Erenlai - Social Changes and Challenges 變動中的華人社會
Social Changes and Challenges 變動中的華人社會

Social Changes and Challenges 變動中的華人社會

Here are materials that examine and assess the current issues that are influencing the Pacific-Asian culture and society.

經濟發展所產生的變動已經全面衝擊了人們的生活型態與觀念。

 

 

 

Monday, 04 October 2010

Reducing the digital divide in Taipei County

Jason Wang, Chairman of the Research, Development and Evaluation Commission for the Taipei County Government, elaborates on their policy to bridge the digital divide in their area.

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Wednesday, 30 June 2010

照顧,不只是一種責任

一個人的失能就是全家人的責任,以平均家戶人口四人計算,目前台灣約有四成人口正承受長期照護的負擔;而讓照顧者在照顧他人時,也能擁有自我與尊嚴,則是社會與國家的共同責任。


Thursday, 13 August 2009

The Challenges of China Road Traffic Safety

Road traffic accidents are global public health problems that account for an estimated 1.2million deaths annually. Without increased efforts and new initiatives, the total number of road traffic injuries and fatalities worldwide is forecast to rise by 65% between 2000 and 2020, while in low and middle-income countries, road traffic fatalities are expected to increase by as much as 80% over the same period.

A World Bank working paper released this August states that China should constitute a priority for the World Bank Global Road Safety Strategy. According to China’s Ministry of Health (MOH), they had the highest number of road traffic fatalities in the world in 2003 (220,000), accounting for 18% of global road traffic fatalities, despite having less than 5% of the global vehicle fleet. Road Traffic Injury (RTI) is the primary cause of injury related death in China (2007).

The Chinese government has taken strong measures, such as the establishment of the Inter-Ministerial Road Safety Forum (October 2003), and the implementation of the Road Traffic Safety Law (May 2004). These measures helped to decrease, from 2005, the per capita rate of road traffic fatalities which account for 28% of all injury related deaths.

The economic cost of RTI was estimated by the Ministry of Health to be 0.40% of GDP in 2003, approximately 30% of this overall cost of injury. Despite this injury has not yet been established as a priority either by the Ministry of Health or the World Bank Health Sector. So the priority of injury should be included within the agendas of the WB, other International Organizations and the Chinese ministry of health alongside the current areas of Health Sector Reform, Emerging Infectious Diseases (e.g. Avian Flu) and Non-Communicable Diseases (e.g. Cardiovascular Diseases).

The World Bank should prepare for the upcoming Five-Year Plan period where they could take the lead in partnership with the WHO, working together with the Chinese Government to implement a more rapid response to the projected burden of road traffic fatalities and injuries.
Download the report on the World Bank website

Attached media :
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Wednesday, 20 May 2009

新流感来了─公卫体系武功已废,如何防疫

本文亦见于2009年6月号《人籁》论辨月刊


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H1N1新流感疫情在全球造成恐慌,曾经过SARS「洗礼」的台湾,如今是否更有能力对付传染疾病?面对疫情,我们真正该担忧的是什么?
----------------------------------------

站在防疫前端的公卫体系
H1N1新型流感疫情来势汹汹,勾起人们2003年SARS肆虐的惨痛集体记忆。许多人问:万一新型流感在台湾大流行,当年人心惶惶、社会无所适从的乱象会不会重演?经过整整六年的磨练增进,今天台湾是否能应付新流感的大流行?

SARS、新型流感或任何其他传染病,都是公共卫生的问题。为成功防治传染病,公卫体系必须及时做好比医疗还要更前端的、与社会力量结合的、有组织的社区防疫、卫生教育、疫情监测通报、调查、检验、居家隔离等等预防性防治工作。

前端的防治工作若没有做好,末端的医疗工作就会异常沉重。2003年SARS肆虐台湾之时,公卫体系无法及时防治,其根本原因乃在:台湾公卫体系已经废了原有的武功,它轻公卫重医疗、过度医疗化,医疗部门过度市场化及私有化。

那么,台湾的公卫体系在过去这六年中,是否已经恢复了它失去的武功?


轻公卫重医疗
首先,许多的变化显现,「轻公卫重医疗」与过度医疗化的问题不仅没有改进,实际上是不断恶化。

在SARS流行之前,台湾投入医疗保健的五千多亿资源中,仅有3%用在预防性公卫工作,其他90%以上都花在医疗。2003年SARS流行后,经费比例稍微上升到将近5%,但是之后又逐渐下滑:2007年,台湾投入医疗保健的经费多了将近八千亿,但还是只有3%左右是预防的经费。

2003年台湾的医疗人力是公卫人力的三十三倍,而2007年增加到三十六倍!因此,无论在经费及人力资源层面,两者简直有如侏儒与巨人!公卫体系最基层、最前线的机构──卫生所,这几年来虽然业务继续增加,人力及经费却不增反减。


过度市场化的医疗产业
其次,在医疗体系过度市场化、私有化方面,问题亦是变本加厉。2003年之前,私立医院无论是医院数、病床数或医事人员数都高高凌驾公立医院,这个差距在2003年之后继续扩大;财团不断的投入医疗产业,谋求利润。

而国家给与公立医院的补助额不断的大幅下降,逼迫公立医院自负盈亏,必须与私立医院争市场、搏利润。结果,公立医院形同私立医院,政府甚至乾脆将许多公立医院委托给财团或私立医院经营。

SARS的经验告诉我们,私立或是市场化的医院以利润为考量,而非以社会大众的健康维护为考量。在SARS流行期间,私人医疗院所为维护其利润而不接受疑似病患,或隐匿疫情,对防疫工作造成很大的阻力。

以此观之,我们对于台湾应付新型流感的能力,真是无法乐观。诚然,有关当局对此次新流感威胁的反应十分敏捷,他们的努力与辛苦有目共睹,而且台湾社会经历了SARS与禽流感后已经变得比较成熟。但是,如果上述体制性问题没有真正改进,我们实在担心现有的公卫体系,无法从容应付新流感的大流行。



更多关于新流感,请看

附加的多媒体:
{rokbox}media/articles/ChenMeiXia_swineflu.jpg{/rokbox}

Wednesday, 20 May 2009

新流感來了─公衛體系武功已廢,如何防疫

本文亦見於2009年6月號《人籟》論辨月刊


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H1N1新流感疫情在全球造成恐慌,曾經過SARS「洗禮」的台灣,如今是否更有能力對付傳染疾病?面對疫情,我們真正該擔憂的是什麼?
----------------------------------------

站在防疫前端的公衛體系
H1N1新型流感疫情來勢洶洶,勾起人們2003年SARS肆虐的慘痛集體記憶。許多人問:萬一新型流感在台灣大流行,當年人心惶惶、社會無所適從的亂象會不會重演?經過整整六年的磨練增進,今天台灣是否能應付新流感的大流行?

SARS、新型流感或任何其他傳染病,都是公共衛生的問題。為成功防治傳染病,公衛體系必須及時做好比醫療還要更前端的、與社會力量結合的、有組織的社區防疫、衛生教育、疫情監測通報、調查、檢驗、居家隔離等等預防性防治工作。

前端的防治工作若沒有做好,末端的醫療工作就會異常沉重。2003年SARS肆虐台灣之時,公衛體系無法及時防治,其根本原因乃在:台灣公衛體系已經廢了原有的武功,它輕公衛重醫療、過度醫療化,醫療部門過度市場化及私有化。

那麼,台灣的公衛體系在過去這六年中,是否已經恢復了它失去的武功?


輕公衛重醫療
首先,許多的變化顯現,「輕公衛重醫療」與過度醫療化的問題不僅沒有改進,實際上是不斷惡化。

在SARS流行之前,台灣投入醫療保健的五千多億資源中,僅有3%用在預防性公衛工作,其他90%以上都花在醫療。2003年SARS流行後,經費比例稍微上升到將近5%,但是之後又逐漸下滑:2007年,台灣投入醫療保健的經費多了將近八千億,但還是只有3%左右是預防的經費。

2003年台灣的醫療人力是公衛人力的三十三倍,而2007年增加到三十六倍!因此,無論在經費及人力資源層面,兩者簡直有如侏儒與巨人!公衛體系最基層、最前線的機構──衛生所,這幾年來雖然業務繼續增加,人力及經費卻不增反減。


過度市場化的醫療產業
其次,在醫療體系過度市場化、私有化方面,問題亦是變本加厲。2003年之前,私立醫院無論是醫院數、病床數或醫事人員數都高高凌駕公立醫院,這個差距在2003年之後繼續擴大;財團不斷的投入醫療產業,謀求利潤。

而國家給與公立醫院的補助額不斷的大幅下降,逼迫公立醫院自負盈虧,必須與私立醫院爭市場、搏利潤。結果,公立醫院形同私立醫院,政府甚至乾脆將許多公立醫院委託給財團或私立醫院經營。

SARS的經驗告訴我們,私立或是市場化的醫院以利潤為考量,而非以社會大眾的健康維護為考量。在SARS流行期間,私人醫療院所為維護其利潤而不接受疑似病患,或隱匿疫情,對防疫工作造成很大的阻力。

以此觀之,我們對於台灣應付新型流感的能力,真是無法樂觀。誠然,有關當局對此次新流感威脅的反應十分敏捷,他們的努力與辛苦有目共睹,而且台灣社會經歷了SARS與禽流感後已經變得比較成熟。但是,如果上述體制性問題沒有真正改進,我們實在擔心現有的公衛體系,無法從容應付新流感的大流行。



更多關於新流感,請看

附加的多媒體:
{rokbox}media/articles/ChenMeiXia_swineflu.jpg{/rokbox}

Wednesday, 20 May 2009

新流感來了─媒體譁眾膚淺,社會學習薄弱

圖片:電子顯微鏡下的H1N1型流感病毒
圖片來源/維基百科
本文亦見於2009年6月號《人籟》論辨月刊


----------------------------------------
H1N1新流感疫情在全球造成恐慌,曾經過SARS「洗禮」的台灣,如今是否更有能力對付傳染疾病?面對疫情,我們真正該擔憂的是什麼?
----------------------------------------

H1N1的威脅
因為對H1N1流感病毒的恐慌,許多地區的口罩被搶購一空。但是,其恐慌程度卻遠超過該疾病對台灣民眾可能的威脅程度。雖然H1N1的傳播速度很快,但是細心的人應該在4月下旬就可以發現它的死亡病例集中在墨西哥。

直到4月29日墨西哥累計176人死亡時,才傳出第一起境外的死亡病例,死者是墨西哥籍嬰兒,在美國探親。這個現象暗示著,除非是親自去墨西哥或接觸到從墨西哥回來的人,否則即使感染,其危害也應該不至於致命。

事實上,美國疾病管制局在5月1日表示,H1N1病毒不具備1918年H1N1的強傳染性基因片段,因此傳染力甚至比禽流感弱。


製造恐慌的媒體
5月2日,墨西哥公衛官員表示墨西哥的致死率已經開始下降。5月5日,大陸國家工程院院士鐘南山表示,甲型H1N1流感隔代傳染能力會明顯遞減:第一代患者傳給第二代患者時,毒性和傳染性都很強;第二代傳給第三代時會明顯減弱;到了第三代,患者基本上沒有太大的傳染性。加拿大衛生官員也表示,H1N1甲型流感病毒在墨西哥境外對人體的傷害沒有想像中嚴重。

反觀台灣,各大主要媒體都偏重報導容易引起民眾恐慌的臆測之言,以及民眾的恐慌情況,而對上述訊息予以漠視,或者未能給予適當的版面和篇幅來披露。

5月5日,美國發生境內感染的死亡案例。但是,台灣媒體大多仍未清楚地交代:死者住家在墨西哥邊界,且原本就罹患慢性疾病。因此,這個案例還是跟墨西哥有極深的淵源,不該引起台灣人的恐慌。


正確訊息的重要
流感病毒因為基因容易重組而改變其特性,因此全世界的公衛體系都嚴陣以待,不敢輕忽。但是,經歷過SARS的危機,許多人都應該有機會瞭解到:及時而正確的訊息,是控制疾病傳播的重要手段。當年若非李明亮每日在電視上公布可信而正確的訊息,SARS對台灣社會的傷害可能還會數倍地嚴重。

不管是面對什麼樣的事件,台灣媒體在報導上經常流於膚淺、片面與譁眾取寵,甚至誇染而唯恐天下不亂。假如這是無法改變的事實,衛生署應以每日更新的網頁和記者會來發布、補充被媒體忽略的重要訊息。而學者也有必要更積極參與蒐集、分析與發布正確的訊息。

但是,面對H1N1,台灣的學者與衛生署官員仍舊一如SARS期間那樣,沒有能力協助社會面對重大事件。比較台海兩岸,大陸從SARS所學到的教訓似乎還勝過我們。

台灣真的是一個沒有能力從慘痛經驗中累積教訓的社會嗎?



更多關於新流感,請看

附加的多媒體:
{rokbox}media/articles/PengMingHui_swineflu.jpg{/rokbox}

Friday, 02 January 2009

你我正在变老

你怕老吗?你了解老人吗?你对老年生活有什么期待?
其实,人们从出生的那一刻起就在变老。
一如花开花落、四季流转,世间所有人都脱离不了这条轨道。

杨培珊 撰文

张老太太今年九十八岁,照台湾的算法应该过百岁生日了。但她告诉子孙,不要宴客或送礼,只要到佛庙点灯,替家人求平安就好。张老太太现在和女儿同住,生活充实而快乐,而且人缘极好,虽没读过书,但口才流利,诗词对句信口拈来,尤其「讲四句」的功夫更在邻里间首屈一指。她以前常被请去「接新娘」、「说好话」,现在无法出远门,但邻居仍常来听她讲古。
陈伯伯是位退休的银行经理,目前住在一家老人养护中心,两次中风使他下肢瘫痪无法行动,但他个性相当乐观,经常帮忙其他老人和来访的家属,还协助工作人员办理一些庆生会和节日活动。由于他的开朗和迷人风范,中心的工作人员、住民及家属们都感到如沐春风,整个院内的气氛都活泼快乐了起来。

从以上例子可以看出,不管社经地位高低、居住安排为何、健康是否无虞,老年生活同样能够过得积极而有意义。关键在于是否能以勇敢的态度面对生活,或能否在他人的协助及支持下进行有意义的活动,并妥善调整自己的心态和生活方式,完成有助于自我发展的生活目标。研究显示,如果老人对自己的生活有决定权、觉得生活有意义、不感觉拖累家人,那么他们的生活满意度也相对较高(注2)。换句话说,老人家需要的是自主与尊严。

无论你想不想要
打从出生,我们都在变老

什么是「老」?其实人们从出生的那一刻起就在变老。只是人们习惯把小孩或年轻人的变老描述为「成长」或「发展」,而把三十岁之后身体器官开始走下坡的过程称为「老化」(注3)。这样的说法可能比较好听,但也模糊了生命的本相。由这个角度看来,「老」其实无所谓好与不好,喜欢不喜欢,它就是那么自然的一个过程,由出生开始,然后一直进行下去。
目前全世界最长寿的国家是日本,其人口平均馀命为八十二岁,其中男性七十九岁,女性八十六岁。想想看,我们的人生规划有到八、九十年那么长吗?很多人都很难想像人生可以那么长,大家常说:「我可不希望活那么老!」但现实是不论我们想不想,现代人的确是一种长寿的物种。我们必须从小开始,调整我们对生命的预期,为不同阶段做好生活的规划。
国家及社会也必须有所调整,设计新的政策与制度来面对。由两千年到二○五○年间,世界上六十五岁以上的老年人口成长预计将超过一倍,由总人口的6.9%增加到16.4%。台湾的老年人口比率于一九九三年底已超过7%,正式达到联合国定义的「高龄化社会」,之后老年人口的比率更快速上升。经建会预估,到二○一七年,台湾老年人口将占总人口的14%,大约每七人就有一位是老人;到了二○二五年,台湾将成为超高龄社会(super-aged society),老年人口将达到总人口的20%(注4)。因此,在个人以及国家社会的层面,都必须尽早准备,才能不忧不惧地面对老年世纪。

成功老化
生命本身就是一种创造

现今老人工作强调的是健康老化(healthy aging)、成功老化(successful aging)、复原力老化(resilient aging)等概念。创造力与成功老化之间的关连相当值得重视。正如我曾访问的一位六十九岁长者所言:「生命本身就是一种创造,特别当你老了,将有许多时间思考所面临的考验,并想出解决方法。」或如另一位所言:「创造力给你一种兴趣、一种盼望,它能填满你的时间和心灵。人总得有个兴趣,没有什么比做一件新工作更有趣的了。」
老年期的「复原力」可定义为:一种存活下去、克服疾病、失能或其他重大失落的能力。详细分析其元素,复原力包括有能力重新诠释压力的意义、能以正向的精神面对及适应压力、维持掌控感、有弹性的想法和作法,以及能运用社会支持与资源。复原力并非无视或否认生命中的暗潮与苦痛,而是一种正向、开朗、「一笑抿恩仇」的能量。

破除歧视
每一个老人都是独特的

许多人都很怕老,也不了解老化的过程,「老人」成了落伍没用的同义词,好像人一老就成了过气商品,失去了价值,再没有什么可以贡献的。这就是所谓的「老年歧视」(ageism)。
通常对老人负面的态度在孩童时期就形成了。有些父母也许是在不注意的时候谈到家里的老人家「麻烦、罗唆、难伺候、老顽固」,孩子就听进去了。即便一句随意出口的话,像是「我才不要像阿嬷一样活那么老呢!」都会使老化的负面图像深入许多人的心中。
媒体也得负很大的责任。想想我们在电视电影、报章杂志上看到的几乎都是年轻的影像,偶有老人出现,不是住疗养院、坐轮椅的,就是孤独无依的拾荒老人。人们看久了,要想把老人看成对家庭和社会的宝贝,确实很困难。
很多人会说:「我很尊重老人家,哪会歧视他们!」老年歧视这个语词在这个讲求「政治正确」的年代,听起来会惹人非议,大家都懂得撇清。其实我们每个人对老人的态度可能源自于以前跟老人相处的经验、媒体中呈现的老人形象,以及文化中普遍流传的一些说法。但这些既定的印象并不一定符合事实。现在,您不妨试著回答下列的问题,看看您对「老」是否存有恐惧或刻板印象:

·老化对你个人而言意味著什么?
·想到老,你最害怕的是什么?
·对老年生活,你有什么期待?
·什么样的人看起来比实际年龄年轻?什么样的人看起来比实际年龄老?
·老年人现在拥有什么是他们以前年轻时没有的?什么是他们以前有,但现在没有的?
·假设你现在已经老了,你平常生活作何消遣?你会和谁在一起?住在哪里?

其实,每个老人都是独特的,丰富的生活历练使每个老人都与众不同。聆听老人诉说过往,或许就能理解为何老人会有今日的形貌与想法。他们的路走的长,看过的风景自然也多,经验的差异性也大。因此,比起年轻人来,老人彼此之间的差异性可能还要更大些。

性别差异
女人较长寿、贫穷比例高

男女两性在老化的过程中呈现出明显的差别。女性的平均馀命较长,已开发国家女性的平均馀命比男性约多五至七岁(注5)。在至少三十五个国家中,女性平均馀命已超过八十岁,如亚洲的日本、香港,欧洲的瑞士、法国,美洲的加拿大等。东非地区生存环境差,女性平均馀命仅有四十七岁。但落后地区男女两性平均馀命差距较小,以东非地区为例,两性平均馀命仅相差两岁。
就婚姻状况而言,因丧偶、离婚或未婚之故,老年女性比较可能处在无配偶状态,老年女性的健康问题也比较多。此外,在经济安全方面,由于不稳定的职业生涯历程,老年女性中经济匮乏者的比例比老年男性更高。

拥抱老年
平心迎接生命花开花落

常听到有人说:「怎么活著活著,不知不觉就老了?」生命就是这么自然,老也是自然的一部分。如同春去秋来、四季流转,其间充满了变化,人的一生也是如此。由生至死,一如自然界中的花开花落,不论你是权能富贵,还是一介平民,都脱离不了这条轨道。
笔者在台湾大学社工系教授「老人学概论」,课堂作业之一是请学生去访问老人,题目中包含对死亡的看法。许多学生选择访问他们的祖父母或外祖父母,但这些学生的中年父母亲往往表示「不要和阿公阿嬷谈到死,不吉利。」但当学生硬著头皮去访问时,却常惊讶地发现,原来他们从来未曾好好地了解老人家的想法。老人家通常需要有人听他们谈一谈自己的丧事要怎么办,东西如何分配。当然子女们总是期待父母能长命百岁,不想谈论死亡,但如果不了解老人家的想法,一旦时候到了,他们必须为老人家做决定,就无法知道是否符合老人家的愿望。
还记得我小时候常常害怕,万一有一天父母亲去世,那我也完了。从事老人工作后,也曾迟疑如何面对尸体,如何向家属致哀。慢慢地,我成长了,不但在工作中不再害怕犹疑,更能聆听、支持与鼓励老人和家属们谈论死亡,并进行相关的准备。当工作人员和老人及家属们一起走这趟生命之旅,我们彼此都感觉平安与宽慰,彷佛被生命之流温柔地拥抱与接纳…

注释

注1 本文由梅陈玉婵与杨培珊合著《台湾老人社会工作:理论与实务》(台北:双叶书廊出版,2005年)之第一、第二章摘编而成。
注2 Mui A. C., Choi, N. G., & Monk, A.(1998). Long-Term care and ethnicity. Westport. CT: Greenwood Press.
注3 Hooyman, N. R., & Kiyak, H. A. (2002). Social gerontology: A multidisciplinary perspective. (sixth Edition). Boston, MA: Allyn and Bacon.
注4 请参阅经建会发布的〈中华民国台湾97年至145年人口推计〉报告。该报告亦指出,台湾社会老化速度越来越快,从高龄化社会(aging society)转为高龄社会(aged society)只需要二十四年(西方国家需要五十到一百年),而从高龄社会转变为超高龄社会只需要八年。
注5 World Health Organization. (2000). Women, aging and health. Retrieved January 2, 2002 from http://www.who.int/inf-fs/en/fact252.html

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【人籁论辨月刊第56期,2009年1月】

附加的多媒体:
{rokbox}media/articles/vielleuse_yangpeishang.jpg{/rokbox}

Thursday, 01 January 2009

你我正在變老

你怕老嗎?你瞭解老人嗎?你對老年生活有什麼期待?
其實,人們從出生的那一刻起就在變老。
一如花開花落、四季流轉,世間所有人都脫離不了這條軌道。

楊培珊 撰文

張老太太今年九十八歲,照台灣的算法應該過百歲生日了。但她告訴子孫,不要宴客或送禮,只要到佛廟點燈,替家人求平安就好。張老太太現在和女兒同住,生活充實而快樂,而且人緣極好,雖沒讀過書,但口才流利,詩詞對句信口拈來,尤其「講四句」的功夫更在鄰里間首屈一指。她以前常被請去「接新娘」、「說好話」,現在無法出遠門,但鄰居仍常來聽她講古。
陳伯伯是位退休的銀行經理,目前住在一家老人養護中心,兩次中風使他下肢癱瘓無法行動,但他個性相當樂觀,經常幫忙其他老人和來訪的家屬,還協助工作人員辦理一些慶生會和節日活動。由於他的開朗和迷人風範,中心的工作人員、住民及家屬們都感到如沐春風,整個院內的氣氛都活潑快樂了起來。

從以上例子可以看出,不管社經地位高低、居住安排為何、健康是否無虞,老年生活同樣能夠過得積極而有意義。關鍵在於是否能以勇敢的態度面對生活,或能否在他人的協助及支持下進行有意義的活動,並妥善調整自己的心態和生活方式,完成有助於自我發展的生活目標。研究顯示,如果老人對自己的生活有決定權、覺得生活有意義、不感覺拖累家人,那麼他們的生活滿意度也相對較高(註2)。換句話說,老人家需要的是自主與尊嚴。

無論你想不想要
打從出生,我們都在變老

什麼是「老」?其實人們從出生的那一刻起就在變老。只是人們習慣把小孩或年輕人的變老描述為「成長」或「發展」,而把三十歲之後身體器官開始走下坡的過程稱為「老化」(註3)。這樣的說法可能比較好聽,但也模糊了生命的本相。由這個角度看來,「老」其實無所謂好與不好,喜歡不喜歡,它就是那麼自然的一個過程,由出生開始,然後一直進行下去。
目前全世界最長壽的國家是日本,其人口平均餘命為八十二歲,其中男性七十九歲,女性八十六歲。想想看,我們的人生規劃有到八、九十年那麼長嗎?很多人都很難想像人生可以那麼長,大家常說:「我可不希望活那麼老!」但現實是不論我們想不想,現代人的確是一種長壽的物種。我們必須從小開始,調整我們對生命的預期,為不同階段做好生活的規劃。
國家及社會也必須有所調整,設計新的政策與制度來面對。由兩千年到二○五○年間,世界上六十五歲以上的老年人口成長預計將超過一倍,由總人口的6.9%增加到16.4%。台灣的老年人口比率於一九九三年底已超過7%,正式達到聯合國定義的「高齡化社會」,之後老年人口的比率更快速上升。經建會預估,到二○一七年,台灣老年人口將佔總人口的14%,大約每七人就有一位是老人;到了二○二五年,台灣將成為超高齡社會(super-aged society),老年人口將達到總人口的20%(註4)。因此,在個人以及國家社會的層面,都必須儘早準備,才能不憂不懼地面對老年世紀。

成功老化
生命本身就是一種創造

現今老人工作強調的是健康老化(healthy aging)、成功老化(successful aging)、復原力老化(resilient aging)等概念。創造力與成功老化之間的關連相當值得重視。正如我曾訪問的一位六十九歲長者所言:「生命本身就是一種創造,特別當你老了,將有許多時間思考所面臨的考驗,並想出解決方法。」或如另一位所言:「創造力給你一種興趣、一種盼望,它能填滿你的時間和心靈。人總得有個興趣,沒有什麼比做一件新工作更有趣的了。」
老年期的「復原力」可定義為:一種存活下去、克服疾病、失能或其他重大失落的能力。詳細分析其元素,復原力包括有能力重新詮釋壓力的意義、能以正向的精神面對及適應壓力、維持掌控感、有彈性的想法和作法,以及能運用社會支持與資源。復原力並非無視或否認生命中的暗潮與苦痛,而是一種正向、開朗、「一笑抿恩仇」的能量。

破除歧視
每一個老人都是獨特的

許多人都很怕老,也不瞭解老化的過程,「老人」成了落伍沒用的同義詞,好像人一老就成了過氣商品,失去了價值,再沒有什麼可以貢獻的。這就是所謂的「老年歧視」(ageism)。
通常對老人負面的態度在孩童時期就形成了。有些父母也許是在不注意的時候談到家裡的老人家「麻煩、囉唆、難伺候、老頑固」,孩子就聽進去了。即便一句隨意出口的話,像是「我才不要像阿嬤一樣活那麼老呢!」都會使老化的負面圖像深入許多人的心中。
媒體也得負很大的責任。想想我們在電視電影、報章雜誌上看到的幾乎都是年輕的影像,偶有老人出現,不是住療養院、坐輪椅的,就是孤獨無依的拾荒老人。人們看久了,要想把老人看成對家庭和社會的寶貝,確實很困難。
很多人會說:「我很尊重老人家,哪會歧視他們!」老年歧視這個語詞在這個講求「政治正確」的年代,聽起來會惹人非議,大家都懂得撇清。其實我們每個人對老人的態度可能源自於以前跟老人相處的經驗、媒體中呈現的老人形象,以及文化中普遍流傳的一些說法。但這些既定的印象並不一定符合事實。現在,您不妨試著回答下列的問題,看看您對「老」是否存有恐懼或刻板印象:

‧老化對你個人而言意味著什麼?
‧想到老,你最害怕的是什麼?
‧對老年生活,你有什麼期待?
‧什麼樣的人看起來比實際年齡年輕?什麼樣的人看起來比實際年齡老?
‧老年人現在擁有什麼是他們以前年輕時沒有的?什麼是他們以前有,但現在沒有的?
‧假設你現在已經老了,你平常生活作何消遣?你會和誰在一起?住在哪裡?

其實,每個老人都是獨特的,豐富的生活歷練使每個老人都與眾不同。聆聽老人訴說過往,或許就能理解為何老人會有今日的形貌與想法。他們的路走的長,看過的風景自然也多,經驗的差異性也大。因此,比起年輕人來,老人彼此之間的差異性可能還要更大些。

性別差異
女人較長壽、貧窮比例高

男女兩性在老化的過程中呈現出明顯的差別。女性的平均餘命較長,已開發國家女性的平均餘命比男性約多五至七歲(註5)。在至少三十五個國家中,女性平均餘命已超過八十歲,如亞洲的日本、香港,歐洲的瑞士、法國,美洲的加拿大等。東非地區生存環境差,女性平均餘命僅有四十七歲。但落後地區男女兩性平均餘命差距較小,以東非地區為例,兩性平均餘命僅相差兩歲。
就婚姻狀況而言,因喪偶、離婚或未婚之故,老年女性比較可能處在無配偶狀態,老年女性的健康問題也比較多。此外,在經濟安全方面,由於不穩定的職業生涯歷程,老年女性中經濟匱乏者的比例比老年男性更高。

擁抱老年
平心迎接生命花開花落

常聽到有人說:「怎麼活著活著,不知不覺就老了?」生命就是這麼自然,老也是自然的一部分。如同春去秋來、四季流轉,其間充滿了變化,人的一生也是如此。由生至死,一如自然界中的花開花落,不論你是權能富貴,還是一介平民,都脫離不了這條軌道。
筆者在台灣大學社工系教授「老人學概論」,課堂作業之一是請學生去訪問老人,題目中包含對死亡的看法。許多學生選擇訪問他們的祖父母或外祖父母,但這些學生的中年父母親往往表示「不要和阿公阿嬤談到死,不吉利。」但當學生硬著頭皮去訪問時,卻常驚訝地發現,原來他們從來未曾好好地瞭解老人家的想法。老人家通常需要有人聽他們談一談自己的喪事要怎麼辦,東西如何分配。當然子女們總是期待父母能長命百歲,不想談論死亡,但如果不瞭解老人家的想法,一旦時候到了,他們必須為老人家做決定,就無法知道是否符合老人家的願望。
還記得我小時候常常害怕,萬一有一天父母親去世,那我也完了。從事老人工作後,也曾遲疑如何面對屍體,如何向家屬致哀。慢慢地,我成長了,不但在工作中不再害怕猶疑,更能聆聽、支持與鼓勵老人和家屬們談論死亡,並進行相關的準備。當工作人員和老人及家屬們一起走這趟生命之旅,我們彼此都感覺平安與寬慰,彷彿被生命之流溫柔地擁抱與接納…

註釋

註1 本文由梅陳玉嬋與楊培珊合著《台灣老人社會工作:理論與實務》(台北:雙葉書廊出版,2005年)之第一、第二章摘編而成。
註2 Mui A. C., Choi, N. G., & Monk, A.(1998). Long-Term care and ethnicity. Westport. CT: Greenwood Press.
註3 Hooyman, N. R., & Kiyak, H. A. (2002). Social gerontology: A multidisciplinary perspective. (sixth Edition). Boston, MA: Allyn and Bacon.
註4 請參閱經建會發布的〈中華民國台灣97年至145年人口推計〉報告。該報告亦指出,台灣社會老化速度越來越快,從高齡化社會(aging society)轉為高齡社會(aged society)只需要二十四年(西方國家需要五十到一百年),而從高齡社會轉變為超高齡社會只需要八年。
註5 World Health Organization. (2000). Women, aging and health. Retrieved January 2, 2002 from http://www.who.int/inf-fs/en/fact252.html

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【人籟論辨月刊第56期,2009年1月】

附加的多媒體:
{rokbox}media/articles/vielleuse_yangpeishang.jpg{/rokbox}

Friday, 31 October 2008

China’s Resilience

Whomever lives or travels in China cannot but be struck by China’s resilience in the midst of the world economic crisis. For sure, China’s stock market is taking a beating, real estate is steadily going down, and unemployment is threatening to become a major social problem. However, most Chinese people still show a robust optimism, consumption remains vibrant, and the majority of Chinese observers believe that China will suffer from the crisis much less than the rest of the world, eventually consolidating its economic and diplomatic rise. Recollections from the Asian economic crisis of 1997-2000 play a role in this decidedly optimistic scenario.

Is this a delusion? In the near future will China meet with much more severe challenges than foreseen today? It is far from being impossible. However, China’s psychological resilience might prove to be a factor of economic resilience as well. The positive energy displayed by ordinary Chinese can help the country tackle its problems with resources not found in countries which suffer from a crisis of confidence and from doubts about their own future. Weathering a storm is largely a question of collective spirit, and economy has proven to be for a very large part a field of social psychology…

It remains that a reversal in the public feelings would be very dangerous for China - an especially volatile country. In other words, the stakes of the crisis are higher for China than for other nations: weathering the storm would be a resounding success giving even more significance to China’s rise; conversely, a breakup of public confidence would have consequences deeper and more far-reaching than anywhere else. China’s resilience makes a pessimistic scenario less likely than an analysis based on mere statistical data would suggest. It remains that resilience has limits and that a breakdown is still a working hypothesis.

(Photo by B.V.)

Tuesday, 30 September 2008

Migrations from Liangshan: New Data

{rokbox}media/articles/YanniHe_LiangshanMigrations.jpg{/rokbox}
eRenlai has published a series of articles on Yi migrants. The team of the magazine also gives regular news about the Yangjuan primary school and the area where it is located, i.e. Yanyuan county in Liangshan autonomous prefecture, southwestern Sichuan.

As it is the case every summer, a team of volunteers went to the school in July and August. This was an opportunity to collect new data on migrations from this area to other parts of China. Here are a few findings, which can give some light on changes taking place when it comes to the relationship between peripheral regions and urban areas.
Among the 107 families living in Yangjuan proper (units 5 and 6 of Baiwu First Village), 61 have members with migrant experience. 81 villagers went out looking for jobs, and 60 of them are currently on their migrant endeavor. Actually, migrants from Yangjuan can roughly be put into two categories---‘the younger migrants’ and ‘the bread-earning migrants’.

There are currently 26 migrants belonging to the younger generation’. Most of them joined the labor migration directly after leaving school (not necessarily until graduation), which also means that they were not the breadwinner of the family. So they do not need so much to compensate their leaving by providing their family with cash. In fact, only a few of them could save some money and send it home.
As a matter of fact, a group of Yi workers who were introduced by friends from afar into a factory of Shanghai consists mostly of girls who, when leaving home hadn’t finished junior high. They left home in spite of doubts or objections within the family, with the dream of living a comfortable city life. But very soon it turned out that money is much more difficult to earn than they thought, and that there are a number of problems to deal with, such as the boiling weather in summer, suburb lifestyle, language, discrimination, homesickness, strict regulation in the factory… However, they gradually learn to get along with Han people, practice Mandarin, pay rent and bill, and surf the Internet. At least, they keep themselves warm and fed, and to a certain extent, some even enjoy the factory life. Each month they earn about 1300 yuan on average, but one year has passed since they started working and several of them failed to save any money. They also see the importance of skill, knowledge, and certificates (Wenping) in one’s career. In the course of their work, few skills can be learned. Within one year they only have one chance to go back home and stay for a short period. Most of them don’t have a long-term plan about the future, they just intend to stay in the factory for some time. When it comes to farm work, some say they “can’t and don’t know how to farm.”

Other young migrants are males now still working in factories or construction sites in places such as Shenzhen and Henan. They do not save much money either. Many of those working in Shenzhen factories are not as lucky as their countrymen in Shanghai. Usually they follow brokers to the factory. There they often work more than 10 hours a day and then earn less than 30 Yuan, from which the brokers will take away 2~3 Yuan. Moreover, the food and housing provided by the factories are rustic, and they barely have labor insurances.

After having been cheated by the job recruiter and having gotten seriously sick in her migration to Shenzhen, one young woman has the following comments:
‘When I decided to work outside, many people opposed the plan, especially my father, who said migration was not what I thought it was. And some people coming back home also tried to persuade me that life out there is hard for most migrants. But I didn’t take in a single word of them, still dreaming that I could be among the few lucky ones and earn money easily… Now I’ve got bad health and spent thousands on medicine, and I deeply regret having migrated. I finally realize that my father had told me the truth! But there are still more young people migrating, including my cousins. I tell them about my experience and try to persuade them not to do so, but they just don’t listen to me and insist on leaving, just like what I did when I migrated…”

The other category of Yangjuan migrants are the bread earners. The cash entailed by children’s education, the increasing cost of farming, the unfavorable weather… all these factors prompt these villagers to buttress their families’ economy by seeking money from outside. Some of them hand their land over to other family members (old parents or wives) and seek additional income from outside. Others have comparatively more land so they leave home only when the busy farming seasons are over. Their goal is simply to bring money home, so they accept unfavorable working condition as long as the pay is high enough. And, unlike the younger migrants, the financial pressure keeps them from spending money on seeking and trying novel things.

Recently, Zhengzhou has become a hot spot for these bread earners. They follow brokers to different construction sites, working more than 10 hours a day, and being paid 140~180RMB by the brokers, who have already extracted a portion (about 10%~25%) from their original earning. If the brokers can’t find work for them in the construction sites, the migrants have to wait, consuming their own money. Some of them spend almost all their savings waiting, and then come back home with empty hands. They often try hard to learn professional knowledge through practice. Also, the pressure and competition at work as well as the high wages for skilled workers enable them to learn skills such as bending steel with machines and woodwork. Some brokers still try avoiding to give the migrants the money they should receive. Many Yangjuan migrants want to go to Zhengzhou because it is pictured as a place with “good’ brokers.

Last year, the prices of farming necessities surged, lessening further the profit of farming. The phosphate fertilizer rose from 20~25 Yuan per bag to 48~50 Yuan, and the corn seeds from less than 7 Yuan/kilogram to 38 Yuan. Some migrants invest their earnings on these highly-priced farming necessities, but the unpredictable weather exerts another risk on the harvest. Ma Linjun, who because of poor health had to come back home, says that, nowadays, compared to the profit brought by farming, earning money through migration seems not that bad. On the other hand, the high price of meat stimulates in the villagers an impulse to find some capital for raising animals. Ali Vuda is one of them. Although in his last labor migration he was cheated by the broker and got 1800 Yuan less than was promised, he still plans to go out because he believes that this time he will be more careful and may find a better broker. He says that once he has saved thirty thousand Yuan he will raise pigs on a large scale. He would spend about 10 thousand on 5 sows, another 10 thousand on the shed, and the rest on forage. He says the buckwheat and corn in his field could be used to feed pigs, and his family, in turn, would sell the young pigs at high price and then buy rice to eat. By then, he says, he would never go out, because seeing the colorful life outside would just make him feel sad about himself. Though they migrate for different reasons, both Ma Linjun and Ali Vuda are family bread earners, adjusting their income in order to fit in with the increasing commodity prices.

Ma Pengchen calls himself a veteran of labor migration in Yangjuan. At the age of 17 he started working outside and has been doing so off and on for almost ten years. He has been to places such as Shenzhen, Shanghai, Wenzhou, Zhengzhou and Tianjin, as well as some other parts of Sichuan. He helps with farming at home in the busy seasons, and migrates at other time, leaving the comparatively easier farm work to his parents. In the early years, he was no different from other young migrants, spending almost all his earnings before coming home. But later on he began to save money for his family, especially since he decided to get married. Till now he has brought about 40 to 50 thousand Yuan back home. When he worked in a factory in Shenzhen, the broker refused to pay the promised wages, alleging that he himself had no money. It was after several quarrels that he finally paid Ma the long-delayed 1400 RMB. Ma plans to leave again soon: he says that, by growing crops and taking care of the animals, his family has a daily average income of about 12 Yuan, while his bending steel skills can bring him more than 100 Yuan of net income in a single day. He also wants to grow some walnut trees at home, because he finds that a big walnut tree may bring in about 4000~5000 Yuan each year (after they are grown, it takes four years before walnut trees begin to bear fruit). He says that growing walnut trees and migration can bring him quite a good income, but he needs to carefully distribute his time and energy between the two in order to optimize the benefit. He urges his nephew, who has been herding the family goats after dropping out of primary school, to go back to school, pointing out that only going back to school can bring about a brighter future for the nephew, and that the bottom line is to finish his junior high.

With different mentalities, both the younger migrants and the migrant family bread earners start on their journeys of seeking fortune away from home. Differences in their desires and responsibilities explain for the variety of outcomes. Presently, some youths from Yangjuan are advancing towards graduation from high school. Consequently, new trends in migration may emerge, and a third category of labor migrants will come into being. In a few years of time, we will see how various educational tracks determine the young migrants’ career paths and their future lives.

PDF version


Tuesday, 09 September 2008

Happy Birthday to KPS!

PDF version of the article
* * *
In 1958, the Jesuits established a small audio studio in Taichung and started to produce short radio programs and dramas that were broadcasted all around Taiwan. In 1960, the studio moved to Taipei. By the mid-sixties, Kuangchi Program Service, as it was named, had also ventured into the field of television, first by producing educational programs, later by launching drama series. From that time on, the "KPS" brand became an integral part of the history of Taiwan’s media industry.

The road traveled by KPS was sometimes bumpy: it required much courage to be the first to produce drama series in Taiwanese; the collaboration with TV stations and the search for an economic model were not all rosy; most importantly, the dramatic shift in the media landscape that took place in the mid eighties have challenged the relevance and working habits of KPS.

KPS might no longer be the "household name" that it used to be during the seventies and the beginning of the eighties, however, it continues to produce first-rate educational and social educational programs; it collaborates with Chinese TV stations on program series relating the life of early missionaries and Chinese Christians; it plays the role of a consultant in many poor countries of East Asia and Oceania that are trying to develop independent, quality, community-based media outlets (community radio stations, websites, music CD and DVD production units, etc.). It uses state-of-the-art digitalized studios in Taiwan and collaborates with a number of channels. It is now experimenting with Internet TV.

Above all, KPS has formed a vast number of media producers, journalists, cameramen, script writers and directors in Taiwan, giving them an ethical, professional and international outlook. The history of Taiwanese media during the last fifty years cannot be separated from the history of KPS. By celebrating the 50th anniversary of KPS, this special issue of Renlai is also recounting a broader story, and reflecting on the challenges that the media industry faces in Taiwan today.

May KPS continue to be a beacon of quality programming, insisting on spiritual values, attending to the needs of marginal sectors of society, offering educational opportunities to all. May it continue to be a sign of hope in an often discouraging media environment, while achieving technological and commercial breakthroughs that will make it, once again, a leader in the Taiwanese media landscape. Such are the wishes we offer to a company which, at 50, remains as young and energetic as ever!
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Thursday, 28 August 2008

讓技職教育再現光芒

技職教育不應成為大學的替代品。
強化「做中學」的特色和證照體制,才能使它重現往日榮光。

撰文│劉孟奇 國立中山大學政治經濟系副教授

時代顛覆大眾偏好的速度,往往令人大吃一驚。昨日還是大熱門的選擇,可能轉眼間就失去優勢地位。舉例而言,就在二十幾年前,如果一個年輕人捨明星高中不入,而就讀一流工專的話,這是非常「正常」的事情;時至今日,如果一個年輕人這麼做,卻可能成為媒體獵奇報導的對象。

為什麼技職體系會失去往日耀眼的光芒?外在環境變遷當然是一個主要因素。過去技職體系的優勢在於重視專業技術訓練,強調畢業後能馬上與職場接軌,獲得當時許多家長與學生的認同。但是到了今日,技術更迭與產業變遷迅速,如果一個年輕人還希望「靠著在學校學到的一技之長,就能吃一輩子」,這種想法恐怕已經不太實際。取而代之的,是必須養成「自我學習,不斷提升」的能力與習慣。

另外,過去要做好工作,可能只需要「埋頭打拼,苦幹實幹」;但是現在許多「好工作」都需要跨領域與整合的能力。如果過於強調單一專業技術訓練,卻忽略了跨領域與整合能力的培養,那麼即使學生畢業後就業不成問題,在往後的職涯發展中,恐怕也會容易遇到「隱形天花板」的障礙。

因此,如果技職體系要回復往日榮光,僅僅只是改善以前的弱項恐怕不夠,而是需要更進一步強化既有的強項。換句話說,技職學校如果只是模仿一般大學,反而會失去自己的利基,甚至更加深社會認為它是「大學替代品」的成見。

技職體系的利基,其實就在於其「從做中學」的優良傳統。歸根結底,不同的年輕人本來就有不同的人格特質與學習特色。有人擅長探究思辨,慣常從抽象原則連結到現實世界;有人則是喜歡親身接觸,親手完成,從具體經驗中一步步建立自己的處事之「道」。技職教育的本質,應該就在於提供後一類年輕人一種更能適才適性的學習管道。

要發揚「從做中學」的利基,技職體系就必須站穩並強化自己的四大支柱:實習、競賽、畢業專題與證照。實習不只是為了取得工作經驗,更是因為對於喜歡「從做中學」的年輕人而言,「實務刺激」是最能激勵學習的有效方法之一。而「競賽」與「畢業專題」,不只是為了強化技術與經驗,更是為了培養學生團隊合作、溝通協調等重要核心能力。

至於證照的重要性,不只在於它有利於學生畢業後的求職與發展;更在於一個具高度公信力與社會聲望的專業證照體制,可以有效建立技職學生的成就管道、身份自信及專業尊嚴。因此,如果政府要重振技職教育,那麼如何針對技職學生在量與質上面的需要,並配合技術變遷及產業需求,建立一個豐富多元、與時俱進的嚴謹證照體制,應是首要之務。

附加的多媒體:
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