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
estates中文 在 Eddie Tam 譚新強 Facebook 的最佳解答
譚新強:西方對帝國主義之反思:販賣黑奴是原罪 鴉片不是?
【明報專訊】英國《金融時報》周末版的House & Home副刊,每周都介紹全球,尤其歐洲的一些漂亮大屋、古堡、花園,甚至私人小島。上月有一篇較特別,為迎合BLM潮流,專題介紹一些以「colonialism and slavery」賺來的不義之財所建造的「country estates」(鄉村莊園),數目超過1000座。文中也指出,除這些大屋外,建立不少英國銀行,以至國會大樓的資金來源,亦是來自殖民地和奴隸主義。其實何止於此,小如英女王王冠上極有名和象徵大英帝國的Koh-i-Noor巨鑽,亦是來自當年的印度殖民地,近年印度經常要求英國歸還,當然不得要領。
文章介紹了好幾座莊園和訪問它們的現在主人(故意包括一家深圳公司)。他們有些自稱不清楚莊園歷史,有些就表示對祖先的罪孽非常遺憾,最開明的就願意在莊園網址上和導賞團中,照實介紹這些「羞恥」歷史。但看完全文,發現一個奇怪「錯漏」——販賣鴉片的歷史隻字不提。是否只有販賣黑奴才賺錢,鴉片竟是一門賠錢的生意?答案當然不是,Keswick家族(怡和集團後人),仍是全英國最富有家族之一。早前在英國都有人把黑奴商人的銅像拋到河中,但坐落在St. James的East India Club則依然健在,亦沒計劃停辦或改名。
答案只有一個,在英國甚至西方眼中,莫非只有販賣黑奴到南北美洲,才是殖民地主義下的罪行,販賣鴉片到中國,大英帝國甚至出兵支持毒梟,發動兩次鴉片戰爭,強佔香港150年,就不是罪行?可能這亦是一種back-handed compliment(反面讚許),暗示中國已變強大,西方覺得毋須再為此抱歉?
今周香港歷史博物館開始關閉「香港故事」展覽,不少人趕去參觀,包括我一位住在香港多年、從事傳媒工作的英國人朋友。他在網上發出龍獅旗照片,說必須在關閉前最後一遊,因為中國即將「airbrush history」(篡改歷史)。當日到訪的當然以中國人居多,但此話出自一位英國人口中,實在有點兒那個,所以我就忍不住留言,問他英國人是否要求中國人繼續緬懷殖民地時代?他反質問我難道不承認受惠於英國在香港建立的「良好」教育制度,言下之意即是我應「感激」殖民地制度!他也承認鴉片戰爭是英國的錯,但他解說從鴉片賺來的不義之財,早已在兩次世界大戰中花光,亦因此英國已得到「atonement」(贖罪)!他的另一位英國朋友,更插嘴說祖先犯下的罪,與他何干,絕對沒有「collective guilt」(集體犯罪責任)這一回事。
這場對話雖只屬私人性質,但亦是一個現今中美(英)局勢的一個寫照。首先要明白現在部分香港人的畸形「戀殖」情懷,其實是一種長達150年「斯德哥爾摩」症候群,在其他很多脫離殖民地時代後的地方,例如印度、新加坡、非洲各國,都曾出現過。他們對昔日宗主國的感情複雜,既愛且恨,一方面痛恨被侵略、屠殺、壓迫和永久種族歧視,但同時又會「感恩」侵略者並沒有完全滅族,更帶來一些先進文明事物,包括西方醫藥、時尚服裝、音樂、飲食習慣等。
最有效洗腦三招:宗教教育傳媒
最有效的洗腦三招是「宗教、教育、傳媒」。我小時候念聖公會學校,也要讀《聖經》,每周上教堂。幾乎全球所有曾被英國佔領的殖民地,即使近百年後,都仍保留一些模仿Eton和Harrow的所謂精英中小學,然後不少學生的最大志願仍是能考進牛津和劍橋。但即使我們這些曾「受惠」英式殖民地教育的人,就必須永世感恩,永遠崇拜英國,就不可以認清史實而醒覺?幾乎所有反殖民地抗爭英雄,如南非曼德拉、印度甘地、新加坡李光耀等,早年都是接受英式精英教育,或甚至留學英國的。但當他們學成後,認清歷史和當時局勢,就逐漸醒覺,致力喚醒國民,齊對帝國和殖民主義進行抗爭!
第二個問題,英國、美國以至整個西方,是否真的有為帝國主義所犯下的各種滔天罪行,包括侵略、屠殺、搶掠、販賣奴隸和毒品等等,作出真心懺悔?兩次大戰是否就能為英美贖罪?我對這狡辯非常驚訝,一戰幾乎只可算是一場無聊血腥的family feud(親戚打架),難分是非黑白,何來英國能以此來贖罪?雖然一戰確有效加速多個其他歐洲帝國的滅亡。二戰黑白較分明,納粹德國希特勒屠殺了600萬猶太人,無論德國開頭有否權利推翻過度苛刻的《凡爾賽條約》,即變得完全不重要。但英國最初力主appeasement議和策略,參戰原因實自衛為主。美國也一樣,如非珍珠港受襲,不見得願意參戰。
至於帝國主義的collective guilt問題,非常有趣,很重要但比較複雜。深入一點來分析,這問題可分為三部分,第一是歷史罪行,應否如普通法中,有statute of limitations(時效法規)?第二是某個人,是否有分擔祖上或整個國家犯下的罪行的責任?第三部分更加要小心,這些西方帝國主義罪行和責任問題,是否真的全都已變成過去式,只是歷史故事,在現代世界已不再發生?
時效法規這問題有大量刑事和國際法案例。一年前,德國審判了一個93歲的前集中營守衛,最後判有罪但獲緩刑。韓國仍努力向日本追討二戰時慰安婦的應得道歉和賠償。美國在學校和職場執行的優惠黑人affirmative action政策,亦當然是為補償數百年的黑奴制度和系統性種族歧視而設立的。明顯帝國主義犯下的違反人道罪行,是未必有時效法規的。所以中國沒有追索英國在中國販毒的刑責,和為後來的侵略作出道歉和賠償,已算非常大方。
其實應否繼續追究歷史責任問題,除時間有多久遠是其中一個考慮外,某件事對現今局勢和情况,仍有多少影響,是更重要的考慮因素。以反民主的美國選舉人票為例,正是黑奴時代遺留下來的不公制度,至今仍無法解決的憲法問題。美國每年槍擊死亡人數高近4萬人,這更完全是憲法第二修正案(2nd Amendment)遺留下來的歷史問題。
雖然香港已有人在此聚居數千年,但鴉片戰爭當然仍是對現今香港最大影響的一件事。這裏的城市設計、法律、教育、醫療制度,都是英國遺留下來的,連街道名和駕駛方向都沒有改變!我已多次指出,為何《基本法》會危險地混淆居留權和國籍,竟容許外籍人士投票、當法官和甚至參選!這就是不平等《南京條約》留下來的痕迹!所以奉勸大家,不可輕言什麼鴉片戰爭是遠古歷史,跟現時香港情况一點關係都沒有。
英美靠祖上侵略發達 子孫難脫責任
第二點是現今英國國民(美國和其他昔日西方列強也是),對祖上的帝國主義侵略行為,需否負上任何責任?這問題的答案,除決定有否法律責任外,更重要是亦影響到西方批評中國現今幾乎所有政策的權利和道德高低。我認為答案有兩個層面——國家和個人,假如某個國家經歷了一次或多次革命和改朝換代,某些法律責任仍需負上,例如前朝簽訂的國際條約,財務責任則看情况而定。至於前朝犯下的人道罪行,無論對內或外,新政府當然盡力與此割席。但即使如此,也未必能完全洗脫責任,戰後的德國和日本,雖算洗心革面,但仍需為二戰不停道歉和賠償。英國的情况更簡單,從發動兩次鴉片戰爭至今,英國政制穩如泰山,絲毫沒有改變,換了的只是女王陛下,從維多利亞傳到她的重孫女伊利沙伯而已。所以現代英國人,怎可跟歷史責任割席?
個人層面,除血緣關係外,遺產法亦保障後人的法律權利。例如英美的Keswick、Swire和很多其他家族,都是仍在享受祖上倚靠帝國主義侵略,殺人放火、偷、搶、販毒、利用黑奴勞工等不道德手段而得來的財富。如果有權利,怎可能沒有責任?
那麼如現代英國人仍對過去罪行有責任,包括對中國的百年侵略,他們憑什麼批評中國侵犯知識產權(美國當然也靠此起家)和所謂不公平貿易手段?中國人勤奮,出賣勞力爭取生活改善,竟反被指控為不公平競爭,簡直是指鹿為馬,可以不理。保護知識產權已大有改善,即使早期有些翻版情况,對比不斷侵略其他國家,遍佈殖民地主義,販賣人口和毒品等嚴重罪行,怎可比擬?這些商業侵權行為,極其量只可算是自製的affirmative action。
中國人努力改善生活 反被指不公平競爭
第三點,這些西方帝國主義討論,真的只是歷史問題,現今已不存在?美英等西方聯盟,不是仍有重兵駐紮在伊拉克、阿富汗和沙特等國,每天仍進行轟炸、無人機暗殺行動嗎?即使當911事件為美國與伊斯蘭仇怨起點(當然不是),過去19年,西方在中東、巴基斯坦和非洲所直接殺害和因戰爭而間接死亡人數,保守估計超過100萬,911死亡人數僅3000,即300倍以上奉還!更離譜的是911的恐怖分子,大部分為沙特國民,但美國沒有轟炸沙特,仍極度支持王儲穆罕默德(Mohammed bin Salman, MbS)和沙特王國,全球有數最極權國家!西方殺害過百萬無辜伊斯蘭教徒,除了是極嚴重人道和戰爭罪行外,亦當然導致全球伊斯蘭更加走向極端原教旨主義,製造更多在全球各地進行恐襲的惡性循環。美國在中東的無窮無盡戰爭,不正是現代帝國主義,跟十字軍東征有何分別?西方憑什麼批評中國和平的一帶一路政策為後現代帝國主義?
上周我指出中國人從未獲得諾貝爾經濟學獎,本身此事不太重要。某程度上,不頒獎給中國,代表西方故步自封,拒絕承認中國經濟奇蹟的重要性,亦未能跳出傳統市場經濟學的框框。更沒有向前考慮如螞蟻的數碼金融科技,和其他資訊科技製造出無限數據,對人類政經制度和系統的衝擊。
但拿不到獎亦代表中國未曾梳理好自己成功發展的理論基礎,不止經濟,亦關乎到內部政治、外交政策,以及甚至遠比西方科學化和成功的治疫公共健康政策。在此「十四五」即將出台之際,除繼續努力發展經濟外,亦必須與西方進行和平、理性和科學化的政經理論和體制的辯論,和檢討西方帝國歷史和對中國影響的討論,都是非常重要的,對全面提升軟實力有極大幫助,應遠比只推廣中文語言教育和中華美食有效!
西方應接受中國和平崛起
當然單方面的自述是不足夠的。西方也必須放棄種族和帝國主義,虛心聆聽中國的解釋,互相交流和學習。西方亦需明白中國政府是得到絕大部分、90%以上人民所支持的,而最重要接受中國的和平崛起。他們更須明白修昔底德陷阱式的零和遊戲思維,已完全過時且非常危險,可導致第三次世界大戰!
除此,人類正面對威脅全球,不尊重國界、政經體制和人種的COVID疫情,已過了大半年,死亡人數過百萬,仍未遏止。明顯個別國家抗疫是不夠的,全球各國必須合作發展醫藥和疫苗,協調抗疫和旅遊政策,才有機會成功。另外,如要成功應付與疫情相關,但更巨大的氣候和環境變化問題,則更需要中美和其他國家的充誠合作。
中環資產投資行政總裁
[譚新強 中環新譚]
https://www.mpfinance.com/fin/columnist2.php?col=1463481132098&node=1603393438597&issue=20201023
estates中文 在 By Candiicexx Facebook 的最讚貼文
[婚禮業界聯合聲明]
近月,香港各處也充斥著催淚煙的氣味,無論大街小巷、商場食肆,或是屋村屋苑,甚至是婚禮場所,都無一倖免。撥開這一層白茫茫的霧霾𥚃頭,是市民的眼淚、市民的驚恐、市民的痛苦,甚至是市民的鮮血。
一直以來,我們婚禮界堅信及擁護香港的法治精神,但鑑於警察行為已經失控,出現大量濫權、濫捕、濫暴情況。相信這是我們,亦是你,更是大眾所不能接受的!
在良知的驅使下,即使我們如何努力地保持專業,也是很有限的,尤其是在警方濫捕及濫暴香港市民的同時,我們已經不能容許自己在婚禮上再給他們送上微笑祝福!縱使我們深信世上有好人壞人之分,警察也有所謂的黑與白之別,但我們更需要的,是公平、公正的去分辨服務對象!
因此,我們現在嚴正聲明:
在成立獨立調查委員會之前,所有警務人員的任何喜慶節目,一律不再接受預約!
以上是我們一班婚禮從業員的心聲,希望能為香港我們這個家,盡一點綿力;以及將一直以來的核心價值包括公平、努力、包容、相愛,好好保護下來。而且我們更希望,香港不同階層、不同行業、不同身份的左鄰右里,也可以一齊加入、一齊加油、一齊罷接警婚!
光復香港,時代革命
香港人,堅持!香港人,反抗!
2019年11月8日
#香港人 #反抗 #光復香港 #時代革命 #五大訴求 #缺一不可 #反送中文宣 #黃 #雨傘 #各行各業一起罷 #拒絕警暴 #我們一起罷 #你不配 #婚禮界 #良知 #黑白
Wedding Planner Industry
In recent months, the smell of tears has been everywhere in Hong Kong, regardless if on the streets, shopping malls, or housing estates.
Housing estates, even wedding venues, are not spared. Underneath the white mist, the public in panic suffers, shedding tears and blood.
Our wedding planner community has always believed and supported the rule of law in Hong Kong, but the police behaviour has been out of control.
There have been a lot of physical and verbal abuses and violence. These circumstances we the public will never accept.
Even if we work hard to maintain professionalism, our options are very limited, especially with the police as our conscience will not allow it.
At the same time that the police is indiscriminately arresting and violently harassing the people of Hong Kong, we do not bless these actions.
Even though we are convinced that there are good people and bad people in the world, the police also have the so-called black and white. But we will only provide service to those that are fair and balanced.
Therefore, we are now solemnly stating:
Before the establishment of the Independent Investigation Commission, any festive programs of all police officers will no longer be accepted!
The above is the voice of our wedding planner industry, hoping to make a little difference for our home in Hong Kong;
And the core values that have always been included are fairness, hard work, tolerance, and love, and these are well protected.
And we also hope that Hong Kong’s different sectors, different industries and different identities can also take the same position.
Join, refuel, and refuse the police wedding preparations together!
Liberate Hong Kong, the revolution of our times!
Hong Kong people, persist! Hong Kong people, resist!
8th November 2019
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