蓋茨筆記:為什麼我認為我們可以預測未來


I’ve always admired Stephen Hawking. He was a brilliant physicist—and an equally brilliant science communicator. His ability to make the universe accessible inspired millions to get interested in the sciences.

我一直很欣賞史蒂芬·霍金。他是一位傑出的物理學家,也是一位同樣傑出的科學傳播者。他能夠讓整個宇宙變得簡單易懂,激發數百萬人對科學產生興趣。

That’s why I was honored to be chosen to be this year’s recipient of the 2019 Professor Hawking Fellowship. As part of the fellowship, I got to deliver a lecture in the historic Cambridge Union debate hall at Cambridge University.

因此我十分榮幸被選為2019年霍金獎學金的獲得者。作為該計劃的一部分,我在劍橋大學歷史悠久的聯合辯論廳發表了演講。

When I was deciding what to talk about, I knew I wanted to try and live up to Hawking's legacy of making the sciences interesting. I picked a topic that's close to my heart—global health—and opted to do something that I hope would' ve delighted Professor Hawking: predict the future.

當我在考慮講什麼時,我知道我想要嘗試和踐行霍金讓科學變得有趣的精神。我挑了一個我非常關注的話題“全球健康”,並且選擇做一件我希望能讓霍金教授欣慰的事情:預測未來。

You can read my remarks below. I’m grateful to the Cambridge Union Society for inviting me to give this lecture.

下面是我的演講稿。感謝劍橋聯合會邀請我來進行這次演講。

Remarks as prepared

2019 Professor Hawking Fellowship Lecture

Cambridge University, United Kingdom

October 7, 2019

2019年霍金獎學金演講

劍橋大學,英國

2019年10月7日

Thank you, Lucy (Hawking). I was lucky to have spent time with your father over the years, and it was wonderful to meet you this morning.

謝謝你,露西·霍金。這些年來,我有幸與你父親為伴,今天早上能見到你真是太好了。

I am deeply honored to be selected as this year’s Hawking fellow. I want to thank the selection committee, the Cambridge Union, and the entire Hawking family for this tremendous distinction.

我很榮幸被選為今年的霍金獎學金獲得者。我要感謝評選委員會、劍橋聯合會和整個霍金家族給我帶來的巨大榮譽。

I first met Professor Hawking in 1997, when I was here to announce a new research lab that Microsoft opened with Cambridge. We saw each other several times over the years—both here in Cambridge, and in Seattle for some particularly memorable dinners. I wish I could tell you something surprising about our conversations, but we mostly talked about physics.

我第一次見到霍金教授是在1997年,當時我就在這裡,宣布微軟與劍橋大學合作建立一個新的研究實驗室。這些年來,我們見過好幾次面,在劍橋和西雅圖共進了幾次特別難忘的晚餐。我很希望能告訴你們一些關於我們所談令人驚訝的事情,但其實我們主要談論的是物理。

Trust me: if you’re as interested in physics as I am and you have an OPPOrtunity to talk to Professor Hawking about his work, you take it. He was as exceptional in person as you imagined he was. He not only had a brilliant mind for physics, but he was also a remarkably gifted communicator.

相信我:如果你和我一樣對物理學感興趣,並且有機會和霍金教授聊聊他的研究,你一定要抓住這個機會。他的個性和你想像中的一樣特別。他不僅在物理方面很有天賦,還是一個非常有天份的溝通者。

Hawking wanted the public to think about and engage with science. He devoted his career to making it accessible and interesting. He urged people to be curious—to learn the facts and ask questions.

霍金希望公眾思考並參與科學。他的整個職業生涯都致力於使它變得通俗易懂且有趣。他鼓勵人們保持好奇心——了解事實並提出問題。

In fact, Hawking’s last book was all about asking big questions. One of those questions was, can we predict the future?

事實上,霍金的最後一本書通篇都是關於提出大問題的。其中一個大問題就是,我們能預測未來嗎?

Today, I want to use this platform created by Professor Hawking and his family to try and answer that question. Can we predict the future? When it comes to the future of health, I believe the answer is yes—we can.

霍金希望公眾思考並參與科學。他的整個職業生涯都致力於使它變得通俗易懂且有趣。他鼓勵人們保持好奇心——了解事實並提出問題。

Why do I think we can predict the future? Because of three facts that explain how we got to where we are today.

為什麼我認為我們可以預測未來呢?因為有三個事實可以解釋我們是如何達成今天的成就的。

Fact #1: Global health has seen dramatic improvements in recent decades.

事實一:近幾十年來,全球健康狀況得到了顯著改善。

The country with the worst health outcomes today is better off than the best country a century ago. The world has seen remarkable drops in childhood mortality and amazing increases in life expectancy.

如今健康狀況最差的國家比一個世紀前健康狀況最好的國家都要好。世界兒童死亡率大幅下降,預期壽命漲幅驚人。

I love this chart, because it shows just how much progress we've made. Each line shows how many people died in each age group, with the youngest at the top and the oldest at the bottom. The left side is 1990, and the right side is 2017.

我喜歡這個圖表,因為它展示了我們已取得了巨大的進步。每一行顯示了各個年齡段的死亡人數,最年輕的人群在最上面,最年老的人群在最下面。左邊是1990年,右邊是2017年。

Look at that top line on the left. In 1990, the age group with the highest mortality rate was, by far, kids under five. 12 million children died that year. Now look at the same line on the right… 6 million. By 2017, under 5 deaths had been cut in half. The age group with the highest mortality rate was 80 to 84. That means that more people are the world are living to see old age.

看左邊頂部的那一行。 1990年,死亡率最高的年齡組是五歲以下的兒童。那一年有1200萬兒童死亡。再看右邊同一行:600萬。到2017年,五歲以下兒童死亡人數減少了一半。死亡率最高的年齡組為80-84歲。這意味著世界上有更多的人活到了老年。

But despite these improvements, we’re still seeing huge inequities in health.

儘管我們已取得了這些進展,我們仍然可以看到健康方面存在巨大的不平等。

Let’s look at a map of under 5 mortality today:

讓我們看一下如今5歲以下兒童死亡率的分佈圖:

Look at where the deaths are: They're mostly in sub-Saharan Africa. And these kids are often dying from diseases that are preventable and treatable, like diarrhea. That's because the breakthroughs that save lives in places like Cambridge and Seattle have been slow to reach them. Which brings me to fact number two…

看看死亡都發生在哪裡:大多在撒哈拉以南的非洲。這些孩子通常死於可以預防和治療的疾病,比如腹瀉。這是因為在劍橋和西雅圖等地挽救生命的突破進展緩慢。這讓我想到了第二個事實……

Fact #2: Improvements are made possible by innovation.

事實二:進步是通過創新實現的。

When most people picture health innovation, they think of big medical breakthroughs—like when Salk developed the first polio vaccine. But innovation isn’t limited to new treatments. Sometimes the biggest impacts come from improved systems, which allow us to reach more people.

當大多數人設想健康領域的創新時,他們想到的是醫學上的重大突破,比如索爾克研製出第一支脊髓灰質炎疫苗。但創新並不局限於新療法,有時最大的影響來自於優化的系統,它使我們得以觸達更多的人。

For example, the oral polio vaccine that's pushed polio to the brink of extinction in recent years has been available since 1961. But for decades, it wasn't accessible to all children everywhere. That changed in 1988, with the creation of a new partnership called the Global Polio Eradication Initiative.

例如,近年來將脊髓灰質炎推向滅絕邊緣的口服脊髓灰質炎疫苗自1961年就已問世,但幾十年來,並非世界各地所有的孩子都能獲得該疫苗。 1988年,隨著一個名為全球根除脊髓灰質炎行動GPEI的新機構的建立,這種情況發生了轉變。

GPEI developed innovative strategies to reach every last child with the vaccine and conducted disease surveillance to trace the virus anywhere in the world. Thanks to tireless efforts of partners and country governments, as well a massive volunteer effort from Rotary International, GPEI has driven down polio cases by over 99.9% globally.

GPEI制定了創新性戰略,目標是觸達並為每一個兒童接種疫苗。它還開展了疾病監測,以便在全球各地追踪病毒。由於合作夥伴和各國政府的不懈努力,以及扶輪國際的大規模志願工作,GPEI已在全球範圍內將脊髓灰質炎病例減少了99.9%以上。

The innovations that enable progress also include new methods of understanding.

推動進步的創新還包括新的認知方法。

When Melinda and I first started this work, we were stunned by how little the world knew about how human health works—and especially about what health looked like in the poorest places. Today, our understanding is a lot deeper and more precise.

When I first got interested in global health, this is all we knew about who suffered from one of the world’s biggest killers: diarrhea.

當我和梅琳達第一次開始這項工作時,我們震驚地發現世界對衛生工作知之甚少,特別是對最貧困地區的健康狀況知之甚少。而我們今天的認識要深刻和準確得多。

當我一開始對全球健康感興趣時,面對世界上最大的健康殺手之一——腹瀉,我們對遭受這種疾病的患者所了解的全部內容都包含在這張表裡。

What does this tell us? Aside from the fact that a lot of people had diarrhea in 1990, not a lot. It tells you what big categories are killing kids in various regions, but not even which country they're in or what's causing their diarrhea. It gives you a sense of the scope of the problem, but it's not particularly useful for coming up with a plan.

它告訴我們什麼?除了在1990年有很多人得了腹瀉這一事實之外,這張表顯示的內容並不是很多。它告訴你在不同的地區有哪些疾病大類造成了兒童死亡,但甚至並沒有告訴你他們在哪個國家或什麼使他們患上了腹瀉。它能讓你體會到問題的嚴重程度,但對於提出計劃來說並不是特別有用。

This is what the data we have on diarrhea looks like today:

這是今天我們有的關於腹瀉的數據:

We can break down diarrhea deaths by country and more than a dozen causes.

Better data helps us use our resources better. For example, by looking at this chart, we know it makes sense to invest more money in rotavirus vaccines for Chad—with its high percentage of deaths—than for Ethiopia, which has a relatively low percentage of rotavirus deaths.

我們可以按國家和十幾種原因來細分腹瀉死亡人數。

更好的數據幫助我們更好地利用資源。例如,通過觀察這張圖表,我們知道,將更多的資金投入到乍得的輪狀病毒疫苗比投入到埃塞俄比亞更有意義,因為乍得的輪狀病毒死亡率相對高於埃塞俄比亞。

This chart is from an incredible tool called the Global Burden of Disease. If you work in global health, it's invaluable. It can tell you almost anything you want to know about who gets what diseases where. If you don't work in global health , it's a great way to track the amazing progress we've made—and the progress still to come. And there's a lot still to come, because…

這張圖表來自一個非常棒的工具,叫做“全球疾病負擔”(Global Burden of Disease。如果你在全球健康領域工作,這個工具是極有價值的。關於哪些人在哪裡患上哪種疾病的相關信息,它可以告訴你幾乎所有你想知道的內容。如果你不在全球健康領域工作,它也是跟踪我們已取得的驚人進展的好方法——而且進展還將繼續。我們還有很多事情要做,因為……

Fact #3: Innovation is a long game.

事實三:創新是一場持久戰。

There’s a reason we talk about the R&D pipeline: innovation often requires years of development. The rotavirus vaccine I just mentioned took decades to reach the people who needed it and was even pulled from the market at one point.

我們談論研發進度是有原因的:創新往往需要多年的發展和積累。我之前提到的輪狀病毒疫苗花了幾十年才得以被需要的人接種,甚至還一度被撤出市場。

Many of the technologies that will shape human health two decades from now are already in development. And recent breakthroughs in understanding about how the body works are setting us up for huge improvements.

未來20年內將影響人類健康的許多技術已經處於研發過程中。最近,在理解身體如何運作方面的突破正為我們帶來巨大的進步。

I'm lucky that my work gives me a view of all the amazing discoveries in the works right now. That's why I'm able to predict the future. Based on what I see coming down the pipeline, I predict that human health will be dramatically altered by two major developments over the next 20 years.

幸運的是,我的工作讓我得以一覽如今領域內所有的驚人發現。這就是為什麼我能預測未來。基於我看到的研發進度,我預測在未來20年裡,人類健康將因兩項重大進展而發生巨大變化。

My first prediction is, we will solve malnutrition and significantly reduce the number of nutrition-related deaths.

我的第一個預測是,我們將解決營養不良問題,並顯著減少與營養相關的死亡人數。

I get asked a lot what I would choose if I could only solve one problem. My answer is always malnutrition.

很多人問我,如果我只能解決一個問題,我會選擇什麼。我的回答總是營養不良問題。

Remember that map of childhood mortality? The one that told us kids are way more likely to die in sub-Saharan Africa than anywhere else in the world? Malnutrition is responsible for about half of those deaths.

還記得那張兒童死亡率地圖嗎?就是那張告訴我們撒哈拉以南非洲的孩子比世界其他地方的孩子更有可能死亡的地圖。這些死亡中約一半是營養不良造成的。

It’s the greatest health inequity in the world. By solving malnutrition, we can fix one of the biggest contributors to inequity.

這是世界上最大的健康不平等問題。通過解決營養不良問題,我們可以消除造成不平等的最大因素之一。

When most people think of malnutrition, they picture a starving kid whose bones are sticking out. That’s wasting, when you have a low weight for your height. Wasting often kills you. But wasting isn’t the only problem that comes from malnutrition.

這是世界上最大的健康不平等問題。句號。通過解決營養不良問題,我們可以消除造成不平等的最大因素之一。

There's also stunting. It happens when you have a low height for your weight, and it's irreversible. Most kids who survive wasting end up stunted. If you don't get enough nutrition during the first three years of life, you don't develop properly—physically or mentally.

大多數人一想到營養不良,就會聯想到一個飢餓的、瘦骨嶙峋的孩子。當相對於身高,你的體重偏低時,就屬於消瘦。消瘦經常會造成死亡。但消瘦並不是營養不良帶來的唯一問題。

還有發育遲緩的問題。當你的身高相對於體重偏低且不可逆轉時,就屬於發育遲緩。大多數在消瘦中倖存的孩子最終都會發育遲緩。如果你在生命的前三年內沒有獲得足夠的營養,你的身體和智力都不能得到正常的發展。

Even if you survive to adulthood, your chances of dying are much higher, and your quality of life is greatly reduced.

即使你活到成年,你的死亡機率也會高得多,生活質量也會大大降低。

This picture is a good example of the long-term effects of stunting:

這張照片很好地說明了發育不良的長期影響:

All of these kids are 9 years old. The three on the left are well below the average height for their age. This is what happens when you miss that key window of growth, the first couple years of your life. You can't make it up.

這些孩子都是9歲。左邊的三個孩子遠遠低於他們這個年齡的平均身高。這就是當你錯過成長的關鍵窗口期(也就是你生命的前幾年)會發生的事情。你將無法彌補。

It’s no exaggeration to say that stunting holds back entire nations. And here’s the most shocking part: despite all of the amazing progress we’ve made on health, one out of every five kids under 5 today is stunted.

毫不誇張地說,發育遲緩阻礙了整個國家的發展。最令人震驚的是:儘管我們在健康方面取得了驚人的進步,但如今仍有五分之一的五歲以下兒童發育遲緩。

Saving these kids isn’t as simple as making sure they have enough food to eat. Stunting can happen even if you’re getting enough calories. To understand why you need to understand how children grow.

拯救這些孩子並不像確保他們有足夠的食物吃那樣簡單。即使你攝入了充足的卡路里,也有可能發生髮育遲緩。要了解原因,你需要理解孩子是如何成長的。

When you eat food, your body takes in energy. That energy is used for lots of things, like powering the brain, fueling physical activity, and supporting your immune system.

吃東西時,你的身體會吸收能量。這些能量被用來做很多事情,比如為大腦提供能量,為體力活動提供燃料,支持你的免疫系統。

For the first couple years of your life, any energy that's left over is used for growing your brain and your muscles and your bones. Infants need to double their birth weight within 6 months. But if you don't have energy left over, that growth doesn't happen as it should. You become stunted.

在生命的前幾年裡,你所剩餘的任何能量都被用來滋養你的大腦、肌肉和骨骼。嬰兒需要在6個月內將出生體重增加一倍。但如果沒有能量富餘,你就得不到應有的生長發育。你成為了發育遲緩的人。

The most obvious reason why is because you don’t get enough of the right food over a long period of time. But there are a few less intuitive causes of stunting.

最明顯的原因是你在很長一段時間內都沒能攝入足量且適合的食物。但發育遲緩還有一些不那麼直觀的原因。

You aren't getting the right micronutrients—vitamins or minerals. You've got an infection that puts your body into a state of inflammation. Your microbiome—the community of good bacteria that live in your body—isn't robust enough. Or your mother suffered from these stresses while you were in the womb or relying on her for breastmilk.

比如:你沒有攝入適合的微量營養素(維生素或礦物質)、感染使你的身體處於炎症狀態、你體內的有益菌群不夠強大,或者你的母親在你還在子宮里或者哺乳的時候遭受了這些。

All of these can make it more difficult for your body to get the nutrients it needs.

所有這些都會使你的身體更難獲得所需的營養素。

The good news is that we have solutions to three of them. You can fix a micronutrient imbalance with fortified foods or supplements. An infection can be treated with medicine or prevented with vaccines. And there are many ways we can improve poor maternal health, including by boosting gender equality and supplementing maternal nutrition maternal nutrition.

好消息是,我們有其中三個問題的解決方案。你可以通過強化食物或補劑來修復微量營養素的不平衡;感染可以用藥物治療或用疫苗預防;我們可以通過許多方式改善孕產婦的不良健康狀況,包括促進性別平等和補充孕期營養。

But until recently, fixing the microbiome has been a complete mystery to us. We’ve learned a lot about it in recent years, and will continue to learn more over the next two decades.

之前,修復微生物群落對我們來說還完全是一個謎。近年來,我們已對這方面了解了很多,並將在未來20年裡繼續了解更多。

That deeper understanding is why I predict we’re going to solve malnutrition.

這些深入的認識就是我預測我們將解決營養不良的原因。

All of us rely on our body's microbiome to function properly. We have more microbial cells living inside our bodies than human cells. These bacteria protect us from infection and are particularly essential to digestion. For example, your body literally cannot break down certain types of plant fibers without an assist from the bacteria in your gut.

要讓身體正常工作,我們所有人都要依賴體內的微生物群。我們體內的微生物細胞比人體細胞還多,這些細菌保護我們免受感染,對消化尤其重要。例如,如果沒有腸道細菌的幫助,你的身體就無法分解某些類型的植物纖維。

In the early 2000s, molecular sequencing techniques let us see for the first time which species and strains live in each person’s microbiome.

在21世紀初,分子測序技術讓我們首次看到哪些物種和菌株生活在人體微生物群中。

Then, in 2013, an American biologist named Jeff Gordon published a landmark study. He and his team studied how the microbiomes of infant twins in Malawi developed over the course of three years. They were mostly interested in the twin pairs where only one twin developed a particularly bad form of malnutrition.

隨後在2013年,美國生物學家傑夫·戈登 (Jeff Gordon) 發表了一項具有里程碑意義的研究。他和他的團隊研究了馬拉維雙胞胎嬰兒的微生物群落在三年內是如何發展的。他們最感興趣的是,有些雙胞胎中只有一個出現了特別嚴重的營養不良。

By analyzing stool samples over time, they found that the microbiome of a twin with the bad form of malnutrition developed way more slowly than one without it—even though they were eating the same food and living in the same environment. When Jeff's team transplanted a sick twin's microbiome into mice, the mice had trouble absorbing nutrients and lost weight.

通過對長期糞便樣本的分析,他們發現儘管這些雙胞胎吃著同樣的食物,生活在同樣的環境中,患有嚴重營養不良的那個雙胞胎的微生物群落比沒有營養不良的那個發展得更慢。當傑夫的團隊把一個患病雙胞胎的微生物組移植到老鼠體內時,這些老鼠開始變得很難吸收營養,體重也下降了。

The twin study indicated that your microbiome is not just a byproduct of your health but can also influence it. It was the first big clue that we might be able to fix malnutrition by changing the gut microbiome.

這項雙胞胎研究表明,微生物群落不僅是健康的副產品,而且能影響你的健康。我們第一次見到這樣的重大線索,證明我們可能通過改變腸道微生物群來解決營養不良問題。

We're still in the relatively early stages of this research. Over the next 10 to 20 years, we're going to learn more about each individual microbial species and how they work with the food you eat to impact health. That knowledge will allow us to smartly engineer interventions that “correct” the microbiome when it's out of whack.

我們仍處於這項研究的相對早期階段。在接下來的10到20年裡,我們將進一步了解每一種微生物,以及它們如何與攝入的食物一起影響人類健康。這些知識將使我們能夠巧妙地設計干預措施,以便在微生物發生紊亂時糾正它們。

You’re probably familiar with one of these interventions: probiotics. In the future, we’ll be able to create next-generation probiotic pills that contain ideal combinations of bacteria—even ones that are tailored to your specific gut.

你可能熟悉其中一種干預措施:益生菌。未來我們將能夠創造出下一代益生菌藥丸,其中包含搭配好的細菌組合,甚至是為你的腸道量身定做的細菌。

Another intervention could be what’s called “microbiota directed complementary foods.” Think of them like fertilizer for the microbiome. Eating them encourages healthy bacteria—the ones that help digest food and protect us from infection—to flourish.

另一個乾預措施可能是所謂的“微生物導向的輔助食品”。你可以把它們想像成微生物的肥料。食用它們能促進健康的細菌(幫助消化食物和保護我們不受感染的那種)的生長。

These microbiome targeted therapies are still in their infancy. If we find a way to make them work and become widely available, I'm optimistic we can prevent stunting. That would be as big a breakthrough as anything else we could do in health over the next two decades.

這些針對微生物的治療方法仍處於初級階段。如果我們能找到一種方法讓它們發揮作用並廣泛應用,那麼我樂觀地相信,我們可以防止營養不良。這將是我們未來20年內在健康方面所能達到的最大突破。

Although I'm most excited about the impact this will have in the poor world, the basic insights we're gaining into how nutrition works will also have huge benefits for the rich world. Over- and under-nutrition are two sides of the same coin. Figuring out how to improve one might also help us improve the other.

儘管這將對貧窮世界產生的影響令我感到非常興奮,我們對營養如何發揮作用的一些基本見解也將為富裕世界帶來巨大的好處。營養過剩和營養不足是一枚硬幣的兩面。找出如何改進其中一個也可能有助於我們改進另一個。

Now that we're understanding more about how the gut gets messed up, we're figuring out how to change it. And that is going to not only help prevent malnutrition and obesity, but lots of other diseases—like asthma, allergies, and some autoimmune diseases, which may be triggered by an unbalanced microbiome.

既然我們已經對腸道有了更多的了解,我們便可以開始想辦法改變它。這不僅有助於防止營養不良和肥胖,還能防止許多其他疾病,如哮喘、過敏和一些自身免疫性疾病——這些疾病可能是由微生物群落失衡引發的。

If we can figure nutrition out—and I believe we will within the next two decades—we’ll save millions of lives and improve even more. Which brings me to my second prediction that will change the future of health…

如果我們能搞清楚營養問題,我相信在未來20年內,我們將拯救數百萬人的生命,甚至改善更多人的生活。這讓我想到我的第二個預言,它將改變健康的未來……

Over the next 20 years, I predict that every nation on the planet will have broadened its healthcare focus from just saving lives to also improving lives.

在接下來的20年裡,我預測地球上每個國家都將把醫療保健的重點從僅僅是拯救生命擴展到改善生活。

This transition marks the single most significant change in how a country thinks about healthcare.

Think about the last time you went to the doctor for a check-up. What were you and your doctor most worried about?

這一轉變標誌著一個國家對醫療保健的看法發生了最重大的變化。

回想一下你上一次去醫生那裡檢查的情景。你和醫生最擔心的是什麼?

If you're like the average Brit, your heart health is a safe bet. You might've discussed your risk factors for things like cancer and Alzheimer's. If you were showing any warning signs, your doctor probably helped you create a plan to stay on the right track.

如果你和普通英國人一樣,那麼你們很有可能會擔心你的心臟健康。你可能已經討論過你患癌症和老年癡呆症的危險因素。如果你出現了任何徵兆,你的醫生可能會幫助你制定計劃,讓你的健康保持在正確的軌道上。

Now imagine that you live in Chad, the country with the highest percentage of preventable deaths.

You likely don’t have a regular check-up, because your local health clinic is too busy treating people who are really sick. You might never see a doctor, only a nurse or another health worker.

現在想像一下你生活在乍得,這個國家可預防性死亡的比例最高。你可能並不會進行定期檢查,因為你們當地的健康診所忙於治療真正生病的人。你可能永遠見不到醫生,只有護士或其他衛生工作者。

When you do see them, it’s probably because something is seriously wrong, like you have a high fever or persistent diarrhea, and you need treatment.

當你的身體出了一些嚴重的問題(比如發高燒或者持續腹瀉)急需治療的時候,你才可能真的見到他們。

What’s the difference between these two approaches? In the UK, the goal of healthcare is to keep you healthy. In Chad, the goal of healthcare is to keep you alive.

這兩種醫保系統有什麼區別?在英國,醫療保健的目標是保持健康。在乍得,醫療保健的目標是保住生命。

It seems like a subtle difference, but it has a huge impact on how you approach healthcare. Within two decades, I believe every country on earth will be able to focus on not just keeping you alive but healthy and well.

這個區別聽起來很微妙,但它對你如何獲得醫療保健服務有著巨大的影響。在二十年內,我相信世界上每個國家都將能不只關註生存,而是關註生活的健康和質量。

The easiest way to track this transition is to look at what percentage of people die from non-communicable diseases versus infectious, maternal, neonatal, and nutritional diseases—disease deaths that we think of as largely “preventable” here in the rich world.

跟踪這一轉變最簡單的方法是,看看在發達國家中,非傳染性疾病與我們認為基本上可以“預防”的傳染病、孕產婦疾病、新生兒疾病和營養性疾病的死亡數比例。

The countries in deep red and orange have a high percentage of preventable deaths—more than 50 percent.

深紅色和橙色國家的可預防死亡比例高達50%以上。

For many of us in this room, preventable deaths in the countries we grew up in fell below 50 percent long before we were born. In other places, it happened more recently. Pakistan crossed the threshold in 1997. South Africa finally made the transition in 2016.

對我們在座的許多人來說,在我們的國家,可預防死亡人數在我們出生之前很久就降到了50%以下。在其他地方,這種情況最近才發生。巴基斯坦在1997年跨過了門檻。南非終於在2016年實現了轉變。

Right now, all of the countries where the majority of deaths come from these preventable causes are in Africa. Two decades from now, those countries will have crossed the 50 percent threshold.

目前,大多數由這些可預防的原因所造成的死亡都來自於非洲。20年後,這些國家將跨過50%的門檻。

How do I know this will happen? A couple reasons.

我為什麼這麼說?有幾個原因。

To start, as I just explained, we’ll have solved nutrition. That’ll make the single biggest improvement.

首先,正如我剛才解釋的,我們將解決營養問題。這將是最大的改善。

I believe we'll also have virtually eliminated malaria by 2040. Many of the countries still above the 50 percent preventable deaths threshold are also the places where malaria kills the most people every year. For example, in Niger, it's responsible for 17 percent of all deaths.

我相信到2040年,我們也將幾乎消滅瘧疾。許多仍高於50%可預防死亡門檻的國家,也是每年瘧疾致死人數最多的地方。例如在尼日爾,瘧疾死亡佔所有死亡的17%。

For a long time, we thought treatment was the best approach. It makes sense, right? Malaria is a curable disease. If you get drugs to enough people—or if you could develop a simple vaccine—you should be able to knock it out .

長期以來,我們認為治療是最好的方法。有道理吧?瘧疾是一種可治癒的疾病。如果你給足夠多的人以藥物,或者開發出一種簡單的疫苗,你就應該能夠把它消滅掉。

The reality is a lot more complicated. What we’ve learned in recent years is that the key to stopping malaria is vector control—and for malaria, the vector is mosquitoes.

現實要復雜得多。近年來我們了解到,控制瘧疾的關鍵是控制傳播媒介,而瘧疾的傳播媒介是蚊子。

We need to stop the mosquitoes that carry malaria if we’re going to stop the disease. There are several promising new developments in the works that give me hope. For one thing, we finally know where the mosquitoes are.

如果我們要阻止瘧疾,就必須消滅攜帶瘧疾的蚊子。這項工作有幾項有潛力的新進展給了我希望。首先,我們終於知道蚊子在哪裡了。

Look at these two maps of Haiti:

看看這兩張海地地圖:

The one on the left shows the malaria rate with a 5×5 km resolution. Believe it or not, even this amount of detail is a huge improvement over what we had 10 years ago. The one on the right uses data from individual health facilities to create pixels that are just 1×1 km square. See how much more detailed it is?

左邊是一個以5×5公里的分辨率顯示瘧疾發病率的地圖。信不信由你,即便只有這點細節,比起10年前也是巨大的進步。右邊的地圖使用來自各個醫療機構的數據,像素只精確到了1×1公里。能看清左邊的清楚多少嗎?

This level of detail means that, instead of blanketing entire regions with bed nets and other anti-malaria measures, health officials can target efforts where they will do the most good.

這種清晰度意味著,衛生官員不必遊走整個地區分發蚊帳和採取其他抗瘧疾的措施,而可以針對重點疫區最大化抗瘧效果。

I'm also excited about the potential of gene editing. Eliminating all the mosquitoes in an area is the quickest way to stop malaria, but it's risky. Most mosquitoes can't carry the malaria parasite. If you got rid of them, you could disrupt the local ecosystem.

我對基因編輯的潛力也感到興奮。消滅一個地區的所有蚊子是阻止瘧疾的最快方法,但這是有風險的。大多數蚊子無法攜帶瘧原蟲。如果你把它們也除掉,就可能會破壞當地的生態系統。

Gene editing lets us target only the bad malaria-carrying mosquitoes. Inserting a gene that prevents these bad mosquitoes from reproducing would buy us time to cure all the people in an area of​​ malaria. Then we could let the mosquito population return without the parasite.

基因編輯讓我們把目標放在攜帶瘧疾的蚊子上。插入一種阻止這些壞蚊子繁殖的基因,將為我們贏得時間治愈瘧疾肆虐地區的所有人。然後我們就可以讓蚊子種群在沒有瘧原蟲的情況下回歸。

This technology is still in the testing phase. We need to understand things like: What's the impact on the food chain if even one species of mosquito starts dying off? How many altered insects would we need to introduce? How long do we need the mosquitoes to be gone? And what political and governmental hurdles do we need to clear?

這項技術仍處於測試階段。我們首先需要理解一些事情:如果其中一種蚊子開始死亡,對食物鏈會有什麼影響?我們需要引進多少種變異昆蟲?我們需要蚊子消失多長時間?有哪些政治及政府方面的阻力需要我們去克服?

Of course, Malaria isn’t the only big killer we’ll make huge progress against.

We’ll also finally turn the tide of the HIV epidemic, thanks in large part to a new generation of highly potent and super long acting HIV drugs.

當然,瘧疾這一致命殺手並不是我們唯一能取得巨大進展的疾病。

我們還將最終扭轉艾滋病毒流行的趨勢,這在很大程度上要感謝新一代高效長效艾滋病毒藥物。

Today, if you get diagnosed with HIV, you can manage the disease using antiretroviral therapy. Thanks to ART, an HIV-positive person now has the same expected lifespan as someone without HIV.

今天,如果你被診斷出感染了艾滋病病毒,你可以通過抗逆轉錄病毒療法來控制這種疾病。多虧了這種療法,感染者現在可以和普通人有同樣的預期壽命。

Since I'm here in Cambridge, I should mention that the United Kingdom is a big reason why we've made as much progress on HIV as we have. The British government is the second largest funder of an organization called the Global Fund—which , among other things, supports more than 17.5 million people who use ART to manage their HIV. I'm actually headed to Lyon later this week for the Global Fund's replenishment conference.

既然我在劍橋,我就應該提到,英國是我們在艾滋病病毒問題上取得如此大進展的一個重要原因。英國政府是一個名為全球基金The Global Fund的組織的第二大資助者。先不提其他貢獻,該組織已支持超過1,750萬使用抗逆轉錄病毒藥物控制艾滋病病毒的人。實際上,我本週晚些時候也要去里昂參加全球基金的籌資會議。

Antiretroviral therapy is amazing, but you have to take a treatment regimen every day and for the rest of your life. If you aren't consistent with taking it, you can develop drug resistance—and even spread a drug resistant strain of the virus to other people.

抗逆轉錄病毒療法雖然很神奇,但你必須在你餘生中的每一天都堅持吃藥。如果你不堅持服用,就可能會產生耐藥性,甚至將一種抗藥性的病毒株傳播給其他人。

The HIV treatments of the future, on the other hand, are miraculous by modern standards. Imagine if, instead of having to take a pill every day, you could get one injection every couple months, maybe even once a year. Or you could get an implant in your arm.

HIV prevention is going to improve, too. Today, you can take a daily pill to reduce your risk of getting infected. In the future, those pills could last longer, so you could take them less frequently.

另一方面,用現代標準來看,未來的艾滋病療法堪稱奇蹟。想像一下,你不必每天都要吃藥,而是每隔幾個月注射一次,甚至一年註射一次。你也可以在手臂上進行植入。

艾滋病的預防也將得到改善。今天,你可以每天吃一片藥來降低感染的風險。在未來,這些藥片可能會持續更長時間,於是你可以減少服用的頻率。

I’m also optimistic about that we’ll one day develop an effective HIV vaccine—which could remove your risk of contracting the virus entirely.

我也很樂觀地認為,有一天我們會開發出一種有效的艾滋病疫苗,可以消除你完全感染病毒的風險。

Fitting lifesaving treatment and prevention options into your life is a lot easier when you don’t have to think about them every day. We’re still years away from that reality. But when we get there, it’ll change the game.

當你不必每天考慮挽救生命的治療方法和預防措施時,把它們融入生活會變得容易得多。我們離那樣的世界還有好多年。但當那天到來時,遊戲規則就會被改變。

So, what happens when a country crosses the preventable death threshold?

那麼,當一個國家跨過可預防死亡的門檻時會發生什麼?

As preventable diseases become less common, chronic conditions become more prevalent. That includes things that can kill you, like Alzheimer's and diabetes—or diseases that just make your life miserable, like arthritis. You're also more likely to suffer from a mental illness , like depression or anxiety.

隨著可預防的疾病變得越來越不常見,慢性病會變得越來越普遍。這包括一些可以殺死你的東西,比如老年癡呆症和糖尿病,或者一些讓你活得很痛苦的疾病,比如關節炎。你也更容易患上精神疾病,比如抑鬱症或焦慮症。

It seems counter-intuitive to view the fact that we’re more likely to be depressed or have a stroke as a sign of progress. But it’s important to remember that human health isn’t measured on a binary scale.

把更容易抑鬱或中風看作進步的標誌似乎很奇怪。但重要的是要記住,人類的健康不是用二進制的標準來衡量的。

Innovation is shrinking the gap between perfect and not perfect health for everyone. And the smaller it gets, the better the world becomes.

創新正在縮小每個人健康和不健康之間的差距。它越小,世界就越美好。

That’s because the shift from longevity to wellness doesn’t just change how we approach healthcare. It unlocks all sorts of amazing opportunities for people and societies to thrive.

這是因為從長壽到健康的轉變不僅僅改變了我們對待醫療保健的方式。它還為人類及社會繁榮打開了各種各樣令人驚奇的機遇。

When we think about how to keep someone well, what we’re really thinking about is their happiness. We’re thinking about how we can ensure they do well at school and are able to provide for their families and contribute to society.

當我們考慮如何讓一個人保持健康,我們真正考慮的是他們的幸福。我們思考如何確保他們在學校表現良好,能夠養家糊口,為社會做出貢獻。

It’s no coincidence that the countries with the highest percentage of preventable deaths also have some of the lowest GDP per capita in the world.

可預防死亡比例最高的國家,其人均國內生產總值(GDP)也處於世界最低水平,這並非巧合。

Improvements in health are fundamental to lifting people out of poverty. When you improve health, people are more productive. And when more children survive to adulthood, families decide to have fewer children—which can lead to a burst of economic growth.

改善健康是脫貧的基礎。健康水平被改善,人們就會更有效率。而當更多的孩子活到成年,家庭就會決定少生孩子,這可能導致經濟的爆發式增長。

In other words, when people thrive physically, economies grow. Poverty goes down. The world gets better.

換句話說,當人們身體健康時,經濟就會增長,貧窮將會減少,世界將會變得更好。

It can be daunting to look at the health inequities that still exist in the world. But if we continue to fund innovation, we can close those gaps. We can solve nutrition, and we can make sure the entire world broadens its focus to include improving lives.

看到世界上仍然存在的健康不平等現象,可能會令人洩氣。但如果我們繼續資助創新,我們就能縮小這些差距。我們可以解決營養問題,我們可以確保全世界都將關注點擴大到改善生活上去。

There’s a catch, though: technology is easy to predict. But progress doesn’t just depend on technology. It also depends on people—who are very hard to predict.

但還是有陷阱存在:技術很容易預測。但進步不僅僅取決於技術。這也取決於那些很難預測的人。

Will we continue to decide that investing in innovation is worthwhile? And will we do what it takes to make sure these innovations reach everyone who needs them?

我們是否會繼續相信投資於創新是值得的?我們是否會盡一切努力確保這些創新惠及所有需要它們的人?

The world is at a critical moment for global health. There are a number of key programs that need to be funded. Nations are deciding right now whether those investments are worth making.

世界正處於全球健康的關鍵時刻,有許多重點項目需要資金支持。現在,各國正在決定是否值得進行這些投資。

One of the other questions Stephen Hawking asked in his last book was, “How do we shape the future?” Investing in global health is one of the best ways we can do that. The future is ours to shape—if we choose to make innovation a priority.

史蒂芬·霍金在他上一本書中問的另一個問題是:我們如何塑造未來?投資於全球健康是我們能做到的最好方式之一。如果我們選擇把創新放在首位,那麼未來就是可以被我們塑造的。

Professor Hawking believed in the magic of science and research. He helped the rest of the world believe in it, too. As remarkable as his contributions to the field of physics were, I believe this is his biggest accomplishment.

霍金教授堅信科學和研究的魔力。他也幫助了全世界相信這一點。儘管他在物理學領域的貢獻非同尋常,但我仍然相信,這才是他最大的成就。

He reminded us to “look up at the stars and not down at our feet.” He taught us all that, if humanity remains focused on expanding what is possible, progress will come.

他提醒我們:“俯視腳下,不如仰望星空。”他教導我們,如果人類繼續專注於擴大潛在的領域,進步就會到來。

Thank you for this tremendous honor.

謝謝你們給予我這項巨大的榮譽。

.(tagsToTranslate)人物 – Bill Gates(t)蓋茨筆記:為什麼我認為我們可以預測未來(t)kknews.xyz

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