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
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請支持 #融樂會,關注香港少數族裔教育
10月17日是 #國際消除貧困日。根據《少數族裔貧窮狀況報告》(2016年),香港五分之一的少數民族生活在貧困線以下。 他們中有64.7%生活在勞動家庭中,比總貧困人口高出約15%。 由於較低的受教育程度和的技能水平而導致的低收入是造成工作貧困的主要原因。 較低的中文水平亦阻礙了他們的就業能力和社區融合。為了解決世代相傳的貧困問題,香港融樂會致力於增加少數民族兒童獲得優質和公平教育的機會。
各有心人可以透過以下連結,捐贈 Hong Kong Unison 香港融樂會
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17th October is the International Day for the Eradication of Poverty.
According to the Poverty Situation Report of Ethnic Minorities (2016), one in five ethnic minorities in Hong Kong lived below the poverty line. 64.7% of them lived in working households, about 15% higher than the overall poor population. Lower employment earnings due to lower educational attainment and skill levels of employed persons were the major causes of working poverty. Having lower Chinese proficiency hindered their employability and community integration.
To tackle inter-generational poverty, Hong Kong Unison has worked tirelessly to increase ethnic minority children’s access to quality and equitable education, including calling on the Education Bureau to
monitor racial discrimination at kindergarten admissions,
abolish racially segregated “designated” primary and secondary schools for non-Chinese speaking students, and
provide additional support in Chinese learning for ethnic minority children in mainstream schools.
Hong Kong Unison firmly believes education can help lift this vulnerable group out of poverty towards upward mobility.
Support Unison – act together now to empower ethnic minority children, their families and communities to end poverty!
All funding received will go towards Unison’s advocacy project “Equitable Education for All”.
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能拿到白宮的hard pass,甚至可以對白宮記者團發布採訪新聞稿,絕對是對一名記者能力的肯定,這背後或許有因為他所在媒體的關係,但是更多是跟著記者的經歷。台灣媒體沒有資金培養一個白宮記者,台灣媒體也沒有國際新聞的市場支持一個駐美記者擁有他所需要的資源,然後如果記者想要達到自己的理想成為白宮記者,就會成為現在尷尬的情況。因為他只能往其他華文媒體走,可是,各種不同的雙重標準下,多麼難聽的話都出來了。甚至我還看到自稱資深駐美記者前輩說自己只是太忙了,不願意拿那張記者證而已...。seriously?現在的人真的只顧立場不顧事實了?還是只懂得拿自己認知的部分事實在左右你的“粉絲”? 大家不問美國總統的教養,卻怪罪了舉手發問的記者不該那樣回答...。端傳媒這篇報導,就是事實描述整個白宮簡報室的情況。
https://theinitium.com/article/20200505-international-white-house-ethnic-chinese-correspondent/
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