比尔盖茨荣获2019年霍金奖学金：为什么我认为我们可以预测未来
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.
我一直很欣赏史蒂芬·霍金。他是一位杰出的物理学家，也是一位同样杰出的科学传播者。他能够让整个宇宙变得简单易懂，激发数百万人对科学产生兴趣。
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.
因此我十分荣幸被选为2019年霍金奖学金的获得者。作为该计划的一部分，我在剑桥大学历史悠久的联合辩论厅发表了演讲。
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.
当我在考虑讲什么时，我知道我想要尝试和践行霍金让科学变得有趣的精神。我挑了一个我非常关注的话题“全球健康”，并且选择做一件我希望能让霍金教授欣慰的事情：预测未来。
You can read my remarks below. I’m grateful to the Cambridge Union Society for inviting me to give this lecture.
下面是比尔盖茨的演讲稿：
Remarks as prepared
2019 Professor Hawking Fellowship Lecture
Cambridge University, United Kingdom
October 7, 2019
2019年霍金奖学金演讲
剑桥大学，英国
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.
谢谢你，露西·霍金。这些年来，我有幸与你父亲为伴，今天早上能见到你真是太好了。
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.
我很荣幸被选为今年的霍金奖学金获得者。我要感谢评选委员会、剑桥联合会和整个霍金家族给我带来的巨大荣誉。
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.
我第一次见到霍金教授是在1997年，当时我就在这里，宣布微软与剑桥大学合作建立一个新的研究实验室。这些年来，我们见过好几次面，在剑桥和西雅图共进了几次特别难忘的晚餐。我很希望能告诉你们一些关于我们所谈令人惊讶的事情，但其实我们主要谈论的是物理。
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：如果你和我一样对物理学感兴趣，并且有机会和霍金教授聊聊他的研究，你一定要抓住这个机会。他的个性和你想象中的一样特别。他不仅在物理方面很有天赋，还是一个非常有天份的沟通者。
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.
霍金希望公众思考并参与科学。他的整个职业生涯都致力于使它变得通俗易懂且有趣。他鼓励人们保持好奇心——了解事实并提出问题。
In fact, Hawking’s last book was all about asking big questions. One of those questions was, can we predict the future?
事实上，霍金的最后一本书通篇都是关于提出大问题的。其中一个大问题就是，我们能预测未来吗?
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创建的这个平台来尝试回答这个问题。我们可以预测未来吗？ 关于健康的未来，我相信答案是肯定的，我们可以。
Why do I think we can predict the future? Because of three facts that explain how we got to where we are today.
为什么我认为我们可以预测未来呢？因为有三个事实可以解释我们是如何达成今天的成就的。
Fact #1: Global health has seen dramatic improvements in recent decades.
事实一：近几十年来，全球健康状况得到了显著改善。
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.
如今健康状况最差的国家比一个世纪前健康状况最好的国家都要好。世界儿童死亡率大幅下降，预期寿命涨幅惊人。
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.
我喜欢这个图表，因为它展示了我们已取得了巨大的进步。每一行显示了各个年龄段的死亡人数，最年轻的人群在最上面，最年老的人群在最下面。左边是1990年，右边是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.
看左边顶部的那一行。1990年，死亡率最高的年龄组是五岁以下的儿童。那一年有1200万儿童死亡。再看右边同一行：600万。到2017年，五岁以下儿童死亡人数减少了一半。死亡率最高的年龄组为80-84岁。这意味着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.
尽管我们已取得了这些进展，我们仍然可以看到健康方面存在巨大的不平等。
Let’s look at a map of under 5 mortality today:
让我们看一下如今5岁以下儿童死亡率的分布图：
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…
看看死亡都发生在哪里：大多在撒哈拉以南的非洲。这些孩子通常死于可以预防和治疗的疾病，比如腹泻。这是因为在剑桥和西雅图等地挽救生命的突破进展缓慢。这让我想到了第二个事实……
Fact #2: Improvements are made possible by innovation.
事实二：进步是通过创新实现的。
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.
当大多数人设想健康领域的创新时，他们想到的是医学上的重大突破，比如索尔克研制出第一支脊髓灰质炎疫苗。但创新并不局限于新疗法，有时最大的影响来自于优化的系统，它使我们得以触达更多的人。
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，近年来将脊髓灰质炎推向灭绝边缘的口服脊髓灰质炎疫苗自1961年就已问世，但几十年来，并非世界各地所有的孩子都能获得该疫苗。1988年，随着一个名为“全球根除脊髓灰质炎行动”（GPEI）的新机构的建立，这种情况发生了转变。
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制定了创新性战略，目标是触达并为每一个儿童接种疫苗。它还开展了疾病监测，以便在全球各地追踪病毒。由于合作伙伴和各国政府的不懈努力，以及扶轮国际的大规模志愿工作，GPEI已在全球范围内将脊髓灰质炎病例减少了99.9%以上。
The innovations that enable progress also include new methods of understanding.
推动进步的创新还包括新的认知方法。
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.
当我和梅琳达第一次开始这项工作时，我们震惊地发现世界对卫生工作知之甚少，特别是对最贫困地区的健康状况知之甚少。而我们今天的认识要深刻和准确得多。
当我一开始对全球健康感兴趣时，面对世界上最大的健康杀手之一——腹泻，我们对遭受这种疾病的患者所了解的全部内容都包含在这张表里。
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.
它告诉我们什么？除了在1990年有很多人得了腹泻这一事实之外，这张表显示的内容并不是很多。它告诉你在不同的地区有哪些疾病大类造成了儿童死亡，但甚至并没有告诉你他们在哪个国家或什么使他们患上了腹泻。它能让你体会到问题的严重程度，但对于提出计划来说并不是特别有用。
This is what the data we have on diarrhea looks like today:
这是今天我们有的关于腹泻的数据：
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.
我们可以按国家和十几种原因来细分腹泻死亡人数。
更好的数据帮助我们更好地利用资源。例如，通过观察这张图表，我们知道，将更多的资金投入到乍得的轮状病毒疫苗比投入到埃塞俄比亚更有意义，因为乍得的轮状病毒死亡率相对高于埃塞俄比亚。
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…
这张图表来自一个非常棒的工具，叫做“全球疾病负担”（Global Burden of Disease）。如果你在全球健康领域工作，这个工具是极有价值的。关于哪些人在哪里患上哪种疾病的相关信息，它可以告诉你几乎所有你想知道的内容。如果你不在全球健康领域工作，它也是跟踪我们已取得的惊人进展的好方法——而且进展还将继续。我们还有很多事情要做，因为……
Fact #3: Innovation is a long game.
事实三：创新是一场持久战。
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.
我们谈论研发进度是有原因的：创新往往需要多年的发展和积累。我之前提到的轮状病毒疫苗花了几十年才得以被需要的人接种，甚至还一度被撤出市场。
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.
未来20年内将影响人类健康的许多技术已经处于研发过程中。最近，在理解身体如何运作方面的突破正为我们带来巨大的进步。
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.
幸运的是，我的工作让我得以一览如今领域内所有的惊人发现。这就是为什么我能预测未来。基于我看到的研发进度，我预测在未来20年里，人类健康将因两项重大进展而发生巨大变化。
My first prediction is, we will solve malnutrition and significantly reduce the number of nutrition-related deaths.
我的第一个预测是，我们将解决营养不良问题，并显著减少与营养相关的死亡人数。
I get asked a lot what I would choose if I could only solve one problem. My answer is always malnutrition.
很多人问我，如果我只能解决一个问题，我会选择什么。我的回答总是营养不良问题。
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.
还记得那张儿童死亡率地图吗？就是那张告诉我们撒哈拉以南非洲的孩子比世界其他地方的孩子更有可能死亡的地图。这些死亡中约一半是营养不良造成的。
It’s the greatest health inequity in the world. By solving malnutrition, we can fix one of the biggest contributors to inequity.
这是世界上最大的健康不平等问题。通过解决营养不良问题，我们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.
这是世界上最大的健康不平等问题。句号。通过解决营养不良问题，我们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.
大多数人一想到营养不良，就会联想到一个饥饿的、瘦骨嶙峋的孩子。当相对于身高，你的体重偏低时，就属于消瘦。消瘦经常会造成死亡。但消瘦并不是营养不良带来的唯一问题。
还有发育迟缓的问题。当你的身高相对于体重偏低且不可逆转时，就属于发育迟缓。大多数在消瘦中幸存的孩子最终都会发育迟缓。如果你在生命的前三年内没有获得足够的营养，你的身体和智力都不能得到正常的发展。
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，你的死亡几率也会高得多，生活质量也会大大降低。
This picture is a good example of the long-term effects of stunting:
这张照片很好地说明了发育不良的长期影响：
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.
这些孩子都是9岁。左边的三个孩子远远低于他们这个年龄的平均身高。这就是当你错过成长的关键窗口期（也就是你生命的前几年）会发生的事情。你将无法弥补。
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.
毫不夸张地说，发育迟缓阻碍了整个国家的发展。最令人震惊的是：尽管我们在健康方面取得了惊人的进步，但如今仍有五分之一的五岁以下儿童发育迟缓。
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.
拯救这些孩子并不像确保他们有足够的食物吃那样简单。即使你摄入了充足的卡路里，也有可能发生发育迟缓。要了解原因，你需要理解孩子是如何成长的。
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.
吃东西时，你的身体会吸收能量。这些能量被用来做很多事情，比如为大脑提供能量，为体力活动提供燃料，支持你的免疫系统。
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.
在生命的前几年里，你所剩余的任何能量都被用来滋养你的大脑、肌肉和骨骼。婴儿需要在6个月内将出生体重增加一倍。但如果没有能量富余，你就得不到应有的生长发育。你成为了发育迟缓的人。
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.
最明显的原因是你在很长一段时间内都没能摄入足量且适合的食物。但发育迟缓还有一些不那么直观的原因。
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：你没有摄入适合的微量营养素（维生素或矿物质）、感染使你的身体处于炎症状态、你体内的有益菌群不够强大，或者你的母亲在你还在子宫里或者哺乳的时候遭受了这些。
All of these can make it more difficult for your body to get the nutrients it needs.
所有这些都会使你的身体更难获得所需的营养素。
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，我们有其中三个问题的解决方案。你可以通过强化食物或补剂来修复微量营养素的不平衡；感染可以用药物治疗或用疫苗预防；我们可以通过许多方式改善孕产妇的不良健康状况，包括促进性别平等和补充孕期营养。
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，修复微生物群落对我们来说还完全是一个谜。近年来，我们已对这方面了解了很多，并将在未来20年里继续了解更多。
That deeper understanding is why I predict we’re going to solve malnutrition.
这些深入的认识就是我预测我们将解决营养不良的原因。
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.
要让身体正常工作，我们所有人都要依赖体内的微生物群。我们体内的微生物细胞比人体细胞还多，这些细菌保护我们免受感染，对消化尤其重要。例如，如果没有肠道细菌的帮助，你的身体就无法分解某些类型的植物纤维。
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世纪初，分子测序技术让我们首次看到哪些物种和菌株生活在人体微生物群中。
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.
随后在2013年，美国生物学家杰夫·戈登 (Jeff Gordon) 发表了一项具有里程碑意义的研究。他和他的团队研究了马拉维双胞胎婴儿的微生物群落在三年内是如何发展的。他们最感兴趣的是，有些双胞胎中只有一个出现了特别严重的营养不良。
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.
通过对长期粪便样本的分析，他们发现尽管这些双胞胎吃着同样的食物，生活在同样的环境中，患有严重营养不良的那个双胞胎的微生物群落比没有营养不良的那个发展得更慢。当杰夫的团队把一个患病双胞胎的微生物组移植到老鼠体内时，这些老鼠开始变得很难吸收营养，体重也下降了。
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.
这项双胞胎研究表明，微生物群落不仅是健康的副产品，而且能影响你的健康。我们第一次见到这样的重大线索，证明我们可能通过改变肠道微生物群来解决营养不良问题。
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.
我们仍处于这项研究的相对早期阶段。在接下来的10到20年里，我们将进一步了解每一种微生物，以及它们如何与摄入的食物一起影响人类健康。这些知识将使我们能够巧妙地设计干预措施，以便在微生物发生紊乱时“纠正”它们。
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.
你可能熟悉其中一种干预措施：益生菌。未来我们将能够创造出下一代益生菌药丸，其中包含搭配好的细菌组合，甚至是为你的肠道量身定做的细菌。
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.
另一个干预措施可能是所谓的“微生物导向的辅助食品”。你可以把它们想象成微生物的肥料。食用它们能促进健康的细菌（帮助消化食物和保护我们不受感染的那种）的生长。
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.
这些针对微生物的治疗方法仍处于初级阶段。如果我们能找到一种方法让它们发挥作用并广泛应用，那么我乐观地相信，我们可以防止营养不良。这将是我们未来20年内在健康方面所能达到的最大突破。
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.
尽管这将对贫穷世界产生的影响令我感到非常兴奋，我们对营养如何发挥作用的一些基本见解也将为富裕世界带来巨大的好处。营养过剩和营养不足是一枚硬币的两面。找出如何改进其中一个也可能有助于我们改进另一个。
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.
既然我们已经对肠道有了更多的了解，我们便可以开始想办法改变它。这不仅有助于防止营养不良和肥胖，还能防止许多其他疾病，如哮喘、过敏和一些自身免疫性疾病——这些疾病可能是由微生物群落失衡引发的。
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…
如果我们能搞清楚营养问题，我相信在未来20年内，我们将拯救数百万人的生命，甚至改善更多人的生活。这让我想到我的第二个预言，它将改变健康的未来……
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.
在接下来的20年里，我预测地球上每个国家都将把医疗保健的重点从仅仅是拯救生命扩展到改善生活。
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?
这一转变标志着一个国家对医疗保健的看法发生了最重大的变化。
回想一下你上一次去医生那里检查的情景。你和医生最担心的是什么？
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.
如果你和普通英国人一样，那么你们很有可能会担心你的心脏健康。你可能已经讨论过你患癌症和老年痴呆症的危险因素。如果你出现了任何征兆，你的医生可能会帮助你制定计划，让你的健康保持在正确的轨道上。
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.
现在想象一下你生活在乍得，这个国家可预防性死亡的比例最高。你可能并不会进行定期检查，因为你们当地的健康诊所忙于治疗真正生病的人。你可能永远见不到医生，只有护士或其他卫生工作者。
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.
当你的身体出了一些严重的问题（比如发高烧或者持续腹泻）急需治疗的时候，你才可能真的见到他们。
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.
这两种医保系统有什么区别？在英国，医疗保健的目标是保持健康。在乍得，医疗保健的目标是保住生命。
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.
这个区别听起来很微妙，但它对你如何获得医疗保健服务有着巨大的影响。在二十年内，我相信世界上每个国家都将能不只关注生存，而是关注生活的健康和质量。
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.
跟踪这一转变最简单的方法是，看看在发达国家中，非传染性疾病与我们认为基本上可以“预防”的传染病、孕产妇疾病、新生儿疾病和营养性疾病的死亡数比例。
The countries in deep red and orange have a high percentage of preventable deaths—more than 50 percent.
深红色和橙色国家的可预防死亡比例高达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.
对我们在座的许多人来说，在我们的国家，可预防死亡人数在我们出生之前很久就降到了50%以下。在其他地方，这种情况最近才发生。巴基斯坦在1997年跨过了门槛。南非终于在2016年实现了转变。
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，大多数由这些可预防的原因所造成的死亡都来自于非洲。20年后，这些国家将跨过50%的门槛。
How do I know this will happen? A couple reasons.
我为什么这么说？有几个原因。
To start, as I just explained, we’ll have solved nutrition. That’ll make the single biggest improvement.
首先，正如我刚才解释的，我们将解决营养问题。这将是最大的改善。
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，我们也将几乎消灭疟疾。许多仍高于50%可预防死亡门槛的国家，也是每年疟疾致死人数最多的地方。例如在尼日尔，疟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.
长期以来，我们认为治疗是最好的方法。有道理吧？疟疾是一种可治愈的疾病。如果你给足够多的人以药物，或者开发出一种简单的疫苗，你就应该能够把它消灭掉。
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.
现实要复杂得多。近年来我们了解到，控制疟疾的关键是控制传播媒介，而疟疾的传播媒介是蚊子。
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.
如果我们要阻止疟疾，就必须消灭携带疟疾的蚊子。这项工作有几项有潜力的新进展给了我希望。首先，我们终于知道蚊子在哪里了。
Look at these two maps of Haiti:
看看这两张海地地图：
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?
左边是一个以5x5公里的分辨率显示疟疾发病率的地图。信不信由你，即便只有这点细节，比起10年前也是巨大的进步。右边的地图使用来自各个医疗机构的数据，像素只精确到了1x1公里。能看清左边的清楚多少吗？
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.
这种清晰度意味着，卫生官员不必游走整个地区分发蚊帐和采取其他抗疟疾的措施，而可以针对重点疫区最大化抗疟效果。
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.
我对基因编辑的潜力也感到兴奋。消灭一个地区的所有蚊子是阻止疟疾的最快方法，但这是有风险的。大多数蚊子无法携带疟原虫。如果你把它们也除掉，就可能会破坏当地的生态系统。
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.
基因编辑让我们把目标放在携带疟疾的蚊子上。插入一种阻止这些坏蚊子繁殖的基因，将为我们赢得时间治愈疟疾肆虐地区的所有人。然后我们就可以让蚊子种群在没有疟原虫的情况下回归。
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?
这项技术仍处于测试阶段。我们首先需要理解一些事情：如果其中一种蚊子开始死亡，对食物链会有什么影响？我们需要引进多少种变异昆虫？我们需要蚊子消失多长时间？有哪些政治及政府方面的阻力需要我们去克服？
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.
当然，疟疾这一致命杀手并不是我们唯一能取得巨大进展的疾病。
我们还将最终扭转艾滋病毒流行的趋势，这在很大程度上要感谢新一代高效长效艾滋病毒药物。
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，如果你被诊断出感染了艾滋病病毒，你可以通过抗逆转录病毒疗法来控制这种疾病。多亏了这种疗法，感染者现在可以和普通人有同样的预期寿命。
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.
既然我在剑桥，我就应该提到，英国是我们在艾滋病病毒问题上取得如此大进展的一个重要原因。英国政府是一个名为“全球基金”（The Global Fund）的组织的第二大资助者。先不提其他贡献，该组织已支持超过1,750万使用抗逆转录病毒药物控制艾滋病病毒的人。实际上，我本周晚些时候也要去里昂参加全球基金的筹资会议。
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.
抗逆转录病毒疗法虽然很神奇，但你必须在你余生中的每一天都坚持吃药。如果你不坚持服用，就可能会产生耐药性，甚至将一种抗药性的病毒株传播给其他人。
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，用现代标准来看，未来的艾滋病疗法堪称奇迹。想象一下，你不必每天都要吃药，而是每隔几个月注射一次，甚至一年注射一次。你也可以在手臂上进行植入。
艾滋病的预防也将得到改善。今天，你可以每天吃一片药来降低感染的风险。在未来，这些药片可能会持续更长时间，于是你可以减少服用的频率。
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.
我也很乐观地认为，有一天我们会开发出一种有效的艾滋病疫苗，可以消除你完全感染病毒的风险。
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.
当你不必每天考虑挽救生命的治疗方法和预防措施时，把它们融入生活会变得容易得多。我们离那样的世界还有好多年。但当那天到来时，游戏规则就会被改变。
So, what happens when a country crosses the preventable death threshold?
那么，当一个国家跨过可预防死亡的门槛时会发生什么？
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.
随着可预防的疾病变得越来越不常见，慢性病会变得越来越普遍。这包括一些可以杀死你的东西，比如老年痴呆症和糖尿病，或者一些让你活得很痛苦的疾病，比如关节炎。你也更容易患上精神疾病，比如抑郁症或焦虑症。
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.
把更容易抑郁或中风看作进步的标志似乎很奇怪。但重要的是要记住，人类的健康不是用二进制的标准来衡量的。
Innovation is shrinking the gap between perfect and not perfect health for everyone. And the smaller it gets, the better the world becomes.
创新正在缩小每个人健康和不健康之间的差距。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.
这是因为从长寿到健康的转变不仅仅改变了我们对待医疗保健的方式。它还为人类及社会繁荣打开了各种各样令人惊奇的机遇。
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.
当我们考虑如何让一个人保持健康，我们真正考虑的是他们的幸福。我们思考如何确保他们在学校表现良好，能够养家糊口，为社会做出贡献。
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.
可预防死亡比例最高的国家，其人均国内生产总值（GDP）也处于世界最低水平，这并非巧合。
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.
改善健康是脱贫的基础。健康水平被改善，人们就会更有效率。而当更多的孩子活到成年，家庭就会决定少生孩子，这可能导致经济的爆发式增长。
In other words, when people thrive physically, economies grow. Poverty goes down. The world gets better.
换句话说，当人们身体健康时，经济就会增长，贫穷将会减少，世界将会变得更好。
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现象，可能会令人泄气。但如果我们继续资助创新，我们就能缩小这些差距。我们可以解决营养问题，我们可以确保全世界都将关注点扩大到改善生活上去。
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.
但还是有陷阱存在：技术很容易预测。但进步不仅仅取决于技术。这也取决于那些很难预测的人。
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?
我们是否会继续相信投资于创新是值得的？我们是否会尽一切努力确保这些创新惠及所有需要它们的人？
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.
世界正处于全球健康的关键时刻，有许多重点项目需要资金支持。现在，各国正在决定是否值得进行这些投资。
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·霍金在他上一本书中问的另一个问题是：“我们如何塑造未来？”投资于全球健康是我们能做到的最好方式之一。如果我们选择把创新放在首位，那么未来就是可以被我们塑造的。
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.
霍金教授坚信科学和研究的魔力。他也帮助了全世界相信这一点。尽管他在物理学领域的贡献非同寻常，但我仍然相信，这才是他最大的成就。
He reminded us to“look 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.
他提醒我们：“俯视脚下，不如仰望星空。”他教导我们，如果人类继续专注于扩大潜在的领域，进步就会到来。
Thank you for this tremendous honor.
谢谢你们给予我这项巨大的荣誉。
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