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  • Today I'd like to talk to you about

    今天,我想和大家聊聊

  • the woman in the picture behind me.

    照片裡的那個女人。

  • Her name is Hosepha.

    她叫荷賽法。

  • And she was born in Cuba

    她是古巴人,

  • several years before the communist revolution.

    在古巴革命前幾年出生。

  • The late 1970's,

    1970年代末,

  • she would then decide to leave

    她毅然決然

  • everything she knew behind,

    離開她熟悉的地方,

  • determined to give her family a chance

    為了給家人一個機會,

  • at a better life in the US.

    一個能在美國好好生活的機會。

  • She also happens to be my grandmother

    正好她就是我的祖母,

  • and one of the most important figures

    在我成長過程中

  • in my life as I was growing up.

    對我最重要的人之一。

  • Some of my happiest childhood memories

    童年記憶裡最快樂的部分,

  • were simply getting to come home,

    就僅僅是每天放學後,

  • every day from school, to be given

    回到家裡,

  • a huge big hug from my grandmother.

    祖母給我的一個大擁抱。

  • But that hug would one day turn my life upside down.

    但這擁抱將讓我的生命風雲變色。

  • You see, as my head brushed up against a side of hers,

    你想,當我的頭 碰觸到她一邊的乳房時,

  • I felt a big lump.

    我碰到一個大硬塊。

  • When I asked her what it was

    當我問她那是甚麼時,

  • she said it was nothing,

    她說沒事。

  • but I would later go on to overhear my family

    但沒過多久我就從家人那裏偷聽到,

  • talking about a tumor and cancer.

    他們在談論腫瘤和癌症。

  • I can't begin to describe to you

    我無法向你們形容

  • what I felt in that moment.

    那一刻我的感受。

  • My grandmother was my whole world

    祖母就是我的全部。

  • and as I stood in that doorway listening

    當我站在走廊偷聽時,

  • I was paralyzed with fear.

    我被嚇得無法動彈,

  • I begged and pleaded with my grandmother

    我拜託她、請求她

  • that she'd go to the doctor,

    一定要去看醫生,

  • but the harsh reality was that

    但殘酷的現實是,

  • my family simply couldn't afford it.

    我家根本無法負擔醫療費。

  • And in my young mind

    在我幼小的心靈裡,

  • the concept of my grandmother's life

    我無法接受把祖母的生命

  • hanging in the balance over a question of money

    與金錢放在同一個天平上衡量,

  • didn't make any sense to me.

    這對我來說根本是荒謬至極。

  • It was perhaps the first time in my life

    這大概是我人生中,

  • I had ever felt powerless.

    第一次感到很無助。

  • Powerless over my circumstances,

    為在這種情況下,

  • powerless at my inability to do anything

    無法替對我如此重要的人做任何事

  • for someone that meant so much.

    而感到無能為力。

  • And I remember desperately wanting a way out.

    我拚命地想找到一條生路。

  • Sometime later, that way out would come

    不久之後,這條路出現了。

  • thanks to the chanced generosity of a family friend,

    多虧一位家族世交的慷慨協助,

  • to whom I'll forever be thankful

    我永遠對他感激不盡。

  • for what he did for my grandmother.

    感謝他為我祖母所做的一切。

  • But, are we comfortable with that?

    但我們就這樣逆來順受嗎?

  • With the notion that a person's life

    一個人的生命取決於財力的多寡,

  • potentially hinges on the means they have?

    這樣的觀念對嗎?

  • That wealth so directly determines

    金錢竟能如此直接地影響

  • something as basic and fundamental as health?

    人最基本應該擁有的健康嗎?

  • At the time, I never questioned that reality.

    當時,我從未質疑過現實。

  • As a kid, I simply internalized my experience

    當我還是小孩的時候,

  • and became intensely focused on the only thing

    我單純憑藉著我的經驗,

  • I felt I had any control over, my education.

    專注在唯一一件我能控制的事上:教育。

  • It wasn't until many years later,

    直到多年後,

  • upon arriving at Stanford,

    我來到了史丹佛大學

  • and taking a health policy course

    修了健康政策課程,

  • that I would come to feel empowered

    我才覺得我終於有能力

  • to revisit and question that reality.

    能夠重新探討那些問題。

  • For ten weeks I sat in class horrified

    這十個星期裡我在教室,

  • and fascinated by what I learned.

    既驚詫又著迷於課堂所學。

  • Horrified by the scale upon which

    驚詫於得知在我們的國家,

  • I saw my own family's health struggles

    還有多少家庭承受著和我們家一樣

  • writ large across our nation.

    有過的掙扎。

  • But fascinated by the potential of policy

    但又著迷於得知

  • to have such far reaching positive effects

    健康政策有多大的潛力,

  • on the lives of so many people.

    能夠給多少人的生命帶來正面幫助。

  • I began to wonder if the current state

    我開始質疑

  • of health care was truly inevitable,

    是否現今的醫護狀態真的是無法改善,

  • or if a different reality was possible.

    或者其實有方法可以解決,

  • And my search for an answer to this question

    為了回答這個問題,

  • would lead me to work

    在過去四年裡

  • over the last four years in five countries,

    我到五個國家做研究,

  • spanning Europe, Asia and Africa.

    從歐洲、亞洲,到非洲。

  • And today I'd like to take you on that journey

    今天,我想帶大家

  • to three of those places.

    到其中的三個國家看看。

  • First on my list was France,

    第一個地方就是法國,

  • which I had learned had been ranked as having

    據我所知,

  • the best health care system in the world,

    世界衛生組織於2000年

  • by the World Health Organization in 2000.

    將法國的醫護體制排名世界第一。

  • And what struck me the most,

    在巴黎的醫院工作時,

  • working in a Parisian hospital, was not

    令我最感到驚訝的

  • only how accessible health care was for everyone,

    不只是所有人都能得到的醫護資源,

  • but how universally agreed upon it was

    而是法國人普遍地

  • among the French that it should be.

    把這種情況視為理所當然。

  • This is something that I would later go on to know

    之後,當我在日本工作的一年裡,

  • about the Japanese health care system,

    我又在日本的醫療體制裡

  • while I was living and working in Japan for one year.

    見識到相同的情形。

  • Here was a country with some

    這是個全世界

  • of the world's best health outcomes,

    擁有最佳醫療衛生成果的國家,

  • longest life expectancy,

    擁有最長的壽命,

  • one of the lowest rates of infant mortality,

    最低的嬰兒死亡率。

  • had managed to achieve universal coverage

    當日本還在為二戰重建時,

  • at a time when Japan was still rebuilding itself,

    日本人已經設法讓醫療健康資源

  • after World War II.

    廣布全國。

  • And yet manages to spend half of what

    並且只花費了美國每人

  • the Unites States spends on health per capita.

    花費在醫療健康上的一半經費。

  • As I reflect on these experiences with you,

    我告訴你們這些經驗,

  • I don't mean to oversimplify the issue

    並不是要過度簡化這個議題,

  • or lead you to believe that I think that

    或只引導你們相信,

  • what has worked in one country is

    一個國家實行的政策

  • directly adaptable or transferable to another.

    能夠直接複製到另一個國家。

  • The more countries and systems

    當我有機會

  • I've had the opportunity to study

    研究更多國家的醫療健康體制,

  • the more I've come to appreciate just how

    我就越能領悟到

  • truly complex the issue of health care is.

    這個議題的複雜程度。

  • But I've also come to believe that

    但我還是相信,

  • what's possible in terms of health care access

    健全醫療體制的能否順利推行

  • is largely dependent on what societies choose to value

    取決於社會是否重視這件事,

  • and make possible for their populations.

    並願意使其推行。

  • The best example I can think of this is Rwanda,

    我所能想到最好的例子就是盧安達。

  • where I recently worked with

    最近,我跟柯林頓健康倡議組織

  • the Clinton Health Access Initiative.

    一起在盧安達工作。

  • A country ravaged by genocide

    盧安達在近二十年內

  • less than 20 years ago.

    才遭受種族屠殺的迫害。

  • 10% of its population murdered,

    百分之十的人民被殺害,

  • with more than half of its population

    而半數以上的人

  • still living in poverty.

    仍過著貧苦的日子。

  • The house I lived in didn't have running water

    我在盧安達時的居所沒有自來水,

  • or direct access to paved roads.

    戶外的街道也是坑窪難行。

  • I was fortunate to have electricity,

    幸運的是,我的居所有電可以使用,

  • the only house in the district to have it.

    那是在那個地區裡唯一供電的住所。

  • And yet, even in the absence of

    盧安達即使資源缺乏,

  • so many resources and basic necessities,

    連基本的生活必需品都難以獲得,

  • they felt it was so indispensable

    他們仍然深刻地了解,

  • that everyone should have a basic

    每位公民都必須享有 是最基本程度的醫療保障

  • minimum level of health care

    是何等的重要,

  • that they chose to make it possible.

    並選擇付諸實行。

  • Now I'm not saying that I think that

    我並不是說

  • Rwanda's health care system is perfect.

    盧安達的健康醫療體制很完善,

  • Much work still remains to be done.

    他們的體制仍然有許多改進的空間。

  • But considering that they have

    但是每當想到,在盧安達

  • an annual health budget of $56 per person

    每個人每年都有56元美金的醫療預算,

  • I'd say they are doing pretty well.

    我就不得不說他們 的確有套很好的醫療體制。

  • And the world is taking notice.

    世界各國也都開始注意到這件事了。

  • Something that seemed so impossible

    不過短短幾年,

  • just a few years ago,

    發展中國家能夠提供其人民

  • the notion that developing nations

    醫療保障,

  • could achieve universal coverage,

    這件曾經聽起來是如此難以置信的事,

  • is now not only increasingly being regarded as feasible,

    在現今不只越來越多人相信它的可行性,

  • but as the next step in continuing

    甚至已經有人開始思考

  • to make sustainable global health progress.

    如何讓全球的醫療系統持續進步。

  • That perhaps has been the biggest

    這對我來說,

  • take home lesson for me.

    也許是最大的難題。

  • Where there's a will there's a way!

    但,有志者事竟成。

  • In the US, this doesn't seem to be a question of resources.

    在美國,資源從來不是個問題。

  • According to the World Health Organization's

    世界衛生組織

  • 2010 World Health Report,

    2010年世界衛生報告指出,

  • the United States spends over

    美國每年在健康醫療上的支出達兩兆,

  • 2 trillion dollars a year on health care,

    而全球醫療預算總合 為五兆三千億美元。

  • out of a global 5.3 trillion.

    美國的醫療支出將近佔了全球的40%,

  • That's approximately 40% of all the money

    就僅僅是一個國家花的,

  • that is spent all over the world on health.

    我們的國家。

  • In one country, in our country.

    但不知為何,五千萬的美國人

  • And yet somehow, 50 million Americans

    受害於體制上的漏洞, 無法享有醫療保障。

  • slip through the cracks, remaining uninsured.

    我在盧安達的同事曾說:

  • In the words of one of my Rwandan colleague, he said,

    「萊登,如果連你們都做不到, 那還有誰做的到?」

  • "Rayden, if your country can't do it, then who can?"

    當我從這個方向 去思考醫療體制這議題時,

  • And when I think about this issue from that perspective,

    我發現問題的所在

  • the question I find myself asking is not

    並不是我們是否能夠

  • whether we can afford to insure a basic

    負擔全美所有人口的 基本健康醫療費用,

  • minimum level of health care for everyone,

    而是想不想這麼做。

  • but whether we choose to make that possible.

    去年在北卡羅來納州

  • Last year, a man in North Carolina robbed a bank,

    發生了一起

  • demanding one dollar, hoping

    一元銀行搶案,

  • to be sent to prison

    搶匪希望被關進監獄,

  • so that he could receive medical attention

    這樣他才能夠接受治療,

  • for a growth in his chest

    因為他胸腔長了腫瘤,

  • he couldn't afford to treat on his own.

    而自己無法負擔醫療費用。

  • How desperate does a human being need to be,

    一個人得要多絕望

  • need to feel,

    才會讓他選擇

  • to be willing to trade his freedom

    用自由

  • for his health?

    換取他的健康?

  • I came to share my story with you today

    儘管健康醫療這議題

  • because despite how divisive the issue

    在我們國家意見有多麼兩極,

  • of health care in our country has become,

    但我相信我們仍深切渴望,

  • I believe that we profoundly want

    而且也有資格擁有更好的生活,

  • and can aspire to more than the status quo,

    我也相信我們可以活在財富貧乏

  • that a world where poverty of wealth

    但醫療不貧乏的世界。

  • does not necessitate the poverty of health is possible.

    在這個世界裡, 像我祖母這樣身患重病的人,

  • A world where people like my grandmother

    不用因為資源缺乏 就放棄接受治療。

  • do not need to forgo potentially life saving treatment

    但這卻還僅僅是個理想,

  • because of a lack of resources.

    因為部份立法者、醫生、健康經濟學者,

  • But this doesn't become possible

    還有提倡者,

  • because a few policy makers, doctors,

    過度追求完美的體制。

  • health economists, advocates get together

    真正能夠使我們的 醫療體制從根改造的,

  • to engineer a perfect solution.

    是我們所有人,我們的社會價值

  • Truly sustainable changes, I believe,

    是否重視並相信

  • are first dependent on what we all,

    新健康醫療體制推行可能性。

  • as a society, choose to value

    我們該重視什麼?

  • and believe to be possible.

    我們該如何選擇?

  • What do we value?

    謝謝。

  • What do we choose?

    (掌聲)

  • Thank you.

  • (Applause)

Today I'd like to talk to you about

今天,我想和大家聊聊

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B1 中級 中文 美國腔 醫療 體制 健康 祖母 國家 衛生

TEDx】健康醫療不僅僅是政策。Rayden Llano在TEDxStanford的演講。 (【TEDx】Health care is more than just policy: Rayden Llano at TEDxStanford)

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