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1、www.XiYuS锡育软件So I want to talk to you today about AIDS in sub-SaharanAfrica.我今天要谈论的是在撒哈拉沙漠以南的非洲那里艾滋病的情况00:16And this is a pretty well-educated audience,so I imagine youall know something about AIDS.我知道在场的观众都受过很良好的教育 所以我可以猜想到你们都了解一些关于艾滋病的事情00:19You probably know that roughly 25 million people in Afri
2、caare infected with the virus,and that AIDS is a disease ofpoverty.你可能知道在非洲大约有两千五百万人 感染了这种病毒，艾滋病是一种因贫穷而带来的疾病00:24And that if we can bring Africa out of poverty,we woulddecrease AIDS as well.如果我们能让非洲摆脱贫困，我们就能同样减轻艾滋病疫情00:30If you know something more,you probably know thatUganda,to date,is the only cou
3、ntry in sub-Saharan Africathat has had success in combating the epidemic,如果你了解足够多的话，你可能知道迄今为止乌干达 是唯一一个在撒哈拉以南非洲的国家中 成功防治艾滋病00:34using a campaign that encouraged people to abstain,befaithful,and use condoms-the ABC campaign.Theydecreased their prevalence in the 1990s from about 15percent to 6 percent
4、over just a few years.启用了鼓励人们禁欲，忠贞，并使用安全套的运动被称为ABC准则。在九十年代它们大大减少了艾滋病的传播 仅仅几年内就从百分之15减到了百分之600:42If you follow policy,you probably know that a few years agothe president pledged 15 billion dollars to fight theepidemic over five years,and a lot of that money is going togo to programs that try to repli
5、cate Uganda and usebehavior change to encourage people and decrease theepidemic.如果你关心时政，你可能知道几年前 总统承诺动用150亿美元在五年间抗击疫情 一大部分钱都会被用来启动一些项目试图仿造乌干达 用行为变革来引导人们并减少疫情。00:54well-educated:adj.受过良好教育的 infected:adj.被感染的/v.传染(infect的过去分词)combating:战斗/与斗争/反对(combat的现在分词)abstain:vi.自制;放弃;避免 condoms:n.医避孕套;橡皮套(condo
6、m复数形式)decreased:减少的prevalence:n.流行;普遍;广泛 pledged:v.保证;抵押;给予(pledge的过去式及过去分词)replicate:vt.复制;折叠/vi.重复;折转/adj.复制的;折叠的/n.复制品;八音阶间隔的反覆音So today Im going to talk about some things that you mightnot know about the epidemic.然而今天我想讲一些 你们可能不知道的事情01:10And then,actually,Im also going to challenge some of these
7、things that you think that you do know.事实上，我同时会颠覆 一些你们自以为知道的事情01:14And to do that Im going to talk about my research as aneconomist on the epidemic.要做到这些我就要讲一下 我作为一个经济学家所做的研究。01:18And Im not really going to talk much about the economy.我不是真的要谈经济01:23Im not going to tell you about exports and prices.我
8、不会谈论什么出口和价格。01:25But Im going to use tools and ideas that are familiar toeconomists to think about a problem thats moretraditionally part of public health and epidemiology.但我会用一些经济学家们熟悉的工具和思想 去思考一个习惯上被认为是 在公共卫生和流行病学领域的问题01:28And I think in that sense,this fits really nicely with this lateralthinking
9、 idea.在这个意义上，这真的很符合横向思维的方式01:36Here Im really using the tools of one academic discipline tothink about problems of another.我会用某个学科的一些工具 来思考另一个学科一些问题01:40So we think,first and foremost,AIDS is a policy issue.我想首先来说，艾滋病是一个政策的问题01:45exports:n.出口商品;输出额 traditionally:adv.传统上;习惯上;传说上 epidemiology:n.流行病学;传
10、染病学 lateral:adj.侧面的,横向的/n.侧部;语边音/vt.横向传球 first and foremost:首先;首要的是And probably for most people in this room,thats how youthink about it.可能对于在这个房里的大多人来说，你们就是这么想的。01:48But this talk is going to be about understanding facts aboutthe epidemic.但这次的演讲是有关于理解疫情传播的实事01:51Its going to be about thinking about
11、 how it evolves,andhow people respond to it.有关于思考它如何逐渐形成，人们又是如何应对的01:55I think it may seem like Im ignoring the policy stuff,which isreally the most important,but Im hoping that at the end of我可能会忽略政策一类的东西 实事它们是最重要的 我希望在演讲完毕你们能知道 我们无法实施有效的政策 除非我们明白的疫情是如何发生的TED演讲者：Emily Oster|艾米莉.奥斯特演讲标题：What do we re
12、ally know about the spread of AIDS?|颠覆我们对非洲艾滋病情况的认知内容概要：Emily Oster,a University of Chicago economist,uses the dismal science to rethinkconventional wisdom,from her Harvard doctoral thesis that took on famed economist AmartyaSen to her recent work debunking assumptions on HIV prevalence in Africa.艾米
13、莉.奥斯特从经济学的角度重新分析了非洲艾滋病情况的数据，并得出了一个惊人的结论:所有我们知道的关于艾滋病在陆地上的传播情况全是错的。really the most important,but Im hoping that at the end ofthis talk you will conclude that we actually cannot developeffective policy unless we really understand how theepidemic works.效的政策 除非我们明白的疫情是如何发生的01:58And the first thing that
14、I want to talk about,the first thing Ithink we need to understand,is:How do people respond tothe epidemic?我想讲的第一点 我认为我们必须理解的第一点是人们如何应对这种流行病的02:10So AIDS is a sexually transmitted infection,and it kills you.艾滋病是经由性传播感染的，它足以致命。02:16So this means that in a place with a lot of AIDS,theres areally signif
15、icant cost of sex.也就是说在一个艾滋病泛滥的地方 性交带来的代价也十分大02:20If youre an uninfected man living in Botswana,where theHIV rate is 30 percent,if you have one more partner this year-a long-term partner,girlfriend,mistress-your chance ofdying in 10 years increases by three percentage points.在博茨瓦那艾滋病感病率是百分之30，如果你是此处
16、的未感染者 如果你今年将多一个长期的伴侣，或许是女友，或许是情妇 在十年内可能死去的概率会提高三个百分点02:24evolves:v.进化,进展(evolve的第三人称单数形式)respond to:响应 uninfected:未感染 long-term:adj.长期的/从长远来看 mistress:n.情妇；女主人；主妇；女教师；女能人That is a huge effect.这种影响是巨大的02:36And so I think that we really feel like,then people shouldhave less sex.所以我们会意识到，人们真的需要减少性行为。02
17、:38And in fact among gay men in the US we did see that kind ofchange in the 1980s.事实上在美国的男同性恋中 在八十年代我们确实看到了这种改变02:41So if we look in this particularly high-risk sample,andtheyre being asked,Did you have more than oneunprotected sexual partner in the last two months?如果我们调查这个独特的高危人群，当他们被问到在过去的两个月里你是否有
18、多于一个未采取保护措施的性伴侣时02:45Over a period from 84 to 88,that share drops from about85 percent to 55 percent.数据表明从84到88年，比例从百分之85下降到百分之5502:52Its a huge change,in a very short period of time.在如此短的时间里，这是一个巨大的变化。02:58We didnt see anything like that in Africa.在非洲我们从未看到这样的改变。03:00So we dont have quite as good d
19、ata,but you can see herethe share of single men having pre-marital sex,or marriedmen having extra-marital sex,and how that changes fromthe early 90s to late 90s,and late 90s to early 2000s.Theepidemic is getting worse.我们没有这么好的数据，但你会发现 单身男人婚前性行为 或者已婚男人的婚外性行为的数据比例如何从九十年代初到九十年代末，从九十年代末到二十世纪初是如何变化的。疫情的传
20、播变得更加严重。03:02People are learning more things about it.人们对疾病的了解更多了03:15high-risk:adj.高危险度的 unprotected:adj.无保护的;未设防的;不受关税保护的/v.无保护(unprotect的过去分词)pre-marital:adj.婚前的 extra-marital:婚外恋we see almost no change in sexual behavior.但在性行为上却几乎没发生变化。03:17These are just tiny decreases-two percentage points-not
21、significant.仅仅有两个百分点的微小减弱03:19This seems puzzling,but Im going to argue you shouldnt besurprised by this.这似乎很令人困惑，但我要说你不应该对此感到吃惊。03:23And that to understand this,you need to think about healththe way than an economist does-as an investment.想要理解这个，你需要用经济学家的思维 来考虑有关健康的事 用一种投资的思想03:27So if youre a soft
22、ware engineer and youre trying to thinkabout whether to add some new functionality to yourprogram,its important to think about how much it costs.如果你是一个软件工程师 当你在思考 在你的设计里是否要加一些新的功能时 要花费多少成本是必须要考虑的。03:33Its also important to think about what the benefit is.能带来多少利益也是必须要考虑的。03:41And one part of that ben
23、efit is how much longer you thinkthis program is going to be active.其中有一点就是你认为 这个设计会在多长时间内有效。03:43If version 10 is coming out next week,theres no point inadding more functionality into version nine.如果第十版会在下周发行，就没有必要在第九版中再加功能了。03:47But your health decisions are the same.而你的健康选择也是如此。03:52Every time yo
24、u have a carrot instead of a cookie,every timeyou go to the gym instead of going to the movies,thats acostly investment in your health.每一次你放弃饼干而去吃胡萝卜时 每一次你去健身中心而不是去电影院时 这就是对你健康的极大投资。03:54decreases:减少(decrease的复数)puzzling:adj.使迷惑的;使莫名其妙的 functionality:n.功能;数泛函性,函数性But how much you want to invest is g
25、oing to depend on howmuch longer you expect to live in the future-even if youdont make those investments.但你要投资多少就取决于 你预期能活多久 就算你不做这些投资04:01AIDS is the same kind of thing.Its costly to avoid AIDS.艾滋病也依旧存在 避免艾滋是花费巨大的04:07People really like to have sex.人们真的很喜欢做爱。04:10But you know,it has a benefit in te
26、rms of future longevity.就未来长寿而言，它确实有好处。04:13But life expectancy in Africa,even without AIDS,is really,really low:40 or 50 years in a lot of places.但在非洲的平均寿命，即使没有艾滋病，依旧非常非常低：在大部分地方是40到50岁。04:19I think its possible,if we think about that intuition,and thinkabout that fact,that maybe that explains some
27、 of this lowbehavior change.可能的话，我们用直觉想想，结合实事想想，这或许能解释一部分这种低行为变革的原因。04:26But we really need to test that.但我们急需检测一下。04:33www.XiYuS锡育软件And a great way to test that is to look across areas in Africaand see:do people with more life expectancy change theirsexual behavior more?一种很好的检测方法就是调查非洲的各个地区：在平均寿命高的
28、地方人们改变性行为的习惯是不是多一些？04:35And the way that Im going to do that is,Im going to lookacross areas with different levels of malaria.我想做的就是 去调查有着不同疟疾疫情的地区。04:42investments:n.经投资,投资的财产;投资学(investment的复数形式)in terms of:依据;按照;在方面;以措词 longevity:n.长寿，长命；寿命 expectancy:n.期望,期待 intuition:n.直觉;直觉力;直觉的知识 malaria:n.内科
29、疟疾;瘴气So malaria is a disease that kills you.疟疾是一种致命的疾病。04:47Its a disease that kills a lot of adults in Africa,in addition toa lot of children.在非洲它使无数的成人和儿童失去生命。04:50And so people who live in areas with a lot of malaria aregoing to have lower life expectancy than people who live inareas with limited
30、 malaria.那住在疟疾病率高的地方的人们 将比疟疾爆发不严重地方的平均寿命要低一些04:53So one way to test to see whether we can explain some of thisbehavior change by differences in life expectancy is to lookand see is there more behavior change in areas where theresless malaria.所以检验的一种方法就是我们是否 能将平均寿命的差异与行为变革相联系 并看看在疟疾疫情较轻的的地区 是不是行为变革就越
31、多。05:00So thats what this figure shows you.大家看看这些数据05:10This shows you-in areas with low malaria,medium malaria,high malaria-what happens to the number of sexualpartners as you increase HIV prevalence.你会发现在疟疾疫情不同的地区 当艾滋病感染率变高时性伴侣的数量如何变化05:12If you look at the blue line,the areas with low levels ofma
32、laria,you can see in those areas,actually,the number ofsexual partners is decreasing a lot as HIV prevalence goes up.看这条蓝线 在这些疟疾疫情较轻的地区 性伴侣的数量在巨减 当艾滋病感染率变高的时候05:20Areas with medium levels of malaria decreases some-itdoesnt decrease as much.And areas with high levels ofmalaria-actually,its increasing
33、 a little bit,although thatsnot significant.在中度疫情的地方也减少了一些 但没那么多。在重度疫情的地区 也减少了一点点，但非常不显著05:30in addition to:除之外 decreasing:adj.渐减的/v.减少;缩减(decrease的ing形式)This is not just through malaria.不仅仅是通过疟疾。05:40Young women who live in areas with high maternal mortalitychange their behavior less in response to
34、 HIV than youngwomen who live in areas with low maternal mortality.在这片地区年轻妇女有着高孕产妇死亡率 为应对艾滋病而改变的行为也比 那些同地区低孕产妇死亡率的女性少些。05:42Theres another risk,and they respond less to this existingrisk.当有另一个威胁时，他们这种威胁的顾虑少些。05:51So by itself,I think this tells a lot about how people behave.就此而言，它告诉我们许多人们如何行为的事实。05:
35、56It tells us something about why we see limited behaviorchange in Africa.它说明了在非洲行为变革十分有限的原因05:59But it also tells us something about policy.同时也说明了一些关于政策的事情06:02Even if you only cared about AIDS in Africa,it might still be agood idea to invest in malaria,in combating poor indoor airquality,improving
36、 maternal mortality rates.就算你只关心在非洲的艾滋病情况 投资治理疟疾也是一种不错的想法 可以改进室内欠佳的空气质量 降低孕产妇死亡率06:04Because if you improve those things,then people are goingto have an incentive to avoid AIDS on their own.因为你一旦改进这些 人们就会自觉地防治艾滋病06:14But it also tells us something about one of these facts that wetalked about before.
37、但它同样也说明了一个我们之前讨论过的事实06:20maternal:adj.母亲的;母性的;母系的;母体遗传的 mortality:n.死亡数,死亡率;必死性,必死的命运 in response to:响应;回答;对有反应 incentive:n.动机;刺激/adj.激励的;刺激的Education campaigns,like the one that the president isfocusing on in his funding,may not be enough.At least notalone.教育运动 就如同总统用他的资金所致力的那样 是不够的 至少单独是不行的06:24If
38、 people have no incentive to avoid AIDS on their own-even if they know everything about the disease-they stillmay not change their behavior.如果人们没有防治艾滋病的自觉 就算人们知道了疾病的知识 他们也不会改变自己的行为06:30So the other thing that I think we learn here is that AIDS is我们必须了解的另一点是艾滋病不会自我修正06:36So the other thing that I thi
39、nk we learn here is that AIDS isnot going to fix itself.06:36People arent changing their behavior enough to decreasethe growth in the epidemic.人们的行为改变不足以 减弱传播的增长06:39So were going to need to think about policy and what kindof policies might be effective.我们要重新考虑政策 哪一种政策会更有效06:44And a great way to lea
40、rn about policy is to look at whatworked in the past.看看过去哪些政策有效能极大帮住我们06:48The reason that we know that the ABC campaign waseffective in Uganda is we have good data on prevalence overtime.我们知道ABC准则在乌干达有效 是因为我们有过去的数据来佐证06:51In Uganda we see the prevalence went down.我们知道在乌干达传播极大的减弱06:56We know they ha
41、d this campaign.Thats how we learn aboutwhat works.而他们有实施了这个运动 所以我们得出它有效的结论06:58Its not the only place we had any interventions.这不是我们有介入的唯一地区07:01campaigns:n.活动;竞选(campaign的复数)/v.参加战役;参加竞选(campaign的第三人称单数形式)interventions:n.法干预,干涉;处置(intervention的复数)Other places have tried things,so why dont we look
42、at thoseplaces and see what happened to their prevalence?别的地方也实施了政策 为什么我们不同样看看这些地方 看看他们的传播率是否变化了07:03Unfortunately,theres almost no good data on HIVprevalence in the general population in Africa until about2003.不幸的是，在非洲截止2003年关于艾滋病传播的在整体人口上的数据再也没有了07:10So if I asked you,Why dont you go and find me t
43、heprevalence in Burkina Faso in 1991?如果我问你 为什么不告诉我 在布基纳法索1991年传播率是多少07:17You get on Google,you Google-and you find,actually theonly people tested in Burkina Faso in 1991 are STD patientsand pregnant women.你上了谷歌 却发现 在布基纳法索1991年受测试的人 只有性病患者和孕妇07:22Which is not a terribly representative group of people
44、.这并不是极具代表性的一个人群07:30Then if you poked a little more,you looked a little more atwhat was going on,youd find that actually that was a prettygood year.如果你再深入一点 你就会发现更多 你会发现当年情况很好07:32Because in some years the only people tested are IV drugusers.因为在那几年被测试者只有静脉吸毒者07:38But even worse-some years its only I
45、V drug users,someyears its only pregnant women.实际上情况更糟 几年只有静脉吸毒者 几年只有孕妇07:41We have no way to figure out what happened over time.我们无法得知那几年到底发生了什么07:45no good:很糟,没有用 in the general:通常,一般 poked:拨We have no consistent testing.我们没有前后一致的测试07:47And in the last few years,weve actually done some goodtesting
46、.在最后几年 我们确实做了一些比较好的测试07:49In Kenya,in Zambia,and a bunch of countries,theres beentesting in random samples of the population.在肯尼亚 在赞比亚 和一些国家 这些测试都是在人口中随机进行的07:54But this leaves us with a big gap in our knowledge.但它却在我们的认知里留下一个巨大的鸿沟08:00So I can tell you what the prevalence was in Kenya in 2003,but I
47、 cant tell you anything about 1993 or 1983.我能告诉你在肯尼亚2003年的感染情况 但我不能告诉你关于1993年到1983年的任何情况08:03So this is a problem for policy,It was a problem for myresearch.现在的政策有问题 我过去的研究也有问题08:09And I started thinking about how else might we figure outwhat the prevalence of HIV was in Africa in the past.我开始思考我们能不
48、能得到别的什么 关于过去非洲艾滋病的感染情况08:13And I think that the answer is,we can look at mortality data,and we can use mortality data to figure out what theprevalence was in the past.结论是我们分析死亡率 用死亡率来估算艾滋病的感染率08:19To do this,were going to have to rely on the fact that AIDSis a very specific kind of disease.要完成这个 我们要
49、建立在 艾滋病是一种非常特殊的疾病的事实上08:27It kills people in the prime of their lives.它在人们年轻的时候置人于死地08:31Not a lot of other diseases have that profile.And you can seehere:this is a graph of death rates by age in Botswana andEgypt.并没有太多其他的疾病也像这样 你可以看到 这是一个以年龄划分关于在博茨瓦那和埃及的人口死亡率的图表08:33a bunch of:一群;一束;一堆 rely on:依靠,依
50、赖Botswana is a place with a lot of AIDS,Egypt is a placewithout a lot of AIDS.博茨瓦纳是一个艾滋病疫情严重的地方 埃及是一个没有太多艾滋病患者的地方08:40And you see they have pretty similar death rates amongyoung kids and old people.它们有着在儿童和老年人群中相似的死亡率08:44That suggests its pretty similar levels of development.这说明他们有着相似的发展水平08:47But