美国人在健康的什么方面达成了一致观点 – Rebecca Onie

TED 精选 2018-12-16

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美国人在健康的什么方面达成了一致观点 - Rebecca Onie

丽贝卡·欧尼指出，或许我们的分歧并没有我们想象的大——至少在健康方面。欧尼分享的研究表明，尽管经济、政治和种族不同，美国人民对他们需要过上好的生活方面意见一致。她呼吁医疗保健供应方和病人应当专注于什么让我们健康，而非专注在让我们生气的事情上面。

00:00
Today, we are a country divided, or at least that's what we're told. We are torn apart by immigration, education, guns and health care. Health care is ugly and it is loud, so loud that it threatens to drown out everything else.
今天，我们是个分裂的国家，或者至少这是我们被告知的。我们被移民，教育，枪支和医疗保健弄得四分五裂。医疗保健是丑陋和喧嚣的，喧嚣到淹没其他一切。

00:20
(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！

00:24
Protesters: Hey hey! Ho ho! Obamacare has got to go!
抗议者：嘿，吼，奥巴马医保必须得走。

00:29
Rebecca Onie: But what if underneath all the noise, we're not divided? What if the things that we don't ask about are the things that we most agree upon? It turns out that when we ask the right questions, the answers are startling, because we agree, not on health care, but on something more important: we agree on health.
但如果在噪声之下，我们没有分裂？如果我们没有问的问题是我们最广泛同意一致的事情呢？其实当我们问正确的问题时，答案是惊人的，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：我们在健康问题上一致。

00:52
For 20 years, I've been obsessed with one question: What do we, what do all of us need in order to be healthy? As a college student in 1995, I spent months talking to physicians at a chaotic hospital in Boston, asking them, "What's the one thing your patients most need to be healthy?" They shared the same story again and again, one that I've heard hundreds of variations of since. They say, "Every day I see a patient with an asthma exacerbation, and I prescribe a controller medication. But I know she is living in a mold-infested apartment. Or I see a kid with an ear infection, and I prescribe antibiotics, but I know there is no food at home. And I don't ask about those issues, because there's nothing I can do."
20多年来，我一直着迷于一个问题：我们需要怎样，我们所有人需要什么才能保持健康？ 1995年我还是个大学生时，我花了几个月的时间和波士顿一家混乱医院的医生交谈，问他们：“你的病人保持健康最需要的一件事是什么？” 他们分享了同样的故事一次又一次，自那之后，我听到了上百个不同版本的变化。他们说：“每天我看到哮喘的病人，就给他们开控制药物。但我知道她住在一间人满为患的公寓里。或者我看到一个耳朵感染的孩子，我给他开了抗生素，我知道他家里缺乏食物。我并不会问这些问题，因为我无能为力。”

01:41
Now, it seemed that it shouldn't be so complicated to design a doctor's visit around what people actually need to be healthy. So I created Health Leads, an organization enabling thousands of physicians and other caregivers to ask their patients, "What do you need to be healthy?" and then prescribe those things -- fruits and vegetables, heat in the winter, electricity to refrigerate their medication -- and we then navigated patients to those resources in their communities.
现在，看起来设计个医生的访问去了解人们要保持健康需要什么并不复杂。所以我创建了健康领导者，用这个组织让成千上万的医生和其他护理人员去询问他们病人， “你需要什么来保持健康？” 然后给他们开这些东西—— 水果和蔬菜，冬天供暖，制冷保鲜药物的电力—— 然后我们引导病人到他们社区的这些资源。

02:13
The model works. A Mass General Hospital study found that navigating patients to essential resources is associated with improvements in blood pressure and cholesterol levels similar to introducing a new drug, but without all the side effects.
这个模式有效。麻省总医院的一项研究发现，将病人引导到必要的资源与血压和胆固醇水平的改善相关，相当于引入新药物的效果，而且没有任何副作用。

02:29
So two decades later, what's changed? It's now widely recognized that just 20 percent of health outcomes are tied to medical care, whereas up to 70 percent are tied to healthy behaviors and what's called the social determinants of health -- basically, everything that happens to us for that vast majority of time when we're not in the doctor's office or the hospital. Health care executives now routinely remind us that our zip code matters more than our genetic code. And one health care publication even recently had the audacity to describe the social determinants of health as "the feel-good buzzword of the year."
那么20年后，什么改变了？现在人们普遍认为只有20%的健康结果跟医疗保健相关，而高达70%与健康行为和被称为社会决定因素联系在一起—— 基本上，我们绝大多数时间发生的一切都不在医生的办公室或者医院中。卫生保健主管们现在经常提醒我们，我们的邮政编码比我们的遗传密码更重要。最近有一份卫生保健出版物大胆地将健康的社会决定因素描述为 “年度让人感觉良好的流行词”。

03:11
Now, there's been some action, too. Over the past decade, six major health care providers and insurers have committed over 600 million dollars to affordable housing, recognizing that it reduces infant mortality and increases life expectancy. But let's be honest. Is our 3.5 trillion dollar health care system fundamentally designed to create health? Absolutely not.
现在，人们也已经有所行动。在过去几十年，6家主要医疗保健提供商和保险公司已经投入超过6亿美元到可负担得起的住房，意识到它可以减低婴儿死亡率并增加预期寿命。但让我们坦诚说。我们那3.5万亿医药保健系统根本上是为了创造健康吗？绝对不是。

03:40
Take access to healthy food. Not long ago, a teenage boy shows up at a hospital in Baltimore, losing weight. Just as his doctors are huddled up figuring out which metabolic panels and blood tests to run, one of my colleagues asks out loud, "Do you think he might be hungry?" It turned out that this kid had been kicked out of his housing and literally hadn't had a meal in weeks. He said he was "... so relieved that somebody finally asked me."
拿获取健康食品来讲。不久前，一个十多岁的小孩出现在巴尔的摩一家医院，身体消瘦。就在医生聚在一起想要搞清楚要进行哪些代谢功能检验和血液测试时，我一个同事大声询问， “你们认为他可能是饿了吗？” 原来结果是这个孩子被赶出了他的房子并且几周没吃过饭了。他说他“终于放心了，有人问我了”

04:12
Somehow, we've created a health care system where asking a patient "Are you hungry?" is so far outside the bounds of what counts as health care that we mostly fail or forget to ask altogether; where doctors lament a hospital's "no third sandwich policy," meaning that if you're a hungry patient in the ER, you can have only two free sandwiches, but as many MRIs as the doctor orders; where, in 2016 in the state of Texas, they spent 1.2 billion dollars on the medical costs of malnutrition instead of on access to healthy food; where a Centers for Medicare and Medicaid Services program stratifies hungry patients, so that some get access to food and some get information about food, with the justification that doing nothing for hungry patients is standard and usual care in this country. And that's just food. The same is true for housing, electricity ... The bottom line is, health care may be changing, but not by enough and certainly not fast enough. We ask the wrong questions of our doctors, of our patients, but also of our citizens. We ask about and argue about health care, but how do voters think about health?
曾经，我们创建了一个医疗保健系统，这个系统中会询问病人：“你饿了吗？” 这个问题目前不在医疗保健的范畴之内，以致我们大部分都不会或忘记发问；那里医生会哀叹医院 “没有第三块三明治政策，” 意味着如果你是个急症室的饥肠辘辘的病人，你只能有两块免费的三明治，但遵循医嘱的核磁共振成像可没少； 2016年的德克萨斯州，他们在营养不良的医疗上花费了12亿美元而不是提供健康的食物；医疗保险和医疗补助服务中心对饥饿的病人分门别类，这样一些人可以获得食物，一些人则获得食物的信息，不为饥饿病人做任何事情的理由是这个国家标准和通常的护理方式。而且这还只是食物。同样的情况也存在于居住，电力… 不论怎样，医疗保健可能在改变，但还不够而且显然不够快速。我们对我们对医生，我们的病人，还有我们的公民问了错误的问题。我们询问并争论医疗保健问题，但选民们是如何思考健康的呢？

05:34
No one could tell us the answer to that question, so we launched a new initiative and hired a polling firm to ask voters across the country: What do you need to be healthy? What was so striking about this was that no one has any clue what we are talking about in health care. Voters do not think the social determinants of health is a feel-good phrase. They actually hate it. "What uneducated person came up with that language?" one of the voters said. Or my favorite was the guy who said, "You're killing me." But when you strip away all the ridiculousness of our language in health care, we know exactly what creates health.
没人能够告诉我们这个问题的答案，于是我们采取了新行动去雇佣一个投票公司询问全国选民的意见：你需要什么来保持健康？最令人震惊的是没人知道我们在医疗保健方面谈的是什么。选民们并不认为健康的社会决定因素是个让人感觉良好的说法。他们其实讨厌它。 “哪个没受过教育的人想出这个词语？” 其中一个投票者说。或者我最喜欢的那个说： “你让我感觉太糟了。” 但当你抽掉我们关于医疗保健语言中那些荒谬之处后，我们确实知道什么构建了健康。

06:19
So take Charlotte, North Carolina. We had two focus groups, one of African American Democratic women and one of white Republican women. And we asked them, "If you had a hundred dollars, how would you spend it to buy health in your community? Turns out, they agree nearly to the last percentage point. First, they agree that health care only sort of impacts health. So they choose to spend the majority of their dollars outside of hospitals and clinics. And second, they agree on what creates health, spending 19 percent on affordable housing and about 25 percent on access to healthy food.
就拿北卡罗来纳州的夏洛特来说。我们有两个焦点小组，一个非裔美国民主党女性和一个白人共和党女性。我们问他们，“如果你有100美元，你会如何在你的社区中购买健康？” 结果，她们的意见基本非常一致。首先，她们认为医疗保健只是影响健康的一种。所以她们选择把大部分钱花在非医院和诊所方面。其次，她们对构建健康的因素一致，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。

06:56
So I am sure you are thinking, "This has got to be a fluke." But it's not. White and Latino male swing voters in Seattle, white and African American Democratic voters in Cleveland, white male Republicans in Dallas, low-income white Democrats in Hendersonville, North Carolina: their answers are strikingly similar, with all of them choosing to spend more money on healthy food and safe housing than they would on hospitals and health centers.
我确定你们在想，“这侥幸获得罢了” 但并不是这样。西雅图的白人和拉丁裔男性中间选民，克利弗兰的白人和非裔美国民主党选民，达拉斯的白人男性共和党人，北卡罗来纳州亨德逊维尔的低收入白民主党人，他们的答案惊人地相似，她们都选择把更多的钱花在健康食物和安全居住上面，而非医院和健康中心上。

07:28
When you ask the right questions, it becomes pretty clear: we may be fractured on health care in this country, but we are unified on health.
当你问了正确的问题，这就变得非常清楚：我们可能在这个国家的医疗保健上支离破碎，但我们在健康方面是一致的。

07:39
The thing that I've been struggling with is why. Why do we agree on health? We agree on health because it is common sense. We all know that the things we need to get healthy -- medicine and medical care -- are not the things we need to be healthy, to not get sick in the first place. But we also agree because of common experience. In a study of 5,000 patients, 24 percent of the patients with commercial health insurance -- meaning, they had a job -- still ran out of food or struggled to find housing or transportation or other essential resources. Twenty-four percent. And we saw the same thing in our focus groups. Nearly every voter knew what it meant to struggle, either themselves or their families or their neighbors.
我一直在纠结的是为什么。为什么我们在健康方面意见一致？我们对健康意见一致是因为这是常识。我们全都知道对我们健康重要的东西—— 药物和医疗保健—— 不是我们保持健康需要的东西，是一开始就不生病。但因为共同的经验我们也同意。在对5千位病人的一项研究中， 24%的病人有商业医疗保险—— 这意味着，他们有工作—— 但他们仍然缺乏食物或者很难找到住房或者交通或者其他重要的资源。 24%。我们也在我们的焦点小组中看到同样的事情。几乎每个投票人都知道挣扎意味着什么，不是他们自己就是他们家人或者他们的邻居。

08:32
One of those white Republican women in Charlotte was a waitress struggling to stay awake with an enormous Big Gulp soda. She just looked exhausted. And she was. She told us that she worked two jobs but still could not afford a membership to the Y, but it was OK that she couldn't go to the gym, she said, because she also could not afford gas and walked 10 miles to and from work every single day.
其中一位夏洛特的白人共和党女性服务员用一大杯苏打水努力保持清醒。她看起来精疲力尽。她确实如此。她告诉我们她打两份工作但仍然无法负担得起Y的会员，但她说，不能去健身房，这没问题，因为她也支付不起油费，每天走10英里路上下班。

09:02
Listening to her, I felt this familiar panic rise in me, the residue of my own childhood. When I was 10 years old, my father lay on the living room floor in the grips of one of his many depressions. As I crouched next to him, he told me that he wanted to kill himself. My father lived, but he struggled to work. And my family survived, but we teetered, down one paycheck, relying on my mom's schoolteacher salary. Even as a little kid, I knew we lived in the shadow of financial and emotional collapse. This is really hard to say, because it's taken me 25 years to be honest with myself that this is why I do this work: knowing that my father needed health care to recover, but to be healthy, my family needed something else, we needed a decent income; and knowing, as so many do more than I, that panic when the basics threaten to slip away.
听着她的描述，我感到熟悉的恐慌在我心中升起，来自我童年的阴影。当我10岁时，我父亲躺在客厅的地板上，被抑郁笼罩着。当我蹲在他旁边时，他告诉我他想自杀。我父亲活下来了，但他苦于工作。我的家人幸存下来，但我们摇摇欲坠，靠着一份薪水，依赖我母亲学校的工资度日。即便是个小孩，我知道我们生活在经济和情感奔溃的阴影中。这真的难以启齿，因为我花了25年的时间来对自己坦诚这就是我做这个工作的原因：知道我父亲需要医疗保健来恢复，但要保持健康，我家人还需要其他东西，我们需要一份体面的收入；还知道，就如很多人更能体会的，那种对基本的东西要溜走时的恐慌。

10:12
To the voters in our focus groups, the solutions were straightforward. As one of those white Republican women in Charlotte said, "Instead of putting all this money into health care, put it into affordable housing. You know, like, take it and distribute it differently." It turns out that when you have the right language and you ask the right questions, the answers become remarkably clear and unanimous. What we know is that, despite all the noise, the plan for health care in this country is that there is no plan. But we have something more powerful than any politician's bill, any candidate's platform, any think tank's policy statement. We have our common sense and our common experience.
对我们焦点小组的选民来说，解决方案很简单。就像夏洛特的一位白人共和党女性说的， “与其把所有钱都投在医疗保健，不如投一些到可负担的住房中。就像，拿着它，用不同的方式来分配它。” 结果表明当你有了正确的沟通语言，你问了正确的问题，答案变得明显清楚和一致。我们知道的是，尽管有所有这些噪音，这个国家的医疗保健计划就是没有一个计划。但我们有比任何政治家的法案、任何候选人平台、任何智囊团的政策声明更强大的东西，我们有我们的常识和我们的共同经历。

11:06
So I ask, if you are a health care executive: Do you know how many of your patients run out of food or struggle to pay the rent at the end of the month? Is that data on your scorecard, shaping your business and your bonuses? If you are a politician: Will you continue to fight on the scorched earth of health care, or will you act on what your voters, what Democratic and Republican voters alike, already know, which is that good wages, healthy food and safe housing are health? And for the rest of us, for the citizens of this country: Will we demand accountability to what we know to be true, which is that our common sense, our common experience, makes us the experts in what it takes to be healthy?
所以我问，如果你是医疗保健主管：你知道你有多少病人缺乏食物或者月底付不起租金吗？这个数据在不在你的计分卡上，影响你的事业和奖金？如果你是个政治家：你会继续在医疗保健的焦土上作战，还是你会为你的选民的利益采取行动，为那些民主党和共和党选民共同的，已经知道的，即体面的薪水，健康的食物和安全的居住环境就是健康而行动？对于我们其他人来说，对于这个国家的公民来说：我们是否会要求对我们所知的事实负责，那就是我们的常识，我们的共同经历，让我们成为健康专家？

11:57
This moment, as it turns out, is not about changing minds. It is about something more powerful. It is about changing the questions we ask and quieting the noise to hear each other's answers. It is about the radical possibility that we the patients, we the physicians, we the caregivers, we the health care executives and yes, even we the people, that we agree. And it is now time -- in fact, long overdue -- for us to marshal the courage to hear those answers and to act upon them.
这一刻，事实证明，这无关改变思想。这事关更强大的事情。这事关改变我们问的问题和安静地听彼此的答案。这事关根治的可能性，我们病人，我们医生，我们护理人员，我们医疗健康主管还有甚至我们人民，我们所一致同意的。现在是时候了—— 其实，早该了—— 让我们鼓起勇气倾听这些答案并付诸行动。