolving the sulfa drug

把磺胺藥溶解在二甘醇中，

in diethylene glycol

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

接著加上一點覆盆子口味， 讓孩童覺得更美味。

Seemed like a brilliant idea,

似乎是很聰明的點子，

except that diethylene glycol is toxic to human beings.

除了一點，二甘醇對人是有毒的。

It's basically antifreeze.

基本上，它是防凍劑。

And so almost immediately, weeks after,

所以，幾乎是馬上，幾週後，

there were dozens of deaths around the United States

美國各地有數十人 因這可怕的調劑方式而死，

from this terrible concoction,

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

瘋狂的是，把二甘醇加到你的藥物中

was not a problem,

並不是問題，

given the existing regulations of the day.

當時既有的法律並沒有規範。

The only thing that the FDA was really interested in

食品及藥物管理局（FDA） 只對一件事感興趣：

was whether you were actually listing

你有沒有確實把藥劑的成份列出

the ingredients of your potion on the label.

在標籤上。

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

若你想把防凍劑加到 咳嗽糖漿中，請自便，

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

只要有把成份列在標籤上即可。 當時的生活是這樣的。

That's what life was like.

But because of this tragedy, laws were changed.

但因為這場悲劇，法律被修改了。

And for the first time, the FDA mandated

這是史上頭一次，FDA 強制要求

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

藥品公司必須要說明 其藥品對消費者無害，

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

這很明顯是該規定的， 但還得靠某人想出來。

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

我們當時所需要的不只是

某種新的奇蹟藥品。

We needed new institutions.

我們需要新制度。

We needed new medi-innovations,

我們需要新的醫療創新，

like three phase trials

比如三期臨床試驗， 以及隨機對照（控制）實驗，

and randomized controlled experiments,

and regulatory bodies, like the FDA,

以及管理機關， 如食品及藥物管理局，

to separate out the fake cures from the real thing.

協助區別假藥和真藥。

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

那種制度創新

在接下來的數十年會越來越重要，

in the decades to come,

because all around the world right now,

因為，現在世界各地

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

都有資金充足的科學家和厲害的實驗室

on tackling the problem of aging itself.

在努力處理老化這個問題本身。

I mean, currently the outer boundary of human life

目前，人類壽命的外在界限

is somewhere around 110 and 115.

約為一百一十到一百一十五歲。 很難活過這歲數。

It's very hard to live past that.

But there is serious research out there

但有很重要的研究指出，

that suggests that we can just blow past that boundary

我們可以突破那界限，

and live for decades longer, maybe even indefinitely.

再多活數十年，甚至無限期活下去。

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

我並不是說會發生這種事， 但已經有人公開在討論。

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

重點是，如果我們真的做了，

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

那會是人類史上 最重大的改變，對吧？

Initially, it would intensely --

一開始，它會大大地——

increase the health inequalities in the world

增加世界上的健康不平等，

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

因為最初只有富人 負擔得起這種治療。

它會嚴重加劇已經 失控的人口成長問題，

It would greatly exacerbate our runaway population growth problem

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

它也會從根本上改變

人類生命弧線的定義。

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

若去問別人，你覺得我們 應該去亂搞永生不死嗎？

ordinary people, most of them say no.

大部分的一般人會說「不」。

But the problem is we don't have collectively

但，問題是，我們集體並沒有

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

一個決策機關能協助我們處理

這麼巨大的改變。

We're like the FDA back in 1930,

我們就像 1930 年的 FDA， 請自便，去製造永生藥吧。

like, go ahead and make your immortality pill.

Just make sure the ingredients are right on the label.

別忘了把成份列在標籤上就好。

那就是我們的現況。

That's where we are.

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

所以，我們需要的創新是

在監督和決策層級的創新，

and decision making,

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

我認為，如果我們努力， 是可以做到這些創新的。

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

我們都知道，規定管過頭是個問題。

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

所以我們要把決策機關設計成

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

對危險以及未預期的結果 都有足夠的敏感度，

but also genuinely open to the possibilities.

還要能真正開放接受各種可能性。

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

但我認為

我們不用那麼著重無限延長壽命，

and more on reducing the gaps that remain in health outcomes

可以多專注在減少

這裡及世界各地 仍然存在的健康結果落差。

here and around the world.

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

畢竟，看看我們過去 一年半經歷了什麼，

平均而言，白種美國人

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

在 2020 年失去了一年的預期壽命，

thanks largely to covid.

主要歸功於新冠肺炎。

African Americans lost three years.

非裔美國人失去了三年。

And we should be focusing on reducing the gap

我們應該專注在減少所謂 健康期和生命期之間的落差。

between what we call health span and lifespan.

The amount of time that we spend

健康期指的是我們基本上很健康

that is fundamentally healthy and full capacity.

且能力健全的那段時期。

I think we all agree that these are problems

我想，大家都認同， 這些都是值得解決的問題，

that are worth solving

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

而現在我們有可以任意 使用的工具來解決它們。

If the first great revolution in human health

如果人類健康的第一次重大革命

是延長人類的整體平均壽命，

was extending the overall average human life,

the second should be about closing the gaps.

那第二次革命則應該和縮小落差有關。

Thank you very much.

非常謝謝。

（掌聲）

(Applause)