演講MP3+雙語(yǔ)文稿:為什么做出健康的決定如此困難

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【演講人及介紹】【David Asch】

行為經(jīng)濟(jì)學(xué)家、衛(wèi)生政策專(zhuān)家David Asch通過(guò)改善醫(yī)生和患者在衛(wèi)生保健和日常生活中做出決定的方式來(lái)促進(jìn)個(gè)人和人群的健康。David Asch通過(guò)改善醫(yī)生和患者在醫(yī)療保健和日常生活中做出決定的方式，促進(jìn)了個(gè)人和人群的健康

【演講主題】為什么做出健康的決定如此困難

【演講文稿-中英文】

翻譯 Jessie Zhang 校對(duì) Jiasi Hao

It's April of 2007, and Jon Corzine, theGovernor of New Jersey, is in this horrific car accident. He's in the rightfront passenger seat of this SUV when it crashes on the Garden State Parkway.He's transported to a New Jersey trauma center with multiple broken bones andmultiple lacerations. He needs immediate surgery, seven units of blood, amechanical ventilator to help him breathe and several more operations along theway. It's amazing he survived. But perhaps even more amazing, he was notwearing a seat belt. And, in fact, he never wore a seat belt, and the NewJersey state troopers who used to drive Governor Corzine around used to beg himto wear a seat belt, but he didn't do it.

那是 2007 年的 4 月，新澤西州的州長(zhǎng)，榮·科贊（Jon Corzine），陷入了一場(chǎng)可怕的車(chē)禍。當(dāng)他乘坐的那輛 SUV 在花園州高速公路撞毀的時(shí)候，他正坐在副駕駛的座位上。他被轉(zhuǎn)移到一家新澤西的創(chuàng)傷治療中心，身上伴有多處骨折和撕裂。他需要立即接受手術(shù)、7 品脫的輸血、一個(gè)幫助他呼吸的呼吸機(jī)，以及即將面臨的又幾場(chǎng)手術(shù)。他能活下來(lái)真的令人震驚。但可能更令人震驚的是，他當(dāng)時(shí)在車(chē)?yán)锔緵](méi)系安全帶。事實(shí)上，他之前從來(lái)不系安全帶，曾經(jīng)開(kāi)車(chē)載過(guò)科贊州長(zhǎng)的新澤西州巡邏隊(duì)員曾求著他系上安全帶，但是他從來(lái)沒(méi)系過(guò)。

00:55

Now, before Corzine was Governor of NewJersey, he was the US Senator from New Jersey, and before that, he was the CEOof Goldman Sachs, responsible for taking Goldman Sachs public, making hundredsof millions of dollars. Now, no matter what you think of Jon Corzinepolitically or how he made his money, nobody would say that he was stupid. Butthere he was, an unrestrained passenger in a car accident, at a time when everyAmerican knows that seat belts save lives.

其實(shí)，在科贊當(dāng)上新澤西州州長(zhǎng)之前，曾是新澤西州的聯(lián)邦參議員，再之前，是高盛投資公司的 CEO ，負(fù)責(zé)高盛的上市，并為其賺取了上億美元。不論你從政治上還是掙錢(qián)方式上是如何看待榮·科贊這個(gè)人的，沒(méi)人會(huì)說(shuō)他是個(gè)蠢人。但是你瞧他，在每一個(gè)美國(guó)人都知道安全帶能救命的時(shí)候，他就是那個(gè)車(chē)禍現(xiàn)場(chǎng)中不系安全帶的人。

01:23

This single story reflects a fundamentalweakness in our approach to improving health behavior. Nearly everything wetell doctors and everything we tell patients is based on the idea that webehave rationally. If you give me information, I will process that informationin my head, and my behavior will change as a result. Do you think Jon Corzinedidn't know that seat belts save lives? Do you think he, like, just didn't get thememo?

這個(gè)簡(jiǎn)單的故事反映出我們?cè)诟纳平】敌袨榈姆椒ㄖ械囊粋€(gè)基本的弱點(diǎn)。我們告訴醫(yī)生和病人的一切東西幾乎都是基于“人類(lèi)行為是理性的”觀點(diǎn)。如果你給我信息，我會(huì)在腦袋里分析那個(gè)信息，然后我的行為會(huì)隨之改變。你覺(jué)得榮·科贊不知道安全帶能救命嗎？你覺(jué)得他只是沒(méi)收到提示便箋嗎？

01:49

(Laughter)

（笑聲）

01:50

Jon Corzine did not have a knowledgedeficit, he had a behavior deficit. It's not that he didn't know better. Heknew better. It's that he didn't do better.

榮·科贊沒(méi)有知識(shí)缺失，他有的是行為上的缺失。他不是知道的少，他知道的并不少。而他，沒(méi)能做好。

02:02

Instead, I think the mind is ahigh-resistance pathway. Changing someone's mind with information is hardenough. Changing their behavior with information is harder still. The only waywe're going to make substantial improvements in health and health care is tomake substantial improvements in the behavior of health and health care.

另外，我認(rèn)為人的思想是個(gè)抵御性很強(qiáng)的東西。用信息改變一個(gè)人的思想已經(jīng)夠難的了，用信息改變他們的行為更是難上加難。我們能在健康和醫(yī)療保健方面做出較大改善的唯一方法，就是盡可能改善人們?cè)诮】岛歪t(yī)療保健方面的行為方式。

02:26

If you hit my patellar tendon with a reflexhammer, my leg is going to jerk forward, and it's going to jerk forward a lotfaster and a lot more predictably than if I had to think about it myself. It'sa reflex. We need to look for the equivalent behavioral reflexes and hitch ourhealth care wagon to those. Turns out, though, that most conventionalapproaches to human motivation are based on the idea of education. We assumethat if people don't behave as they should, it's because they didn't know anybetter. "If only people knew that smoking was dangerous, they wouldn'tsmoke." Or, we think about economics. The assumption there is that we'reall constantly calculating the costs and benefits of every one of our actionsand optimizing that to make the perfectly right, rational decision. If thatwere true, then all we need to do is to find the perfect payment system fordoctors or the perfect co-payments and deductibles for patients, and everythingwould work out.

如果你用一個(gè)反射錘敲擊我的臏腱，我的腿會(huì)向前彈起，而且會(huì)比我自己想著讓它彈起的時(shí)候彈得更快，更具可預(yù)測(cè)性。這是一種反射行為。我們得找到相似的反射行為，并把我們的醫(yī)療保健都靠到這些反射行為上來(lái)。但實(shí)際上，最常規(guī)的激勵(lì)人們的舉措?yún)s是建立在“教育”這一理念上的。我們假定如果人們沒(méi)有做出他們應(yīng)有的行為是因?yàn)樗麄內(nèi)狈χR(shí)?！叭绻藗冎莱闊熀芪ｋU(xiǎn)，他們就不會(huì)抽煙了?！被蛘?，我們會(huì)從經(jīng)濟(jì)的角度思考。我們假定自己會(huì)不斷地計(jì)算我們每一個(gè)行為蘊(yùn)含的成本和收益，以及為了收益最大化，我們會(huì)做出完全正確且理性的決定。如果這是真的，所有我們需要的僅僅是給醫(yī)生找到一個(gè)完美的付費(fèi)系統(tǒng)，或是能給患者完美計(jì)算出部分承擔(dān)費(fèi)用和免賠額，然后一切就自然解決了。

03:22

A better approach lies in behavioraleconomics. Behavioral economists recognize that we are irrational. Ourdecisions are based on emotion, or they're sensitive to framing or to socialcontext. We don't always do what's in our own long-term best interests. But thekey contribution to behavioral economics is not in recognizing that we areirrational; it's recognizing that we are irrational in highly predictable ways.In fact, it's the predictability of our psychological foibles that allows us todesign strategies to overcome them. Forewarned is forearmed. In fact,behavioral economists often use precisely the same behavioral reflexes that getus into trouble and turn them around to help us, rather than to hurt us.

行為經(jīng)濟(jì)學(xué)中有一個(gè)更好的方法。行為經(jīng)濟(jì)學(xué)家意識(shí)到我們其實(shí)是非理性的。我們的決定是建立在情緒上的，或是被社會(huì)環(huán)境或規(guī)則框架所影響的。我們不總是會(huì)做出有利于我們長(zhǎng)遠(yuǎn)利益的行為。但是，對(duì)行為經(jīng)濟(jì)學(xué)最主要的貢獻(xiàn)不是對(duì)“人類(lèi)是非理性的”認(rèn)識(shí)，而是意識(shí)到“人類(lèi)的非理性行為是高度可預(yù)測(cè)的”。事實(shí)上，正是我們心理上那些小缺陷的可預(yù)測(cè)性使我們能設(shè)計(jì)出策略來(lái)攻克它們。預(yù)先警告就宛如事先武裝。事實(shí)上，行為經(jīng)濟(jì)學(xué)家經(jīng)常精準(zhǔn)利用 那些讓我們陷入麻煩的 行為反射，轉(zhuǎn)而讓它們來(lái)幫助我們，而不是傷害我們。

04:08

We see irrationality play out in somethingcalled "present bias," where the outcomes in front of us are muchmore motivating than even more important outcomes far in the future. If I'm ona diet -- and I'm always on a diet --

我們可以在一種叫做“即時(shí)偏誤”的現(xiàn)象中看見(jiàn)非理性的作用，這種現(xiàn)象，是我們正在面對(duì)的結(jié)果比將來(lái)會(huì)出現(xiàn)的更重要的結(jié)果更能調(diào)動(dòng)我們的積極性。如果我在節(jié)食——其實(shí)我一直在節(jié)食——

04:24

(Laughter)

（笑聲）

04:26

and someone offers me a luscious-lookingpiece of chocolate cake, I know I should not eat that chocolate cake. Thatchocolate cake will land on that part of my body -- permanently -- where thatkind of food naturally settles. But the chocolate cake looks so good anddelicious, and it's right in front of me, and the diet can wait 'til tomorrow.

這時(shí)有人給了我一個(gè)看上去很美味的巧克力蛋糕，我知道我不應(yīng)該吃那個(gè)蛋糕。那塊巧克力蛋糕會(huì)沉積在我身體中——永遠(yuǎn)——就在這類(lèi)食物會(huì)自然沉積的身體部位上。但是那塊巧克力蛋糕看起來(lái)如此美味，而且它就在我的眼前，那節(jié)食可以明天再說(shuō)了。

04:47

I used to love the comedian Steven Wright.He would have these Zen-like quips. My favorite one was this: "Hard workpays off in the future, but laziness pays off right now."

我曾經(jīng)很喜歡一個(gè)喜劇演員，史蒂文·賴(lài)特。他經(jīng)常說(shuō)些很有禪意的玩笑話。我最喜歡的是這個(gè)：“努力了將來(lái)會(huì)有回報(bào)，但是懶惰了現(xiàn)在就會(huì)有回報(bào)。”

04:58

(Laughter)

（笑聲）

05:00

And patients also have present bias. If youhave high blood pressure, even if you would desperately like to avoid a stroke,and you know that taking your antihypertensive medications is one of the bestways to reduce that risk, the stroke you avoid is far in the future and takingmedications is right now. Almost half of the patients who are prescribed highblood pressure pills stop taking them within a year. Think of how many lives wecould save if we could solve just that one problem.

患者也有即時(shí)偏誤。如果你有高血壓，即使你極度想避免中風(fēng)，而且你知道吃降血壓藥是降低這種風(fēng)險(xiǎn)最有效的方式之一，然而，中風(fēng)是很久以后可能發(fā)生的事，而吃藥則是現(xiàn)在要做的。幾乎有一半開(kāi)了降血壓藥的患者在一年內(nèi)就停止了服藥。想想如果我們單單解決這一個(gè)問(wèn)題就能拯救多少生命。

05:31

We also tend to overestimate the value ofsmall probabilities. This actually explains why state lotteries are so popular,even though they return pennies on the dollar. Now, some of you may buy lotterytickets -- it's fun, there's the chance you might strike it rich ... But let'sface it: this would be a horrible way to invest your retirement savings. I oncesaw a bumper sticker -- I am not making this up -- that said, "Statelotteries are a special tax on people who can't do math."

我們也容易高估小概率事件的價(jià)值。這也許能解釋為什么國(guó)營(yíng)彩票即使回報(bào)極小，卻依舊這么受歡迎。在座的一些人可能會(huì)買(mǎi)彩票——買(mǎi)彩票挺有意思的，你有可能中大獎(jiǎng)、變富有——但是咱們清醒一點(diǎn)吧：這可能是個(gè)花掉你養(yǎng)老金的很糟糕的方式。我曾經(jīng)看到過(guò)一張車(chē)尾貼——這不是我編的——寫(xiě)著，“國(guó)營(yíng)彩票是向不會(huì)數(shù)學(xué)計(jì)算的人征收的智商稅”。

06:00

(Laughter)

（笑聲）

06:01

It's not that we can't do the math, it'sthat we can't feel the math.

我們并不是不會(huì)做數(shù)學(xué)計(jì)算，我們是感受不到這種計(jì)算。

06:06

And we also pay much too much attention toregret. We all hate the feeling of missing out.

而且我們花太多精力在后悔上。我們都痛恨錯(cuò)過(guò)機(jī)會(huì)的感覺(jué)。

06:12

So, actually, there was this recentlottery, a mega-jackpot lottery, that had a huge payoff, something like over abillion dollars. And everyone in my office is pooling money to buy lotterytickets, and I'm not having any of this. There I am, like, swaggering aroundthe office, "Lotteries are a special tax on people who can't domath."

所以，事實(shí)上，最近有個(gè)彩票，大樂(lè)透彩票，回報(bào)超高，大概超過(guò) 10 億美元。我辦公室里的每個(gè)人都在掏錢(qián)集資買(mǎi)彩票，我一點(diǎn)都不理解。我在辦公室里轉(zhuǎn)悠，嚷嚷著：“彩票是向不會(huì)數(shù)學(xué)計(jì)算的人征收的智商稅?！?/p>

06:29

（笑聲）

06:30

And then it hits me: uh oh. What if theywin?

然后一個(gè)想法擊中了我：啊呀，萬(wàn)一他們中獎(jiǎng)了呢？

06:34

(Laughter)

（笑聲）

06:36

I'm the only one who shows up at work thenext day.

我就成了第二天唯一來(lái)上班的人了。

06:39

(Laughter)

（笑聲）

06:40

Now, it's not that I didn't want mycolleagues to win. I just didn't want them to win without me. Now, it wouldhave been easier if I had just taken my 20-dollar bill and put it into theoffice shredder, and the results would have been the same. Even though I knew Ishouldn't participate, I handed over my $20 bill, and I never saw it again.

不是我不想讓我的同事中獎(jiǎng)。我只是不想讓他們丟下我，自己中獎(jiǎng)。如果我當(dāng)初拿出一張 20 美元鈔票直接塞進(jìn)辦公室的碎紙機(jī)里，事情本會(huì)簡(jiǎn)單很多，而且結(jié)果也會(huì)是一樣的。即使我知道我不應(yīng)該參與，我還是遞出了 20 美元鈔票，之后我再也沒(méi)見(jiàn)過(guò)它。

07:00

(Laughter)

（笑聲）

07:01

We've done a bunch of experiments withpatients in which we give them these electronic pill bottles so we can tellwhether they're taking their medication or not. And we reward them with alottery. They get prizes. But they only get prizes if they had taken theirmedication the day before. If not, they get a message that says something like,"You would have won a hundred dollars, but you didn't take your medicineyesterday, so you don't get it."

我們和患者做過(guò)一些實(shí)驗(yàn)。我們給患者們電子藥瓶，以便于知道他們是否在吃藥。我們用彩票獎(jiǎng)勵(lì)他們。他們能得到獎(jiǎng)品。但他們只有在前一天吃藥的情況下才能得到獎(jiǎng)品。如果沒(méi)吃，他們會(huì)收到一條諸如此類(lèi)的信息：“你本來(lái)能贏 100 美金，但是你昨天沒(méi)吃藥，所以你沒(méi)法得到這筆錢(qián)?！?/p>

07:28

Well, it turns out, patients hate that.They hate the sense of missing out, and because they can anticipate thatfeeling of regret and they'd like to avoid it, they're much more likely to taketheir medications. Harnessing that sense of hating regret works. And it leadsto the more general point, which is: once you recognize how people areirrational, you're in a much better position to help them.

事實(shí)證明，患者們痛恨那種感覺(jué)。他們痛恨錯(cuò)過(guò)的感覺(jué)，而且因?yàn)樗麄兡茴A(yù)判到那種悔恨的感覺(jué)，于是想要盡量避開(kāi)它，所以他們更有可能會(huì)吃藥了。掌控那種痛恨后悔的感覺(jué)是有用的。它引出了更一般化的觀點(diǎn)，即：一旦你認(rèn)識(shí)到人是非理性的，你就會(huì)處于一個(gè)能夠更好地幫助他們的位置。

07:54

Now, this kind of irrationality works outeven in men's restrooms. So, for those of you who don't frequent urinals, letme break this down for you.

這種非理性甚至在男廁所也能用得上。在座的不常光顧小便池的人，讓我給你們解析一下。

08:05

(Laughter)

（笑聲）

08:06

There is pee all over the floor.

地板上全是尿。

08:08

(Laughter)

（笑聲）

08:11

And it turns out that you can solve thisproblem by etching the image of a fly in the back of the urinal.

事實(shí)證明，你只要在小便池上蝕刻一個(gè)蒼蠅的形象，就能解決這個(gè)問(wèn)題。

08:17

(Laughter) (Applause)

（笑聲）（掌聲）

08:21

And it makes perfect sense.

這完全說(shuō)得通。

08:22

(Laughter)

（笑聲）

08:24

If I see a fly, I'm gonna get that fly.

如果我看見(jiàn)一只蒼蠅，我一定要射中那只蒼蠅

08:27

(Laughter)

（笑聲）

08:31

That fly is going down.

那只蒼蠅會(huì)被沖入下水道。

08:33

(Laughter)

（笑聲）

08:34

Now, this naturally begs the question thatif men can aim, why were they peeing on the floor in the first place? In fact,if they were going to pee on the floor, why pee in front of the urinal? Youcould pee anywhere.

這自然地引出了一個(gè)問(wèn)題：如果男人們上廁所時(shí)能瞄準(zhǔn)，他們一開(kāi)始為什么要尿到地上？實(shí)際上，如果他們本來(lái)就打算尿到地上，又為什么要跑到小便池前面去尿？你可以在任何地方尿。

08:45

(Laughter)

（笑聲）

08:46

And the same thing works in health care. Wehad a problem in our hospital in which the physicians were prescribingbrand-name drugs when a generic drug was available. Each one of the lines onthis graph represents a different drug. And they're listed according to howoften they're prescribed as generic medications. Those are the top areprescribed as generics 100 percent of the time. Those down at the bottom areprescribed as generics less than 20 percent of the time. And we'd have meetingswith clinicians and all sorts of education sessions, and nothing worked -- allthe lines are pretty much horizontal. Until, someone installed a little pieceof software in the electronic health record that defaulted the prescriptions togeneric medications instead of the brand-name drugs. Now, it doesn't take astatistician to see that this problem was solved overnight, and it has stayedsolved ever since. In fact, in the two and a half years since this programstarted, our hospital has saved 32 million dollars. Let me say that again: 32million dollars. And all we did was make it easier for the doctors to do whatthey fundamentally wanted to do all along.

同樣的道理也適用于醫(yī)療保健。我們醫(yī)院當(dāng)時(shí)有個(gè)這樣的問(wèn)題：當(dāng)普通藥可供選擇的時(shí)，醫(yī)生們卻一直在開(kāi)品牌藥。這張圖上的每條線代表一種不同的藥物。這些藥根據(jù)被當(dāng)做普通藥開(kāi)的頻率被列了出來(lái)。位于頂部的，是一直都被當(dāng)做普通藥開(kāi)的。下面那些，不到 20% 的機(jī)率是被當(dāng)做普通藥開(kāi)的。我們跟臨床醫(yī)師們開(kāi)過(guò)會(huì)，也辦過(guò)各種教學(xué)會(huì)議，但是都沒(méi)用——所有的這些線，幾乎都沒(méi)變。直到，有個(gè)人在電子健康記錄表里安裝了一個(gè)小軟件，把處方設(shè)置為默認(rèn)開(kāi)普通藥，而非品牌藥?，F(xiàn)在，不用統(tǒng)計(jì)分析員也能看出來(lái)，問(wèn)題一夜之間就解決了，而且之后再?zèng)]有出現(xiàn)此類(lèi)問(wèn)題。事實(shí)上，在這個(gè)項(xiàng)目上線的兩年半內(nèi)，我們醫(yī)院已經(jīng)省下了 3200 萬(wàn)美元。讓我再說(shuō)一遍： 3200 萬(wàn)美元。我們所做的，只不過(guò)是把醫(yī)生們一直以來(lái)想做的事變得容易做了而已。

10:00

It also works to play into people's notionsof loss. We did this with a contest to help people walk more. We wantedeveryone to walk at least 7,000 steps, and we measured their step count withthe accelerometer on their cell phone. Group A, the control group, just gottold whether they had walked 7,000 steps or not. Group B got a financialincentive. We gave them $1.40 for every day they walked 7,000 steps. Group C gotthe same financial incentive, but it was framed as a loss rather than a gain:$1.40 a day is 42 dollars a month, so we gave these participants 42 dollars atthe beginning of each month in a virtual account that they could see, and wetook away $1.40 for every day they didn't walk 7,000 steps.

利用人們對(duì)損失的概念也有用。我們辦了場(chǎng)比賽來(lái)幫助人們走更多路。我們想讓每個(gè)人至少走 7 千步，我們也用他們手機(jī)上的計(jì)步器以記錄他們行走的步數(shù)。A 組，控制變量組，僅被告知他們是否走夠 7 千步。B 組，有金錢(qián)刺激。每天如果他們走了 7 千步，我們就獎(jiǎng)勵(lì)他們 1.4 美金。C組，有相同的金錢(qián)刺激，但這種刺激被包裝成損失而不是收益： 每天 1.4 美金 即 42 美金一個(gè)月，所以在每個(gè)月的頭一天 我們給這些參與者 42 美金，就放在他們能看見(jiàn)的虛擬賬戶(hù)里，然后如果他們每天沒(méi)走夠 7 千步，我們就從賬戶(hù)里取走 1.4 美金。

10:52

Now, an economist would say that those twofinancial incentives are the same. For every day you walk 7,000 steps, you're$1.40 richer. But a behavioral economist would say that they're different,because we're much more motivated to avoid a $1.40 loss than we are motivatedto achieve a $1.40 gain. And that's exactly what happened. Those in the groupthat received $1.40 for every day they walked 7,000 steps were no more likelyto meet their goal than the control group. The financial incentive didn't work.But those who had a loss-framed incentive met their goal 50 percent more of thetime. It doesn't make economic sense, but it makes psychological sense, becauselosses loom larger than gains. And now we're using loss-framed incentives tohelp patients walk more, lose weight and take their medications.

一個(gè)經(jīng)濟(jì)學(xué)家可能會(huì)說(shuō)，這兩種金錢(qián)刺激的結(jié)果是一樣的。因?yàn)槊刻炷阕邏?7 千步的話，你都能賺 1.4 美金。但是一個(gè)行為經(jīng)濟(jì)學(xué)家會(huì)說(shuō)，它們的結(jié)果是不同的，因?yàn)槲覀優(yōu)楸苊鈸p失 1.4 美金會(huì)比賺取 1.4 美金來(lái)得更有動(dòng)力。實(shí)驗(yàn)結(jié)果也確實(shí)如此。那些每天因?yàn)樽?7 千步而收到 1.4 美金的人并不比控制變量組（沒(méi)有金錢(qián)激勵(lì)）更能達(dá)到目標(biāo)。金錢(qián)刺激沒(méi)能起作用。而那些受到損失刺激的人則有 50% 更高的可能完成目標(biāo)。這在經(jīng)濟(jì)學(xué)上說(shuō)不通，但在心理學(xué)上是說(shuō)得通的，因?yàn)閾p失比收益帶來(lái)的刺激更大?，F(xiàn)在我們已經(jīng)在用這種損失刺激法去幫助患者走更多路、減肥，以及吃藥了。

11:43

Money can be a motivator. We all know that.But it's far more influential when it's paired with psychology. And money, ofcourse, has its own disadvantages. My favorite example of this involves adaycare program. The greatest sin you can commit in daycare is picking up yourkids late. No one is happy. Your kids are crying because you don't love them.

錢(qián)可以是一個(gè)激勵(lì)因素，我們都知道這一點(diǎn)。但當(dāng)它與心理學(xué)配對(duì)使用時(shí)更具有影響力。當(dāng)然，金錢(qián)有其自身缺點(diǎn)。我最喜歡的例子，說(shuō)的是一個(gè)日托項(xiàng)目。你能在日托中犯下的最大的罪孽就是接孩子接晚了。沒(méi)人開(kāi)心。你的孩子在哭，因?yàn)槟悴粣?ài)他們。

12:08

(Laughter)

（笑聲）

12:09

The teachers are unhappy because they leavework late. And you feel terribly guilty. This daycare program in Israel decidedthey wanted to stop this problem, and they did something that many daycareprograms in the US do, which is they installed a fine for late pickups. And thefine they chose was 10 shekels, which is about three bucks. And guess whathappened? Late pickups increased. And if you think about it, it makes perfectsense. What a deal! For 10 shekels --

老師不開(kāi)心，因?yàn)樗麄兿掳嗤砹?。你也覺(jué)得極其內(nèi)疚。以色列的這個(gè)日托項(xiàng)目就想解決這個(gè)問(wèn)題，而且他們做的，是許多美國(guó)日托項(xiàng)目也在做的事，就是給晚接孩子的人設(shè)置罰款。他們把罰款定為 10 謝克爾（以色列貨幣單位），大概相當(dāng)于 3 美元。猜猜然后發(fā)生了什么？晚接孩子的情況惡化了。如果你仔細(xì)想想的話，這完全說(shuō)得通。多合適的買(mǎi)賣(mài)?。?10 謝克爾——

12:39

(Laughter)

（笑聲）

12:40

you can keep my kids all night!

你就能一晚上不用接孩子！

12:42

(Laughter)

（笑聲）

12:45

They took a perfectly strong intrinsicmotivation not to be late, and they cheapened it. What's worse, when theyrealized their mistake and they took away the financial incentive, the latepickups still stayed at the high level. They had already poisoned the socialcontract.

家長(zhǎng)們卯足了內(nèi)在動(dòng)機(jī)，準(zhǔn)時(shí)接孩子，結(jié)果日托機(jī)構(gòu)把這個(gè)動(dòng)機(jī)因素變得廉價(jià)了。更糟的是，當(dāng)日托機(jī)構(gòu)意識(shí)到自己的錯(cuò)誤，把遲到罰款的規(guī)則撤回時(shí)，晚接孩子的情況絲毫沒(méi)有改觀。他們已經(jīng)毒害了社會(huì)契約。

13:02

Health care is full of strong intrinsicmotivations. We have doctors and patients who already want to do the rightthing. Financial incentives can help, but we shouldn't expect money in healthcare to do all of the heavy lifting. Instead, perhaps the most powerfulinfluencers of health behavior are our social interactions. Social engagementworks in health care, and it works in two directions.

醫(yī)療保健充滿(mǎn)了強(qiáng)大的內(nèi)在動(dòng)機(jī)。醫(yī)生和患者本身就想做正確的事。金錢(qián)刺激也有正面作用。但是我們不能盼著金錢(qián)能在醫(yī)療保健中承擔(dān)全部的重任。相反，對(duì)健康行為最有效的影響因素可能是我們的社會(huì)互動(dòng)。社會(huì)參與在醫(yī)療保健中是起作用的，主要體現(xiàn)在兩個(gè)方面

13:29

First, we fundamentally care what othersthink of us. And so one of the most powerful ways to change our behavior is tomake our activities witnessable to others. We behave differently when we'rebeing observed than when we're not. I've been to some restaurants that don'thave sinks in the bathrooms. Instead, when you step out, the sink is outside inthe main part of the restaurant, where everyone can see whether you wash yourhands or not. Now, I don't know for sure, but I am convinced that handwashingis much greater in those particular settings. We are always on our bestbehavior when we're being observed.

第一，我們本能地在意別人對(duì)我們的看法。所以改變我們行為最有效的方法之一就是讓我們的行為能被別人看見(jiàn)。我們?cè)诒挥^察，和不在被觀察時(shí)候的行為表現(xiàn)是不同的。我去過(guò)幾個(gè)飯店，它們廁所里沒(méi)有水槽，但當(dāng)你走出來(lái)，水槽在外面，在飯店的主要位置，這時(shí)候所有人都能看見(jiàn)你洗沒(méi)洗手。我不是很確定，但我敢保證在那些特定環(huán)境下洗手的人變多了。我們?cè)诒挥^察的時(shí)候，總能表現(xiàn)出最好的行為。

14:04

In fact, there was this amazing study thatwas done in an intensive care unit in a Florida hospital. The handwashing rateswere very low, which is dangerous, of course, because it can spread infection.And so some researchers pasted a picture of someone's eyes over the sink. Itwasn't a real person, it was just a photograph. In fact, it wasn't even theirwhole face, it was just their eyes looking at you.

事實(shí)上，在佛羅里達(dá)一家醫(yī)院的重癥監(jiān)護(hù)室里，進(jìn)行了一項(xiàng)很棒的研究。這里的洗手率非常低，當(dāng)然，這很危險(xiǎn)，因?yàn)樵撔袨闀?huì)傳播疾病，導(dǎo)致感染。所以一些研究員在水槽上貼了一張人眼的照片。那不是一個(gè)真人，只是一張照片。實(shí)際上，那甚至都不是一整張臉，只是一雙眼睛看著你。

14:26

(Laughter)

（笑聲）

14:27

Handwashing rates more than doubled. Itseems we care so much what other people think of us that our behavior improveseven if we merely imagine that we're being observed.

洗手率翻了不止一倍。我們似乎是如此在意別人對(duì)我們的看法，以至于我們的行為會(huì)就此改進(jìn)，即使我們僅僅只是想象我們?cè)诒粍e人觀察著。

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