關於 primary health care course ，我們在網路上蒐集到這些相關的討論、資訊與評價

- Chữa đề Writing thật tiếp theo thôi cả nhà ơi - Đề số 10 nhé: Some people think it is more important to spend public money on promoting a healthy lifestyle in order to prevent illness than to spend it on the treatment for people who are already ill. To what extent do you agree or disagree?

Bài mẫu:

The state spending on public health has become a widely perpetual concern. Some individuals argue that these already scarce resources should be reserved for the prevention of lifestyle-related illness. In my opinion, the government should focus more on the prevention of illnesses rather than medical treatment.

On the one hand, certain acute diseases, non-preventable regardless of governmental efforts to promote a healthy lifestyle, still need a state budget allocation for medical care. One of the primary duties of the government is to provide publicly funded healthcare to the whole population. Therefore, covering therapeutic and medical costs for those already developing symptoms of acute conditions would be a significant part of that duty, helping mitigate the financial burden associated with those maladies. In other words, a dearth of investment in treatment would be devastating patients’ individual life and wreaking havoc on overall social welfare.
On the other hand, promoting a healthy lifestyle as a prevention strategy is meant to avoid the entire economic burden of chronic diseases, affecting a significant proportion of the population. Those conditions, occurring across different life course stages, share common preventable risk factors relating to unhealthy behaviors, including poor nutrition, inadequate physical activity, and chronic heavy drinking and smoking. If left unchecked, trends in chronic diseases risk factors combined with a growing and aging population will increase the numbers of people living with chronic conditions, later causing the heavy burden of illness in patients, their families, and the community. Therefore, given a scarcity of state budgets for various public services, the government should directly provide information, including health education campaigns, or regulating information, such as limits on advertising and guidelines on food labelings. As a result, positive changes in individual lifestyle would follow, helping them withstand the ravages of time, and saving the state budget for other economically beneficial needs, such as technological investment, education, and infrastructure, rather than spending on treatment.
In conclusion, while allocating its healthcare budget in treatment, the government should promote a healthy lifestyle to avoid preventable chronic diseases due to its economic rationality.
Words: 341

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Tháng 9 này, cùng IELTS Fighter Find your Fire - thắp đam mê, kệ Covid, học tập nâng cao kiến thức mỗi ngày nha. Các bạn cùng chờ đón cuộc thi Đại sứ IELTS Junior nè, Livestream học tập mỗi tuần và workshop online cho sinh viên siêu thú vị nữa nha. Theo dõi fanpage IELTS Fighter - Chiến binh IELTS để cập nhật thông tin nóng thường xuyên nhé.

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

Someone sent this to me. I agree. We cant keep using lockdowns to handle this situation. Poverty is on the rise.💙😌

-“ A CMCO on KL and Selangor is overkill. What happened to targeted lockdowns? We cannot be lurching from one lockdown to the next, especially for Klang Valley. Do mass testing with antigen RTK to quickly identify and isolate positive cases. (https://codeblue.galencentre.org/2020/10/12/klang-valley-lockdown-no-dine-ins-jogging-work-letter-needed-to-cross-kl-selangor-putrajaya/)

What is the justification for such a strict lockdown on the entire capital city and Selangor? Are we going to see police roadblocks throughout KL and Selangor like during MCO 1? The government must reverse this decision. It is a wholly disproportionate public health response.

With just 34 local Covid cases reported in KL within past 14 days as of yesterday, the govt shuts down the entire capital city? Putrajaya only has 13 cases. Selangor has 224 cases, but only two are red zones (Petaling - 53 cases, Klang - 82 cases).

A Klang Valley CMCO is completely irrational.

And news flash, economic sector can't continue if you prevent people from going out. And obviously we'll see Covid cases reported every day because we can never eradicate the virus until we get a vaccine. After lockdown is lifted, then Covid cases will go up again. Then what?

The MCO was supposed to buy us time to prepare the health care system for future outbreaks, NOT to eradicate the virus. What did we do for the past six months since MCO in March? Are you saying we didn't prepare enough?

WHO has warned against using lockdowns as a primary means of controlling the virus, stating it could have a dramatic impact on poverty. What exactly do you hope to achieve with a Klang Valley lockdown? Slow the virus transmission to prepare some more? Aren't we already prepared?

The government has repeatedly said, as recently as less than a week ago, that our health care system is prepared for Covid outbreaks. So what on earth is the justification for a Klang Valley CMCO that generally prohibits people from leaving home except for work/ buy necessities?

PM said May 1 that it’s impossible for any country to hit zero Covid cases. Ismail Sabri repeated this point on Oct 3. What I want to know is — what exactly is a tolerable number of daily Covid cases in a district for the govt? 20? 50? 100? Or nationwide — 200? 500? 1,000?

MOH claims that they advised a Klang Valley CMCO to prevent yellow zones from turning red, as various districts are recording new cases every day. Well, of course we'll see Covid infections daily; that's the nature of the disease. The old govt narrative (which it has since discarded) during the early days of the RMCO of less than 50 daily cases, or even ZERO cases a day, made absolutely no sense.

With increased testing, we’ll naturally pick up more cases. The more you test, the more you get. Important thing is to expand testing so that we detect and isolate infectious people quickly. So it doesn’t matter even if we record hundreds of cases, as long as we isolate quickly.

Now police are saying they'll mount roadblocks in the same way like the first MCO in March. So is this CMCO or MCO 1? Expect huge traffic jams in Klang Valley if the cops are gonna check each car for an employment letter to get to work. And if authorities are going to treat Klang Valley CMCO like MCO 1, expect to see the repeated hurdles to seeking medical treatment that cancer patients previously suffered, not to mention postponed appointments for regular medications from clinics for those with chronic conditions like diabetes and high blood pressure. (https://www.malaymail.com/news/malaysia/2020/10/12/cmco-police-to-mount-roadblocks-again-in-kl-selangor-putrajaya/1912050)

I'm sorry to say, but Malaysia's Covid public health policies since the Sabah election were an absolute shambles. No restriction of peninsula-Sabah travel during the election, either for politicians/ campaigners/ voters (the EC could have allowed outstation voters to vote in peninsular stations; they didn't). No enforcement of SOPs on any campaign rally during the election. No mandatory 14-day quarantine upon return from Sabah. No significant expansion of testing -- either RT-PCR or rapid antigen tests.

And before the election, no prosecution of lawmakers who clearly (and even admitted themselves) broke SOPs, including mandatory quarantine. I don't think enforcers even checked government premises to see if they follow the SOPs that they enforce on private citizens and businesses, like MySejahtera check-ins, provision of hand sanitizers, or wearing face masks. Visit government offices in Putrajaya and see how many actually comply with SOPs. Parliament doesn't mandate MySejahtera and hardly provides any hand sanitizer throughout the entire building.

The government also ignored repeated warnings from medical professionals and civil society about prison and detention centre outbreaks. Worse, enforcers even dragged people to police stations and made them wait in crowded and congested areas just to receive their saman. The Sabah surge came from cases first reported on Sept 1 in the Lahad Datu police lock-up and Tawau prison.

And now suddenly, wham, a two-week lockdown on the entire Klang Valley, even though the country's main Covid hospital, Sungai Buloh Hospital, is located in Selangor, not to mention the many other tertiary hospitals in the Klang Valley. Of all places, Klang Valley has the best public health care system. How can Klang Valley not be prepared for a Covid outbreak?

People may be allowed to go to work during the CMCO, but what about small businesses and roadside stalls? Only privileged white collar workers can afford to work from home. And only lawmakers and civil servants can go through any lockdown without worrying about next month's salary.
Boo Su-Lyn (no idea who that is)

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[WHY HONG KONG HAS THE LONGEST LIFE EXPECTANCY?]

50.1 years. According to the World Health Organization, this is the average life expectancy in the country of Sierra Leone. As of now, one of the lowest in the world.

At the other end of the spectrum, we have countries like Italy, Iceland, Singapore and Switzerland all with an average life expectancy well into their 80’s. Now beating all those countries however, is (of course) Japan, topping the list at 83.7 years. (Note that the UN data is a little different). Regardless, this is the country with the longest average life expectancy.

But, this video is not about Japan, because there is a city with an even longer life expectancy.

This is Hong Kong, a city with over 7.4 million people living on about a thousand square kilometres of land. One of the most densely populated places on the planet - a fast paced city that never sleeps.

It’s a city of contradictions with towering buildings next to lush green mountains, street food stalls alongside McDonald’s & KFC’s, markets selling cheap counterfeits in front of designer stores, but the most surprising perhaps is the extremely long life expectancy of the people living in what is one of the most polluted cities in the world.

Hong Kong has an average life expectancy of 84.3 years.

Ironically enough, Hong Kong literally translates to ‘Fragrant Harbour’.

This video will cover:
- Hong Kong weather and climate
- Londons' Great Smog of 1952
- Geographical access to good food
- Cuisine / diet
- Accessibility of walkways and footpaths
- Fitness and habits
- Taichi & Qigong
- Environment
- WHO global network of age-friendly cities
- Hong Kong's healthcare system / primary care / hospital treatment
- Smoking
- Strong family ties
- Mahjong
- Retirement age
- Many older generation Hong Kongers were not boring in China, but in Mainland China
- China's Cultural Revolution