關於 economic inequality in hong kong ，我們在網路上蒐集到這些相關的討論、資訊與評價

今早為Asian Medical Students Association Hong Kong (AMSAHK)的新一屆執行委員會就職典禮作致詞分享嘉賓，題目為「疫情中的健康不公平」。
感謝他們的熱情款待以及為整段致詞拍了影片。以下我附上致詞的英文原稿：

It's been my honor to be invited to give the closing remarks for the Inauguration Ceremony for the incoming executive committee of the Asian Medical Students' Association Hong Kong (AMSAHK) this morning. A video has been taken for the remarks I made regarding health inequalities during the COVID-19 pandemic (big thanks to the student who withstood the soreness of her arm for holding the camera up for 15 minutes straight), and here's the transcript of the main body of the speech that goes with this video:

//The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, continues to be rampant around the world since early 2020, resulting in more than 55 million cases and 1.3 million deaths worldwide as of today. (So no! It’s not a hoax for those conspiracy theorists out there!) A higher rate of incidence and deaths, as well as worse health-related quality of life have been widely observed in the socially disadvantaged groups, including people of lower socioeconomic position, older persons, migrants, ethnic minority and communities of color, etc. While epidemiologists and scientists around the world are dedicated in gathering scientific evidence on the specific causes and determinants of the health inequalities observed in different countries and regions, we can apply the Social Determinants of Health Conceptual Framework developed by the World Health Organization team led by the eminent Prof Sir Michael Marmot, world’s leading social epidemiologist, to understand and delineate these social determinants of health inequalities related to the COVID-19 pandemic.

According to this framework, social determinants of health can be largely categorized into two types – 1) the lower stream, intermediary determinants, and 2) the upper stream, structural and macro-environmental determinants. For the COVID-19 pandemic, we realized that the lower stream factors may include material circumstances, such as people’s living and working conditions. For instance, the nature of the occupations of these people of lower socioeconomic position tends to require them to travel outside to work, i.e., they cannot work from home, which is a luxury for people who can afford to do it. This lack of choice in the location of occupation may expose them to greater risk of infection through more transportation and interactions with strangers. We have also seen infection clusters among crowded places like elderly homes, public housing estates, and boarding houses for foreign domestic helpers. Moreover, these socially disadvantaged people tend to have lower financial and social capital – it can be observed that they were more likely to be deprived of personal protective equipment like face masks and hand sanitizers, especially during the earlier days of the pandemic. On the other hand, the upper stream, structural determinants of health may include policies related to public health, education, macroeconomics, social protection and welfare, as well as our governance… and last, but not least, our culture and values. If the socioeconomic and political contexts are not favorable to the socially disadvantaged, their health and well-being will be disproportionately affected by the pandemic. Therefore, if we, as a society, espouse to address and reduce the problem of health inequalities, social determinants of health cannot be overlooked in devising and designing any public health-related strategies, measures and policies.

Although a higher rate of incidence and deaths have been widely observed in the socially disadvantaged groups, especially in countries with severe COVID-19 outbreaks, this phenomenon seems to be less discussed and less covered by media in Hong Kong, where the disease incidence is relatively low when compared with other countries around the world. Before the resurgence of local cases in early July, local spread of COVID-19 was sporadic and most cases were imported. In the earlier days of the pandemic, most cases were primarily imported by travelers and return-students studying overseas, leading to a minor surge between mid-March and mid-April of 874 new cases. Most of these cases during Spring were people who could afford to travel and study abroad, and thus tended to be more well-off. Therefore, some would say the expected social gradient in health impact did not seem to exist in Hong Kong, but may I remind you that, it is only the case when we focus on COVID-19-specific incidence and mortality alone. But can we really deduce from this that COVID-19-related health inequality does not exist in Hong Kong? According to the Social Determinants of Health Framework mentioned earlier, the obvious answer is “No, of course not.” And here’s why…

In addition to the direct disease burden, the COVID-19 outbreak and its associated containment measures (such as economic lockdown, mandatory social distancing, and change of work arrangements) could have unequal wider socioeconomic impacts on the general population, especially in regions with pervasive existing social inequalities. Given the limited resources and capacity of the socioeconomically disadvantaged to respond to emergency and adverse events, their general health and well-being are likely to be unduly and inordinately affected by the abrupt changes in their daily economic and social conditions, like job loss and insecurity, brought about by the COVID-19 outbreak and the corresponding containment and mitigation measures of which the main purpose was supposedly disease prevention and health protection at the first place. As such, focusing only on COVID-19 incidence or mortality as the outcomes of concern to address health inequalities may leave out important aspects of life that contributes significantly to people’s health. Recently, my research team and I collaborated with Sir Michael Marmot in a Hong Kong study, and found that the poor people in Hong Kong fared worse in every aspects of life than their richer counterparts in terms of economic activity, personal protective equipment, personal hygiene practice, as well as well-being and health after the COVID-19 outbreak. We also found that part of the observed health inequality can be attributed to the pandemic and its related containment measures via people’s concerns over their own and their families’ livelihood and economic activity. In other words, health inequalities were contributed by the pandemic even in a city where incidence is relatively low through other social determinants of health that directly concerned the livelihood and economic activity of the people. So in this study, we confirmed that focusing only on the incident and death cases as the outcomes of concern to address health inequalities is like a story half-told, and would severely truncate and distort the reality.

Truth be told, health inequality does not only appear after the pandemic outbreak of COVID-19, it is a pre-existing condition in countries and regions around the world, including Hong Kong. My research over the years have consistently shown that people in lower socioeconomic position tend to have worse physical and mental health status. Nevertheless, precisely because health inequality is nothing new, there are always voices in our society trying to dismiss the problem, arguing that it is only natural to have wealth inequality in any capitalistic society. However, in reckoning with health inequalities, we need to go beyond just figuring out the disparities or differences in health status between the poor and the rich, and we need to raise an ethically relevant question: are these inequalities, disparities and differences remediable? Can they be fixed? Can we do something about them? If they are remediable, and we can do something about them but we haven’t, then we’d say these inequalities are ultimately unjust and unfair. In other words, a society that prides itself in pursuing justice must, and I say must, strive to address and reduce these unfair health inequalities. Borrowing the words from famed sociologist Judith Butler, “the virus alone does not discriminate,” but “social and economic inequality will make sure that it does.” With COVID-19, we learn that it is not only the individuals who are sick, but our society. And it’s time we do something about it.

Thank you very much!//

Please join me in congratulating the incoming executive committee of AMSAHK and giving them the best wishes for their future endeavor!

Roger Chung, PhD
Assistant Professor, CUHK JC School of Public Health and Primary Care, @CUHK Medicine, The Chinese University of Hong Kong 香港中文大學 - CUHK
Associate Director, CUHK Institute of Health Equity

【新發佈學術文章 My New Publication】
對貧窮與健康的感知及兩者之間的惡性循環：一個香港醫療服務主要持份者的質性研究

背景
貧窮與健康息息相關。現時有關貧窮與健康之間的惡性循環的研究主要集中於發展中國家，惟當中聯繫貧窮與健康的機制未必能全盤應用於亞洲發達地區。這項研究旨在探索香港醫療服務主要持份者對貧窮與健康之間的惡性循環驅動機制和因素的看法。

方法
我們透過焦點小組訪談社會工作者（n = 8），慢性病患者（n = 8），老年人（n = 6），基層醫療醫生（n = 7）及非正式照顧者（n = 10），仔細轉錄並閱讀所得意見，然後基於社會建構主義作主題分析以識別及整合關鍵主題。

結果
在這高度發達但貧富懸殊的亞洲城市中，貧窮與健康之間的惡性循環依然持續。權力和機會不平等造成物質和社會制約，進而令影響健康的社會決定因素分佈得更不均。在雙軌醫療系統下，醫療服務使用亦因社會階梯高低而有所不同。隨著健康狀況惡化，醫療、社福及勞工干預政策的不協調和不足進一步加劇患者的經濟困難。除此以外，基於受訪者對貧窮本質的認知及其在公共政策中的操作以及不同持份者對疾病概念的理解，此研究還討論了驅動惡性循環的政策因素。

結論
儘管經濟繁榮，貧窮與健康之間的惡性循環仍然是香港現正面臨的巨大挑戰。為了打破循環，潛在政策方向包括採納按比例的普世主義，推動社會融合和加強醫社協作。

Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong

BACKGROUND:
Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong.

METHODS:
Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism.

RESULTS:
In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders.

CONCLUSIONS:
The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.

Link: https://rdcu.be/b1s6o

🇩🇰 這是一篇深度報導，來自歐洲現存最古老的報紙：丹麥Weekendavisen，題目是從香港抗爭運動、香港聯繫加泰羅尼亞的集會，前瞻全球大城市的「永久革命」。一篇報導訪問了世界各地大量學者，我也在其中，雖然只是每人一句，加在一起，卻有了很完整的圖像。

以下為英譯：

Protest! The demonstrations in Hong Kong were just the beginning. Now there are unrest in big cities from Baghdad to Barcelona. Perhaps the stage is set for something that could look like a permanent revolution in the world's big cities.

A world on the barricades

At the end of October, an hour after dark, a group of young protesters gathered at the Chater Garden Park in Hong Kong. Some of them wore large red and yellow flags. The talk began and the applause filled the warm evening air. There were slogans of independence, and demands of self-determination - from Spain. For the protest was in sympathy with the Catalan independence movement.

At the same time, a group of Catalan protesters staged a protest in front of the Chinese Consulate in Barcelona in favor of Hong Kong's hope for more democracy. The message was not to be mistaken: We are in the same boat. Or, as Joshua Wong, one of the leading members of the Hong Kong protest movement, told the Catalan news agency: "The people of Hong Kong and Catalonia both deserve the right to decide their own destiny."

For much of 2019, Hong Kong's streets have been ravaged by fierce protests and a growing desperation on both sides, with escalating violence and vandalism ensuing. But what, do observers ask, if Hong Kong is not just a Chinese crisis, but a warning of anger that is about to break out globally?

Each week brings new turmoil from an unexpected edge. In recent days, attention has focused on Chile. Here, more than 20 people have lost their lives in unrest, which has mainly been about unequal distribution of economic goods. Before then, the unrest has hit places as diverse as Lebanon and the Czech Republic, Bolivia and Algeria, Russia and Sudan.

With such a geographical spread, it is difficult to bring the protests to any sort of common denominator, but they all reflect a form of powerlessness so acute that traditional ways of speaking do not seem adequate.

Hardy Merriman, head of research at the International Center for Nonviolent Conflict in Washington, is not in doubt that it is a real wave of protest and that we have not seen the ending yet.

"I have been researching non-violent resistance for 17 years, and to me it is obvious that there are far more popular protest movements now than before. Often the protests have roots in the way political systems work. Elsewhere, it is about welfare and economic inequality or both. The two sets of factors are often related, ”he says.

Economic powerlessness

Hong Kong is a good example of this. The desire among the majority of Hong Kong's seven million residents to maintain an independent political identity vis-à-vis the People's Republic of China is well known, but the resentment of the streets is also fueled by a sense of economic powerlessness. Hong Kong is one of the most unequal communities in the world, and especially the uneven access to the real estate market is causing a stir.

According to Lee Chun-wing, a sociologist at Hong Kong Polytechnic University, the turmoil in the city is not just facing Beijing, but also expressing a daunting showdown with the neoliberal economy, which should diminish the state's role and give the market more influence, but in its real form often ends with the brutal arbitrariness of jungle law.

'The many protests show that neoliberalism is unable to instill hope in many. And as one of the world's most neoliberal cities, Hong Kong is no exception. While the protests here are, of course, primarily political, there is no doubt that social polarization and economic inequality make many young people not afraid to participate in more radical protests and do not care whether they are accused of damage economic growth, 'he says.

The turmoil is now so extensive that it can no longer be dismissed as a coincidence. Something special and significant is happening. As UN Secretary General António Guterres put it last week, it would be wrong to stare blindly at the superficial differences between the factors that get people on the streets.
“There are also common features that are recurring across the continents and should force us to reflect and respond. It is clear that there is growing distrust between the people and the political elites and growing threats to the social contract. The world is struggling with the negative consequences of globalization and the new technologies that have led to growing inequality in individual societies, "he told reporters in New York.

Triggered by trifles

In many cases, the riots have been triggered by questions that may appear almost trivial on the surface. In Chile, there was an increase in the price of the capital's subway equivalent to 30 Danish cents, while in Lebanon there were reports of a tax on certain services on the Internet. In both places, it was just the reason why the people have been able to express a far more fundamental dissatisfaction.

In a broad sense, there are two situations where a population is rebelling, says Paul Almeida, who teaches sociology at the University of California, Merced. The first is when more opportunities suddenly open up and conditions get better. People are getting hungry for more and trying to pressure their politicians to give even more concessions.

“But then there is also the mobilization that takes place when people get worse. That seems to be the overall theme of the current protests, even in Hong Kong. People are concerned about various kinds of threats they face. It may be the threat of inferior economic conditions, or it may be a more political threat of erosion of rights. But the question is why it is happening right now. That's the 10,000-kroner issue, ”says Almeida.

Almeida, who has just published the book Social Movements: The Structure of Social Mobilization, even gives a possible answer. A growing authoritarian, anti-democratic flow has spread across the continents and united rulers in all countries, and among others it is the one that has now triggered a reaction in the peoples.

“There is a tendency for more use of force by the state power. If we look at the death toll in Latin America, they are high considering that the countries are democracies. This kind of violence is not usually expected in democratic regimes in connection with protests. It is an interesting trend and may be related to the authoritarian flow that is underway worldwide. It's worth watching, 'he says.

The authoritarian wave

Politologists Anna Lürhmann and Staffan Lindberg from the University of Gothenburg describe in a paper published earlier this year a "third autocratic wave." Unlike previous waves, for example, in the years before World War II, when democracy was beaten under great external drama , the new wave is characterized by creeping. It happens little by little - in countries like Turkey, Nicaragua, Venezuela, Hungary and Russia - at such a slow pace that you barely notice it.

Even old-fashioned autocrats nowadays understand the language of democracy - the only acceptable lingua franca in politics - and so the popular reaction does not happen very often when it becomes clear at once that the electoral process itself is not sufficient to secure democratic conditions. Against this backdrop, Kenneth Chan, a politician at Hong Kong Baptist University, sees the recent worldwide wave of unrest as an expression of the legitimacy crisis of the democratic regimes.

“People have become more likely to take the initiative and take part in direct actions because they feel that they have not made the changes they had hoped for through the elections. In fact, the leaders elected by the peoples are perceived as undermining the institutional guarantees of citizens' security, freedom, welfare and rights. As a result, over the past decade, we have seen more democracies reduced to semi-democracies, hybrid regimes and authoritarian regimes, ”he says.

"Therefore, we should also not be surprised by the new wave of resistance from the people. On the surface, the spark may be a relatively innocent or inconsiderate decision by the leadership, but people's anger quickly turns to what they see as the cause of the democratic deroute, that is, an arrogant and selfish leadership, a weakened democratic control, a dysfunctional civil society. who are no longer able to speak on behalf of the people. ”The world is changing. Anthony Ince, a cardiff at Cardiff University who has researched urban urban unrest, sees the uprisings as the culmination of long-term nagging discontent and an almost revolutionary situation where new can arise.

"The wider context is that the dominant world order - the global neoliberalism that has dominated since the 1980s - is under pressure from a number of sides, creating both uncertainty and at the same time the possibility of change. People may feel that we are in a period of uncertainty, confusion, anxiety, but perhaps also hope, ”he says.
Learning from each other.

Apart from mutual assurances of solidarity the protest movements in between, there does not appear to be any kind of coordination. But it may not be necessary either. In a time of social media, learning from each other's practices is easy, says Simon Shen, a University of Hong Kong political scientist.

“They learn from each other at the tactical level. Protesters in Hong Kong have seen what happened in Ukraine through YouTube, and now protesters in Catalonia and Lebanon are taking lessons from Hong Kong. It's reminiscent of 1968, when baby boomers around the globe were inspired by an alternative ideology to break down rigid hierarchies, 'he says.
But just as the protest movements can learn from each other, the same goes for their opponents. According to Harvard political scientist Erica Chenoweth, Russia has been particularly active in trying to establish cooperation with other authoritarian regimes, which feel threatened by riots in the style of the "color revolutions" on the periphery of the old Soviet empire at the turn of the century.

"It has resulted in joint efforts between Russian, Chinese, Iranian, Venezuelan, Belarusian, Syrian and other national authorities to develop, systematize and report on techniques and practices that have proved useful in trying to contain such threats," writes Chenoweth in an article in the journal Global Responsibility to Protect.

Max Fisher and Amanda Taub, commentators at the New York Times, point to the social media as a double-edged sword. Not only are Twitter and Facebook powerful weapons in the hands of tech-savvy autocrats. They are also of questionable value to the protesting grass roots. With WhatsApp and other new technologies, it is possible to mobilize large numbers of interested and almost-interested participants in collective action. But they quickly fall apart again.

The volatile affiliation is one of the reasons why, according to a recent survey, politically motivated protests today only succeed in reaching their targets in 30 percent of cases. A generation ago, the success rate was 70 percent. Therefore, unrest often recurs every few years, and they last longer, as Hong Kong is an example of. Perhaps the scene is set for something that might resemble a permanent revolution in the world's big cities - a kind of background noise that other residents will eventually just get used to.

"Since there is still no obvious alternative to neoliberalism, the polarization that led to the protests initially will probably continue to apply," says Lee of Hong Kong Polytechnic University. "At the same time, this means that the anger and frustration will continue to rumble in society."