愈窮愈多病,愈富愈健康

研究﹕愈窮愈多病 收入低求診愈少

【明報專訊】港大一項研究顯示，家庭收入愈低者，出現慢性疾病的問題愈多，亦更不快樂；研究同時顯示，愈窮、存在健康問題最多的基層人士，享有的醫療服務反而最少。學者建議政府做好基層醫療系統，令基層獲得足夠醫療保障。

窮人血壓較高

港大公共衛生學院於2009年開展為期5年的「愛+人」全港住戶研究，是次研究抽樣調查了8355戶。研究顯示，每月家庭收入每增加1萬元，受訪者平均收縮壓（上壓）及舒張壓（下壓）分別下降1.3及0.18毫米水銀柱（mmHg）。一般人上下壓不應高於140及90，研究顯示，收入高於6萬元者平均為123及78的「標準水平」，但收入少於3000元者則平均達140及81。

月入少於1萬 平均患1.1種病

研究同時顯示，家庭收入低於1萬元的家庭中，每人平均患有1.1項慢性疾病，而月入高於3萬元的家庭人均患0.4項。雖然疾病較多，但收入愈少，求診次數愈少。若同時分析往公立醫院及私立醫院求診數字，則可發現基層往公立醫院求診比例與其患病數目相若，但患病較少的有錢人，往私院求診的次數卻與疾病數目成反比。

學者籲改善基層醫療措施

港大社會醫學系系主任梁卓偉指出，以上疾病及求診數字，正正印證了「逆向照顧法則」，即最窮最多健康問題者享有的醫療服務愈少，而當醫療護理服務最受市場力量影響時，情況會愈明顯。他指出，雖然結果顯示貧窮會影響健康，但暫時未有象顯示貧富不均會加劇這情況。

他認為政府應防患於未然，加強公私營合作、醫療券等基層醫療措施。

(明報6.1.2013)

City's poor get sick, the rich get drunk

For the second year in a row, a Fairfax Media analysis of health statistics has found residents of some of the northern suburbs are the healthiest when it comes to everything but alcohol use.

Hospitalisations linked to alcohol use were highest in the wealthiest parts of Sydney, with Manly having a higher rate than any other local government area for the second year in a row, and Sydney, Mosman, Hunters Hill and North Sydney were not far behind.

The figures, from Health Statistics NSW, show the problem is getting worse. In all but Hunters Hill the rate of hospitalisations increased between 2009 and 2011.
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The hospitalisations are linked to long-term alcohol use, and include only residents of those suburbs - not people who visit them to drink.

The analysis reveals stark differences in the health of the rich and poor in Sydney, with almost all the highest rates of deaths and hospitalisations linked to conditions such as diabetes, body mass and heart disease clustered in the poorest areas.

The director of Curtin University's public health advocacy institute, Mike Daube, said the analysis showed we were developing a two-tiered health system.

''The haves have better health and the have-nots have poorer health and live shorter lives,'' Professor Daube said. ''This isn't a coincidence; this fits with everything we know about patterns of health and

it really does show that good health is essentially the preserve of the most affluent.''

Once again Campbelltown, which is the second-poorest local government area in Sydney according to Bureau of Statistics rankings, was found to be Sydney's most unhealthy area.

It was in the worst-performing areas in every category except alcohol-related hospitalisations.

More than a quarter of all women in Campbelltown smoke during pregnancy, compared with about 1 per cent in Willoughby, Sydney's healthiest area.

But Fairfield did far better than its ranking as the poorest local government area in Sydney would suggest, managing to avoid being among the worst performers in any category.

Professor Daube said the figures showed a huge number of hospital stays were linked to preventable, lifestyle-related conditions.

''The preventable health problems are putting massive pressures on a health system that is already heavily stretched,'' he said. He was concerned that the state government had cut funding for anti-smoking campaigns while such high smoking rates were still being seen.

He said it was clear alcohol did not respect social status, and governments were unwilling to tackle the problem.

The chief executive of the Foundation for Alcohol Research and Education, Michael Thorn, said more needed to be done to find out why alcohol hospitalisations were affecting wealthy areas.

''Age could have an impact,'' he said. ''It's one of these sort of unspoken things that we target young kids drinking … but we certainly know that wealthier people and older people are consuming a lot.''

The foundation's annual poll showed that people aged over 40 drank more regularly than younger people, who tended to have between two and four days off in a week.

''We know from looking at total alcohol consumption in a year that people in their 20s and 30s ease off, that's driven in part by economics and family considerations … and then they certainly take it up again as they get older,'' Mr Thorn said.

(Sydney Morning Herald 6.1.2013)

無獨有偶，明報和Sydney Morning Herald今天都分別報導香港和悉尼的現象：愈窮愈多病，愈富愈少病。悉尼的富人比窮人健康，唯獨是為了杯中物才至提高入醫院的比率。

壓力是生病的最大誘因，為囗奔馳，胼手胝足，也不能應付基本生活所需，就好像長途賽跑，愈跑愈落後，愈來愈窮，任憑鬥志幾頑強，根本沒有希望，又怎樣鬥下去?

現在的有錢人比以前聰明，健康意識比以前強，飲食也節制多了，少吃junk food ，不攝取過量糖、鹽及脂肪，病痛自然較少。

如果因壓力致病，基本上是貧窮之哀，若因飲食習慣不良而搞壞身體，絕對不值得。不良飲食，當然是吃junk food、抽煙和飲酒。有些人總是說，甚麼都不能吃，還有人生樂趣嗎？坦白講又不是易牙妙手的烹調，大部分都是味精主導的食物，不見得有吸引之處。很多身軀龐大的人，就是這些美國式廉宜飲食的成果，食物總缺乏新鮮蔬果。到Costco買東西，往往見到肥胖的人購物車中放著十分抵買的大pizza、大蛋糕。那種蛋糕，一個就相等於我幾個月的耗糖量，想起也不寒而慄。有人誤以為我很懂得煮和吃，事實上並非如此。我吃得簡單，只會在請客時才花點心思，那是對客人的尊重。

講到抽煙，我絕對有資格講，我幾乎甚麼煙都抽過。由鼻煙壺倒在掌心，用尾指挑一點放在鼻孔索的鼻煙，以水過濾煙油的水煙，煙斗、捲煙,、雪茄和香煙，我都抽過，全部都是臭煙。十七、八世紀以後，已沒有人講吸煙有好處，其實吸煙一無是處。戒煙事在人為，我二十幾年前玩夠了，就一直沒有再抽過。至於飲酒，無論有甚好處，不飲有沒有壞處呢？我不認同飲紅酒的益處，就算有，也不見得抵得過它的害處。有很多研究飲紅酒有益的資金來自酒商，結論偏頗。總之，自己可以控制得到的飲食，要好自為之。不論貧富，長壽而多病，值得嗎？