How many of you have had your doctor ask you about sex? Your mental health? Alcohol use? These questions are almost universal. But how many of you have had your doctor ask you about money? Most of us haven't. But that is strange, because compared to most high-income countries, child poverty is an epidemic in the United States. It creates conditions that may elevate stress hormone levels and impair brain development. Poor children in the US are one and a half times more likely to die and twice as likely to be hospitalized as their middle-class counterparts.
在座有多少人曾經被醫生 問過你的性生活? 你的婚姻狀況? 酒精使用? 這些問題幾乎可說是很普遍的。 但在座有多少人曾經 被醫生問過錢的問題? 大部分人沒有。 但那很奇怪,因為和 大部分高收入國家相比, 在美國,兒童貧窮問題非常流行。 它所造成的症狀, 可能會提高壓力荷爾蒙的量, 傷害大腦發展。 在美國,和中產階級孩童 相比,貧窮孩童的 死亡機率是 1.5 倍, 住院機率是 2 倍。
So my colleague Dr. Michael Hole and I started asking moms about money. We knew we needed to reimagine what a doctor's visit looks like, to get kids out of poverty and to give them a fair shot at a healthy life.
我和我的同事麥可荷爾醫生 開始問母親關於錢的問題。 對於「看醫生」應該是什麼 樣子的,我們得要有新的觀念, 來讓孩子們能脫離貧困, 讓他們也有公平機會, 過著健康的人生。
Our questions led to a surprising solution: tax credits. It turns out, the earned income tax credit, or EITC, is the best poverty prescription we have in the US. The average mom gets two to three thousand dollars a year from it. When families get it, moms and babies are healthier: fewer depressed moms, babies weighing more at birth. But one out of five families who could get it doesn't, and most who do lose of hundreds of dollars to the for-profit tax-preparation industry.
我們的問題帶出了 一個讓人吃驚的解決方案: 稅額扣抵。 結果發現,EITC, 也就是勞動所得稅扣抵制, 是美國最好的貧窮處方。 一般的母親每年能從 EITC 得到 $2000~3000。 當家庭能得到扣抵, 母親和寶寶都會比較健康: 比較少憂鬱的母親, 嬰兒在出生時的體重比較重。 但每五個可以得到扣抵的家庭 當中就有一個沒有得到, 且大部分得到扣抵的家庭 還要花費數百元, 錢到了營利報稅產業的口袋裡。
One day, a mom asked us why we couldn't do her taxes while she waited for the doctor.
有一天,有位母親問我們, 為什麼我們不能幫她報稅, 當時她正在等著看醫生。
(Laughter)
(笑聲)
We all know that purgatory. Why not make good use of that time?
我們都知道那根本是煉獄。 為什麼不好好利用那時間呢?
So we started StreetCred, an organization prescribing tax preparation in clinics serving kids. This is a brand-new approach and one that left some questioning our sanity. After all, we're doctors, not accountants. But we have something accountants don't: access to families. Over 90 percent of kids in the US see a doctor at least once a year. Their parents trust us and will do anything to give them a better life.
所以我們開始了 StreetCred, 它是個組織,在兒童診所中 開「報稅服務」。 這是個全新的方法, 不過也讓一些人懷疑 我們頭殼有沒有壞去。 畢竟,我們是醫生,不是會計師。 但我們有會計師所沒有的: 我們能接觸家庭。 美國有超過 90% 的孩子, 每年至少要看醫生一次。 他們的父母相信我們, 且願意做任何事 來讓孩子過更好的生活。
Doctors in every clinic around the country could be doing this work, too -- it's simple, really. The hospital registers as a tax-preparation site, and everyone, from medical students to retirees, can volunteer as a tax preparer after passing an IRS exam. It's not as hard as it sounds, I promise. I certainly never thought I would be doing other people's taxes, but here I am.
美國各地每個診所的醫生 也都可以做這項工作—— 它其實很簡單。 醫院掛號處可以當作報稅站, 每個人,從醫學系學生到退休者, 只要通過國稅局的考試 就可以當報稅義工。 我保證,它沒有聽起來那麼難。 我肯定從來沒有想過 我會幫別人報稅, 但我現在就在做了。
We're nearing the end of our third year. In the first two, we returned 1.6 million dollars to 750 families in Boston alone. This year --
我們已經到了第三年尾聲。 前兩年,光在波士頓, 我們就為 750 個家庭 得到了 160 萬元的退稅。 今年——
(Applause)
(掌聲)
This year, we've expanded to nine sites in four states. Sixty-three percent of our families have never heard of the EITC. How can you claim something you haven't heard of? And half have never used free tax preparation.
今年,我們擴展到 在四個州有九個站點。 我們服務的家庭中, 有 63% 從來沒有聽過 EITC。 如果你沒聽過, 怎麼可能會要求退稅呢? 半數人沒用過免費的協助報稅服務。
That two to three thousand dollars a year goes a long way. Take hunger. An adequately nutritious, low-cost diet for a mom and two young kids costs 477 dollars a month. With EITC money, that family can eat for five to six months. Or think about medical care. Twenty million children in the US lack access to care meeting modern pediatric standards. And yet, the average cost of that care is only 400 dollars per kid per year. EITC money can help fix this access problem. Perhaps most powerfully of all, this money gives moms hope. One mom used her refund for her son to study abroad in Spain. She was struggling to pay her rent, but she saw EITC money as his shot at a better future.
若一年能得 $2000~3000 的退稅, 可以用很長一段時間。 比如飢餓。 一位母親和兩位小孩若要吃 營養適當且花費低的飲食, 一個月要花 $477。 若有 EITC 的錢,就夠讓 那個家庭吃五到六個月。 或是,想想醫療照護。 美國有兩千萬孩童無法取得 符合現代小兒科標準的照護。 然而,那種照護的成本, 一位孩童一年只要 $400。 EITC 的錢能用來處理這問題。 還有個可能是最強大的用途, 這筆錢能給予母親希望。 有一位母親把她的退稅用來 讓兒子出國到西班牙讀書。 她要付房租都很辛苦, 但她把 EITC 的錢視為是個機會, 能讓她兒子有更美好的未來。
We have an opportunity, as doctors and as citizens, to get to the root of this problem. We can reimagine health care as a place addressing the causes of poor health, be it infections or finances.
身為醫生和公民,我們有個機會 能從根源處理這個問題。 我們能改變健康照護的觀念, 讓它能夠處理不良健康的成因, 不論這成因是感染 或是財務。
Thank you.
謝謝。
(Applause)
(掌聲)