气候变化、健康与贫困的关联 Cheryl Holder: The link between climate change, health and poverty

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演员: Cheryl Holder


台词
I arrived in the US from Kingston, Jamaica in the summer of '68.
1968 年夏天, 我从牙买加首都金斯敦来到美国。
My family of six crammed into a small, two-bedroom apartment
我们一家六口挤在布鲁克林的
in a three-story walk-up in Brooklyn.
一间位于三楼的、 无电梯且狭小的两居室公寓。
The block had several children --
这个街区有几个孩子——
some spoke Spanish, some spoke English.
他们有的讲西班牙语, 有的讲英语。
Initially, I wasn't allowed to play with them
最初我的父母不让我和他们玩,
because, as my parents said, "Them too rambunctious" --
因为他们说, “这些孩子太野了”——
(Laughter)
(笑声)
so I could only watch them from my window.
所以我只能透过窗户看他们玩耍。
Rollerskating was one of their favorite activities.
溜旱冰是他们最喜欢的活动之一。
They loved hitching a ride at the back of the city bus,
他们喜欢挂在城市公交车的尾部,
letting go of the rear bumper
当公交车到达我家门口的
as the bus arrived at the bottom of the block
街区末端时,
in front of my building.
松开抓住车后部保险杠的手。
One day there was a new girl with them.
有一天,孩子中新来了一位女孩。
I heard the usual squeals of laughter interspersed with, "Mira, mira!
我听到了和平常一样的笑声里
Mira, mira!"
夹杂着叫声,“ Mira, mira!”
Spanish for, "Look, look!"
这在西班牙语里是 “快看,快看!” 的意思。
The group grabbed onto the back of the bus at the top of the block,
那群孩子在街区前端 抓住一辆公交车尾部,
and as they rolled down laughing and screaming, "Mira, mira, mira, mira,"
正当他们一边大笑一边叫着: “ Mira, mira, mira, mira ”
the bus abruptly stopped.
公交车忽然停了。
The experienced riders adjusted and quickly let go,
那些经验丰富的 “骑手” 快速调整姿势并松开了手,
but the new girl lurched back and fell onto the pavement.
然而,那个新来的女孩 向后倾斜摔向了人行道,
She didn't move.
她没有动。
The adults outside ran to help her.
四周的大人们跑过去帮她。
The bus driver came out to see what had happened
公交车司机下车查看发生了什么,
and call for an ambulance.
并叫了救护车。
There was blood coming from her head.
血从那个女孩的头上流淌下来。
She didn't open her eyes.
她没有睁开眼睛。
We waited for the ambulance,
我们等着救护车,
and waited,
一直等着,
and everyone said, "Where is the ambulance?
每个人都在问:“救护车在哪?
Where is the ambulance?"
救护车呢?”
The police finally arrived.
最后,警察终于来到了现场。
An older black American man said, "Ain't no ambulance coming."
一个上了年纪的黑人说, “救护车根本不会来。”
He said it again loudly to the cop.
他又对着警察大声重复了这句话——
"You know ain't no ambulance coming.
“你们知道救护车根本不会来。
They never send no ambulance here."
他们从不派救护车来这里。”
The cop looked at my neighbors who were getting frustrated,
警察们瞥了眼 我愤怒且沮丧的邻居们,
lifted the girl into the patrol car
把女孩抬进巡逻车里,
and left.
便离开了。
I was 10 years old at the time.
我当时 10 岁。
I knew this wasn't right.
我知道这件事是错的。
I knew there was something more we could do.
我知道我们有能力做些什么。
The something I could do was become a doctor.
而我做的事是成为了一名医生。
I became an internist
我成为了一位内科医师,
and committed my career to caring for those we often call the underserved,
并把我的事业奉献给了 那些我们通常照顾不到的人,
the vulnerable,
容易受伤害的脆弱人群,
like those neighbors I had when I first immigrated to America.
比如我刚移民到美国时, 遇见的那些邻居们一样。
During my early training years in Harlem in the '80s,
80 年代,我在哈莱姆接受培训时,
I saw a shocking increase in young men with HIV.
我看到了年轻男性 感染艾滋病的人数激增。
Then when I moved [to] Miami,
之后在我搬到迈阿密后,
I noticed HIV included women and children,
我意识到艾滋病患者 还包括妇女和孩子,
primarily, poor black and brown people.
主要是贫困的黑人和棕色人种。
Within a few years, an infection seen in a select population
短短几年内, 特定人群中出现的感染
became a worldwide epidemic.
发展成了蔓延全世界的流行病。
Again I got the urge to do something.
我又有了做点什么的冲动。
Fortunately, with the help of activists and advocates and educators
幸运的是,在一些 活动家、拥护者、教育者,
and physicians like me who treat the disease,
和一些像我一样 治疗疾病的医生的支持下,
we found a way forward.
我们找到了一个前行的方法。
There was a massive education effort to reduce HIV transmission
人们投入了大量精力进行群众教育, 为了减少了艾滋病的传播,
and provide legal protection for those with the disease.
并为艾滋病患者提供合法的保护。
There was a political will to make sure
还有政治意愿——
that as many patients as possible worldwide,
确保世界范围内 尽可能多的艾滋病患者,
regardless of ability to pay,
无论贫富
could get access to medication.
都可以得到治疗。
Within a couple of decades there were new treatments
几十年内,新的治疗方法出现了,
that transformed this life-threatening infection to a chronic disease,
该方法能把危及生命的艾滋病 转变为诸如糖尿病的
like diabetes.
慢性病。
Now there's a vaccine on the horizon.
现在还有望研究出疫苗。
Over the last five to seven years,
在过去五到七年里,
I've noticed a different epidemic among the patients in Florida,
我发现佛罗里达的病人中 出现了一种新的流行病,
and it looks something like this.
看起来像是这样——
Ms. Anna Mae, a retired clerical worker living on a fixed income in Opa-locka,
安娜 · 麦伊住在奥帕洛卡, 她退休了并有着稳定收入。
walked in for medication refills.
一天,她走进诊室开药。
She had common chronic conditions of high blood pressure, diabetes,
她患有常见的慢性病—— 高血压、糖尿病、
heart disease and asthma
心血管病和哮喘,
with overlapping chronic obstructive pulmonary disease --
她还同时患有
COPD.
慢性阻塞性肺病。
Ms. Anna Mae was one of my more adherent patients,
安娜是我长期的病人,
so I was surprised she needed refills of her breathing medicines
她比往常来诊所 补充呼吸药物的时间要早,
earlier than usual.
所以我还挺意外的。
Towards the end of the visit,
她临走时,
she handed me a Florida Power and Light form and asked me to sign it.
安娜递给我一张佛罗里达 电网公司的表签字。
She was behind on her light bill.
她没能及时付电费。
This form allowed physicians to document serious medical conditions
这张表要求医生 列出严重的健康状况,
requiring equipment that would be impacted
申明如果断了电,
if the patient's electricity was disconnected.
患者的医疗器械会受到影响。
"But Ms. Anna Mae," I said,
“但是安娜,” 我说,
"you don't use any medical devices for breathing.
“你无需使用任何医疗器械协助呼吸。
I don't think you qualify."
我不知道你是否符合要求。”
Further questioning revealed she had been using her air conditioner
进一步询问后,我得知 安娜每时每刻都在使用空调,
day and night because of the heat so she could breathe.
因为天气太热, 不然她将难以呼吸。
Needing to buy more asthma inhalers left her little money;
需要购买哮喘吸入器的硬性需求 使她手头拮据,
she couldn't pay all the bills so it piled up.
所以她没钱支付那些电费, 于是账单便堆积起来了。
I filled out the form,
我填好表,
but knowing she might be denied,
但知道她可能还是会被断电,
I also sent her to the social worker.
我把她送到了社会工作者那里。
Then there was Jorge,
然后,还有乔治,
such a sweet, kind man
他是一个如此善良的人,
who often gifted our clinic
他经常给我们诊所送来
with some of the fruits he sold on the streets of Miami.
他在迈阿密路边卖的水果。
He had signs of worsening kidney function
当他在炎热天气下卖水果时,
whenever he worked days on end on those hot streets
他常常因为脱水
due to dehydration --
产生肾衰竭的症状——
just not enough blood getting to the kidneys.
只是肾脏缺少血液流通。
His kidneys worked much better whenever he took some days off.
每当他休息几天, 他肾脏的状况就会好很多。
But with no other support, what could he do?
但没有别的经济来源, 他还能怎么办呢?
As he says, "Rain or shine, cold or heat, I have to work."
他说:“无论晴雨冷热, 我都需要工作。”
But the most damning case of all may be Ms. Sandra Faye Twiggs
最倒霉的其实可能是 珊德拉 · 特威格斯小姐,
of Fort Lauderdale with COPD.
她也患有慢性阻塞肺病。
She was arrested after fighting with her daughter over a fan.
一次,她在和她女儿 争抢风扇后被逮捕。
On her release from jail,
她从监狱出来后,
she returned to her apartment,
回到了她的公寓,
coughed nonstop
咳个不停,
and died three days later.
三天后去世了。
Here's what else I noticed:
我还注意到了这些:
the data show allergy seasons are starting weeks earlier,
数据显示, 过敏高发期比平常早了几周,
nighttime temperatures are rising,
夜间温度在上升,
trees are growing faster
树木长得更快了,
and mosquitos carrying dangerous diseases like Zika and dengue
蚊子携带着危险病毒, 例如寨卡和登革热
are showing up in areas they didn't exist before.
出现在它们原先不存在的区域。
I also see signs of impending climate gentrification.
我还看到了气候中产阶层化的迹象。
That's when richer people move into poorer neighborhoods
这指的是相较富裕的人
that are at higher elevation
搬进相较贫穷 且海拔较高的地区,
and less subject to flood damage from climate change.
以免受气候变化带来的洪水破坏。
Like in my patient Madame Marie who came in stressed and anxious,
我的病人玛丽小姐 带着焦虑和不安来到诊所,
because she was evicted from her apartment in Miami's Little Haiti
因为她被从自己迈阿密 小海地的公寓中驱逐出来,
to make room for a luxury apartment complex
以此为高级公寓群腾出空间。
whose developers understood that Little Haiti would not flood
开发商们都知道小海地不会闹洪水,
because it's ten feet above sea level.
因为它高于海平面 10 英尺。
An undeniable, clear and consistent warming trend is on the way.
一股不可否认的、显而易见的, 持续的热浪正扑面而来。
A health emergency even bigger than HIV/AIDS seems to be in the works,
它带来的是一场比艾滋病 更为严重的卫生突发事件,
and it was my low-income patients that were dropping clues
而我的那些低收入病人群体正预示着
of what this would look like.
这场危机的种种迹象。
This new epidemic is climate change,
这场新的流行病是气候变化,
and it has a variety of health effects.
它对我们的健康能造成诸多影响。
Climate change impacts us in four major ways.
这些影响主要分四类:
Directly, through heat, extreme weather and pollution;
最直接的是,热潮、极端气候和污染;
through the spread of the disease;
还有通过疾病的传播;
through disruption of our food and water supply;
破坏或中断我们食物和水资源供应;
and through disruption of our emotional well-being.
还有我们的心理健康。
In medicine we use mnemonics to aid our memory,
医学上我们会用助记词汇来帮助记忆,
and this mnemonic, "heatwave,"
这里我们用一个词叫 “ heatwave "(热潮)
shows the eight significant health effects of climate change.
展现了气候变化的八个重大健康影响。
H: Heat illnesses.
H:热病,即中暑。
E: Exacerbation of heart and lung disease.
E:心肺疾病加重。
A: Asthma worsening.
A:哮喘恶化。
T: Traumatic injuries,
T:创伤性损伤,
especially during extreme weather events.
特别是在极端天气事件期间。
W: Water and foodborne illnesses.
W:水和食源性疾病。
A: Allergies worsening.
A:过敏恶化。
V: Vector-borne diseases spreading, like Zika, dengue and Lyme.
V:载体传播疾病, 如寨卡、登革热和莱姆病。
And E: Emotional stresses increasing.
E:心理压力增加。
Poor, vulnerable people are already feeling the effects of climate change.
贫穷脆弱的人已经 感觉到了气候变化的影响。
They are the proverbial canary in a coal mine.
他们是众所周知的 “矿井中用来测试危险的金丝雀”。
Truly, their experiences are like oracles or prophecies.
真的,他们的经历就像预言一般,
The guiding light for us to pay attention
这是一道光,指引我们更加意识到
that we are doing something to our world first that's hurting them first.
我们对地球所做的一些事情 最先在伤害着他们。
But in a matter of time, we are next.
但到头来,我们会是下一个受害者。
If we act together --
如果我们一起行动——
doctors, patients and other health professionals --
医生、病人和其他医疗权威——
we will find solutions.
我们会找到解决方案。
We have done this with the HIV crisis.
我们已经用这个方法 解决过艾滋病危机。
There [it] was thanks to the activism of patients with HIV
多亏了艾滋病患者的积极性——
that demanded medications and better research,
要求有效药物的研发, 以及更好的研究,
and the collaboration of doctors and scientists
以及医生和科学家的合作,
that we were able to control the epidemic.
我们才得以控制那场流行病。
And then it was thanks to international health agencies,
也多亏那些国际卫生组织、
NGOs, politicians and pharmaceutical companies
非政府组织、政客,以及制药公司,
that HIV medication became available in low-income countries.
治疗艾滋病的药物 才得以出现在低收入国家。
There is no reason we can't also apply this model of collaboration
我们没有理由不再次 开展这样的合作,
to address the health effects of climate change before it's too late.
在为时过晚前,找到方法 解决气候变化带来的健康影响。
Climate change is here.
气候变化已经开始了。
It's already damaging the health and homes of poor people.
它已经开始损害穷人的健康 和破坏他们的住所。
Like my patient Jorge,
像我的病人乔治一样,
most of us will have to work,
我们大部分人将必须工作,
whether rain or shine,
无论是下雨还是天晴,
cold or heat.
寒冷或炎热。
But together these patients and their doctors, hand-in-hand,
不过,病人和医生 使用一些基本工具
with some basic tools,
联合起来,
can do so much to make this climate transition less brutal
可以让气候变化带来的影响
for all of us.
变得不那么残酷。
These patients inspired me to found a clinicians' organization
这些病人们鼓舞我创建了 一个临床医生组织
to fight climate change.
以抗争气候变化。
We focus on understanding the health effects of climate change,
我们致力于理解 气候变化对健康的影响,
learning to advocate for patients with climate-related illnesses
学习如何支持并拥护那些 患有气候相关疾病的患者,
and encouraging real-world solutions.
并鼓励世界落实解决办法。
A recent Gallup study showed three of the most respected professions
盖洛普(Gallup)公司 最近的一个调查显示,
are nurses, doctors and pharmacists.
最受尊重的三个职业是 护士、医生和药剂师。
So as respected members of society,
作为备受尊重的社会成员,
we have amplified voices to influence climate change policy
我们有更强有力的声音 来影响气候变化的政策
and politics.
和政治局面。
There is so much we can do.
我们可以做很多事。
As clinicians, our many patient contacts allows us
作为临床医生, 我们与病人的直接接触
to see things before others.
让我们有先见之明。
And this puts us in an ideal position to be on the frontlines of change.
这让我们处在改革前线的理想位置。
We can teach climate-related illnesses in our health-professional schools.
我们可以在医学院 教授气候相关疾病的知识。
We can collect data on our patients' climate-related conditions
我们可以收集病人 与气候相关病情状况的数据,
by making sure there are billing codes to identify them.
并确保能编码识别它们。
We can do climate-related health research.
我们可以做与气候相关的健康研究;
We can teach how to have green practices in homes.
向人们讲授居家环保理念;
We can advocate for our patient energy needs.
拥护病人的能源需求。
We can help them get safer homes.
我们可以帮他们找到 可以更安全居住的房子;
We can help them get necessary equipment in those homes
当情况恶化时,帮他们找到必需的
when conditions worsen.
医疗器械。
We can testify in front of lawmakers as to the findings,
我们还可以利用研究结果向立法者证明
and we can medically treat our patients' climate-related illnesses.
在医学上, 我们能够治疗气候相关的疾病。
Most importantly, we can help prepare our patients mentally and physically
更重要的是,通过结合 经济和社会正义因素的医疗模型,
for the health challenges they will face,
我们能帮助病人 同时从身体和心理上
using a model of medicine
为他们即将要面对的
that incorporates economic and social justice.
健康挑战做准备。
This would mean Ms. Sandra Faye Twiggs with COPD,
这意味着特威格斯小姐
who died after being released from jail
不会在和女儿争抢风扇出狱后,
after a fight with her daughter over a fan,
因慢性阻塞性肺病去世。
would have known that the heat in her apartment made her sick and angry
相反,她会知道炎热的公寓 容易使她生气、发病,
and seek a safer place to go for cooling.
她会找个更安全的地方乘凉,
Even better, her apartment would never have been so hot.
更好的是,她的公寓也不会那么热。
From the poor, I've learned our lives are not only vulnerable
从穷人那里, 我意识到生命不但脆弱,
but are stories of resilience, innovation and survival.
而且充满了适应能力、 创新和幸存的故事。
Like that wise old man who loudly spoke truth to the cop
正如智慧的老人,在那个夏夜:
that summer night:
大声向警察说出真相:
"Ain't no ambulance coming,"
“救护车根本不会来”,
and compelled him to deliver that little girl to the hospital instead.
并且强迫警察把小女孩送去医院。
You know what?
你们知道吗?
Listen up.
听好了。
If there's going to be a medical response to climate change,
如果要针对气候变化做出医学回应,
it is not going to be just waiting for an ambulance.
它不会仅仅是等待一辆救护车。
It is going to happen because we the clinicians take the first step.
回应会发生是因为我们 作为医生们能迈出第一步。
We make so much noise
我们的呼喊声
that the issue cannot be ignored or misunderstood.
响亮到让这个问题 无法被忽略或误解。
It is going to start with the stories our patients tell
这将从我们病人讲述的故事,
and the stories we tell on their behalf.
也从我们替他们讲述的故事开始。
We're going to do what is right for our patients like we've always done,
我们将一如既往地为病人做正确的事,
but also what is right for our environment,
但同时也是为了我们的环境,
for ourselves
为了我们自己,
and for all the people on this planet --
为了地球上的全人类——
all of them.
所有人。
Thank you.
谢谢。
(Applause and cheers)
(掌声和欢呼)