When I moved to Harare in 1985, social justice was at the core of Zimbabwe's national health policy.
当我1985年搬到哈拉雷时，社会公正问题是津巴布韦国家健康政策的核心。
The new government emerged from a long war of independence and immediately proclaimed a socialist agenda:
新政府摆脱了长期的独立战争后，立即公布了一项社会主义政策：
health care services, primary education became essentially free.
使健康医疗服务与初等教育成为基本免费项目。
A massive expansion of rural health centers placed roughly 80 percent of the population less than a two-hour walk from these facilities,
大规模的农村卫生服务中心，使得80%的人口步行两小时以内便可抵达，
a truly remarkable accomplishment. In 1980, the year of independence, 25 percent of Zimbabwean children were fully immunized.
这是一个真正非凡的进步。在1980年，也就是津巴布韦独立年，25%的孩童进行了常规免疫接种。
By 1990, a mere decade later, this proportion stood at 80 percent.
到1990，仅仅十年之后，这一比例上升到80%。
I felt tremendously privileged to be part of this transformation, a revolution.
我十分荣幸能参与这次转变。
The excitement, the camaraderie, was palpable.
这场革命中兴奋之情和同志友爱都十分真切。
Working side by side with brilliant Zimbabweans -- scientists, doctors, activists
与杰出的津巴布韦人民--科学家、医生、活动家，肩并肩工作，
I felt connected not only to an African independence movement, but to a global progressive public health movement.
我感到参与的不仅是一个非洲独立运动，更是一场进步的全球公众健康运动。
But there were daunting challenges. Zimbabwe reported its first AIDS case in 1985, the year I arrived.
我也面临过一些令人畏缩的困难。在1985年，我到达的那一年，津巴布韦报告了第一例艾滋病。
I had taken care of a few patients with AIDS in the early 1980s,
我在20世纪80年代初初照料过几个艾滋病人，
when I did my medical training at Harlem Hospital, but -- we had no idea what lay in store for Africa.
当时我在Harlem医院接受医学培训，但是我们完全想不到会在非洲遇到什么。
Infection rate stood at about two percent in my early days there.
我刚到那里的时候，感染率大约2%，这一比例迅速增大。
These would soar to one out of every four adults by the time I left Harare 17 years later.
当我17年后离开哈拉雷的时候，每四名成人就有一名感染。
By the mid-1990s, I'd told hundreds of people in the prime of life that they were HIV-positive.
到20世纪90年代中期，我告诉过数百个朝气蓬勃的年轻人，他们的艾滋病病毒检验呈阳性。
I saw colleagues and friends die, my students, hospital patients, die.
我目睹同事和朋友们死去，我的学生和医院病人也因此死亡。
In response, my colleagues and I set up a clinic. We did condom demonstrations.
面对这种情况，我和同事开办了一家诊所。我们演示如何使用避孕套。
We launched school education and workplace interventions. We did research.
我们在学校教育和工作场所进行宣传。我们开展研究。
We counseled the partners of infected men about how to protect themselves.
我们为艾滋病感人群的染伴侣提供如何保护自己的建议。
We worked hard, and at the time, I believed that I was doing my best.
我们非常努力做着这一切，我相信当时我已经竭尽全力。
I was providing excellent treatment, such as it was. But I was not talking about structural change.
我提供了最好的治疗措施，至少在当时的条件下如此。但是我没有做出建设性地改变。
Former UN Secretary Kofi Annan has spoken candidly about his personal failure leading to the Rwandan genocide.
前联合国秘书长科菲·安南曾经坦白地承认，是他个人的错误导致了卢旺达大屠杀。
In 1994, he was head of the UN peacekeeping department.
在1994年，他是联合国维和部门的领导。
At a 10-year memorial for the genocide, he reflected, "I believed at the time I was doing my best,
在大屠杀十年纪念仪式上，他回忆说，“当时我相信我已经竭尽所能，
but I realized after the genocide that there was more I could and should have done to sound the alarm and rally support."
但是大屠杀之后我才意识到，还有很多是我可以做并且应该做的，去敲响警钟，去寻求支持。”
The AIDS epidemic caught the health community unprepared, and today,
艾滋病的爆发使医疗团体措手不及，
when the World Health Organization estimates that 39 million people have lost their lives to this disease,
世界卫生组织估计，当今有三千九百万人死于这一疾病。
I'm not alone in feeling remorse and regret at not having done more earlier.
许多人同我一样，因为没能更早地阻止这一切而感到悔恨和惋惜。
But while living in Zimbabwe, I didn't see my role as an advocacy or a political one.
但当我生活在津巴布韦时，并没有意识到自己是倡导者或政治人士。
I was there for my technical skills, both my clinical and my research epidemiology skills.
我本以为是因为自己的医疗知识前去那里的，是因为我的临床和传染病研究。
And in my mind, my job was to take care of patients and to do research to better understand the population patterns of transmission,
我一直觉得，我的工作是照顾病人、通过研究来更好地理解传染的人口特征，
and I hoped that we'd slow the spread of the virus.
我希望可以减缓病毒的传播速度。
I was aware that socially marginalized populations were at disproportionate risk of getting and dying of AIDS.
我意识到社会边缘群体感染并死于艾滋病的比例出奇的高。
And on the sugar plantations, which really more closely resembled feudal fiefdoms than any modern enterprise,
在蔗糖种植园，这类相比于现代企业更近似于封建领地的地方，
60 percent of pregnant women tested HIV-positive.
60%的孕妇艾滋病病毒测试呈阳性。
I worked to show how getting infected was not a moral failure but instead related to a culture of male superiority,
我的工作是向人们展示被感染并不是道德沦丧，而是与男权意识有关，
to forced migrant labor and to colonialism. Whites were largely unscathed.
与强迫外来劳工和殖民主义有关。白人大部分都安然无恙。
As health professionals, our tools were pitifully weak:
作为医疗专家，我们的手段令人遗憾的无力：
imploring people to change their individual behaviors, use condoms, reduce number of partners.
恳求人们改变他们的个人行为，使用避孕套，减少伴侣数目。
Infection rates climbed, and when treatment became available in the West, treatment that remains our most potent weapon against this virus,
感染率还是攀升，作为我们对抗病毒最有效的武器，当治疗在西方已经可行的时候，
it was unaffordable to the public sector across Africa.
对于整个非洲公共部门，治疗是负担不起的。
I didn't speak out about the unequal access to these life-saving drugs
我没有大胆地说出对挽救生命药品获取的不平等
or about the underlying economic and political systems that were driving infection rates in such huge swaths of the population.
或者潜在经济和政治系统中的问题，是导致如此大面积人群中感染率居高不下的驱动力。
I rationalized my silence by reminding myself that I was a guest in the country,
我为我的沉默找了借口，提醒自己我只是这个国家的访客，
that sounding the alarm could even get me kicked out, keep me from doing good work,
敲响警钟可能会被驱逐出境，让我无法做好工作，
taking care of my patients, doing much-needed research.
照料我的病人，做迫切需要的研究。
So I didn't speak out about the government's early stance on AIDS. I didn't voice my concerns loudly enough.
所以我没有对政府早期的艾滋政策大胆直言。我表达我的担忧不够大声。
Many doctors, health professionals, may think I did nothing wrong.
许多医生、保健工作者，可能会觉得我没有做错。
Our pact with our patients, the Hippocratic Oath and its variants, is about the sanctity of the patient-doctor relationship.
我们对于病人的承诺，就如希波克拉底誓言和它的不同版本，是神圣不可侵犯的医患关系。
And I did everything I could for each and every patient of mine.
我对我的每一个病人竭尽所能。
But I knew that epidemics emerge along the fissures of our society, reflecting not only biology,
但是我知道，伴随着我们社会分裂产生的传染病，反映的不单是生物学现象，
but more importantly patterns of marginalization, exclusion, discrimination related to race, gender, sexuality, class and more.
更重要的是边缘化、不包容、种族歧视、性别歧视、阶级歧视的现象。
It was true of AIDS. It was true just recently of Ebola.
对于艾滋病如此。对于最近的埃博拉如此。
Medical anthropologists such as Paul Farmer, who worked on AIDS in Haiti, call this structural violence:
医疗人类学家，例如保罗·法玛尔，在海地从事艾滋病工作，称之为结构性暴力：
structural because inequities are embedded in the political and economic organization of our social world,
结构性，因为不平等植根于我们社会环境的政治和经济组织，
often in ways that are invisible to those with privilege and power;
经常为特权和政权阶层所无视；
and violence because its impact -- premature deaths, suffering, illness -- is violent.
暴力，因为它的影响，比如早逝、苦难、疾病，是暴力的。

We do little for our patients if we fail to recognize these social injustices.
我们为病患做的很少，如果我们没有意识到这些社会不公正。
Sounding the alarm is the first step towards doing public health right,
敲响警钟是向正确方向引导公众保健的第一步，
and it's how we may rally support to break through and create real change together.
这是我们寻求支持的方式，一起去突围、去创造真正改变的方式。
So these days, I'm not staying quiet. I'm speaking up about a lot of things,
所以现如今，我没有保持沉默。我对很多事大胆直言，
even when it makes listeners uncomfortable, even when it makes me uncomfortable.
尽管让听者感到不适，尽管让我感到不适。
And a lot of this is about racial disparities and institutionalized racism,
这其中，很多是关于种族隔离和有组织的种族主义，
things that we're not supposed to have in this country anymore, certainly not in the practice of medicine or public health.
这些不应该发生在这个国家的事情，不应该存在于医疗实践中或者公众保健中的事情。
But we have them, and we pay for them in lives cut short.
但是它们确实存在，我们为此付出缩短生命的代价。
That's why sounding the alarm about the impact of racism on health in the United States,
这就是在美国，对种族主义影响保健事业敲响警钟的原因，
the ongoing institutional and interpersonal violence that people of color face,
持续的、有组织的、人际间的对有色人种的暴力，
compounded by our tragic legacy of 250 years of slavery, 90 years of Jim Crow and 60 years of imperfect equality,
与我们悲剧性的历史息息相关，250年的奴隶制度，90年的种族歧视，60年的不完善的平等关系，
sounding the alarm about this is central to doing my job right as New York City's Health Commissioner.
为此敲响警钟，是我作为纽约市卫生专员的工作重心。在
In New York City, premature mortality -- that's death before the age of 65 -- is 50 percent higher for black men than white ones.
纽约市，过早死亡率，即在65岁之前过世，黑人比白人高出50%。
A black woman in 2012 faced more than 10 times the risk of dying related to childbirth as a white woman.
在2012年，黑人女性相比白人女性，面对着多于10倍的与生育相关的死亡风险。
And though we've made enormous strides in reducing infant mortality rates,
尽管我们在减少婴儿死亡率方面已经取得了巨大的进步，
a black baby still faces nearly three times the risk of death in its first year of life as compared to a white baby.
黑人婴儿出生后，第一年死亡率依旧是白人婴儿的近三倍。
New York City's not exceptional. These statistics are paralleled by statistics found across the United States.
纽约市并非特例。这些统计数据在美国全境都相类似。
A recent New York Times analysis reported that there are 1.5 million missing black men across the country.
一份最近的纽约时报分析报道，全国大概有一千五百万的失踪黑人男性。
They noted that more than one out of every six black men
作者指出，25至54岁的黑人男性，每六人中，
who today should be between the ages of 25 and 54 years have disappeared from daily life, lost either to prison or premature death.
就有至少一人从日常生活中消失，或因牢狱之灾，或因过早死亡。
There is great injustice in the daily and disproportionate violence faced by young black men,
年轻黑人日常要面对不成比例的暴力行为，这是非常不公平的，
the focus of recent protests under the banner #BlackLivesMatter.
这些都存在于最近高举“黑人生命很重要”标语的抗议中。
But we have to remember that enduring and disparate rates and the occurrence and outcome of common medical conditions
但是我们需要记住持久且奇高的疾病比率，以及普通医疗的现状和结果，
heart disease, cancer, diabetes, HIV -- diseases that may kill slowly and quietly and take even more black lives prematurely.
心脏病，癌症，糖尿病，艾滋病--那些缓慢地安静地吞噬生命的疾病，让更多黑人生命过早消逝的疾病。
As the #BlackLivesMatter movement unfolded, I felt frustrated and angry
随着“黑人生命很重要”运动的展开，我感到受挫和生气，
that the medical community has been reluctant to even use the word "racism" in our research and our work.
医疗团体在研究和工作中，甚至对“种族主义”一词的使用都犹豫不决。
You've probably felt something every time I've said it.
我每次说它时，你大概已经有所感觉。
Our medical students held die-ins in their white coats,
医学学生身着白袍，以死抗议生化武器，
but the medical community has largely stood by passively as ongoing discrimination continues to affect the disease profile and mortality.
但是医疗团体面对持续的种族歧视对疾病状况和死亡率的影响，很大程度上袖手旁观。
And I worry that the trend towards personalized and precision medicine,
我很担心趋向个人化和准确化的药物，
looking for biological or genetic targets to better tailor treatment,
找寻生物和基因目标以更好的设计疗法，
may inadvertently cause us to lose sight of the big picture, that it is the daily context,
可能会不经意地使我们不能着眼大局，而这正是日常生活的场景，
where a person lives, grows, works, loves, that most importantly determines population health, and for too many of us, poor health.
一个人的生活、成长、工作、相爱的地方，重要地影响着群体健康。对我们很多人来说，健康不良。
As health professionals in our daily work, whether in the clinic or doing research, we are witness to great injustice:
在日常工作生活中，作为保健工作者，无论在诊所里还是做研究时，我们都是巨大不公正的目击者：
the homeless person who is unable to follow medical advice because he has more pressing priorities;
流浪者无法遵从医嘱，因为他要优先考虑更加紧迫之事；
the transgender youth who is contemplating suicide because our society is just so harsh;
年轻的变性人尝试自杀，因我们的社会太过无情；
the single mother who has been made to feel that she is responsible for the poor health of her child.
单身母亲被迫使感到需要对她孩子的健康不良负责。
Our role as health professionals is not just to treat our patients but to sound the alarm and advocate for change.
作为保健工作者，我们的角色不只是治疗我们的病人，更是敲响警钟，主张变革。
Rightfully or not, our societal position gives our voices great credibility, and we shouldn't waste that.
不论合理与否，我们的社会岗位让我们的声音更加可信，而我们不应该浪费它。
I regret not speaking up in Zimbabwe, and I've promised myself that as New York City's Health Commissioner,
我对在津巴布韦没能坦率表达感到后悔，我已经对自己承诺，作为纽约市保健专员，
I will use every opportunity I have to sound the alarm and rally support for health equity.
我将会利用拥有的所有机会去敲响警钟，去为保健平等寻求支持。
I will speak out against racism, and I hope you will join me,
我将对种族歧视直言反对，我也希望你们能够加入我，
and I will join you when you speak out against sexism or any other form of inequality.
而我也会加入你们，当你们为性别歧视或者任何一种不平等直言反对之时。
It's time for us to rise up and collectively speak up about structural inequality.
是时候让我们起来反抗了，共同地对结构性不平等大胆直言。
We don't have to have all the answers to call for change. We just need courage.
对倡导变革，我们不需要拥有所有答案。我们只需勇气。
The health of our patients, the health of us all, depends on it.
我们病患的健康，我们自身的健康，全赖于此。