字幕表 動画を再生する 英語字幕をプリント There's an old joke about a cop who's walking his beat in the middle of the night, and he comes across a guy under a street lamp who's looking at the ground and moving from side to side, and the cop asks him what he's doing. The guys says he's looking for his keys. So the cop takes his time and looks over and kind of makes a little matrix and looks for about two, three minutes. No keys. The cop says, "Are you sure? Hey buddy, are you sure you lost your keys here?" And the guy says, "No, no, actually I lost them down at the other end of the street, but the light is better here." There's a concept that people talk about nowadays called big data, and what they're talking about is all of the information that we're generating through our interaction with and over the Internet, everything from Facebook and Twitter to music downloads, movies, streaming, all this kind of stuff, the live streaming of TED. And the folks who work with big data, for them, they talk about that their biggest problem is we have so much information, the biggest problem is, how do we organize all that information? I can tell you that working in global health, that is not our biggest problem. Because for us, even though the light is better on the Internet, the data that would help us solve the problems we're trying to solve is not actually present on the Internet. So we don't know, for example, how many people right now are being affected by disasters or by conflict situations. We don't know for really basically any of the clinics in the developing world, which ones have medicines and which ones don't. We have no idea of what the supply chain is for those clinics. We don't know -- and this is really amazing to me -- we don't know how many children were born, or how many children there are in Bolivia or Botswana or Bhutan. We don't know how many kids died last week in any of those countries. We don't know the needs of the elderly, the mentally ill. For all of these different critically important problems or critically important areas that we want to solve problems in, we basically know nothing at all. And part of the reason why we don't know anything at all is that the information technology systems that we use in global health to find the data to solve these problems is what you see here. And this is about a 5,000-year-old technology. Some of you may have used it before. It's kind of on its way out now, but we still use it for 99 percent of our stuff. This is a paper form, and what you're looking at is a paper form in the hand of a Ministry of Health nurse in Indonesia who is tramping out across the countryside in Indonesia on, I'm sure, a very hot and humid day, and she is going to be knocking on thousands of doors over a period of weeks or months, knocking on the doors and saying, "Excuse me, we'd like to ask you some questions. Do you have any children? Were your children vaccinated?" Because the only way we can actually find out how many children were vaccinated in the country of Indonesia, what percentage were vaccinated, is actually not on the Internet but by going out and knocking on doors, sometimes tens of thousands of doors. Sometimes it takes months to even years to do something like this. You know, a census of Indonesia would probably take two years to accomplish. And the problem, of course, with all of this is that with all those paper forms — and I'm telling you we have paper forms for every possible thing. We have paper forms for vaccination surveys. We have paper forms to track people who come into clinics. We have paper forms to track drug supplies, blood supplies, all these different paper forms for many different topics, they all have a single common endpoint, and the common endpoint looks something like this. And what we're looking at here is a truckful o' data. This is the data from a single vaccination coverage survey in a single district in the country of Zambia from a few years ago that I participated in. The only thing anyone was trying to find out is what percentage of Zambian children are vaccinated, and this is the data, collected on paper over weeks from a single district, which is something like a county in the United States. You can imagine that, for the entire country of Zambia, answering just that single question looks something like this. Truck after truck after truck filled with stack after stack after stack of data. And what makes it even worse is that that's just the beginning, because once you've collected all that data, of course someone's going to have to -- some unfortunate person is going to have to type that into a computer. When I was a graduate student, I actually was that unfortunate person sometimes. I can tell you, I often wasn't really paying attention. I probably made a lot of mistakes when I did it that no one ever discovered, so data quality goes down. But eventually that data hopefully gets typed into a computer, and someone can begin to analyze it, and once they have an analysis and a report, hopefully then you can take the results of that data collection and use it to vaccinate children better. Because if there's anything worse in the field of global public health, I don't know what's worse than allowing children on this planet to die of vaccine-preventable diseases, diseases for which the vaccine costs a dollar. And millions of children die of these diseases every year. And the fact is, millions is a gross estimate because we don't really know how many kids die each year of this. What makes it even more frustrating is that the data entry part, the part that I used to do as a grad student, can take sometimes six months. Sometimes it can take two years to type that information into a computer, and sometimes, actually not infrequently, it actually never happens. Now try and wrap your head around that for a second. You just had teams of hundreds of people. They went out into the field to answer a particular question. You probably spent hundreds of thousands of dollars on fuel and photocopying and per diem, and then for some reason, momentum is lost or there's no money left, and all of that comes to nothing because no one actually types it into the computer at all. The process just stops. Happens all the time. This is what we base our decisions on in global health: little data, old data, no data. So back in 1995, I began to think about ways in which we could improve this process. Now 1995, obviously that was quite a long time ago. It kind of frightens me to think of how long ago that was. The top movie of the year was "Die Hard with a Vengeance." As you can see, Bruce Willis had a lot more hair back then. I was working in the Centers for Disease Control, and I had a lot more hair back then as well. But to me, the most significant thing that I saw in 1995 was this. Hard for us to imagine, but in 1995, this was the ultimate elite mobile device. Right? It wasn't an iPhone. It wasn't a Galaxy phone. It was a Palm Pilot. And when I saw the Palm Pilot for the first time, I thought, why can't we put the forms on these Palm Pilots and go out into the field just carrying one Palm Pilot, which can hold the capacity of tens of thousands of paper forms? Why don't we try to do that? Because if we can do that, if we can actually just collect the data electronically, digitally, from the very beginning, we can just put a shortcut right through that whole process of typing, of having somebody type that stuff into the computer. We can skip straight to the analysis and then straight to the use of the data to actually save lives. So that's actually what I began to do. Working at CDC, I began to travel to different programs around the world and to train them in using Palm Pilots to do data collection instead of using paper. And it actually worked great. It worked exactly as well as anybody would have predicted.