I have a pretty strong French accent,

加上一口非常重的法國口音

so that's going to be clear in a moment.

很容易就能看出來吧！

Maybe a sobering thought

很怵目驚心吧！

and something you all know about.

有些事你們早就知道

And I suspect many of you gave

而且我相信你們之中有很多人

something to the people of Haiti this year.

今年度捐了些東西給海地

And there is something else

還有

I believe in the back of your mind

我相信，在內心深處

you also know.

你們也都知道

That is, every day,

那就是每天

25,000 children die

有25,000名孩童不幸喪生

of entirely preventable causes.

而且死於完全可事先預防的原因

That's a Haiti earthquake every eight days.

這數字相當於每8天就發生一次海地地震

And I suspect many of you probably gave something

同樣地，我相信你們之中有很多人

towards that problem as well,

也想對這不幸貢獻心力

but somehow it doesn't happen

但災難發生的強度

with the same intensity.

和帶給人的震撼通常不成正比

So why is that?

為什麼呢？

Well, here is a thought experiment for you.

看一下這樣一個實驗

Imagine you have a few million dollars that you've raised --

假設你募得幾百萬美金

maybe you're a politician in a developing country

你是個開發中國家的官員

and you have a budget to spend. You want to spend it on the poor:

為了幫助窮人，編列了相關預算

How do you go about it?

你會從何著手呢?

Do you believe the people who tell you

是相信你所聽到的

that all we need to do is to spend money?

只要花錢

That we know how to eradicate poverty,

就能幫助窮人脫離貧窮

we just need to do more?

現在只是做得還不夠？

Or do you believe the people who tell you that

或是相信另外一種說法

aid is not going to help, on the contrary it might hurt,

援助根本無法解決問題，相反地，還會造成傷害

it might exacerbate corruption, dependence, etc.?

像是助長貪污及依賴

Or maybe you turn to the past.

回顧過去

After all, we have spent billions of dollars on aid.

已有幾十億美金花在援助上

Maybe you look at the past and see.

或許你會想知道

Has it done any good?

這些援助究竟有沒有用？

And, sadly, we don't know.

很遺撼，我們不知道

And worst of all, we will never know.

更糟的是，我們永遠不會知道

And the reason is that -- take Africa for example.

為什麼會這樣呢？舉非洲的例子

Africans have already got a lot of aid.

非洲人得到很多援助

These are the blue bars.

看看這些藍色長條圖

And the GDP in Africa is not making much progress.

然而非洲的GDP始終沒有任何改善

Okay, fine. How do you know what

那又怎樣？你怎麼知道

would have happened without the aid?

如果沒有援助又會是怎樣呢？

Maybe it would have been much worse,

也許GDP比現在更糟

or maybe it would have been better.

或是更好也不一定

We have no idea. We don't know what the counterfactual is.

我們不知道，我們無法知道這不存在的事實

There's only one Africa.

只有一個非洲無從驗證起

So what do you do?

那該怎麼辦呢？

To give the aid, and hope and pray that something comes out of it?

繼續給予援助，滿懷希望地祈禱著問題能夠解決？

Or do you focus on your everyday life

或是繼續過日子

and let the earthquake every eight days

無視於每8天

continue to happen?

持續發生的地震?

The thing is, if we don't know

事實上，如果我們不知道

whether we are doing any good,

自己所做的事是對的

we are not any better

我們甚至不如

than the Medieval doctors and their leeches.

中世紀的醫生和那些水蛭

Sometimes the patient gets better, sometimes the patient dies.

有時病人的病好轉了，有時卻回天乏術

Is it the leeches? Is it something else?

到底是因為水蛭或是其他原因？

We don't know.

誰知道

So here are some other questions.

在這我提出幾個問題

They're smaller questions,

只是小問題

but they are not that small.

但並非全然不重要

Immunization, that's the cheapest way

疫苗接種，現今最便宜的方法

to save a child's life.

拯救孩童寶貴的生命

And the world has spent a lot of money on it:

我們也已為此花費龐大金錢

The GAVI and the Gates Foundations

全球疫苗免疫聯盟和比爾蓋茲基金會

are each pledging a lot of money towards it,

也分別砸下很多的資源

and developing countries themselves have been doing a lot of effort.

開發中國家自身也投入相當多的心力

And yet, every year

然而，毎年

at least 25 million children

至少2500萬名孩童

do not get the immunization they should get.

卻得不到應該接種的疫苗

So this is what you call a "last mile problem."

這就是所謂的"最後一哩難題"

The technology is there,

明明技術已經純熟

the infrastructure is there,

基礎設施也有

and yet it doesn't happen.

結果卻仍不如預期

So you have your million.

所以縱使資金充裕

How do you use your million

問題是你該怎麼使用

to solve this last mile problem?

才能解決這最後一哩的難題

And here's another question:

還有個問題

Malaria. Malaria kills almost

瘧疾，瘧疾每年至少奪走

900,000 people every year,

90萬條人命

most of them in Sub-Saharan Africa,

大部份都發生在撒哈拉以南非洲

most of them under five.

而且是5歲以下孩童

In fact, that is the leading cause of under-five mortality.

事實上這也是造成5歲以下孩童死亡的首要原因

We already know how to kill malaria,

我們早就知道對抗瘧疾的方法

but some people come to you and say,

但有人跑來告訴你

"You have your millions. How about bed nets?"

你有那麼多錢，拿來買蚊帳如何？

Bed nets are very cheap.

蚊帳很便宜

For 10 dollars, you can manufacture and ship

10塊錢，包含製造加運送

an insecticide treated bed net

還加防蟲劑處理過

and you can teach someone to use them.

你可以教導當地居民如何使用

And, not only do they protect the people who sleep under them,

這樣，不只睡在蚊帳內的人得到保護

but they have these great contagion benefits.

還能產生連鎖效應

If half of a community sleeps under a net,

如果一半居民使用蚊帳

the other half also benefits

另一半人跟著受惠

because the contagion of the disease spread.

就是因為防疫效果的擴散

And yet, only a quarter of kids at risk sleep under a net.

然而，瘧疾高危險群的孩童僅有1/4睡在蚊帳內

Societies should be willing to go out

很多人應該會願意

and subsidize the net, give them for free,

免費捐贈蚊帳

or, for that matter, pay people to use them

或是，提供補貼

because of those contagion benefits.

因為這樣，防疫效果會更好

"Not so fast," say other people.

有些人則認為，太快了吧

"If you give the nets for free,

如果你免費送蚊帳

people are not going to value them.

他們不會珍惜

They're not going to use them,

也不會好好用

or at least they're not going to use them as bed nets,

也許拿去做別的用途

maybe as fishing nets."

被當成魚網也說不定

So, what do you do?

所以你該如何做呢？

Do you give the nets for free to maximize coverage,

免費送，擴大防疫效果

or do you make people pay

或是他們必須付點錢

in order to make sure that they really value them?

確保他們會善加利用？

How do you know?

你又怎麼知道結果呢？

And a third question: Education.

第三個問題：教育

Maybe that's the solution, maybe we should send kids to school.

也許這是個方法，讓孩童接受教育

But how do you do that?

但該怎麼做呢？

Do you hire teachers? Do you build more schools?

聘請老師？加蓋學校？

Do you provide school lunch?

要不要供應午餐？

How do you know?

你又怎麼知道那種方法更好？

So here is the thing.

這就是問題所在

I cannot answer the big question,

我也不知道

whether aid did any good or not.

援助究竟是好是壞

But these three questions, I can answer them.

但以下這三個問題，我可以回答

It's not the Middle Ages anymore,

現在不是中世紀

it's the 21st century.

現在是21世紀

And in the 20th century,

20世紀時

randomized, controlled trials

隨機對照試驗

have revolutionized medicine

引發醫藥革命

by allowing us to distinguish

也讓我們有能力區分

between drugs that work

這些藥

and drugs that don't work.

究竟有沒有效果

And you can do the same

現在你可以用同樣的方法

randomized, controlled trial for social policy.

把隨機對照試驗用在社會政策上

You can put social innovation to the same

你可以在社會政策上，進行相同的

rigorous, scientific tests

嚴謹的科學測試

that we use for drugs.

如同我們對藥物一般

And in this way, you can take the guesswork

減少用猜測的方式

out of policy-making

來制定政策

by knowing what works,

而是清楚知道那些政策可行

what doesn't work and why.

那些不可行，還有原因是什麼

And I'll give you some examples with those three questions.

再舉幾個例子

So I start with immunization.

就從疫苗開始

Here's Udaipur District, Rajasthan. Beautiful.

這裡是印度的拉賈斯坦烏代布爾區，很美吧

Well, when I started working there,

當我開始在那工作時

about one percent of children

只有百分之一的孩童

were fully immunized.

對麻疹有免疫

That's bad, but there are places like that.

很糟的數字，但很多地方都是這樣

Now, it's not because the vaccines are not there --

原因並非因為沒有疫苗

they are there and they are free --

不但有，而且免費

and it's not because parents do not care about their kids.

也並非父母親不關心自己的小孩

The same child that is not immunized against measles,

沒有免疫的小孩

if they do get measles, parents will spend

如果真得了麻疹，父母親會花

thousands of rupees to help them.

大把鈔票來救自己的孩子

So you get these empty village subcenters

所以，如你所看到的，疫苗注射中心是空的

and crowded hospitals.

醫院卻擠滿了人

So what is the problem?

這問題到底在哪？

Well, part of the problem, surely, is people do not fully understand.

部份原因，當然，是當地居民對麻疹並不了解

After all, in this country as well,

畢竟，在這偏僻地方

all sorts of myths and misconceptions

對於麻疹

go around immunization.

充滿謎團和誤解

So if that's the case, that's difficult,

如果真是這樣，很糟糕

because persuasion is really difficult.

因為人很難被說服

But maybe there is another problem as well.

即使讓他們接受了，到實際付諸行動

It's going from intention to action.

中間還是會發生很多問題

Imagine you are a mother

假設你是個母親

in Udaipur District, Rajasthan.

在拉賈斯坦烏代布爾區這樣一個偏遠地方

You have to walk a few kilometers to get your kids immunized.

為了讓孩子接種疫苗，首先必須走好幾公里的路

And maybe when you get there, what you find is this:

好不容易走到了，在你眼前的卻是

The subcenter is closed. Ao you have to come back,

關了門的注射中心，你只好打道回府

and you are so busy and you have so many other things to do,

但你真的很忙，有太多其他的事要做了