I'm a physician trained in infectious diseases, and following my training, I moved to Somalia from San Francisco. And my goodbye greeting from the chief of infectious diseases at San Francisco General was, "Gary, this is the biggest mistake you'll ever make."
我是一名治疗传染性疾病的医生。 学业结束以后, 我从旧金山 去了索马里。 当时旧金山综合医院 传染科主任 送给我的离别致辞是 ”加里,这是你一生中最错误的决定。“
But I landed in a refugee situation that had a million refugees in 40 camps, and there were six of us doctors. There were many epidemics there. My responsibilities were largely related to tuberculosis, and then we got struck by an epidemic of cholera. So it was the spread of tuberculosis and the spread of cholera that I was responsible for inhibiting. And in order to do this work, we, of course, because of the limitation in health workers, had to recruit refugees to be a specialized new category of health worker. Following three years of work in Somalia, I got picked up by the World Health Organization, and got assigned to the epidemics of AIDS. My primary responsibility was Uganda, but also I worked in Rwanda and Burundi and Zaire, now Congo, Tanzania, Malawi, and several other countries. And my last assignment there was to run a unit called intervention development, which was responsible for designing interventions.
我在难民营落脚, 那里有40个难民营收容了100万难民。 却只有我们6个医生。 流行病随处可见。 我的职责主要是针对 肺结核 和令人震惊的流行性霍乱。 我负责阻止肺结核 和霍乱的 大幅扩散。 为了让工作得以顺利进行, 我们数量有限的医护人员 不得不从难民中招人来 特训成医护人员。 在索马里工作了三年以后, 我被世界卫生组织选中 从事防治艾滋病流行的工作。 我的主要工作是在乌干达。 我也在卢旺达、布隆迪、 扎伊尔、刚果、 坦桑尼亚、马拉维和其他几个国家工作过。 我最后一个任务是负责一个 叫干预发展的机构。 这个机构主要负责干预治疗的设计工作。
After 10 years of working overseas, I was exhausted. I really had very little left. I had been traveling to one country after another. I was emotionally feeling very isolated. I wanted to come home. I'd seen a lot of death, in particular epidemic death, and epidemic death has a different feel to it. It's full of panic and fear, and I'd heard the women wailing and crying in the desert. And I wanted to come home and take a break and maybe start over.
10年的海外工作 令我身心疲惫。 我几乎身无分文。 常年的四处奔波, 令我倍感孤独无助。 我想回家歇歇。 我看过太多的死亡, 尤其是流行病造成的死亡。 流行病死亡给人的感受是不一样的, 它令人触目惊心。 我听多了沙漠里女人的 恸哭和哀吟。 我很想回家歇歇 也许重新开始。
I was not aware of any epidemic problems in America. In fact, I wasn't aware of any problems in America. In fact -- seriously. And in fact I would visit friends of mine, and I noticed that they had water that came right into their homes. How many of you have such a situation? (Laughter) And some of them, many of them actually, had water that came into more than one room. And I noticed that they would move this little thermoregulatory device to change the temperature in their home by one degree or two degrees. And now I do that.
在美国,我没发现任何流行病的 问题。 实际上,我没觉得美国有任何问题。 真的。 我去看望我的一些朋友时 我看到他们有水 水直接在家里就可以喝到。 你们中多少人家里是这种情况? (笑声) 有些朋友,其实是很多朋友, 可以在家里的不同房间直接喝到水。 我还发现他们在家里安装了 小巧的调温装置, 可以一度一度地或者两度两度地调解 家里的室内温度。 我家现在也是这样。
And I really didn't know what I would do, but friends of mine began telling me about children shooting other children with guns. And I asked the question, what are you doing about it? What are you in America doing about it? And there were two essential explanations or ideas that were prevalent.
所以我不知道我该做什么好。 我的一个朋友告诉关于 青少年之间的枪击事件。 我就想 你该做什么来阻止这样的事件? 你在美国该做什么来阻止这样的事件? 大家都知道主要有两种方案 或者说办法。
And one was punishment. And this I had heard about before. We who had worked in behavior knew that punishment was something that was discussed but also that it was highly overvalued. It was not a main driver of behavior, nor was it a main driver of behavior change. And besides that, it reminded me of ancient epidemics that were previously completely misunderstood because the science hadn't been there before, epidemics of plague or typhus or leprosy, where the prevalent ideas were that there were bad people or bad humors or bad air, and widows were dragged around the moat, and dungeons were part of the solution.
一个是惩罚。 我以前就听说过的方法。 我们以前研究行为学的 知道惩罚是经常被探讨的方法。 但它也是个被高估的方法。 它不是行为的主要驱动力, 也不是行为改变的主要驱动力。 而且,它让我意识到 过去的流行病 就曾经被完全曲解。 当时的科学没有普及到 瘟疫、 斑疹伤寒和麻风病(疫区)。 所以当时大家普遍认为 疫区的人差、环境差、空气差。 寡妇们被拖到护城河。 (拖进)地牢甚至是解决(流行病)的方法之一。
The other explanation or, in a way, the solution suggested, is please fix all of these things: the schools, the community, the homes, the families, everything. And I'd heard this before as well. I'd called this the "everything" theory, or EOE: Everything On Earth. But we'd also realized in treating other processes and problems that sometimes you don't need to treat everything.
另一种方案,或者说, 解决方法是 请改善所有的设施: 学校、公共场所、私人住处、各个家庭,以及 所有的东西。 我也同样知道这个方法。 我把这叫做“凡事”理论。 或者说EOE:世上万物。 但是我们也认识到 在治疗流行病的过程中 有时候你并不需要改变所有的东西。
And so the sense that I had was there was a giant gap here. The problem of violence was stuck, and this has historically been the case in many other issues. Diarrheal diseases had been stuck. Malaria had been stuck. Frequently, a strategy has to be rethought. It's not as if I had any idea what it would look like, but there was a sense that we would have to do something with new categories of workers and something having to do with behavior change and something having to do with public education.
所以我的感觉是 人们的认识上有一个鸿沟。 暴力问题(的解决)陷入僵局。 这历来都是 其他重大问题的特点。 腹泻病(的治疗)曾陷入僵局。 疟疾(的治疗)也曾陷入僵局。 通常情况下,一个治疗方案必需进行反思。 不是说我知道应该怎么做, 我是觉得我们需要 和一种全新类别的工作者一起来解决这个问题。 这样的新方案应该可以改变人们的行为, 这样的新方案应该用公共教育的方式来实行。
But I began to ask questions and search out the usual things that I had been exploring before, like, what do the maps look like? What do the graphs look like? What does the data look like? And the maps of violence in most U.S. cities looked like this. There was clustering. This reminded me of clustering that we'd seen also in infectious epidemics, for example cholera. And then we looked at the maps, and the maps showed this typical wave upon wave upon wave, because all epidemics are combinations of many epidemics. And it also looked like infectious epidemics. And then we asked the question, well what really predicts a case of violence? And it turns out that the greatest predictor of a case of violence is a preceding case of violence. Which also sounds like, if there is a case of flu, someone gave someone a case of flu, or a cold, or the greatest risk factor of tuberculosis is having been exposed to tuberculosis.
我开始提出问题, 研究我以前探讨过的 一些常见指标。 比如说,分布图是什么样的? 图表是什么样的? 数据又是什么样的? 那么在美国大部分的城市, 暴力事件的分布图 就象这个。 是丛集分布的。 这让我意识到我们以前见过的 流行传染病就是丛集分布的。 比如说霍乱。 我们观察曲线图发现 曲线图里有这样的典型曲线。 一个波形叠着一个波形的分布。 因为所有的流行病 都合并着其他流行病而生。 而暴力事件的曲线图和流行病的曲线图也很相似。 然后我们就问了, 怎样预警暴力案件呢? 结果我们发现对一个暴力事件的 最好预警就是上一次的暴力事件。 这就跟流感疫情相似, 就象某人把流感,或者感冒传给别人, 最大的罹患因素就是 结核病的接触史。
And so we see that violence is, in a way, behaving like a contagious disease. We're aware of this anyway even in our common experiences or our newspaper stories of the spread of violence from fights or in gang wars or in civil wars or even in genocides.
我们发现暴力事件,在某种程度上, 很象传染病的爆发。 其实,我们 在日常生活中 或者媒体的报道中都可以了解到 争吵中的暴力会蔓延成 帮派斗争,内战, 甚至蔓延成为种族屠杀。
And so there's good news about this, though, because there's a way to reverse epidemics, and there's really only three things that are done to reverse epidemics, and the first of it is interrupting transmission. In order to interrupt transmission, you need to detect and find first cases. In other words, for T.B. you have to find somebody who has active T.B. who is infecting other people. Make sense? And there's special workers for doing that. For this particular problem, we designed a new category of worker who, like a SARS worker or someone looking for bird flu, might find first cases. In this case, it's someone who's very angry because someone looked at his girlfriend or owes him money, and you can find workers and train them into these specialized categories.
有个好消息,就是, 我们知道治疗传染病的方式。 只要做好三件事就可以 阻止传染病的发生。 第一点就是切断传播途径。 为了切断传播途径, 我们需要找到第一个案例。 就是说,如果是结核病,你必须要找到 谁有活动性结核病菌,谁会把结核病传染给别人。 对吧? 我们有专业人员来做这个工作。 对这样特定的问题, 我们设计出新类别的工作者。 就象(寻找)非典(传染源)的工作者, (寻找)禽流感(传染源)的工作者, 去找到首例患病者。 在这个(暴力事件的)案例里,起因是有人 因为别人偷看了他的女朋友 或者别人欠了他的钱而动怒。 你可以找到一些人,训练他们成为 特殊类型的工作者。
And the second thing to do, of course, is to prevent further spread, that means to find who else has been exposed, but may not be spreading so much right now like someone with a smaller case of T.B., or someone who is just hanging out in the neighborhoods, but in the same group, and then they need to be, in a way, managed as well, particular to the specific disease process.
第二点呢,当然就是 防止扩散。 就是说,要找到谁有可能被牵涉进去。 虽然他可能不会很快被牵涉, 就像在结核病传染的小型案例里一样。 哪怕那个人不过是到那个地区转了一圈 但是在一个圈子里(活动)。 那么这些人就需要,以某种方式, 被好好管理。 就象处理某些特殊疾病的过程一样。
And then the third part, the shifting the norms, and that means a whole bunch of community activities, remodeling, public education, and then you've got what you might call group immunity. And that combination of factors is how the AIDS epidemic in Uganda was very successfully reversed.
那么第三点就是,恢复到正常。 就是说整个社区活动的 重组和公共教育。 然后你可以做到所谓的 “群体免疫”。 这几个因素的结合 使我们当初成功地阻止了 艾滋病在乌干达的扩散。
And so what we decided to do in the year 2000 is kind of put this together in a way by hiring in new categories of workers, the first being violence interruptors. And then we would put all of this into place in one neighborhood in what was the worst police district in the United States at the time. So violence interruptors hired from the same group, credibility, trust, access, just like the health workers in Somalia, but designed for a different category, and trained in persuasion, cooling people down, buying time, reframing. And then another category of worker, the outreach workers, to keep people in a way on therapy for six to 24 months. Just like T.B., but the object is behavior change. And then a bunch of community activities for changing norms.
在2000年我们决定尝试 把这些因素结合起来。 首先我们采用了一些新类型的工作者, 作为第一批暴力阻止者。 然后我们把(我上面提到的)三个因素全部运用到 某个社区, 美国国内的 某个治安差的地区。 暴力阻止者是从(动怒者)同一个圈子里选出来的, 有信誉、值得信任、能接近(动怒者), 就象在索马里的那些(在难民营受训的)医护工作者一样。 只不过他们为不同的目的而工作。 他们受训学习如何劝说别人, 让(动怒者)息怒,和他们一起消磨时间,转变他的态度。 还有其他类别的员工, 外展员工,是在某种程度上 让动怒者接受6到24个月的心理辅导。 就象结核病的治疗,只不过这次是行为上的改变。 然后呢,一些社区活动就会 恢复正常。
Now our first experiment of this resulted in a 67-percent drop in shootings and killings in the West Garfield neighborhood of Chicago.
我们首次实验结果 显示在芝加哥西加费尔德地区, 枪击案和枪杀案 减少了67%。
(Applause)
(掌声)
And this was a beautiful thing for the neighborhood itself, first 50 or 60 days, then 90 days, and then there was unfortunately another shooting in another 90 days, and the moms were hanging out in the afternoon. They were using parks they weren't using before. The sun was out. Everybody was happy.
这对一个社区来说, 是一件非常好的事。 刚开始坚持了50天,或60天,然后是90天, 在接下来的90天里, 那里仅发生了一件不幸的枪击事件。 那些社区里的妈妈们开始在下午一起出来散步, 他们开始利用他们以前不曾利用的公园。 太阳出来了。每个人都很高兴。
But of course, the funders said, "Wait a second, do it again." And so we had to then, fortunately, get the funds to repeat this experience, and this is one of the next four neighborhoods that had a 45-percent drop in shootings and killings. And since that time, this has been replicated 20 times. There have been independent evaluations supported by the Justice Department and by the CDC and performed by Johns Hopkins that have shown 30-to-50-percent and 40-to-70-percent reductions in shootings and killings using this new method. In fact, there have been three independent evaluations of this now.
但当然了,有些捐款人说,“等等, 你再做一次。” 所以呢,我们幸运地 拿到了资金来重复这个实验。 在其他四个实验社区中的一个社区 枪杀案和凶杀案减少了45%。 从那时开始,这个实验已经被重复了 20次。 我们的实验被独立评估过。 这个评估是由司法部门和 疾病预防控制中心支持,由约翰霍普金斯大学来实行的。 评估结果显示我们的实验把枪击案和杀人案 减少到了30-50% 和40-60%。 这是采用(我上面提到的)新方法做到的。 实际上,我们的工作目前为止已经通过了三次独立 评估。
Now we've gotten a lot of attention as a result of this, including being featured on The New York Times' Sunday magazine cover story. The Economist in 2009 said this is "the approach that will come to prominence." And even a movie was made around our work. [The Interrupters]
也因此受到了很多人的瞩目。 其中包括 《纽约时报》周日杂志的封面特别推荐。 2009年的《经济学家》杂志 报道说,我们的工作是“卓越的尝试“。 甚至有一部电影是围绕我们的工作来拍摄的。 [中断]
However, not so fast, because a lot of people did not agree with this way of going about it. We got a lot of criticism, a lot of opposition, and a lot of opponents. In other words, what do you mean, health problem? What do you mean, epidemic? What do you mean, no bad guys? And there's whole industries designed for managing bad people. What do you mean, hiring people who have backgrounds? My business friends said, "Gary, you're being criticized tremendously. You must be doing something right."
但是,先不要急, 因为很多人还不同意 我们的做法。 我们受到了很多的批评, 很多的反对意见, 很多的敌对态度。 (他们问),(你说这是)健康问题,是什么意思? (你说这是)流行病,是什么意思? (你说)他们不是很坏的人,是什么意思? 社会上已经有了 管理坏人的方案。 你说的雇用有(不良)背景的人, 是什么意思? 我的商业界朋友说, ”格里,你的工作受到了严厉地批评, 你一定是做了正确的事!“
(Laughter)
(笑声)
My musician friends added the word "dude."
我的音乐家朋友还加了一个词儿”伙计“。
So anyway, additionally, there was still this problem, and we were getting highly criticized as well for not dealing with all of these other problems. Yet we were able to manage malaria and reduce HIV and reduce diarrheal diseases in places with awful economies without healing the economy.
事实上, 暴力问题确实还是存在。 我们的工作受到了另一种严厉批评 因为我们的工作无法处理所有的其他问题。 目前为止,我们能控制疟疾, 减少艾滋病和腹泻的发病, 在那些贫困的 没有经济复苏的地区。
So what's actually happened is, although there is still some opposition, the movement is clearly growing. Many of the major cities in the U.S., including New York City and Baltimore and Kansas City, their health departments are running this now. Chicago and New Orleans, the health departments are having a very large role in this. This is being embraced more by law enforcement than it had been years ago. Trauma centers and hospitals are doing their part in stepping up. And the U.S. Conference of Mayors has endorsed not only the approach but the specific model. Where there's really been uptake even faster is in the international environment, where there's a 55-percent drop in the first neighborhood in Puerto Rico, where interruptions are just beginning in Honduras, where the strategy has been applied in Kenya for the recent elections, and where there have been 500 interruptions in Iraq.
所以实际上, 尽管有一些反对意见, 很明显大家都行动起来了。 美国的很多大城市, 包括纽约和巴的摩尔 和堪萨斯城。 他们的卫生部门在开展着类似的工作。 芝加哥和新奥尔良的卫生部门 在这样的工作中发挥着巨大的作用。 执法部门比几年前更加 接受我们的工作。 创伤中心和医院 也在不断跟进。 美国市长联席会议 已经核准不仅要开展类似的工作 而且要作为特别模式来做。 也有一些行动更加迅速的 国际组织。 在波多黎各的第一个试点区域, 犯罪率减少了55%。 在洪都拉斯切断(犯罪)工作正在着手进行。 在肯亚最近的选举活动中,我们的工作模式 已经被列入计划。 伊拉克已经完成了500次切断犯罪的工作。
So violence is responding as a disease even as it behaves as a disease. So the theory, in a way, is kind of being validated by the treatment. And recently, the Institute of Medicine came out with a workshop report which went through some of the data, including the neuroscience, on how this problem is really transmitted.
暴力事件可以当作疾病来对待, 它的表现形式就象一个疾病的表现形式。 我们的理论,某种意义上说, 是在处理过程中得到了验证的。 最近,医学研究中心 提出了一个研究报告 提供了包括了神经科学方面的 一些数据 来解释暴力是如何传播的。
So I think this is good news, because it allows us an opportunity to come out of the Middle Ages, which is where I feel this field has been. It gives us an opportunity to consider the possibility of replacing some of these prisons with playgrounds or parks, and to consider the possibility of converting our neighborhoods into neighborhoods, and to allow there to be a new strategy, a new set of methods, a new set of workers: science, in a way, replacing morality. And moving away from emotions is the most important part of the solution to science as a more important part of the solution.
我认为这个是好消息, 因为这些研究让我们有机会 走出以往的 中世纪般的陈旧思维。 这些研究给我们重新考虑 把一些监狱变成 儿童游乐场和公园的可能性。 重新考虑 把我们的社区变成 采用新模式 新方法,新类型的工作者的社区。 用科学的方法来替代道德的方法。 控制住情绪 是解决问题中最重要的一部分。 用科学的方法来解决是更加重要的。
So I didn't mean to come up with this at all. It was a matter of, I wanted actually a break, and we looked at maps, we looked at graphs, we asked some questions and tried some tools that actually have been used many times before for other things. For myself, I tried to get away from infectious diseases, and I didn't.
我不是说所有的问题最终都能用我们的方法来解决。 重要的是, 我想要有个突破, 让我们能够看着分布图,看着图表, 提出一些问题, 然后尽量采用 以前在其他方面运用过很多次的 方法。 对我自己来说,我曾试图从 感染性疾病中脱身。 可是我没有。
Thank you.
谢谢大家!
(Applause)
(掌声)