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VikramPatel_2012G-_通过公众参与来实现所有人的精神健康_
I want you to imagine this for a moment. [00:12]
Two men, Rahul and Rajiv, living in the same neighborhood , from the same educational background, similar occupation , and they both turn up at their local accident emergency complaining of acute chest pain. [00:15]
neighborhood:n.附近;地区;街坊;adj.附近的; educational:adj.教育的;有关教育的;有教育意义的 occupation:n.职业;占领;占用;工作; emergency:n.紧急情况;突发事件;非常时刻;adj.紧急的;备用的; complaining:adj.抱怨的;v.抱怨;控诉;(complain的现在分词) acute:adj.严重的,[医]急性的;敏锐的;激烈的;尖声的;
Rahul is offered a cardiac procedure , but Rajiv is sent home. [00:29]
cardiac:n.强心剂;强胃剂;adj.心脏的;心脏病的;贲门的; procedure:n.步骤;手术;(商业、法律或政治上的)程序;
What might explain the difference in the experience of these two nearly identical men? [00:35]
identical:adj.同一的;完全相同的;n.完全相同的事物;
Rajiv suffers from a mental illness. [00:41]
mental:adj.精神的;脑力的;疯的;n.精神病患者;
The difference in the quality of medical care received by people with mental illness is one of the reasons why they live shorter lives than people without mental illness. [00:44]
Even in the best-resourced countries in the world, this life expectancy gap is as much as 20 years. [00:53]
life expectancy:预期寿命; gap:n.差距;间隙;缺口;间隔;v.使豁裂;豁开;
In the developing countries of the world, this gap is even larger. [01:01]
But of course, mental illnesses can kill in more direct ways as well. The most obvious example is suicide . [01:05]
obvious:adj.明显的;显著的;平淡无奇的; suicide:n.自杀;自杀行为;自杀者;adj.自杀的;v.自杀;vi.自杀;
It might surprise some of you here, as it did me, when I discovered that suicide is at the top of the list of the leading causes of death in young people in all countries in the world, including the poorest countries of the world. [01:12]
But beyond the impact of a health condition on life expectancy, we're also concerned about the quality of life lived. [01:25]
impact:n.影响;效果;碰撞;冲击力;v.挤入,压紧;撞击;对…产生影响; concerned:adj.有关的;关心的;v.关心;与…有关;(concern的过去时和过去分词)
Now, in order for us to examine the overall impact of a health condition both on life expectancy as well as on the quality of life lived, we need to use a metric called the DALY, which stands for a Disability-Adjusted Life Year. [01:33]
overall:v.全部; n.外套; adj.全面的; as well as:也;和…一样;不但…而且; metric:adj.米制的;公制的;按公制制作的;用公制测量的;
Now when we do that, we discover some startling things about mental illness from a global perspective . [01:46]
startling:adj.惊人的;让人震惊的;极鲜亮的;v.使惊吓;使吓一跳;(startle的现在分词) global:adj.全球的;总体的;球形的; perspective:n.观点;远景;透视图;adj.透视的;
We discover that, for example, mental illnesses are amongst the leading causes of disability around the world. [01:52]
amongst:prep.在…之中;在…当中(等于among); disability:n.残疾;无能;无资格;不利条件;
Depression , for example, is the third-leading cause of disability, alongside conditions such as diarrhea and pneumonia in children. [01:59]
Depression:n.沮丧;洼地;不景气;忧愁; diarrhea:n.腹泻,痢疾; pneumonia:n.肺炎;
When you put all the mental illnesses together, they account for roughly 15 percent of the total global burden of disease . [02:08]
account for:对…负有责任;对…做出解释;说明…的原因;导致;(比例)占; roughly:adv.粗糙地;概略地; burden:n.负担;责任;船的载货量;v.使负担;烦扰;装货于; disease:n.病,[医]疾病;弊病;vt.传染;使…有病;
Indeed, mental illnesses are also very damaging to people's lives, but beyond just the burden of disease, let us consider the absolute numbers. [02:16]
The World Health Organization estimates that there are nearly four to five hundred million people living on our tiny planet who are affected by a mental illness. [02:29]
Organization:n.组织;机构;体制;团体; estimates:n.估计;估价;估计的成本;v.估价;估算(estimate的第三人称单数和复数)
Now some of you here look a bit astonished by that number, but consider for a moment the incredible diversity of mental illnesses, from autism and intellectual disability in childhood , through to depression and anxiety , substance misuse and psychosis in adulthood , all the way through to dementia in old age, and I'm pretty sure that each and every one us [02:38]
astonished:adj.吃惊的; incredible:adj.难以置信的,惊人的; diversity:n.差异(性):多样性:多样化: autism:n.[心理][内科]孤独症;自我中心主义; intellectual:n.知识分子;脑力劳动者;adj.智力的;脑力的;理智的;有才智的; childhood:n.童年;幼年;孩童时期 anxiety:n.焦虑;渴望;挂念;令人焦虑的事; substance:n.物质;实质;主旨;物品; misuse:vt.滥用;误用;虐待;n.滥用;误用;虐待; psychosis:n.精神病;精神错乱; adulthood:n.成年;成人期; dementia:n.[内科]痴呆;
present here today can think of at least one person, at least one person, who's affected by mental illness in our most intimate social networks. [02:57]
intimate:n.知己; v.暗示; adj.亲密的;
I see some nodding heads there. [03:08]
But beyond the staggering numbers, what's truly important from a global health point of view , what's truly worrying from a global health point of view , [03:12]
staggering:adj.惊人的; v.蹒跚; (stagger的现在分词) point of view:观点;见地;立场;
is that the vast majority of these affected individuals do not receive the care that we know can transform their lives, and remember, we do have robust evidence that a range of interventions , medicines, psychological interventions , and social interventions , can make a vast difference . [03:20]
majority:n.大部分:大多数:多数票:成年人: individuals:n.[经]个人;[生物]个体(individual的复数); transform:v.使改变;使改观;使转换;n.[数]变换式;[化]反式; robust:adj.强健的;健康的;粗野的;粗鲁的; evidence:n.证据,证明;迹象;明显;v.证明; interventions:n.[法]干预,干涉;处置(intervention的复数); psychological:adj.心理的;心理学的;精神上的; make a vast difference:只要有一点优势就足以起很大作用;
And yet, even in the best-resourced countries, for example here in Europe, roughly 50 percent of affected people don't receive these interventions. [03:37]
In the sorts of countries I work in, that so-called treatment gap approaches an astonishing 90 percent. [03:45]
so-called:adj.所谓的;号称的; treatment:n.治疗;疗法;对待;处理;讨论; approaches:v.靠近,接近; n.方式,方法,态度; astonishing:adj.令人十分惊讶的;v.使十分惊讶;使吃惊;(astonish的现在分词)
It isn't surprising, then, that if you should speak to anyone affected by a mental illness, the chances are that you will hear stories of hidden suffering, shame and discrimination in nearly every sector of their lives. [03:54]
discrimination:n.歧视;区别,辨别;识别力; sector:n.部门;扇形,扇区;象限仪;函数尺;vt.把…分成扇形;
But perhaps most heartbreaking of all are the stories of the abuse of even the most basic human rights, such as the young woman shown in this image here that are played out every day, [04:10]
heartbreaking:adj.令人心碎的;使人悲痛的; abuse:n.滥用;虐待;辱骂;弊端;恶习,陋习;v.滥用;虐待;辱骂; played out:adj.失去影响(或作用);
sadly, even in the very institutions that were built to care for people with mental illnesses, the mental hospitals. [04:23]
institutions:n.机构;慈善机构;风俗习惯,制度;(institution的复数)
It's this injustice that has really driven my mission to try to do a little bit to transform the lives of people affected by mental illness, and a particularly [04:30]
injustice:n.不公正;不讲道义; mission:n.使命,任务;代表团;布道;v.派遣;向…传教; particularly:adv.特别地,独特地;详细地,具体地;明确地,细致地;
critical action that I focused on is to bridge the gulf between the knowledge we have that can transform lives, the knowledge of effective treatments , and how we actually use that knowledge in the everyday world. [04:39]
critical:adj.鉴定的;[核]临界的;批评的,爱挑剔的;危险的;决定性的;评论的; gulf:n.海湾;深渊;分歧;漩涡;vt.吞没; effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象; treatments:n.治疗;疗法;对待;处理;讨论;(treatment的复数)
And an especially important challenge that I've had to face is the great shortage of mental health professionals , such as psychiatrists and psychologists , particularly in the developing world. [04:51]
especially:adv.尤其;特别;格外;十分; shortage:n.短缺;不足;缺少; professionals:n.[管理]专业人员(professional的复数); psychiatrists:n.精神病学家;精神科医生;(psychiatrist的复数) psychologists:n.[心理]心理学家(psychologist的复数形式);
Now I trained in medicine in India, and after that [05:02]
I chose psychiatry as my specialty , much to the dismay of my mother and all my family members who kind of thought neurosurgery would be a more respectable option for their brilliant son. [05:04]
psychiatry:n.精神病学;精神病治疗法; specialty:n.专业,专长;特产;特性;招牌菜;adj.特色的;专门的;独立的; dismay:n.沮丧,灰心;惊慌;vt.使沮丧;使惊慌; neurosurgery:n.[外科]神经外科; respectable:adj.值得尊敬的;人格高尚的;相当数量的;n.可敬的人; option:n.选择;可选择的东西;
Any case, I went on, I soldiered on with psychiatry, and found myself training in Britain in some of the best hospitals in this country. I was very privileged . [05:15]
privileged:adj.有特权的; v.给予特权; (privilege的过去式和过去分词)
I worked in a team of incredibly talented, compassionate , but most importantly, highly trained, specialized mental health professionals. [05:22]
incredibly:adv.难以置信地;非常地; compassionate:adj.慈悲的;富于同情心的;vt.同情;怜悯; highly:adv.高度地;非常;非常赞许地; specialized:adj.专业的; v.专门研究(或从事); (specialize的过去式和过去分词)
Soon after my training, I found myself working first in Zimbabwe and then in India, and I was confronted by an altogether new reality. [05:31]
Zimbabwe:n.津巴布韦(国家名,位于非洲); confronted:v.使…无法回避;降临于;处理;面对;对抗;(confront的过去分词和过去式)
This was a reality of a world in which there were almost no mental health professionals at all. [05:39]
In Zimbabwe, for example, there were just about a dozen psychiatrists, most of whom lived and worked in Harare city, leaving only a couple to address the mental health care needs of nine million people living in the countryside. [05:44]
health care:n.卫生保健;
In India, I found the situation was not a lot better. [05:58]
To give you a perspective, if I had to translate the proportion of psychiatrists in the population that one might see in Britain to India, one might expect roughly 150,000 psychiatrists in India. [06:01]
translate:v.翻译;被翻译;被译成;(使)转变; proportion:n.比例;部分;份额;均衡;v.摊派;使相称;
In reality, take a guess. [06:14]
The actual number is about 3,000, about two percent of that number. [06:17]
It became quickly apparent to me that I couldn't follow the sorts of mental health care models that I had been trained in, one that relied heavily on specialized, expensive [06:22]
apparent:adj.显然的;表面上的; relied:v.依赖;依靠;信赖;信任;(rely的过去分词和过去式)
mental health professionals to provide mental health care in countries like India and Zimbabwe. [06:30]
I had to think out of the box about some other model of care. [06:35]
think out:解决;仔细考虑;发现;
It was then that I came across these books, and in these books I discovered the idea of task shifting in global health. [06:40]
shifting:adj.不断移动的;流动的;v.转移;赶快;快速移动;变换;(shift的现在分词)
The idea is actually quite simple. The idea is, when you're short of specialized health care professionals, use whoever is available in the community , train them to provide a range of health care interventions, and in these books I read inspiring examples, [06:48]
whoever:任何人:无论是谁: community:n.社区;[生态]群落;共同体;团体; inspiring:adj.鼓舞人心的;灌输的;v.鼓舞;激发;使感悟;(inspire的现在分词)
for example of how ordinary people had been trained to deliver babies, diagnose and treat early pneumonia, to great effect. [07:02]
diagnose:vt.诊断;断定;vi.诊断;判断;
And it struck me that if you could train ordinary people to deliver such complex health care interventions, then perhaps they could also do the same with mental health care. [07:10]
complex:adj.复杂的;合成的;n.复合体;综合设施;
Well today, I'm very pleased to report to you that there have been many experiments in task shifting in mental health care across the developing world over the past decade, and I want to share with you the findings of three particular such experiments, all three of which focused on depression, the most common of all mental illnesses. [07:19]
findings:n.调查发现;判决;裁决;(finding的复数)
In rural Uganda , Paul Bolton and his colleagues , using villagers, demonstrated that they could deliver interpersonal psychotherapy for depression and, using a randomized control design, showed that 90 percent of the people receiving this intervention recovered as compared to roughly 40 percent in the comparison villages. [07:37]
rural:adj.农村的,乡下的;田园的,有乡村风味的; Uganda:n.乌干达(非洲国家); colleagues:n.同事;同行(colleague的复数); demonstrated:v.证明;证实;论证;说明;表达;(demonstrate的过去分词和过去式) interpersonal:adj.人际关系的;人际的; psychotherapy:n.心理疗法;精神疗法; randomized:adj.[数]随机化的,随机的;v.使随机化;做任意排列(randomize的过去分词); compared:adj.比较的,对照的; v.相比; (compare的过去式和过去分词) comparison:n.比较;对比;相比;
Similarly , using a randomized control trial in rural Pakistan, [07:57]
Similarly:adv.同样地;类似于;
Atif Rahman and his colleagues showed that lady health visitors, who are community maternal health workers in Pakistan's health care system, could deliver cognitive behavior therapy for mothers [08:01]
maternal:adj.母亲的;母性的;母系的;母体遗传的; cognitive:adj.认知的,认识的;
who were depressed , again showing dramatic differences in the recovery rates. Roughly 75 percent of mothers recovered as compared to about 45 percent in the comparison villages. [08:11]
depressed:adj.沮丧的; v.使抑郁; (depress的过去式和过去分词) dramatic:adj.突然的;巨大的;令人吃惊的;激动人心的; recovery:n.恢复,复原;痊愈;重获;
And in my own trial in Goa, in India, we again showed that lay counselors drawn from local communities could be trained to deliver psychosocial interventions for depression, anxiety, leading to 70 percent recovery rates as compared to 50 percent in the comparison primary health centers. [08:22]
counselors:n.辅导员;顾问(counselor的复数形式); communities:n.社区;社会;团体;共有(community的复数) psychosocial:adj.社会心理的;心理社会学的;
Now, if I had to draw together all these different experiments in task shifting, and there have of course been many other examples, and try and identify what are the key lessons we can learn that makes for a successful task shifting operation, [08:38]
identify:v.识别:鉴定:确认:发现:
I have coined this particular acronym , SUNDAR. [08:50]
acronym:n.首字母缩略词;
What SUNDAR stands for, in Hindi , is " attractive ." [08:54]
Hindi:n.北印度语;adj.北印度的; attractive:adj.吸引人的;有魅力的;引人注目的;
It seems to me that there are five key lessons that I've shown on this slide that are critically important for effective task shifting. [08:58]
critically:adv.精密地;危急地;批评性地;用钻研眼光地;
The first is that we need to simplify the message that we're using, stripping away all the jargon that medicine has invented around itself. [09:05]
simplify:vt.简化;使单纯;使简易; stripping:v.脱光衣服;表演脱衣舞;除去;(尤指)剥光;(strip的现在分词) jargon:n.行话,术语;黄锆石;
We need to unpack complex health care interventions into smaller components that can be more easily transferred to less-trained individuals. [09:14]
unpack:vt.卸下…;解除…的负担;vi.打开包裹; components:n.部件;组件;成份(component复数); transferred:v.(使)转移,搬迁;(使)调动;(transfer的过去分词和过去式)
We need to deliver health care, not in large institutions, but close to people's homes, and we need to deliver health care using whoever is available and affordable in our local communities. [09:21]
affordable:adj.负担得起的;
And importantly, we need to reallocate the few specialists who are available to perform roles such as capacity-building and supervision . [09:31]
reallocate:v.重新分配;再指派; perform:v.表演;执行;履行;演出;工作,运转(好/不好); capacity-building:能力建设; supervision:n.监督,管理;
Now for me, task shifting is an idea with truly global significance , because even though it has arisen out of the situation of the lack of resources that you find [09:40]
significance:n.意义;重要性;意思; arisen:v.出现;发生;兴起;(人早上)起来;(arisen是arise的过去分词) resources:n.[计][环境]资源; v.向…提供资金(resource的第三人称单数);
in developing countries, I think it has a lot of significance for better-resourced countries as well. Why is that? [09:51]
Well, in part, because health care in the developed world, the health care costs in the [developed] world, are rapidly spiraling out of control, and a huge chunk of those costs are human resource costs. [09:57]
spiraling:adj.盘旋的; v.盘旋着上升或下降; (spiral的现在分词) chunk:n.大块;矮胖的人或物;
But equally important is because health care has become so incredibly professionalized that it's become very remote and removed from local communities. [10:09]
professionalized:vi.专业化;职业化;vt.使…专业化;使…专业化; remote:adj.偏远的;偏僻的;遥远的;久远的;
For me, what's truly sundar about the idea of task shifting, though, isn't that it simply makes health care more accessible and affordable but that it is also fundamentally empowering . [10:18]
accessible:adj.易接近的;可进入的;可理解的; fundamentally:adv.从根本上;基础地;重要地 empowering:v.授权;给(某人)…的权力;增加(某人的)自主权;(empower的现在分词)
It empowers ordinary people to be more effective in caring for the health of others in their community, and in doing so, to become better guardians of their own health. Indeed, for me, task shifting is the ultimate example of the democratization of medical knowledge, and therefore, medical power. [10:29]
empowers:授权;使能够(empower的第三人称单数); guardians:n.保护人,[法]监护人(guardian的复数形式); ultimate:adj.最终的;极限的;根本的;n.终极;根本;基本原则; democratization:n.民主化;
Just over 30 years ago, the nations of the world assembled at Alma-Ata and made this iconic declaration . [10:48]
assembled:v.聚集;集合;收集;装配;组装;(assemble的过去分词和过去式) iconic:adj.图标的,形象的; declaration:n.宣言;宣告;宣布;公告;
Well, I think all of you can guess that 12 years on, we're still nowhere near that goal. [10:55]
nowhere:v.无处; n.无处; adj.不存在的;
Still, today, armed with that knowledge that ordinary people in the community can be trained and, with sufficient supervision and support, can deliver a range of health care interventions effectively, perhaps that promise is within reach now. [11:00]
sufficient:adj.足够的;充分的;
Indeed, to implement the slogan of Health for All, we will need to involve all in that particular journey , and in the case of mental health, in particular we would [11:16]
implement:v.实施;执行;贯彻;使生效;n.工具; slogan:n.口号;标语; involve:v.包含;需要;牵涉;牵连;影响;(使)参加; journey:n.旅行;行程;vi.旅行; in particular:尤其,特别;
need to involve people who are affected by mental illness and their caregivers . [11:26]
caregivers:n.照顾者;看护人(caregiver的复数);
It is for this reason that, some years ago, the Movement for Global Mental Health was founded as a sort of a virtual platform upon which professionals like myself and people affected by mental illness could stand together, shoulder-to-shoulder, [11:30]
virtual:adj.[计]虚拟的;实质上的,事实上的(但未在名义上或正式获承认); platform:n.平台; v.把…放在台上[放在高处;
and advocate for the rights of people with mental illness to receive the care that we know can transform their lives, and to live a life with dignity . [11:44]
advocate:v.拥护;支持;提倡;n.支持者;提倡者;辩护律师;出庭辩护人; dignity:n.尊严;高贵;
And in closing, when you have a moment of peace or quiet in these very busy few days or perhaps afterwards, spare a thought for that person you thought about [11:53]
spare:v.节约,吝惜;饶恕;分出,分让;adj.多余的;瘦的;少量的;n.剩余;备用零件;
who has a mental illness, or persons that you thought about who have mental illness, and dare to care for them. Thank you. (Applause) [12:02]
(Applause) [12:10]