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← 90 seconds to change the world | Alan Greene | TEDxBrussels

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Showing Revision 25 created 09/08/2020 by Krystian Aparta.

  1. Today we're going to talk about
    a very powerful idea
  2. that can transform the lives of children
    around the world.
  3. It's an idea that's simple,
    that's easy to implement
  4. and that costs little or nothing.
  5. But it does require
    that we join together to accomplish it.
  6. But even that's good news,
  7. because we're living
    in a participation age.
  8. We are not just consuming culture,
    we're creating it together.
  9. When it comes to medicine,
    participatory medicine,
  10. taking charge of our own health
  11. is fundamental
    to transforming health care.
  12. And participatory public health
  13. enables us to tackle
  14. the world's biggest
    health problems together.
  15. We can't just rely on public institutions
    to get the job done,
  16. as important as they are,
  17. if we want to change huge things fast.
  18. So today we're going to talk about
    a global, historic campaign
  19. called TICC TOCC.
  20. It's a participatory campaign.
  21. But first, we have to set the stage.
  22. There are a few things you need to know.
  23. There are two atoms
    that are very common, very plentiful,
  24. but they all too often do not end up
  25. in the right place at the right time.
  26. And the consequences
    for children's health,
  27. for their developing brains,
    for the neurons in their developing brains
  28. are immense.
  29. The first of these is oxygen.
  30. I can remember, when each
    of my own children were born,
  31. this sense of joy and relief
    when I heard their first cry.
  32. Their lungs were filled with air.
  33. It's an instinctive thing in us parents
    to feel great when they cry
  34. and not good when we don't hear anything.
  35. The first minute of life
    is often called the golden minute,
  36. because it's so important.
  37. And the reason that it's called
    the golden minute,
  38. is that there is a huge difference
    between babies who get enough oxygen
  39. in that first minute after being born
  40. and those who don't get enough.
  41. In fact, the World Health
    Organization has estimated
  42. that 29% of all newborn deaths
    around the planet
  43. come from not getting
    enough oxygen at birth.
  44. We call it birth asphyxia.
  45. And that's just part of the problem.
  46. There is a million kids who die every year
    from not getting enough oxygen.
  47. There's another million or even more
    who get enough oxygen to survive,
  48. but not enough to thrive,
  49. and they're left
    with lifelong consequences
  50. like cerebral palsy
    or epilepsy or learning disabilities
  51. or a developmental delay.
  52. And even that's not the whole story.
  53. One in 10 newborns around the world -
  54. in some places one in seven -
  55. get suboptimal amounts of oxygen at birth.
  56. In public health, there is this concept
    that's really useful,
  57. called disability-adjusted life-years,
    or a related concept,
  58. quality-adjusted life-years,
  59. and very simply, it's a measure of health.
  60. It's the number of years
    of health that are lost
  61. because of disability or disease or death.
  62. And when you look around the planet
    at loss of health in childhood,
  63. far and away the number one cause
    of kids losing health
  64. is not getting enough oxygen
    in the first minutes of life.
  65. The stakes couldn't get any higher
    than this, for children's health.
  66. So how do we solve it?
  67. Well, one solution of course, would be
  68. we could just get
    an oxygen canister in every village
  69. and every room where a baby is born.
  70. We could solve it, it's simple,
  71. but not easy to implement
    and not inexpensive.
  72. Especially when you talk about refilling
    the oxygen canisters,
  73. this would get really tough.
  74. Another solution would be
    just to get a simple bag and mask
  75. into the rooms where babies are born.
  76. It's a lot cheaper
    than an oxygen canister.
  77. Just pushing room air
    into the baby's lungs
  78. has enough oxygen to make a difference.
  79. But again, it's not easy to implement.
  80. Another solution would be to train
    childbirth attendants.
  81. There's a really cool coalition called
    Helping Babies Breathe,
  82. and they're dedicated to making
    the golden minute successful for babies.
  83. And their goal is to have a trained,
    certified birth attendant
  84. at every delivery in the world by 2015.
  85. It's a great goal, an ambitious goal.
  86. Support them.
  87. But the idea we're talking about today
  88. is simpler, easier to implement, cheaper,
    can make change faster
  89. and makes all the other interventions
    more effective.
  90. Now, the other atom
    that we need to consider today
  91. represents a problem
    that's even more widespread
  92. than not getting enough oxygen,
  93. and that's not getting enough iron.
  94. Iron is central to our lifeblood.
  95. It's what allows our blood to carry
    oxygen to our brains and the other organs.
  96. And when we don't have enough iron,
    we don't make enough red cells.
  97. It's called iron deficiency anemia
  98. and it's one of the world's
    biggest public health problems.
  99. Iron deficiency anemia can cause
    poor gross motor development,
  100. it can cause poor memory,
    it can cause fatigue,
  101. it can cause you to get sick more often
    and have a harder time getting better.
  102. But when it comes to iron deficiency,
  103. iron deficiency anemia
    is just the tip of the iceberg.
  104. Because a lot of people
    have normal red blood cells
  105. but are still iron deficient enough
    to affect their intelligence,
  106. perhaps forever.
  107. Somewhere around two billion
    people on our planet
  108. have lost intelligence
    because of iron deficiency.
  109. It's a huge problem!
  110. The World Health Organization estimates
  111. that if we could just fix that one problem
    in a developing nation,
  112. just fix iron deficiency,
  113. we would increase their productivity
    about 20%, their GNP by 20%.
  114. Huge health and economic benefit.
  115. And it's not just developing nations.
  116. In the developed world,
    in the United States where I come from,
  117. iron deficiency is still common.
  118. The latest estimate
    in the United States is that kids today,
  119. who are 0-5 years old, in the US,
  120. together have lost 9 million IQ points
    from not getting enough iron.
  121. That's in the US!
  122. At a staggering price tag
  123. of about a 100 billion dollars
    for those kids
  124. in lifetime lost earnings
  125. because of their decreased intelligence.
  126. So if we were to spend billions of dollars
  127. to fix iron deficiency,
  128. it'd be a good investment.
  129. And one way to deal with the problem
    would be to manufacture
  130. and package and distribute
    iron supplements all over the world.
  131. And there's people doing that,
    it's a great idea.
  132. Tens of millions of kids have been helped,
    but it hasn't solved the problem.
  133. Another idea would be
    to distribute iron supplements
  134. to pregnant women around the world:
  135. there are fewer of them, it would help
    the moms, the babies, great idea.
  136. I support a group called
    Vitamin Angels that's doing that.
  137. I've traveled with them to villages
    that had never seen a doctor before
  138. and seen the impact of getting iron
    and other micronutrients to them.
  139. It's very cost-effective, it's very cool.
  140. Another way of solving the iron problem
  141. would be to fortify
    all of our infant formula
  142. and all of our infant cereals with iron.
  143. And that's the leading
    solution in the West.
  144. But there's something kind of off kilter
    about that solution.
  145. And here is the clue.
  146. Among the highest-risk kids in the world,
    for iron deficiency,
  147. are the babies
    who are exclusively breastfed
  148. for longer than 6 months.
  149. And to me, I found that really
    counterintuitive,
  150. because breast milk, human milk
    is the perfect food for human babies.
  151. Why would those be the ones at risk?
  152. I mean, it's what's got
    the right nutrients.
  153. Here it is:
  154. breast milk is "low" in vitamin D.
  155. Because presumably, historically,
    babies got vitamin D from the sun.
  156. Today, they spend
    most of their lives indoors.
  157. And breast milk is "low" in iron
  158. presumably because historically,
    they got it a different way.
  159. And not from boxed cereal
    and infant formula.
  160. So I want to tell you an idea now
  161. that I want you to remember
    for the rest of your lives.
  162. It's time to get to the solution here.
  163. I want to ring a bell
    that can't be unrung,
  164. to change your perception.
  165. And here is the idea:
  166. at the moment a baby is born,
  167. anywhere on the planet,
  168. a third of their blood
    is outside their body.
  169. The circulation that's been nourishing
    them through all of development,
  170. a third of it is still outside their body
    at the moment of birth.
  171. And for all of human history,
    for as long as we have been humans,
  172. until very recently,
  173. what happened was this beautiful thing:
  174. the baby would emerge,
  175. and then you would see the umbilical cord
    would start pulsing, pumping,
  176. pushing blood into the baby.
  177. And the baby would get
    about 30% more blood
  178. during the 90 seconds or so longer
    than we currently allow the blood to flow.
  179. What does this 30% extra blood do?
  180. Well, first of all, they're basically
    getting iron supplements,
  181. without the packaging,
    without the manufacture,
  182. without distribution.
  183. They're getting iron-rich blood,
    enough iron to last them for months,
  184. and largely eliminate iron deficiency
    anemia in kids without cost.
  185. They're not just getting iron though,
    they also getting oxygen!
  186. Before a baby is born,
  187. they get all of their oxygen
    through the umbilical cord.
  188. And in that golden minute
    after they're born,
  189. all the circulation is changing around
    and the lungs are starting to open up,
  190. they're still getting oxygen
    through the cord.
  191. During that golden minute
    while the lungs are getting set up,
  192. oxygen is coming through.
  193. And it's not just oxygen.
  194. They get red blood cells,
  195. the only cells in the body
    that can carry oxygen.
  196. They get 30% more blood volume,
  197. 60% more red blood cells,
  198. in that extra 90 seconds.
  199. It's red cell rich blood.
  200. It's a packed red blood cell transfusion.
  201. You know, recently,
    Lance Armstrong has made the news,
  202. even though he never tested positive
    for drugs in his blood.
  203. But allegedly, his wins
    in the Tour de France came in part
  204. because he was infusing himself
    with his own red blood cells.
  205. And that's a technique we know works.
  206. When you get extra red blood cells,
    you got extra strength, extra endurance
  207. and it's been the state
    of nature for newborns
  208. since the beginning of human history,
  209. to get this pack of red blood cells.
  210. And it's not just red blood cells.
  211. It's even richer in white
    blood cells, comparatively.
  212. You know, I said that lack of oxygen
    is the biggest cause of loss of health.
  213. But the most immediate cause
    of newborn death is infections.
  214. 32% of all newborn deaths
    is from infections.
  215. The umbilical cord blood is rich
    in white blood cells to fight infections
  216. and antibodies that mom has created.
  217. Perhaps the most important thing
  218. is that that umbilical cord blood
    is packed with stem cells,
  219. these cells with genetic potential
    to prevent and repair
  220. damage throughout the body.
  221. You'll be learning more
    about stem cells later today,
  222. but just one example.
  223. We've learned just in recent years
    that muscular dystrophy,
  224. that we used to think was primarily
    damage to the muscles, isn't.
  225. It is primarily damage to the stem cells
    that repair muscle damage.
  226. Babies, throughout most of history,
    had gotten cutting-edge medical treatment,
  227. an autologous stem-cell transplant
    at birth, as a course of nature.
  228. But, in 1913 an idea took hold in the West
  229. and spread around the globe.
  230. And idea was this:
  231. as soon as baby emerges,
    to clamp the cord,
  232. to surgically clamp it.
  233. To cut off, to choke off
    the supply of oxygen,
  234. to cut off the flow of blood,
  235. to lock out the white blood cells,
  236. to lock out the antibodies
  237. and to take that umbilical cord,
    stem cell treasure
  238. and throw it in the trash.
  239. Which, I think, is one of leading reasons
    that we have chronic illnesses
  240. rising in kids today.
  241. Thankfully, many kids have
    sufficient reserves
  242. to be able to handle that loss.
  243. But many don't.
  244. That leads us to the TICC TOCC campaign.
  245. Very simple idea:
    Transitioning Immediate Cord Clamping
  246. To Optimal Cord Clamping.
  247. It's not a business,
    it's not even a non-profit,
  248. it's a shared idea.
  249. Waiting an extra 90 seconds or so,
    till the cord stops pulsing,
  250. the way we have throughout
    almost all of human history.
  251. This is a powerful participatory idea,
  252. and one that's really easy to spread.
  253. Far easier to spread than it is
    to spread supplements,
  254. or equipment, or antibiotics,
  255. and certainly than stem cell transplants.
  256. It's something that I'm convinced
    that we can do.
  257. And why am I convinced we can do it?
  258. Because we've done it before.
  259. Back in 1913, when the idea
    of clamping quickly spread,
  260. that was foreign,
  261. but it spread across the globe,
  262. even in the places no physician
    had ever been,
  263. because the 20th century saw
    what had been unprecedented advances
  264. in travel and in communications.
  265. It was airplanes and telephones
    that let it spread.
  266. But today?
  267. Today, we have the internet.
  268. Today, we have mobile technology.
  269. Today, we have YouTube.
  270. Today things can spread
    Gangnam Style around the globe
  271. faster than you can imagine.
  272. On Facebook, there are a billion people
  273. and on average, we're only
    4.74 degrees of separation,
  274. we can reach everywhere.
  275. Twitter's even closer,
    3.43 degrees of separation.
  276. And I've been in the most remote villages.
  277. They have no electricity, no toilets,
    but people have cell phones.
  278. This is something we can do.
  279. Bang!
  280. We can take networked bits
    and get the atoms we need
  281. to the developing neurons
    and they'll unleash genetic potential.
  282. The TICC TOCC movement has a motto.
  283. It's a common phrase: "first do no harm."
  284. I hope you'll never hear it
    the same way again.
  285. Because the first intervention
    of the 21st century medicine,
  286. the first thing that we do for a baby,
  287. is surgical clamps and severing
    that has no evidence base.
  288. There is no credible evidence of benefit.
  289. There is solid evidence, though,
  290. that it depletes iron stores,
  291. that it decreases oxygen,
  292. that it diminishes
    oxygen-carrying capacity,
  293. that it deters our abilities
    to fight infections
  294. and that it deprives babies
  295. of some of the most unique
    and important cells in their body.
  296. If you look up, there is big scientific
    evidence showing the safety and benefit
  297. of doing it the way
    nature has always done it.
  298. It's often called delayed
    cord clamping in the literature.
  299. I object to the term -
  300. it's not late, it's optimal cord clamping.
  301. It's on time.
  302. So how do we participate in this together?
  303. How does a TICC TOCC campaign work?
  304. And it couldn't be easier.
  305. To participate, it's only two things.
  306. First, request optimal cord clamping
    for your loved ones.
  307. And second, share this simple idea
    with your networks.
  308. Your social networks, online and off.
  309. Preferably as loud and as far as you can.
  310. But just request it and share it.
  311. And that's it!
  312. We can change the world.
  313. It's not just humans who have done this
    through all of human history, by the way.
  314. Primates too have umbilical cords,
    and they instinctively wait.
  315. None of them will sever the cord
    before it stops pulsing.
  316. And it's not just primates.
  317. Mammals, throughout the world,
    have umbilical cords.
  318. And they instinctively wait.
  319. None of them will actively sever the cord,
  320. they'll wait.
  321. Today,
  322. TICC TOCC,
  323. more than a quarter
    of a million babies will be born.
  324. For most of them,
  325. it'll be clamped immediately
    and thrown in the trash.
  326. This intervention works
    for kids born by C-section,
  327. or vaginally, born on time or early,
  328. whether you want to bank
    the cord blood stem cells or not.
  329. We can change it.
  330. Let's do it.
  331. Thanks very much!
  332. (Applause)