關於 why study public health ，我們在網路上蒐集到這些相關的討論、資訊與評價

After I posted on my leave plans on Sunday, a few of you asked what was on my reading list, so I am sharing some books I have read / am reading / or hope to read. Three of the books are available from the National Library Singapore. Do check out the NLB app (iOS: https://go.gov.sg/moiqhc | Android: https://go.gov.sg/hu17bc). It is a marvellous resource, and you will definitely be able to discover many books to suit your interests.

[ Nuclear Folly, a History of the Cuban Missile Crisis
by Serhii Plokhy ]
The Cuban Missile Crisis in 1962 brought the world to the brink of nuclear war. I had read "13 Days", the short memoir by Robert Kennedy about it as a teenager, and later Graham Allison's "Essence of Decision", a seminal study using the Crisis to analyse decision making from different perspectives. Both were mainly based on US records. Plokhy's book draws on Soviet archives, to present events from both the US and Soviet points of view. Many mistakes were made on both sides. The saving grace was that both President John Kennedy and General Secretary Nikita Khrushchev desperately wanted to avoid a nuclear war. But even then the two sides avoided a nuclear exchange only by a hair’s breadth, and only by chance, because events once set in motion were no longer entirely within the two leaders' control. A gripping read.

[ The Bilingual Brain, and what it tells us about the science of language
by Albert Costa ]
Having learnt several languages myself, and grappled with our bilingualism policy in schools, this book was a natural choice. I am still reading it. Did you know that a newborn infant already recognises and prefers the language (or languages) which their mother spoke while they were in her womb, and within hours of birth can also distinguish between two different languages that they have never heard before? Infants pick up a language (or two) naturally in their first years, but learning a second or third language later in life is much harder. This book explains why.

[ Capturing Light, the Heart of Photography
by Michael Freeman ]
A book about the different sorts of light, how they influence the photo you take, and how to use them to create the effect and mood that you want. Photographers know about the golden hour and blue hour, hard light and soft light, direct and indirect lighting, front and back lighting, haze, mist and fog, and so many more variations. The book includes lots of the author’s photos illustrating his points, taken over many years. Hope to pick up something from reading it. But the key in photography (as in so many other skills) is to practise and practise, if you want to improve.

[ Bettering Humanomics, A New, and Old, Approach to Economic Science
by Deidre Nansen McCloskey ]
The author, a distinguished economist, argues that economics is not just about incentives and institutions, mathematical models and observed behaviour. It should take a broader, more humanistic approach, paying attention to ethics and values, “what people believe, and the stories they tell one another”, as one reviewer put it. Certainly in government we must think about these broader factors all the time, while making sure we get the economics right. Not just in trade and industry or finance, but also in national development, education, health, manpower, sustainability and the environment, social and family development, and so much of public policy. I haven't read this book yet, but saw an enthusiastic book review, and look forward to reading the book itself.

Happy reading! – LHL

PRESS STATEMENT (IN REPLY TO RONNIE LIU)

I refer to the press statement from the State Assemblyman of Sungai Pelek, titled “Muhyiddin must come clean on the COVID-19 vaccine.” The State Assemblyman has claimed several inaccuracies, allegations, and misrepresentations that require answering in this statement.

I will answer them one by one.

1. The State Assemblyman has alleged that the mRNA vaccine will alter the DNA of a person. He has also questioned whether it will be approved by JAKIM based on the same premise.

Briefly, in our cells, mRNAs (messenger RNAs) are temporary molecules that are made from our genomic DNA before it is translated to make a protein. It is essentially a short-term, temporary message.
In this case, the temporary message instructs the body to produce one of the proteins on the surface of the coronavirus. The immune system will then learn to recognise the virus protein and produce antibodies against it. That’s all the mRNA vaccine does. It does not alter your DNA.

In response to State Assemblyman’s query if JAKIM will approve the vaccine since “it is capable of altering the DNA of a person?” The DNA issue has been addressed above. In addition, I have already stated that JAKIM is part of the Jawatankuasa Khas Jaminan Akses Bekalan Vaksin COVID-19 (JKJAV) which assesses COVID-19 vaccines. Furthermore, Minister in the Prime Minister's Department (Religious Affairs) YB Datuk Seri Dr Zulkifli Mohamad Al-Bakri clarified in Parliament, the Muzakarah (Conference) of the National Fatwa Council will study and deliberate on the matter.

2. The State Assemblyman has also questioned who will be paying for the vaccine. If he read beyond the headlines of the announcement, he would have seen that the Prime Minister has pledged that the Government will fund the public COVID-19 vaccination programme for Malaysians with an initial target of 70% of our population to reach herd immunity. The Malaysian Government has set aside at least RM 3 billion solely for this purpose.

3. The pricing of the Pfizer vaccine is covered by a non-disclosure agreement as each country negotiates directly with the pharmaceutical company. Suffice it to say we are satisfied with the terms and pricing that we have agreed upon. The terms we have reached protect Malaysia’s interests both financially and with regards to the safety of the vaccine.

I can categorically confirm that it is definitely less than the RM100 per dose as assumed by the State Assemblyman.

4. The State Assemblyman also claimed that we are rushing to sign deals with vaccine manufacturers. I can categorically say that this is false. We have been negotiating with vaccine manufacturers since April 2020 when we announced our Science Diplomacy strategy. We are considering all data provided by the companies we are negotiating with in order to make the best, most informed decision. This is just the first of many deals that we are considering. Negotiations are ongoing including with vaccine manufacturers from China (including the manufacturer which the State Assemblyman strongly champions). I would like to emphasise that the vaccines must be deemed safe and efficacious by the National Pharmaceutical Regulatory Agency (NPRA) under MOH before we execute the agreements and begin the vaccination process.

It is important to note that not any one pharmaceutical company will be able to supply vaccines for the entire Malaysian population. This is why the multi-pronged approach to procure a portfolio of vaccines is significant in order to obtain enough doses to meet our herd immunity target of 70% of the population.

5. With regards to the ultra-cold supply chain required; the shipment will be handled and delivered by Pfizer directly.

As for ultra-cold storage, we have ultra-low temperature freezers in universities and research institutes in the country which can be redeployed, if necessary. Pfizer has also shown that the vaccines are stable at 2-8 degree Celsius for five days.

We are also not getting the 12.8 million doses in one shot. They will be staggered throughout the year. Our planning for storage will take the delivery schedule into consideration.

6. MOH’s efforts during the crisis have not only been domestically praised but also internationally recognised. They have been working constantly and consistently to ensure that Malaysians have among the best standards of healthcare in the world. All of us will help where we can.

We are taking a whole-of-government approach to the COVID-19 crisis. It is all hands-on deck. Every one of my Cabinet colleagues is involved in this effort to get us through this pandemic.

On the question as to why I am involved, I co-chair the JKJAV with Health Minister, YB Dato’ Seri Dr Adham Baba. MOSTI is also involved in vaccine negotiations as the ministry in charge of biotechnology. The Malaysia Genome Institute under MOSTI is producing whole genome sequencing and bioinformatics analysis to detect mutations in the genome from COVID-19 samples.

MOSTI is also in the midst of developing a National Vaccine Roadmap. The National Institutes of Biotechnology (NIBM), Malaysia under MOSTI is collaborating with multiple foreign research institutes in vaccine development R&D as well.

I continue to welcome questions and queries on this important national endeavour.

KHAIRY JAMALUDDIN

30 NOVEMBER 2020

https://www.khairykj.com/statements/press-statement-in-reply-to-ronnie-liu

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

Episode 5: CYCLING IN SINGAPORE TOUR WITH GOPRO HERO 9 Health benefits of regular cycling
Health benefits of regular cycling

Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.

The health benefits of regular cycling include:
increased cardiovascular fitness
increased muscle strength and flexibility
improved joint mobility
decreased stress levels
improved posture and coordination
strengthened bones
decreased body fat levels
prevention or management of disease
reduced anxiety and depression.
Back to top
Cycling and specific health issues

Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control

Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.

Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.

If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.
Cardiovascular disease and cycling

Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.

Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.
Cancer and cycling

Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.
Diabetes and cycling

The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling

Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.

Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling

Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.

Health benefits of regular cycling

Cycling is mainly an aerobic activity, which means that your heart, blood vessels and lungs all get a workout. You will breathe deeper, perspire and experience increased body temperature, which will improve your overall fitness level.

The health benefits of regular cycling include:
increased cardiovascular fitness
increased muscle strength and flexibility
improved joint mobility
decreased stress levels
improved posture and coordination
strengthened bones
decreased body fat levels
prevention or management of disease
reduced anxiety and depression.
Back to top
Cycling and specific health issues

Cycling can improve both physical and mental health, and can reduce the chances of experiencing many health problems.
Obesity and weight control

Cycling is a good way to control or reduce weight, as it raises your metabolic rate, builds muscle and burns body fat. If you’re trying to lose weight, cycling must be combined with a healthy eating plan. Cycling is a comfortable form of exercise and you can change the time and intensity – it can be built up slowly and varied to suit you.

Research suggests you should be burning at least 8,400 kilojoules (about 2,000 calories) a week through exercise. Steady cycling burns about 1,200 kilojoules (about 300 calories) per hour.

If you cycle twice a day, the kilojoules burnt soon add up. British research shows that a half-hour bike ride every day will burn nearly five kilograms of fat over a year.
Cardiovascular disease and cycling

Cardiovascular diseases include stroke, high blood pressure and heart attack. Regular cycling stimulates and improves your heart, lungs and circulation, reducing your risk of cardiovascular diseases.

Cycling strengthens your heart muscles, lowers resting pulse and reduces blood fat levels. Research also shows that people who cycle to work have two to three times less exposure to pollution than car commuters, so their lung function is improved. A Danish study conducted over 14 years with 30,000 people aged 20 to 93 years found that regular cycling protected people from heart disease.
Cancer and cycling

Many researchers have studied the relationship between exercise and cancer, especially colon and breast cancer. Research has shown that if you cycle, the chance of bowel cancer is reduced. Some evidence suggests that regular cycling reduces the risk of breast cancer.
Diabetes and cycling

The rate of type 2 diabetes is increasing and is a serious public health concern. Lack of physical activity is thought to be a major reason why people develop this condition. Large-scale research in Finland found that people who cycled for more than 30 minutes per day had a 40 per cent lower risk of developing diabetes.
Bone injuries, arthritis and cycling

Cycling improves strength, balance and coordination. It may also help to prevent falls and fractures. Riding a bike is an ideal form of exercise if you have osteoarthritis, because it is a low-impact exercise that places little stress on joints.

Cycling does not specifically help osteoporosis (bone-thinning disease) because it is not a weight-bearing exercise.
Mental illness and cycling

Mental health conditions such as depression, stress and anxiety can be reduced by regular bike riding. This is due to the effects of the exercise itself and because of the enjoyment that riding a bike can bring.