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。他是一位杰出的物理學(xué)家，也是一位同樣杰出的科學(xué)傳播者。他能夠讓整個(gè)宇宙變得簡單易懂，激發(fā)數(shù)百萬人對(duì)科學(xué)產(chǎn)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(jiǎng)學(xué)金的獲得者。作為該計(jì)劃的一部分，我在劍橋大學(xué)歷史悠久的聯(lián)合辯論廳發(fā)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(dāng)我在考慮講什么時(shí)，我知道我想要嘗試和踐行霍金讓科學(xué)變得有趣的精神。我挑了一個(gè)我非常關(guān)注的話題“全球健康”，并且選擇做一件我希望能讓霍金教授欣慰的事情：預(yù)測(cè)未來。
You can read my remarks below. I’m grateful to the Cambridge Union Society for inviting me to give this lecture.
下面是比爾蓋茨的演講稿：
Remarks as prepared
2019 Professor Hawking Fellowship Lecture
Cambridge University, United Kingdom
October 7, 2019
2019年霍金獎(jiǎng)學(xué)金演講
劍橋大學(xué)，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(jiǎng)學(xué)金獲得者。我要感謝評(píng)選委員會(huì)、劍橋聯(lián)合會(huì)和整個(gè)霍金家族給我?guī)淼木薮髽s譽(yù)。
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(dāng)時(shí)我就在這里，宣布微軟與劍橋大學(xué)合作建立一個(gè)新的研究實(shí)驗(yàn)室。這些年來，我們見過好幾次面，在劍橋和西雅圖共進(jìn)了幾次特別難忘的晚餐。我很希望能告訴你們一些關(guān)于我們所談令人驚訝的事情，但其實(shí)我們主要談?wù)摰氖俏锢怼?/p>
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(duì)物理學(xué)感興趣，并且有機(jī)會(huì)和霍金教授聊聊他的研究，你一定要抓住這個(gè)機(jī)會(huì)。他的個(gè)性和你想象中的一樣特別。他不僅在物理方面很有天賦，還是一個(gè)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.
霍金希望公眾思考并參與科學(xué)。他的整個(gè)職業(yè)生涯都致力于使它變得通俗易懂且有趣。他鼓勵(lì)人們保持好奇心——了解事實(shí)并提出問題。
In fact, Hawking’s last book was all about asking big questions. One of those questions was, can we predict the future?
事實(shí)上，霍金的最后一本書通篇都是關(guān)于提出大問題的。其中一個(gè)大問題就是，我們能預(yù)測(cè)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.
今天，我想使用霍金教授及其家人創(chuàng)建的這個(gè)平臺(tái)來嘗試回答這個(gè)問題。我們可以預(yù)測(cè)未來嗎？ 關(guān)于健康的未來，我相信答案是肯定的，我們可以。
Why do I think we can predict the future? Because of three facts that explain how we got to where we are today.
為什么我認(rèn)為我們可以預(yù)測(cè)未來呢？因?yàn)橛腥齻€(gè)事實(shí)可以解釋我們是如何達(dá)成今天的成就的。
Fact #1: Global health has seen dramatic improvements in recent decades.
事實(shí)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(gè)世紀(jì)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(yù)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(gè)圖表，因?yàn)樗故玖宋覀円讶〉昧司薮蟮倪M(jìn)步。每一行顯示了各個(gè)年齡段的死亡人數(shù)，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(shù)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.
盡管我們已取得了這些進(jìn)展，我們?nèi)匀豢梢钥吹浇】捣矫娲嬖诰薮蟮牟黄降取?/p>
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布圖：
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(fā)生在哪里：大多在撒哈拉以南的非洲。這些孩子通常死于可以預(yù)防和治療的疾病，比如腹瀉。這是因?yàn)樵趧蚝臀餮艌D等地挽救生命的突破進(jìn)展緩慢。這讓我想到了第二個(gè)事實(shí)……
Fact #2: Improvements are made possible by innovation.
事實(shí)二：進(jìn)步是通過創(chuàng)新實(shí)現(xiàn)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(dāng)大多數(shù)人設(shè)想健康領(lǐng)域的創(chuàng)新時(shí)，他們想到的是醫(yī)學(xué)上的重大突破，比如索爾克研制出第一支脊髓灰質(zhì)炎疫苗。但創(chuàng)新并不局限于新療法，有時(shí)最大的影響來自于優(yōu)化的系統(tǒng)，它使我們得以觸達(dá)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(zhì)炎推向滅絕邊緣的口服脊髓灰質(zhì)炎疫苗自1961年就已問世，但幾十年來，并非世界各地所有的孩子都能獲得該疫苗。1988年，隨著一個(gè)名為“全球根除脊髓灰質(zhì)炎行動(dòng)”（GPEI）的新機(jī)構(gòu)的建立，這種情況發(fā)生了轉(zhuǎn)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(chuàng)新性戰(zhàn)略，目標(biāo)是觸達(dá)并為每一個(gè)兒童接種疫苗。它還開展了疾病監(jiān)測(cè)，以便在全球各地追蹤病毒。由于合作伙伴和各國政府的不懈努力，以及扶輪國際的大規(guī)模志愿工作，GPEI已在全球范圍內(nèi)將脊髓灰質(zhì)炎病例減少了99.9%以上。
The innovations that enable progress also include new methods of understanding.
推動(dòng)進(jìn)步的創(chuàng)新還包括新的認(rèn)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(dāng)我和梅琳達(dá)第一次開始這項(xiàng)工作時(shí)，我們震驚地發(fā)現(xiàn)世界對(duì)衛(wèi)生工作知之甚少，特別是對(duì)最貧困地區(qū)的健康狀況知之甚少。而我們今天的認(rèn)識(shí)要深刻和準(zhǔn)確得多。
當(dāng)我一開始對(duì)全球健康感興趣時(shí)，面對(duì)世界上最大的健康殺手之一——腹瀉，我們對(duì)遭受這種疾病的患者所了解的全部內(nèi)容都包含在這張表里。
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.
它告訴我們什么？除了在1990年有很多人得了腹瀉這一事實(shí)之外，這張表顯示的內(nèi)容并不是很多。它告訴你在不同的地區(qū)有哪些疾病大類造成了兒童死亡，但甚至并沒有告訴你他們?cè)谀膫€(gè)國家或什么使他們患上了腹瀉。它能讓你體會(huì)到問題的嚴(yán)重程度，但對(duì)于提出計(jì)劃來說并不是特別有用。
This is what the data we have on diarrhea looks like today:
這是今天我們有的關(guān)于腹瀉的數(shù)據(jù)：
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(xì)分腹瀉死亡人數(shù)。
更好的數(shù)據(jù)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?yàn)檎У玫妮啝畈《舅劳雎氏鄬?duì)高于埃塞俄比亞。
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(gè)非常棒的工具，叫做“全球疾病負(fù)擔(dān)”（Global Burden of Disease）。如果你在全球健康領(lǐng)域工作，這個(gè)工具是極有價(jià)值的。關(guān)于哪些人在哪里患上哪種疾病的相關(guān)信息，它可以告訴你幾乎所有你想知道的內(nèi)容。如果你不在全球健康領(lǐng)域工作，它也是跟蹤我們已取得的驚人進(jìn)展的好方法——而且進(jìn)展還將繼續(xù)。我們還有很多事情要做，因?yàn)椤?/p>
Fact #3: Innovation is a long game.
事實(shí)三：創(chuàng)新是一場(chǎng)持久戰(zhàn)。
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?wù)撗邪l(fā)進(jìn)度是有原因的：創(chuàng)新往往需要多年的發(fā)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(chǎng)。
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(nèi)將影響人類健康的許多技術(shù)已經(jīng)處于研發(fā)過程中。最近，在理解身體如何運(yùn)作方面的突破正為我們帶來巨大的進(jìn)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(yùn)的是，我的工作讓我得以一覽如今領(lǐng)域內(nèi)所有的驚人發(fā)現(xiàn)。這就是為什么我能預(yù)測(cè)未來?；谖铱吹降难邪l(fā)進(jìn)度，我預(yù)測(cè)在未來20年里，人類健康將因兩項(xiàng)重大進(jìn)展而發(fā)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(gè)預(yù)測(cè)是，我們將解決營養(yǎng)不良問題，并顯著減少與營養(yǎng)相關(guān)的死亡人數(shù)。
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(gè)問題，我會(huì)選擇什么。我的回答總是營養(yǎng)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?nèi)龉阅戏侵薜暮⒆颖仁澜缙渌胤降暮⒆痈锌赡芩劳龅牡貓D。這些死亡中約一半是營養(yǎng)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(yǎng)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(hào)。通過解決營養(yǎng)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(shù)人一想到營養(yǎng)不良，就會(huì)聯(lián)想到一個(gè)饑餓的、瘦骨嶙峋的孩子。當(dāng)相對(duì)于身高，你的體重偏低時(shí)，就屬于消瘦。消瘦經(jīng)常會(huì)造成死亡。但消瘦并不是營養(yǎng)不良帶來的唯一問題。
還有發(fā)育遲緩的問題。當(dāng)你的身高相對(duì)于體重偏低且不可逆轉(zhuǎn)時(shí)，就屬于發(fā)育遲緩。大多數(shù)在消瘦中幸存的孩子最終都會(huì)發(fā)育遲緩。如果你在生命的前三年內(nèi)沒有獲得足夠的營養(yǎng)，你的身體和智力都不能得到正常的發(fā)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，你的死亡幾率也會(huì)高得多，生活質(zhì)量也會(huì)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(fā)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(gè)孩子遠(yuǎn)遠(yuǎn)低于他們這個(gè)年齡的平均身高。這就是當(dāng)你錯(cuò)過成長的關(guān)鍵窗口期（也就是你生命的前幾年）會(huì)發(fā)生的事情。你將無法彌補(bǔ)。
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.
毫不夸張地說，發(fā)育遲緩阻礙了整個(gè)國家的發(fā)展。最令人震驚的是：盡管我們?cè)诮】捣矫嫒〉昧梭@人的進(jìn)步，但如今仍有五分之一的五歲以下兒童發(fā)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.
拯救這些孩子并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(fā)生發(fā)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(shí)，你的身體會(huì)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(dòng)提供燃料，支持你的免疫系統(tǒng)。
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.
在生命的前幾年里，你所剩余的任何能量都被用來滋養(yǎng)你的大腦、肌肉和骨骼。嬰兒需要在6個(gè)月內(nèi)將出生體重增加一倍。但如果沒有能量富余，你就得不到應(yīng)有的生長發(fā)育。你成為了發(fā)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(shí)間內(nèi)都沒能攝入足量且適合的食物。但發(fā)育遲緩還有一些不那么直觀的原因。
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(yǎng)素（維生素或礦物質(zhì)）、感染使你的身體處于炎癥狀態(tài)、你體內(nèi)的有益菌群不夠強(qiáng)大，或者你的母親在你還在子宮里或者哺乳的時(shí)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(huì)使你的身體更難獲得所需的營養(yǎng)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(gè)問題的解決方案。你可以通過強(qiáng)化食物或補(bǔ)劑來修復(fù)微量營養(yǎng)素的不平衡；感染可以用藥物治療或用疫苗預(yù)防；我們可以通過許多方式改善孕產(chǎn)婦的不良健康狀況，包括促進(jìn)性別平等和補(bǔ)充孕期營養(yǎng)。
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(fù)微生物群落對(duì)我們來說還完全是一個(gè)謎。近年來，我們已對(duì)這方面了解了很多，并將在未來20年里繼續(xù)了解更多。
That deeper understanding is why I predict we’re going to solve malnutrition.
這些深入的認(rèn)識(shí)就是我預(yù)測(cè)我們將解決營養(yǎng)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(nèi)的微生物群。我們體內(nèi)的微生物細(xì)胞比人體細(xì)胞還多，這些細(xì)菌保護(hù)我們免受感染，對(duì)消化尤其重要。例如，如果沒有腸道細(xì)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(jì)初，分子測(cè)序技術(shù)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.
隨后在2013年，美國生物學(xué)家杰夫·戈登 (Jeff Gordon) 發(fā)表了一項(xiàng)具有里程碑意義的研究。他和他的團(tuán)隊(duì)研究了馬拉維雙胞胎嬰兒的微生物群落在三年內(nèi)是如何發(fā)展的。他們最感興趣的是，有些雙胞胎中只有一個(gè)出現(xiàn)了特別嚴(yán)重的營養(yǎng)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(duì)長期糞便樣本的分析，他們發(fā)現(xiàn)盡管這些雙胞胎吃著同樣的食物，生活在同樣的環(huán)境中，患有嚴(yán)重營養(yǎng)不良的那個(gè)雙胞胎的微生物群落比沒有營養(yǎng)不良的那個(gè)發(fā)展得更慢。當(dāng)杰夫的團(tuán)隊(duì)把一個(gè)患病雙胞胎的微生物組移植到老鼠體內(nèi)時(shí)，這些老鼠開始變得很難吸收營養(yǎng)，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(xiàng)雙胞胎研究表明，微生物群落不僅是健康的副產(chǎn)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(yǎng)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?nèi)蕴幱谶@項(xiàng)研究的相對(duì)早期階段。在接下來的10到20年里，我們將進(jìn)一步了解每一種微生物，以及它們?nèi)绾闻c攝入的食物一起影響人類健康。這些知識(shí)將使我們能夠巧妙地設(shè)計(jì)干預(yù)措施，以便在微生物發(fā)生紊亂時(shí)“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(yù)措施：益生菌。未來我們將能夠創(chuàng)造出下一代益生菌藥丸，其中包含搭配好的細(xì)菌組合，甚至是為你的腸道量身定做的細(xì)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(gè)干預(yù)措施可能是所謂的“微生物導(dǎo)向的輔助食品”。你可以把它們想象成微生物的肥料。食用它們能促進(jìn)健康的細(xì)菌（幫助消化食物和保護(hù)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(duì)微生物的治療方法仍處于初級(jí)階段。如果我們能找到一種方法讓它們發(fā)揮作用并廣泛應(yīng)用，那么我樂觀地相信，我們可以防止?fàn)I養(yǎng)不良。這將是我們未來20年內(nèi)在健康方面所能達(dá)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.
盡管這將對(duì)貧窮世界產(chǎn)生的影響令我感到非常興奮，我們對(duì)營養(yǎng)如何發(fā)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(yǎng)過剩和營養(yǎng)不足是一枚硬幣的兩面。找出如何改進(jìn)其中一個(gè)也可能有助于我們改進(jìn)另一個(gè)。
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(jīng)對(duì)腸道有了更多的了解，我們便可以開始想辦法改變它。這不僅有助于防止?fàn)I養(yǎng)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(fā)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(yǎng)問題，我相信在未來20年內(nèi)，我們將拯救數(shù)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(gè)預(yù)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年里，我預(yù)測(cè)地球上每個(gè)國家都將把醫(yī)療保健的重點(diǎn)從僅僅是拯救生命擴(kuò)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(zhuǎn)變標(biāo)志著一個(gè)國家對(duì)醫(yī)療保健的看法發(fā)生了最重大的變化。
回想一下你上一次去醫(yī)生那里檢查的情景。你和醫(yī)生最擔(dān)心的是什么？
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，那么你們很有可能會(huì)擔(dān)心你的心臟健康。你可能已經(jīng)討論過你患癌癥和老年癡呆癥的危險(xiǎn)因素。如果你出現(xiàn)了任何征兆，你的醫(yī)生可能會(huì)幫助你制定計(jì)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(xiàn)在想象一下你生活在乍得，這個(gè)國家可預(yù)防性死亡的比例最高。你可能并不會(huì)進(jìn)行定期檢查，因?yàn)槟銈儺?dāng)?shù)氐慕】翟\所忙于治療真正生病的人。你可能永遠(yuǎn)見不到醫(yī)生，只有護(hù)士或其他衛(wèi)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(dāng)你的身體出了一些嚴(yán)重的問題（比如發(fā)高燒或者持續(xù)腹瀉）急需治療的時(shí)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(yī)保系統(tǒng)有什么區(qū)別？在英國，醫(yī)療保健的目標(biāo)是保持健康。在乍得，醫(yī)療保健的目標(biāo)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(gè)區(qū)別聽起來很微妙，但它對(duì)你如何獲得醫(yī)療保健服務(wù)有著巨大的影響。在二十年內(nèi)，我相信世界上每個(gè)國家都將能不只關(guān)注生存，而是關(guān)注生活的健康和質(zhì)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.
跟蹤這一轉(zhuǎn)變最簡單的方法是，看看在發(fā)達(dá)國家中，非傳染性疾病與我們認(rèn)為基本上可以“預(yù)防”的傳染病、孕產(chǎn)婦疾病、新生兒疾病和營養(yǎng)性疾病的死亡數(shù)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(yù)防死亡比例高達(dá)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(duì)我們?cè)谧脑S多人來說，在我們的國家，可預(yù)防死亡人數(shù)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(fā)生。巴基斯坦在1997年跨過了門檻。南非終于在2016年實(shí)現(xiàn)了轉(zhuǎn)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(shù)由這些可預(yù)防的原因所造成的死亡都來自于非洲。20年后，這些國家將跨過50%的門檻。
How do I know this will happen? A couple reasons.
我為什么這么說？有幾個(gè)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(yǎng)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。許多仍高于50%可預(yù)防死亡門檻的國家，也是每年瘧疾致死人數(shù)最多的地方。例如在尼日爾，瘧疾死亡占所有死亡的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(rèn)為治療是最好的方法。有道理吧？瘧疾是一種可治愈的疾病。如果你給足夠多的人以藥物，或者開發(fā)出一種簡單的疫苗，你就應(yīng)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(xiàn)實(shí)要復(fù)雜得多。近年來我們了解到，控制瘧疾的關(guān)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(xiàng)工作有幾項(xiàng)有潛力的新進(jìn)展給了我希望。首先，我們終于知道蚊子在哪里了。
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 5x5 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 1x1 km square. See how much more detailed it is?
左邊是一個(gè)以5x5公里的分辨率顯示瘧疾發(fā)病率的地圖。信不信由你，即便只有這點(diǎn)細(xì)節(jié)，比起10年前也是巨大的進(jìn)步。右邊的地圖使用來自各個(gè)醫(yī)療機(jī)構(gòu)的數(shù)據(jù)，像素只精確到了1x1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(wèi)生官員不必游走整個(gè)地區(qū)分發(fā)蚊帳和采取其他抗瘧疾的措施，而可以針對(duì)重點(diǎn)疫區(qū)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(duì)基因編輯的潛力也感到興奮。消滅一個(gè)地區(qū)的所有蚊子是阻止瘧疾的最快方法，但這是有風(fēng)險(xiǎn)的。大多數(shù)蚊子無法攜帶瘧原蟲。如果你把它們也除掉，就可能會(huì)破壞當(dāng)?shù)氐纳鷳B(tài)系統(tǒng)。
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(biāo)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(shí)間治愈瘧疾肆虐地區(qū)的所有人。然后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(xiàng)技術(shù)仍處于測(cè)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(duì)食物鏈會(huì)有什么影響？我們需要引進(jìn)多少種變異昆蟲？我們需要蚊子消失多長時(shí)間？有哪些政治及政府方面的阻力需要我們?nèi)タ朔?/p>
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(dāng)然，瘧疾這一致命殺手并不是我們唯一能取得巨大進(jìn)展的疾病。
我們還將最終扭轉(zhuǎn)艾滋病毒流行的趨勢(shì)，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(zhuǎn)錄病毒療法來控制這種疾病。多虧了這種療法，感染者現(xiàn)在可以和普通人有同樣的預(yù)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(yīng)該提到，英國是我們?cè)诎滩〔《締栴}上取得如此大進(jìn)展的一個(gè)重要原因。英國政府是一個(gè)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(xiàn)，該組織已支持超過1,750萬使用抗逆轉(zhuǎn)錄病毒藥物控制艾滋病病毒的人。實(shí)際上，我本周晚些時(shí)候也要去里昂參加全球基金的籌資會(huì)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(zhuǎn)錄病毒療法雖然很神奇，但你必須在你余生中的每一天都堅(jiān)持吃藥。如果你不堅(jiān)持服用，就可能會(huì)產(chǎn)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(xiàn)代標(biāo)準(zhǔn)來看，未來的艾滋病療法堪稱奇跡。想象一下，你不必每天都要吃藥，而是每隔幾個(gè)月注射一次，甚至一年注射一次。你也可以在手臂上進(jìn)行植入。
艾滋病的預(yù)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(fēng)險(xiǎn)。在未來，這些藥片可能會(huì)持續(xù)更長時(shí)間，于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(rèn)為，有一天我們會(huì)開發(fā)出一種有效的艾滋病疫苗，可以消除你完全感染病毒的風(fēng)險(xiǎn)。
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(dāng)你不必每天考慮挽救生命的治療方法和預(yù)防措施時(shí)，把它們?nèi)谌肷顣?huì)變得容易得多。我們離那樣的世界還有好多年。但當(dāng)那天到來時(shí)，游戲規(guī)則就會(huì)被改變。
So, what happens when a country crosses the preventable death threshold?
那么，當(dāng)一個(gè)國家跨過可預(yù)防死亡的門檻時(shí)會(huì)發(fā)生什么？
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(yù)防的疾病變得越來越不常見，慢性病會(huì)變得越來越普遍。這包括一些可以殺死你的東西，比如老年癡呆癥和糖尿病，或者一些讓你活得很痛苦的疾病，比如關(guān)節(jié)炎。你也更容易患上精神疾病，比如抑郁癥或焦慮癥。
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.
把更容易抑郁或中風(fēng)看作進(jìn)步的標(biāo)志似乎很奇怪。但重要的是要記住，人類的健康不是用二進(jìn)制的標(biāo)準(zhǔn)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(chuàng)新正在縮小每個(gè)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?yàn)閺拈L壽到健康的轉(zhuǎn)變不僅僅改變了我們對(duì)待醫(yī)療保健的方式。它還為人類及社會(huì)繁榮打開了各種各樣令人驚奇的機(jī)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(dāng)我們考慮如何讓一個(gè)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?cè)趯W(xué)校表現(xiàn)良好，能夠養(yǎng)家糊口，為社會(huì)做出貢獻(xiàn)。
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(yù)防死亡比例最高的國家，其人均國內(nèi)生產(chǎn)總值（GDP）也處于世界最低水平，這并非巧合。
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(chǔ)。健康水平被改善，人們就會(huì)更有效率。而當(dāng)更多的孩子活到成年，家庭就會(huì)決定少生孩子，這可能導(dǎo)致經(jīng)濟(jì)的爆發(fā)式增長。
In other words, when people thrive physically, economies grow. Poverty goes down. The world gets better.
換句話說，當(dāng)人們身體健康時(shí)，經(jīng)濟(jì)就會(huì)增長，貧窮將會(huì)減少，世界將會(huì)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(xiàn)象，可能會(huì)令人泄氣。但如果我們繼續(xù)資助創(chuàng)新，我們就能縮小這些差距。我們可以解決營養(yǎng)問題，我們可以確保全世界都將關(guān)注點(diǎn)擴(kuò)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(shù)很容易預(yù)測(cè)。但進(jìn)步不僅僅取決于技術(shù)。這也取決于那些很難預(yù)測(cè)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(huì)繼續(xù)相信投資于創(chuàng)新是值得的？我們是否會(huì)盡一切努力確保這些創(chuàng)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.
世界正處于全球健康的關(guān)鍵時(shí)刻，有許多重點(diǎn)項(xiàng)目需要資金支持?，F(xiàn)在，各國正在決定是否值得進(jìn)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(gè)問題是：“我們?nèi)绾嗡茉煳磥?？”投資于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(chuàng)新放在首位，那么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(jiān)信科學(xué)和研究的魔力。他也幫助了全世界相信這一點(diǎn)。盡管他在物理學(xué)領(lǐng)域的貢獻(xiàn)非同尋常，但我仍然相信，這才是他最大的成就。
He reminded us to“l(fā)ook 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?！彼虒?dǎo)我們，如果人類繼續(xù)專注于擴(kuò)大潛在的領(lǐng)域，進(jìn)步就會(huì)到來。
Thank you for this tremendous honor.
謝謝你們給予我這項(xiàng)巨大的榮譽(yù)。
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