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  • I thought in getting up to my TED wish

    當我預備這段「TED願望」演講時

  • I would try to begin by putting in perspective what I try to do

    我想比較一下我想達到的成果

  • and how it fits with what they try to do.

    跟他們想達到的成果有多吻合

  • We live in a world that everyone knows is interdependent,

    大家都知道我們生存在一個互相依存的世界

  • but insufficient in three major ways.

    但這世界有三點不足之處

  • It is, first of all, profoundly unequal:

    第一:非常不平等

  • half the world's people still living on less than two dollars a day;

    地球上半數的人靠着少於兩美金一天活着

  • a billion people with no access to clean water;

    十億人没有日常清潔食水

  • two and a half billion no access to sanitation;

    二十五億人無法享用衛生設施

  • a billion going to bed hungry every night;

    十億人每晚空着肚子入睡

  • one in four deaths every year from AIDS, TB, malaria

    每四個人之中有一個會死於愛滋病, 肺結核, 瘧疾

  • and the variety of infections associated with dirty water --

    和其他由不潔食水引起的疾病

  • 80 percent of them under five years of age.

    當中百分之八十是五歲以下的小孩。

  • Even in wealthy countries it is common now to see inequality growing.

    就算在富有國家,貧富懸殊的蔓延漸趨普遍

  • In the United States, since 2001 we've had five years of economic growth,

    在美國,自2001年以來我們經歷過五年的經濟增長

  • five years of productivity growth in the workplace,

    和五年的生產力增長

  • but median wages are stagnant and the percentage of working families

    但中位數工資停滯

  • dropping below the poverty line is up by four percent.

    在貧窮線以下的勞動家庭增加了百分之四

  • The percentage of working families without health care up by four percent.

    沒有醫療保障的勞動家庭增加了百分之四

  • So this interdependent world which has been pretty good to most of us --

    對大部分人來說,這個互相依存的世界對待大家不錯

  • which is why we're all here in Northern California doing what we do

    所以我們才有機會在北加州做我們的事

  • for a living, enjoying this evening -- is profoundly unequal.

    享受這個晚會 - 這是十分不平等的

  • It is also unstable.

    也是不穩定的

  • Unstable because of the threats of terror,

    不穩定是因為恐怖主義的威脅

  • weapons of mass destruction, the spread of global disease

    大規模殺傷性武器, 全球性疾病的擴散

  • and a sense that we are vulnerable to it in a way that we weren't not so many years ago.

    我們的脆弱感,比起數年前,明顯多了

  • And perhaps most important of all, it is unsustainable

    最重要的是,這些不穩定

  • because of climate change, resource depletion and species destruction.

    是由於氣候變化,資源消耗和物種滅絕。

  • When I think about the world I would like to leave to my daughter

    當想到我希望留給我女兒

  • and the grandchildren I hope to have,

    和孫兒的世界

  • it is a world that moves away from unequal, unstable, unsustainable

    那世界將會遠離不平等和不穩定

  • interdependence to integrated communities -- locally, nationally and globally --

    接近綜合,聯繫起來的社區 - 在地區,國家,以至全球

  • that share the characteristics of all successful communities:

    分享所有成功社區的特徵

  • a broadly shared, accessible set of opportunities,

    分享平等機會

  • a shared sense of responsibility for the success of the common enterprise

    分擔建立一個成功共同事業的責任

  • and a genuine sense of belonging.

    分享一分真摯的歸宿感

  • All easier said than done.

    談何容易

  • When the terrorist incidents occurred in the United Kingdom a couple of years ago,

    當數年前英國發生恐怖襲擊時

  • I think even though they didn't claim as many lives as we lost in the United States on 9/11,

    雖然死難者人數比美國的九一一恐怖襲擊少

  • I think the thing that troubled the British most

    但最令英國人不安的是

  • was that the perpetrators were not invaders, but homegrown citizens

    這些恐怖分子並不是外來的入侵者,而是在英國土生土長的公民

  • whose religious and political identities were more important to them

    對這些人來說,他們的政冶,宗教身份

  • than the people they grew up with, went to school with,

    比起一同長大,一同上學

  • worked with, shared weekends with, shared meals with.

    一同上班,一同過週末,一同吃飯的人更為重要

  • In other words, they thought their differences

    換句話說,他們覺得人與人之間的差別

  • were more important than their common humanity.

    比人間的共通點重要

  • It is the central psychological plague of humankind in the 21st century.

    這是二十一世紀人類最中心的「心理瘟疫」

  • Into this mix, people like us, who are not in public office,

    在這樣的環境下,像我們這些非公職人員

  • have more power to do good than at any time in history,

    有史無前例最強的力量去作出貢獻

  • because more than half the world's people

    因為半個世界的人

  • live under governments they voted in and can vote out.

    可以投票選出當權的政府,也可以投票趕他們下台

  • And even non-democratic governments are more sensitive to public opinion.

    就算是非民主國家也比以往對民意敏感

  • Because primarily of the power of the Internet,

    主要是因為互聯網的力量

  • people of modest means can band together and amass vast sums of money

    就算只有綿薄之力的人也可以組織起來,積聚金錢

  • that can change the world for some public good if they all agree.

    建立公共利益,改變世界 - 當大家都同意時

  • When the tsunami hit South Asia, the United States contributed 1.2 billion dollars.

    當南亞海嘯發生後,美國政府捐贈了12億美元

  • 30 percent of our households gave.

    百分之三十的美國人民捐贈了

  • Half of them gave over the Internet.

    其中一半是通過互聯網捐贈

  • The median contribution was somewhere around 57 dollars.

    中位數捐贈金額大慨是$57美元

  • And thirdly, because of the rise of non-governmental organizations.

    第三點,由於非政府組織的上升

  • They, businesses, other citizens' groups, have enormous power

    它們跟一些商業機構和其他民間團體,擁有龐大力量

  • to affect the lives of our fellow human beings.

    可以影響我們的生活

  • When I became president in 1993,

    當我在1993年當上美國總統時

  • there were none of these organizations in Russia.

    在俄羅斯並無這類組織

  • There are now a couple of hundred thousand.

    現在的俄羅斯有數十萬個這類的組織

  • None in India. There are now at least a half a million active.

    在印度, 當時無這類組織。現在至少有五十萬活躍的非政府組織。

  • None in China. There are now 250,000 registered with the government,

    在中國, 從零增長至二十五萬個有向政府登記的組織

  • probably twice again that many who are not registered for political reasons.

    因為政冶原因而沒登記的可能有兩倍那麽多

  • When I organized my foundation, and I thought about the world as it is

    當我策劃我的基金會時,想起現今的世界

  • and the world that I hope to leave to the next generation,

    和我希望為下一代留下的世界

  • and I tried to be realistic about what I had cared about all my life

    我嘗試切實地想,我還可以為我有生以來熱心的事

  • that I could still have an impact on.

    作出甚麽影響呢?

  • I wanted to focus on activities

    我想著重於

  • that would help to alleviate poverty, fight disease, combat climate change,

    扶貧,打擊疾病,適應氣候變化

  • bridge the religious, racial and other divides that torment the world,

    修補正在折磨着我們世界的宗教和種族分歧

  • but to do it in a way that would either use

    我想可以利用

  • whatever particular skills we could put together in our group

    我們(基金會人員)的綜合技能

  • to change the way some public good function was performed

    去改變一些公益事業的運作

  • so that it would sweep across the world more.

    令它們可以遍布全球

  • You saw one reference to that in what we were able to do with AIDS drugs.

    你們看到之前提及到艾滋病藥物

  • And I want to say that the head of our AIDS effort,

    我們艾滋病工作的領袖

  • and the person who also is primarily active in the wish I'll make tonight,

    對我今晚這「願望」工作的主要人物

  • Ira Magaziner, is here with me and I want to thank him for everything he's done.

    Ira Magaziner - 今晚也在場。我想對他的所有貢獻道謝

  • He's over there.

    他在這裡

  • (Applause)

    [掌聲]

  • When I got out of office and was asked to work, first in the Caribbean,

    當我離任時,我被邀請到加勒比海

  • to try to help deal with the AIDS crisis,

    去應付當地的愛滋病危機

  • generic drugs were available for about 500 dollars a person a year.

    通用的藥物大慨需要每人一年五百元

  • If you bought them in vast bulks,

    如你買入大量的話

  • you could get them at a little under 400 dollars.

    四百元以下便可以買到一盒

  • The first country we went to work in, the Bahamas,

    在我們第一個目的地國家 - 巴哈馬

  • was paying 3,500 dollars for these drugs.

    這些藥物的售價是三千五百元

  • The market was so terribly disorganized

    那裡的市場十分混亂和無規則

  • that they were buying this medicine through two agents

    所以兩家商人

  • who were gigging them sevenfold.

    可以用七倍以上的價格操控着市場½

  • So the very first week we were working,

    在一個星期的時間內

  • we got the price down to 500 dollars.

    我們把那些藥物的價格降至五百元

  • And all of a sudden, they could save seven times as many lives

    忽然間,同一數目的金錢

  • for the same amount of money.

    可解救七倍以上的生命

  • Then we went to work with the manufacturers of AIDS medicines,

    之後,我們跟艾滋病藥物製造商合作

  • one of whom was cited in the film,

    影片中提及到其中一個製造商

  • and negotiated a whole different change in business strategy,

    談判了一套全新的商業策略

  • because even at 500 dollars, these drugs

    因為就算是五百元,這些藥物

  • were being sold on a high-margin, low-volume, uncertain-payment basis.

    的銷售模式是高利潤,低產量,和不明確的付款模式

  • So we worked on improving the productivity of the operations

    所以我們在改善生產力方面做工作

  • and the supply chain, and went to a low-margin, high-volume,

    供應鏈變為低利潤,高產量

  • absolutely certain-payment business.

    付款有保障的生意

  • I joked that the main contribution we made

    我開玩笑地說,我們對打擊愛滋病

  • to the battle against AIDS was to get the manufacturers

    主要的貢獻是令生產商

  • to change from a jewelry store to a grocery store strategy.

    改變它們的商業策略,由珠寶店變成雜貨店

  • But the price went to 140 dollars from 500.

    價格由五百元下降至一百四十元

  • And pretty soon, the average price was 192 dollars.

    很快地,平均價格為一百九十二元

  • Now we can get it for about 100 dollars.

    現在,一百元便可以買到那些藥物了

  • Children's medicine was 600 dollars,

    以往兒童藥物的售價是六百元

  • because nobody could afford to buy any of it.

    因為根本没人可以負擔得起

  • We negotiated it down to 190.

    我們議價至一百九十元

  • Then, the French imposed their brilliantly conceived airline tax

    然後,法國人高明地徵收航空公司稅

  • to create a something called UNITAID,

    去建立UNITAID

  • got a bunch of other countries to help.

    得到一些國家的支持

  • That children's medicine is now 60 dollars a person a year.

    兒童藥物的價格現在是每人六十元一年

  • The only thing that is keeping us from basically saving the lives

    唯一阻礙着我們拯救

  • of everybody who needs the medicine to stay alive

    所有依靠藥物生存的人

  • are the absence of systems necessary to diagnose, treat and care

    是没有所需的體制去診斷,醫治和照顧人們

  • for people and deliver this medicine.

    以及發放這些藥物

  • We started a childhood obesity initiative with the Heart Association in America.

    我們跟美國心臟協會開始了一系列關注兒童肥胖的活動

  • We tried to do the same thing by negotiating industry-right deals

    我們照樣嘗試跟業界談判交易

  • with the soft drink and the snack food industry to cut the caloric

    跟汽水和零食業界商議減少含高卡路里

  • and other dangerous content of food going to our children in the schools.

    和其他有害物質的食品進入兒童的學校

  • We just reorganized the markets.

    我們重組了市場

  • And it occurred to me that in this whole non-governmental world,

    我突然想到在這個非政府世界

  • somebody needs to be thinking about organizing public goods markets.

    我們需要一些人去整理公共物品市場

  • And that is now what we're trying to do,

    這是我們現在想做的事

  • and working with this large cities group to fight climate change,

    和跟這些大城市團體合作對抗氣候變化

  • to negotiate huge, big, volume deals that will enable cities

    談判這類大型交易可以令

  • which generate 75 percent of the world's greenhouse gases,

    排放全球百分之七十五溫室氣體的城市

  • to drastically and quickly reduce greenhouse gas emissions

    急劇和迅速地减少排放溫室氣體

  • in a way that is good economics.

    從經濟上明智的角度實行

  • And this whole discussion as if it's some sort of economic burden,

    當大家議論這課題時常把它當作經濟負擔

  • is a mystery to me.

    這令我感到迷惑

  • I think it's a bird's nest on the ground.

    我覺得對抗氣候變化會帶來垂手可得的益處

  • When Al Gore won his well-deserved Oscar

    當戈爾以電影《難以忽視的真相》

  • for the "Inconvenient Truth" movie, I was thrilled,

    獲得他應得的奥斯卡金像獎,我十分高興

  • but I had urged him to make a second movie quickly.

    我勸他盡快製作第二套電影

  • For those of you who saw "An Inconvenient Truth,"

    看過《難以忽視的真相》的人都知道

  • the most important slide in the Gore lecture is the last one,

    戈爾的講議之中最重要的一段是最後那一段

  • which shows here's where greenhouse gases are going

    顯示出溫室氣體的排放量是這麽多

  • if we don't do anything, here's where they could go.

    如我們甚麽都不做,排放量可能會是這麼多

  • And then there are six different categories

    然後有六個類別的事情

  • of things we can do to change the trajectory.

    我們的行動可以改變未來溫室氣體的排放量

  • We need a movie on those six categories.

    我們需要一套電影去講解這六個類別的事情

  • And all of you need to have it embedded in your brains

    而你們必需把它深印腦海

  • and to organize yourselves around it.

    使它啟發和整理你們的生活

  • So we're trying to do that.

    我們正在這方面工作

  • So organizing these markets is one thing we try to do.

    整理這些市場是我們工作的其中一項

  • Now we have taken on a second thing, and this gets to my wish.

    現時我們展開了第二項工作,進入了「我的願望」這題目

  • It has been my experience in working in developing countries

    從我在發展中國家的工作經驗來說

  • that while the headlines may all be -- the pessimistic headlines may say,

    悲觀的新聞頭條可能會說

  • well, we can't do this, that or the other thing because of corruption --

    由於貪污腐敗這也不行,那也不行

  • I think incapacity is a far bigger problem in poor countries than corruption,

    我覺得在貧窮國家之中,比起貪污腐敗,無能是更嚴重的問題

  • and feeds corruption.

    它能孕育腐敗

  • We now have the money, given these low prices, to distribute

    因為價格下降,我們現在有足夠支金去發放

  • AIDS drugs all over the world to people we cannot presently reach.

    艾滋病藥物給全球有需要的人,包括我們暫時未能延伸到的地方

  • Today these low prices are available in the 25 countries where we work,

    至今,在我們工作的六十二國家當中,二十五個國家

  • and in a total of 62 countries,

    的藥物價格成功地被减低

  • and about 550,000 people are getting the benefits of them.

    大慨五十五萬人受惠

  • But the money is there to reach others.

    但這基金的目的是延伸力量去幫助未能受惠的人

  • The systems are not there to reach the people.

    現有的體制未能有效地接觸到所有有需要的人

  • So what we have been trying to do,

    所以我們至今想做的是

  • working first in Rwanda and then in Malawi and other places --

    首先在盧旺達工作,然後到馬拉維和其他地方

  • but I want to talk about Rwanda tonight --

    今晚我想講在盧旺達的工作

  • is to develop a model for rural health care in a very poor area

    我們正在發展一個貧窮農村地區衛生保健模式

  • that can be used to deal with AIDS, TB, malaria, other infectious diseases,

    去對抗艾滋病,結核病,瘧疾和其他傳染病

  • maternal and child health, and a whole range of health issues

    照顧孕婦和兒童保健,以及解決面對着發展中國家

  • poor people are grappling with in the developing world,

    貧窮人口的一系列的健康問題

  • that can first be scaled for the whole nation of Rwanda,

    這個衛生保健模式首先是以盧旺達這國家作為規模

  • and then will be a model that could literally

    之後我們可以貫徹這個模式

  • be implemented in any other poor country in the world.

    於其他貧窮的國家

  • And the test is: one, will it do the job?

    我們面臨的考驗是,第一: 這能解決問題嗎?

  • Will it provide high quality care?

    這衛生保健模式能提供高質量的保健服務嗎?

  • And two, will it do it at a price

    第二:衛生保健服務的價格

  • that will enable the country to sustain a health care system

    該國是否能夠負擔和維持得到的

  • without foreign donors after five to 10 years?

    五年至十年後仍不需依靠外國捐助者?

  • Because the longer I deal with these problems,

    我在這問題上的工作時間越長

  • the more convinced I am that we have to --

    我越堅信我們必需構建系統

  • whether it's economics, health, education, whatever --

    無論是經濟,衛生,教育

  • we have to build systems.

    或其他方面

  • And the absence of systems that function

    如沒有這些有效地運作的系統

  • break the connection which got you all in this seat tonight.

    恐怕你們今晚便不能來臨這晚會

  • You think about whatever your life has been,

    當你反思你的人生至今

  • however many obstacles you have faced in your life,

    無論你面對過多少挫折

  • at critical junctures you always knew

    在緊要關頭時,你知道

  • there was a predictable connection between the effort you exerted

    你可根據你付出的努力

  • and the result you achieved.

    去預計可達到的結果

  • In a world with no systems, with chaos,

    但在一個沒有系統的混亂世界

  • everything becomes a guerilla struggle,

    所有事情都像打游擊戰

  • and this predictability is not there.

    無法預見將來

  • And it becomes almost impossible to save lives,

    拯救生命,教育孩子

  • educate kids, develop economies, whatever.

    發展經濟等等事情,變得幾乎是不可能的

  • The person, in my view,

    以我之見

  • who has done the best job of this in the health care area,

    有一個人在醫療保健方面作出了最大貢獻

  • of building a system in a very poor area, is Dr. Paul Farmer,

    在貧窮地區建立了醫療保健系統。這人是法默醫師

  • who, many of you know, has worked for now 20 years with his group,

    很多人都知道,他己經在他的組織「健康伙伴」工作了二十年

  • Partners in Health, primarily in Haiti where he started,

    他主要在海地開始

  • but they've also worked in Russia, in Peru

    但他們也在俄羅斯,秘魯

  • and other places around the world.

    和世界上其他國家工作過

  • As poor as Haiti is, in the area where Farmer's clinic is active --

    就算如海地般貧窮,在有法默醫師的診所的地方

  • and they serve a catchment area far greater

    他們的服務的範圍

  • than the medical professionals they have would indicate they could serve --

    遠遠大於他們的醫療專業人士的預想

  • since 1988, they have not lost one person to tuberculosis, not one.

    從1988年起,他們没有一個病人死於肺結核

  • And they've achieved a lot of other amazing health results.

    除此以外,他們其他的醫療成果也十分驚人

  • So when we decided to work in Rwanda

    當我們決定了在盧旺達工作時

  • on trying to dramatically increase the income of the country and fight the AIDS problem,

    我們想幫助這國家增加收入和打擎艾滋病問題

  • we wanted to build a healthcare network,

    我們想造一個醫療保健網絡

  • because it had been totally destroyed during the genocide in 1994,

    因為當地的醫療保健網絡在1994年的種族滅絕中被徹底摧毀

  • and the per capita income was still under a dollar a day.

    而人均收入仍是低至每天1美元

  • So I rang up, asked Paul Farmer if he would help.

    所以我打電話給法默醫師,問他可否幫助我們

  • Because it seemed to me if we could prove there was a model in Haiti

    我覺得如果我們可以證明在海地

  • and a model in Rwanda that we could then take all over the country,

    和在盧旺達的模式是可行以在全國實行的

  • number one, it would be a wonderful thing for a country

    第一:對盧旺達來說是一件好事

  • that has suffered as much as any on Earth in the last 15 years,

    因為這國家這15年來遭受過的極大浩劫

  • and number two, we would have something that could then be adapted

    第二:如這醫療保健模式是有效的,我們便可把它

  • to any other poor country anywhere in the world.

    帶到其他貧窮國家

  • And so we have set about doing that.

    這是我們的目標

  • Now, we started working together 18 months ago.

    至今,我們一起工作了18個月

  • And we're working in an area called Southern Kayonza,

    我們在一個叫南卡永扎的地方工作

  • which is one of the poorest areas in Rwanda,

    這是盧旺達最貧困的地區之一

  • with a group that originally includes about 400,000 people.

    我們由一個包括大約40萬人的組織開始

  • We're essentially implementing what Paul Farmer did in Haiti:

    基本上實現法默醫師在海地的工作

  • he develops and trains paid community health workers

    培訓有償的社區衛生工作者

  • who are able to identify health problems,

    這些社區衛生工作者能夠識別健康問題

  • ensure that people who have AIDS or TB are properly diagnosed

    確保患有艾滋病或肺結核的人得到正確的診斷

  • and take their medicine regularly,

    並定期吃藥

  • who work on bringing about health education, clean water and sanitation,

    他們其它的工作包括健康教育,引進清潔食水和衛生設施

  • providing nutritional supplements and moving people up the chain of health care

    提供營養補充品和讓有更嚴重的健康問題的人

  • if they have problems of the severity that require it.

    得到有需要的醫療保健

  • The procedures that make this work have been perfected,

    這項工作的程序

  • as I said, by Paul Farmer and his team

    經法默醫師和他的隊員