socioeconomic status health的八卦，Yahoo名人娛樂都在討論

[教育時評] Developing Empathy

為什麼同理於此時比以往任何時刻都重要？

同理(empathy)可以定義為從他人觀點理解感受他人所感的能力。這與同情(sympathy)不同，同情是對處於困境之人感到難過的感覺。在某些情況下，兩個術語有共同之處是因為同理是一種共鳴的關切，其中包括希望人們更好的渴望。

心理學家已辨識出不同種類的同理，主要為情感和認知兩種類型。情感同理心 (affective empathy)是指能分享他人感受的能力。它使我們能夠「鏡像」他人的感受並覺察他們的焦慮或恐懼。

認知同理心(cognitive empathy)，也稱為換位思考，是識別和理解他人感受的能力。有效的溝通需要情感同理心和認知同理心兩者，因為它們可以幫助我們建立情感連結並向受眾傳達信息。同理對於協作和領導力也很重要，因為一個人需要理解和預期他人的情感和行為，才能與之工作並帶領他們走向成功。

人們可以看到同理呈現在所有職業中。老師需要靠同理來理解和滿足學生的多樣化需求。研究表明，富有同理心的醫療人員的患者享有更好的健康狀況。警察需要同理來拉近與之打交道的人的距離，來減少以武力處理的狀況。想想當警察缺乏對示威者的同理時會發生什麼。

現在比以往任何時候都更需要同理心。身份政治，政府競爭，甚至是最近的健康危機，都在逐漸蠶食我們的同理心和同情心，導致更大的緊繃，分裂和衝突。社交媒體上有多少發文在強調相互幫助的需要，又有多少在傳播恐懼和仇恨？

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並非所有希望都已失去。我們仍可以懷有和培養同理心。我們可以試著練習：

1.積極傾聽 (Active listening)：傾聽並關注他人意見。不要只是簡單地摒除與自身不同的觀點。

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2.破除認同屏障(Shared identity)：了解與自己不同的人。與其只關注兩者間的差異，不如考慮自己與他們分享的共同點。想像自己如何能設身處地的換位思考。

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3.制止不平等和冷漠 (Combating inequality and indifference)：許多獲得較高社會經濟地位（socioeconomic status、SES）的人有時同理稍弱，因為他們較少有連結、依靠或與他人合作的需求。這並不意味所有富裕之人都對他人的需求漠不關心，但他們可能更需要去關注維持對他人的同理。

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4.閱讀與改變觀點 (Reading and changing perspectives)：研究表明，閱讀文學小說（例如《殺死一隻知更鳥》，《老鼠與男人》）著重於人物心理及其與世界的互動。這些書激發讀者理解角色的意圖和動機，且這種的意識可以被帶入現實世界。但是，我認為，所有書籍，即使是非小說類書籍（例如《安妮·弗蘭克日記》）也能做到這一點，讀者不應受到書本類型的限制。重點在以閱讀了解他人的思維方式，從他人的角度思考和「體驗」生活，並將所學應用在自己的生活中。

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因此，為協助學生發展同理這一重要能力，我決定在我們的粉專上發起一個全新的系列：翻轉視界 (Changing Perspectives)。除了定期發布的《時事英文》、《教育時評》和《學習資源》，我們還將分享來自世界各地的人們的故事，文章中會提供關鍵詞、翻譯並向你提出批判性問題以期能幫助各位從不同的角度解讀世界！但是，單單思考並不夠！希望你可以不僅通過閱讀來發展同理，也通過理解和與他人合作將同理應用到生活中來取得成功。

References

Bal, P. M., & Veltkamp, M. (2013). How does fiction reading influence empathy? An experimental investigation on the role of emotional transportation. PloS one, 8(1).

Kaplan, S. (2016, July 22). Does reading fiction make you a better person? The Washington Post. Retrieved from https://www.washingtonpost.com/news/speaking-of-science/wp/2016/07/22/does-reading-fiction-make-you-a-better-person/

Keen, S. (2007). Empathy and the Novel. Oxford University Press on Demand.

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Why is empathy more important now than ever?

Empathy can be defined as the capacity to understand feel what others experience from their perspectives. It differs from sympathy, the feeling of feeling sorry for someone in a difficult situation. In some instances, the terms overlap as sympathy is an empathetic concern, which includes the desire to see people better off.

Psychologists have identified different types of empathy, two main types being affective and cognitive. Affective empathy refers to the ability to share the feelings of others. It enables us to “mirror” what others feel and detect their anxiety or fears. Cognitive empathy, also known as perspective-taking, is the ability to identify and understand how others feel. Both are needed in effective communication because they help us build emotional connections and relay information to our audiences. Empathy is also essential for collaboration and leadership as one needs to understand and anticipate the emotions and behaviors of others to work with them and lead them to success.

One can see empathy present in all professions. Teachers need it to understand and meet the diverse needs of students. Research shows medical workers high in empathy have patients who enjoy better health. The police need it to feel less distant from people they are dealing with and defuse situations with less physical force. Think about what happens when the police lack empathy with protestors.

Empathy is needed more than ever now. Identity politics, government rivalry, and even the latest health crisis are gradually stripping us of our empathy and compassion, leading to greater tension, division, and conflict. How many posts on social media highlight the need to help one another, and how many spread fear and hate?

Not all hope is lost. We can still nurture and cultivate empathy. We can practice:

1. Active listening: Listen and be mindful of the opinions of others. Don’t merely dismiss every viewpoint different than your own.

2. Shared identity: Learn about people who are different from you. Rather than focus only on the differences, think about what you have in common. Imagine what you would do in their situation.

3. Combating inequality and indifference: Many who have attained higher socioeconomic status (SES) sometimes have diminished empathy because they have less of a need to connect with, rely on, or collaborate with others. This does not mean that all wealthy individuals are indifferent to the needs of others, but they might need to be more mindful about maintaining empathy towards everyone.

4. Reading and changing perspectives: Research shows that reading literary fiction (e.g., To Kill a Mockingbird, Of Mice and Men) focuses on the psychology of characters and their interaction with the world. These books motivate readers to understand character intentions and motivations, and such awareness can be carried into the real world. However, I personally believe that all books, even non-fiction (e.g., the Diary of Anne Frank), can do the same, and readers should not be restricted by the genre. The point is to read to understand the mindset of others, to think and “experience” life from their perspectives, and to apply these lessons to your own life.

Thus, to help students develop empathy, I have decided to launch a new series on our page: Changing Perspectives (翻轉視界). In addition to our regular posting of News English, Opinions in Education, and Learning Resources, we will share stories of people from around the world, provide key words, translations, and ask you critical questions to help you view the world from other perspectives! However, thinking is not enough! Develop empathy through reading but also apply it to your lives by understanding and working with others to achieve success.

References

Bal, P. M., & Veltkamp, M. (2013). How does fiction reading influence empathy? An experimental investigation on the role of emotional transportation. PloS one, 8(1).

Kaplan, S. (2016, July 22). Does reading fiction make you a better person? The Washington Post. Retrieved from https://www.washingtonpost.com/news/speaking-of-science/wp/2016/07/22/does-reading-fiction-make-you-a-better-person/

Keen, S. (2007). Empathy and the Novel. Oxford University Press on Demand.

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圖片出處：https://bit.ly/2JUYzA9

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tl;dr: View the world from different perspectives. Have empathy and be nice.

教育時評: http://bit.ly/39ABON9

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

【公共衛生系列 -- 最新研究結果】

我與我的博士生及研究團隊用了1976年至2010年的死亡數據分析的最新研究結果！請細閱／廣傳！

《香港因不同社會經濟地位在死亡風險上所存在的差距在高速經濟發展下有拉闊的現象：1976年至2010年的年齡、時段及出生年代分析》

重點：
• 死亡率在兩性別中都呈下落現象，並通常在較低社會經濟地位的群組裏較高。
• 各種死因的死亡風險因不同社會經濟地位而存在的差距在1930-40年代出生的群組首先出現。
• 至今，香港的死亡風險因不同社會經濟地位而存在的差距隨著時間不斷拉闊。
• 死亡風險的變化與戰後的高速經濟發展有重合的地方。
• 高速經濟發展為人口健康帶來的益處在較高社會經濟地位的群組相對較低社會經濟地位的群組明顯。

概略：
目的：香港為二戰後全球最快的經濟發展體系之一。與此同時，死亡風險也在過去幾十年出現大幅度的下落。然而死亡風險的跨代趨勢與社會經濟地位之間的關係仍有待探討。

方法：我們將1976年至2010年的死亡數據用地區性社會經濟地位分類並進行了一系列有關年齡、時段及出生年代的分析 ，從而檢察出生年代如何影響社會經濟地位。研究探討包括所有死因的整體死亡率和不同死因的分類數據，包括缺血性心脏病、其它心血管疾病、肺癌、其它癌症、呼吸道疾病、其它醫療疾病和其它死因。

結果：年齡標準化死亡率在兩性別中都呈下落現象，並通常在較低社會經濟地位的群組裏較高。各種死因的死亡風險因不同社會經濟地位而存在的差距在1930-40年代出生的群組首先出現並於之後年代出生的群組裏持續拉闊。這些研究結果反映死亡風險在較低社會經濟地位群組裏的跨代下落幅度未及在較高社會經濟地位群組中所見的高。

結論：經濟發展為健康所帶來的益處也因社會經濟地位而異，較高社會經濟地位群組所受益處較多。因此，我們應更多關注在戰後嬰兒潮出生並徘徊在較低社會經濟地位的人士。

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"Socioeconomic disparity in mortality risks widened across generations during rapid economic development in Hong Kong: an age-period-cohort analysis from 1976 to 2010"

Highlights:
• Age-standardized mortality was generally higher in those of lower socioeconomic status (SES) and declined in both sexes.
• Greater mortality risks for people of lower SES emerged because of the cohorts born in 1930s-1940s.
• Socioeconomic disparity of mortality risks continued to widen till recent cohorts.
• The changes of mortality risks coincided with one of the fastest postwar economic developments.
• Health benefits brought by rapid economic development were greater for people of higher SES.

Abstract:
Purpose
Hong Kong has been one of the fastest growing postwar economies with substantial decline in mortality risks during the past decades. Nevertheless, it is unclear whether there is a socioeconomic disparity in the trends of mortality risks across generations.

Methods
We conducted a series of sex-specific age-period-cohort analyses by neighborhood-level socioeconomic status (SES) using mortality data from 1976 to 2010 to examine the socioeconomic disparity of cohort effects. Outcomes included all-cause mortality and mortality from ischemic heart disease, other cardiovascular diseases (CVD), lung cancer, other cancers, respiratory diseases (RD), other medical causes, and external causes.

Results
Age-standardized mortality rates declined in both sexes, with generally higher rates observed in those of lower SES. Socioeconomic disparity in the risks of all mortality outcomes emerged and widened starting from cohorts born around the 1930s-1940s. These results suggested that mortality risks associated with lower SES did not decline across generations as much as those associated with higher SES.

Conclusions
The share of health benefits brought by economic growth was notably unequal by SES with greater benefits for those of higher SES. More attention should be paid to postwar baby boomers of lower SES.