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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【After Winning Majority in LegCo: Beijing's Crackdown May Trigger International Intervention】
***感謝Hong Kong Columns - Translated,將我早前撰寫『議會過半想像:以「#國際攬炒」反制「臨立會2.0」』長文(https://www.facebook.com/joshuawongchifung/photos/a.313299448762570/2887650867994069/)翻譯成英文,鼓勵國際社會關注立會選舉一旦過半的沙盤推演,在最惡劣形勢下的制衡策略。***
中文精簡版本:https://www.facebook.com/joshuawongchifung/photos/a.564294826996363/2888641404561682/
Hongkongers have experienced our revolution for over half a year. They no longer take a consequentialist view to the effectiveness of their movement as they did years ago, or waste time second-guessing the intentions and background of fellow activists. Following the defensive battles at CUHK and PolyU, November’s District Council election saw a great victory of unity. More marvellous is the union between peaceful and “valiant” protesters.
In the process of resisting tyranny, the people have realised that one cannot prioritize one strategy over another. This is also how the common goal of “35+” came into being—the hope that we will win over half of the seats in the Legislative Council (LegCo) this September, such that the political spectrum that represents the majority of Hongkongers is able to gain control of legislative decisions. The political clout of Hongkongers will increase if 35 or more seats are successfully secured on our side. It is certainly one vital step to achieve the five demands within the system.
The possibility of realizing legislative majority
Technically it is not unrealistic to win a majority even under the current undemocratic system. Back in the 2016 LegCo election, we already won 30 seats. In addition to the District Council (First) functional constituency seat that is already in the pocket of the pan-democrats, as long as the candidates in Kowloon East and New Territories West do not start infighting again, we could safely secure 33 seats based on the number of pan-dem votes in 2016.
The other 3 seats required to achieve a majority depend on democrats’ breakthrough among the functional constituencies by dispersing the resources of the Liaison Office. They also count on whether the turnout this September could exceed 71.2% — that of last year’s District Council elections. Some of the factors that could affect the turnout include: will the epidemic persist into the summer? Will there be potential violent repression of protests in the 2 weeks preceding the election? Will Hong Kong-US relations be affected by the downturn of the global economy?
Therefore, the ambition of “35+” is to be prioritised by the resistance as both a means and an end. I have already expressed my support for an intra-party primary at the coordination meeting. In the meantime, it is pleasing to see the ongoing debates reaching a consensus of maximising the seats among geographical constituencies in the upcoming election.
Whilst enthusiastic coordination, we should also assess the post-election landscape and gauge Beijing’s reactions: if we do not reach 35 seats, Hong Kong will be subject to tighter control and more severe repression by China; but if the democratic parties successfully form a majority in LegCo, CCP’s fears of a “constitutional crisis” would become imminent. Hence, the key questions are how the Pan-Democrats should deal with the volatile political situation in Hong Kong and how they are going to meet Beijing’s charge head-on.
Watching out for Beijing’s dismissal of LegCo after reaching majority
To take back control of LegCo such that it faithfully reflects the majority’s principles and needs is the definition of a healthy democracy. Recently, however, DAB’s Tam Yiu-chung has warned that the plan of the Pan-Dems to “usurp power” in the LegCo would only lead to Beijing’s forceful disqualification of certain members or the interpretation of the Basic Law. This proves that winning a majority in LegCo is not only a popular conception but also a realistic challenge that would get on the nerves of Beijing. Could Beijing accept a President James To in LegCo? These unknown variables must be addressed upon achieving a majority.
While there is no telltale sign as to Beijing’s exact strategy, we are already familiar with the way CCP manipulated the Basic Law in the past 4 years. Having experienced three waves of disqualifications in LegCo, twice kicked out of LegCo with my team, and thrice locked up in jail, I have no false hopes of an easy compromise from Beijing: they would not let Pan-Dems control LegCo for half a year and wait (as is the proper procedure) until after having negatived the Budget to dissolve the legislature, and thereby giving them an easy victory in the re-elections. The greater the Pan-Dems threaten Beijing’s rule in Hong Kong, the more likely that it will trigger Beijing’s repression.
Since the disqualification and arrest of lawmakers have already become “normalised”, one can even imagine the police stepping into the LegCo building to force Pan-Dems into voting. Neither is it beyond our imagination to expect the CCP to kick out all 70 lawmakers in a fit of rage and replace them with a provisional LegCo “2.0” [HKCT note: The first was from 25 Jan 1997 to 30 Jun 1998]. To depend on a majority that could lead to a chapter of a “new testament” for One Country, Two Systems is perhaps what many elites long for, but they are overly optimistic:for a ticket to the promised land will not be available at the Chief Executive election campaign a year and a half later.
Admittedly, the Pan-Dems cannot unilaterally initiate “Laam-chaau” [HKCT note: mostly translated into “scorched-earth” mentality or “mutual destruction”; some even translated into “If I burn, you burn with us”]. The most they can do is to force a standstill of the government, and not for long the LegCo will have been eliminated from the equation to make the wheels turn again. It all leaves the plan of “Negativing the motion → Dissolving LegCo → Re-election after re-election → the stepping down of Carrie Lam” merely as overly positive speculation, probably resulting from their overestimate of CCP's capacity for rational calculation. The Pan-Dems must guard their frontlines and recognise what the biggest threat from Hong Kong to China could be. In this case, should LegCo sessions be disrupted or suspended, the Pan-Dems would have to be well prepared to surmount the expected obstacles and prevent the disqualification crisis 4 years ago—a Catch-22 indeed.
Productive tension from global intervention: Using Laam-chaau against the CCP
What aggravates the CCP the most is the potential threat to Hong Kong’s unique status as the one and only “separate customs territory”. Any miscalculation will compromise its role as the Chinese economy’s “white gloves”. Imagine if CCP were to disqualify all 70 elected lawmakers and convene a meeting north of the Shenzhen River to pass a resolution to Hong Kong’s affairs (much like the Provisional Legislative Council “1.0" in 1997), how great will the shock be in a world with an effective Hong Kong Human Rights and Democracy Act? However hard it is to predict the future one thing is certain: With the US presidential election just around the corner, blows to the separation of powers would not be tolerated, and the West would necessarily effect countermeasures against the Hong Kong government.
Beijing has been relying upon Hong Kong to navigate the international community for decades. While clamping down on the political freedom of the cosmopolitan city, Beijing desires to maintain the financial centre’s economic freedom. Hence, we started lobbying for the Hong Kong Human Rights and Democracy Act four years ago, and today we are determined to promote “Laam-chaau” on an international scale.
The will of the voters must be reflected in an election. If a “35+” legislature were to be dismissed and replaced, such flagrant violation of democracy would assuredly cause a greater backlash than the infamous extradition bill. Knowing what the reality ahead of us could be, we have to combine our election and international strategies to oppose the placement of a 35+ LegCo with an “Emergency Legislative Council 2.0”, to advance an international “Laam-chaau” to Hong Kong’s status as “separate customs territory”. Only then will we stand a chance to resist the regime and to realise the five demands.
Adjusting our mindset: Overcoming the “constitutional crisis” to reach a resolution
Upon the realization of the “35+” LegCo, it is expected that the CCP will launch a devastating counterattack. The Pan-Dems should not expect LegCo to run normally; neither can the lawmakers realise their governing blueprints they have for Hong Kong. Rather, candidates will be able to compete against one another with visions of a liberated Hong Kong through popular vote. Bringing this point up has nothing to do with undermining the common goal of reaching a majority in LegCo, but rather channels the battle of LegCo to positive use upon the rule of law’s death and a “constitutional crisis” ahead. Knowing that Hongkongers have nothing to fall back on, all Pan-Dems should not miss the only way to the realization of “35+”.
Thus, be they partisans, nonpartisans, incumbent politicians, amateur politicians, or the civil society as a whole – if we stay in the political discourse of 2016 and continue to perpetuate old stereotypes, that is to deal with the divisions on the pan-democratic camp by favouring the most “local” faction; to consider only resource allocation and self-aggrandizement as the purpose of a LegCo campaign; to ignore how potential lawmakers are fitted to what specific roles; to turn a blind eye to the journey of resistance since last summer (extending indefinitely into the future)—They would lead as astray and cost us lose a precious opportunity for change by winning a 35+ majority.
The extent to which the pan-democrats can stay united in light of the political atmosphere since last summer is another problem that our side must to address. Before the watershed moment of 12th June 2019, many democratic delegates were trapped in the mentality of needing to “preserve people’s livelihood”, “be content of what we have accomplished”, and other strategies that favours stability. As the government refuses to heed to the five demands, whether the democrats, especially those in the functional constituencies, have the political will to go all-in is the real difficult question that confronts us in the upcoming LegCo election.
All in all, if “35+” cannot be realised, it is unsurprising to see LegCo being more heavily suppressed in the next 4 years; even if "35+" is achieved, it is questionable whether the pan-democrats are able to weather multiple attacks, verbal or physical, from the regime (judging from its power in the last four years) and utilise the international Laam-chaau strategy against the displacement of LegCo. Adhering to the motto of “we fight on, each in his own way”, I can only hope that Hongkongers in elections, street confrontations and international front can reconcile with each other, so that we may collectively compel the government to yield to our demands in the next six months. It is only by reaching a resolution before a real constitutional crisis that we can combat the institutional violence of the regime and not be devoured by it.
https://hkcolumn.blogspot.com/2020/04/joshua-wong-after-winning-majority-in.html?fbclid=IwAR216gf53pG_j9JOpDfr2GItvjLfrFSekKTPzoEs3-s9KBqvPEwz865P8vw
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