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要筆戰前先認知這社會如何對待基層吧。
汗編曾經聽過一句話，我覺得說得非常好。
The level of civilisation can be quantified by how we treat our most vulnerable and disadvantaged.
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感謝以下汗粉投稿！
@dukailin
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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
後補，發出此帖文後，收到一位讀者的訊息，稱「無國界醫生」在捐款人通訊電郵裡，有提及他們做過的事情，為公平起見，在這裡也轉載一下，大家自行解讀。
注：以下係節錄，在「無國界醫生」的臉書及其網站都找不到，Google 也找不到，如果是真，他們也算是終於為香港做了應做的事。
「An MSF emergency team arrived in Hong Kong at the end of January to start a new project. Their focus is community engagement with vulnerable people, for example those more at risk of developing severe infection such as the elderly. It also includes those who are less likely to have access to important medical information, such as the socio-economically disadvantaged. This activity is similar to the services MSF provided in Hong Kong during the SARS outbreak in 2003.
Our teams have already conducted sessions with street cleaners, refugees and asylum seekers, and the visually impaired in recent weeks. Through face-to-face sessions, our team is able to share up-to-date, evidence-based medical information, but are also there to listen and answer the many questions people may have. We are also providing psychological first aid with simple coping mechanisms that can help manage the stress and anxiety a new outbreak brings. You may have seen that global supplies of medical protective equipment are stretched thin. MSF is sending one tonne of Personal Protective Equipment to Hong Kong St. John Ambulance. The staff are transporting high-risk cases, and therefore, it is important to ensure that they have the specialised protection they need to work safely.
MSF is also shipping specialised medical protective equipment to Wuhan Jinyintan Hospital in the capital city of Hubei province in mainland China, the epicentre of the outbreak. Weighing 3.5 tonnes, these supplies are being dispatched from MSF Supply in Brussels, Belgium through the Hubei Charity Federation to reach the hospital where they are very much needed.」
「無國界醫生應對2019冠狀病毒病（COVID-19）的工作
過去一個月，有關2019冠狀病毒病（COVID-19）的新聞是全球關注的焦點。我們希望您一切安好，身體健康，並想藉此機會向您介紹無國界醫生應對這種新疫症的最新消息。
無國界醫生一支緊急救援隊伍於一月底抵達香港展開新項目，主要是接觸社區內的脆弱人群，如長者等較容易出現嚴重感染，以及較難獲得重要醫療資訊的人，包括基層人士。2003年香港爆發嚴重急性呼吸系統綜合症（又稱沙士或非典型肺炎）時，無國界醫生也曾進行類似的工作。
這兩周，我們分別與街道清潔工、難民和尋求庇護者以及視障人士進行健康教育對談，分享最新的實證醫療資訊，同時聆聽和解答他們的疑問。我們也通過心理急救，協助人們掌握簡單的技巧，以應對疫情帶來的壓力和焦慮。
您可能也知道，全球的醫療防護裝備供應相當緊張。無國界醫生正運送一噸個人防護裝備到港，捐贈予香港聖約翰救護機構。該機構的人員有機會接送懷疑感染患者，因此，確保他們能有專門保護安全地工作，是非常重要的。
此外，無國界醫生正運送專門的防護裝備到疫情最嚴重的湖北省內的武漢市金銀潭醫院。這批重3.5噸的醫療物資，已從無國界醫生位於比利時布魯塞爾的物資供應中心出發，將透過湖北省慈善總會送往急需有關醫療物資的武漢市金銀潭醫院。
您可以按此進入我們的網頁，瀏覽有關防疫措施的影片和 COVID-19 的醫學資訊。我們將在這個專頁定期更新我們的應對工作，以及實用的健康教育資訊。我們希望這些資訊有助您在這段期間，照顧好自己和摯親好友。
祝
一切安好
無國界醫生（香港）」
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以下是原帖內容：
我純粹有少少好奇，到底這幾個星期，那個很有國界的「無國界醫生」，有沒有為危難中的香港，做了些甚麼？
於是我上他們的 Facebook 看看，中文版的專頁，十一月以來就沒有更新。再訪其網站，見到這篇文章： https://www.msf.org/msf-update-2019-ncov-coronavirus-outbre…
有呢段： An MSF team is being sent to Hong Kong with an initial focus on health education for vulnerable groups, such as the elderly and other at-risk groups. （無國界醫生的一支隊伍，正被派往香港，最初的工作重點，是為弱社群，如老人和其他高風險的人士，提供健康教育。）
其實而家香港醫護及社區，最需要個人防護物資，唔係對高危人士的健康教育講座。醫療連 PPE 都無，但都唔見 MSF 有乜嘢行動，只係提及 2003 年，捐咗四十箱醫療保護物資畀醫管局。2003 年，2003 年，2003 年⋯⋯
要強調，捐款畀 NGO，唔係交易，唔係買賣，更唔等同買保險，你捐咗款，唔代表對方要為你做事情。
但想一下，從去年到今天，香港人以前幫過嘅國際大型 NGO，又有幾多會喺香港危難之際，對香港伸出援手，而唔係單純當你係提款機？
人道危機，唔出聲。
醫療危機，唔幫手。
係啊，確實幾失望。
注：呢張相，係 MSF 喺 2003 年影嘅，佢哋 2003 年時，送咗 40 盒醫療物資畀醫管局，來自佢哋個網站。
思考了很久覺得這些事情不說自己很難繼續拍影片。
我後來跟我一個外語學院的學姐聊到這隻影片的內容。她跟我說，翻譯學幾乎很少外教上課，但這種本來就不太需要外教。但是英語系（偏向學習文學類），大概是這樣類比的，假設一學期10堂課，「至多」2堂外教上課。她跟我說：「武大整體的英文教育偏低，國際化程度還不夠，但還在努力了」我也跟另外一個人聊，同樣讀經濟系，台大所有的教材都是英文的。還有一個大陸人來跟我說，確實英文的教育不是很夠。
關於那隻影片我確第一次這樣沒有反覆練習思考就用英文說，所以思慮不夠縝密。
但我為什麼比較慢發就是因為我給自己時間去打臉自己，讓內容完善。
以下的內容我影片其實都有補充。
1⃣️大陸大學都不一樣，所以我說的是武大
2⃣️各校各院校都不一樣
3⃣️英文不是最重要的能力。
我也是這麼認為的，團隊合作、共同表達都是很重要的能力。
我今天會提出我覺得英文在武大使用的不夠是我個人兩年下來的心得。
這樣說吧，大一大二學中文的教材，如果你未來決定往研究所走，絕對會有很辛苦的落差。不要說什麼，這些單字很簡單隨便查查就知道。你確定你用對單字了嗎？
最簡單的「需求」，經濟學來說是”demand”。英文的話need ,requirement都是可以的。但是jargon 是demand 。你如果要往上唸，gre/gmat都是有可能要考到的。在需要這些英文的情況下，我真的覺得武大的英文不夠。
也有人說就業在大陸的話，不需要這麼多英文。當然可以，你開心就好。
大家知道我分享很多大陸大學的好處，但壞處呢？課業學習的壓力呢？師資呢？
我拍這支影片就是想逐步慢慢給你們更多資訊，最全面的分享我的選擇給學弟妹參考要不要做來大陸發展的選擇。
最後有人說：「擔心你單拍一支影片被人有心利用。」我很謝謝你的關心親愛的哼，但是我拍一整隻說大陸大學「好處」，都能被人有心利用😊
我會有我固有的思維，但我知道我思考都很不縝密，所以我很愛跟朋友聊天，聽取別人的意見然後修正。我真的沒有做好我會道歉，也會即時停損以免誤導更多人。但我實在很討厭我都說了，在我有回答的問題上再提出一樣的質疑。
如果我分享的事情，你們覺得不對，請不要姑息我，請來跟我溝通。
「自反而縮，雖千萬人吾往矣。」
⭐️來找我玩⭐️
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