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

➥新冠肺炎全球大流行至今，隨著幾個確診個案於非洲幾個國家發生，如何阻止新冠肺炎於非洲國家蔓延成為國際間公共衛生的重要議題。


然而於亞洲,美國和歐洲國家採取的介入措施，不見得適用於非洲國家；首先，保持社交距離於非洲國家的成效有限，因為非洲國家人口結構相對年輕化，保持社交距離和封城對於醫療負荷過重的國家有效，但對醫療資源缺乏的國家成效有限。


再者，對非洲國家的民眾，經濟的壓力比起病毒的威脅更加嚴峻，封城和追溯感染源等措施取決於各個國家之間的政治，社交互動以及新冠肺炎流行的階段。


因此，對於非洲國家的防疫介入措施應著重於強化個人衛生，勤洗手以及開放有限度的工時，隨著非洲以外的國家採取保持社交距離和封城等措施，使新冠肺炎疫情趨緩之際，持續積極監控疫情和隔離有其必要性，以避免新冠肺炎疫情的再次擴散。 (「財團法人國家衛生研究院」蔡慧如博士 摘要整理➥http://forum.nhri.org.tw/covid19/virus/j854/ )


📋 Limiting the spread of COVID-19 in Africa: one size mitigation strategies do not fit all countries (2020/04/28)+中文摘要轉譯
■ Author：
Shaheen Mehtar,Wolfgang Preiser,Ndèye Aissatou Lakhe,et al.
■ Link：
(The Lancet) https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30212-6/fulltext


🔔豐富的學術文獻資料都在【Covid-19 新冠肺炎資源網】
■ http://forum.nhri.org.tw/covid19/


#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇

➥【重點摘要】：
儘管回答“何時恢復正常”這個問題是多麼具有挑戰性，但是解決“如何恢復正常”這個問題同樣令人生畏。在沒有突破性治療或疫苗的情況下，美國必須如南韓使用強迫手段，從減災過渡到圍堵。


受COVID-19影響最嚴重地區共同的特徵是人口密集。除非有廣泛的群體免疫，決策者在決行時必須考慮大型聚會、節日、會議、和體育賽事的風險。


■檢測是重要的。
首先，血清抗體檢測可提供族群暴露的估計值，並假設(並希望)之前的暴露是可以提供保護的，且保護力可維持到疫苗出現。以再生值2~3來估計，至少需有50%~66%的人受到感染才能產生群體免疫效果。


第二，病毒抗原的檢測可偵測正在感染個案，這對阻止傳播是重要的；這些檢測必須易於執行，快速，可在醫療機構外取得，且價格合理。


當檢測結果為陽性時，必須立即通知、教育、隔離感染者，並找出他們的接觸者。在資源不足區，必須在不增加汙名化及邊緣化的情況下，最大程度執行檢測、隔離、和接觸者追蹤程度這些介入措施。


美國必須投資公共衛生，以保障人民的福祉，並避免未來流行病再度造成個人及經濟的損失。緊急干預措施包括建立公共衛生基礎設施、紓困計畫、及物資供給計畫，以面對COVID-19或其他流行病再度發生的狀況。


COVID-19的流行帶來了空前的創造力、想像力、和同理心；美國加速整合遠距醫療至患者管理，並促進更順暢及方便的交流。在美國重新開放之前，美國必須確保這場戰役以正確的公共衛生策略作結，其中包括了廣泛的篩檢、為受影響的人們提供資源、及對不茲不倦幫助美國走過這場疾病的醫療工作人員表達感激。(「財團法人國家衛生研究院」莊淑鈞博士 摘要整理)


📋 From mitigation to containment of the COVID-19 pandemic – Putting the SARS-CoV-2 genie back in the bottle(2020/04/17)+中文摘要轉譯

➥Author：Rochelle P. Walensky, Carlos del Rio
➥Link： JAMA
https://jamanetwork.com/journals/jama/fullarticle/2764956


#2019COVID19Academic
衛生福利部
疾病管制署 - 1922防疫達人
疾病管制署
國家衛生研究院-論壇