When you think back on 2023, how will you remember it?

当你回顾2023年时，你将如何记起？

For me, this will always be the year I became a grandparent. It will be the year I spent a lot of precious time with loved ones—whether on the pickleball court or over a rousing game of Settlers of Catan. And 2023 marked the first time I used artificial intelligence for work and other serious reasons, not just to mess around and create parody song lyrics for my friends.

对我来说，这将永远是我成为祖父的一年。这将是我与所爱的人共度宝贵时光的一年——无论是在匹克球场上，还是在激动人心的《卡坦岛》游戏中。2023年标志着我第一次将人工智能用于工作和其他正经事，而不仅仅是为了胡闹和为我的朋友创作拙劣的歌词。

This year gave us a glimpse of how AI will shape the future, and as 2023 comes to a close, I’m thinking more than ever about the world today’s young people will inherit. In last year’s letter, I wrote about how the prospect of becoming a grandparent made me reflect on the world my granddaughter will be born into. Now I’m thinking more about the world she will inherit and what it will be like decades from now, when her generation is in charge.

今年让我们看到了人工智能将如何塑造未来，随着2023年即将结束，我比以往任何时候都更多地思考当今年轻人将继承的世界。在去年的年度展望中，我写道，即将成为祖父母的展望如何让我反思孙女即将出生的世界。现在，我更多地在考虑她将继承的世界，以及几十年后，当她这一代人有话语权时，世界会是什么样子。

I can begin to picture it: the tools she will use, the ways she will stay in touch with her loved ones, the problems these innovations will help solve. We now have a better sense of what types of jobs AI will be able to do by itself and which ones it will serve as a copilot for. And it’s clearer than ever how AI can be used to improve access to education, mental health, and more. It motivates me to make sure this technology helps reduce—and doesn’t contribute to—the awful inequities we see around the world. I've always been a firm believer in the power of innovation to offer every child an equal chance to survive and thrive. AI is no exception.

我可以开始想象：她将使用的工具，她与亲人保持联系的方式，以及这些创新将帮助解决的问题。现在，我们对人工智能能够独自完成哪些工作，以及充当哪些工作的人工智能助手有了更好的认识。而且，我们比以往任何时候都更清楚地知道，如何利用人工智能来改善教育、心理健康等方面的机会。这激励我去确保这项技术有助于减少——而不是助长——我们在世界各地看到的严重的不平等现象。我一直坚信创新的力量可以为每个孩子提供平等的生存和发展机会。人工智能也不例外。

The early years of a new age are often marked by lots of changes. If you are old enough to remember, think back to the beginning of the internet. At first, you probably didn’t know many people who were using it. But it became more common over time until, one day, you realized most people had email addresses, bought things online, and used search engines to answer their questions.

一个新时代的最初几年往往以许多变化为标志。如果你年纪够大，还记得互联网诞生之初的情景。起初，你可能不知道有多少人在使用它。但随着时间的推移，它变得越来越普遍，直到有一天，你意识到大多数人都有电子邮件地址，在网上购物，并使用搜索引擎来回答他们的问题。

我很高兴今年迎来了我的小外孙女。

We are just at the beginning of this transition right now. This is an exciting and confusing time, and if you haven’t figured out how to make the best use of AI yet, you are not alone. I thought I would use AI tools for the foundation’s strategy reviews this year, which require reading hundreds of pages of briefing materials that an AI could accurately summarize for me. But old habits are hard to break, and I ended up preparing for them the same way I always do.

我们现在正处于这一转变的开端。这是一个令人兴奋和困惑的时代，如果你还没有想好如何充分利用人工智能，那你并不孤单。我本以为今年会在基金会的战略评估中使用人工智能工具，这需要阅读数百页的简报材料，而人工智能可以准确地为我总结。但旧习难改，我最终还是按照往常的方式做了准备。

Of course, AI is far from the only defining feature of 2023. My heart is broken for the continued suffering of Israelis and Palestinians, as well as for the people of Sudan. At the same time, more people are being forced to endure hardship as a result of more frequent extreme weather events caused by climate change. And families around the world continue to be hit hard by rising inflation and slow economic growth.

当然，人工智能远不是2023年的唯一定义。我为以色列人和巴勒斯坦人以及苏丹人民继续遭受的苦难感到心碎。与此同时，由于气候变化导致极端天气事件更加频繁，更多的人被迫忍受苦难。世界各地的家庭继续受到通货膨胀加剧和经济增长缓慢的沉重打击。

There’s no question these are challenging times, but I remain optimistic about the future. The speed of innovation has never been faster. We’re making big strides on tough problems—like Alzheimer’s, obesity, and sickle cell disease—that will improve the lives of millions of people. My friend the late Hans Rosling used to say that “things can be bad and getting better.” It’s a good reminder that progress is not only possible but happening every day.

毫无疑问，这是一个充满挑战的时代，但我对未来依然乐观。创新的速度前所未有。我们在阿尔茨海默病、肥胖症和镰状细胞病等棘手问题上取得了长足进步，这将改善数百万人的生活。我的朋友、已故的汉斯·罗斯林（Hans Rosling）曾经说过："事情可能会变得更糟，也可能会变得更好。这句话很好地提醒我们，进步不仅是可能的，而且每天都在发生。

左图：南非CAPRISA的研究小组正在利用数据改进对同时感染艾滋病毒和结核病的患者的治疗。

右图：一名乌干达护士在艾滋病毒疫苗临床试验期间检查参与者的检测结果。（卢克·德雷/盖蒂图片社）

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That’s why I remain dedicated to making sure that, even in the face of setbacks, the world continues to do more to help the poorest people. I do the bulk of this work through the Gates Foundation, where my colleagues remain dedicated to improving global health, education, gender equality, and more. While I could write a thousand pages about the incredible work they’re doing with our partners, this letter focuses on just a few of the most exciting breakthroughs.

这就是为什么我仍然致力于确保即使面对挫折，世界继续为帮助最贫穷的人群做出更多的努力。我的大部分工作是通过盖茨基金会完成的，我的同事们继续致力于改善全球健康、教育、性别平等等方面的工作。虽然我可以写上几千页的篇幅来介绍他们与我们的合作伙伴一起所做的令人难以置信的工作，但这封信只集中介绍其中几项最令人兴奋的突破。

I also write about why I’m optimistic about the world’s climate progress. Most of my climate and energy work is done through Breakthrough Energy, although the Gates Foundation is helping people in low- and middle-income countries adapt to a warming world. I also continue to privately fund research into other areas like Alzheimer’s disease. And I still get to advise Microsoft, which gives me insight into what’s coming down the pipeline and how it can be used to make the world a more equitable place.

我还写了我对世界气候进展持乐观态度的原因。我的大部分气候和能源工作都是通过突破能源（Breakthrough Energy）完成的，尽管盖茨基金会正在帮助中低收入国家的人们适应气候变暖的世界。我还继续为阿尔茨海默病等其他领域的研究提供私人资助。我还在为微软公司提供建议，这让我能够深入了解即将推出的产品，以及如何利用这些产品让世界变得更加公平。

I’m lucky that my work gives me insight into all the ways the world is getting better. The challenges we face feel a lot less daunting when you understand what exactly it will take to tackle them. In this letter, I will share just a few reasons I am optimistic about the year ahead. I hope they make you as excited about all the progress to come as I am.

我很幸运，我的工作让我了解到这个世界正在变得越来越好。当你了解我们所面临的挑战时，你就会觉得这些挑战并不那么可怕。在这封信中，我将与大家分享我对未来一年感到乐观的几个原因。我希望它们能让你和我一样，对即将实现的所有进展感到期待。

AI is about to supercharge the innovation pipeline.

人工智能将为创新管线提供超动力。

My work has always been rooted in a core idea: Innovation is the key to progress. It’s why I started Microsoft, and it’s why Melinda and I started the Gates Foundation more than two decades ago.

我的工作始终植根于一个核心理念：创新是进步的关键。这是我创办微软的原因，也是二十多年前我和梅琳达创办盖茨基金会的原因。

Innovation is the reason our lives have improved so much over the last century. From electricity and cars to medicine and planes, innovation has made the world better. Today, we are far more productive because of the IT revolution. The most successful economies are driven by innovative industries that evolve to meet the needs of a changing world.

创新是我们的生活在上个世纪得到极大改善的原因。从电力和汽车到医药和飞机，创新让世界变得更加美好。今天，由于信息技术革命，我们的生产力大大提高。最成功的经济体都是由创新产业推动的，这些产业不断发展，以满足不断变化的世界的需求。

My favorite innovation story, though, starts with one of my favorite statistics: Since 2000, the world has cut in half the number of children who die before the age of five.

不过，我最喜欢的创新故事要从我最喜欢的一个统计数据说起：自2000年以来，世界上五岁以下儿童的死亡人数减少了一半。

How did we do it? One key reason was innovation. Scientists came up with new ways to make vaccines that were faster and cheaper but just as safe. They developed new delivery mechanisms that worked in the world’s most remote places, which made it possible to reach more kids. And they created new vaccines that protect children from deadly diseases like rotavirus.

我们是如何做到的？一个关键原因是创新。科学家们想出了更快、更便宜但同样安全的疫苗制造新方法。他们开发出了在世界最偏远地区也能使用的新接种机制，从而使更多的儿童能够接种疫苗。他们还创造了新疫苗，保护儿童免受轮状病毒等致命疾病的侵袭。

In a world with limited resources, you have to find ways to maximize impact. Innovation is the key to getting the most out of every dollar spent. And artificial intelligence is about to accelerate the rate of new discoveries at a pace we’ve never seen before.

在一个资源有限的世界里，你必须找到最大化影响的方法。创新是让每一分钱发挥最大效益的关键。而人工智能将以前所未有的速度加快新发现的速度。

One of the biggest impacts so far is on creating new medicines. Drug discovery requires combing through massive amounts of data, and AI tools can speed up that process significantly. Some companies are already working on cancer drugs developed this way. But a key priority of the Gates Foundation in AI is ensuring these tools also address health issues that disproportionately affect the world's poorest, like AIDS, TB, and malaria.

迄今为止，最大的影响之一是创造新药。药物发现需要梳理海量数据，人工智能工具可以大大加快这一过程。一些公司已经在用这种方法开发抗癌药物。但盖茨基金会在人工智能领域的一个关键优先事项是确保这些工具也能解决艾滋病、结核病和疟疾等严重影响世界上最贫困人口的健康问题。

We’re taking a hard look at the wide array of AI innovation in the pipeline right now and working with our partners to use these technologies to improve lives in low- and middle-income countries.

我们正在认真研究目前正在进行的大量人工智能创新，并与我们的合作伙伴合作，利用这些技术改善中低收入国家的生活。

In the fall, I traveled to Senegal to meet with some of the incredible researchers doing this work and to celebrate the 20th anniversary of the foundation’s Grand Challenges initiative. When we first launched Grand Challenges—the Gates Foundation’s flagship innovation program—it had a single goal: Identify the biggest problems in health and give grants to local researchers who might solve them. We asked innovators from developing countries how they would address health challenges in their communities, and then we gave them the support to make it happen.

今年秋天，我前往塞内加尔会见了一些从事这项工作的优秀研究人员，并庆祝盖茨基金会“大挑战”20周年。盖茨基金会的旗舰创新项目“大挑战”最初启动时只有一个目标：找出健康领域的最大问题，并向可能解决这些问题的当地研究人员提供资助。我们询问发展中国家的创新者将如何解决其社区面临的健康挑战，然后我们为他们提供支持，帮助他们实现目标。

Many of the people I met in Senegal were taking on the first-ever AI Grand Challenge. The foundation didn’t have AI projects in mind when we first set that goal back in 2003, but I’m always inspired by how brilliant scientists are able to take advantage of the latest technology to tackle big problems.

我在塞内加尔遇到的许多人都参加了有史以来的首次人工智能大挑战。当我们在2003年第一次设定目标时，基金会并没有考虑人工智能项目，但我总是被聪颖的科学家们如何能够利用最新技术来解决重大问题所鼓舞。

很高兴从阿姆里塔·马哈莱（Amrita Mahale）那里了解到ARMMAN团队如何开发人工智能聊天机器人来改善孕妇的健康状况。

Much of their work is in the earliest stages of development—there’s a good chance we won’t see any of them used widely in 2024 or even 2025. Some might not even pan out at all. The work that will be done over the next year is setting the stage for a massive technology boom later this decade.

他们的许多工作都处于最早期的开发阶段——我们很有可能在2024年甚至2025年都无法看到其中任何一项技术得到广泛应用。有些甚至根本不会成功。明年的工作将为2030年之前的大规模技术繁荣奠定基础。

Still, it’s impressive to see how much creativity is being brought to the table. Here is a small sample of some of the most ambitious questions currently being explored:

尽管如此，看到这么多的创意被提到台面上还是令人印象深刻。以下是目前正在探讨的一些最具雄心的问题的一小部分：

● Can AI combat antibiotic resistance? Antibiotics are magical in their ability to end infection, but if you use them too often, pathogens can learn how to ignore them. This is called antimicrobial resistance, or AMR, and it is a huge issue around the world—especially in Africa, which has the highest mortality rates from AMR. Nana Kofi Quakyi from the Aurum Institute in Ghana is working on an AI-powered tool that helps health workers prescribe antibiotics without contributing to AMR. The tool will comb through all the available information—including local clinical guidelines and health surveillance data about which pathogens are currently at risk of developing resistance in the area—and make suggestions for the best drug, dosage, and duration.

●人工智能能否对抗抗生素耐药性？抗生素具有终结感染的神奇功效，但如果使用过于频繁，病原体就会学会如何忽视它们。这就是所谓的抗菌药物耐药性（AMR）。这在全世界都是一个巨大的问题，尤其是在非洲，因为非洲的AMR死亡率最高。加纳Aurum研究所的Nana Kofi Quakyi正在开发一种人工智能驱动的工具，帮助卫生工作者在开具抗生素处方时避免造成AMR。该工具将梳理所有可用信息——包括当地临床指南和健康监测数据，了解哪些病原体目前在该地区有产生耐药性的风险——并就最佳药物、剂量和疗程提出建议。

● Can AI bring personalized tutors to every student? The AI education tools being piloted today are mind-blowing because they are tailored to each individual learner. Some of them—like Khanmigo and MATHia—are already remarkable, and they’ll only get better in the years ahead. One of the things that excites me the most about this type of technology is the possibility of localizing it to every student, no matter where they live. For example, a team in Nairobi is working on Somanasi, an AI-based tutor that aligns with the curriculum in Kenya. The name means “learn together” in Swahili, and the tutor has been designed with the cultural context in mind so it feels familiar to the students who use it.

●人工智能能否为每个学生提供个性化辅导？目前正在试点的人工智能教育工具令人耳目一新，因为它们是为每个学习者量身定制的。其中一些工具，如Khanmigo和MATHia，已经非常出色，而且在未来几年只会越来越好。这类技术最让我兴奋的一点是，无论学生住在哪里，都有可能将其本地化。例如，内罗毕的一个团队正在开发Somanasi，这是一种基于人工智能的导师，与肯尼亚的课程保持一致。这个名字在斯瓦希里语中的意思是“一起学习”，导师的设计考虑到了文化背景，因此使用它的学生感觉很熟悉。

左图：在肯尼亚内罗毕的一间教室里，学生们与人工智能导师互动。

右图：托尼·恩敦古（Tonee Ndungu）——他的团队正在开发Somanas——展示他们最新版本的个性化教育辅导。

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● Can AI help treat high-risk pregnancies? A woman dies in childbirth every two minutes. That’s a horrifying statistic, but I’m hopeful that AI can help. Last year, I wrote about how AI-powered ultrasounds could help identify pregnancy risks. This year, I was excited to meet some of the researchers at ARMMAN, who hope to use artificial intelligence to improve the odds for new mothers in India. Their large language model will one day act as a copilot for health workers treating high-risk pregnancies. It can be used in both English and Telugu, and the coolest part is that it automatically adjusts to the experience level of the person using it—whether you’re a brand-new nurse or a midwife with decades of experience.

● 人工智能能否帮助治疗高危妊娠？每两分钟就有一名妇女死于分娩。这是一个可怕的统计数字，但我希望人工智能能有所帮助。去年，我有写到人工智能驱动的超声波检查如何帮助识别妊娠风险。今年，我很高兴能见到ARMMAN公司的研究人员，他们希望利用人工智能来提高印度新妈妈的分娩成功率。他们的大型语言模型有朝一日将成为医护人员治疗高危妊娠的人工智能助手。它可以用英语和泰卢固语使用，最酷的是，它会根据使用它的人的经验水平自动调整——无论你是一位完全没有经验的护士，还是一位有几十年经验的助产士。

● Can AI help people assess their risk for HIV? For many people, talking to a doctor or nurse about their sexual history can be uncomfortable. But this information is super important for assessing risk for diseases like HIV and prescribing preventive treatments. A new South African chatbot aims to make HIV risk assessment a lot easier. It acts like an unbiased and nonjudgmental counselor who can provide around-the-clock advice. Sophie Pascoe and her team are developing it specifically with marginalized and vulnerable populations in mind—populations that often face stigma and discrimination when seeking preventive care. Their findings suggest that this innovative approach may help more women understand their own risk and take action to protect themselves.

● 人工智能能否帮助人们评估感染艾滋病毒的风险？对很多人来说，向医生或护士谈论自己的性史可能会让人感到不舒服。但是，这些信息对于评估艾滋病等疾病的风险和开具预防性治疗处方却非常重要。南非的一款新聊天机器人旨在让艾滋病风险评估变得更容易。它就像一个不带偏见、不做评判的咨询师，可以提供全天候的建议。索菲·帕斯科（Sophie Pascoe）和她的团队在开发这款聊天机器人时，特别考虑到了边缘化人群和弱势群体——这些人群在寻求预防性治疗时往往遭遇污名化和歧视。他们的研究结果表明，这种创新方法可以帮助更多的妇女了解自身的风险，并采取行动保护自己。

● Could AI make medical information easier to access for every health worker?When you’re treating a critical patient, you need quick access to their medical records to know if they’re allergic to a certain drug or have a history of heart problems. In places like Pakistan, where many people don’t have any documented medical history, this is a huge problem. Maryam Mustafa’s team is working on a voice-enabled mobile app that would make it a lot easier for maternal health workers in Pakistan to create medical records. It asks a series of prompts about a patient and uses the responses to fill out a standard medical record. Arming health workers with more data will hopefully improve the country’s pregnancy outcomes, which are among the worst in the world.

●人工智能能否让每位医务工作者更容易获取医疗信息？在治疗危重病人时，你需要快速查阅他们的病历，了解他们是否对某种药物过敏或有心脏病史。在巴基斯坦这样的地方，很多人没有任何病史记录，这是一个大问题。玛丽亚姆·穆斯塔法（Maryam Mustafa）的团队正在开发一款支持语音的移动应用程序，它能让巴基斯坦的孕产妇保健工作者更轻松地创建医疗记录。该应用会询问一系列有关病人的信息，然后根据回答填写标准病历。为卫生工作者提供更多的数据，有望改善巴基斯坦的妊娠结局，该国的妊娠结局是世界上最糟糕的。

There is a long road ahead for projects like these. Significant hurdles remain, like how to scale up projects without sacrificing quality and how to provide adequate backend access to ensure they remain functional over time. But I’m optimistic that we will solve them. And I’m inspired to see so many researchers already thinking about how we deploy new technologies in low- and middle-income countries.

像这样的项目还有很长的路要走。仍然存在巨大的障碍，比如如何在不牺牲质量的情况下扩大项目规模，以及如何提供足够的后台访问权限以确保项目长期保持功能。但我乐观地认为，我们一定能解决这些问题。看到这么多研究人员已经在思考如何在中低收入国家部署新技术，我很受启发。

We can learn a lot from global health about how to make AI more equitable. The main lesson is that the product must be tailored to the people who will use it. The medical information app I mentioned is a great example: It’s common for people in Pakistan to send voice notes to one another instead of sending a text or email. So, it makes sense to create an app that relies on voice commands rather than typing out long queries. And the project is being designed in Urdu, which means there won’t be any translation issues.

在如何让人工智能更加公平方面，我们可以从全球健康领域学到很多东西。最主要的经验是，产品必须针对使用人群量身定制。我提到的医疗信息应用程序就是一个很好的例子：在巴基斯坦，人们通常会互相发送语音便签，而不是发送短信或电子邮件。因此，创建一个依靠语音指令而不是输入冗长查询的应用程序是很有意义的。而且该项目是用乌尔都语设计的，这意味着不会有任何翻译问题。

If we make smart investments now, AI can make the world a more equitable place. It can reduce or even eliminate the lag time between when the rich world gets an innovation and when the poor world does.

如果我们现在进行明智的投资，人工智能可以让世界变得更加公平。它可以减少甚至消除富裕世界获得创新与贫穷世界获得创新之间的滞后时间。

“We can learn a lot from global health about how to make AI more equitable. The main lesson is that the product must be tailored to the people who will use it.”

“在如何让人工智能更加公平方面，我们可以从全球健康领域学到很多东西。最主要的经验是，产品必须针对使用人群量身定制。”

If I had to make a prediction, in high-income countries like the United States, I would guess that we are 18–24 months away from significant levels of AI use by the general population. In African countries, I expect to see a comparable level of use in three years or so. That’s still a gap, but it’s much shorter than the lag times we’ve seen with other innovations.

如果让我做个预测，在美国这样的高收入国家，我猜离普通民众大量使用人工智能还有18-24个月的时间。而在非洲国家，我预计在3年左右的时间里，人工智能的使用就会达到相当的水平。这仍然是一个差距，但比我们在其他创新中看到的滞后时间要短得多。

The core of the Gates Foundation’s work has always been about reducing this gap through innovation. I feel like a kid on Christmas morning when I think about how AI can be used to get game-changing technologies out to the people who need them faster than ever before. This is something I am going to spend a lot of time thinking about next year.

盖茨基金会的核心工作一直以来是通过创新缩小这一差距。当我想到如何利用人工智能将改变游戏规则的技术以前所未有的速度提供给需要的人时，我感觉自己就像迎接圣诞节早晨的孩子。这是我明年要花很多时间思考的问题。

A long-awaited malnutrition breakthrough is almost here.

期待已久的营养不良问题的突破即将到来。

At the Gates Foundation, we are willing to take big bets. We know every risk might not pay off—but that’s okay. Our goal isn’t just incremental progress. It’s to channel our efforts and resources into major initiatives that, if successful, could save and improve lives.

在盖茨基金会，我们愿意下大赌注。我们知道每一次冒险都可能没有回报，但这没关系。我们的目标不仅仅是逐步取得进展。我们的目标是将我们的努力和资源投入到重大项目中，这些项目一旦成功，就能拯救和改善生命。

When you’re making a big bet, you often wait a long time to see if it pays off. The feeling is incredible when you finally realize it’s going to succeed. We are close to that moment with one of the big bets I’ve been most excited about: Using our understanding of the gut microbiome to prevent and treat malnutrition.

当你下一个大赌注时，你往往要等待很长时间才能看到它是否有回报。当你终于意识到它会成功时，那种感觉是难以置信的。我最兴奋的一次豪赌就接近了这一时刻：利用我们对肠道微生物群的了解来预防和治疗营养不良。

I often get asked what I would choose if I could only solve one problem. My answer is always malnutrition. It’s the greatest health inequity in the world, affecting about one in every four children. If you don’t get enough nutrition during the first two years of life, you don't develop properly—physically or mentally. By tackling malnutrition, we can reduce one of the biggest contributors to childhood mortality.

经常有人问我，如果只能解决一个问题，我会选择什么。我的答案不变：营养不良。这是世界上最严重的健康不平等现象，大约每四个儿童中就有一个受到影响。如果在生命的头两年得不到足够的营养，身体和智力都无法正常发育。通过解决营养不良问题，我们可以减少导致儿童死亡的最大因素之一。

照片中所有的孩子都是9岁，但中间的三个孩子由于发育迟缓，远远低于同龄孩子的平均身高。

The causes of malnutrition are a lot more complicated than just not getting enough food. Around 15 years ago, researchers began to suspect that the bacteria that live in your gut—your microbiome—might play a role after noticing that oral childhood vaccines like polio weren’t as effective in places with high rates of malnutrition. It was clear that something prevented them from being absorbed properly.

营养不良的原因远比没有得到足够的食物要复杂得多。大约15年前，研究人员注意到脊髓灰质炎等口服儿童疫苗在营养不良率高的地区效果不佳，他们开始怀疑生活在肠道中的细菌——微生物群——可能在其中发挥了作用。很明显，有什么东西妨碍了它们被正常吸收。

This suspicion was confirmed in 2013, when biologist Jeff Gordon published a landmark study looking at the microbiomes of infant twins in Malawi. It revealed that your microbiome is not just a byproduct of your health but a determinant of it. This was the first big clue that we might be able to reduce malnutrition by changing the gut microbiome.

这种怀疑在2013年得到了证实，当时生物学家杰夫·戈登（Jeff Gordon）发表了一项具有里程碑意义的研究，研究了马拉维一对双胞胎婴儿的微生物群。微生物群不仅是健康的副产品，还是健康的决定因素。这是第一条重要线索，表明我们或许可以通过改变肠道微生物群来减少营养不良问题。

“I often get asked what I would choose if I could only solve one problem. My answer is always malnutrition.”

“经常有人问我，如果只能解决一个问题，我会选择什么。我的答案不变：营养不良。”

In the last 10 years, we have learned more about the gut microbiome than we learned in the 1,000 years before that. We’ve discovered that the bacteria living in your gut can be in a dysfunctional state that causes inflammation so you can’t absorb nutrients. And we found that you can make the biggest improvements to the gut microbiome if you intervene early.

在过去的十年里，我们对肠道微生物群的了解比之前的1000年还要多。我们发现，生活在肠道中的细菌可能处于功能失调状态，从而导致炎症，使人无法吸收营养。我们发现，如果及早干预，就能最大程度地改善肠道微生物群。

One of the first gut bacteria to appear in human development is called B. infantis. It helps break down the sugars in breastmilk into nutrients the body needs to grow. Breastmilk, in turn, provides food for B. infantis and your entire gut microbiome. It’s a virtuous cycle. But if a baby doesn’t have enough B. infantis bacteria at the beginning, they may not absorb enough nutrients from breastmilk to support the growth of other necessary gut bacteria.

在人类发育过程中最先出现的肠道细菌之一叫做婴儿双歧杆菌。它能帮助将母乳中的糖分分解成人体生长所需的营养物质。反过来，母乳又为婴儿双歧杆菌和整个肠道微生物群提供食物。这是一个良性循环。但是，如果婴儿一开始没有足够的婴儿双歧杆菌，他们就可能无法从母乳中吸收足够的营养来支持其他必要的肠道细菌的生长。

It's almost impossible to overcome this deficit. You can have access to all the nutritious food in the world, and it won’t matter. If your gut’s growth path gets thrown off early, you may never be able to absorb all the nutrients you need.

要克服这种缺陷几乎是不可能的。你可以获得世界上所有富含营养的食物，但这并不管用。如果你的肠道生长路径过早被打乱，你可能永远无法吸收到所需的全部营养。

But what if we could give at-risk infants B. infantis as a probiotic supplement? Could we intervene early enough to set them on the right path?

但是，如果我们能给高危婴儿服用婴儿双歧杆菌作为益生菌补充剂呢？我们能否及早干预，让他们正常发育？

That’s what foundation partners have been looking into for years—and we’re finally close to an answer. Phase III trials are underway on a powdered B. infantis supplement that can be added to breastmilk. 16,000 babies from five countries are involved, and researchers are tracking each one to make sure the probiotic is both safe and effective.

这正是基金会合作伙伴多年来一直在研究的问题——我们终于找到了答案。我们正在对一种可添加到母乳中的婴儿双歧杆菌粉末补充剂进行三期临床。来自5个国家的16000名婴儿参与了试验，研究人员正在对每个婴儿进行跟踪，以确保益生菌既安全又有效。

The results so far are amazing: Feeding infants this probiotic helps them move their microbiome into that positive state so they can grow up and achieve their full potential. This could be a tremendously helpful tool for preventing malnutrition.

目前的研究结果令人惊叹：通过给婴儿喂食这种益生菌，可以帮助他们的微生物群进入积极状态，从而使他们能够长大并充分发挥潜力。这对预防营养不良大有裨益。

While the trials are ongoing, foundation partners are also trying to figure out how to reduce the cost of manufacturing. It’s essential that we make the cost cheap enough that they can be widely used in low-income countries where malnutrition rates are highest.

在试验进行的同时，基金会的合作伙伴也在努力研究如何降低生产成本。我们必须使成本足够低廉，以便在营养不良率最高的低收入国家广泛使用。

The next step is (hopefully) broader regulatory approval and scaled-up, high quality, and reliable manufacturing. The WHO has already released guidance on how to use these probiotics, which is a big hurdle to clear. I’m also optimistic about ongoing research into other form factors, like a liquid version that’s given directly to infants rather than mixed into breastmilk.

下一步（希望）是获得更广泛的监管批准，并扩大高质量和可靠的生产规模。世卫组织已经发布了如何使用这些益生菌的指南，这是需要扫清的一大障碍。我对正在进行的其他形式的研究也很乐观，比如直接给婴儿服用的液体版本，而不是混合在母乳中。

I’m also excited about the possibility of improving the gut microbiome before an infant is even born. New research has found that a baby’s microbiome is connected to their mother’s. Addressing inflammation in the womb can have additional benefits to the woman, the placenta, and the developing fetus.

在婴儿出生前就能改善肠道微生物群，这也让我感到兴奋。新的研究发现，婴儿的微生物群与母亲的微生物群息息相关。解决子宫内的炎症问题会给产妇、胎盘和发育中的胎儿带来更多益处。

What if we could give an expectant mother a probiotic supplement that would put her child’s gut on the right path from day one? It’s unclear yet what exactly these live biotherapeutics would look like or how they would be administered, since this is very early-stage research. But studies show a healthy microbiome could help babies gain an additional 5 grams of weight per day in the late stages of pregnancy.

如果我们能给准妈妈提供一种益生菌补充剂，让她的孩子从出生第一天起肠道就正常发育，那会怎么样呢？目前还不清楚这些活体生物药到底是什么样的，也不清楚如何给药，这还只是非常早期的研究。但研究表明，健康的微生物群可帮助婴儿在妊娠晚期每天增加5克体重。

Over the past decade, the field of child health has moved faster and further than I thought I’d see in my lifetime. It’s been amazing to watch the microbiome go from something that was completely invisible to a key strategy for tackling one of the greatest health inequities in the world. I can’t wait to see how much more we learn—and how we use that knowledge to save lives—in the year ahead.

在过去的十年里，儿童健康领域的发展速度超出了我一生中的预期。看到微生物群从一个完全看不见的东西变成解决世界上最大健康不平等之一的关键策略，真是令人惊叹。我迫不及待地期待在接下来的一年里我们将学到多少新知识，以及我们将如何运用这些知识来拯救生命。

The climate conversation has entered a new era.

气候对话已经进入了一个新时代。

What happens when you bring heads of state, student activists, business leaders, and philanthropists together and ask them to work on the climate crisis? A whole lot of progress, it turns out.

如果把国家首脑、学生活动家、商界领袖和慈善家聚在一处，让他们共同应对气候危机，会发生什么？他们会取得丰硕的成果。

Earlier this month, I spent several productive and awe-inspiring days at the COP28 conference in Dubai. This was my third COP—I also went to the conferences in Paris and Glasgow.

本月早些时候，我参加了举办于迪拜的COP28（第28届联合国气候变化大会），在那度过的几天十分充实，让人大开眼界。算上我此前参加的举办于巴黎和格拉斯哥的COP（联合国气候变化大会），这已经是我第三次参加了。

These meetings are a great way to track how the climate fight is evolving over time. I’m always blown away by the passion from young climate activists. It’s especially interesting to see how the overall intensity of the climate discussion has gone up over the years as more people see and experience extreme weather events all over the world.

这些会议很好地向人们揭示了气候斗争是如何随着时间演变的。年轻的气候活动家们所具有的热情深深感染了我。有趣的是，随着世界上越来越多人目睹和感受到极端天气的发生，人们对气候问题的讨论热度也越来越高。

I’m hopeful that this intensity will drive us to invest more in innovations that will help those who are most affected by climate change—especially poor farmers who live near the equator. They deserve our attention because they’ve done nothing to cause this problem, yet it literally threatens their lives. On that front, it was exciting to see a greater focus on adaptation at this year’s COP, including the inclusion of an entire day devoted to health.

我希望，这一热度将推动我们加大对创新的投资，以帮助那些在气候变化中，受影响最大的人群，尤其是生活在赤道附近的贫困农民。他们并不是气候问题的制造者，然而他们的生活却深受其害，因此，他们需要我们的关注。令人欣慰的是，在这方面，人们于今年的COP上对气候适应投入了更多的关注，甚至花了一整天时间来专门探讨健康问题。

左图：生产这些枣的棕榈树可以忍受含盐的水，因此它们可以在更多地方生长。

右图：国际盐碱农业研究中心的Tarifa Al Zaabi博士在迪拜举行的COP上介绍了她在盐碱环境中种植作物的研究。

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I was also struck by how sophisticated and nuanced the conversation around climate has become. The biggest change I saw in Dubai was how broad the discussion is about mitigation—and especially clean energy.

让我感到吃惊的还有人们探讨气候问题的方式是如此详尽。我在迪拜目睹的最大变化是，人们关于减缓气候变化的讨论尤为广泛，尤其是清洁能源方面。

At previous COPs, a lot of the focus was on scaling up wind and solar. At this COP, there was a lot more discussion about other sectors that contribute significant emissions, like agriculture and manufacturing. (I’ve written before about what I’m doing to reduce and offset my own emissions.) It’s also clear that leaders are thinking seriously about how countries can build a green energy future that pulls from many different sources. Wind and solar remain a key part of that future, but leaders now recognize that you need to supplement them with something more reliable when the sun isn’t shining or the wind isn’t blowing.

在前几届COP上，人们多把关注点集中在推广风能和太阳能上。而在本次缔约方大会上，更多的讨论是其他造成大量排放的行业，如农业和制造业。（我以前曾写过关于我如何减少和抵消自身排放的文章）。很显然，各国领导人也在认真思考，各国如何才能建设一个从多种不同来源获取绿色能源的未来。风能和太阳能将仍是未来能源的重要组成部分，但各国领导人现在认识到，在光能或风能不足时，需要有更可靠的能源作为补充。

That something increasingly includes nuclear energy.

这其中越来越多地包括了核能。

“Nuclear is the only carbon-free energy source that can reliably deliver power day and night, through every season, almost anywhere on earth, that has been proven to work on a large scale.”

“在无碳能源中，核能是唯一一个几乎可以在地球上任何地方、不分昼夜和季节供电的，其可靠性已经得到广泛证实。”

Over the last year, I have noticed a major shift toward overall acceptance of nuclear. In the past, when I would bring it up, I would often have to explain why nuclear isn’t the boogeyman many people assumed it was. But lately, I’ve spent a lot more time explaining how we scale the technology up rather than why we need it at all. I was excited to see nearly two dozen countries pledge at COP to triple their nuclear capacity by 2050.

去年，我注意到人们对核能的整体接受度发生了重大转变。过去我提起核能时，往往得向人们解释核能并非如他们所想是个妖魔化的存在。但最近，我花更多时间来说明我们如何普及核能技术的应用，而不是为什么我们需要它。我很高兴看到近二十多个国家在COP上承诺到2050年将核电能力提高两倍。

I think one reason for this shift is practical. Nuclear is the only carbon-free energy source that can reliably deliver power day and night, through every season, almost anywhere on earth, that has been proven to work on a large scale. As countries make progress on their climate plans, more people are realizing that we will likely need nuclear power to meet the world’s growing need for energy while eliminating carbon emissions.

我认为人们态度发生转变的一个原因是核能的实用性。在无碳能源中，核能是唯一一个几乎可以在地球上任何地方、不分昼夜和季节供电的，其可靠性已经得到广泛证实。随着各国在其气候计划方面取得进展，越来越多人意识到，我们很可能需要核电来满足世界日益增长的能源需求，以及消除碳排放的需要。

I also attribute some of the shift to the progress being made on next-generation nuclear technology.

关于人们态度转变的另一部分原因，我归结于下一代核技术研发中取得的进展。

For decades, nuclear technology remained stagnant. High-profile disasters like Chernobyl and Three Mile Island put a spotlight on the real risks that come with nuclear power. And instead of getting to work on solving those problems, we just stopped trying to advance the field. Luckily, that is changing.

几十年来，核技术的研发一直停滞不前。切尔诺贝利和三哩岛等广为人知的核事故让人们意识到核电所蕴含的真实风险。我们并没有着手解决这些问题，而是选择不再继续研究这一领域。幸好这种情况正发生变化。

I’m optimistic about the approach created by TerraPower, a company I founded in 2008. Earlier this year, I visited the future home of the first TerraPower plant in Kemmerer, Wyoming. When this plant opens—potentially in 2030—it will be the most advanced nuclear facility in the world, and it will be much safer and produce far less waste than conventional reactors.

对于泰拉能源（Terrapower）——我于2008年创立的一家公司——所研发的技术，我抱以乐观的态度。今年早些时候，我去到怀俄明州凯默勒，到访了泰拉能源的首座工厂选址。这座核电站有可能在2030年投入使用，届时它将成为世界上最先进的核设施，与传统反应堆相比，它将更加安全，产生的废料也会少得多。

左图：怀俄明州凯默勒的发电厂将于2026年停止燃煤，并于2036年完全关闭。

右图：今年早些时候，我参观了位于凯默勒的诺顿（Naughton）发电厂。按照计划，所有工人只要愿意，都可以在泰拉能源（TerraPower）工厂找到工作。

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A lot of people are still (understandably!) skeptical about the economics of nuclear power, since building new plants is so expensive. My hope is that the Kemmerer plant will remove some of those doubts. Building the facility will bring 1,600 construction jobs to town at its peak. And once it’s up and running, it will employ between 200 and 250 people—including workers from the local coal plant that’s scheduled to shut down soon.

很多人仍对核电的经济性持怀疑态度（这是可以理解的！），因为建造新核电站的成本非常昂贵。我希望凯默勒核电站能一定程度上消除人们的疑虑。在建设高峰期，核电站的建设将为小镇带来1600个建筑工作岗位。一旦开始运行，它将雇用200到250名员工，其中包括一些来自当地煤炭厂的工人，该煤炭厂按计划即将关停。

In 2024, construction will begin on the sodium test facility in Kemmerer. (You can read more about the super-cool role sodium plays.) This is an important step as TerraPower continues to make progress toward breaking ground on the nuclear facility.

钠测试设施将于2024年在凯默勒开工建设。（你可以在此阅读更多关于钠的信息，了解其重要性）这是泰拉能源在持续推进核设施建设方面踏出的重要一步。

TerraPower uses a fission reactor, which is what most people think of when they picture a nuclear power plant. It creates power by splitting atoms apart. But scientists are also working on a completely new type of reactor that pushes atoms together to generate energy. This process is called fusion, and it’s the same process that powers the sun.

正如大多数人想象中的核电站一样，泰拉能源采用裂变反应堆，通过分裂原子来产生能量。但科学家们同时正研究一种全新的反应堆，以让原子聚在一起产生能量。这个过程与太阳的发电过程相同，这被称为核聚变。

Almost exactly one year ago, scientists at the Lawrence Livermore National Laboratory achieved the first fusion reaction that generated more energy than it took in. This was a tremendous achievement and a huge step forward. The technology is still in the R&D phase, but there are plenty of reasons for continued optimism.

差不多整整一年前，劳伦斯利弗莫尔国家实验室里的科学家们首次实现了聚变反应，产生的能量超过了吸收的能量。这是一项伟大的成就，也是向前迈出的一大步。这项技术仍处于研发阶段，但我们有充足的理由对其应用持以乐观的态度。

这张图片展示的是1986年的一次核聚变实验。劳伦斯利弗莫尔国家实验室的科学家们几十年来一直在研究核聚变点火，他们终于在去年实现了这一目标。（Corbis/盖蒂图片社)

It’s always exciting to see zero-emission technologies go from idea to reality. One of the highlights of my trip to COP was walking around the technology start-up zone. Most of the companies there didn’t exist eight years ago when the world declared at the Paris COP that it was committing to climate innovation.

零排放技术从设想变为现实的转变从来都令人振奋。参观技术初创区的经历是我此次COP之行的亮点之一。八年前，当各国在巴黎COP上宣布致力于气候创新时，这里的大多数公司还不存在。

In 2024 and beyond, I predict we will see lots of new innovations coming into the marketplace—even in very complicated areas like nuclear. The climate crisis can feel overwhelming, but I find it easier to stay optimistic when you focus on all the progress we’re making. If the world continues to prioritize funding innovation, I’m hopeful we can make good progress on our climate goals.

我预测，在2024年及未来，我们将看到大量新型技术进入市场——即使是像核能这样非常复杂的领域。气候危机可能会让人感到不知所措，然而，当你意识到我们所取得的进展，就更容易持有乐观的态度。如果全世界继续将重点放到对技术创新的投资上，我相信我们能在实现气候目标方面取得广阔的进展。

2024 elections will shape the future of global health and the climate.

2024年的选举将塑造全球卫生和气候的未来。

I recently read a statistic that blew my mind: More pe