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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#蔡壁如 太后,你的論文抄襲也被起底了
踢爆蔡壁如碩士論文抄襲
翁達瑞 / 美國大學教育
李眉蓁的碩士論文抄襲鬧得沸沸揚揚,民眾黨不分區立委蔡壁如也跟著起哄。奇怪的是,蔡壁如輕縱李眉蓁,卻把矛頭指向蔡英文與陳其邁。蔡壁如道貌岸然的在臉書貼長文,對蔡英文和陳其邁說教,主題就是「學術倫理」。
有句西諺這麼說:「住玻璃屋的人不要亂丟石頭!」台灣人也有一個說法:「刮別人鬍子前,請先把自己的鬍子刮乾淨!」蔡壁如顯然缺乏這兩句話的智慧!為什麼呢?
因為蔡壁如自己的碩士論文也涉及「抄襲」,而且罪證確鑿!
蔡壁如碩士論文的英文摘要,有一大段抄襲自谷歌翻譯。蔡壁如明知抄襲不對,所以故意重組某些句型,為的是逃避抄襲軟體的偵測。蔡壁如騙得了電腦,但騙不了我這位資深學者。
以下是我就「壁如版」與「谷歌版」的文詞比對,證明蔡壁如的碩士論文涉及抄襲。我只舉一個例子,那就是蔡壁如論文摘要第二段的第一句:
「在眾多社群媒體中,臉書對於政治人物而言,為一個重要的政治行銷工具,不僅可以和選民達成充分的互動以建立自我的支持社群,同時亦能觀察議員關心的議題。」(附圖一)
這個句子在「壁如版」的翻譯如下:
「For politicians, Facebook is a very good political marketing tool. It can not only reach full interaction with voters, but also build self-supporting communities and observe issues of concern to Members. 」(附圖二)
同一個中文句子,「谷歌版」的翻譯如下:
Among the many social media, Facebook is an important political marketing tool for politicians. It can not only reach full interaction with voters to build a self-supporting community, but also observe issues of concern to members.(附圖三)
接著我來比對「壁如版」跟「谷歌版」的文詞:
1、兩個版本都把一個中文句子拆成兩個,而且兩個版本也都把議員翻為「members」。這不是巧合,而是抄襲。
2、「壁如版」刪除「谷歌版」的「Among the many social media」,接著把「important」改為「very good」,即便中文的用詞是「重要」,不是「很好」。另外,「壁如版」又把句尾的「for politicians」拿到句首。這些更動都是為了逃避抄襲軟體的偵測。
3、在下一個英文句,「壁如版」幾乎全部照抄「谷歌版」,只是把「but also」從最後一個動詞「observe」挪到之前的另一個動詞「build」。除此之外,兩個句子「一摸一樣」。
4、中文「自我的支持社群」,英文的「self-supporting community」是錯誤的翻譯。結果「壁如版」與「谷歌版」不約而同犯了相同的錯誤。這不是巧合,而是抄襲。
5、為了逃避抄襲軟體偵測,「壁如版」又把「谷歌版」的「a self-supporting community 」改為「self-supporting communities」。這才是柯文哲說的「脫褲子放屁」,因為兩者的語意完全一樣。
6、因為上述的句型更動,「壁如版」的翻譯反而沒有「谷歌版」忠實。這在學術界有個說法:「倒水連盆裡的嬰兒一起倒掉了!」
所謂的學術抄襲,就是剽竊他人的詞句據為己有,沒有交代引述來源。這是學術不誠信,欺騙、誤導讀者。蔡壁如不是不能引用谷歌翻譯,但必須加註「英文摘要取材自谷歌翻譯」。問題是,這麼加註就無法通過口試,因為論文必須是學生自己的作品,包括中英文摘要。
短短的摘要就有這麼多問題,我不敢想像整本論文的品質。從這段抄襲的句子,我看到一個「又懶、又壞、又沒格調」的作弊學生。懶在用最方便的方式作弊;壞在用盡心機掩飾作弊;沒格調在抄襲谷歌翻譯作弊。
不過我還是要說:「蔡壁如偷吃還會擦嘴!」這種「明知故犯」的抄襲反而更可惡,因為會「擦嘴」的人知道「偷吃」不對。但不管蔡壁如怎麼擦嘴,都掩飾不了她罪證確鑿的抄襲行為。
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醫者有社會責任去保障公眾健康,我們認為梁卓偉教授和陳家亮教授作為香港兩所醫學院院長責無旁貸。因此,我們呼籲所有醫護人員參與連署,懇請兩位院長履行社會使命發表聲明保障社會大眾的健康和人身安全。
連署連結: https://forms.gle/teMGNCiZPMYatVbh8
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《致香港大學李嘉誠醫學院院長、中文大學醫學院院長的公開信》
梁教授、陳教授道鑒:
有鑑於在六月十二日、七月二日及二十一日,香港警察濫用武力以控制群眾。如此行徑實對公眾健康遺害無窮,我們一眾醫療人員對此極為關切。作為香港大學李嘉誠醫學院院長、中文大學醫學院院長,吾等懇請兩位院長細察香港警察控制群眾之手段,以保障公眾健康。
據多家本地及國際媒體報導,香港警察於六月十二日,發射多輪催淚彈、橡膠子彈及布袋彈,以驅散聚集在金鐘的示威者。報導提及,警方向示威者發射至少一百五十枚催淚彈,二十輪布袋彈以及數枚橡膠子彈,造成至少七十二人受傷。從多家媒體直播可見,橡膠子彈更直射一名教師眼球,創傷嚴重,對其視力之損害非同等閒。另外,警方亦曾以數枚催淚彈包抄示威者,堵塞其退路;而當示威者被逼退守至中信大廈,警方竟朝人群中央投以催淚彈,造成數以百計的市民受傷及呼吸困難,生死攸關,不容小覷。此外,警方向一名手無寸鐵的市民,近距離發射橡膠子彈,以致其下腹嚴重受傷,情況慘不忍睹。
據多份醫學期刊綜述──如《刺針》(Lancet)[1] 及英國醫學期刊(BMJ (Open))[2],橡膠子彈乃可致命武器。同時,橡膠子彈不易操控,準確性低,有引致重傷,乃至死亡之風險。多份期刊不約而同指出,橡膠子彈不適宜用於密集人群之管制。
然而,香港警察漠視上述已知風險,仍於七月二日及七月二十一日繼續使用此類武器。在七月二十一日,警察更於鄰近民居之地,向群眾發射多輪催淚彈及橡膠子彈,當中更殃及記者。此等武器之禍害影響深重,不單有損呼吸系統,更會導致燒傷、嚴重鈍物創傷及爆炸性創傷。據媒體報導,武器造成至少十四人受傷;更有市民懼於警方之搜捕行動,而未敢求醫,致使受傷數字難以估算。
人權醫療組織(Physicians for Human Rights)醫生哈爾(Dr Rohini Haar)在接受紐約時報訪問時指出,警方對市民使用不成比例的武力,實有濫用武力之嫌。早在二零一四年,潘冬平教授[3]亦對香港警察使用催淚氣體情況深表關注,擔心催淚氣體損害市民呼吸系統。可見,催淚彈、橡膠子彈及豆袋彈等武器危害不輕,對香港市民公眾健康的損害不容置疑。
兩大醫學學院一直致力培育杏林菁英,不遺餘力。一眾醫療人員亦謹承《希波克拉底誓詞》之教誨,不論病患身份職要,一直為全人類之福祉著想,嚴守不懈。學院循循善誘,吾等縷心刻骨。誓詞薪火相傳,代代不息;缺少對生命健康之尊重,醫療人員何以自立?故此,我們一眾醫療人員懇請院長,發表聲明,呼籲香港警察:
一、避免濫用催淚彈及任何類型子彈,以免導致人命傷亡及其他不可見之損傷。
二、在使用武力時,必須顧及市民安全,並保持專業克制。
醫療人員一直存仁心,行仁術;保護市民之健康,乃至生命,吾等責無旁貸。院長為學為醫,高風峻節,茍以吾等同心同德,捍衛市民之生命健康,必見杏林春暖。
謹祝
道安
一眾醫療人員謹上
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Dear Professor Leung and Professor Chan,
We are a group of healthcare professionals, some of us being also graduates from the Faculty of Medicine of the University of Hong Kong and the Chinese University of Hong Kong. We are writing to express our gravest concerns over the persistent and serious threats to the health of members of the public posed by weapons deployed in crowd control by the Hong Kong Police Force (HKPF) on 12 June, 2 July and 21 July. We hereby urge the Deans of the sole Faculties of Medicine in Hong Kong to take actions in censuring the HKPF and the Hong Kong Government against the serious health risks in their crowd-control tactics.
On 12 June, as reported by multiple local and international news agencies, the HKPF fired multiple rounds of tear gas, rubber bullets and bean-bag rounds to disperse protesters in Admiralty. Over 150 canisters of tear gas, 20 bean-bag rounds and several rubber bullets have admittedly been directed at protestors which resulted in at least 72 injuries. As evident in the live reports from various media sources, a teacher suffered traumatic ocular injury causing significant vision loss when his eye was hit by a rubber bullet; hundreds of citizens suffered various degrees of injuries and respiratory distress consequential upon the numerous tear gas canisters shot at Citic Tower in Admiralty where protesters were trapped in a life-threatening space filled with tear gas; an unarmed man sustained injury in his lower abdomen when a rubber bullet was directed at him in a short distance.
According to multiple studies and reviews from high impact factor medical journals, in particular the Lancet[1] and BMJ (Open)[2], rubber bullets can be lethal. Their notorious inaccuracy and risk of severe injury and death render them inappropriate and unsafe means of force in crowd control.
However, despite the known risks of these weapons, the HKPF tenaciously deployed them on citizens on 2 July and 21 July. On 21 July, 55 canisters of tear gas, 5 rubber bullet rounds and 24 sponge bullets were admittedly shot, some without immediate warning, at protestors and even at journalists notwithstanding the numerous residential buildings and citizens in the vicinity. The use of these weapons has left members of the public with at the very least, various types of injuries and further, burns, blunt force trauma and explosive injuries. 14 injuries have by far been reported where others did not present themselves to the hospital in fear of the risk of prosecution.
Dr Rohini Haar of Physicians for Human Rights had in a recent interview told the New York Times that the force used by the HKPF was disproportionate and excessive. In Hong Kong, Professor Ronnie Poon had as early as in 2014 expressed openly his earnest concern over both the short term and long term health risks in the use of tear gas in particular to one’s respiratory system when the HKPF first fired tear gas at Hong Kong citizens [3]. It is indisputable that these named weapons put the health of Hong Kong citizens at serious risks.
Doctors have striven to stand by the Hippocratic oath that they remain members of society, the identity of which comes before their profession, with special obligations to all fellow human beings. The two medical schools in Hong Kong have been established accordingly for the nurture of healthcare professionals to serve the public with benevolent hearts and minds. This is the time to honour our oath that human life should deserve the utmost respect and to maintain by all means such noble traditions of the medical profession.
We, as healthcare professionals, therefore implore the Deans of the only Faculties of Medicine in Hong Kong, in the service of humanity with conscience and dignity, to take the lead in safeguarding the public’s health and to issue a statement to urge the Hong Kong Police Force to:
(1) refrain from using tear gas and bullets in any form on protestors to prevent further bloodshed and severe non-reversible injuries; and
(2) exercise due restraint over the use of force when handling protests and at all times, put the safety of Hong Kong citizens at the highest priority.
Regards,
A group of healthcare professionals
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Healthcare professionals have a social responsibility to safeguard the health of members of the public. We believe that, as Deans of the faculties of medicine in Hong Kong, Professor Leung and Professor Chan bear a paramount obligation in this regard. We appeal to all healthcare professionals to join us in this petition to urge the deans to issue a statement to honour their obligation to defend the public from health risks.
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Petition Link: https://forms.gle/teMGNCiZPMYatVbh8
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參考資料/References
[1] Mahajna, A., Aboud, N., Harbaji, I., Agbaria, A., Lankovsky, Z., Michaelson, M., . . . Krausz, M. M. (2002). Blunt and penetrating injuries caused by rubber bullets during the Israeli-Arab conflict in October, 2000: A retrospective study. The Lancet, 359(9320), 1795-1800. doi:10.1016/s0140-6736(02)08708-1
[2] Haar, R. J., Iacopino, V., Ranadive, N., Dandu, M., & Weiser, S. D. (2017, December 01). Death, injury and disability from kinetic impact projectiles in crowd-control settings: A systematic review
[3] Professor Ronnie Poon Facebook: https://www.facebook.com/138599119760/posts/10152753050039761?s=1014598371&sfns=mo
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