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

「Everything worth doing has a hard part.
每件值得做的事情都有個困難的部分」

以下文章取自Seth Godin的部落格,我把它翻成中文。原文連結附在最下方。

「 “What’s the hard part?”
困難的部分是哪一部分？

A simple question, often overlooked, as if ignoring it will make the problem go away.
這是一個常常被忽略的簡單問題。好像,忽略它,就會讓問題消失一樣

Everything worth doing has a hard part.
每件值得做的事情都有個困難的部分

If it didn’t, it would have been done already.
如果沒有的話,它早就已經被完成了

The hard part, we can hope, will become easier if you allocate resources and focus and effort.
我們是可以這樣的希望著,如果您有分配資源並且專注跟努力的話,困難的部分就會變得比較簡單

That’s the point of the work, to whittle away at the hard part.
這就是下苦工的意義,減輕困難的部分

But, if we refuse to ask and answer, then how can we possibly focus on what matters?
但是如果我們拒絕問跟答這個問題（“困難的部分是哪一部分”）
那我們怎麼可能可以專注在真正重要的地方呢？

It’s often a lot more fun and relaxing to focus on the parts that aren’t hard.
通常,專注在沒有那麼困難的部分有趣並且輕鬆多了

Or to pretend that the hard part is easy.
或者,假裝困難的部分不存在是簡單的

Better, I think, if we’ve decided that the work is worth doing, to get serious about the parts that are worth our effort.
我認為比較好的方式是,如果我們決定我們要下苦功的部分是值得被做的。
那就嚴肅以待值得我們努力的那一部分」

以學英文來說,有哪些部分對您來說是特別困難的呢？

文法？閱讀？口說？背單字？聽？介系詞？

就像是賽斯高登說的「每件值得被做的事情都有個困難的部分」。很多時候,在學習中,困難的部分有好多部分。我們需要像是玩瑪莉兄弟一樣,一關一關的去破關。闖關失敗,檢討失敗原因,再重新來過一遍,直到破關為止。直到有一天,透過持續不斷的下苦功練習,困難的部分會變得簡單,變成你的一部分。您可以使用的一部分。

等那天到來,您就會了解,你付出的努力,是值得的。

https://seths.blog/2019/10/whats-the-hard-part/?fbclid=IwAR2lDFXqe3jKPv0vlfQNH61bU0HNPM5lglXXz2O6MXnJqGO4I2A7ZYdS7t4

【火車頭上售賣熱騰騰的栗子】
【Hot chestnuts sold at a locomotive】

冬天時, 常在葡萄牙的街頭上見到小販在販賣熱騰騰的栗子。在寒冷時，買來一小點，還未打開來吃，光是只捧著那包熱栗子，人都即時溫暖了許多。

Chestnuts are often seen being sold at small carts in Portugal. In a cold winter day, buy some chestnuts and before I even open them and eat, the hot chestnuts in the paper bag have already warmed me up.

以火車頭造型的車來售賣栗子，確實可愛，至少吸引到我的目光。:-)

Selling chestnuts at an unreal locomotive. Quite an interesting idea.... at least it has attracted my attention! :-)

也許來葡萄牙遊玩的華人旅客真的增長了不少，最近發現在里斯本市中心 Rossio 火車站附近擺賣的一位栗子小販，他的小車上竟然出現了中文介紹! 是一直已經有這些中文字在那小車上？ 還是只是我以前從來沒有留意過呢？:-)

Probably Portugal has become more popular among Chinese visitors, because I recently found that on a small cart selling chestnuts (located near Rossio train station in Lisbon), the hawker put up some description in Chinese words too! Has he put up that Chinese description for a long time already, and just that I have overlooked it myself in the past? :-)