听力课堂TED音频栏目主要包括TED演讲的音频MP3及中英双语文稿，供各位英语爱好者学习使用。本文主要内容为演讲MP3+双语文稿:气候变化、健康和贫困之间的关联，希望你会喜欢！
【演讲者及介绍】Cheryl Holder
Cheryl Holder致力于提高气候知识的普及，并提高人们对气候变化对弱势群体影响的认识。
【演讲主题】气候变化、健康和贫困之间的关联
The link between climate change, health and poverty
【中英文字幕】
翻译者Ziyao Wang校对者Jiasi Hao
I arrived in the US from Kingston, Jamaica in the summer of '68. My family of six crammed into a small, two-bedroom apartment in a three-story walk-up in Brooklyn. The block had several children -- some spoke Spanish, some spoke English. Initially, I wasn't allowed to play with them because, as my parents said, "Them too rambunctious" --
1968年夏天，我从牙买加首都金斯敦来到美国。我们一家六口挤在布鲁克林的一间位于三楼的、无电梯且狭小的两居室公寓。这个街区有几个孩子——他们有的讲西班牙语，有的讲英语。最初我的父母不让我和他们玩，因为他们说，“这些孩子太野了”——
(Laughter)
（笑声）
so I could only watch them from my window. Rollerskating was one of their favorite activities. They loved hitching a ride at the back of the city bus, letting go of the rear bumper as the bus arrived at the bottom of the block in front of my building. One day there was a new girl with them. I heard the usual squeals of laughter interspersed with, "Mira, mira! Mira, mira!" Spanish for, "Look, look!" The group grabbed onto the back of the bus at the top of the block, and as they rolled down laughing and screaming, "Mira, mira, mira, mira," the bus abruptly stopped. The experienced riders adjusted and quickly let go, but the new girl lurched back and fell onto the pavement. She didn't move.
所以我只能透过窗户看他们玩耍。溜旱冰是他们最喜欢的活动之一。他们喜欢挂在城市公交车的尾部，当公交车到达我家门口的街区末端时，松开抓住车后部保险杠的手。有一天，孩子中新来了一位女孩。我听到了和平常一样的笑声里夹杂着叫声，“Mira,mira！”这在西班牙语里是“快看，快看！”的意思。那群孩子在街区前端抓住一辆公交车尾部，正当他们一边大笑一边叫着：“Mira,mira,mira,mira”公交车忽然停了。那些经验丰富的“骑手”快速调整姿势并松开了手，然而，那个新来的女孩向后倾斜摔向了人行道，她没有动。
The adults outside ran to help her. The bus driver came out to see what had happened and call for an ambulance. There was blood coming from her head. She didn't open her eyes. We waited for the ambulance, and waited, and everyone said, "Where is the ambulance? Where is the ambulance?" The police finally arrived. An older black American man said, "Ain't no ambulance coming." He said it again loudly to the cop. "You know ain't no ambulance coming. They never send no ambulance here." The cop looked at my neighbors who were getting frustrated, lifted the girl into the patrol car and left.
四周的大人们跑过去帮她。公交车司机下车查看发生了什么，并叫了救护车。血从那个女孩的头上流淌下来。她没有睁开眼睛。我们等着救护车，一直等着，每个人都在问：“救护车在哪？救护车呢？”最后，警察终于来到了现场。一个上了年纪的黑人说，“救护车根本不会来。”他又对着警察大声重复了这句话——“你们知道救护车根本不会来。他们从不派救护车来这里。”警察们瞥了眼我愤怒且沮丧的邻居们，把女孩抬进巡逻车里，便离开了。
I was 10 years old at the time. I knew this wasn't right. I knew there was something more we could do. The something I could do was become a doctor. I became an internist and committed my career to caring for those we often call the underserved, the vulnerable, like those neighbors I had when I first immigrated to America.
我当时10岁。我知道这件事是错的。我知道我们有能力做些什么。而我做的事是成为了一名医生。我成为了一位内科医师，并把我的事业奉献给了那些我们通常照顾不到的人，容易受伤害的脆弱人群，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, I saw a shocking increase in young men with HIV. Then when I moved [to] Miami, I noticed HIV included women and children, primarily, poor black and brown people. Within a few years, an infection seen in a select population became a worldwide epidemic. Again I got the urge to do something. Fortunately, with the help of activists and advocates and educators and physicians like me who treat the disease, we found a way forward. There was a massive education effort to reduce HIV transmission and provide legal protection for those with the disease. There was a political will to make sure that as many patients as possible worldwide, regardless of ability to pay, could get access to medication. Within a couple of decades there were new treatments that transformed this life-threatening infection to a chronic disease, like diabetes. Now there's a vaccine on the horizon.
80年代，我在哈莱姆接受培训时，我看到了年轻男性感染艾滋病的人数激增。之后在我搬到迈阿密后，我意识到艾滋病患者还包括妇女和孩子，主要是贫困的黑人和棕色人种。短短几年内，特定人群中出现的感染发展成了蔓延全世界的流行病。我又有了做点什么的冲动。幸运的是，在一些活动家、拥护者、教育者，和一些像我一样治疗疾病的医生的支持下，我们找到了一个前行的方法。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，并为艾滋病患者提供合法的保护。还有政治意愿——确保世界范围内尽可能多的艾滋病患者，无论贫富都可以得到治疗。几十年内，新的治疗方法出现了，该方法能把危及生命的艾滋病转变为诸如糖尿病的慢性病。现在还有望研究出疫苗。
Over the last five to seven years, I've noticed a different epidemic among the patients in Florida, and it looks something like this. Ms. Anna Mae, a retired clerical worker living on a fixed income in Opa-locka, walked in for medication refills. She had common chronic conditions of high blood pressure, diabetes, heart disease and asthma with overlapping chronic obstructive pulmonary disease -- COPD. Ms. Anna Mae was one of my more adherent patients, so I was surprised she needed refills of her breathing medicines earlier than usual. Towards the end of the visit, she handed me a Florida Power and Light form and asked me to sign it. She was behind on her light bill. This form allowed physicians to document serious medical conditions requiring equipment that would be impacted if the patient's electricity was disconnected. "But Ms. Anna Mae," I said, "you don't use any medical devices for breathing. I don't think you qualify." Further questioning revealed she had been using her air conditioner day and night because of the heat so she could breathe. Needing to buy more asthma inhalers left her little money; she couldn't pay all the bills so it piled up. I filled out the form, but knowing she might be denied, I also sent her to the social worker.
在过去五到七年里，我发现佛罗里达的病人中出现了一种新的流行病，看起来像是这样——安娜·麦伊住在奥帕洛卡，她退休了并有着稳定收入。一天，她走进诊室开药。她患有常见的慢性病——高血压、糖尿病、心血管病和哮喘，她还同时患有慢性阻塞性肺病。安娜是我长期的病人，她比往常来诊所补充呼吸药物的时间要早，所以我还挺意外的。她临走时，安娜递给我一张佛罗里达电网公司的表签字。她没能及时付电费。这张表要求医生列出严重的健康状况，申明如果断了电，患者的医疗器械会受到影响。“但是安娜，”我说，“你无需使用任何医疗器械协助呼吸。我不知道你是否符合要求。”进一步询问后，我得知安娜每时每刻都在使用空调，因为天气太热，不然她将难以呼吸。需要购买哮喘吸入器的硬性需求使她手头拮据，所以她没钱支付那些电费，于是账单便堆积起来了。我填好表，但知道她可能还是会被断电，我把她送到了社会工作者那里。
Then there was Jorge, such a sweet, kind man who often gifted our clinic with some of the fruits he sold on the streets of Miami. He had signs of worsening kidney function whenever he worked days on end on those hot streets due to dehydration -- just not enough blood getting to the kidneys. His kidneys worked much better whenever he took some days off. But with no other support, what could he do? As he says, "Rain or shine, cold or heat, I have to work."
然后，还有乔治，他是一个如此善良的人，他经常给我们诊所送来他在迈阿密路边卖的水果。当他在炎热天气下卖水果时，他常常因为脱水产生肾衰竭的症状——只是肾脏缺少血液流通。每当他休息几天，他肾脏的状况就会好很多。但没有别的经济来源，他还能怎么办呢？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 of Fort Lauderdale with COPD. She was arrested after fighting with her daughter over a fan. On her release from jail, she returned to her apartment, coughed nonstop and died three days later.
最倒霉的其实可能是珊德拉·特威格斯小姐，她也患有慢性阻塞肺病。一次，她在和她女儿争抢风扇后被逮捕。她从监狱出来后，回到了她的公寓，咳个不停，三天后去世了。
Here's what else I noticed: the data show allergy seasons are starting weeks earlier, nighttime temperatures are rising, trees are growing faster and mosquitos carrying dangerous diseases like Zika and dengue are showing up in areas they didn't exist before.
我还注意到了这些：数据显示，过敏高发期比平常早了几周，夜间温度在上升，树木长得更快了，蚊子携带着危险病毒，例如寨卡和登革热出现在它们原先不存在的区域。
I also see signs of impending climate gentrification. That's when richer people move into poorer neighborhoods that are at higher elevation and less subject to flood damage from climate change. Like in my patient Madame Marie who came in stressed and anxious, because she was evicted from her apartment in Miami's Little Haiti to make room for a luxury apartment complex whose developers understood that Little Haiti would not flood because it's ten feet above sea level.
我还看到了气候中产阶层化的迹象。这指的是相较富裕的人搬进相较贫穷且海拔较高的地区，以免受气候变化带来的洪水破坏。我的病人玛丽小姐带着焦虑和不安来到诊所，因为她被从自己迈阿密小海地的公寓中驱逐出来，以此为高级公寓群腾出空间。开发商们都知道小海地不会闹洪水，因为它高于海平面10英尺。
An undeniable, clear and consistent warming trend is on the way. A health emergency even bigger than HIV/AIDS seems to be in the works, and it was my low-income patients that were dropping clues of what this would look like. This new epidemic is climate change, and it has a variety of health effects. Climate change impacts us in four major ways. Directly, through heat, extreme weather and pollution; through the spread of the disease; through disruption of our food and water supply; and through disruption of our emotional well-being. In medicine we use mnemonics to aid our memory, and this mnemonic, "heatwave," shows the eight significant health effects of climate change.
一股不可否认的、显而易见的，持续的热浪正扑面而来。它带来的是一场比艾滋病更为严重的卫生突发事件，而我的那些低收入病人群体正预示着这场危机的种种迹象。这场新的流行病是气候变化，它对我们的健康能造成诸多影响。这些影响主要分四类：最直接的是，热潮、极端气候和污染；还有通过疾病的传播；破坏或中断我们食物和水资源供应；还有我们的心理健康。医学上我们会用助记词汇来帮助记忆，这里我们用一个词叫“heatwave"（热潮）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, especially during extreme weather events.
T：创伤性损伤，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. They are the proverbial canary in a coal mine. Truly, their experiences are like oracles or prophecies. The guiding light for us to pay attention that we are doing something to our world first that's hurting them first. But in a matter of time, we are next.
贫穷脆弱的人已经感觉到了气候变化的影响。他们是众所周知的“矿井中用来测试危险的金丝雀”。真的，他们的经历就像预言一般，这是一道光，指引我们更加意识到我们对地球所做的一些事情最先在伤害着他们。但到头来，我们会是下一个受害者。
If we act together -- doctors, patients and other health professionals -- we will find solutions. We have done this with the HIV crisis. There [it] was thanks to the activism of patients with HIV that demanded medications and better research, and the collaboration of doctors and scientists that we were able to control the epidemic. And then it was thanks to international health agencies, NGOs, politicians and pharmaceutical companies that HIV medication became available in low-income countries. There is no reason we can't also apply this model of collaboration to address the health effects of climate change before it's too late.
如果我们一起行动——医生、病人和其他医疗权威——我们会找到解决方案。我们已经用这个方法解决过艾滋病危机。多亏了艾滋病患者的积极性——要求有效药物的研发，以及更好的研究，以及医生和科学家的合作，我们才得以控制那场流行病。也多亏那些国际卫生组织、非政府组织、政客，以及制药公司，治疗艾滋病的药物才得以出现在低收入国家。我们没有理由不再次开展这样的合作，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. It's already damaging the health and homes of poor people. Like my patient Jorge, most of us will have to work, whether rain or shine, cold or heat. But together these patients and their doctors, hand-in-hand, with some basic tools, can do so much to make this climate transition less brutal for all of us.
气候变化已经开始了。它已经开始损害穷人的健康和破坏他们的住所。像我的病人乔治一样，我们大部分人将必须工作，无论是下雨还是天晴，寒冷或炎热。不过，病人和医生使用一些基本工具联合起来，可以让气候变化带来的影响变得不那么残酷。
These patients inspired me to found a clinicians' organization to fight climate change. We focus on understanding the health effects of climate change, learning to advocate for patients with climate-related illnesses and encouraging real-world solutions.
这些病人们鼓舞我创建了一个临床医生组织以抗争气候变化。我们致力于理解气候变化对健康的影响，学习如何支持并拥护那些患有气候相关疾病的患者，并鼓励世界落实解决办法。
A recent Gallup study showed three of the most respected professions are nurses, doctors and pharmacists. So as respected members of society, we have amplified voices to influence climate change policy and politics. There is so much we can do. As clinicians, our many patient contacts allows us to see things before others. And this puts us in an ideal position to be on the frontlines of change.
盖洛普（Gallup）公司最近的一个调查显示，最受尊重的三个职业是护士、医生和药剂师。作为备受尊重的社会成员，我们有更强有力的声音来影响气候变化的政策和政治局面。我们可以做很多事。作为临床医生，我们与病人的直接接触让我们有先见之明。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. We can collect data on our patients' climate-related conditions by making sure there are billing codes to identify them. We can do climate-related health research. We can teach how to have green practices in homes. We can advocate for our patient energy needs. We can help them get safer homes. We can help them get necessary equipment in those homes when conditions worsen. We can testify in front of lawmakers as to the findings, and we can medically treat our patients' climate-related illnesses. Most importantly, we can help prepare our patients mentally and physically for the health challenges they will face, using a model of medicine that incorporates economic and social justice.
我们可以在医学院教授气候相关疾病的知识。我们可以收集病人与气候相关病情状况的数据，并确保能编码识别它们。我们可以做与气候相关的健康研究；向人们讲授居家环保理念；拥护病人的能源需求。我们可以帮他们找到可以更安全居住的房子；当情况恶化时，帮他们找到必需的医疗器械。我们还可以利用研究结果向立法者证明在医学上，我们能够治疗气候相关的疾病。更重要的是，通过结合经济和社会正义因素的医疗模型，我们能帮助病人同时从身体和心理上为他们即将要面对的健康挑战做准备。
This would mean Ms. Sandra Faye Twiggs with COPD, who died after being released from jail after a fight with her daughter over a fan, would have known that the heat in her apartment made her sick and angry and seek a safer place to go for cooling. Even better, her apartment would never have been so hot.
这意味着特威格斯小姐不会在和女儿争抢风扇出狱后，因慢性阻塞性肺病去世。相反，她会知道炎热的公寓容易使她生气、发病，她会找个更安全的地方乘凉，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 but are stories of resilience, innovation and survival. Like that wise old man who loudly spoke truth to the cop that summer night: "Ain't no ambulance coming," and compelled him to deliver that little girl to the hospital instead.
从穷人那里，我意识到生命不但脆弱，而且充满了适应能力、创新和幸存的故事。正如智慧的老人，在那个夏夜：大声向警察说出真相：“救护车根本不会来”，并且强迫警察把小女孩送去医院。
You know what? Listen up. If there's going to be a medical response to climate change, it is not going to be just waiting for an ambulance. It is going to happen because we the clinicians take the first step. We make so much noise that the issue cannot be ignored or misunderstood. It is going to start with the stories our patients tell and the stories we tell on their behalf. We're going to do what is right for our patients like we've always done, but also what is right for our environment, for ourselves and for all the people on this planet -- all of them.
你们知道吗？听好了。如果要针对气候变化做出医学回应，它不会仅仅是等待一辆救护车。回应会发生是因为我们作为医生们能迈出第一步。我们的呼喊声响亮到让这个问题无法被忽略或误解。这将从我们病人讲述的故事，也从我们替他们讲述的故事开始。我们将一如既往地为病人做正确的事，但同时也是为了我们的环境，为了我们自己，为了地球上的全人类——所有人。
Thank you.
谢谢。
(Applause and cheers)
（掌声和欢呼）