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.
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.
You can read my remarks below. I’m grateful to the Cambridge Union Society for inviting me to give this lecture.
Remarks as prepared
2019 Professor Hawking Fellowship Lecture
Cambridge University, United Kingdom
October 7, 2019
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.
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.
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.
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.
In fact, Hawking’s last book was all about asking big questions. One of those questions was, can we predict the future?
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.
Why do I think we can predict the future? Because of three facts that explain how we got to where we are today.
Fact #1: Global health has seen dramatic improvements in recent decades.
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.
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.
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…
Fact #2: Improvements are made possible by innovation.
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.
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.
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.
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:
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.
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.
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.
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.
I get asked a lot what I would choose if I could only solve one problem. My answer is always malnutrition.
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.
It’s the greatest health inequity in the world. By solving malnutrition, we can fix one of the biggest contributors to inequity.
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.
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.
Even if you survive to adulthood, your chances of dying are much higher, and your quality of life is greatly reduced.
This picture is a good example of the long-term effects of stunting:
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.
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.
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.
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.
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.
All of these can make it more difficult for your body to get the nutrients it needs.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
To start, as I just explained, we’ll have solved nutrition. That’ll make the single biggest improvement.
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.
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.
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.
Look at these two maps of Haiti:
The one on the left shows the malaria rate with a 5×5 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 1×1 km square. See how much more detailed it is?
左边是一个以 5×5 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 1×1 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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
So, what happens when a country crosses the preventable death threshold?
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.
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.
Innovation is shrinking the gap between perfect and not perfect health for everyone. And the smaller it gets, the better the world becomes.
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.
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.
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.
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.
In other words, when people thrive physically, economies grow. Poverty goes down. The world gets better.
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.
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.
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?
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.
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.
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.
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.
Thank you for this tremendous honor.