My heart is racing in my chest.

在座的大多數可能可以 體會我現在的感覺。

My palms are a little bit clammy.

我的心臟跳很快。

I'm sweating.

我的手掌有點黏。

And my breath is a little bit shallow.

我在流汗。

Now, these familiar sensations are obviously the result

我的呼吸有點急促。

of standing up in front of a thousand of you

很明顯，這些熟悉的感覺是因為

and giving a talk that might be streamed online

我站在你們無數人面前演講，

to perhaps a million more.

而且這個演講可能會放到網路上

But the physical sensations I'm experiencing right now

供上百萬人觀看。

are actually the result of a much more basic mind-body mechanism.

但是我現在的這個身體反應

My nervous system is sending a flood of hormones

實際上是很基本的身心機制的結果。

like cortisol and adrenaline into my bloodstream.

我的神經系統正在輸送

It's a very old and very necessary response that sends blood and oxygen

許多如皮質醇和腎上腺素等荷爾蒙 到我的血液裡。

to the organs and muscles that I might need

這是一個非常老且非常必要的反應。

to respond quickly to a potential threat.

它送我所需的血液和氧氣 到器官和肌肉裡

But there's a problem with this response,

讓我可以快速回應潛在的威脅。

and that is, it can get over-activated.

但是這個回應有一個問題，

If I face these kinds of stressors on a daily basis,

那就是，它可能反應過度。

particularly over an extended period of time,

如果我每天面對這些種種壓力，

my system can get overloaded.

持續一段時間後，

So basically, if this response happens infrequently: super-necessary

我的系統可能會不堪負荷。

for my well-being and survival.

基本上，如果這個反應不常發生，

But if it happens too much,

那對於我的健康和生存是很必要的。

it can actually make me sick.

但是如果它經常發生，

There's a growing body of research examining the relationship

那就可能會讓我生病。

between chronic stress and illness.

有越來越多的研究檢視

Things like heart disease and even cancer

慢性壓力和疾病之間的關係。

are being shown to have a relationship to stress.

心臟病，甚至癌症等疾病

And that's because, over time, too much activation from stress

顯然與壓力有關係。

can interfere with my body's processes that keep me healthy.

那是因為，長時間 太多來自壓力的激活

Now, let's imagine for a moment that I was pregnant.

會干擾我的身體保持健康的過程。

What might this kind of stress,

現在，我們想像一下 我現在懷孕了。

particularly over the length of my pregnancy,

這種壓力，

what kind of impact might that have

特別在整個懷孕期間，

on the health of my developing fetus?

對我體內正在發育的胎兒

You probably won't be surprised when I tell you

可能造成什麼影響？

that this kind of stress during pregnancy is not good.

你們可能不會驚訝 當我告訴你們

It can even cause the body to initiate labor too early,

懷孕期間的這種壓力很不好。

because in a basic sense, the stress communicates

它甚至可能導致身體太早生產，

that the womb is no longer a safe place for the child.

因為，基本上，壓力告知身體

Stress during pregnancy is linked with things like high blood pressure

子宮已經不是胎兒的安全所在了。

and low infant birth weight,

懷孕期間的壓力與高血壓

and it can begin a cascade of health challenges

和嬰兒體重不足等有關聯，

that make birth much more dangerous

而這些啟動一連串的健康挑戰，

for both parent and child.

使母親和胎兒在生產時更加危險。

Now of course stress, particularly in our modern lifestyle,

當然，特別是我們現代的生活方式，

is a somewhat universal experience, right?

壓力是相對普遍的經驗，對嗎？

Maybe you've never stood up to give a TED Talk,

或許你未曾在台上做 TED 的演講，

but you've faced a big presentation at work,

但是你曾在工作場合做過大型的發表，

a sudden job loss,

或是突然失去工作，

a big test,

面對一個大的考驗，

a heated conflict with a family member or friend.

甚至與家庭成員或朋友有熱烈的衝突。

But it turns out that the kind of stress we experience

但事實證明，我們經驗的那種壓力，

and whether we're able to stay in a relaxed state long enough

以及我們是否能夠 足夠長久地保持放鬆狀態，

to keep our bodies working properly

使我們的身體保持正常運作，

depends a lot on who we are.

基本上取決於我們是那種人。

There's also a growing body of research

有越來越多的研究顯示

showing that people who experience more discrimination

經歷更多的歧視的人

are more likely to have poor health.

更可能有比較差的健康狀態。

Even the threat of discrimination,

即使是歧視的威脅，

like worrying you might be stopped by police while driving your car,

像是擔心你可能會在開車時 被警察攔下來，

can have a negative impact on your health.

就可能對你的健康有負面影響。

Harvard Professor Dr. David Williams,

哈佛大學教授大衛 · 威廉斯博士

the person who pioneered the tools that have proven these linkages,

是開發能證明關連的工具的先驅。

says that the more marginalized groups in our society

他說在我們的社會， 越是被邊緣化的族群，

experience more discrimination and more impacts on their health.

經歷越多的歧視 和遭受越多對於健康的影響。

I've been interested in these issues for over a decade.

我十多年來一直對這些問題感興趣。

I became interested in maternal health

特別是有關孕婦的健康

when a failed premed trajectory instead sent me down a path

讀醫科的計劃的失敗， 反而把我送上了

looking for other ways to help pregnant people.

尋找其他方式幫助孕婦之路。

I became a doula,

我成了一個陪產婦，

a lay person trained to provide support

一位受訓練的非專業人士，

to people during pregnancy and childbirth.

為婦女在懷孕期間和生產時提供支持。

And because I'm Latina and a Spanish speaker,

而且因為我會講西班牙語， 是拉丁美洲裔，

in my first volunteer doula gig at a public hospital in North Carolina,

當我在北卡羅來納州的 一家公立醫院擔任陪產婦志工時，

I saw clearly how race and class impacted the experiences

我清楚地看到了種族和階級 如何影響到

of the women that I supported.

我所陪產的婦女的經驗。

If we take a look at the statistics about the rates of illness

如果我們看看懷孕期間 和生產時的疾病的比率的統計資料，

during pregnancy and childbirth,

我們就會清楚地看到 由威廉姆斯博士概述的模式。

we see clearly the pattern outlined by Dr. Williams.

特別是非裔美國婦女，

African-American women in particular

她們的嬰兒出生時是否健康， 有著與白人婦女完全不同的經驗。

have an entirely different experience than white women

特別是在美國的最南部地區，

when it comes to whether their babies are born healthy.

黑人婦女中的母親和嬰兒的死亡率，

In certain parts of the country, particularly the Deep South,

實際上與撒哈拉以南非洲人的 這些比率相似。

the rates of mother and infant death for black women

在那些社區，

actually approximate those rates in Sub-Saharan African.

白人婦女的那些比率接近零。

In those same communities,

甚至在全國，黑人婦女

the rates for white women are near zero.

在懷孕和分娩期間死亡的比率

Even nationally, black women are four times more likely

是白人婦女的四倍。

to die during pregnancy and childbirth

四倍的死亡率。

than white women.

黑人嬰兒在滿一歲前的死亡率 也是白人的兩倍。

Four times more likely to die.

黑人嬰兒早產和出生時重量太輕， 那是發展不足的跡象，

They're also twice as likely for their infants to die

是白人嬰兒的兩三倍。

before the first year of life

本土印第安婦女這些問題的比率

than white infants,

也比白人婦女高，

and two to three times more likely

有些拉丁美裔的族群也是如此。

to give birth too early or too skinny --

在過去十年， 作為一個陪產婦轉業的記者和博主，

a sign of insufficient development.

我一直在試圖提出

Native women are also more likely to have higher rates of these problems

關於美國有色人種婦女，

than white women,

特別是黑人婦女，

as are some groups of Latinas.

在懷孕和生產的經驗 是如何不同的警報。

For the last decade as a doula turned journalist and blogger,

但是當我告訴人 關於這些令人震驚的統計，

I've been trying to raise the alarm

我通常聽到的假設是

about just how different the experiences of women of color,

那是因為貧窮，或是得不到醫療照顧。

but particularly black women,

但事實證明，這些不是全部的原因。

are when it comes to pregnancy and birth in the US.

即使中產階級的黑人婦女， 比起中產階級的白人婦女，

But when I tell people about these appalling statistics,

仍然有更不好的結果。

I'm usually met with an assumption that it's about either poverty

這個群組內的差距實際上更大。

or lack of access to care.

雖然是否得到醫療照顧 肯定還是個問題，

But it turns out, neither of these things tell the whole story.

即使有色人種的婦女 接受到推薦的產前保健，

Even middle-class black women still have much worse outcomes

在前述比率上她們仍然偏高。

than their middle-class white counterparts.

所以我們回來追溯

The gap actually widens among this group.

從歧視到壓力， 到健康欠佳的過程，

And while access to care is definitely still a problem,

這個許多有色人種 都相信的圖開始成形：

even women of color who receive the recommended prenatal care

種族歧視真的使我們生病。

still suffer from these high rates.

仍然聽起來過於誇張嗎？

And so we come back to the path

請聽聽以下：移民， 特別是黑人和拉丁移民，

from discrimination to stress to poor health,

在剛抵達美國時， 他們實際上有比較好的健康狀態。

and it begins to paint a picture that many people of color know to be true:

但當他們留在這個國家的時間越長， 他們的健康越惡化。

racism is actually making us sick.

和我一樣出生在美國的 古巴移民家庭的人，

Still sound like a stretch?

實際上更有可能 有比我的祖父母更差的健康狀態。

Consider this: immigrants, particularly black and Latina immigrants,

研究人員稱之為「移民者的矛盾」。

actually have better health when they first arrive in the United States.

它並進一步說明了

But the longer they stay in this country, the worse their health becomes.

美國的環境裡，

People like me, born in the United States to Cuban immigrant parents,

有使我們生病的東西。

are actually more likely to have worse health than my grandparents did.

但是事情是這樣的：

It's what researchers call "the immigrant paradox,"

種族歧視使有色人種生病，

and it further illustrates

特別是黑人婦女和嬰兒， 是個很巨大的問題。

that there's something in the US environment

我可以花所有的時間 與你談論它，

that is making us sick.

但我不會如此做， 因為我想告訴你一個解決方案。

But here's the thing:

好消息是， 有一個不是特別昂貴解決方案。

this problem, that racism is making people of color,

它不需要任何昂貴的藥物治療，

but especially black women and babies, sick, is vast.

或是新的科技。

I could spend all of my time with you talking about it,

這個解決方案叫做「JJ 方式」。

but I won't, because I want to make sure to tell you about one solution.

這位是珍妮 · 喬瑟夫。

And the good news is, it's a solution that isn't particularly expensive,

她是佛羅里達州奧蘭多市的助產士，

and doesn't require any fancy drug treatments

服務孕婦十多年了。

or new technologies.

在她稱之為便利診所裡，

The solution is called, "The JJ Way."

珍妮和她的團隊

Meet Jennie Joseph.

每年為超過 600 名婦女 產前護理。

She's a midwife in the Orlando, Florida area

她的客戶，大多數是黑人、 海地裔，和拉丁裔婦女。

who has been serving pregnant women for over a decade.

她們在當地醫院分娩。

In what she calls her easy-access clinics,

通過提供方便和尊重的產前保健，

Jennie and her team provide prenatal care to over 600 women per year.

珍妮得到很不可思議的成就：

Her clients, most of whom are black, Haitian and Latina,

幾乎所有她的客戶 都生了健康、足月的嬰兒。

deliver at the local hospital.

她的方法看起來很簡單。

But by providing accessible and respectful prenatal care,

珍妮說她所有的訪視 從櫃檯開始。

Jennie has achieved something remarkable:

她的團隊中的每個成員 時時刻刻都對她診所的每個婦女

almost all of her clients give birth to healthy, full-term babies.

都盡可能提供支持。

Her method is deceptively simple.

沒有人由於缺錢而被拒絕。

Jennie says that all of her appointments start at the front desk.

JJ 方式是無論有什麼障礙， 他們都不會讓財務成為問題。

Every member of her team, and every moment a women is at her clinic,

沒有人會因為比預約時間晚到被責備。

is as supportive as possible.

沒有人在言語上被貶低或輕視。

No one is turned away due to lack of funds.

珍妮的候診室，比起診所， 感覺更像你的阿姨的客廳。

The JJ Way is to make the finances work no matter what the hurdles.

她稱這個空間是「變相的教室」。

No one is chastised for showing up late to their appointments.

坐在排列成一個圓圈的 鬆軟舒適的椅子上，

No one is talked down to or belittled.

孕婦在等待她們的預約時，

Jennie's waiting room feels more like your aunt's living room than a clinic.

與一位負責教育的工作人員 一對一聊天，

She calls this space "a classroom in disguise."

或上團體產前課程。

With the plush chairs arranged in a circle,

當你終於被叫去做 你的預約檢查時，

women wait for their appointments in one-on-one chats

你會見到阿里克斯或崔伊娜

with a staff educator,

她們是珍妮的醫療助理。

or in group prenatal classes.

兩位都是年輕的黑人婦女， 她們本身也都是母親。

When you finally are called back to your appointment,

她們的方法是非正式和友好的。

you are greeted by Alexis or Trina,

在一次參訪時我觀察到，

two of Jennie's medical assistants.

崔伊娜和一位年輕的準媽媽聊天，

Both are young, African-American and moms themselves.

一面量著她的血壓。

Their approach is casual and friendly.

這個拉丁裔媽媽一直有孕吐的問題。

During one visit I observed,

當崔伊娜在為血壓袖帶放氣時，

Trina chatted with a young soon-to-be mom

她說：「我們改改你的處方，好嗎？

while she took her blood pressure.

我們不能任由你吃不下東西。」

This Latina mom was having trouble keeping food down due to nausea.

那個「我們」在珍妮的模式裡 是一個非常關鍵的部分。

As Trina deflated the blood pressure cuff,

她將工作人員、孕婦和她的家人 都視為團隊的一份子，

she said, "We'll see about changing your prescription, OK?

有著共同的目標：

We can't have you not eating."

讓媽媽生出一個健康的嬰兒。

That "we" is actually a really crucial aspect of Jennie's model.

珍妮說崔伊娜和阿里克斯 實際上是她的護理模式的中心。

She sees her staff as part of a team that, alongside the woman and her family,

作為護理提供者的角色， 她只是支持他們的工作。

has one goal:

崔伊娜每天花很多時間在她的手機上，

get mom to term with a healthy baby.

向客戶發關於各種各樣事情的短信。

Jennie says that Trina and Alexis are actually the center of her care model,

一位婦女發短信詢問 她在醫院治療時使用的處方藥物，

and that her role as a provider is just to support their work.

在懷孕時是否可以服用。

Trina spends a lot of her day on her cell phone,

答案是不可以。

texting with clients about all sorts of things.

另一位婦女發短信附上 在珍妮的照顧下出生的嬰兒的相片。

One woman texted to ask if a medication she was prescribed at the hospital

最後，當你終於被叫去 見醫療提供者，

was OK to take while pregnant.

你已經在候診室量了體重，

The answer was no.

並在浴室做了尿液測試。

Another woman texted with pictures of an infant born under Jennie's care.

這和傳統醫學模式，有很大的不同。

Lastly, when you finally are called back to see the provider,

因為它將責任和信息 放回到婦女的手中。

you've already taken your own weight in the waiting room,

在一般的醫療環境，

and done your own pee test in the bathroom.

如果妳沒有遵從他們的推薦， 你可能會被譴責──

This is a big departure from the traditional medical model,

那是低收入婦女經常接觸到的。

because it places responsibility and information

珍妮的模式是盡可能地支持孕婦。

back in the woman's hands.

那個支持對於每天面對 種族主義和歧視壓力的婦女而言，

So rather than a medical setting where you might be chastised

是個關鍵的緩衝。

for not keeping up with provider recommendations --

珍妮的模式最好的是：

the kind of settings often available to low-income women --

它非常成功。

Jennie's model is to be as supportive as possible.

記得我告訴你們，

And that support provides a crucial buffer

有關黑人婦女更有可能早產，

to the stress of racism and discrimination facing these women every day.

或者生出體重過低的嬰兒，

But here's the best thing about Jennie's model:

甚至死於懷孕和分娩併發症的 統計資料嗎？

it's been incredibly successful.

JJ 方式幾乎完全 消除了這些問題，

Remember those statistics I told you,

從珍妮稱為「瘦小寶貝」開始。

that black women are more likely to give birth too early,

她幾乎讓所有她的客戶

to give birth to low birth weight babies,

生出像這個的健康和大塊頭的嬰兒。

to even die due to complications of pregnancy and childbirth?

（聽眾）噢！

Well, The JJ Way has almost entirely eliminated those problems,

（米里亞姆·柔依拉·佩雷斯） 這是一位女嬰，

starting with what Jennie calls "skinny babies."

珍妮的一位客戶在六月生產的。

She's been able to get almost all her clients to term

在珍妮服務的地區， 一位有類似背景的的婦女，

with healthy, chunky babies like this one.

在和她的客戶同一家醫院生產，

Audience: Aw!

有三倍的機率

Miriam Zoila Pérez: This is a baby girl

會生出低於正常體重的嬰兒。

born to a client of Jennie's this past June.

珍妮突破了一個幾十年來 幾乎無法解決的問題。

A similar demographic of women in Jennie's area

你們有些人可能會想，

who gave birth at the same hospital her clients did

JJ 方式所需要的一對一的關注，

were three times more likely to give birth

要擴展的話，可能成本會很高。

to a baby below a healthy weight.

但你們的想法是錯的。

Jennie is making headway into what has been seen for decades

與醫療提供者見面 不是珍妮模型的中心，

as an almost intractable problem.

這是有好理由的。

Some of you might be thinking,

與醫療提供者見面是很貴的，

all this one-on-one attention that The JJ Way requires

為了維持她的模式， 她必須看很多客戶才能打平。

must be too expensive to scale.

但是珍妮對每一位婦女 不需要花很多時間，

Well, you'd be wrong.

如果她的團隊成員可以提供 客戶所需要的支持、資訊和照顧。

The visit with the provider is not the center of Jennie's model,

珍妮模式的美是她實際上相信

and for good reason.

這個模式在幾乎任何衛生保健機構 都可以做到的。

Those visits are expensive, and in order to maintain her model,

這是等待發生的一個醫療照顧的革命。

she's got to see a lot of clients to cover costs.

那些我與你們分享的問題是很大的。

But Jennie doesn't have to spend a ton of time with each woman,

它們來自悠久歷史

if all of the members of her team can provide the support, information

基於種族和階級分層的社會裡的 種族和階級歧視。

and care that her clients need.