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2 澳門明愛 60 周年系列活動之攜手開拓扶貧新路國際交流會議論文集 PROCEEDINGS of 60 th Anniversary Event of Caritas Macau International Conference Joining Hands to Identify New Roads for Poverty Alleviation Copyright 2012 by Caritas Macau Largo de Sto. Agostinho No. 1-A, Macau ISBN All rights reserved. No part of this book may be reproduced, in any form or by any means, without permission in writing from Caritas Macau. Page 1

Caritas Macau Largo de Sto. Agostinho No. 1-A, Macau ISBN 978-99937-644-5-8 All rights reserved.

3 1. 序目錄 Table of Contents Page Preface 攜手開拓扶貧新路國際交流會議程序 Programme of International Conference Joining Hands to Identify New Roads for Poverty Alleviation 講者文稿 Papers from Speakers K1 Mr. Ted Bruce 貧窮不是不可避免的 - 加拿大的經驗 Poverty is Not Inevitable - A Canadian Perspective K2 Mr. Michel Roy 對抗貧窮與不公帄以構建公義社會 : 教會與明愛的回應 Struggling Against Poverty and Inequalities and Promoting Justice: What is the Church and Caritas Response K3 王建軍先生 Mr. Jianjun Wang 中國殘疾人扶貧開發政策與實踐 The Policy and Practice for the Development of Helping the Poor Disabled People in China A1 蕭楊輝博士 Dr. Philip Yeung-Fai Siu 澳門之貧乏與扶貧政策 Poverty and Strategies for Poverty Alleviation in Macau A2 Fr. Rocco Pairat Sriprasert 為泰國邊緣社群包括愛滋病患者及街童的服務經驗分享 The Work Programs for the Marginalized Groups in Thailand Especially the HIV Infectors and Homeless Children A3 陳世賢先生 Mr. Shih-Hsien Chen 沒有圍牆的醫院 A Hospital Without Walls - Taitung St. Mary's Hospital B1 陳美潔小姐 Ms. Maggie Mei-Kit Chan 協助低收入家庭及群體脫貧的實務經驗及分享 The Practical Experience in Helping the Low-Income Families and Groups to Overcome Poverty B2 Prof. Richard Wilkinson 為何帄等對每個人也會更好 The Spirit Level: Why Equality is Better for Everyone C1 Dr. Allah Bakhsh Malik 從全球角度探討跨領域合作扶貧 Cross Sector Cooperation to Alleviate Poverty in a Global Perspective C2 徐月賓教授 Prof. Yuebin Xu 改善中國農村貧困老人生活質素的有效策略 Effective Strategies to Improve the Life Quality of the Rural Elderly in China C3 梁祖彬教授 Prof. Joe C.B. Leung 如何幫助貧困人士增強在社會上的競爭力 Effective Measures to Enhance the Poorest's Competitiveness in Society Page 2

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4 D1 施日莊先生 Mr. John Sayer 協助亞洲地區窮困人士自力更生 Helping the Poor to Become Self-Reliant in the Asian Context D2 陳文良先生 Mr. Wen-Liang Chen 為扶貧項目開展的籌募工作 Revisiting the Implication of Fundraising for the Poor D3 陳智川博士 Dr. Chi-Chuen Chan 貧窮與問題賭博的心理因素反思 The Psychology of Poverty and Problem Gambling D4 Dr. Benedict Alo D Rozario 為孟加拉邊緣社群尤其無助婦女提升尊嚴的發展項目 The Activities of Caritas Bangladesh for the Development of Dignity of the Marginalized Groups Especially the Helpless Women in Bangladesh E1 鄧玉華博士 Dr. Yuk-Wa Tang 澳門的貧窮問題與社會保障 Social Security and Poverty Problems in Macau E2 薛新婭教授 Prof. Xinya Xue 社會組織介入醫療扶貧社會工作的實踐與思考 Reflections on the Practice of Poverty Alleviation in Medical Sector E4 黃海珊小姐 Ms. Hoi-San Wong 內地山區助學服務新思維 Development for Support to Students in Remote Areas in China S1 黃珮琦小姐 Ms. Joanna Pui-Kei Wong 明糧坊短期食物補助服務的理念及經驗分享 The Concept and Experience of Short-Term Food Subsidy Scheme S2 何美華小姐 Ms. Mei-Va Ho- 脫貧的見證 Witness for Combating Poverty S3 何國明先生 Mr. Kok-Meng Ho 脫貧的見證 Witness for Combating Poverty 主持人簡介 Introductions of Moderators 相片集 Photo Album 新聞剪報 News Clipping Page 3

Chi-Chuen Chan 貧窮與問題賭博的心理因素反思 The Psychology of Poverty and Problem Gambling---------------------------------------------------- 107 D4 Dr.

5 序六十年前, 耶穌會陸毅神父眼見當時大量內地難民湧入澳門, 生活艱苦, 本著扶助弱小之心, 遂以岡頂為基地, 開展慈善救濟工作, 為生活貧困人士提供物質援助和社會服務, 這是澳門明愛的貣源陸毅神父的默默耕耘, 加上員工及義工們一直堅守仁愛信念, 努力不懈為澳門社區服務, 時至今日, 澳門明愛的服務範疇遍及安老復康家庭帅兒青少年教育熱線輔導更生人士露宿者勞工文化推廣以至助養等眾多領域澳門雖然逐步走出貧窮, 但貧富懸殊卻隨著整體社會經濟的富裕而日益加遽在豐盛的物質生活下, 許多人心靈空虛, 另一邊廂, 貧困家庭屈居於斗室, 足襟見肘々繁榮的背後, 潛藏著各種各樣的社會問題和挑戰 2011 年 12 月 8 日是澳門明愛成立六十周年的日子, 為紀念月前辭世的陸毅神父一生對社會所作的貢獻, 澳門明愛特別主辦並由澳門社工學院協辦攜手開拓扶貧新路國際交流會議, 共同探索對抗貧窮的新方向和有效策略這論文集收錄了來自各地的專家學者在會議上發表的演說文章, 供關心貧窮問題和弱勢群體生活狀況的人士, 尤其社會服務界同工閱覽參考期望透過具實務智慧的經驗分享及學術交流, 啟發我們的視野和能量, 在扶貧路上携手同行, 發展社會公義澳門明愛總幹事潘志明 Page 4

的富裕而日益加遽在豐盛的物質生活下, 許多人心靈空虛, 另一邊廂, 貧困家庭屈居於斗室, 足襟見肘々繁榮的背後, 潛藏著各種各樣的社會問題和挑戰 2011 年 12 月 8 日是澳門明愛成立六十周年的日子, 為紀念月前辭世的陸毅神父一

6 Preface Sixty years ago, Father Luis Ruiz Suarez, S.J. witnessed the influx of Mainland refugees into Macau and they were difficult to earn a living. Driven by the mission of helping the underprivileged, he made use of Largo de Santo Agostinho as base and started off charitable relief work by providing tangible assistance and social services to people living in poverty. This was the origin of Caritas Macau. The perseverance of Fr. Luis, along with the benevolence upheld by dedicated staff and volunteers, brought forth impetus to serving the Macau society laboriously. Today, Caritas Macau covers a wide spectrum of social services respectively on elderly, disability, family, children, youth, education, hotline counseling, ex-offenders, street sleepers, laborers, cultural promotion and child sponsorship. Macau has gradually stepped out of poverty but the disparity between the rich and the poor has rapidly widened alongside the affluence in economy of the entire society. On one hand, many people feel vacuous despite enjoying a luxuriously materialistic life. On the other hand, poor families are living in overcrowded condition and feeling sad all the days. Various social problems and challenges are breeding behind the prosperity. The Eighth of December 2011 was the 60 th anniversary of the establishment of Caritas Macau. In order to commemorate the lifelong devotion of Fr. Luis who passed away recently, the International Conference Joining Hands to Identify New Roads for Poverty Alleviation was hosted by Caritas Macau and co-organized by Macau Institute of Social Work with an aim to explore innovative ways and effective strategies for combating poverty. This proceedings collects the papers presented at the International Conference by experts and scholars coming from different parts of the world, for perusal and reference of those who are concerned with the poverty issue and living situation of vulnerable groups, especially colleagues of the social service sector. Through experience sharing and academic exchange of the practice wisdom, it is anticipated that our vision and momentum would be inspired. Let us work hand in hand for the agenda of poverty alleviation and for the development of social justice. Paul Pun, Chi Meng Secetary-General Caritas Macau Page 5

people living in poverty. This was the origin of Caritas Macau. The perseverance of Fr.

7 由 From 下午 2:15 2:15 p.m. 時間題目講者 / 主持人 Time Topic Speakers / Moderators 至 To 上午 9:00 上午 9:30 註冊 9:00 a.m. 9:30 a.m. Registration 上午 9:30 9:30 a.m. 上午 10:00 10:00 a.m. 30 分鐘 30 min 澳門明愛六十周年誌慶暨國際交流會議開幕禮 The Celebration of Caritas Macau 60th Anniversary and Opening Ceremony of International Conference 專題演說主持人 : 陳洪濤先生 Mr. Peter Chan Moderator of Keynotes Session: 香港大學行為健康中心學人 Research Fellow, Centre of Behavioral Health, University of Hong Kong 北京師範大學社會發展與公共政策學院榮譽教授 Honorary Professor, School of Social Development and Public Policy, Beijing Normal University 演說 / Presentation K1: Mr. Ted Bruce 45 分鐘貧窮不是不可避免的 - 加拿大的經驗 Co-Chair, the BC Poverty Reduction Coalition 45 min Poverty is Not Inevitable - A Canadian Perspective Executive Director, Population Health with Vancouver Coastal Health 15 分鐘小休上午 10:00 中午 12:30 15 min Tea Break 10:00 a.m. 12:30 p.m. 演說 / Presentation K2: Mr. Michel Roy 40 分鐘 40 min 對抗貧窮與不公平以構建公義社會 : 教會與明愛的回應 Struggling Against Poverty and Inequalities and Promoting 國際明愛總幹事 Secretary General, Caritas Internationalis Justice: What is the Church and Caritas Response 演說 / Presentation K3: 王建軍先生 Mr. Jianjun Wang 中國殘疾人扶貧開發政策與實踐中國殘疾人聯合會扶貧辦主任 40 分鐘 The Policy and Practice for the Development of Helping the Director, Office of Poverty Alleviation, China Disabled Persons' 40 min Poor Disabled People in China Federation 中國肢殘人協會副主任 Vice-chairman, China Physically Handicapped Persons' Association 討論 Discussion 中午 12:30 下午 2:15 午膳 12:30 p.m. 2:15 p.m. Lunch Break 論壇 A 主持人 : 馮偉先生 Mr. Wai Fung Moderator of Forum A: 澳門社工學院主任 Supervisor, Macau Institute of Social Work 演說 / Presentation A1: 澳門之貧乏與扶貧政策 Poverty and Strategies for Poverty Alleviation in Macau 下午 3:45 3:45 p.m. 25 分鐘 25 min 25 分鐘 25 min 25 分鐘 25 min 蕭楊輝博士 Dr. Philip Yeung-Fai Siu 澳門大學社會科學及人文學院政府與行政學系副教授 Associate Professor, Department of Government and Public Administration, Faculty of Social Sceinces and Humanities, University of Macau 演說 / Presentation A2: Fr. Rocco Pairat Sriprasert 為泰國邊緣社群包括愛滋病患者及街童的服務經驗泰國明愛總幹事分享 Secretary General, Caritas Thailand The Work Programs for the Marginalized Groups in Thailand Especially the HIV Infectors and Homeless Children 演說 / Presentation A3: 沒有圍牆的醫院 A Hospital Without Walls - Taitung St. Mary's Hospital 討陳世賢先生 Mr. Shih-Hsien Chen 台灣台東聖母醫院執行長 Chief Executive Officer, Taitung St. Mary's Hospital 論 Discussion 下午 3:45 下午 4:00 15 分鐘小休 3:45 p.m. 4:00 p.m. 15 min Tea Break 論壇 B 主持人 : 林玉鳳小姐 Ms. Agnes Iok-Fong Lam Moderator of Forum B: 澳門大學社會科學及人文學院傳播系助理教授兼新聞與公共傳播課程主任 Assistant Professor and Interim Head of Department of Communication, Programme Coordinator of Bachelor of Journalism and Public Communication, Faculty of Social Sciences and Humanities, University of Macau 下午 4:00 4:00 p.m. 攜手開拓扶貧新路國際交流會議程序 Programme of International Conference Joining Hands to Identify New Roads for Poverty Alleviation 下午 5:30 5:30 p.m. 25 分鐘 25 min 50 分鐘 50 min 二零一一年十二月八日 8 th December 2011 演說 / Presentation B1: 協助低收入家庭及群體脫貧的實務經驗及分享 The Practical Experience in Helping the Low-Income Families and Groups to Overcome Poverty 演說 / Presentation B2: 為何平等對每個人也會更好 The Spirit Level: Why Equality is Better for Everyone 討陳美潔小姐 Ms. Maggie Mei-Kit Chan 香港明愛社會工作部部長 Director, Social Work Services, Caritas Hong Kong Prof. Richard Wilkinson Co-Director, The Equality Trust Professor Emeritus of Social Epidemiology at the University of Nottingham Medical School Honorary Professor at UCL Visiting Professor at the University of York 論 Discussion Page 6

School of Social Development and Public Policy, Beijing Normal University 演說 / Presentation K1: Mr.

8 時間 Time 由 From 至 To 上午 9:15 9:15 a.m. 上午 11:00 11:00 a.m. 上午 11:15 11:15 a.m 上午 11:00 11:00 a.m. 上午 11:15 11:15 a.m. 中午 12:45 12:45 p.m. 40 分鐘 40 min 25 分鐘 25 min 題目 Topic 講者 / 主持人 Speakers / Moderators 論壇 C 主持人 : 賴偉良博士 Dr. Dicky Wai-Leung Lai Moderator of Forum C: 澳門理工學院公共行政高等學校客座副教授 Associate Professor, School of Public Administration, Macao Polytechnic Institute 演說 / Presentation C1: Dr. Allah Bakhsh Malik 從全球角度探討跨領域合作扶貧 Secretary to the Government, Literacy and NF Basic Education Department at Cross Sector Cooperation to Alleviate Poverty in a Global Perspective Government of Punjab Pakistan The Honorable Mention of the UNESCO Confucius Prize for Literacy Award Winner of 2011 演說 / Presentation C2: 徐月賓教授 Prof. Yuebin Xu 改善中國農村貧困老人生活質素的有效策略北京師範大學社會發展與公共政策學院教授 Effective Strategies to Improve the Life Quality of the Rural Elderly in Professor, School of Social Development and Public Policy, Beijing Normal China University 演說 / Presentation C3: 梁祖彬教授 Prof. Joe C.B. Leung 25 分鐘 25 min 如何幫助貧困人士增強在社會上的競爭力 Effective Measures to Enhance the Poorest's Competitiveness in Society 香港大學社會工作及社會行政學系教授 Professor, Department of Social Work and Social Administration, The University of Hong Kong 社區投資共享基金副主席 Vice-chairperson, Community Investment Inclusion Fund 討論 Discussion 15 分鐘小休 15 min Tea Break 論壇 D 主持人 : 袁志海先生 Mr. Philip Yuen Moderator of Forum D: 澳門明愛行政主任 Director of Administration, Caritas Macau 演說 / Presentation D1: 施日莊先生 Mr. John Sayer 25 分鐘協助亞洲地區窮困人士自力更生香港樂施會總裁 25 min Helping the Poor to Become Self-Reliant in the Asian Context Director General, Hong Kong Oxfam 演說 / Presentation D2: 陳文良先生 Mr. Wen-Liang Chen 25 分鐘為扶貧項目開展的籌募工作中華社會福利聯合勸募協會副秘書長 25 min Revisiting the Implication of Fundraising for the Poor Deputy Secretary General, United Way of Taiwan 演說 / Presentation D3: 陳智川博士 Dr. Chi-Chuen Chan 20 分鐘貧窮與問題賭博的心理因素反思聖若瑟大學客席教授 20 min The Psychology of Poverty and Problem Gambling Visiting Professor, University of Saint Joseph, Macau 演說 / Presentation D4: Dr. Benedict Alo D Rozario 為孟加拉邊緣社群尤其無助婦女提升尊嚴的發展項目孟加拉明愛總幹事 20 分鐘 The Activities of Caritas Bangladesh for the Development of Dignity Executive Director, Caritas Bangladesh 20 min of the Marginalized Groups Especially the Helpless Women in Bangladesh 討論 Discussion 中午 12:45 下午 2:15 午膳 12:45 p.m. 2:15 p.m. Lunch Break 論壇 E 主持人 : 劉先怡先生 Mr. Shien-Yee Liu Moderator of Forum E: 台灣明愛會專員 Project Coordinator on China Concern, Caritas Taiwan 下午 2:15 2:15 p.m. 下午 4:00 4:00 p.m. 25 分鐘 25 min 25 分鐘 25 min 25 分鐘 25 min 20 分鐘 20 min 演說 / Presentation E1: 澳門的貧窮問題與社會保障 Social Security and Poverty Problems in Macau 演說 / Presentation E2: 社會組織介入醫療扶貧社會工作的實踐與思考 Reflections on the Practice of Poverty Alleviation in Medical Sector 演說 / Presentation E3: 綜援人士就業支援服務實踐經驗 Experience of Integrated Employment Assistance Scheme for the Comprehensive Social Security Assistance Applicants 演說 / Presentation E4: 內地山區助學服務新思維 Development for Support to Students in Remote Areas in China 鄧玉華博士 Dr. Yuk-Wa Tang 澳門社會保障學會監事長 Chairman of the Supervisory Committee, Macau Social Security Society 澳門理工學院澳門聖若瑟大學兼任講師 Visiting Professor, Macao Polytechnic Institute and University of Saint Joseph 薛新婭教授 Prof. Xinya Xue 西北大學社會學與社會工作系教授 Professor, Department of Sociology and Social Work, Northwest University 仇建文先生 Mr. Kin-Man Kau 香港基督教女青年會就業服務計劃經理 IEAS Manager, Hong Kong Young Women's Christian Association 黃海珊小姐 Ms. Hoi-San Wong 澳門聖公會北區青年服務隊社會工作員 Social Worker, Macau Sheng Kung Hui North District Youth Service Team 討論 Discussion 下午 4:00 下午 4:15 15 分鐘小休 4:00 p.m. 4:15 p.m. 15 min Tea Break 座談主持人 : 馮慧瑛小姐 Ms. Emily Wai-Ying Fung Moderator of Seminar: 澳門明愛復康服務社工顧問 Social Work Consultant, Rehabilitation Service, Cartias Macau 香港自助組織發展中心董事 Director, Self-Help Development Centre, Hong Kong 下午 4:15 4:15 p.m. 下午 5:00 5:00 p.m. 下午 5:00 5:00 p.m. 下午 5:30 5:30 p.m. 45 分鐘 45 min 30 分鐘 30 min 二零一一年十二月九日 9 th December 2011 議題 / Topic 脫貧的見證 Witness for Combating Poverty 黃珮琦小姐 Ms. Joanna Pui-Kei Wong 澳門明愛家庭服務部及明糧坊 - 短期食物補助計劃主任 Service Supervisor, Family Service and Short-Term Food Subsidy Scheme, Caritas Macau 何美華小姐 Ms. Mei-Va Ho 何美華會計師事務所合夥人 Partner, HMV & Associates - Certified Public Accountant 何國明先生 Mr. Kok-Meng Ho 澳門傷殘人士服務協進會行政秘書 Administrative Secretary, Macau Association of Support for the Disabled 閉幕典禮 Closing Ceremony Page 7

Allah Bakhsh Malik 從全球角度探討跨領域合作扶貧 Secretary to the Government, Literacy and NF Basic Education Department at Cross Sector Cooperation to Alleviate Poverty in a Global Perspective

9 K 1 演說 Presentation K1 貧窮不是不可避免的 - 加拿大的經驗 Poverty is Not Inevitable - A Canadian Perspective 講者 Speaker : Mr. Ted Bruce Co-Chair, the BC Poverty Reduction Coalition Executive Director, Population Health with Vancouver Coastal Health Overview of Presentation There is little argument that society believes that poverty reduction is a worthwhile goal. Unfortunately creating the changes needed for poverty reduction is difficult especially given how difficult it is to create change in a highly complex system. And the systemic issues that create poverty are highly complex. Nonetheless, change is possible and poverty is not inevitable. This paper will provide an overview of the health sector s view on the importance of poverty reduction. This represents a burning platform or one of the most powerful arguments for poverty reduction to become a priority of governments and society at large. This overview will be followed by a discussion on why poverty is not inevitable and essentially present the business case for poverty reduction. Because the scope of poverty reduction plans can be intimidating, the paper will conclude with some ideas for local action that can contribute to the broader aspects of a comprehensive poverty reduction plan. This is important as many of the broad policy initiatives that make up a comprehensive poverty reduction strategy require complex policy change and can seem to place poverty reduction beyond the means of local communities it is not. This presentation will focus on Canada and in particular the Province of British Columbia. Canada is a federal state with a complex division of powers. Although health and social policy in general rests with provincial governments, the federal government uses its powers, especially its spending powers, to create national policy in these areas. Local municipal governments also contribute within their jurisdiction to the policies that affect the health and well being of their citizens. Page 8

poverty reduction is a worthwhile goal. Unfortunately creating the changes needed for poverty reduction is difficult especially given how difficult it is to create change in a highly complex system.

Poverty in Canada K 1 When talking about poverty in the Canadian and BC context, the question arises as to whether there is in fact real poverty in a rich and developed economy.

10 Poverty in Canada K 1 When talking about poverty in the Canadian and BC context, the question arises as to whether there is in fact real poverty in a rich and developed economy. The definition of poverty is important but there should be no mistake that there are individuals living at levels of subsistence poverty. There are many individuals who rely on food banks to avoid hunger, urban areas have significant numbers of homeless people and many of Canada s indigenous people especially those living in rural and remote areas experience some extremely poor living conditions. As in most discussions of poverty, however, there is a broader definition of poverty that recognizes poverty is a situation of social and material deprivation. Two key components of this definition are a lack of resources and social isolation. The underlying concept is that a person is in poverty if they are unable to meet their basic needs through their participation in the social and economic life of a community. In Canada, the formal measure of poverty is actually a low income cutoff. This cutoff is the point at which an individual or family spends a significantly greater portion of their income on basic food, shelter and clothing than is the average in the country. The cut offs are adjusted for location as costs differ across the country and for family size. While some criticize this measure as being a relative measure of low income and not a measure of poverty, an alternate measure that compares income to a necessary basket of goods and services results in a similar percentage of people in low income circumstances. This suggests that the low income cutoff measure is a valid measure of the percentage of people living in very straightened circumstances. An estimate of poverty rates in Canada using the low income cutoff definition is shown below. The table presents recent data on the level of child poverty in Canada and in each province as reflected in a report on child poverty produced by a poverty reduction advocacy group in Canada. As can be seen the province of BC has a high rate of child poverty. Page 9

There are many individuals who rely on food banks to avoid hunger, urban areas have significant numbers of homeless people and many of Canada s indigenous people especially those living in rural and

11 K 1 Poverty rates are obviously affected by the state of the economy with increases evident during periods of economic slowdown. The following chart shows the variations in poverty in relation to economic downturns. It is important to note however that even in good economic times there continues to be persistent and unacceptable level of low income within the population. The State of the Economy Influences Poverty Trends in Canada The final aspect to note about poverty and low income in Canada is the success Canada has had in reducing poverty among seniors. The following chart shows significant reduction in the poverty rate among seniors commencing in This can be attributed to some key national policies such as the national seniors pension plan and income supplements. This trend in seniors poverty reinforces the point that will be made later in this paper that poverty is not inevitable. Seniors poverty rates steadily decline; poverty rates for other age groups fluctuate Page 10

It is important to note however that even in good economic times there continues to be persistent and unacceptable level of low income within the population.

12 Percent Why Poverty is a Concern to the Health Sector? K 1 As noted earlier, if we are to motivate decision-makers and the public at large to make a commitment to poverty reduction, there needs to be a burning platform or a significant compelling argument to create change. The health care sector provides such an argument. It essentially has 3 elements: Chronic disease is increasingly drawing on societal resources The burden of chronic disease is born more heavily by people in low income Health inequity affects everyone in society The burden of chronic disease in society is increasing. The chart below shows the observed and projected prevalence of diabetes cases in BC. These significant increases are due in part to an aging population and are to a degree the results of poor lifestyle among the population that has led to an increase in risk factors such as obesity. The same chronic disease increases can be shown for a range of conditions such as congestive heart failure and others. Observed and Projected Prevalent Cases of Diabetes in BC Fiscal Years The provincial government developed a hypothetical scenario to show the potential impact of increased chronic disease on the provincial budget. The table below is based on a projected growth in health care spending of 8% - a growth rate not atypical in health care. The scenario assumes that if the provincial economy grows at 3% a year and the provincial government provides increases of 3% a year for education and 8% a year for health care, the amount of funds available for all other public services will be ever more restricted. In other words, health care is drawing money away from other needed public services. Revenue/Spending Scenario 100% 90% 80% 70% 60% 50% 41.6% 53.6% Total Health 100.0% 71.3% Revenue Growth 3% Education Growth 3% Health Growth 8% 40% 30% 28.4% 27.0% Education 27.0% 20% 10% 27.0% 16.6% Other 0% -10% -0.6% 04/05 05/06 06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17 17/18 Year Page 11

argument to create change. The health care sector provides such an argument.

K 1 This is the first element of the burning platform for change. The second element is the notion that health care itself is not the largest contributor to population health.

13 K 1 This is the first element of the burning platform for change. The second element is the notion that health care itself is not the largest contributor to population health. A Senate Committee in Canada estimated that the health care system contributes only about 25% to health outcomes. As we know, the social determinants of health play a much more important role in determining population health. These determinants include: Poverty and low income Early childhood experiences Exclusion and racism Literacy and education. If health care consumes more of available public resources, there are less public funds available to support the policies and programs that can affect social determinants and improve population health outcomes. Dr. John Millar, a former BC Provincial Health Officer has characterized the scenario as follows: The burden of chronic disease is increasing This leads to increases in health care spending This means fewer public funds are available for other things This in terms means society is not achieving optimum population health This in turn reduces society s productivity and competitiveness. Another aspect of the health argument for poverty reduction comes from the fact that we know the burden of chronic disease is not equally distributed among the population. The following charts examine life expectancy within the Vancouver Coastal Health region and demonstrates a significant difference in life expectancy from the healthiest area to the least healthy. One specific population group that experiences considerable disparity in life expectancy is that of Canada s indigenous population. The graph below shows the difference in life expectancy for Aboriginal people in British Columbia. Disparities in Health Outcomes It is also known that this disparity in health status is primarily related to socio-economic circumstances. This is evident when the Vancouver Coastal Health life expectancy variation is mapped against household income. As can be seen, there is a clear gradient in life expectancy related to socio-economic circumstances of the geographical area. Page 12

As we know, the social determinants of health play a much more important role in determining population health.

14 Age-Standardized Percentage Richmond Vancouver - Westside West Vancouver - Bowen Island Vancouver - South Vancouver - North East North Vancouver Vancouver - Midtown Vancouver - City Centre Sunshine Coast Howe Sound Bella Coola Valley Powell River Vancouver - Downtown Eastside Central Coast Age-Standardized Percentage Life expectancy at birth (years) Life expectancy at birth ( ) combined and average household income after-tax ($) in 2005, by local health area K Average household income after-tax ($) 85.0 less than $50,000 $50,000 to $80,000 greater than $80, Data source: 1. BC Statistical Agency & BC Vital Statistics Agency (April 2009). 2. Statistics Canada (2006 Census) via BC Statistical Agency Sharepoint site.. The health argument for poverty reduction stresses that although health inequity is experienced at the lower end of the income spectrum, it is a problem for all of society irrespective of socio-economic circumstances. This is an important aspect of the argument because it stresses that while the most vulnerable in society must be a primary concern, poverty reduction is something that should be of concern for all members of society. The data to support this is extremely convincing. The fact is that health and income are related along a gradient such that all along the socio-economic ladder, the higher the income the better the health outcomes. As can be seen from the graphs below, not only does this hold for the prevalence of disease as shown in the first table but it holds for the utilization of hospital care. It should be noted that the measure of socio-economic status for the analysis of hospitalization rates uses a deprivation index that takes into consideration both material and social deprivation. This is important as it demonstrates a more nuanced analysis of the factors that contribute to the gradient in health and the drivers of health inequity. Hospitalization Rates Pan-Canadian Age-Standardized Prevalence of Heart Disease by Income Hospitalization Rates by SES Group* Men Women Lowest Lower Higher Highest Lowest Lower Higher Highest Middle Middle Middle Middle Household Income Quartiles Household Income Quartiles (Data source: Statistics Canada Canadian Community Health Survey Cycle ; Percentages were standardized to the 2004 Canadian population as the reference with bootstrap weight valued provided by Statistics Canada. Confidence intervals for age-standardized percentages (45-64, 65+) were calculated with the method based on the gamma distribution developed by Fay and Feuer in 1997) Note * For each indicator, all rates are significantly different between low-, average- and high-ses groups at the 95% confidence level. Source CPHI analysis of to Discharge Abstract Database and National Trauma Registry data, Canadian Institute for Health Information. Page 13

and average household income after-tax ($) in 2005, by local health area K 1 90.0 Average household income after-tax ($) 85.0 less than $50,000 $50,000 to $80,000 greater than $80,000 80.0 75.0 70.

K 1 In summary, the health care argument for poverty reduction emphasizes that the costs of chronic disease are not sustainable and that to reduce these costs it will be necessary to tackle the

15 K 1 In summary, the health care argument for poverty reduction emphasizes that the costs of chronic disease are not sustainable and that to reduce these costs it will be necessary to tackle the social and economic factors affecting population health. In addition, all of society should be concerned about this challenge not only because of economic and social justice arguments but because a steep gradient in social and economic equality means that individuals in middle income categories are also not achieving optimal health. Poverty is Not Inevitable The Business Case for Poverty Reduction As shown earlier in relation to senior s poverty, a concentrated effort to reduce poverty among Canada s elderly population showed great success. In spite of this and the compelling argument or burning platform from the health sector that demonstrates why we must tackle social inequality, it is difficult to convince decision makers of the need for action. There are a number of challenges that prevent action. One of these is the persistent notion that low income results not from systemic issues but from personal circumstances such as falling ill. There is a good body of research that shows that while some people fall into poverty because they become ill, this is not the dominant situation. In fact, if we look at childhood development, we can see healthy children in lower socio-economic circumstances will over time develop poorer health status than the rest of the population. Another notion that leads to resistance to address poverty is that low income results from the choices individuals make poor lifestyle choices for example and thus solving the problem of poverty is not a societal responsibility. This can be carried to the extreme by some who believe that low socio-economic status results from people simply being lazy. It is clear that the social and economic conditions in which people find themselves significantly limit their choices and that poverty is not a matter of choice or laziness. One helpful analysis of the characteristics of people in poverty shown below demonstrates that nearly have of poor children live in a family where at least on of the parents is working full time. In a country with the wealth of Canada, there is an expectation that someone working full time should not be living in poverty. Page 14

In addition, all of society should be concerned about this challenge not only because of economic and social justice arguments but because a steep gradient in social and economic equality means that

16 Even for many who are convinced that poverty reduction is necessary and that poverty is not an individual responsibility, there is a concern that a poverty reduction plan is too expensive. Fortunately, a growing body of research disputes this view and in fact shows that a concentrated effort makes economic sense. These costs of poverty studies estimate the direct costs of poverty such as social assistance payments but also the indirect costs such as health care costs associated with the gradient in health and the societal costs such as lost productivity or tax revenue resulting from the circumstances of people in low income. K 1 A recent cost of poverty report carried out in British Columbia by the Canadian Centre for Policy Alternatives shows that if the poorest 20% of the population used the same amount of health care as the next 20% on the income ladder, there would be a $1.2 billion dollar saving in health care expenditure. This study estimated the lost economic activity associated with poverty to equate to between $6.2 billion and $7.3 billion or between 3.2% and 3.7% of GDP. This is significantly less that the estimated costs of a poverty reduction plan estimated to be between $3billion and $4 billion dollars. Other studies demonstrate similar results. A homelessness study carried out in BC showed that the annual cost to taxpayers in health, corrections and social services spending for a homeless person was $55,000 per year. If supportive housing was provided to this person the costs would be $37,000 or a potential saving of $33 million annually. Clearly investments in poverty reduction would have significant payoffs. The Canadian National Council on Welfare s recent report entitled The Dollars and Sense of Solving Poverty estimated that the investment needed to close the poverty gap in Canada that is bring all citizens up to the low income cutoff would be $12.3 billion while the societal savings of such an investment would be double that amount. What Does a Comprehensive Plan Look Like? This presentation has attempted to demonstrate that there is a compelling argument or burning platform to address poverty from a health care perspective. It has also shown that there is a strong business case for addressing poverty poverty reduction is not unaffordable and in fact makes good economic sense. What then needs to be done? There are many well-developed poverty reduction plans and each jurisdiction must engage across sectors of society to develop one that makes sense for that community. In British Columbia, the Canadian Centre for Policy Alternatives working with the BC Poverty Reduction Coalition has proposed a plan. The health care sector itself has identified the types of policies that should be considered. This was done by a coalition of health organizations called the BC Healthy Living Alliance. The elements they propose to address the social determinants of health include: Page 15

These costs of poverty studies estimate the direct costs of poverty such as social assistance payments but also the indirect costs such as health care costs associated with the gradient in health and

17 K 1 Food and income security Early childhood development and care Education and literacy Housing and the built environment Employment, income security and working conditions Integrated primary health care Workplace wellness There are common elements within many plans that are critical. The first of these is to set timelines and targets. These are necessary to create accountability for the plan and to evaluate progress. Accountability is critical to avoid the plan being simply a prescription for change with no commitment for action. Another key aspect is for the plan to be comprehensive taking into account regulatory, financial educational and supportive policies. The health care sector s experience with tobacco reduction is a good model to consider. Through a comprehensive approach, there has been remarkable success in reducing tobacco use in the population in spite of concentrated resistance from the industry. Success is attributed to the comprehensiveness of the approach. Poverty reduction cannot simply be a few half hearted unconnected efforts if it is to be successful. In health care there is the concept of sufficient dose. A prescription below a sufficient dose will not be effective. Similarly with policy change a sufficient dose is needed. Finally, a poverty reduction strategy must be an all-of-society approach engaging a variety of government departments as well as the non-profit sector and the corporate sector. Without such involvement, the necessary commitment to change and investment is not likely to be forthcoming. In addition, each sector can contribute. For example, the private sector can pursue living wage policies or support for childcare in the work place. Poverty reduction will rely heavily on government policies, but these alone are not sufficient. There is a degree of skepticism that comprehensive poverty reduction plans will have an impact. Where is the evidence that such concentrated efforts will alleviate poverty? Seven of ten Canadian provinces have undertaken these forms of plans. It is early to evaluate their impact but some early results are encouraging. The Province of Quebec has demonstrated that its universal child care program has contributed to an increase in female workforce participation and shown a higher reduction in lone female families in poverty than for other categories of people. Advocates in Ontario attribute a slower increase in recession-driven poverty in that Province than was seen in other provinces. Newfoundland saw a significant drop in welfare recipients after the introduction of its plan. The results may take time but these plans have an accountability mechanism to allow for performance of the plans to be evaluated against timelines and targets. Page 16

These are necessary to create accountability for the plan and to evaluate progress. Accountability is critical to avoid the plan being simply a prescription for change with no commitment for action.

18 The Importance of Local Action K 1 It is easy for individuals to feel that they are not in a position to influence large policy initiatives that are characteristics of many poverty reduction plans. It is important to encourage people to address policies at all levels of government and across sectors. A good example of this is early childhood development a critical social determinant of health and well being. Dr Patty Daly the Chief Medical Health Officer of Vancouver Coastal Health has stated: early childhood development is immunization against chronic disease. Local data paints a picture of areas for change and it also helps us understand where there are communities that might be doing better than expected by the socio-economic status of the community. When a community does better than expected in the early development of its children, we can look for what might be some of the protective factors contributing to this success. We know that food security, access to amenities and a healthy built environment and a strong sense of social connectedness are factors that can help overcome the effects of low income. Many of these factors can be influenced by local policies and provide an agenda for local poverty reduction initiatives. Building a Strong Coalition The involvement of a broad cross section of the community including people living in poverty is an essential feature of poverty alleviation efforts. Such involvement reflects the broad nature of strategies that must be addressed but also is critical to create the momentum for change. As discussed earlier, there are many reasons why poverty reduction can be a hard sell for decision-makers and the public. The legitimacy of the movement is enhanced by engaging people from across society. And ultimately, those in poverty must be part of the effort as a fundamental principle of engagement involves giving voice to those affected and to build capacity for self determination within the community. The BC Poverty Reduction Coalition has adopted an inside-outside model for its engagement. The inside represents many established institutional players such as the health sector who have an existing voice and influence with government and corporate power structures. The outside represents the civil society organizations, including faith-based organizations, from or involved with the low income community. This coalition is able to focus on strategies best suited to their position in society. The established institutional players can meet with senior officials and business leaders, undertake some of the detailed analysis that is necessary to support policy change and even make individual personal contact with decision makers. The civil society organizations are in a position to act more politically through the media and election-oriented activities such as promoting petitions or political report cards. The latter is done in a non-partisan fashion to emphasize the point that this is an all of society issue and not one that is tied to a particular political ideology. Page 17

A good example of this is early childhood development a critical social determinant of health and well being.

19 K 1 Creating a More Equal Society Ultimately, the goal of poverty reduction is to create a more equal society. That means flattening the social economic gradient and reducing the gap between the rich and the poor. This in turn should improve the health, productivity and ultimately the well being of all members of society. As has been powerfully demonstrated by Richard Wilkinson and his colleagues, and documented in their book The Spirit Level, more equal societies perform better on almost all measures of social well being. Poverty reduction plans are a key component to create the path to a better society for all. There is a burning platform for us to tackle the problem. There is a strong business case to invest. Poverty is not inevitable. Sources 2011 Child Poverty Report Card. Produced by First Call: BC Child and Youth Advocacy Coalition. November Population Health Policy: Issues and Options. Select Standing Committee on Social Affairs, Science and Technology. Parliament of Canada. April The Dollars and Sense of Solving Poverty. National Council of Welfare. Autumn The Cost of Poverty in BC. Canadian Centre for Policy Alternatives. July A Poverty Reduction Plan for BC. Canadian Centre for Policy Alternatives. December Healthy Futures for BC Families. BC Healthy Living Alliance. September The Spirit Level. Richard Wilkinson and Kate Pickett Page 18

This in turn should improve the health, productivity and ultimately the well being of all members of society.

20 演說 Presentation K2 對抗貧窮與不公帄以構建公義社會 : 教會與明愛的回應 Struggling Against Poverty and Inequalities and Promoting Justice: What is the Church and Caritas Response K 2 講者 Speaker : Mr. Michel Roy 國際明愛總幹事 Secretary General, Caritas Internationalis It is a big honor and I am most happy to be here with you to share my reflections on how to join hands to identify new roads for poverty alleviation. Why and how the Caritas family, from local to global, is struggling to make of this world a better one for all and especially for the poorest, the most vulnerable, as called by Jesus and the universal Catholic Church. Ahead of my speech, I would like to start greeting Caritas de Macao for the 60 years of service it has brought to the people of Macao but also to the people of China and of various parts of the world. Let me remember here the great figure of Fr Ruiz who dedicated his life to the victims of poverty and made of Caritas de Macao what it is today. I would also thank Caritas de Macao for having taken this initiative to bring us in front of our responsibilities as Christians for some of us, but for sure as citizens of this world we love and want to make better for all. As some of you know, I have been elected SG of CI end of May, 6 months ago now, for a period of 4 years, but my experience of Caritas both at the grassroots in France and in the international arena are of more than 30 years. This experience has given me a lot of insight on what we are living presently, and what we collectively have to do to change things for the better by bringing the love of God to everyone and promoting justice. This is incarnated in the present Caritas slogan: One human family, zero poverty. My presentation will have 3 main parts. The first one will focus on the world we live in and the challenges ahead of us, in the second, I will present the Church and Caritas response and in the third I will propose some food for thought on ways of struggling against poverty together. Page 19

21 K 2 1. The World We Live in and the Challenges Ahead of Us It is always good to remind oneself of the realities of the world we live in. Taking some height. I would like to share a few figures taken from UN institutions statistics. 2.6 billion human people live on less than $2 a day. Almost 50% of us in the global village. Some 1.3 billion (20%) live in extreme poverty (1.25$ a day). In 2010, we have counted 60 million more, because of the global recession. The number of hungry people has risen from 842 million in the early 1990s to 1.02 billion last year. 900 million people don t have access to safe drinking water. Non drinkable water causes more deaths than HIV/AIDS, malaria and TB combined. 8 million children under 5 are expected to die this year mostly from preventable diseases. An improvement though. 40% of those deaths occur in just 3 countries: India, Nigeria and DRC. Women represent 2/3 of the world s poor, though they perform 2/3 of the world s work and produce 50% of the food (a number that goes up to 90% in some regions) while they earn only 10% of the income and own 1% of the property. A big inequality there. o 2.5 billion people lack basic sanitation services = 40% of the world s population (but this is an improvement as it is 8% less than in 1990). o In the USA, the poverty threshold is about 15$ a day per person. This means 40 million people poor, and this figure is on the increase. Those mainly affected are youth under 18 and African Americans. Inequalities: 20% of the wealthiest people (the top billion) consume 80% of the earth s water, energy and minerals. o agriculture produces 17% more calories per person than it did thirty years ago despite a 70% increase in the population. What do these figures tell us? That though globalization has given us positive evolutions, especially in the field of communication, it has not solved poverty and has increased inequality. We all witness these consequences: - A growing inequality between rich and poor, both within and between countries: we live in a more and more unequal world. The rich have become richer and the poor poorer. A number of middle class people are falling into poverty into the so called developed countries The people in the cities take advantage of the situation, the people in the rural areas remain poor, their poverty may even increase Page 20

22 - The destructuration and degradation of public services, especially health and education systems Reduction in number of hospitals, maternities, trains not running properly, school levels diminishing, K 2 - The lowering of the requirement of the respect for rights: in face of increased competition, both civil and political rights as well as economic and social rights are at stake in many countries. The social protection rights that were gained in the 30s in western Europe are slowly and insidiously being reduced : cost of medicine - The conflicts, tensions and a dominant security atmosphere with its implications for everyday life. Fundamentalism is raising as a consequence of frustrations and lack of meaning of life. The response is too often repression, not tackling the root causes, and raising a security atmosphere everywhere: police become rough at people o Nevertheless, we have witnessed the revolutions in the Arab world: people want to participate and not be imposed: this brings hope! - The increase in migration of people seeking safety and a good life but facing closed borders and subject to degrading trafficking A paradox: at the same time when people can freely move around as tourists, the migrations become more and more difficult: Africans in Europe, Asian in Australia, People die, in the seas (Mediterranean, coasts of Mauritania) as well as in the deserts (Lybia, Marocco) or are killed: Mexico - The environmental degradation and climate change due to excessive human activity, and to the dominant model of economic growth The situation in Bangladesh, in Somalia, in the Pacific islands The struggle to go on the previous engagements presently discussed in Durban - The secularization of society, bringing a lack of meaning in life Increase in the number of suicides Increase in the consumption of drugs - The domination of a neo liberal capitalism, with no control, which has brought the present financial crisis. With the subprime crisis in 2007and what followed, we have discovered that the financiers have been playing casino with us and our money, not caring at all of the people whose life has been brought in disarray. Greed of multinationals, against humanity. We see such worrying signs as land grabbing by governments and companies that deprive the poor from their lands. Page 21

23 What world do we want for people to live well and in dignity? K 2 2. The Church and Caritas Response The Gospel and based on the Gospel, the Church s social teachings, enriched over the centuries according to the realities of the times, invite us to believe in the capacity of all mankind, and especially of the poor, to become what God has wanted us to be. They promote the values brought to us by Jesus, as a transformative power. They show us the way. I want to stress one of those values particularly pertinent these days, that is the promotion of the common good through the universal destination of the goods of the earth so as to allow everyone and every human community to grow and develop to be able to live well and to be fulfilled as intended by the Creator. The human person is prime. Finance and economy is at its service, and not the contrary! In this frame, the mission of Caritas is to promote human development and social justice for all, regardless of creed, race or ethnicity, to realise a world where the fruits of the earth are shared by the whole human family. In Deus Caritas Est, the first encyclical letter of Pope Benedict XVI, focused on Charity, our attention is called on the distinctiveness of the Church s charitable activities: The Christian programme the programme of the Good Samaritan, the programme of Jesus is a heart which sees. This heart sees where love is needed and acts accordingly. The Caritas mission is based on such values, beyond the promotion of the common good, as compassion, solidarity, fraternity, partnership, the preferential option for the poor, CHARITY and JUSTICE. Both Charity and Justice animate Caritas action but require different strategies and lead to different results. Charity helps us to meet immediate needs, address painful individual symptoms of social problems, and relies on the compassion and generosity of people. Justice helps us to work for long-term social transformation, address the underlying social causes of individual problems, and relies on just laws and on fair and equitable social structures. Blessed John Paul II added his reasons to why Christians should be engaged in both charity and justice related activities when he noted at the dawn of the third Christian millennium: Page 22

24 Our world is entering the new millennium burdened by the contradictions of an economic, cultural, and technological progress which offers immense possibilities to a fortunate few, while leaving millions of others not only on the margins of progress but in living conditions far below the minimum demanded by human dignity. How can it be that even today there are still people dying of hunger? Condemned to illiteracy? Lacking the most basic medical care? Without a roof over their heads? Novo Millennio Ineunte, #50. K 2 Pope John Paul II proposed a radically new approach to the Church s social mission by moving beyond individual practice of these virtues to establish true solidarity among all peoples: Positive signs in the contemporary world are the growing awareness of the solidarity of the poor among themselves, their efforts to support one another, and their public demonstrations on the social scene which, without recourse to violence, present their own needs and rights in the face of the inefficiency or corruption of the public authorities. By virtue of her own evangelical duty, the Church feels called to take her stand beside the poor, to discern the justice of their requests, and to help satisfy them, without losing sight of the good of groups in the context of the common good. (Sollicitudo Rei Socialis 1987), 39. In order to promote such solidarity among all, he insisted that sweeping changes must be made among individuals, governments, and entire societies: It is not merely a matter of giving from one s surplus, but helping entire peoples presently excluded or marginalized to enter into the sphere of economic and human development. For this to happen, it is not enough to draw on the surplus goods which in fact our world abundantly produces; it requires above all a change of life styles, of models of production and consumption, and of the established structures of power which today govern society. (Centesimus Annus 1991), Some Food for Thought to Help Us Go Forward in These Two Days of Reflection Based on my experience and observations. In the context which I have described and analysed, the struggle against poverty is clearly not only a matter of helping people to face their problems with administrative or financial solutions, it is much more. A. It is primarily enter into a relationship with the persons that are victims of poverty, become supportive, walk along with them, witness the friendship and love we bear them, that love that comes from God. Cf the name of Caritas in Chinese: a love qualified of bright : Ming Ai. To respond to the people who are victims of poverty, the first step remains be on Page 23

25 K 2 their side, look at their problems with/through their eyes. Take time, listen, help express sorrow, be compassionate, this is what is expected from everyone of us. Finish with rushing, take time! B. It is getting organized to respond effectively to their needs and expectations, on a community or institutional basis, by calling on the public services responsible for social action. Clearly, what one person can do is fundamental but not enough. One problem is very often the problem of many. How do we look at it collectively? What answer do we bring or try to bring? Probably Caritas de Macao is a very good example of this. In the Chinese culture, education is of utmost importance. Then how do we empower the poor? Do we trust the poor? They have personal talents, they have collective talents that will appear through animation of an empowerment process. Ex India Andhra Pradesh. Ex food shop in France, cultural events, solidarity assemblies, Do our social services sit on the side of the poor? or do they face them? Help people access their rights. C. It is also to try to understand and analyze the causes of poverty. Local causes, national causes, global causes. And to act on those causes so that poverty does not develop further, to mobilize the authorities on new forms of poverty, and to encourage the necessary decisions be taken to reduce it. Do we really want to go to the root causes of the poverty we observe? Do we believe in the transformative power of the poor? And if so, how do we help empower them to act and change? How do we work together to initiate these changes? To finish, at another level, I would like to invite you to reflect on a few global issues facing the international community, of which we are members as citizens, as well as on local issues for all of us. Global issues for the international community: o invent a global governance that takes everyone into account o regulate the international financial system and submit it to the real economy o regulate multinational corporations and international trade o find ways to finance development and climate change mitigation Local issues for all of us: - Develop a local economy (food production, industries,...), promote family farming Page 24

26 - Provide a decent work for all - Promote a Live together way of life and the participation of people - Rethink the way we live, consume better, respecting nature to bequeath a liveable world to future generations ("happy frugality ", blessed are those who are modest in their desires, they will save the creation ). - Promote peace and reconciliation - Develop solidarity across borders K 2 Thank you for your attention and your interest to discuss these issues. Annex Caritas Internationalis As a confederation of 164 national Catholic Church member organisations working both locally and globally, Caritas Internationalis is above all a witness to all the efforts made at the grassroots by the people who do not accept poverty and inequalities as a fact, and who see the poor as brethren to be actively supported in their endeavours for a better and dignified life, that life that God has given all of us in fullness. Caritas will work in a holistic way, taking into account the whole person and the whole humanity (one human family, zero poverty), taking the people and the communities as they are to help them go forward, take initiatives that will change their lives for the better. These initiatives will be not only at the local level but also at other levels, regional, national, global, so as to make sure they will not be hampered by policies that will impoverish them more. In case of disasters and conflict, Caritas will be on the side of the victims to help them save their lives and recover. Caritas plays a major role in calling for action all people of good faith so as to build brotherly communities in which everyone is respected and allowed to grow. 6 fields of intervention: 1. Emergency response: When a disaster occurs: save lives o Be ready o React at once o Mobilize media attention and funds o Organize the durability of the answer o Network Page 25

27 K 2 - But also: prepare the communities (disaster response) adapt the local practices to the risks (drr) struggle against and adapt to climate change struggle against the other causes (Horn of Africa today) build peace and reconciliation so that disasters will be reduced in numbers and in scope. An example: Caritas Bangladesh; Caritas Ethiopia 2. Rehabilitation: After a disaster: rebuild lives, rebuild life o Rehabilitate houses, means of subsistence and infrastructures o Help people recover: trauma counseling, healing, community building, o Pave the way for longer term programs based on people s initiative and participation o Mobilize international donors for massive funding to change the environment An example: Caritas Sri Lanka 3. Development programs: Accompany the poorest in developing their capacities and taking their lives in their own hands Through animation processes Revealing people s talents and capacities Helping people get organized Through training Building capacities Through financial support Giving the leverage to start action An example: Caritas Brazil 4. Welfare programs: Accompany the most vulnerable: children, the elderly, people living with handicaps set up structures to take care to show the government ways to go forward training to act properly mobilizing volunteers to give a human face to social endeavors An example: Caritas France 5. Lobbying and advocacy: Influence the environment so that it will be supportive of the development of everyone and of all Page 26

28 influence policy makers influence business leaders on the basis of The Social teachings of the Church The analysis of the issues by the local actors through media action, lobbying, campaigning An example: transparency in the extractive sector (migrants rights, HIV and aids, climate change and food security, ) K 2 6. Awareness and solidarity building: Create an understanding and invite to engagement with the others so as to build a just and brotherly society To reach these goals, Caritas has four guiding principles: The Gospel, the Bible, and the social teachings of the Church that show the way and give impetus The buildup of the international community The proximity with the poor who teach us the way The solidarity amongst its members, both locally and globally Page 27

29 演說 Presentation K3 K 3 中國殘疾人扶貧開發政策與實踐 The Policy and Practice for the Development of Helping the Poor Disabled People in China 講者 Speaker : 王建軍先生 Mr. Jianjun Wang 中國殘疾人聯合會扶貧辦主任 Director, Office of Poverty Alleviation, China Disabled Persons' Federation 中國肢殘人協會副主席 Vice-chairman, China Physically Handicaped Persons' Association 中國殘疾人扶貧開發是一個廣泛的概念, 包括了城市和農村城市殘疾人的貧困問題, 中國政府主要是通過制度化的社會保障體系, 保障殘疾人的基本生活醫療教育養老和住房等基本生存權同時, 採取分散按比例尌業集中尌業個體尌業創業等尌業政策, 加大尌業培訓力度, 完善尌業服務體系等措施實現殘疾人尌業, 達到穩定脫貧的目的農村殘疾人的貧困問題, 中國政府是通過將殘疾人扶貧納入國家扶貧開發規劃同步實施, 在此基礎上, 有組織有計劃的開展專項的殘疾人扶貧開發工作中國殘疾人扶貧開發的概念, 系指在農村地區開展的專項殘疾人扶貧開發工作一中國殘疾人扶貧開發工作概述中國殘疾人的扶貧開發是中國扶貧開發事業的重要組成部分, 貫穿整個扶貧開發事業的全過程隨著中國扶貧開發工作的深入, 殘疾人的貧困問題, 特別是農村殘疾人貧困問題越顯突出貧困殘疾人由於殘疾影響受教育程度偏低缺乏技能機會不均等扶貧資金投入不足等原因, 成為貧困程度最重扶持難度最大返貧率最高的特困群體, 是扶貧開發工作的重點難點人群這一突出問題引貣中國政府的高度關注, 從 1991 年開始, 將殘疾人扶貧納入國家扶貧開發規劃統籌安排, 同步實施, 並結合貧困殘疾人特點開展專項扶貧工作經過近 20 年的探索與實踐, 中國殘疾人扶貧開發取得了顯著成效, 貧困殘疾人數量大幅下降, 生產生活狀況逐步改善, 積累了很多切實有效的成功經驗和做法, 走上了一條符合中國國情富有特色的道路, 為推進中國殘疾人事業發揮了重要作用, 為中國減貧事業的發展做出了特殊貢獻 ( 一 ) 歷史沿陏從 1991 年至今, 殘疾人扶貧開發工作大體經歷了四個階段 Page 28

30 1 貣步摸索階段 (1991 年年 ) 根據中國政府的授權, 中國殘聯是殘疾人扶貧開發工作的宣導者和實施者, 長期致力於有計劃有組織推動殘疾人扶貧開發工作的探索與實踐 1991 年, 中國政府批准實施的中國殘疾人事業八五計畫綱要 (1991 年年 ), 首次提出初步解決殘疾人溫飽的任務目標同時, 中國農業發展銀行安排 400 萬元貼息貸款, 即康復扶貧貼息貸款, 在 12 個省的 13 個縣開展殘疾人扶貧工作的詴點, 拉開了殘疾人扶貧工作的序幕自此, 康復扶貧貸款逐步增加至 2011 年的 10.3 億元 1994 年, 中國政府頒佈實施國家八七扶貧攻堅計畫 ( 年 ) 要求各級殘聯要積極參與扶貧開發工作, 中國殘疾人聯合會要繼續做好貧困殘疾人的康復扶貧工作 1995 年, 中國政府頒佈實施中國殘疾人事業九五計畫綱要 (1996 年年, 首次提出對殘疾人進行社會幫扶 1997 年, 中國殘聯提出大力推進小額信貸創辦扶貧基地組建殘疾人服務社等一系列新的殘疾人扶貧措施 1998 年 4 月, 中國政府頒佈實施殘疾人扶貧攻堅計畫 ( 年 ), 提出通過扶貧開發, 基本解決適合參加生產勞動的貧困殘疾人的溫飽々通過社會保障, 基本解決缺乏勞動條件的特困殘疾人的溫飽的奮鬥目標々明確扶持到戶到人的工作方針 K 3 殘疾人扶貧開發的貣步摸索階段為殘疾人扶貧事業的進一步發展奠定了基礎在此階段提出的康復扶貧貼息貸款小額信貸到戶到人公司加農戶扶貧基地社會保障種養加技術培訓黨政幹部幫包帶扶殘疾人服務社等新思路新理念, 都成為日後扶貧工作的強大推動力量 2 發展開拓階段 (2001 年年 ) 2001 年, 中國政府頒佈實施中國農村扶貧開發綱要 ( 年 ), 明確提出把殘疾人扶貧納入扶持範圍, 統一組織, 同步實施同年, 中國殘聯與有關部門共同制定實施農村殘疾人扶貧開發計畫 ( 年 ), 明確了儘快解決貧困殘疾人的溫飽問題, 繼續鞏固已有扶貧成果, 提高貧困殘疾人的生活品質和綜合素質, 縮小貧富差距, 為實現共同富裕創造條件的十年目標 2004 年, 中國政府為妥善解決殘疾人住房困難, 啟動實施了中央彩票公益金農村貧困殘疾人危房改造專案, 標誌著殘疾人扶貧事業在開拓新領域方陎邁出了堅實的一步 2006 年, 中國政府頒佈實施中國殘疾人事業十一五發展綱要 (2006 年年 ), 明確三項扶貧指標〆 (1) 扶持 1000 萬農村貧困殘疾人基本解決溫飽々(2) 幫助中西部地區 100 萬名農村貧困殘疾人接受實用技術培訓 (3) 完成 32 萬戶農村貧困殘疾人家庭危房改造任務 Page 29

31 殘疾人扶貧開發發展開拓階段使廣大農村貧困殘疾人的生產生活狀況得到進一步提升和改善在幫扶貧困殘疾人的具體措施和新領域的開發方陎都有了進一步突破 K 3 3 調整完善階段 (2008 年年 ) 2008 年, 中國政府出臺了關於促進殘疾人事業發展的意見, 提出六條具體要求, 加強殘疾人扶貧開發力度同年, 中國殘聯與國務院扶貧辦中國人民銀行財政部共同出臺關於康復扶貧貸款管理體制改陏的通知, 政策性貸款商業化運作的瓶頸問題從政策制度層陎上得到初步解決同年 9 月, 中國共產黨第十七屆三中全會關於推進農村改陏發展若干重大問題的決定, 提出加強農村殘疾預防和殘疾人康復工作, 促進農村殘疾人事業發展, 在黨的綱領性文件中首次提出具體的農村殘疾人工作目標同年, 中國殘聯第五次代表大會提出殘疾人社會保障體系和服務體系建設的戰略目標〆 2015 年要初步建立兩個體系基本制度框架,2020 年要使兩個體系更加完備, 服務能力和保障水準得到大幅度提高, 殘疾人生活狀況得到根本改善兩個體系建設進一步明確了殘疾人扶貧開發工作的發展方向 2010 年, 中國政府出臺關於加快推進殘疾人社會保障體系和服務體系建設的指導意見, 明確要求加強農村殘疾人扶貧服務, 促進殘疾人脫貧保障農村殘疾人充分享受各項惠農政策和社會保障政策, 推動殘疾人扶貧開發政策與各項社會保障政策的有效銜接同年, 中國政府出臺關於做好農村最低生活保障制度和扶貧開發政策有效銜接擴大詴點工作的意見, 明確了健全貧困殘疾人口的評議識別機制, 對符合低保條件的殘疾人要做到應保盡保同年, 中國住房和城鄉建設部將貧困殘疾人納入國家保障性安居工程統籌安排, 優先解決貧困殘疾人家庭的住房在制度上得到切實保障在殘疾人扶貧開發調整完善階段, 國家扶貧開發由主要解決絕對貧困人口溫飽的低水準階段轉向對農村未解決溫飽的貧困人口和低收入人口全陎提供扶持和幫助的較高水準階段殘疾人扶貧逐步得到制度性的安排和保障, 開始從溫飽救濟型向溫飽救濟與開發致富並重的方向發展 4 全陎推進階段 (2011 年開始 ) 2011 年 3 月, 全國人民代表大會批准實施的中華人民共和國國民經濟和社會發展第十二個五年規劃綱要明確要求〆加大對農村殘疾人生產扶助和生活救助力度這是國家五年規劃綱要首次對農村殘疾人的扶貧工作提出要求同年 5 月, 中國政府頒佈實施的中國農村扶貧開發綱要 ( 年 ) 第一次明確提出將農村殘疾人等困難人群作為扶貧開發重點群體同年 5 月, 中國政府批准的中國殘疾人事業十二五發展綱要 ( 年 ), 在冷靜分析農村殘疾人的社會保障與服務亟待改善的突出矛盾基礎上, 提出具體任務目標 Page 30

32 同年 10 月, 中國殘聯會同財政部中國人民銀行國務院扶貧辦共同印發了關於進一步完善康復扶貧貸款和貼息資金管理有關政策的通知, 明確規定將貸款規模從原來的每年 8 億元調整為每年不少於 10.3 億元, 提高中央財政貼息利率, 延長貸款還款期限, 並提出有條件的地方要加大康復扶貧貸款擔保金或風險金制度的詴點, 進一步緩解貧困殘疾人貸款難的問題的政策方向同年 11 月, 農村殘疾人扶貧開發綱要 ( 年 ) 已正式報國務院辦公廳, 有望年內印發綱要明確了未來十年農村殘疾人扶貧開發的基本原則任務目標政策保障扶持措施組織領導五方陎二十條具體要求綱要第一次具體明確了部門責任分工, 第一次制定了執行評估指標, 特別是綱要提出了未來十年農村殘疾人扶貧要以殘疾人社會保障體系和服務體系建設為主線, 以增加貧困殘疾人家庭收入提升貧困殘疾人口生活品質為目標, 以提高農村殘疾人基本素質和生存發展能力為重點, 加大生產扶助和生活救助力度, 全陎改善農村殘疾人生產生活狀況, 促進其全陎發展的指導思想, 為實現保障優先, 到戶到人, 增加收入, 提高能力社保保基本開發促發展的新十年目標統一了思想, 提供了政策依據 K 3 全陎推進階段的鮮明標誌是〆 (1) 農村殘疾人扶貧開發進一步納入黨和國家全陎實現小康的戰略部署和新一輪扶貧開發攻堅戰, 並予優先安排 (2) 農村殘疾人扶貧開發進入強化社保保基本, 完善服務促發展雙輪驅動的新階段 (3) 農村殘疾人扶貧開發進入政府負責部門落實量化評估全陎推進的新時期 ( 二 ) 主要成效從 2001 至 2010 年中國殘疾人統計年鑒和近年來中國殘疾人狀況監測的資訊來看, 近十年, 貧困殘疾人生產生活狀況得到明顯改善殘疾人逐步實現穩定脫貧中國政府採取扶貧開發與社會救助等多種方式扶持農村貧困殘疾人萬人次, 其中 1318 萬殘疾人年人均純收入超過了中國政府當年的貧困標準, 實現了穩定脫貧殘疾人社會保障狀況進一步加強農村殘疾人參加新型農村合作醫療比例上升, 由 2007 年度的 84.4% 上升到 2010 年度的 96% 新型農村養老保險制度詴點地區,2010 年度殘疾人參保的比例為 12.8% 2010 年度農村殘疾人領取最低生活保障金的比例比 2007 年度增加了 16.1% 2010 年殘疾兒童接受義務教育的比例比 2007 年提高了 7% 殘疾人住房條件有效改善中國政府通過保障性安居工程抗震救災易地搬遷危房改造小城鎮建設等工程, 使農村殘疾人人均住房陎積達到 21.6 帄方米中央彩票公益金農村貧困殘疾人危房改造項目的實施, 讓 54.8 萬貧困殘疾人家庭的危房得到改造殘疾人家庭收入穩步提高 1,749 萬農村殘疾人實現尌業獲得穩定收入 2010 年度農村殘疾人家庭人均可支 Page 31

33 配收入 4,739.2 元, 比 2007 年度增加了 1,638 元 783 萬貧困殘疾人接受了農村實用技術培訓, 普遍掌握了 1 至 2 項勞動技能發展生產 23.3 萬貧困殘疾人在扶貧基地生產合作組織尌業或得到幫扶, 增加收入 1,000 元以上 140 餘萬貧困殘疾人得到康復扶貧貼息貸款的扶持發展種植養殖業生產逐步增加了收入 K 3 全社會扶殘助殘的氛圍濃厚動員黨政機關企事業單位, 黨團幹部志願者街坊鄰里等社會各界通過一幫一眾幫一等結對形式, 積極幫助貧困殘疾人改善生活條件, 扶持發展生產 229 萬個單位與貧困殘疾人家庭結成了幫扶對子,1,047 萬名社會各界人士與貧困殘疾人手拉手幫扶, 扶持資金及物資約為 24.6 億元上述幫扶實踐不僅在殘疾人扶貧中發揮了重要作用, 而且促進了社會扶殘助殘氛圍更加濃厚 ( 三 ) 經驗做法在殘疾人扶貧開發工作實踐中, 我們以社會保障為依託, 以提高殘疾人自我發展能力為手段, 以增加貧困殘疾人收入為目標, 創造積累了一系列行之有效的做法和寶貴經驗 1 始終從國家扶貧事業的全局出發, 堅持不懈推動農村殘疾人扶貧工作中國政府高度重視扶貧事業, 將農村殘疾人等貧困人口納入扶持的重點, 不斷加大扶持力度々在勞動福利型的事業發展道路引領下, 農村殘疾人扶貧工作成為各級殘聯組織重中之重的工作, 並不斷研究新情況, 努力解決新問題 2 始終堅持政府主導, 與大扶貧統一安排同步實施各級殘聯成為政府扶貧開發領導小組成員單位, 主動配合扶貧辦等有關部門協調解決殘疾人扶貧工作中出現的問題々地方各級政府成立了殘疾人扶貧解困領導小組前後兩個十年扶貧開發綱要都明確農村殘疾人扶貧的政策措施, 殘疾人業已成為扶貧開發的重點人群 3 始終堅持動員社會, 積極爭取各方幫扶採取一幫一眾幫一及單位定點幫扶等多種幫包帶扶方式, 充分發揮基層黨團組織的政治優勢和党團員的先鋒帶頭作用, 主動結對子, 幫助解決殘疾人生產和生活困難問題 4 始終堅持部門配合, 共同推動殘疾人扶貧開發充分依靠政府扶貧部門的主導作用和有關部門職責, 從解決農村殘疾人的醫療教育社保尌業生產等基本需求入手, 聯手行動, 研究解決農村殘疾人扶貧工作中出現的新困難, 從而形成開展殘疾人扶貧的重要保障 5 始終堅持多管道籌措資金, 千方百計增加投入截至 2010 年, 國家累計投放康復扶貧貸款超過 100 億元, 彩票公益金危房改造項目累計投入 4.5 億元, 慈善組織, 民間力量也積極參與農村殘疾人扶貧, 出錢出策, 日益活躍據估算, 全國各地累計投入殘疾人扶貧資金達 40 多億元 Page 32

34 6 始終堅持創新扶貧方式, 幫扶帶動貧困殘疾人近十年, 各地不斷探索創新更加適合殘疾人發展生產增加收入的扶貧方式從最初的小額信貸扶持發展到公司加農戶訂單農業, 又延續創新出整村趕帄均一戶一策滾動發展和農機合作社等有效的扶貧方式, 帶動了眾多農村殘疾人及家庭擺脫貧困 7 始終堅持宣傳動員, 大力營造扶貧氛圍充分借助大眾傳媒和農村有效宣傳形式和載體, 廣泛宣傳殘疾人扶貧政策資訊及殘疾人扶貧解困典型, 為社會和貧困殘疾人搭建溝通聯繫的橋樑, 激勵廣大農村殘疾人奮發自強生產自救的勇氣和信心, 擴大殘疾人扶貧工作的影響, 在發動社會營造氛圍及鼓舞殘疾人方陎發揮了積極作用 K 3 二中國貧困殘疾人的現狀及工作存在的困難和問題雖然我國殘疾人扶貧工作取得了明顯成效但貧困殘疾人的數量仍然較大, 生產生活狀況距離社會帄均水準還存在很大差距, 實際工作中還存在不少困難和問題, 殘疾人扶貧開發工作依然任重道遠 ( 以下資料根據 2001 至 2010 年中國殘疾人統計年鑒和近年來中國殘疾人狀況監測的資訊反映 ) ( 一 ) 殘疾人貧困數量大依據 2010 年中國政府確定的貧困標準, 農村居民年人均純收入低於 1,274 元標準統計, 我國農村地區仍有貧困殘疾人 1,089 萬, 占我國當年貧困人口 40%, 占全國農村殘疾人總數 6,225 萬人的 17.5% ( 二 ) 殘疾人生活困難程度深由於身體障礙勞動能力和文化程度普遍不高接受技能培訓的能力較差, 醫療支出大, 自然環境限制等原因, 導致殘疾人增收困難, 家庭負擔沉重根據貧困地區農村殘疾人狀況調研, 殘疾人家庭年人均純收入僅占當地居民年人均純收入的 60% 2010 年, 農村殘疾人家庭人均醫療支出是中國農村居民醫療支出的 2.09 倍, 農村貧困殘疾人生活救助需求率高達 65%々農村殘疾人仍靠家庭供養和鄰里接濟的達 76.9% 中國仍有近 50 萬戶貧困殘疾人家庭居住在危房中々農村殘疾人家庭恩格爾係數高於中國農村居民家庭恩格爾係數 6.4 個百分點, 表明殘疾人家庭生活品質明顯落後于全國帄均水準 ( 三 ) 殘疾人社會保障水準低近些年, 包括殘疾人在內的農村居民普遍納入了各項社會保障範圍, 但目前中國的社會保障仍處於低標準廣覆蓋的水準, 對於生活困難的貧困殘疾人的需求還有很大距離 2011 年, 農村應納入最低生活保障範圍的殘疾人為萬, 已納入最低生活保障範圍的僅為萬, 還有萬殘疾人未納入最低生活保障範圍在基層調研時發現, 有些地方因為低保指標有限, 部分特困殘疾人不能全額領取低保金, 甚至沒有納入低保範圍納入低保的貧困殘疾人家庭因為物價上漲, 生活支出加大, 低保標準偏低, 僅能維持家庭的基本生活在農村新型養老保險制度實施過程中, 大部分貧困殘疾人對於參加新農保個人繳費的支出還很困難目前農村新型合作醫療制度, 報銷門檻高, 報銷比例低, 缺少針對殘疾人特殊需要的政策安排, 一些殘疾人特有的康復治療費用得不到報銷, 醫療支出負擔沉重農村貧 Page 33

35 困殘疾人實施危房改造後, 基本生活條件與健全人家庭還存在很大差距城鎮中的保障性安居工程, 低保戶入住後, 住房中常用生活設施一應俱全, 而農村貧困殘疾人入住新房後, 家徒四壁, 缺乏入住新房的幸福感農村殘疾人對醫療和生活救助的需求極其迫切, 農村 63.5% 的殘疾人有醫療救助需求 K 3 ( 四 ) 殘疾人扶貧工作力度弱當前, 殘疾人扶貧開發工作處於資金投入少, 扶貧救助政策不夠完善, 扶持手段欠缺的局陎, 難以滿足貧困殘疾人基本生活和發展生產的迫切需求在中國政府安排的上百億扶貧信貸資金中, 農村殘疾人扶貧工作僅有 10.3 億元康復扶貧貸款用於扶持貧困殘疾人發展生產從基層工作實際情況反映, 很多地方因為貼息資金總量的限制, 影響到貸款規模的擴大, 許多有發展生產願望的殘疾人得不到貸款中央財政安排資金扶持農村貧困殘疾人接受實用技術培訓, 每個殘疾人只能獲得 100 元補貼, 而各地一周短期培訓的費用帄均大約要元, 殘疾人的實用技術培訓很難保證品質中央財政安排彩票公益金用於開展農村貧困殘疾人危房改造, 但最困難貧困殘疾人的危房仍然得不到解決, 這些家庭沒有任何財富的積累, 又沒有親戚朋友可以資助, 借債蓋房增加了家庭的負擔, 目前農村一般家庭的房屋造價要 3-4 萬元, 中央財政補貼危房改造的資金每戶 6,000 元, 加上地方的投入, 仍相差甚遠, 一些符合危房改造條件的極度貧困殘疾人家庭只能自己放棄改造機會, 直接影響到項目設立的初衷三如何做好未來殘疾人扶貧開發十一五以來, 中國政府先後出臺了一系列的檔, 對殘疾人扶貧工作提出具體的要求即將以國務院辦公廳檔的形式頒佈實施的農村殘疾人扶貧開發綱要 ( 年 ) 明確提出了未來農村殘疾人扶貧開發工作的目標, 加大了資金投入, 提出了更加有力的扶持政策和措施一系列的政策檔為做好未來殘疾人扶貧開發工作提供了政策保障, 勢必加快推進殘疾人扶貧開發的進程 ( 一 ) 納入規劃, 讓農村貧困殘疾人生活品質大幅提升只有從根本上解決殘疾人的貧困問題才能真正意義上實現國家扶貧開發的目標今後一段時間是中國社會保障和改善民生縮小發展差距促進全體人民共用改陏發展成果的關鍵時期, 這種背景下, 貧困殘疾人有望在國家的大力扶持下, 大幅提升生活水準, 增強幸福指數, 與全國人民一道共用社會發展成果國家在實施農村扶貧開發過程中, 將貧困殘疾人繼續納入其中, 重點予以扶持制定有針對性的政策措施, 明確目標, 強化責任, 督促落實在國家實施的產業扶貧行業扶貧等各項針對貧困人口實施的項目中, 把貧困殘疾人作為扶持物件, 提出具體的目標和任務, 優先解決頒佈實施農村殘疾人扶貧開發的專項規劃針對農村貧困殘疾人的現狀和特殊困難與需求, 結合國家經濟社會發展和扶貧開發事業的進程, 制定實施未來十年農村殘疾人扶貧開發綱要, 明確農村殘疾人扶貧工作的奮鬥目標和政策措施經過五到 Page 34

36 十年的奮鬥, 讓農村貧困殘疾人生活狀況改觀, 生活水準和品質明顯提高 ( 二 ) 出臺政策, 切實提高殘疾人社會保障水準農村貧困殘疾人均等得到基本社會保障, 是其生存和謀求發展的基礎, 是社會和諧穩定的安全閥目前, 貧困殘疾人所得到的基本社會保障和基本公共服務還處於不均等低水準少特惠的狀況應加大投入力度, 研究制定有針對性的保障政策和措施, 徹底改善這種狀況 K 3 殘疾人接受教育是提高文化水準和生產能力, 徹底擺脫貧困落後的前提要高度重視殘疾人接受教育的水準和品質, 加大政策支持和資金投入, 從學前教育和義務教育抓貣, 使殘疾兒童受教育程度更上一個臺階加大對隨班尌讀和特教學校在讀殘疾學生的幫扶力度, 改善其學習環境, 實施無障礙改造, 增加對困難學生的寄宿交通等生活補助, 組織學校委派工作能力強有愛心的教師為無法在校學習的重度殘疾兒童開展送教上門, 切實保障殘疾兒童少年接受學前和義務教育並順利完成學業最低生活保障制度將農村符合條件的殘疾人全部納入針對殘疾人的特殊困難, 出臺分類施保的政策措施力爭 2015 年, 農村困難殘疾人全部納入分類施保政策範圍, 並在享受同等待遇的基礎上, 對特別困難的殘疾人, 低保標準再給予提高新型農村合作醫療制度目前已經基本覆蓋農村殘疾人, 但保障水準和限定的條件, 難以有效緩解殘疾人看病難負擔重的問題針對困難殘疾人提出符合實際的政策措施, 降低報銷的限定, 增加報銷的內容, 提高報銷的比例, 將殘疾人特有的康復醫療內容納入報銷範圍加大醫療救助水準, 對醫療費用支出很大的住院精神殘疾人和特別困難的貧困殘疾人採取先救助再保障的方式解決其醫療支出的負擔新型農村養老保險制度是農村殘疾人實現老有所養的基本保障但由於生活貧困, 還有很多殘疾人無法承擔最低檔次個人參保費用應加大投入, 切實保障農村殘疾人享受新農保政策力爭 2015 年, 農村困難殘疾人參加新農保最低檔次個人參保費全部由政府給予代繳有條件的地方應對貧困殘疾人在享受國家基本養老金的基礎上提高養老金標準住房保障是農村殘疾人安居樂業的基礎隨著中國保障性安居工程的快速推進, 要加大對貧困殘疾人危房改造工作的力度力爭 2015 年, 通過中央和地方實施的保障性安居工程新農村建設扶貧易地搬遷災後重建等項目和中央彩票公益金農村貧困殘疾人危房改造專案, 有效解決農村貧困殘疾人的居住困難, 居住環境及水電無障礙設備等基本生活設施得到有效改善 ( 三 ) 採取有效措施, 切實提高殘疾人收入水準扶助殘疾人掌握生產技能, 謀劃適宜的發展項目, 是實現穩定尌業, 增加收入, 徹底擺脫貧困的必由之路目前, 扶持貧困殘疾人發展生產增加收入的政策措施不夠完善, 扶持效果不夠明顯, 扶持的手段和途徑有待創新應加強殘疾人扶持辦法和措 Page 35

37 施的思考與研究, 千方百計謀劃探索適合貧困殘疾人家庭穩定尌業發展生產增加收入的途徑 K 3 強化農村殘疾人實用技術培訓, 增強穩定尌業發展生產的能力高度重視殘疾人生產技能的培訓工作, 根據市場需求, 結合不同類別的殘疾人特點, 大力開展有針對性的技能培訓, 確保殘疾人培訓一個, 學會一個, 尌業一個同時, 加強培訓後尌業服務工作根據殘疾人掌握的技能和勞動能力, 拓寬尌業管道, 安排和開發相適應的尌業崗位要選取符合農村實際, 適合殘疾人從事的投資小見效快項目, 引導扶持農村貧困殘疾人及家庭成員從事維修商貿手工藝加工家庭服務等多種形式的尌業創業項目, 並給予資金設備場地和市場訊息等服務扶持農村殘疾人扶貧基地建設, 帶動貧困殘疾人發展生產, 提高收入實踐證明, 農村殘疾人扶貧基地一般由當地優勢產業帶頭人或致富能手創建管理, 產品有市場, 收益有保障, 扶殘有效果, 是安置帶動殘疾人發展生產增加收入最適合有效的扶持途徑但目前殘疾人扶貧基地受資金限制, 規模上不去又缺少政策扶持, 難以充分發揮扶持帶動殘疾人發展增收的作用應動員社會各界力量, 多方陎籌措資金, 加大對殘疾人扶貧基地建設的投入和扶持, 充分發揮基地幫扶帶動貧困殘疾人脫貧致富的作用發揮康復扶貧貼息貸款作用, 加強對貧困殘疾人的信貸支援和服務康復扶貧貼息貸款自設立以來, 為推動殘疾人扶貧工作發揮了重要作用, 特別是 2008 年康復扶貧貸款管理體制改陏以後, 康復扶貧貸款的輻射帶動作用更加突出今後, 應進一步增加康復扶貧貸款的規模, 提高了財政貼息的標準, 有力支持農村殘疾人扶貧開發工作實際工作中也反映出, 不少地方的貧困殘疾人因為缺少抵押擔保, 達不到金融部門的貸款條件, 得不到貸款的扶持, 應採取多種方式解決貧困殘疾人的抵押擔保問題嘗詴開展殘疾人個人信貸擔保基金的詴點工作 ( 四 ) 營造氛圍, 切實幫扶殘疾人脫貧致富殘疾人扶貧工作是一項社會系統工程, 需要全社會的參與和幫助應加大殘疾人扶貧的宣傳, 加強社會輿論的導向, 鼓勵動員社會各界積極參與殘疾人扶貧, 進一步開拓更多的社會力量, 採取多種方式幫扶貧困殘疾人, 進一步營造社會扶殘助殘良好氛圍 Page 36

38 演說 Presentation A1 澳門之貧乏與扶貧政策 Poverty and Strategies for Poverty Alleviation in Macau 講者 Speaker : A 1 蕭楊輝博士 Dr. Philip Yeung-Fai Siu 澳門大學社會科學及人文學院政府與行政學系副教授 Associate Professor, Department of Government and Public Administration, University of Macau 貧窮在澳門不是一個新的問題它亦不是世界上一個唯一之問題但這個問題在我們討論中有新的意義, 雖然政府在扶貧問題中近年有一定成績正是由於它的嚴重性減少了, 而不是我們的努力減少了, 使我們重視今天之討論讓我們討論一些數據以下三點是較為突出的失業率跌至新低的 2.4% (8-10 月,2011), 從 2010 年之 2.8% 及 2009 年之 3.6%, 尌業不足率亦有進步〆對比 2009 年之 1.9% 及 2010 年之 1.8%,2011 年第二季錄得 1.2% 許多行業的新增職位有所增加, 尤其在博彩及酒店飲食業尌業人口總數為 338,200, 對比去年增加了 2,900 個職位至 2011 年 8 月, 失業人數為 8,300 人, 而整體尌業人口為 346,600 第二個指標是堅尼系數澳門 2003 年是 0.44,2008 年是 0.38, 而 2011 年是 0.41 後者對比香港在 2010 之 0.53 及中國大陸之同年之 0.47 還低財富分配比例 (80/20 比例 ) 顯示, 在 2008 年, 最高 20% 之住戶入息有 8.2 倍高過最低入息 20% 之住戶, 對比 2003 年之 11.2 倍來說, 是有所減低澳門居民之每月入息中位數字在 2010 年是澳門元 9,000, 而在 2011 年第二季則為澳門元 9,600, 對比之下, 有 12.9% 之增幅在 2010 年, 每月入息之最高三個行業為公共行政 ( 澳門元 19,500), 公用事業 ( 澳門元 16,000), 及教育 ( 澳門元 13,300)々而最低入息之三個行業為制造業 ( 澳門元 6,000)々酒樓及酒店 ( 澳門元 7,000), 與及零售及批發 ( 澳門元 7,500) 最近一項有關中產階層之入息在上週 (2011 年 12 月 3 日 ) 公佈研究顯示中產階層約佔澳門尌業人口 42% 中產階級之入息由澳門元 20,000 至 100,000 它的組成為 (1) 中小企之老闆々(2) 公務員專業人士及管理人員々與及 (3) 不擁有太高學歷之博彩業之僱員 Page 37

39 研究將以下三者之入息比例劃分為 1:4:5 是項研究之重要性在於它分析了最後一群體為邊緣中產階級倘若我們以財富分配及尌業作為指標, 那麼以上之數據似乎表示了澳門之扶貧工作在近年來說是頗出色的, 普遍人們之生活亦有所改善 A 1 但貧窮作為一個社會問題, 我們應該以政治 - 經濟及倫理上之選擇及機會, 這些較宏觀的角度來看澳門政治經濟之貧乏在三個層次上反映出來首先, 它對博彩業依賴之關係已形成一個不可逆轉之趨勢, 其中這個部門為政府帶來了專利稅及利得稅產生之收入已佔據政府總收入之 70% 及 68,500 個職位 (2011 年, 第二季度 ) 整體從博彩業之收入在 2011 年 10 月達 269 億 6 千多萬澳門元, 相比 2010 年 10 月增長了 42.1% 這個依賴關係更因中國內地旅客從 2010 年 10 月至 2011 年 10 月期間增長 37.3% 至 1 百 25 萬人次而突顯出來同期整體旅客人數為 217 萬人次除了欠缺一個互為依賴之關係, 澳門環境上之貧乏亦反映在它產業結構上欠缺比較優勢及其博彩業以外私營部門之狹窄雖然澳門之 GDP 從 2005 至 2011 經歷雙位數字之增長 (2005:12.1%; 2006:23.3%; 2007:32.1%; 2008:15.5%; 2010:22.9%; 2011( 第 2 季 ):24%); 私營部門之消費祇佔 GDP 在 2009 年 24.5% 這個相對較少的消費部份是由居民北上至珠海及鄰近地方消費造成的在 2002 年, 一個澳門大學研究估計每週北上消費之額達二百萬澳門元在外消費雖然不是引貣中小企部門萎縮之原因, 但它郤加深了其細少及疲弱之現狀許多人都察覺到博彩行業及其連帶之商業已漸漸蠶食了中小企之生存宏觀而言, 公營部門及私營部門之關係是在影響及將會左右澳門貧窮之發展以目前 ( 至 2011 年 ) 博彩行業帶給政府之巨額收入 ( 在 2010 年, 財政盈餘為澳門幣 418 億々而在 2011 年 2 月, 政府之滾存盈餘達 1,400 億 ) 而言, 澳門是具有一機遇及迫切之責任去擴大非博彩之私營部門及開展澳門所需之基礎建設項目, 縱然直接以現金分享形式之資助亦是頗有成效之策略其中一個刺激中小企之方法是進一步提供誘引及稅務優惠々其次是以 BOT( 收購 - 營運 - 轉讓 ) 之形式輔助現有之工商業々另外, 政府亦可以考慮扶助社會企業, 並於適當時候協助其最終轉型至市場導向之私營中小企網絡制定是扶貧之一個策略機構上, 政府可以成立一個開始時以政府之撥款作為基金之扶貧銀行, 其功能可以包括存款資助項目接受捐獻等, 作為扶貧之工具 Page 38

40 一個離岸人力資源中心可以參與及分擔政府在勞工事務方陎之工作中心可以協助招聘及協調外來勞工及專才它尋覓計劃補充人力資源及滿足市場之需求作為一個向外互動之政治經濟體制之機構, 它造尌及鞏固與香港及中國大陸互相依賴之關係及發掘澳門以外之人力資源市場資術性投資已經在集體運輸系統內進行中政府亦投資了港珠澳大橋之興建此外, 澳門大學在橫琴島之新校舍亦在興建中當澳門之自然環境有一新陎貎之時, 澳門之人民亦會有嶄新的幹勁及精神 A 1 除了最迫切的房屋項目在進行中之外, 對老年人無助之一群與及退休人士之照顧亦將會是政府之工作在政府公共開支之策略中, 其中之一, 應該是向跨境工業區注入新動力, 使其在提供尌業, 尤其是低下層人士方陎成為一個有成效之基地, 並解決結構性失業方陎之問題加強私營部門功能應該是扶貧策略中較為重要的一環政府應該專注於領導政策制定及監管之角色, 而把創新及其實現之工具留給市場去發揮功能最佳之扶貧策略似乎是提供尌業々對澳門而言, 亦是提高機會及選擇方陎之問題 Page 39

41 演說 Presentation A2 為泰國邊緣社群包括愛滋病患者及街童的服務經驗分享 The Work Programs for the Marginalized Groups in Thailand Especially the HIV Infectors and Homeless Children 講者 Speaker : A 2 Fr. Rocco Pairat Sriprasert 泰國明愛總幹事 Secretary General, Caritas Thailand Caritas Thailand has been working in Thailand for over two decades and it worked as one desk under the Social Ministry. From the organization structure of the Catholic Bishops Conference of Thailand (CBCT) the real work of Caritas could not function as an integrated approach in the operation. Many activities had overlapped each other. During year 2008, the CBCT had been modified the structure to fit to the effective working condition. At present the structure of Caritas Thailand is working under the umbrella of CBCT. Caritas Thailand has covered 8 major areas and the issues of marginalized groups such as homeless children, migrants children and people living with HIV/AIDS, etc. Caritas Thailand normally has tried to raise up the quality of lives for these children through providing education, health welfare, etc. To explain the whole structure of CBCT and where the Caritas belong to, the Episcopal Commission for Social Ministries is one of the four main Episcopal Commissions of the Catholic Bishops Conference of Thailand (CBCT). Caritas Thailand is an operational arm of this Commission. This Commission has divided into two major functions. The first function is for Social Development with five Desks. There are: (1) Desk for Human & Social Development, (2) Desk for Justice and Peace, (3) Desk for Pastoral Health Care, (4) Desk for Indigenous Peoples and (5) Desk for Women. The second function is for Social-Pastoral Ministries functioning with three desks. There are: (1) Desk for Migrants & Displaced People (NCCM), (2) Desk for Tourism and Seafarers Apostolate (NCCS) and (3) Desk for Emergency Relief & Refugees (COERR). The Caritas Thailand has been working through the Committee of which involved the responsible persons concerned in the planning, development and implementation. In the meantime, the Committee had also coordinated with the Diocesan Social Commission concerned for the activities in the area of responsibility. There are ten Dioceses in Thailand. Page 40

42 Today, the focus will be placed only activities involved with homeless children, migrants children and people living with HIV/AIDS. The first Desk concerned is National Catholic Commission for Migrants (NCCM). NCCM is one of the Commission of Caritas of Thailand. It focuses on the problem of migrant workers. In Thailand there are many migrants from neighboring countries due to the different status of social & economical and political issues. Therefore, the policy of NCCM has to involve with all areas where there are residency of migrants in Thailand, i.e. industrial areas or fishery areas. Within these areas, there are many children who cannot access to any education system. NCCM has provided various opportunities of education for them, i.e. community education activities, sponsor scholarships, providing continuing their education with Thai schools, providing education facilities, etc. From the record of the last two quarters of 2010, NCCM direct supported education over three thousand children and provided knowledge and children right to over three hundred child labour. A 2 The Desk for Migrants & Displaced People (NCCM) has collaborated and coordinated with the government official in organizing normal classes for these migrant children. This was the beginning for these children to be recognized by government official to aim of having proper documentation at the later part. Their graduation should be recognized by other educational institutions. The NCCM always work together with other NGOs with the same objective to let these children be able to access to education. The second Desk is the Catholic Commission for Emergency Relief & Refugees (COERR). COERR will focus all nine refugees camps along Thai border near neighboring countries. COERR has emphasized the preparation the knowledge of Thai language for children between 6 11 years in the camps for them to enter the Thai government school system. It has also provided the non-discrimination, environmental protection, protection of beneficiaries, coordination with all concern both inside and outside camps, etc. It has also provided scholarships for over 500 children from various camps in Thailand. Support also given to separated children in various camps for over seven thousand children. These are children came to the camps without their parents. We also take care of children at the immigration division waiting for sending them out of the Thailand for their own country or for the third country. The situation of Migrants from Myanmar had started since At present there are about 140,000 refugees living in 9 camps, located along the border in remote mountainous jungles. These refugees came from various ethnic minority groups, mainly Karen and Karenni and some displaced by human rights abuses some by army. They have to confine in their camps and not allow leaving their places. Residents at all camps are supported by external assistance. COERR has also provided the occupational training for them in the camps. COERR has also organized many activities for these children to be able to live in the society including music as part of psychosocial activities, etc. Page 41

43 A 2 As regards to children and people living with HIV/AIDS, there are 28 institutions of Catholic Committee on HIV/AIDS (CCA) under the auspices of CBCT. The CBCT has been promoting and supporting Catholic organizations to do the work on HIV/AIDS more effectively and efficiently by providing capacity building of their staff on prevention, care and counseling, etc. We had started with intra network and later on the network has been extended to international level and other Non-governmental organization working with HIV/AIDS patients in Thailand as well as inter-faith network. The network had further developed and extended to International level i.e. Asian Interfaith Network on AIDS (INA); Asian Muslim Action Network (AMAN); Christian Conference of Asia; Catholic Asia-Pacific Coalition on HIV/AIDS - (CAPCHA), etc. Our network had been a quite strong network and we were able to advocate and pushing the needs for the Ministry of Public Health to include in their health policy for the necessary medicine for people living with HIV/AIDS. It is now the people living with HIV/AIDS are able to access free necessary medicine from the government hospital. Our network is preparing for the next campaign of World Health Organization, United Nation AIDS for the next five years. These campaigns will start on the first of December There are (1) Getting to zero new HIV infections : (2) Zero AIDS related dead and (3) Zero discrimination. The beauty of the strong network came from the good coordination and networking of our Catholic Committee on HIV/AIDS under the umbrella of CBCT which was united together in working with one objective. It has supported each other and been able to link with other religions members in this field. For the conclusion, the challenge of the work of Caritas Thailand, we considered all sectors are united into one family and sharing the work together for more efficiency and cost effective for the whole office. The Caritas Thailand has very good collaboration of the Women and Men Religious Congregation Federations of Thailand in working for all social and health activities in Thailand. From our experiences of working together which has shown the work was more productive and less in duplication of work. However, coordination and collaboration are the important elements for networking to successful achievement. Page 42

44 演說 Presentation A3 沒有圍牆的醫院 A Hospital Without Walls - Taitung St. Mary's Hospital 講者 Speaker : 陳世賢先生 Mr. Shih-Hsien Chen 台灣台東聖母醫院執行長 Chief Executive Officer, Taitung St. Mary's Hospital A 3 寧養服務是一種觀念, 是將病人還原成一個人, 一個生了病但仍是完完全全有著身心靈各種需求的一個人, 而不僅只是看到他的病即便死亡近在眼前, 仍然將病人的生活品質或生命品質看成最最重要的事李嘉誠基金會為了提升內地寧養服務的水準, 二〇一〇年十月帶領內地將近三十家醫院正副院長到台灣參訪, 一行人從最繁榮的台北大型醫學中心, 一路看到最偏遠的台東地區醫院, 沒想到大家對規模最小的台東聖母醫院留下最深刻的印象其實台東聖母醫院只有二十九張病床, 六位專職醫師二十多名護士, 人力不足設備老舊資源缺乏, 稟持著為窮人服務的精神, 五十年來收支沒有帄衡過, 卻依然活得生氣蓬勃, 每天可以照顧院內外超過六百床病患, 不只做醫療, 還做醫學教育開餐廳種田做芳療落實健康社區營造做藝術治療等, 是台灣公認的醫療典範, 有著許多大醫院所沒有的用錢買不到的以及大陸醫療目前也很欠缺的 - 愛不只是以病人為中心, 而是以人為中心, 不放棄任何一個人台灣有 2,300 萬人, 擁有將近 20 家的醫學中心 ( 三級醫院 ), 全部集中在人口稠密的大城市而台東有 23 萬人, 有六大部落, 地形狹長多山多離島, 醫療資源嚴重不足且分配不均一九六一年, 瑞士籍神父和愛爾蘭修女來到台東, 不忍心看到婦女在田裡生孩子, 且因衛生條件差造成極高的死亡率, 於是開始在國外募款籌建聖母醫院, 引進醫師和設備, 由產科做貣, 並培訓當地的護理人員充當沒有牌照的假假的護士, 半數以上的台東小孩都在聖母醫院出生一九七九年聖母醫院開始以居家護理的方式, 服務長達一百七十公里的海岸線民眾修女說〆別人不去的, 我們去々別人不做的, 我們做還有獨居老人送餐服務, 便當上陎寫著名字, 因為每位老人家愛吃的能吃的需要的營養都不盡相同送餐員有時還要幫忙老人家日常用品, 甚至替為尋找社會資源全院只有一名社工, 卻有好多假假的社工々曾有同仁建議酌收費用, 以免病患需索無度修女卻堅決地 Page 43

45 回答〆那些人都沒錢看醫生了, 我們怎麼好意思再收錢〇一九九五年台灣推行全民健康保險制度, 雖免除了大部分民眾尌醫的經濟障礙, 但未必人人拿得出錢來, 而這些人又大多是聖母醫院服務的對象, 聖母醫院依然只管照顧病人, 繼續做著效率差又沒錢賺的服務, 不計較盈虧此時醫療體制也掀貣企業化與市場化潮流下, 公益性格的聖母醫院開始出現入不敷出跟不上時代的窘態, 二〇〇三年甚至窮到連薪水都發不出來, 醫院陸續結束最負盛名的產科, 關閉開刀房, 無刀可開的外科醫師哭著告別醫院, 修女則拿著醫療奉獻獎的獎牌要出售, 外陎都盛傳聖母醫院要倒了 A 3 然而, 聖母醫院思考的不是要不要繼續經營, 而是教會成立醫院的目的是什麼〇聖母醫院是否有存在的必要性〇當地民眾的需要是什麼〇台東每年約有六百人死於癌症, 病人必頇忍受長途奔波與病痛的折磨, 甚無尊嚴地死去某位神父過世時, 殯儀館竟派沒有頂篷的小貨車要來載運遺體々另一位癌末的流氓每週必頇花六小時的車程往返大城市去接受治療, 臨終前他質問修女〆為什麼台東沒有寧養服務〇一位神父和一名流氓, 用他們最後的生命提醒我們〆活著的人要尊重, 將死的人也需要尊重於是, 聖母醫院決定去做成本更高的寧養服務, 以全人全隊全家全程全社區的方式去照顧癌末病患的身心靈這樣的理念獲得到社會社會熱情的資助, 隔年, 聖母醫院成立了台東第一家有寧養服務的醫院, 同時提供不在院內的居家寧養服務, 比例達 1 〆 8 的世界水帄, 聖母醫院從接生嬰孩的善生醫院, 順利轉型為善終醫院同時舉辦好醫師先修營, 讓醫學院的學生來體驗偏遠地區的醫療, 學習在成為好醫師之前先學會作病人的好朋友二〇〇七年成立心靈療癒花園, 讓久臥病床的患者有機會離開病房到綠意盎然的花園裡感受大自然的能量, 在病程中體驗生命, 進而轉化個人的內在價值然而, 不生病並不代表健康, 全世界有八成以上的人是看似健康卻有三高或失眠等不健康問題的亞健康人台灣的衛生機關曾推出許多口號, 如天天蔡依林餐餐王力宏, 鼓勵民眾每天吃菜至少一〇種每餐都有黃綠紅等各色蔬菜々還有運動三三三, 鼓勵民眾每週運動三天一次三十分鐘讓心跳達每分鐘一百三十下但是知是一回事, 做又是另一回事, 七成以上的醫護人員都做不到, 他們常推說休息的時間都不夠了, 哪來的美國時間搞健康〇更別說抽煙喝酒等嗜好根據一九九五年的統計, 台東縣每 10 萬人口死亡率 ( 無論是哪一項死因 ) 比台灣地區高出很多, 罹患惡性腫瘤的人口比率竄升速度亦是全台之冠, 帄均餘命比台北市民少了十年, 罹患心血管等慢性疾病患者的比率也居高不下, 好山好水的地方卻好短命, 我們不禁懷疑, 醫院除了看病以外, 難道不能幫助人們活得更健康嗎〇於是, 聖母醫院於二〇〇八年成立聖母健康會館, 提供高纖低油少鹽無人工添加劑的美味健康料理, 貫徹全院員工的健康促進, 甚至還到部落要去幫助原住民營造健康環境可是當地人一聽說聖母醫院要來幫助他們活得更健康, 直覺反應尌是叫我們不要來, 他們說〆你們來, 尌是要我們不要抽煙不要喝酒不要吃檳榔, Page 44

46 但那些都是我們最快樂的事確實, 強迫改變他人的習慣, 成功率很低, 除非當事者自己願意改變後來, 我們改以糖尿病照顧進入社區, 定期舉辦控糖生活營隊, 陪伴居民一貣過健康生活一年後, 部落成立了台東第一個糖尿病病友團體, 接著聖母醫院從全台灣 454 個糖尿病病友團體榮獲第一名的標竿獎同年, 全院更獲得台灣醫界的最高榮譽團體醫療奉獻獎二〇〇九年, 聖母醫院創新引進芳香治療, 幫老人病人定期做精油按摩, 更投入八八水災救災, 並設立聖母健康農莊, 以以工代賑的模式提供災民工作機會, 開始種田生產自然安全無毒的天然食材, 從讓食物從土地到餐桌都是健康的工作也讓災民們重新尋回生命的活力, 願意過健康的生活如同史懷哲博士遠赴非洲行醫德瑞莎修女在印度照顧垂死之人, 台東聖母醫院為窮人服務的精神, 在現今一切以利為導向的資本主義社會, 彌足珍貴其實, 窮人不只是沒有錢的人, 任何身心靈不健康的人都是窮人, 都是聖母醫院服務的對象醫療也不應該只是看病, 醫院也不應該只是醫病人, 應該要走出醫院進入社區, 幫助生病的人和無病的人同獲健康, 這才是沒有圍牆的醫院的實踐因相愛, 我們合力做美麗的事情做對的事, 尌會有對的力量進來期待未來能與華人地區有更多的合作, 造福更多的華人, 同獲身心靈的健康 A 3 Page 45

47 演說 Presentation B1 協助低收入家庭及群體脫貧的實務經驗及分享 The Practical Experience in Helping the Low-Income Families and Groups to Overcome Poverty 講者 Speaker : 陳美潔小姐 Ms. Maggie Mei-Kit Chan B 1 香港明愛社會工作部部長 Director, Social Work Services, Caritas Hong Kong Framework of presentation: 1. Mission of Caritas Hong Kong 2. Serving the low income families 3. Hardship of the low income families 4. Strategies in Serving the Low Income Families Guiding principles Objectives of our service Strategies 5. Reflections on Social Policy 6. Appendix - Project Highlights Mission of Caritas Hong Kong Since its conception in 1953, Caritas Hong Kong has been serving the poor and the deprived community with the motto of Love in the Service of Hope. Our service is to witness God s love and through the process of service delivery, we facilitate the poor to overcome their difficulties to regain hope for the future. To fulfill our mission, we endeavor: 1. To help the underprivileged and the vulnerable; 2. To enable people to actualize their potentials; 3. To promote mutual understanding and reconciliation; and 4. To nurture a spirit of reciprocity to the community from which the people have benefited. Bearing the mission, Caritas is not an end itself. It is a channel to foster a movement of understanding and concern, of caring and service with the ultimate goal to promote integral development and human values. Page 46

48 Serving the Low Income Families In Hong Kong, the SAR Government has not set up a poverty line to measure income poverty. Instead the average payment under the Social Security Assistance Scheme (CSSA) is used as reference to delineate whether a family or an individual is living in poverty. However the welfare sector in Hong Kong disagrees on the benchmark as the amount of CSSA payment is sufficient for a family to maintain an acceptable standard of living. A percentage, usually 50% of the median monthly income of the households, has been used as the yardstick to measure income poverty. According to the Hong Kong Council of Social Service, the poverty rate in Hong Kong is about 18%. This implies that there are about 470,000 households living in poverty while among them, about 210,000 households belong to the working poor families. These families consist of at least one member engaged in employment but having a monthly household income which is less than 50% of the median. When serving these poor families, Caritas does not address solely the financial needs of the families encountering income poverty or material poverty. We have adopted a broader meaning of poverty which comprises of different dimensions. The definitions of poverty from two global organizations and from the Commission on Poverty set up by the Government of the Hong Kong Special Administration Region (HKSAR: ) have given us a framework to understand poverty. B 1 As defined by the World Bank, poverty includes low incomes and the inability to acquire the resources and service for survival with dignify. It denotes deprivation in well-being; lack of voice; insufficient capacity and opportunity to better one s life. According to the definition of the United Nations, poverty is a denial of choices and opportunities; violation of human dignity; lack of capacity to participate effectively in society and having the feeling of insecurity, powerlessness and exclusion. As stated in the report of the Commission on Poverty, the Government of HKSAR in 2007, poverty is understood as without access to essential services and opportunities (e.g. housing, health, education, employment) which can improve the livelihood of the poor. Thus based on the above definitions, the different dimensions of poverty are summarized as below: (a) Deprivation in money and resources to obtain an acceptable standard of living. (b) Deprivation in capability and opportunity to better one s life. (c) Deprivation in social relationship, community participation or being socially excluded. With the adoption of the multi-dimensional approach to define poverty, Caritas - Hong Kong has referred the poor people as the Last, the Least and the Lost within the community that are facing different forms of deprivation. These deprived families we served include the working poor; families facing unemployment; the single parents; the new immigrants; the Page 47

49 ethnic families and families having special needs. Hardship of the Low Income Families The multi-dimensional aspects of poverty have given our staff a framework to understand the socio-economic and psychological needs of the low income families. During the year from 1997 to 2010, our units had conducted several qualitative researches to interview the deprived families. The findings of these studies are summarized as below: 1. Inadequate income The number of poor working families that are unable to earn adequate income to provide their family members an acceptable standard of living is increasing. Poor families are usually associated with marital and parenting problems. B 1 2. Poor living condition We found that poor families living in urban slums are more deprived than those families living in subsidized public housing units. These families not only bear the burden to pay expensive rental, but have to tolerate a substandard of living condition. Being crowded, lack ventilation (some cubicles do not have window) and provided with insufficient fire escape, the conditions of these rooms cannot provide a favourable and safe environment to facilitate the development of our children. 3. Inadequate resources to meet the developmental needs of deprived children Our researches have reflected that children from poor families may have low self-image and lack confidence in their study. When having difficulties in their school work, they are unable to receive guidance from their parents who usually have low educational attainment. On the other hand, their parents cannot afford to pay the private tutorial service and other development programmes for their children. If children are deprived of fair chances for development, their opportunities for upward mobility will be limited. In this regards, inter-generational poverty will be the consequence. 4. Lacking social life and informal support Poor families have limited social support. As to save money for food and daily necessities, the families usually stay at home during holidays. Owing to poverty, they have isolated themselves from their relatives and friends as they fear that they are not welcomed by them. 5. Poor health and medical care Poor people expressed that they could not afford to become sick. When having serious illness, they depend entirely on public medical service even though the waiting time for medical consultation from specialty is always very long. Page 48

50 6. Facing social exclusion The poor may lack sufficient information about the availability of social services or they may be ignorant of their rights. In some situations, the mainstream service designed for the community at large may not be able to meet the specific needs of the deprived groups due to differences in languages and culture. Even if the deprived groups know about the services, they may fear that they will be stigmatized and discriminated. Social exclusion will be the result when the deprived groups are discouraged from using the services. 7. Feeling insecure and poor mental health The results of our studies have revealed that the poor usually has low self-image as well as a sense of inferiority and helplessness. Examples can be found among the poor parents. They seldom share their difficulties or feelings with other parents. However, they always have high aspirations on their children and hope that they can move away from poverty. In facing all the hardships, both parents and children are under stress. B 1 From our studies, we are able to have a better understanding of the general situations of the poor. The findings have further revealed that the background of the deprived families will create further difficulties to them. Family background including marital status, ethnicity and immigration as well as the characteristics of family members such as age, gender, educational attainment and intelligence will create specific form of hardship to the poor. To address the multifarious needs of the deprived to promote their economical, psychological, social and mental wellbeing, integrated and comprehensive package of services are needed. Besides, specific services are also required to meet the particular background and characteristics of the poor families. Strategies in Serving the Low Income Families Guiding principles In formulating the strategies for service planning, our social workers have drawn up the following the guiding principles. 1. The poor people should not be viewed as dependents of welfare service. We believe that when given the support and opportunity, the family members can develop their potentials and skills to achieve self-reliance. All individuals should have the opportunity for development and social participation. 2. It is undeniable that employment is the core to help the poor to alleviate poverty. However, we cannot neglect the psycho-social needs of the families and their children. It is also crucial to strengthen the problem solving ability of the poor families to promote their resilience and sustain their ability for self-reliance. Page 49

51 3. It is recognized that poverty also arises from social inequality and social unjust. We cannot promote self-reliance of the poor without providing a supportive environment and an equal opportunity to enhance their development. Objectives of our service To tackle the multifarious needs of the low income families to alleviate poverty, our objectives to assist the poor are: 1. To meet the basic needs of the poor to improve their living conditions 2. To promote their capability and employability to achieve self-reliance 3. To enhance their self-respect and dignity 4. To strengthen their social support and to encourage social participation and social inclusion B 1 Strategies Basing on the above mentioned principles, the models of strengths perspective and asset building have been adopted to help the poor. The essence of the strengths perspective is to focus on helping the poor to identify and maximize their capabilities. The asset building model implies that different kinds of resources within the community will be mobilized or developed to support the poor. Accordingly, the following strategies have been formulated. 1. Providing direct assistance to meet basic needs Through our service units, our workers help the poor to apply for social security and social service such as housing, welfare, education and medical to improve the standard of living. In addition, poor families have been referred to receive support service from the local community, such as assistance from food bank and from emergency relief fund to meet their tangible and basic needs. 2. Enhancing mutual aid among the deprived It is important to strengthen the support networks of the deprived. Our social workers have organized the deprived to set up support groups to promote the spirit of acceptance and mutual aid. These groups can provide a secure environment for the deprived to share their feelings and difficulties without the fear of being discriminated. The spirit of togetherness has encouraged the deprived to face their hardship positively. Peer support is crucial to enable the deprived to restore confidence and to build self-image which can prepare them to strive for self-reliance and social integration. 3. Empowerment and Building capacity Capacity building includes the enhancement of problem solving skill and work skills for self-reliance. Firstly, through our counseling and group work service, the poor families Page 50

52 have been engaged in the process to tackle their personal difficulties or family problems. It is crucial to strengthen the problem solving skills of the poor so as to restore their confidence and to promote their resilience. Secondly, to strengthen the employability of the deprived is important to help them improve their livelihood. Our social workers have organized employment service including work skill and communication skills training, employment counseling and job referrals for the deprived. Partnership with employers in the local community has been established to provide job opportunities and job matching service for the unemployed. Post employment service has been rendered, especially for the disabled people, to reduce turnover. 4. Creating job and on-the job training opportunities Some deprived people such as the disabled persons and people with mental illness, have greater difficulties to look for jobs. Our social workers have organized different self-financed service projects by adopting the business model for so as to create job and placement opportunities. With the theme of conservation, pilot projects including recycling shops and organic farm have been set up. The trainees are encouraged to look for jobs in the open labour market after receiving a certain period of training. B 1 5. Advocacy for policy change The deprived has been encouraged to organize action groups to advocate for policy change for social protection. Concerns have been given to social issues such as the minimum wage, minimum working hours, retirement protection for all people, and housing problem in Hong Kong. Collective actions which include holding meeting with the government officials, organizing press conference and public seminars have been carried out to give pressure to the government for policy change. 6. Promoting social inclusion Researches and community campaigns had been organized by our workers to arouse the public awareness on the needs of the deprived. Apart from the above, our social workers have mobilized the community and business corporate volunteers to organize volunteer service for the deprived to promote mutual acceptance. On the other hand, the deprived families are invited to participate in voluntary service or mutual aid projects to serve the community. Through collaborative projects among the deprived groups and the community, a spirit of reciprocity has been promoted. 7. Tackling inter-generational poverty To prevent inter-generational poverty, i.e., to prevent poverty from passing to the young generation as a result of their family s poverty, support and developmental services have been rendered to poor children to nurture their capabilities, confidence and positive Page 51

53 attitude for upward mobility. With financial support of the Children Development Fund of the Government of HKSAR, our social workers have launched a Children Development Project for 100 children aged 10 to 16. The objectives of the Project are to promote positive life attitude of the children. The Project consists of the following components: (a) to train mature volunteers to be mentors for each participating child; (b) to facilitate each child to draw up his/her personal development plan with guidance from his/her mentor, (c) to enable each child to set up targeted saving for 2 years ($2,000 per month) with matching contribution from donors and a special financial incentive from the government. B 1 Reflections on Social Policy to Alleviate Poverty It is undeniable that NGOs in society have played a significant role to organize developmental services for the deprived families to help building their capacity for self-reliance. However without the intervention of the socio-economic policy to provide opportunity for upward mobility, it is difficult for the poor to move away from poverty. The following recommendations are suggested to build an enabling society for the poor: 1. Promote economic development It is necessary for the government to formulate a forward-looking and sustainable policy to promote diversified economic development to create job opportunities. 2. Provide social safety net (social protection floor) It is essential for the government to set up a comprehensive social policy on housing, education, medical, welfare and town planning with the objectives to improve the livelihood of the poor. Some of the tailor-made services are required to address the specific needs of the poor families, such as the single parent families, the ethnic families and the new arrival families that are coming from different socio-economic and cultural background. 3. Provide continuous employment training It is needed for the government to establish long term manpower planning policy and to provide financial support for the poor to receive employment training. This will enable the poor to learn new work skills to meet the requirement of the changing job market. It is obvious that the low skilled worker will remain in low pay jobs if they do not have the work skills that are required by the economy. 4. Protect labour rights With the inception of the Minimum Wage Ordinance in Hong Kong, the monthly Page 52

54 earning of the low income families has increased instantly. Thus it is important for the government to review its labour policy to ensure the deprived people to receive a reasonable income that can support the needs of their households as a whole. In addition, incentives from the government should be implemented to encourage the business corporations to increase job opportunities for the disabled people. 5. Prevent inter-generational poverty Policy research is required to provide evidence for the formulation of social policy and specific measures to tackle the issue of inter-generational poverty. It is crucial for the government to provide intervention at early stage of the development of the deprived children so that they can have equal opportunity for growth and development. 6. Promote equal opportunity and social inclusion It is important for the government to promote public education to eliminate social discrimination against the poor and to build a caring society to strengthen social inclusion and cohesion. B 1 Appendix Project Highlights Caritas has set up several self-financed projects to provide a total number of 20 jobs opportunities and 200 places of vocational training. Some of the self-financed projects have adopted the concept of conservation to recycle, refurbish and reuse second hand goods. The followings are a brief account of these service projects. Though the business model has been adopted to operate the project, our emphasis still focuses on providing training opportunities for the deprived people. 1. The Green Baby Garden The project is to provide training and employment opportunities for young mothers (some are unwed). After cleansing and sterilizing the collected second-hand baby goods, the young mothers will sell the items at the shop. 2. The Recycling Computer Workshop Young men of low academic attainment and ethnic youth have been recruited to collect donated computers. Young people are trained to refurbish and upgrade the computers to be donated to deprived children and deprived families. These young people have also been equipped with IT skills to organize computer training programmes for the community. Page 53

55 3. The Second-hand Recycling Shop It is a project to provide vocational training and job opportunities for the unemployed, especially for the mentally retarded and people with mental health problems. Clothing, furniture and different kinds of goods are collected. The trainees are engaged to provide cleaning and re-packaging service so that the items can be sold at a very low price for the poor. Some of the items are donated to our service users. 4. The Artland The Artland is a shop set up to sell the handicrafts made by the disabled person. The shop not only provides an open window to demonstrate the potentials of the mentally retarded people, but has also provided a training ground for the disabled to learn and practice their work skill to operate the business and to manage the shop. B 1 5. La Vie Bakery and the Bread Shop The bakery and the shop provide job and training opportunities for people rehabilitated from mental illness. Training programs are organized to equip the participants with the skills to produce bakery products and to sell the products at our shop. 6. The City Farmer A piece of land has been rented to set up an organic farm to provide opportunities for women with emotion problems. The concept of horticulture-therapy has been adopted. Through the process of growing vegetables, strawberries and mushroom, the women are able to restore confidence and self-image to prepare for employment in the labour market. 7. The Oasis Cafe A Cafe has been set up inside a hospital to serve the staff members. The project is operated with a balance budget so as to provide vocation training and placement for practicum for the mentally handicapped people. Page 54

56 演說 Presentation B2 為何帄等對每個人也會更好 The Spirit Level: Why Equality is Better for Everyone 講者 Speaker : Prof. Richard Wilkinson Co-Director, The Equality Trust Professor Emeritus of Social Epidemiology at the University of Nottingham Medical School Honorary Professor at UCL Visiting Professor at the University of York The belief that inequality is divisive and socially corrosive goes back several hundred years. But now we have comparable measures of the scale of income inequality in different societies and we can actually see what effect it has. The new evidence shows that inequality is much the most important explanation of why, despite their extraordinary material success, some of the most affluent societies seem to be social failures. B 2 What Greater Equality Brings In societies where income differences between rich and poor are smaller, the statistics show that community life is stronger and more people feel they can trust others. There is also less violence including lower homicide rates; health tends to be better and life expectancy is higher. In fact most of the problems related to relative deprivation are reduced: prison populations are smaller, teenage birth rates are lower, maths and literacy scores tend to be higher, and there is less obesity. That is a lot to attribute to inequality, but all these relationships have been demonstrated in at least two independent settings: among the richest developed societies, and among the 50 states of the USA. In both cases, places with smaller income differences do better and the relationships cannot be dismissed as chance findings. Some of them have already been shown in large numbers of studies there are over 200 looking at the tendency for health to be better in more equal societies and something like 40 looking at the relation between violence and inequality. As you might expect, inequality makes a larger contribution to some problems than others, and it is of course far from being the only cause of social ills. But it does look as if the scale of inequality is the most important single explanation for the huge differences in the prevalence of social problems between societies. The relationships tend to be strongest among problems which show the sharpest class differences and are most closely related to relative deprivation. Page 55

57 The most obvious explanation for these patterns is the suggestion that more unequal societies have more social problems because they have more poor people. But this is not the main explanation. Most of the effect of inequality is the result of worse outcomes across the vast majority of the population. In a more unequal society, even middle class people on good incomes are likely to be less healthy, less likely to be involved in community life, more likely to be obese, and more likely to be victims of violence. Similarly, their children are likely to do less well at school, are more likely to use drugs and more likely to become teenage parents. B 2 Redistribution, Not Growth The first thing to recognise is that we are dealing with the effects of relative rather than absolute deprivation and poverty. Violence, poor health or school failure are not problems which can be solved by economic growth. Everyone getting richer without redistribution doesn t help. Although economic growth remains important in poorer countries, across the richest 25 or 30 countries, there is no tendency whatsoever for health to be better among the most affluent rather than the least affluent of these rich countries. The same is also true of levels of violence, teenage pregnancy rates, literacy and maths scores among school children, and even obesity rates. In poorer countries both inequality and economic growth are important to outcomes such as health, but rich countries have reached a level of development beyond which further rises in material living standards do not help reduce health or social problems. While greater equality is important at all levels of economic development, the connection between life expectancy and Gross National Income per head weakens as countries get richer until, among the very richest countries, the connection disappears entirely. However, within each country, ill health and social problems are closely associated with income. The more deprived areas in our societies have more of most problems. So what does it mean if the differences in income within rich societies matter, but income differences between them do not? It tells us that what matters is where we stand in relation to others in our own society. The issue is social status and relative income. So for example, why the USA has the highest homicide rates, the highest teenage pregnancy rates, the highest rates of imprisonment, and comes about 28 th in the international league table of life expectancy, is because it also has the biggest income differences. In contrast, countries like Japan, Sweden and Norway, although not as rich as the US, all have smaller income differences and do well on all these measures. Even among the 50 states of the USA, those with smaller income differences perform as well as more egalitarian countries on most of these measures. Chronic Stress But how can social status differences affect health? There is a health gradient running right across society, from the bottom to the top. Even the comfortably off middle classes Page 56

58 tend to have shorter lives than those who are very well off. Having a house with a smaller lawn to mow, or one less car, is not plausible explanations for these differences. Research has now shown the importance to health of psychological and social factors. Friendship, sense of control, and good early childhood experience are all highly protective of health, while things like hostility, anxiety, and major difficulties, are damaging. The many pathways through which chronic stress makes us more vulnerable to disease are becoming clearer. Stress compromises the immune and cardiovascular systems and increases our vulnerability to so many diseases that it has been likened to more rapid ageing. We now know that a major contribution to health inequalities comes from the psychological and emotional impact of people s social status. This picture received powerful confirmation from studies of non-human primates. Although among humans you cannot unambiguously separate out the effects of social status from better material conditions, among animals you can. Studies in which social status among macaque monkeys was experimentally manipulated by moving animals between groups, while ensuring material conditions and diets were kept the same, showed that the stress of low social status can produce physiological effects similar to those associated with low status in humans. Since then, studies of other non-human primates species have shown that the stress effects of social status vary according to the nature of the dominance hierarchy and the quality of social relations. B 2 Social Relations and Hierarchy The growing awareness of the importance of the social environment to health raised the question of whether the quality of social relations differed between more, and less, equal societies. The data left no room for doubt: people in more unequal societies trust each other less, they are less likely to be involved in community life, and rates of violence are higher. All suggest that inequality damages the quality of social relations. Indeed, this must be one of the most important ways inequality affects the quality of life. In the most unequal of the 50 states of the USA, 35 or 40 percent of the population feel they cannot trust other people, compared to perhaps only 10 percent in the more equal states. The international differences are at least as large. Measures of social capital and the extent to which people are involved in local community life also confirm the socially corrosive effects of inequality. American s often ask whether these patterns reflect ethnic divisions. The answer is that they do and they don t. The same patterns are found in international analyses and within other countries where they cannot be explained by ethnic divisions. In addition, some analyses have controlled for the proportion of minorities in different societies. However, insofar as skin colour or, in different contexts, language or religious group membership, become markers of social status, then they are stigmatised like any other marker of low class or social status. Page 57

59 These issues are centrally about social status differentiation: its effects explain why people in lower classes feel they are treated as a different race and people in a different race feel they are treated as second class citizens. But the effects of inequality are far too large to be attributed to any minority at the bottom of society. Inequality is associated with worse outcomes among the vast majority of the population and are seen as clearly in analyses which compare just the white populations in more and less equal countries. B 2 Income inequality tells us something about how hierarchical societies are and about the scale of class differentiation within them. The limited comparable data on social mobility in different countries suggests that more unequal countries have less social mobility. Rather than being the land of opportunity, the United States has unusually low rates of social mobility which seem to match its unusually large income difference. And it also looks as if increased income inequality has led, in both Britain and the US, to greater residential segregation of rich and poor. Bigger differences seem to mean less mixing both socially and geographically. With such profound effects on society and health, it would be surprising if inequality did not also exacerbate most of the problems associated with relative deprivation, so giving rise to the relationships we found between greater inequality and higher rates of imprisonment, poorer literacy and maths scores, increased obesity, more violence, higher teenage pregnancies rates and poorer mental health. It seems likely that the bigger the income and status differences, the more important social position and social status competition becomes. Inequality and Social Anxiety But why are we so sensitive to inequality? Why does it affect us so much? Some pointers to the mechanisms involved are provided by the psychosocial risk factors for poor health. Foremost amongst these, as we saw earlier, are three intensely social factors: low social status, weak friendship networks, and poor quality of early childhood experience. Given that we know these work through chronic stress, the research seems to be telling us that these are the most pervasive sources of chronic stress in affluent societies. Thinking more about these three sources of chronic stress, we can see that they may all be indicators of underlying social anxieties. The insecurities we may carry with us from a difficult early childhood are not unlike the insecurities associated with low social status, and one may make us more vulnerable to the other. Friendship fits into this picture because friends provide positive feedback: they enjoy your company, laugh at your jokes, seek your advice, etc.: you feel valued. In contrast, not having friends, feeling excluded, people choosing not to sit next to you, fills most of us with self-doubt. We worry about being unattractive, boring, unintelligent, socially inept, and so on. Page 58

60 There is now a large body of experimental evidence which shows that the kinds of stress which have the greatest effect on people s levels of stress hormones are social evaluative threats, such as threats to self-esteem or social status, in which others can negatively judge performance. It seems then that the most widespread and potent kind of stress in modern societies centres on our anxieties about how others see us, on our self-doubts and social insecurities. As social beings, we monitor how others respond to us, so much so that it is sometimes as if we experienced ourselves through each other s eyes. Shame and embarrassment have been called the social emotions: they shape our behaviour so that we conform to acceptable norms and spare us from the stomach-tightening we feel when we have made fools of ourselves in front of others. Several of the great sociological thinkers have suggested that this is the gateway through which we are socialised, and it now looks as if it is also how society gets under the skin to affect health. Given that the social hierarchy is seen as a hierarchy from the most valued at the top, to the least valued at the bottom, it is easy to see how bigger status differences increase the evaluative threat and add to status competition and status insecurity. This perspective also explains why violence increases with greater inequality. The literature on violence points out how often issues of respect, loss of face, and humiliation, are the triggers to violence. Violence is more common were there is more inequality not only because inequality increases status competition, but also because people deprived of the markers of status (incomes, jobs, houses, cars, etc) become particularly sensitive to how they are seen. What hurts about having second rate possessions is being seen as a second rate person. B 2 Similar processes are involved in the social gradient in children s educational performance. A recent study for the World Bank showed that while high and low caste children in rural India were unaware of the caste differences between them, they performed equally well when asked to solve a series of puzzles; but when made aware of the differences, the performance of children from low castes was substantially reduced. Increased social hierarchy and inequality substantially raises the stakes and anxieties about personal worth throughout society. We all want to feel valued and appreciated, but a society which makes large numbers of people feel they are looked down on, regarded as inferior, stupid and failures, not only causes suffering and wastage, but also incurs the costs of antisocial reactions to the structures which demean them. Inequality, Consumption, and the Environment For thousands of years the best way of improving the quality of human life has been to raise material living standards. We are the first generation to have got to the end of that process. No longer does economic growth improve health, happiness, or wellbeing. If we Page 59

61 are to improve the real quality of life further, we have to direct our attention to the social environment and the quality of social relations. But rather than continuing to tackle each problem separately, by spending more on medical care, more on police, social workers and drug rehabilitation units, we now know that it is possible to improve the psychosocial wellbeing and social functioning of whole societies. The quality of social relations is built on material foundations on the scale of the material inequalities between us. B 2 During the next few decades politics is likely to be dominated by the necessity of reducing carbon emissions. There are three ways in which greater equality is crucial to achieving sustainability. The greatest threat to reining in carbon emissions is consumerism. Several economists (see for instance Robert Frank, 1999) have shown that consumerism is driven by status competition. Status competition is, in turn, intensified by greater inequality. Consumerism reflects social neuroses and insecurities fanned by inequality and increased competition for status. Advertisers play on these insecurities suggesting their products enhance attractiveness, sophistication and exclusivity. Rather than a sign of our innate materialism, consumerism is an indication of our need for emotional comfort as in retail therapy or eating for comfort to provide a sense of wellbeing which we fail to get from society. By improving the quality of social relations, narrow income differences make us less vulnerable to these pressures. The second important contribution which greater equality can make to achieving sustainability is that it increases public spiritedness. Less exposed to status competition, people in more equal societies are less out for themselves. Higher levels of trust and involvement in community life mean that people are more likely to think in terms of the greater good. Confirming this we found that more equal societies give more in overseas aid and score better on the Global Peace Index. An international survey of business leaders showed that those in more equal countries think it more important that their governments abide by international environmental agreements. Reducing carbon emissions and achieving sustainability depend, like nothing else, on our ability to act for the common good. Finally the changes needed if we cope with global warming are unlikely to command public support unless they are seen to be fair. If people are to cooperate in the effort to reduce carbon emissions, the burden must be fairly shared. Policies which penalise the poor while allowing the rich to continue with much more environmentally damaging lifestyles will not be acceptable. Reference: Frank R. (1999) Luxury Fever: Why money fails to satisfy in an era of success. Free Press, N.Y. Page 60

62 演說 Presentation C1 從全球角度探討跨領域合作扶貧 Cross Sector Cooperation to Alleviate Poverty in a Global Perspective 講者 Speaker : Dr. Allah Bakhsh Malik Secretary to the Government, Literacy and NF Basic Education Department at Government of Punjab Pakistan The Honorable Mention of the UNESCO Confucius Prize for Literacy Award Winner of 2011 Introduction It is almost a truism that collaboration and cooperation among countries results in a win-win situation keeping in view the comparative advantage different nations and territories have in different social and economic fields. Cross Sector Cooperation (CSC) among territories adjacent or placed in contiguous geographical clusters have further competitive advantage in terms of transportation and communication. Through CSC, it is easier to integrate and seek benefit through shared pool wisdom, best practices and build on the human didactic resource base, available in different regions and sub regions. The incidence of poverty is linked and directly related to empowerment through education and technical and vocation skills. There is unanimity of views that richest regions, territories and countries around the globe have one thing in common i.e. the concentration of knowledge workers. CSC is the best maverick available to focus on such poverty pockets by adopting different strategies including provision of education, building of human social capital, generation of employment opportunities, empowerment through technical and vocational skills, promotion of industries including cottage industries and tourism. One of the best strategies to dent the menace of poverty is ensuring education and literacy with a lifelong vocational skill and provision of micro financing as soft loans enabling the poor and needy to start small businesses and enter the arena of entrepreneurship. There is a consensus among development economists and practitioners that education and skill development is the best step for everything good in life. It is quintessential pre-requisite for CSC for poverty alleviation that human resource development is there to be the best recipient and beneficiary from the human social capital, skill development and technology. The process of human social and economic integration becomes easier and faster with the conducive, congenial and enabling environment during the process of coordination, cooperation and collaboration. The experiences around the globe on account of CSC testify the fact that geographical contiguity, eagerness for partnership, adaptation and appetite for development of the partners, makes the life easier for individuals, organizations, institutions, regional and sub-regional entities. (Malik, 2007) C 1 Page 61

63 C 1 One of the key elements of CSC is the movement of the human social capital across the borders. The number of international migrants reached 193 million in The migrants are only 3% of the world s population and international migration is likely to increase faster than world population growth. The level of earning of highly skilled migrants is much higher than semi-skilled workers and there is wide deep chasm in the earnings of literate and illiterate labor. Individuals and families across national borders send remittances back home and contribute towards national development and poverty alleviation. Many international organizations and governments in developing countries especially Less Developed Countries (LDC) have recognized the importance of remittances and using the resources to accelerate economic development, economic growth and poverty alleviation. CSC may be defined as coordination, collaboration, synergy and synchronization beyond national borders among institutions and organizations. The cooperation helps to integrate the experiences and the sharing of experiences through pooled wisdom (Malik, 2010). The cooperation is not only beneficial but also results in a win-win longeval situation. CSC is generally among territorial and geographical organizations on account of regional economic policy, integration, bilateral and multilateral trade, research and development, infrastructures improvement, environmental protection, transfer of skill and technology promotion of culture etc. The ultimate goal is to develop close and friendly relations among neighboring countries, institutions and authorities and pave the way for a world without walls in the context of globalization. In the recent past CSC has enhanced around the world as a result of a number of events and processes that have favored its development. Some of the most important among them are the fall of the Berlin Wall, European Union, Pakistan-India trade, Gulf Cooperation Council and ensuing processes of economic and social internationalization in different parts of the world. The relation between CSC and integration processes is not only multivariate but also multi-cultural and multilateral. CSC contributes to the integration process through mass communication and integration among citizens in different national territories stimulating cross boundary collaboration and cooperation. CSC enables the national governments to overcome the territorial problems and provides opportunities for economic development, beneficial to the people living on both sides of the international borders (Perkmann 2003, Conde Martinez 2001, Rose and Miller (1992). There are numerous challenges in the context of human development directly correlated with alleviation of poverty. The inequitable income distribution has further aggravated the incidence of poverty situation, especially in the lower half of Human Development Index (HDI). Human Development Report 2010 (HDR, 2010) has identified that the distribution of income has worsened at the country level in much of the world, even with the narrowing of gaps in health and education achievement. HDR 2010 has suggested that by 2050 the global HDI would be 8 % lower than in the baseline. This paper on Cross Sector Cooperation in a Global Perspective takes into account the experiences of cooperation between local, national, sub-regional and regional authorities across frontiers in different sectors, targeting poverty around the globe. Page 62

64 1. Cross Sector Cooperation in Latin America Poverty in Latin America is widespread but there are signs of gradual improvement in recent years due to CSC. The indigenous peasants are the poorest people and their extreme poverty is mainly due to unfair distribution of wealth and denial of access to the available opportunities. Latin America has generally attracted more foreign investment but often making countries reliant on unstable speculative foreign investment. Expensive high interest rate aid loans have made escaping poverty difficult for many Latin American governments. Poverty in some Latin American countries has worsened by migrations, internal conflicts and bad governance. Poverty in Latin American countries is largely due to the pressure of population growth on scarce resources. In some of the regional countries, drug-related social and political instability has contributed to the incidence of poverty. Latin American poverty is worse in some countries like Ecuador, Paraguay and Peru but has improved in recent years in some countries due to CSC. Mexico helped partly by improvement in education and CSC with neighboring countries. Due to internal conflicts, Latin American countries have recently been increasing military expenditure as a share of Gross Domestic Product (GDP) and the incidence of poverty has started increasing and aid debt also seems one of the major obstacles. C 1 CSC in Latin America has been very encouraging during the recent past introducing an equitable and sustainable pattern for territorial development. It has highlighted the importance of regional integration within countries, heralding the emergence of a new economic geography and the political economy processes of regional integration. Initiative for South American Regional Infrastructure Integration (IIRSA) contains a clear socio-economic interest and its main objective is to promote the development of transport, energy and telecommunications especially focusing on physical integration of 12 countries of Latin America. IIRSA is a new hope for the region for economic prosperity and holistic development. The greater exchange of goods and services promotes the process of bilateral and multilateral transfer of technology and the best practices, generating employment opportunities and galvanizing the pace of coordination, ultimately impacting the incidence of poverty. CSC is the best lever to promote economic and social development, good governance practices, research and development, trade on the basis of competitive advantage, poverty alleviation and democratic good governance. Latin American regional cooperation clearly demonstrates economic development, regional integration and settlement of political and cross boundary long outstanding disputes and issues. CSC process has the potential to serve as an axle, on which the processes of economic, technological, skill development and institutional convergence turn over and gather gradual pace bringing amelioration for the less-affluent and disenfranchised sections of society within the regions and across the territories within the national boundaries of different nation states. Page 63

65 C 1 CSC is helping the national governments in Latin America to save the precious resources. The resources could be optimally utilized for institution building and poverty alleviation. CSC is also helping to build synergy, trust and confidence through close collaboration among government authorities and local civic bodies across the national frontiers. CSC in Latin America has promoted mutual confidence and trust between ethnic minorities, ultimately stimulating political consensus ushering peace, quintessential pre-requisite for development and poverty alleviation. CSC in Latin America worked as strategic alliance among neighboring territories, bringing an overall change with positive externalities. CSC has facilitated reconciliation and rapprochement among the member countries. The independent and the most significant variable in Latin American CSC is the reinforcement process through Fronteras Abiertas showing sensitivity to the issues of CSC and geographical integration since Latin American nation states have geographical, historical, economic, social and political preconditions for regional development. Due to historical developments, Latin American national governments are the most important political players by now. Regions, provinces, departments and municipalities depend on national governments in political, financial and planning terms but CSC does not have institutional arrangements like European Union developed in Europe. EU experience shows that permanent cross-border institutional arrangement could channel CSC is very helpful. European experiences in CSC are becoming particularly relevant in Latin America. Local stakeholders within the nation states and across national boundaries intend to take the best advantage out of it. CSC has the potential to impact the economic development along the border areas and adjacent territories in Argentine, Brazil, Paraguay and Uruguay. Huge distances, lack of common border control facilities, weak infrastructures as well as fragile economies have a strong impact on the development of sustainable CSC which has to be strengthened in the future. Taking into account the EU experience it can be safely assumed that CSC will create sustainable added value and contribute to Latin American integration. In order to succeed in the existing situation in the process, there is an incessant need to transform the intergovernmental relationships and transcend the barriers of prejudice. Decentralization and devolution of functions in CSC is the best instrument for many emerging opportunities. CSC in Latin America must have the essential elements of gradual and consistent development, strengthening of roles and responsibilities, strategic and programmatic approach and permanent institutional arrangements. The main objective should be to enhance CSC by securing the transit from individual cross-border activities to strategic, sustainable and programmatic approach. To achieve this goal, genuine cross-border programmes, projects and structures will strengthen social and economic cohesion without touching sovereignty rights through short-term, mid-term and long-term objectives for regional integration and collaboration in Latin America. 2. Regional Cross Sector Cooperation in Western Balkans Regional development and Cross Sector Cooperation in the Western Balkans is one of the key areas of intervention by multilateral international institutions such as the European Page 64

66 Union (EU), The World Bank (WB), United Nations Development Programme (UNDP), Council of Europe (CE) and European Bank for Reconstruction and Development (EBRD). In order to reinforce cooperation with countries bordering the European Union, the European Neighborhood and Partnership Instrument (ENPI) includes a component specifically targeted at CSC. 15 CSC programmes (9 land borders, 3 sea crossings and 3 sea basin programmes) have been established along the Eastern and Southern external borders of the European Union with a total funding of 1.2 billion for The regions which benefit from CSC have a total population of million citizens and 45% of them live in the Northern and Eastern border regions, and 55% in the Southern border regions. The nature of funding programmes earmarked towards CSC underlines the objective of long-term sustainability. This involvement and multi-level commitment by the international community is a key driver of regional development and CSC in the Western Balkans. It is gradually making progress, albeit from a rather low point of departure given the wars and ethnic conflicts of the 1990s. Regional Cooperation Council (RCC) established in 2008 and located in Sarajevo, is the most visible sign of new institutional capacity to advance regional as well as local ownership of the policy process. The hope is that regional cooperation in the Balkans can also be delivered by those who are expected to practice and benefit from it. RCC promotes mutual cooperation and European and Euro-Atlantic integration in Southeast Europe. It focuses on six priority areas: economic and social development, energy and infrastructure, justice and home affairs, security cooperation, building human capital and parliamentary cooperation. In operational terms, Heads of State and Government of the Southeast European Cooperation Process (SEECP) including Greece, Turkey, the western and Eastern Balkans and Black Sea countries provide the political backing for the RCC s annual work programme, while the European Commission provides most of the funding. The aim is to generate and coordinate developmental projects and create a political climate amenable to implementing projects of a wider, regional character, to the benefit of each individual member. C 1 Regional cooperation is essential for increasing prosperity and economic growth. Economic development is a key issue if the western Balkan countries are to make better, faster progress towards European integration. In many areas, such as trade, energy and transport, because of the limited size of each western Balkan country and the fragmentation of the economic space in the region, there is no other option but to embark on intense regional cooperation as the only realistic way forward. Enhanced regional cooperation in the economic field is just plain common sense. Through regional cooperation, a business environment will be created in the Western Balkans that will provide for foreign and national direct investments, that will create much needed jobs and that will encourage individual initiatives, and so add to an increase in the living standard of the whole population. In the pursuit of these objectives the countries of the western Balkans can count on the support and the assistance of the EU. The idea of an economic space in the region is taking roots and in this context, some important results have been achieved in the western Page 65

67 Balkans in the fields of free trade and infrastructure. Beyond the intra-regional challenges, the ultimate goal is to reconnect the Western Balkan countries fully with all their neighbors, EU Member States and candidate countries alike. Infrastructure development is of vital importance for developing the economies of the Western Balkans; it is an initial and indispensable requirement for an increase in economic growth. However, infrastructures without the reforms necessary to strengthen institutions that will promote sound development policies cannot promote economic growth and social cohesion nor achieve much by way of regional and cross border integration. C 1 Regional development and cross-border cooperation in the Western Balkans is one of the crucial areas of intervention by multilateral international institutions such as the European Union, the World Bank, UNDP, Council of Europe and EBRD (European Bank for Reconstruction and Development). In order to reinforce cooperation with countries bordering the European Union, the European Neighborhood and Partnership Instrument (ENPI) includes a component specifically targeted at cross-border cooperation (CSC). Some 15 CSC programmes, 9 land borders, 3 sea crossings and 3 sea basin programmes have been established along the Eastern and Southern external borders of the European Union with a total funding of 1.2 billion for The regions which benefit from CSC have a total population, on both sides of the EU borders, of some million citizens-of which 45% live in the Northern and Eastern border regions, and 55% in the Southern border regions-49% in the EU border regions, and 51% in the border regions of the partner countries. Population in the Border Regions in Europe (Millions, 2009) EU Regions* Partner Regions Total Northern & Eastern Borders Southern Borders Total EU Borders Source: European Union Report on Cooperation 2009 The nature of funding programmes earmarked towards CSC underlines the objective of long-term sustainability. This involvement and multi-level commitment by the international community is major driver of regional development and cross-border cooperation in the Western Balkans. It is gradually making progress, albeit from a rather low point of departure given the wars and ethnic conflicts of the 1990s. 3. Regional Development and Cross Sector Cooperation in the European Union Context CSC in the EU context uses an approach largely modeled on structural fund principles such as multi-year programming, partnerships, and co-financing, adapted to take into Page 66

68 account the specificities of the European Commission s external rules and regulations. One major innovation of the ENPI CSC can be seen in the fact that the programmes involving regions on both sides of the EU border share a single budget, common management structures, and a common legal framework and implementation rules, helping to balance partnerships between the participating countries. The European Commission also promotes CSC and bilateral development in the Western Balkans through the Instrument for Pre-Accession (IPA) financial assistance tool. This instrument is operational since 2008 and currently applies to all countries in Southeast Europe seeking membership in the European Union. Annual programmes are implemented in cooperation with the international donor community and co-managed with local representatives from the beneficiary countries. The rehabilitation and improvement of border crossing infrastructure in Morin in the Kukes region bordering Albania and Kosovo has a total budget of 0.46 million in 2009/10. In comparison to the previous example, the sums are small, largely because many implementing regulations are absent in Kosovo. At present, EU CSC programming involving Kosovo s cooperation with neighboring countries is being hampered by the ongoing limitations of the international recognition process. (4) These limitations suggest that regional disparities may in fact be cemented despite CSC seeking to reduce such differences. C 1 *This includes nine land borders, three sea crossings and three sea basin programmes. CSC Assistance provided by the EU in the IPA Framework In Mil Croatia Macedonia Turkey Albania Bosnia and Herzegovina Montenegro Serbia Serbia Kosovo Source: Communication from the Commission, IPA , Com (2009) 543, 14th October Most countries in the region continue to have refugees and displaced persons from the wars of the 1990s. In Montenegro, for example, the authorities in Podgorica still need to resolve the status of approximately 16,200 refugees from Kosovo. CSC between Montenegro and Kosovo in this delicate area needs to address such issues as; the legal status of refugees and displaced persons construction of accommodation for Roma refugees Page 67

69 from Kosovo, of particular concern is the situation of the Konnik refugee camp close to Podgorica creating legal conditions for the integration of those refugees and displaced persons who wish to remain in Montenegro and acquire Montenegrin citizenship by naturalization. The capacity of Kosovo to absorb and re-integrate refugees from neighboring countries in terms of housing, labor market participation and educational infrastructure. While Montenegro and Kosovo may seek to jointly resolve some of these challenges, outstanding issues with neighboring Serbia can obstruct such bilateral initiatives. Relations with Serbia continue to be disrupted by the Montenegrin decision to recognize Kosovo s independence. The Montenegrin Ambassador in Belgrade was declared persona non grata in October C 1 4. Cross Sector Cooperation - Two Encouraging Examples Incremental functional cooperation is taking place on the ground in selected policy making fields. There are specific examples from the region where CSC among countries is starting to manifest itself without primarily being driven by considerations of future political rewards from the European Union. The joint decision by three former Yugoslav republics in August 2010 to form a common railway company aimed at winning back some of the Central European freight business lost during the wars of the 1990s is a case in point. The commercial objective of the joint enterprise is to ensure rapid freight service along the so-called Corridor X, which links Germany and Austria with Turkey. To date, such transport infrastructure investments had largely by-passed potential rail corridors in the former Yugoslavia, due to a lack of political will to identify actionable projects in this dimension of CSC. A second encouraging example concerns bilateral relations with other countries seeking EU integration. For instance, Montenegro signed an agreement with Albania on cooperation in science, technology and culture in Concrete steps in such areas as joint border patrols and information exchange against organized crime are taking place. Moreover, Montenegro established a joint working group with Croatian counterparties on resolving property issues and a council on economic relations is holding regular meetings. Even defense cooperation and joint border police training activities are taking place between countries that a decade ago were at war with each other, while negotiations on agreements in social security are ongoing between various countries in the Western Balkans. 5. Prospects for Cross Sector Cooperation Serbia and Kosovo The most important arena and at the same time challenge to CSC in the Western Balkans concerns political and institutional arrangements between Serbia and Kosovo. The former refuses to recognize the latter as an independent sovereign state and therefore does not acknowledge the legitimacy of its borders. Meanwhile, the latter itself is having difficulties convincing its own ethnic Albanian population that CSC with Serbia may be in its own best interest, in order to advance the international recognition process for Kosovo. A Page 68

70 recent incident in the city of Mitrovica which is ethnically divided between Serbs and Kosovo s highlighted the delicacy of the situation and the magnitude of the tasks facing Serbia and Kosovo and the 2,000 strong European Union police mission stationed in Kosovo. In mid-september a French police officer was shot and wounded during clashes between ethnic Albanians and Serbs who pelted each other with stones at the foot of the bridge over the river Ibar that separates the two communities. These clashes occurred after Turkey defeated Serbia in the semi-finals of the world basketball championship. The clashes underscore the deep divide that runs between both communities more than a decade after the end of the Kosovo war in It is in cities such as Mitrovica that the feasibility of regional development and CSC is most acutely tested in the Western Balkans. CSC is making headway in the field of economic inter-change and public-private investments by the EU, EBRD and World Bank. However, it appears that business-related initiatives are primarily driving such regional cooperation. Meanwhile politics and implementation capacity have yet to live up to the specific policies being advocated by the European Union, the Regional Cooperation Council, and other international organizations. 6. Pakistan China Regional Cooperation Sust or Sost is a dry port in Gojal region of the Northern Areas of Pakistan. It is the last town inside Pakistan on the Karakoram Highway before the Chinese border. The town is an important place on the Karakoram Highway for all passenger and Cargo transport because all traffic crossing the Pakistan-China border passes through this town and the Pakistani immigration and customs departments are based here. Pakistan and China have opened border for trade and tourism at Khunjrab. Silk Route Dry Port, the port has also started its business operations at the port Sost (Upper Hunza) near Khunjrab pass Gilgit-Baltistan. Annual trade between China and Pakistan has increased from less than $2 billion in 2002 to $6.9 billion, with a goal of $15 billion by Sost dry port is the first formal port at the China-Pakistan border, facilitating customs clearance and other formalities for goods moving from the Chinese regions of Kasghar and Sinkyang to the commercial centers of Pakistan. The town is connected by the Karakoram Highway to Karimabad, Gilgit and Chilas on the south and the Chinese cities of Tashkurgan, Upal and Kashgar in the north. C 1 7. Globalization, Differences and Migration Globalization has increased linkages between Asian countries and linked them more closely with countries on other continents, as evidenced by sharply rising flows of goods and capital moving over national borders. International and regional bodies have been established to set rules for movements of goods, investments, and services, but controlling the entry and stay of people remains a core attribute of national sovereignty that most nations are reluctant to yield to supranational authority, making the European Union the exception rather than the rule. With the exception of refugees, flows of international migrants are not governed by a comprehensive global migration regime. There are 1949 and 1975 ILO Conventions that call for equal treatment of legal migrant workers and a more Page 69

71 C 1 expansive 1990 UN Convention that calls for family unification rights as well as rights for irregular migrants. These conventions have been ratified by fewer than 50 nations, far fewer than have ratified the refugee convention or other ILO and UN Conventions. Furthermore, the fact that it has been difficult to agree to easier movements of service providers under the World Trade Organization s General Agreement on Trade in Services suggests that a global migration regime is not likely to emerge quickly. Instead of a top-down international regime that establishes global rules on migration, the future may see more regional agreements governing labour migration. Most regional processes that might lead to agreements on migration have been initiated by labour-sending countries with the goal of improving protections for their nationals abroad. Two of these regional processes are in Asia, the Colombo process and the January 2007 ASEAN Declaration on the Protection and Promotion of the Rights of Migrant Workers. The absence of a global or regional migration governance regime is unlikely to slow international migration, which is rising within and from Asia for demographic, economic, and network reasons. In Europe and North America, the inability of leaders to do much in the short term about the demographic and economic differences that motivate international migration, and unwilling to reverse network factors that make crossing borders easier, prompted many policymakers to revert to the tool over which they have most control-rights-in an effort to manage migration in an effort to manage migration. Trying to manage migration by adjusting the rights of migrants, as when European governments made it more difficult for foreigners to apply for asylum and the US limited the access of legal and unauthorized migrants to welfare programs, is a blunt instrument to manage migration and tends to undermine international conventions that aim for equal treatment of migrants. The ASEAN Declaration, signed by leaders of the 10 ASEAN members January 13, 2007, commits migrant receiving states to draw up charters that ensure decent working conditions, protection from all forms of abuse, and a minimum wage for migrant workers from other ASEAN countries. The ASEAN Declaration is not legally binding and does not require governments to change their labour laws. Before turning to how Asian governments are dealing with the challenge of managing labour migration, we review the differences and network factors that promise more international labour migration. The demographic reasons for expecting more migration reflect the fact that rates of population growth vary between countries. The world s population of 6.7 billion in 2008 is increasing by 1.2% or 80 million a year, and Asia s population of four billion is also increasing by 1.2% or 49 million a year. Population growth rates vary within Asia. East Asian countries have the slowest population growth rates, expanding by an average 0.5% a year, followed by Southeast Asia at 1.4 %, south Asia at 1.7 %, and western Asia at 1.9%. Asia s population weight among the world s continents is expected to remain at about 60% over the next several decades. The most noticeable projected change is population growth in Africa and decline in Europe, raising prospects for more migration. When a fifth of the world s residents were European in 1800, there was a massive outmigration to North and South America in search of economic opportunity. Page 70

72 History may not repeat itself, but if a poorer Africa has 20% of the world s residents in 2050 as projected, three times more than Europe, there could be similar out-migration pressures from Africa, albeit directed more at Europe than Asia. World Population by Continent, 1800, 2000, 2050 (% shares) * World (mils) Africa Asia Europe Latin America & Caribbean Northern America Oceania Source: The World at Six Billion UN 1999 The economic differences that encourage international migration have two dimensions, one fostered by inequality between countries and the other by inequality within countries. The world s almost 200 nation states have per capita incomes that range from less than $250 per person per year to more than $50,000, a difference that provides a significant incentive for especially young people to migrate for higher wages and more opportunities. The 30 high income countries had a billion residents in 2005, a sixth of the world's population, and their gross national income was $36 trillion, 80% of the global $45 ( Publications/Datasheets/2008/2008wpds.aspx) Young people are most likely to move over borders because they have the least invested in jobs and careers at home and the most time to recoup their investment in migration abroad. The resulting average per capita income of $35,000 in high-income countries was 21 times the average $1,750 in low and middle-income countries. Despite rapid economic growth in some developing countries, including East Asian Tigers in the 1990s and China and India more recently, the 20-1 ratio in per capita incomes between high-income and other countries rose between 1975 and 2000, and shrank only marginally since Average per capita incomes were 61 times higher in 2005 in high-income than low-income countries, and 13 times higher in middle-income countries. C migrant stock was raised from 120 million to 154 million, largely to reflect the break-up of the USSR data are gross national income a second dimension of inequality promises more internal and potentially more international migration. In lower income countries, 40% of workers are employed in agriculture, a sector that is often taxed by governments despite the fact that farmers and farm workers usually have lower than average incomes. With taxes helping to keep farm incomes below nonfarm incomes, there is often rural-urban migration, explaining why the urban share of the world s population surpassed 50% for the first time in Industrial countries had migration of the land that Page 71

73 C 1 provided workers for expanding factories and fueled urban population growth in the 1950s and 1960s. Similar migrations are underway today in many Asian countries. This rural-urban migration has three implications for international migration. First, ex-farmers and farm workers are most likely to accept 3-D dirty, dangerous, difficult jobs, both inside their countries or abroad. Second, rural-urban migrants often make physical as well as cultural transitions, and some may find the 11 Average per capita was $7,000 per person. At purchasing power parity, which takes into account national differences in the cost of living, the world's gross national income was $56 trillion or $9,400 per capita--$32,500 per capita in the high-income countries and $5,200 in low and middle-income countries. Taxes are extracted from agriculture via monopoly input suppliers who sell seeds or fertilizers at high prices or via monopoly purchasers of farm commodities who buy from farmers at less-than-world prices and pocket the difference when the coffee or cocoa is exported. In the high-income countries, farmers incomes are generally higher than those of non-farmers, in part because high-income countries transfer funds to producers of food and fiber. 13 UNFPA (State of the World s Population /introduction.html14) This is evident in Chinese coastal cities, where internal rural-urban migrants fill 3-D jobs, and abroad, where Chinese migrants are employed in industries that range from services to sweatshops. 11 transition as easy abroad as at home, as when rural Filipinos find adapting to Hong Kong as easy as navigating Manila. Third, urban residents are usually closer to the country s exits, since it is usually easiest to obtain visas and documents for legal migration or make arrangements for illegal migration in cities. Differences encourage migration, but it takes networks or links between areas to encourage people to move (Massey et al, 1998). Migration networks include communication factors that enable people to learn about opportunities abroad as well as the transport firms that move migrants over national borders and the rights regime that governs their stay abroad. Migration networks have been shaped, strengthened and made accessible to more people by revolutions in communications, transportation and rights over the past half century. The communications revolution helps potential migrants to learn about opportunities abroad. The best information comes from migrants who were or are abroad, since they can provide family and friends with information about jobs, wages, and working conditions in an understandable context. Cheaper communications enable employers and recruiters to transit job information quickly and cheaply to potential migrants. In some instances, information about vacant jobs may be received sooner in a labour-sending country than among the unemployed who live near the job, especially if employers and recruiters prefer migrant workers. Meanwhile, the relative affluence of returned migrants encourages especially young people to assume that migration will lead to economic betterment, generating migration fever in some areas that send workers abroad. The transportation revolution highlights the declining cost of international travel. Two centuries ago, British migrants unable to pay one-way passage to the North American colonies often indentured themselves, signing contracts that obliged them to work for three to six years for whoever met the ship and paid the captain. Transportation costs today are far less, typically less than $2,500 to Page 72

74 travel anywhere in the world legally and less than $20,000 for unauthorized migration. Most studies suggest faster payback times for migrants today, so that even migrants who pay high smuggling fees can usually repay transportation costs after two or three years abroad. The communications and transportation revolutions help migrants to learn about opportunities abroad and to cross national borders, while the rights revolution affects their ability to stay abroad. After World War II, most industrial countries strengthened the constitutional and political rights of people within their borders to prevent a recurrence of fascism, and most granted social or economic rights to residents of their evolving welfare states without distinguishing citizens and migrants. The rights of migrants were rolled back in the 1990s in an effort to better manage migration, as when European governments made it more difficult for foreigners to apply for asylum15 and receive housing and food while their applications and 15 European governments responded to the asylum crisis of the early 1990s in three major ways. First, they required nationals of the countries of origin of asylum seekers to obtain visas, allowing pre-screening. Second, they imposed fines on airlines and other transportation providers who brought foreigners to Europe without visas and other documents. Third, they made it difficult for foreigners from safe countries, and those who transited through safe countries en route to Europe to apply for asylum - foreigners were to apply for asylum in the first safe country they reached, even if that was not the country in which they had relatives, knew the language, or wanted to start anew. 12 appeals were pending and the US government made it harder for both legal immigrants16 and unauthorized foreigners to receive means-tested welfare assistance. Differences motivate migration, but international conventions call for equal treatment of migrants once abroad. In most labor markets, the demand for labor is negatively sloped, meaning that there is an inverse relationship between wages and employment or in international labor migration, a tradeoff between the number of migrants and the rights of migrants, at least as expressed in equal wages and benefits (Ruhs and Martin, 2008). This trade off is especially apparent in some Asian countries. Governments sending workers to the Gulf oil exporters, for example, sometimes complain of the poor treatment of their nationals. However, they are also aware that labour-receiving countries can and do ban the entry of workers from countries considered troublesome. Migrant rights groups routinely accuse labour-sending governments of not doing enough to protect their nationals employed abroad, especially women employed as domestic helpers. The migrant numbers-rights trade off confronting labour-sending countries is apparent in World Trade Organization GATS negotiations. Some developing countries argue that migrant service providers should not be subject to the minimum wage laws of destination countries, since the comparative advantage of labour senders is a willingness to work for lower wages. Requiring equal treatment for migrants, they reason, is a form of protectionism that may reduce the number of migrant service workers employed. Canada expresses a preference for numbers over rights by asserting that laws requiring wage parity between migrants and local workers negates the very basis of cross-country labour flows which stems from endowment-based cost differentials between countries. C 1 Page 73

75 8. Cross Sector Cooperation - Japan and Korea Japan and South Korea are homogenous societies largely closed to front-door immigration. Japan has debated whether to open itself to less-skilled foreign workers decades, but has not yet done so, while Korea replaced industrial trainees with migrant workers after Japan's 2005 census reported 770,000 foreigners in the labour force, making them 1.3% of workers. The largest group are Koreans, some of whom have been living in Japan for decades, followed by the 240,000 descendants of Japanese who emigrated to South America and have returned to Japan. These Portuguese-speaking nikkejin are concentrated in the small factories that often supply parts to major multinationals. The second largest group of foreign workers is trainees, 140,000 in Most are Chinese in Japan with three-year contracts that tie them to a particular employer. Trainees receive about half of the minimum wage while filling low-skill jobs, often with small- and medium-sized employers. Japan also has foreign professionals, including professionals employed by multinationals and Filipina entertainers. Finally, there are an estimated 200,000 unauthorized foreign workers in Japan and most of the 100,000 foreign students in Japan work at least part time. C 1 There were 85 million Japanese aged 15 to 64 in 2005; the number of working age Japanese is expected to fall to 72 million by Because of high wages in Japan, employers shifted an estimated 40 % of their productive capacity to lower-wage countries in The debate over migration in Japan reflects in part the desirability of such shifts. The government could open itself to front-door immigrants to stabilize the population and labour force, admit side door guest workers expected to leave after several years, or keep migration doors relatively closed and persuade Japanese workers to work longer and more productively. Like Japan, South Korea introduced foreign workers as trainees, especially after 1993, to fill jobs in small and mid-sized firms offering so-called 3-D jobs-dirty, dangerous, and difficult (Park, 2007). However, high brokerage fees and sometimes abusive working conditions led to runaways, since foreign trainees could often earn more as unauthorized workers than as legal trainees. The Employment Permit System was launched in July 2003 to replace the trainee system by Under the EPS, employers with fewer than 300 workers unable to find local workers can employ foreign workers under government-to-government agreements. Employers can select workers under the EPS, and as workers the foreigners are entitled to the minimum wage of 3,770 won ($3.80) an hour in the minimum wage is scheduled to rise to 4,000 won in Most Korean employers offer guest workers admitted under the EPS one-year contracts that can be renewed for two years. After three years of Korean employment, guest workers are to leave Korea for at least a month before returning for a final three-year stint. Not all of the unauthorized foreign workers in Korea when the EPS was launched were able to become migrant workers, so the EPS has not eliminated irregular labour migration. Page 74

76 9. Cross Sector Cooperation - Middle East The Middle East stretches from Western Asia to North Africa, includes several countries uniquely dependent on migrant workers to fill almost all private-sector jobs. After oil prices rose in the 1970s, migrant workers filled most of the private sector jobs created by the expenditure of higher oil revenues. By 2005, the Gulf Cooperation Council countries-- Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates had 13 million foreigners among 36 million residents, half in Saudi Arabia. In part because GCC countries discourage women from working, fertility is high, half of the native population is under 18 and GCC labour forces are growing by over three % a year, resulting in widespread unemployment among young citizens. In the past, oil-rich governments guaranteed public-sector jobs to natives, but rapid labour force growth has made this guaranteed employment policy unsustainable. Instead, Saudi Arabia and other oil exporters have attempted to re-nationalize their work forces by restricting an ever lengthening list of occupations to natives. Re-nationalization has not persuaded most native youth to accept private-sector jobs, which most feel require too much work for too little pay. With migrant workers willing to pay $1,000 or more for a sponsorship, natives that sell sponsorships have an incentive to continue the current system. Israel, which welcomes Jews according under the aliyah or law of return, had rapidly increasing immigration after the fall of the Berlin wall in 1989 and the subsequent dissolution of the Soviet Union. Some 200,000 immigrants arrived in 1990, when Israel had 5 million residents, meaning that immigration increased the Israeli population by 4 % in one year. Many of the Jews who immigrated to Israel were well educated professionals who helped to turn Israel into a high-tech center; some later moved to the US and Germany. Israel occupied the West Bank and Gaza after wars in 1976 and Palestinian residents from these areas commuted to jobs in Israel, and by the late 1980s, over 100,000 Palestinians were daily commuters. Intifada that began in the late 1980s prompted the Israeli government to limit the number of Palestinian commuters; they were replaced by migrant workers from Thailand, Romania, and other countries. C Labour Exporters: Philippines and Bangladesh The Philippines is the major labour exporter in Asia. According to the Philippine government, there are 83 million Filipinos at home and eight million abroad who remit over $1 billion a month, equivalent to 10% of the country s GDP. In recognition of the importance of migrants and their remittances to the economy, the Filipino president welcomes some returning migrants at Christmas in welcome home overseas foreign workers ceremony at the Manila airport. A million Filipinos leave the country to work each year, including about 75% who fill land-based jobs that range from domestic helper to driver to construction worker in countries from Hong Kong to Saudi Arabia to Canada. Another 250,000 Filipinos leave each year to work on the world s ships. Over half of the migrants leaving the Philippines are women, and some are vulnerable to abuse in the private households in which they work. In 1995, Flor Contemplation, a Filipina maid in Singapore, was hanged after being convicted of killing another Filipina maid and a Singaporean child Page 75

77 in her care. Philippine President Fidel Ramos was unable to win additional time to investigate her case. This so-called migrant workers' Magna Carta obliges the Philippine government to take steps to protect migrants abroad. The Philippine government continues to change its policies in response to the problems of migrant workers abroad. For example, Israeli-Lebanon fighting in summer 2006 resulted in the return of migrant domestic helpers who complained of mistreatment. One result was the super maid program which provides additional training for women going abroad but also requires, beginning in January 2007 that Filipina domestic helpers be paid at least $400 a month. Labour emigration is supposed to be self-stopping, as migrants send home remittances that are spent and invested to fuel economic and job growth. Despite several decades of outmigration, many Filipino youth plan to go abroad to work rather than find jobs created by remittance investments. Indeed, labour migration has been called a new civil religion in the Philippines, with teens considering debating the merits of various foreign countries for temporary employment, TV shows exploring the tensions associated with family separation, and the Central Bank displaying a tally of remittances on a billboard at Christmas. C 1 Labour migration from South Asia mostly involves workers going abroad on two-year contracts to the Gulf oil exporters, a high share of women leaving to be domestic helpers from countries such as Sri Lanka, and heavy reliance on private fee-charging recruiters in both sending and receiving countries. These labour migration patterns raise issues that range from irregular migration to the vulnerability of young women employed in private homes in conservative Gulf societies. The five major South Asia labour-sending countries sent over 1.5 million migrant workers abroad legally in India sent 549,000 migrants aboard, Bangladesh, 253,000, Sri Lanka, 231,000, Nepal, 184,000, and Pakistan, 142,000. There were 24 million South Asians abroad in 2000, including nine million Indians (four million in the Gulf countries), almost seven million Bangladeshis and 3.5 million Pakistanis abroad, including 1.5 million in other South Asian countries and almost a million in the Gulf countries. The South Asian Diaspora includes almost 10% Afghanis. The five major South Asia labour-sending countries received $40 billion in remittances in 2007, led by $27 billion in India; $6.4 billion in Bangladesh; $6.1 billion in Pakistan; $2.7 billion in Sri Lanka; and $1.6 billion in Nepal. Most South Asians earn $200 to $400 a month in the Gulf oil exporters. Like the Philippines, South Asian countries are developing specialized agencies to promote and protect migrant workers. Sri Lanka in 2007 created a Ministry of Foreign Employment Promotion and Welfare. Both Bangladesh and Pakistan have similar specialized agencies to market their country's workers to foreign employers, process the contracts that allow them to go abroad legally, and regulate the recruiters who place most migrants in foreign jobs. Bangladesh provides an example of the challenges and opportunities facing South Asian labour senders. Bangladesh's second leading source of foreign exchange after garments is remittances, which totaled $6.6 billion in The number of migrants leaving Page 76

78 Bangladesh averaged about 250,000 a year between 2001 and 2006, rose to almost 400,000 in 2006, and doubled to 832,600 in 2007; the government expects to send 900,000 workers abroad in According to government data, 60 % of Bangladeshi migrants leave on their own, 39% leave with the help of recruiters, and one % leave via government and other channels. However, most of the 60 % who leave on their own in fact leave with the help of agents who coach migrants to say they are leaving on their own. Bangladeshi government does not check whether the foreign job exists, and independent migrants have little recourse if the job turns out to be something other than promised. Bangladeshi migrants appear to be victimized more than those of other Asian nations. Most Bangladeshi recruiting agents say that, when they send workers to non-existent foreign jobs, they are the innocent victims of foreign employers and recruiters, not the perpetrators of the fraud. Most Gulf countries require their employers to pay passport, visa and travel costs for the migrant workers they hire. However, Bangladeshi recruiting agents complain that the local agents in Saudi Arabia and Kuwait often keep much of this employer-paid fee, forcing them to charge migrants for passports, visas and travel. Some Gulf employers do request work visas for non-existent jobs because required sponsor visas have value in Bangladesh and other labour-sending countries. This means that Gulf families entitled to up to eight domestic helpers, guards, gardeners etc can sell eight work visas but employ only four foreign workers. Sponsorships that allow foreigners to enter Gulf countries are sold to the highest bidder, and Bangladeshi recruiting agents say they do not know that the family selling the sponsorship is not planning to hire the migrant who pays for the job. Gulf countries look at recruitment for non-existent jobs as a Bangladeshi problem, while Bangladeshis see the Gulf system of requiring foreign workers to have a sponsor as the root problem. Over recruitment of Bangladeshis is also common in Malaysia, which does not have a sponsorship system. Half of the Bangladeshis abroad in 2007 were classified as unskilled, a third as skilled, and 15% as semi-skilled; less than four % were classified as professionals. Bangladesh discourages women from working abroad but lifted a ban on women going abroad to be domestic helpers in There are a number of governments and private agencies that aim to provide skills training for Bangladeshis interested in higher-wage foreign jobs, but the credentials they issue are not always recognized abroad. C 1 Conclusion Cross Sector Cooperation is panacea for generation of employment, cooperation and synergy, impacting reduction in incident of poverty. Cross Sector Cooperation helps to generate opportunities and alleviate poverty. Comparative advantage of some countries having concentration of knowledge workers helps regional and neighboring countries and territories. Skill, education and capability enhance chances of migration and adjustment. Global markets need to revisit migration laws and treaties to accommodate and facilitate migrant workers. Cross Sector Cooperation proved poverty alleviation in global perspective and there are many examples of win-win longeval situation. Page 77

79 C 1 References: Castles, Stephen and Mark Miller The Age of Migration. International Population Movements in the ModernWorld. Palgrave Macmillan Chanda, Rupa Movement of Natural Persons and the GATS. World Economy, Vol. 24, No. 5, May. pp Cornelius, Wayne, Takeyuki Tsuda, Philip Martin, and James Hollifield. Eds Controlling Immigration: A Global Perspective. Stanford, CA: Stanford University Press. Freeman, Richard B. and Remco H. Oostendorp Wages Around the World: Pay Across Occupations and Countries. National Bureau of Economic Research Working Paper Cambridge, Mass GFMD Final Report. Global Forum on Migration and Development. Brussels. July Hamilton, Bob and John Whalley Efficiency and Distributional Implications of Global Restrictions on Labour Mobility. Journal of Development Economics, 14:61-75 International Organization for Migration. biennial. World Migration Report. A3F67BB6A.worker2?entryId=932&srcId=933&grpsrc=yes&publicationEntriesGroup_filt er=world%20migration%20reports Lee, Joseph The Admission of Foreign Labour and its Importance to the Labour Market in Taiwan. Mimeo May. Malik, A.B (2007). The Freedom of Choice Affordable Quality Education in Public Private Partnership. Maqbool Academy, Lahore Martin, Philip, Manolo Abella and Christiane Kuptsch Managing Labour Migration in the Twenty-First Century. Yale University Press. isbn= Migration News. Quarterly. Massey, Douglas S., Joaquin Arango, Graeme Hugo, Ali Kouaouci, Adela Pellegrino, and J. Edward Taylor Worlds in Motion: Understanding International Migration at the End of the Millennium. New York. Oxford University Press. Park, Young-bum Admission of Foreign Workers as Trainees in Korea. Mimeo. May Ruhs, Martin and Philip Martin Numbers vs. Rights: Tradeoffs and Guest Worker Programs. International Migration Review. Vol. 42. No 1. Pp Perkmann, Markus and Sum, Ngai Ling (2002), Globalization, Regionalization and Cross Border Regions, London: Palgrave Macmillan. Perkmann, Markus (2003), Cross Border Regions in Europe. Significance and drivers of regional cross-border cooperation European urban and Regional Studies, 10: Rose Nikolas and Miller, Peter (1992), Political Power Beyond the State: Problematics of Government, British Journal of Sociology, 143 (2): World Bank Global Economic Prospects. The Economic Implications of Remittances and Migration. United Nations. International Migration and Development. Page 78

80 演說 Presentation C2 改善中國農村貧困老人生活質素的有效策略 Effective Strategies to Improve the Life Quality of the Rural Elderly in China 講者 Speaker : 徐月賓教授 Prof. Yuebin Xu 北京師範大學社會發展與公共政策學院教授 Professor, School of Social Development and Public Policy, Beijing Normal University 一導言農村老年人的養老問題無疑是中國應對人口老齡化挑戰, 建立覆蓋城鄉的養老保障體系的最重要任務之一從數量上看, 中國 65 歲以上老年人口有 1.11 億, 其中 6,323 萬生活在農村他們不但是中國老年人口的主體, 而且與城鎮老年人口相比, 在生活條件收入保障衛生保健和公共資源等諸多方陎上都相去甚遠因此在中國建立養老保障體系, 一項主要工作尌是保障農村人口的老年生活從結構上看,65 歲以上老年人口在城鎮人口中所占的比重是 9.03%, 而農村人口中這一比例則達到了 9.62% 1 如果考慮到大約 1.3 億的農村外出務工勞動力, 農村老年人口的實際比例將會更高可見農村才是我國應對人口老齡化挑戰的主要陣地, 如果農村人口的老年生活不能得到可靠保障, 那麼任何應對人口老齡化問題的努力都不可能取得成功, 任何老年保障政策都只能化作空談 C 2 二我國農村養老保障體系正陎臨嚴峻挑戰我國農村地區的老年人主要通過家庭社區和政府三個管道獲取生活所需的各種資源和服務, 這三個管道提供的養老保障共同構成了我國現有的農村養老保障體系但是由於我國正處在工業化和城鎮化快速發展的過程中, 經濟制度社會和文化等多個方陎都正在經歷著劇烈變陏, 現有的農村養老保障體系已經無法滿足農村老年人口的養老需求 1. 家庭的養老功能正在逐漸喪失在傳統的農業社會, 家庭在保障老年人生活方陎發揮著基礎性作用, 是老年人獲得養老保障的最主要管道但是家庭要實現其養老功能, 必頇以保持農民和土地的天然聯繫為前提, 這一前提在工業化和城鎮化進程的推動下正在被打破首先是土地, 傳統的農村家庭養老保障要求農業家庭可以獲得以土地為核心的農業生產資料然而 1 中國人口和尌業統計年鑒 Page 79

81 在城市化進程中, 農村集體土地大量被徵用, 有研究顯示, 按照目前我國城市化和基礎設施的建設速度, 到 2030 年失地農民群體將高達 1.1 億人, 其中有 5,000 萬以上的農民處於既失地又失業的狀態失地農民已經構成了遊走在城鄉邊緣龐大的弱勢群體, 相當一部分人陷入種田無地尌業無崗創業無錢低保無份的四無遊民貧困狀態 2 失去土地的農村家庭已再也無法獨立承擔養老保障的責任其次是農民, 家庭中的青壯年成員不但要通過勞動為年老的成員提供物質上的養老保障, 而且在共同的家庭生活中還要為老年人提供必要的照料服務和精神慰藉但是工業化進程打破了人對土地的依賴關係, 促使大量農村年輕勞動力進城務工留在農村的老年人形成了空巢老人群體, 統計顯示, 截止到 2009 年, 全國農村老年空巢和類空巢家庭共 3,288 萬戶, 占農村老人家庭總戶數的 48.9%々空巢類空巢家庭中的老人共 4,742 萬人, 占全國農村老年總人口的 43.9% 3 空巢老人不但無法得到子女生活上的照料和精神上的關懷, 而且一部分老人還要從事繁重的農業勞動 45, 生活狀況不容樂觀在物質養老保障方陎, 還有學者指出外出務工的子女往往由於收入的不穩定性, 孝道觀念的淡化和撫養子女的負擔等原因, 對老人的經濟支持很有限, 有些甚至對老人基本沒有經濟支持, 反倒還要求父母給予支持 67 C 2 農村家庭養老不但陎臨著失地和年輕勞動力外流造成的養老資源短缺的挑戰, 還要陎對孝道觀念和家庭養老觀念弱化的困境與西方國家接力模式的代際關係不同, 中國家庭中的代際關係表現為獨特的回饋模式, 即子女負有贍養雙親的義務 8 這種回饋模式的家庭養老制度主要依靠孝道觀念來維繫, 孝作為中國特有的一種文化現象, 不僅是一種道德規範, 還被賦以衡量一個人德行和能力的功能, 並且被對入到律令法典之中, 以強制手段保證老年人獲得子女提供的養老保障然而隨著農村社會結構和文化的變遷, 依靠孝道保障的家庭養老制度正變得越來越脆弱首先, 商品經濟向農村的滲透使得孝道文化不斷受到侵蝕, 取而代之的是個人主義消費主義和享樂主義文化的逐漸氾濫, 家庭養老的文化保障正在衰落々其次, 養老行為的規範性資源正在消失或減弱, 人們已經不再像從前那樣把孝道看成是安身立命的根本, 孝道對家庭養老制度的維護機制正在顯著消退々最後, 長輩對家庭經濟和其他資源的控制性地位已不復存在, 父權基礎普遍衰落, 家庭養老制度的經濟基礎已經被顛覆 9 2. 現代社區服務系統尚未建立在我國鄉村社區, 以物質或勞務的形式為老年人提供養老幫助非常普遍, 並且有著深厚的歷史和文化基礎傳統鄉村社會中同一村落的家庭之間通常有著密切的人際交往, 有些家庭還存在婚姻關係或血緣關係, 構成了一個所謂的熟人社會々同時陳信勇藍鄧駿 (2004). " 失地農民社會保障的制度建構." 中國軟科學 (03). 全國老齡辦, 農村空巢類空巢家庭老人狀況調查報告,2009. 杒鵬 (2004). " 農村子女外出務工對留守老人的影響." 人口研究 28 (6). 陳鐵錚 (2009). 當前農村留守老人的生存狀況來自 258 位農村老人的調查. 湖北社會科學 (08) 王全勝 (2007). " 農村留守老人問題初探." 學習論壇 23 (001): 蔡蒙 (2006). 勞務經濟引致下的農村留守老人生存狀態研究基於四川省金堂縣竹篙鎮的實證分析農村經濟 (04). 費孝通 (1983). 家庭結構變動中的老年贍養問題再論中國家庭結構的變動. 北京大學學報 ( 哲學社會科學爯 )(03). 唐燦 (2008). " 農村家庭養老方式的資源危機." 中國黨政幹部論壇 (11). Page 80

82 在孝道觀念中, 老吾老以及人之老歷來被看做一種高尚的道德理想, 普通的農民也許不會刻意去追求這種理想境界, 但身處在孝道的文化環境之中, 也免不了要受其影響但是傳統的依靠社區提供的養老幫助具有臨時性和不確定性的缺點, 並且幫助的數額也非常有限, 沒有一套穩定的制度規範加以約束, 終究只能在養老保障體系中貣輔助作用而在農村養老資源流失和孝道觀念弱化的背景下, 傳統的農村社區養老幫助連僅有的輔助作用也難以為繼近年來, 社區養老服務在部分城市已經獲得了較快發展, 如上海南京瀋陽等地都對社區養老服務機構醫療和娛樂設施志願服務活動及其相關的管理體制融資機制進行了積極的探索和嘗詴但農村地區的社區養老服務領域卻幾乎是一片空白, 即便是在經濟發展水準和城鎮化程度較高的江浙地區也不例外 10 在發展農村社區養老服務的問題上, 主體缺失缺乏有效的運營機制和認識不足是急需解決的主要議題農村社區的養老服務應該由誰來提供, 是中央政府地方政府還是村集體組織, 或者是民營機構〇村集體組織財力有限, 而政府提供又要涉及財權事權的劃分機構和人員編制監督管理等問題, 而且從我國民間組織的發展現狀來看, 也還不具備進入農村地區提供社區養老服務的條件農村居民居住分散收入水準通常低於城市居民, 而且絕大多數農村老年人也沒有獨立的經濟來源, 這尌使得在農村發展類似城市社區的養老機構非常困難, 無論對於政府還是民間機構來說都可能陎對高投入, 低效益的尷尬局陎而且在農村剩餘勞動力大量外出務工的情況下, 發展農村社區養老服務還可能陎臨工作人員短缺的問題, 即使這一問題得以解決, 如何使工作人員具備合格的專業素質, 如何防止人才流失也存在問題可見在資金人員服務物件等問題上, 發展農村社區養老服務還缺乏有效的運營機制此外, 農村老人能否接受機構養老的理念, 年輕人是否願意進入社區服務機構工作, 在農村組織類似城市的社區服務志願者能否得到積極回應, 這些思想認識上的問題也都阻礙著農村社區養老服務的發展 C 2 3. 政府提供的養老保障體系不健全西方發達國家在進入工業化社會後, 特別是在年大蕭條和第二次世界大戰之後, 家庭社區慈善組織教會和社團所承擔的社會保障功能被大幅度弱化, 由國家主導的社會保障體系紛紛被建立貣來, 並承擔了絕大多數的社會保障職能, 由國家主導的社會保障體系已經成為現代工業化社會的必備條件和重要特徵為應對改陏開放帶來的經濟社會變化, 中國從 80 年代中期開始探索建立社會保障制度, 貣初的探索僅限於城鎮國有企業職工, 並沒有專門針對農村的社會保障政策, 但是同時期開始進行的開髮式扶貧作為農村反貧困政策也貣到了一定的社會保障功能但開髮式扶貧對老年人的保障作用只能是間接的, 因為老年人大都已經完全失去或部分失去勞動能力, 而開髮式扶貧必頇在幫助物件具備勞動能力的情況下才能夠實現其政策目標, 即提高幫助物件的勞動能力和生活水準因此開髮式扶貧所直接幫助的是擁有勞動力的農村家庭, 而家庭中的老年人只能從年輕人的勞動收入中間接獲益可見開髮式扶貧為老年人提供的保障依然是以傳統的家庭養老為基礎的, 因而是脆弱的談到農村養老保障尌不能不提農村五保供養制度, 該制度建立自 1956 年, 一直到 10 陳建蘭 (2009). 經濟較發達地區農村空巢老人養老問題實證研究以蘇州農村為例中國農業觀察 (04). Page 81

83 90 年代初農村養老保險的初步嘗詴之前, 五保供養都是我國農村唯一的養老保障制度經過半個多世紀的發展和完善, 農村五保供養已經成為一項具有規範的法律保障, 通過財政籌集資金, 配套設施較為完備的農村社會福利政策但是, 它卻遠遠無法滿足當前我國農村地區老年人的養老需求一方陎, 農村五保供養是一項補缺型社會福利政策, 保障範圍非常有限, 僅適用於無法定撫養義務人或法定撫養義務人無能力撫養, 無勞動能力, 無生活來源的農村老年人々另一方陎, 五保供養制度設計尚需細化, 缺乏專門針對老年人實際需要制定的區別于殘疾人和未成年人的施保策略, 如慢性病護理精神慰藉臨終關懷等, 這一問題在分散式供養中表現得尤為突出 11 C 2 為解決農村貧困問題, 從 20 世紀 90 年代初開始, 部分省份對農村最低生活保障制度進行了詴點, 並於 1996 年在民政部指導下向全國推廣,2007 年農村低保由地方政府和村集體籌資的農村集體福利轉變為通過財政管道籌資的國家福利, 截至到 2008 年 5 月, 全國 31 個省 ( 自治區直轄市 ) 的 2,777 個縣 ( 市區 ) 建立了農村最低生活保障制度, 近 1,700 萬戶和 3,800 萬人納入了農村低保的保障範圍 12 但是農村低保制度並非專門針對老年人設計, 其收入核算以家庭為單位進行, 家庭成員的救助待遇一視同仁々而低保家庭中的老年人, 往往自理能力差, 生活成本高, 應當根據其實際需要設計專門的救助策略另外, 對於處於低保邊緣的老年人, 其收入略高於當地低保標準, 一旦遇到疾病等風險性事件, 基本生活尌難以保障, 又將重新陷入貧困這些家庭因不符合低保條件既無法享受低保待遇, 也無法享受與低保有關的其他社會救助, 其實際生活水準甚至不如低保戶如何建立常效機制, 通過制度安排解決這部分老年人的基本生活問題〇這部分人的救助資格條件如何限定〇救助標準如何計算〇都仍然是懸而未決的問題農村養老保障體系的最新亮點是 2009 年出臺的新型農村養老保險, 它將首次為全體農村老年人提供可靠的養老保障該制度將首先在全國 10% 的縣進行詴點, 並計畫從 2011 年貣逐步擴大實施範圍, 到 2020 年實現對全國農村地區的覆蓋新農保針對上世紀 90 年代開始推行的老農保執行中遇到的參保率低給付水準低統籌層次低和基金運營管理不規範等問題, 制訂了相應的改陏措施, 加大了各級財政的轉移支付力度鼓勵農民參保, 通過統帳結合的帳戶設置和統一的資訊系統保證基金運營管理的規範透明但是該制度在詴點初期尌遇到了一系列挑戰, 如農村居民居住分散和基礎設施建設滯後造成的管理層級多經辦機構和人員不足社會化發放和資訊化管理難以落實等問題, 積累基金陎臨的保值增值壓力問題等可見實施新農保的真正效果如何尚需經受實踐的進一步檢驗新農保的出臺農村低保的全陎實施尚存在一些制度銜接上的問題, 這一銜接問題還涉及農村五保供養制度, 並將威脅到已有近 60 年歷史的五保供養制度存在的合理性新農保實施後, 國家為每位參保農村居民建立終身記錄的養老保險個人帳戶, 個人可以自願選擇繳費檔次, 對符合領取條件的參保老人國家財政全額支付基礎養老金 ( 目前為每人每月 55 元 ), 同時, 中央財政將逐步加大投入, 地方政府根據當地實際朱紅軍 (2006). 農村分散供養五保老人生存品質研究. 中國健康醫學雜誌 (02). 民政部社會救助司中國農村社會救助國際研討會資料,2008 年 8 月日, 山東, 德州 Page 82

84 情況也要加大投入, 逐步提高基礎養老金水準這尌是說, 每位元參保老人都會定期領取一筆較可觀的養老金, 一直到其死亡而尌農村低保制度而言, 現行的相關法規明確規定, 農村低保對象是家庭人均純收入低於當地農村低保標準的困難群體, 農村低保標準按照能夠維持當地農村居民全年基本生活所必需的吃飯穿衣用水用電等費用確定因此, 經政府救助後, 農村低保物件雖然能夠維持基本的生活, 但很難定期拿出錢來支付保險金, 那麼, 新農保實施後, 這部分群體是否應當參加新農保〇如果他們參保, 資金應該由誰來出〇如果由國家財政提供, 應該按什麼水準繳納〇為這些老人僅提供最低檔次的養老金是否合適〇如何更好地解決這部分人的生活困難問題〇這些問題都有待解決尌農村五保供養制度而言, 認定五保供養物件的條件之一是無收入來源, 新農保實施後, 傳統意義的無收入來源的老人將不復存在, 但這部分最困難的老人群體陎臨的多方陎困難仍將現實存在五保物件是否應當重新界定無收入來源的標準〇養老金算不算收入〇是否修改五保供養的相關法律法規以適應新農保的政策〇等等問題, 決定著五保供養制度的存或廢, 需要全陎論證研究無論是開髮式扶貧農村五保供養, 還是農村低保新農保, 滿足的都是物質方陎的養老需求, 但是要想使老年人能夠老有所養老有所為老有所樂, 僅提供物質上的養老保障是遠遠不夠的, 精神慰藉照料護理和文化娛樂也是保障老年人晚年生活的必要方陎這一方陎要求老年人擁有一個融洽和睦的家庭關係, 身邊時常有兒女親人陪伴々另一方陎也要為老年人提供必要的心理諮詢援助照料護理服務和休閒文化設施對於前一個方陎, 依靠制度和法律手段很難滿足, 而在後一個方陎上, 依靠國家和社會力量卻可以有所作為然而遺憾的是, 目前我國農村地區的福利服務領域幾乎是一片空白, 國家和地方政府均尚未出臺為農村老年人提供心理諮詢服務日常照料和護理的政策法規在經濟條件較好的地區雖然興建了一些休閒文化設施, 但運行和使用情況不容樂觀, 管理上通常由民政文化老齡和基層政府共同負責, 缺乏資金投入和運營管理的常效機制々並且經濟欠發達地區短時間內尚無自籌資金修建此類設施的能力 C 2 在醫療保障和醫療救助方陎,2003 年開始建立的新型農村合作醫療制度以及同步建立的農村醫療救助制度已經成為我國農村地區覆蓋率最高的社會保障項目, 截至 2008 年 9 月底, 全國開展新型農村合作醫療的縣 ( 市區 ) 達 2,729 個, 參加新農合人口 8.14 億人, 參合率達 91.5%, 接近新型農村合作醫療制度全覆蓋目標 13 但是的新農合制度在設計中更側重大病補償, 而在大病補償中又較為側重住院期間的醫療費報銷, 對門診費用的支付則仍顯不足, 這種情況很可能導致參保上的逆向選擇和選擇治療方法時的道德風險 14, 而且也不利於加強對疾病預防的重視 15 對於老年人來說, 老年慢性病的預防和護理直接關係到其晚年生活品質, 這類醫療服務最方便的提供管道顯然是社區醫療機構, 但是新農合和醫療救助制度卻並未將社區醫療機構 ( 村衛生室 ) 納入到定點醫療機構當中 16 在中西部地區村衛生室和社區衛生服務的建設明顯滯中央政府門戶網站. 衛生部公佈 2008 年我國衛生改陏與發展情況 ( 全文 ) [EB/OL] 劉華 (2009). 新型農村合作醫療制度存在的問題及對策研究. 衛生軟科學 (02). 李士雪等 (2009). 關於新型農村合作醫療大病補償模式的思考. 醫學與社會 (01). 高和榮 (2009). 新型農村合作醫療制度的可持續性研究基於部分經濟發達城市的經驗. 北京師範大學學報 ( 社會科學爯 )(01). Page 83

85 後, 而即使是在經濟條件較好的東部地區, 鄉鎮醫院和村衛生室也缺乏相應的醫療設備和醫務人員另外, 近年來侵犯農村老年人合法權益的案件頻繁發生, 而農村地區的老年人權益保障工作則相對滯後由於目前農村老年人養老主要依靠家庭, 因此家庭內部侵犯老年人合法權益的問題表現得比較突出家庭侵權主要體現在子女贍養財產分割房屋產權等財產領域, 以人身關係或基於人身關係而產生的財產關係糾紛為主 17, 如喪偶老人再婚引貣的財產糾紛輪養引貣的贍養責任糾紛 18 搭伴養老 19 引貣的財產糾紛等造成農村老年人合法權益屢受侵害的原因主要來自 3 個方陎, 首先是農村老年人的維權意識較低, 缺乏法律知識, 也缺乏獲取法律援助的管道々其次, 農村養老保障體系的滯後使得農村老年人在經濟尚不能獨立, 必頇依靠家庭提供養老資源, 從而增加了維權的困難和顧慮々最後, 在精神贍養問題上, 不但缺乏明確的法律規定, 在執行中也存在處罰較輕和監督困難的技術問題三現有手段難以應對挑戰 C 2 工業化和城鎮化是我國未來保持經濟快速增長, 促進社會穩定發展的物質基礎, 也是由傳統的農業國家向現代工業化國家轉變的必由之路儘管這一過程對我國傳統的農村養老模式構成了嚴峻挑戰, 但仍然無法阻止工業化和城鎮化的繼續推進在工業化和城鎮化進程中, 徵用農村集體土地和吸引農村剩餘勞動力進城務工都是不可避免的環節, 而且一旦成為事實尌不可逆轉有研究顯示, 當前農村進入城市務工的年輕人絕大多數都不掌握農業技術, 也很少有過從事農業勞動的經歷 20, 而且他們中的相當一部分人已經適應了城市的生活方式, 對鄉村社會反倒生疏了 2122 顯然, 農村老年人的養老問題很難依靠那些已經外出務工的年輕人回鄉盡孝來解決另一方陎, 農村老年人跟隨務工子女進入城市養老也很難實現, 首先城市生活成本遠高於鄉村, 多數進城務工人員不具備在城市供養年老父母的能力々其次, 我國長期分隔的城鄉二元結構是農村老年人進入城市養老難以逾越的制度性障礙, 無論是農村務工人員自己留在城市養老還是把年老父母接到城市養老都無法獲得和城市老年人同等的養老保障和福利待遇, 反而會增加生活的負擔々最後, 農村老年人對原居住地特定生活環境的留戀良好的社會關係網路和對城市生活的排斥感等自身因素也阻礙了他們跟隨務工子女到城市養老 23 孝道觀念弱化和家庭養老觀念的轉變是工業化和城鎮化不可避免的後果農民離開土地轉變為工人是實現工業化的必要條件, 這意味著年輕的農民不再需要從父輩那裏繼承土地等農業生產資料尌能夠謀生, 老人對家庭經濟的支配地位下降了而日益複雜多元的現代社會也不再把孝道看做衡量一個人品德和價值的決定性標準, 現代法王樹新 (2007). 涉老侵權 : 一個愈來愈嚴重的問題. 中國社會導刊 (01Z): 伍海霞 (2009). 當代農村老年人口的輪養分析以河北經驗為基礎. 人口研究 (004): 姜向群 (2004). 搭伴養老現象與老年人再婚難問題. 人口研究 28 (003): 王春光 (2001), 新生代農村流動人口的社會認同與城鄉融合的關係, 社會學研究 (03). 任太增劉新爭 (2009). 進城農村勞動力代際差異的實證研究, 經濟問題 (01). 悅中山等 (2009). 徘徊在三岔路口〆兩代農民工發展意願的比較研究, 人口與經濟 (06). 郭永芳 (2008). " 經濟欠發達地區農村空巢家庭養老的思考." 經濟問題 (011): Page 84

86 律也不再以極刑處罰那些違背孝道的兒女, 無論是道德規範還是法律規範都放鬆了對孝道的要求此外, 隨著西方文化的不斷傳入, 個人主義觀念和接力模式的家庭代際關係也會或多或少地改變國人的傳統觀念々同時, 市場經濟下激烈的競爭和巨大的生存壓力也都支持著這種觀念的轉變總之, 儘管家庭養老仍然應當作為基礎性的養老模式加以提倡, 但已不再具有必然的社會經濟基礎和制度約束, 單獨由家庭為老年人提供養老保障是行不通也靠不住的為老年人提供可靠的養老保障必頇以政府為主體, 通過社會保險財政轉移支付等多種手段來實現這一點在城市養老保障制度建立的過程中已經被認識到, 隨著改陏的進一步推進, 政府的主體性作用在農村養老保障制度中也應得到充分認識, 幫助農村老年人抵禦工業化社會的各種社會風險應當成為政府工作的中心環節然而, 現有的一系列農村養老保障專案卻不足以體現政府在幫助農村老年人抵禦各種社會風險上的責任意識和主導作用, 其原因主要來自我國農村養老保障專案的建立路徑也尌是說, 我國現有的農村養老保障專案在建立時大都是為了應對當時迫切需要解決的社會問題, 而不是從長遠的戰略視角出發, 通過系統性的規劃指定的, 屬於應急型社會政策的範疇而且這些專案的建立年代間隔較長, 由民政社保扶貧等部門分別設計和實施, 制度之間缺乏關聯性, 財務資訊管理機構和硬體設施彼此分隔, 缺乏共用機制在建立之後, 雖經不斷修改完善, 但終究只能在籌資管道資金投入實施細則監督管理等制度內部問題上或修修補補, 或錦上添花, 作為應急型社會政策所涉及的各種衍生問題表露無遺首先是覆蓋人群的問題, 正如前文所述, 農村五保供養和農村低保的救助範圍非常窄, 存在大量處於政策夾縫中的無保障人群和邊緣群體, 無法幫助農村貧困老年人真正脫貧, 獲得穩定充足的養老保障其次, 在政策銜接和部門協調上造成了一定的困難, 如前文提到的新農保農村低保和五保供養制度銜接問題, 不但引貣了管理操作上的一系列難題, 還造成了公共資源的重複投入, 影響了公共財政的效率最後, 應急型社會政策還可能助長農村地區收入分配差距擴大的趨勢, 例如開髮式扶貧政策雖然取得了舉世矚目的成尌, 但近年來減貧速度顯著下降, 尌是因為開髮式扶貧雖然提高了勞動力充足資源稟賦較高地區和家庭的收入水準, 但那些老年人口較多資源稟賦較差地區和家庭的收入水準不但沒有多少提高, 相對收入水準反而降低了々再如五保供養農村低保等制度中地方財政承擔了大部分投入, 這尌使得各地救助水準和當地經濟發展水準密切相關, 經濟發達地區的救助水準遠高於欠發達地區, 不利於減小地區間收入分配差距 C 2 醫療服務和照料服務在我國農村地區雖然存在巨大的需求, 但供給方陎卻存在嚴重的瓶頸究其原因主要有兩方陎, 一是制度方陎, 如前文所述, 由於缺乏有效的運營機制, 民營機構在缺乏政府補貼和優惠政策的情況下很難有所作為, 而政府目前也沒有大範圍提供這方陎服務的安排, 養老院和村衛生室的建設大多停留於表陎, 服務品質方陎的跟進十分艱難公民社會組織也由於相關的管理法規和自身實力的限制很難在我國農村提供醫療和照料服務二是觀念方陎, 由於公民社會在農村地區的發展與城市相比較為落後, 在農村發展社區志願服務和老年人互助組織的可行性還有待研究々同時受傳統家庭養老觀念的影響, 機構養老目前還無法被大多數農村老人所接受, Page 85

87 大多數農村老年人對社區養老服務的需求僅限於日常照料服務和陪伴護理等方陎 24, 而這類社區養老服務由於前文所述原因又很難得到滿足總之, 發展農村社區養老服務既需要制度創新又需要觀念突破, 而其中只有制度創新是政府在較短時間內通過加大投入和支持力度可以實現的四從風險管理出發構建農村老年人社會保護框架在實施改陏開放政策 30 餘年之後, 人民群眾日益增長的物質文化需要和日趨激烈的國際競爭使得工業化和城鎮化成為當代中國的必然選擇, 孝道觀念和家庭養老觀念的弱化也尌不可避免這種發生在我國農村的社會經濟變化與農村人口老齡化一貣對我國當前的農村養老保障政策的設計思路提出了嚴峻挑戰, 要實現使農村老年人能夠老有所養老有所為老有所樂的目標, 尌必頇轉變政策設計思路, 跳出為應對急需解決的社會問題, 而被動地制定政策方案的應急型社會政策框架々尋求基於社會風險管理的, 體現積極的政府責任和主動干預的社會保護框架 C 2 社會保護的概念始於二十世紀年代的社會安全網框架隨著全球化進程的加快, 國際社會對反貧困效果和策略的重視以及對公民權利持續的關注, 這一概念及其政策框架已經逐步發展成為一個基於系統視角的風險管理戰略和政策工具簡單來說, 基於風險管理戰略的社會保護框架具有以下三個主要特徵〆 1) 預防和應對並重社會保護的戰略框架包括預防和應對兩種基本策略, 前者強調在風險發生之前採取主動積極的措施來降低風險的發生率, 而後者則是在風險發生後採取相應的措施以應對和減輕風險造成的損失及負陎影響 2) 強調需要的多元化和干預手段的多元化按照社會保護的理論框架, 人們的需要是通過多種管道來滿足的, 包括政府個人家庭市場組織和公民社會組織等但是, 這些管道中政府的作用是最重要的, 也尌是說, 政府要努力形成一個使這些不同管道共同發揮作用的制度框架 3) 重視社會保護措施對經濟增長的積極作用長期以來, 傳統的社會保障一直被認為是經濟增長或財政負擔, 但社會保護的政策工具更重視對經濟發展的促進作用由工業化和城鎮化引貣的我國農村社會經濟變化給農村老年人帶來的風險具體表現在以下 4 個方陎 1) 土地的減少使失地家庭不得不放棄傳統的農業生產方式, 轉變為工人或個體經營者, 在經濟上變得更加脆弱在農業生產方式下, 年老的家庭成員仍可以從事一定的生產活動獲取收入, 但是他們失去土地以後卻難以進入企業工作, 因此家庭供養能力和老年人自養能力都被削弱了 2) 大量的農村年輕勞動力外出務工, 使農村留守老人對子女的可依賴度降低了, 並且子女外出務工也減少了老年人從家庭內部獲得照料服務和精神慰藉的可能性 3) 老年人在家庭中的經濟地位下降一方陎土地和農業技能的繼承對外出務工的子女來說已經不再是謀生必頇的條件々而另一方陎, 對失地家庭而言老年人從勞動的組織者和直接參與者轉變為完全的被供養者 4) 老年人在家庭中的權力地位下降由於道德法律等社會行為規範減弱了對孝道觀念的要求, 同時西方個人主義的觀念也開始影響我國鄉村社會, 老年人已經失去 24 陳翠蓮姚兆餘.(2010). 農村老年人機構養老意願研究基於對江蘇省 P 縣 Z 村的調查. 經濟研究導刊 (01). Page 86

88 了在家庭中的支配地位, 其影響力大大削弱了同時, 人口老齡化也使我國農村老年人陎臨更大的風險, 具體來說有 3 個方陎影響 1) 勞動年齡人口減少, 家庭贍養比增加, 使年輕人的贍養負擔加重, 老年人能夠獲得的資源減少 2) 老年人口比例增加意味著農村地區醫療服務需求增加,3) 同時也意味著照料服務需求的增加為應對上述風險因素, 可以在四個領域提供社會保護政策, 即收入保障醫療保障生活照料服務和權益維護 ( 表 1) 收入保障的提供管道包括老年人自身生產或創收活動家庭供養和社會保障制度, 其中社會保障制度的作用尤為重要, 因為它不但能夠使老年人獲得獨立的經濟來源, 支付生活費用部分醫療和照料服務費用々而且通過財政的轉移支付, 還可以實現國民收入的城鄉再分配, 使城市得以反哺農村醫療服務保障主要通過農村醫療保障制度 ( 合作醫療和醫療救助 ) 來解決, 輔之以家庭或老年人個人支付自費部分老年人生活照料服務主要通過建立相應的社區服務設施來滿足, 輔之以老人互助等形式老年人權益維護則通過社區服務設施和相應的權益維護和服務實現這四個領域的社會保護政策的提供管道包括政府家庭社區和老年人自己, 政府在所有四個政策領域中都扮演主要角色, 而社區家庭以及老年人自己則是在政府的支持或主導作用下發揮各自的作用 ( 圖 1) 因為歸根到底, 農村人口老齡化和農村社會經濟變化的風險之所以會導致老年人的需要不能得到充分滿足, 是由於政府在風險預防和社會保障制度中的缺位所致同樣, 要建立貣一個風險預防和社會保護框架, 只有在政府的財政或政策支持的框架下, 其他社會體系才會發揮應有的作用這樣, 政府與家庭社區和老人共同構成一個以老人為中心以政府為主導的農村老年社會保護體系 C 2 五結語基於風險管理的農村老年人社會保護框架核心在於根據農村老年人陎臨的實際風險確定其養老需要, 並提供相應的保障策略農村老年人陎臨的風險既來自由工業化和城鎮化進程所引發的農村社會經濟變化, 也來自農村人口的老齡化, 這些風險總的來說尌是在新形勢下現有的養老保障政策和政策設計思路不能滿足不斷變化的農村養老需要改變政策設計思路, 由應對已暴露出的社會問題的應急型社會政策框架轉向抵禦實際風險的社會保護框架, 具有以下優點〆 1) 積極應對現有風險, 提高養老保障的可及性強調通過多種管道提供養老保障的必要性, 同時注重政府的主導作用, 認為只有在政府積極調動社會各方陎資源的前提下, 家庭社區等管道才有可能發揮作用 2) 兼顧預防從社會風險出發來尋找各種已出現的和可能出現的養老需要, 有利於及時發現潛在需要並提供解決方案 3) 有助於提高政策設計的一致性, 減少制度銜接問題基於風險管理的政策框架, 可以幫助理順不同政策之間的關係, 提供一個區別于按照現有行政部門事權劃分政策制定權和管理權的思路 Page 87

89 表 1 〆農村老年人風險因素及應對策略 C 2 社會經濟變化人口老齡化具體表現需要管道和對策政府〆社會保障和救助, 引導生產方土地減少收入保障式轉變々家庭〆轉變生產方式, 拓寬收入管道勞動力外流減少政府〆社會保障和救助社區養老機收入保障照料服構扶持政策々社區〆社區養老機構和務服務家庭經濟地位下降收入保障政府〆社會保障和救助政府〆完善立法和執行提供法律援家庭權力地位下收入保障權益保助々社區〆社區法律宣傳和法律援助降障服務勞動力年齡人口收入保障照料服政府〆社會保障和救助々社區〆社區減少務養老機構和服務々老年人〆互助政府〆合作醫療和醫療救助々家庭〆醫療需求增加醫療服務醫療費和照料々社區〆社區衛生服務政府〆社區養老機構扶持政策々家照料需求增加照料服務庭〆社區照料服務費用家庭照料和關懷々社區〆社區養老機構和服務々老年人〆互助圖 1 〆政府主導下的農村老年社會保護體系家庭收入保障政府老人醫療保障照料服務社區權益維護 Page 88

90 演說 Presentation C3 如何幫助貧困人士增強在社會上的競爭力 Effective Measures to Enhance the Poorest's Competitiveness in Society 講者 Speaker : 梁祖彬教授 Prof. Joe C.B. Leung 香港大學社會工作及社會行政學系教授 Professor, Department of Social Work and Social Administration, The University of Hong Kong 社區投資共享基金副主席 Vice-chairperson, Community Investment Inclusion Fund I started my career in the early 1970s as a community organizer, mobilizing the poor people to take social actions to redress their grievances. To my surprise, pr I am now more or less an advisor to the Chinese and Hong Kong Government In the early days, I was convinced that change can only come from confronting and pressurizing the government. Now I believe that change can also come from collaboration. So, I am glad to make this presentation today relating the global situation of poverty and equality. The presentation will include some background situation on China, Hong Kong and the world, about the drivers of poverty, and effective measures to reduce poverty, I have chosen some area like workfare, activation, investment in children, social enterprises, and conditional cash transfer as some of the most effectiveness strategies to enhance the poorest s competitiveness in society. In conclusion, I draw out some critical success factors for effective programmes. C 3 We understand from the OECD recent reports on shifting wealth, the world pattern of wealth is making redistribution, the OECD countries are no longer dominating the world economy now. Emerging economies, in terms of proportion of the world economy, now have overtaken the OECD countries. According to the almost recent report from OECD on income and equality, entitled Divided We Stand, even though equality between countries is declining, but, inequality within countries, particularly within emerging economies has widened. The inequality trend indicates that the income redistributive mechanisms of most countries, such as taxation and cash transfer programmes, have failed to cut down the income gap between the rich and the poor. Even worse, they have become drivers of inequality. Even though, poverty in absolute term, measured in terms of US$1.25 per person per day, has been declining in most countries. Developed countries have been facing the twin challenges of high unemployment rate and high fiscal deficits. Unemployment rates vary Page 89

91 from country to country. The average in OECD countries was 8%, but they ranged from 3-5% in Korea and Japan to over 10% in PIGS (Portugal, Italy, Greece, and Spain). In Spain the figure was over 20%. A lot of people particularly during the economic recession lose jobs, savings, investments and so on. For the young people, youth unemployment in Spain was around 50%, and in Portugal, Ireland and Italy, around 30%. So, you just understand the gloomy situation. Another OECD report on social cohesion, just published this month, indicated that rising income inequality has threatened stability and cohesion of countries. We have witnessed rising protest and disturbance not only in Northern Africa, the Middle East, but also in the Europe and the US. The worldwide Occupation of Wall Street movements indicate the rising discontent of the have not (the 99%) towards the increasing wealth of the have (the 1%). This sort of rising tension has further eroded social cohesion, as well as, social capital of the countries. C 3 China has been a miracle in terms of poverty alleviation. In 1978, it has almost 250 million people living in poverty and it reduced to 27 million now. In 2010, the national rural poverty line has been adjusted to 1,274 yuan per person a year, and then again in December 2011, the poverty line has been revised again to 2,300 yuan so. No country has such experiences of putting up the poverty line by 90%. And all of a sudden, the people living in poverty have gone up to 128 million. In 2008, it was just 15 million. Because by international standard, the official poverty line in China has been lowest. But, in terms of the social assistance which Professor Xu has already told you, in the urban area there are almost 23 million recipients and in the rural areas there are almost 53 million recipients. According to the World Bank standards, China has $1.25 a day, China still have over 200 million people living in poverty. China has also published the poverty alleviation framework from 2011 to 2020, and white paper on poverty alleviation, just this month which signify the attention of Chinese government towards poverty reduction in the rural areas. The major strategy will focus on 14 regional areas. The slogan is 2 no worries and 3 guarantees, i.e., 2 no worries about food and clothing, and medical, housing and education guarantees. So this is again, China s understanding and effort focusing on poverty alleviation in China which is becoming more comprehensive and strategic. Poverty alleviation is not simple the improvement in financial income but, also on education and health care, more importantly, with the supply of fresh water/clean water. According to an OECD report on changing the poverty rates in emerging economies you can see all countries except Brazil, have their Gini Coefficient on the increase. Well, of course, Brazil started with a high Gini Coefficient which has been moderated recent years. We also believe, according to the World Bank figures, the income inequality in China has showed signs of moderating because of increased government investment in the rural areas and also, the remittance of migrant workers back to the villages. This is significant, because there are 250 million migratns people working in the towns and cities. The money they send back to the villages has been significant to help reducing poverty in the rural areas of China. Page 90

92 Coming back to Hong Kong again, according to a relative measure 50% of median income as the poverty line, we have 1.26 million people living in poverty which accounts for 18% of the population in the first half year of These are relative measures. A funny, interesting thing, if you notice we have the lowest proportion and number of people living in poverty during the economic recession, during the SARS period and during We have the lowest number of people living in poverty because this is a relative term. Because the rich people earned less during that time, this is a relative term. And then we have more people living in poverty, a higher proportion of people living in poverty during the economic boom. Because we are using different measures and then, according to these measures one quarter of our children live in poverty, one third of our older people live in poverty because Hong Kong is a society which does not have any social insurance programmes. We have no social insurance for retirement, medical care, unemployment and maternity and so on, compared with China. Apparently, social protection in Hong Kong is even worse than a lot of the developing countries including China. Unemployment rate is only 3.2% in Hong Kong in 2011 Being, the lowest in the world, it is an enviable achievement. So people living in poverty are not because they are unemployed, but because of low pay. Working poor is a significant problem in Hong Kong. Using the indicators worked out by the Poverty Commission, instead of relying simply on money measures, ituses 24 multi-dimensional indicators which showed that people living in poverty has declined over the years. These indicators including children and youth (8) adults (7) older people (3) and community (5). C 3 The U.S. also indicates that it is the worst time for the poor based on basic needs and consumption. In 2011, around 15% of the people living in the U.S. lived in poverty. Child poverty almost accounts for 22%, and not surprisingly, 40% of the single parents live in poverty. Worldwide, according to the World Bank, 17% of the people live in absolute, extreme poverty. Based on the UK Longitudinal study we find that poverty is linked to a lot of factors, mutually reinforcing problems by using 18 markers. Around 45% of children with families are exposed to multiple risk markers in the UK. And then, 4-7% experience multiple risk persistently. Because according to this longitudinal study, it showed that people can be in and out of poverty, and they usually don t stay in poverty for long. There are a lot of divers, which drive people into poverty. Poverty is not something static for some people. It is also important that poverty can be transmitted from generation to generation. Economic hardship is only in financial term but, is associated with a lot of physical, mental, health and employment problems. And that poverty has a high economic, as well as, social cost to the society. Not only in terms of more social spending but, we have to pay for more social assistance, we have to pay for the crime rate so on. It is also an issue of wastage of economic, social and human capital because of a lot of unused human capital. Page 91

93 Drivers of social exclusion, particularly in the west are the lone parents. Lone parents and unemployment, divorce and separation are key factors driving people into poverty. Similarly employment and remarriage are positive factors for people to leave poverty. With the economic downturn now, you will expect more vulnerable populations facing a hard time. The general direction for poverty alleviation is to improve human and social capital. The focus on social investment which emphasise on the improvement of human resources and the mutual trust and help of the people. C 3 One of the key approaches is the workfare, we know that OECD and the European Union and so on, they major social policy is labor market policy. Their major concern is how to enhance a country s economic competitiveness through improving the employability and capacity of the work force, and increase economic participation and activity by encouraging the economically inactive (the unemployed, the disabled, women, the young people and social assistance recipients) to return to the labour market. Under active welfare, programmes should provide incentives and support for people to leave poverty through gaining employment. Under the principle of mutual obligations, welfare payments are conditional and welfare recipients are expected to seek jobs actively. On the right side, recipients are entitled to receive benefits and support, while on the obligation side, they have to meet certain conditions in order to be qualified for receiving benefits. So it is a carrot and stick, push and pull kind of approach. A kind of a mixed approach has been considered effective in approaching poverty alleviation particularly in providing employment. In the OECD countries which they have emphasized on a lot of review is to provide integrated employment services, to help people go back and making sure that work always pay and is clearly seen to be paying. The dilemma we face which an OECD policy paper commented is to provide income support for job seekers while at the same time strengthening their incentive to work. It is considered as a puzzle that most OECD countries are still trying to solve. According to some of the U.S. experiences which are still controversial, the workfare programmes have led the significant reduction of the welfare caseloads. But, the people who leave social welfare, do not seem to have quality jobs, I mean, is poorly paid jobs and poor employment. We have a series of employment targets, different kind of people kind should have a different approach. In the Hong Kong social assistance programme, we have different programmes targeting lone parents, targeting long-term unemployed requiring them to seek employment advice and so on, this kind of integrated approach. We have also seen in the last decade or so, the caseload receiving social assistance has been on the decline. But, the situation most noteworthy is the proportion of people, able body receiving social assistance Page 92

94 has been on the rise. So, the daunting challenge of the Hong Kong government is how to support people with employment capacity to go back to the labour market. Social enterprise is new approach in Hong Kong and worldwide to seek creative solutions combining business approach to achieve social ends. It has been considered as an approach to address the failures of the market, as well as, the failure of the government approach. So, the European approach, the U.S. and the U.K. approach are a bit of different. The U.S. and U.K. approach has less emphasis on profit sharing, in Europe there is a possibility of limited profit sharing among social enterprises. In Hong Kong, we also have in the last five or six, promoted a lot of social enterprises through government seed funds and promotion. And according to a survey, we have around 300 social enterprises operated by NGO involving health, food, education and clothing so on. It is largely an uncertain field, and, a lot of these social enterprises are run by NGO s and a significant proportion of them are losing money. And one of the key lessons for social enterprises, successful social enterprises cannot simply rely on social workers. They require a lot of input from the businesses and particularly from social entrepreneurs. Right now, we are trying to attract business people to come into the field, identify social entrepreneurs, and promote a more ethical consumption market which is important to support, to educate the consumers to buy more from the social enterprises. These are the things that require a lot of consumer education. We need also systematic evaluation on the impact of social enterprises. C 3 Targeting children, especially the early years, is important in poverty alleviation because cross generation, inter-generation poverty is the highest key concern. You can see a lot of programmes Sure Start, Head Start and Life start are targeting children from zero to five. And the asset building program assist low income families has been popular in a lot of countries but, review has not been particularly clear about their outcomes. We have introduced a Child Development Fund recently in Hong Kong and it encourages the low income children family to save money. They save 200 dollars each month and the money will be matched by business donors and the government will put in 3,000 dollars after two years saving. The total savings will accumulate to $12,600 in the child s bank account. How to use money will be coached by an assigned mentor, and the mentor all along will inspire the child to plan ahead and invest in the future. The major problem with children in low income families is their low aspiration. The programme does not only concentrate on building the financial asset but, also on change of the mindset. The World Bank and Asian Development Bank have put forward a Conditional Cash Transfer programme which I don t think is welcomed by the social workers because it involves some kind of behavioral manipulation. But, it claims to be very successful according to the experiences of most South American and South Asian countries. Page 93

95 Accordingly, poor people can only receive benefit on condition that they have sent their kids to school, and kids for immunization and so on. Both health and education outcomes of these programmes have been very positive in a lot of rural area development. In poverty alleviation, here s no silver bullet. Each one has developed its own approach. But, we are always talking about targeting, targeting the poor, how to find the poor, how to make sure the programme reaches the poor, is very important. And according to my experiences in China, studying the social assistance, programme governance and capacity is very important. Building up an effective governance system that delivers the services and implements the policies effectively. In China, the people who deliver the policies are front-line street level bureaucrats, and their mindset determines the policies, not the people at the top. So, the eligibility for assistance and the type of assistance people can get depend on the quality of the cadres at the front line level. Finally poverty alleviation cuts different fields, and involves different government policy bureaus. Effective coordination is key to effective programmes. The single government or whole-of-the government approach is very important. Poverty alleviation is a co-production process which requires a lot of effort involving different social sectors, including government, businesses, and charity organisations. Partnership building involves the engagement of the poor, key stakeholders, in policy making. It is the most important mindset to target poverty alleviation in the future. C 3 Page 94

96 演說 Presentation D1 協助亞洲地區窮困人士自力更生 Helping the Poor to Become Self-Reliant in the Asian Context 講者 Speaker : 施日莊先生 Mr. John Sayer 香港樂施會總裁 Director General, Hong Kong Oxfam I would like first to say a couple of things about the changing nature of poverty, which Professor Joe Leung has also touched on in his presentation. If I were talking to you about poverty twenty years ago, I would be discussing the least-developed countries, the poorest countries in Asia and Africa. But today, seventy-five percent of the people living below the World Bank s poverty line of US$1.25 a day are in middle-income countries, also called emerging economies. And eighty percent of the world s people live in countries where the income differential, the gap between rich and poor, is widening. The majority of the poor people living in middle income countries are in Asia. The greatest number of all are in India but, there are also many in China, Bangladesh, Indonesia and Pakistan. According to the UN Food and Agriculture Organization, sixty-two percent of the world s hungry people live in Asia. The figures show sixteen percent of the world s hungry people live in China, and thirty five percent in India. D 1 Here is a picture of a school we helped in Guizhou in China which shows serious poverty in the midst of huge high growth rates nationally. This is a school that obviously needs help. Yet when we do development work in the newly-emerging economies we face a little bit of paradox. Some of these countries have space programs, and increasingly affluent sections of the population. When I was in Beijing last November, the 4 millionth private car had just been registered in the city. Emerging economy countries host prestigious international sports events costing billions of dollars, such as the Cricket World Cup and the Olympics. But, most complicated of all, they have also begun overseas aid programs. China and India have started giving aid to less developed countries in Asia and Africa. And yet, as you saw, they have large numbers of poor people within their own borders. What challenge does this pose for aid agencies and development organizations that wish to assist India and China? Page 95

97 Poverty in newly-emerging economies is clearly related to the question of distribution, inclusion, equal opportunities, the sharing of the benefits of growth. In the high growth process, how can we include people, how can we give people fair access to productive resources and a fairer share of the results? How can we influence government spending and government poverty reduction policies? Second major issue related to poverty today is the fact that we live in a resource-constrained world; a world with a very finite environment figures show we are already living beyond the carrying capacity of the world. Just the other day it was announced the world s population had passed seven billion people. The bottom 20% of the world s people enjoy a very small share of resources and wealth and this share is not improving. Put these facts together, and what we have got to do by 2050 is live within the resource constrains of the world but, support a population which will grow to nine billion people according to the UN and also, most importantly, share what we have more equally to raise that proportion of the share of the wealth enjoyed by the bottom twenty percent of the world s people. The resource constrains are many. When we look at non-renewable energy supplies it is obvious that they are fast being used up. D 1 More basic still is food. We need to produce seventy percent more food for the nine billion people expected by We need to do that in the context that changing weather patterns and the impact of this on harvests resulting from climate change, a reduced area of agricultural land due to development, pollution and salt water intrusion. Professor Xu noted the challenge of reduced agricultural land in his presentation. Agricultural land, fish stocks, and fresh water all under threat in terms of sufficient and sustainable supplies. Other problems include land grabbing from poorer people and land switched from food to bio-fuel production. Something like forty percent of the U.S. corn crop now is not grown to feed people, it is instead processed for fuel. Speculative and unjust food trade systems, subsidies in rich countries to produce food that is wasted and barriers for poor countries to produce and export food also contribute to our failure to provide food for everyone even today. There are a lot of food losses in developing countries from poor storage and transportation, while in rich countries huge amounts of raw and prepared food are thrown away. Page 96

98 Another important factor in food production is the role of smallholder farmers. Smallholders feed two billion people, fifty percent of the world s poor people are smallholders and yet agricultural investment has dropped from national governments and international aid programmes, particularly to help small farmers. We believe that improved investment in smallholders is one of the ways in which we can raise global food production. Agricultural production is no longer increasing as it was. Production went up at the beginning of this decade but, it is not increasing anymore. More worrying still is food production per capita. Arable land is now at almost half the area per capita that it was in Yields have fallen one percent per annum as the limits of the gains from the green revolution were reached. Demand for water is set to increase by thirty percent as well. These are worrying trends we have yet to address. A similar picture faces us in the scramble for resources. In the past ten years, 80 million hectares of land, an area twice the size of Germany, has been taken from the poor and bought up by companies or governments. Professor Xu talked about 40 to 50 million farmers in China losing their land, in his presentation. All over the world, land grabbing is a serious problem. What do these trends mean for poor people? With climate change, we know it means more flooding, it means more droughts; it means people are losing their livelihood. Uncertainly and shocks such as those brought by climate change hit poor people first and hit them hardest. But it is not just changing weather that brings shocks, volatility and uncertainty. Our economic systems have been doing the same. Economic downturns, crashes and tsunamis have hit poor people hard. The East Asian crisis of 1997 and the 2008 financial tsunami both led to people losing their jobs, their homes and their livelihoods. D 1 Oxfam commissions studies from GlobeScan who do a regular survey of 26 countries of more than a thousand people in each of those countries. The populations surveyed include India, China, Pakistan and Brazil as well as some of the developed countries. When people are asked about the major causes of poverty in the world they first pick low wages in some industries; then government/societal corruption; negligence /incompetence of people in power; society s failure to provide education/training; wars; the failure of industry to create jobs; followed by environmental catastrophes. So many people see these social and political causes of poverty. This 26-nation survey shows people feel responsibility for improving the lives of poor people lies with international organizations, by this they mean the World Bank, the U.N. system, then companies operating in poor countries. They consider governments of poor countries and the governments of rich countries equally responsible according to this survey. Page 97

99 INGOs, international charities such as Oxfam, local charities, religious organizations, people living in poverty themselves follow. So the survey reveals that there is a lot of belief that institutions, governments and companies should and could do more to solve the problem of poverty. The survey also indicates that most people feel the economic system is not very fair or not at all fair, and the trend shows it s not getting any better. Fewer people recently also agreed that the world going in the right direction. In 2001, over fifty percent of the people responded that the world is going in the right direction, now it s down to thirty-one percent. Related to this may be the decline in enthusiasm for free market capitalism. The number who responded in the survey that the free market economy is best economic system has dropped in the past decade, from over sixty percent to fifty four percent. Particularly interesting is the very strong drop in the USA. We hear reports in the USA on Fox News, that the political right is in the ascendant but this survey shows that the proportion of US people who believe the free market economy is the best system has plummeted from eighty percent to below sixty percent. So there are many people questioning the kind of results our current economic system delivers. D 1 So what do these trends mean for tackling poverty? Service delivery such as health care, feeding programmes, school-building by charities was never on its own a realistic approach to ending the problem of poverty in a sustainable way. Too much aid in the form of hand-outs can lead to even more dependency on outside help, both from poor people and from the governments of developing countries. Understanding this, aid began to be more focused on programs to help people strengthen their own capacity to grow food, earn a wage or improve their communities. But even these programmes are not enough on their own. These global and national environmental and economic problems can sweep away, or literally wash away, all the benefits of service delivery and long term projects. Tens of millions of people who had risen above the poverty line in the 1990s were pushed back into poverty as a result of the East Asian economic crisis. Much of the gains of hard-won community level poverty reduction programmes were swept away by the larger economic system under which we live. The conclusion has to be that working for high-level policy change which addresses the structural causes of inequality is also an essential part of ending poverty. Oxfam certainly does livelihood improvement projects, seeking to make markets work for poor people. For example, working on the bamboo supply chain in Vietnam, and with chili farmers in Africa. But at the same time we have various policy advocacy components built-in to these productive projects, aiming to help people to become stronger at understanding laws, information, how markets work, and to be able to form marketing groups for themselves, speak up for themselves, bargain for themselves, and plan for Page 98

100 themselves. Self-reliance is built on knowledge, fair access to productive resources, access to markets, provision of government services, capacity to get credit, savings and insurance. We aim to strengthen people s ability to help themselves economically, as well as socially, so that when the grant money stops, the aid from groups like Oxfam stops, poor people are left permanently stronger, more assertive and more self-confident, better able to look out for their rights to negotiate with the government for essential services and fair market access that they need, as well as to bargain with companies over the prices of goods they need to buy and sell. Policy change should be built into the simplest of aid programs in addition to encouraging participation and empowering the people involved with the capacity to organize. Building civil society and social capital is an important component of building a mature and harmonious society, so that there is a balance between business, government and NGOs, which can then all contribute in complimentary ways to solve problems of poverty. We say we are working to reduce or even eradicate poverty. But what is the opposite of poverty? Does that mean everyone should have a big house, a Mercedes-Benz and a swimming pool? We do not think this is desirable or achievable. The opposite of poverty, we believe, is responsible wellbeing, where people can achieve a state in which they can realize their full human capacity. This goes beyond basic material needs. We have examples from countries like Bhutan, which has a Gross Domestic Happiness index, which is a very interesting concept. An increasing number of development thinkers in universities and NGOs and other areas are talking about Responsible Wellbeing. The idea is that people need to achieving more than just self-sustenance basic material needs and also attain a decent life of dignity, a sense of self-worth, and respect from others. Wellbeing also includes the ability to make choices, to enjoy collective freedoms including the freedom to help others and the capacity to help others. With rights come responsibilities, and part of the theory of Responsible Wellbeing includes the achievement of a capacity for empathy and caring. As a globally interconnected society, many of our choices as consumers and producers affect the lives of other people and require responsible decisions that go beyond utilitarian economic choices. D 1 In all work on poverty, two linked issues become important: the issue of the rights of women and the issue of security within society. Security begins not with wars between states, or civil wars, but security starts in the household, in the family. Women suffering violence at the hands of their husbands or their fathers is an issue of safety and security of concern for all of us caring about poverty. Women are a key to reducing poverty, disease and hunger, as it is women who are the early educators, as the people primarily responsible for nutrition and health of children in the family, as the group who do at least half of the productive work in the world. If women are not more equally involved in positions of Page 99

101 authority and control of financial decisions, then we can never reduce poverty. As Professor Xu talked about migrant workers in the Mainland. In the work Oxfam does with migrant workers, it s not only important to help when they arrive in the city. They suffer problems of housing and school for their children but it is also a question of dignity and self-esteem. So Oxfam does quite a lot of programs on the self-worth of workers by supporting organizations that arrange workers cultural events, libraries, shops, cinemas and theatres groups. The message from these self-help groups is: I am a migrant worker, I am contributing to the growth of my nation, respect me, treat me with dignity. Helping migrants is not just about material improvement for the lives of migrant workers, it is recognition of their contribution to the societies in which they work. And we have even supported an organization in Beijing that has set up a museum of the history of migrant workers in China to emphasise that contribution. Even in emergency relief work, policy advocacy can be important. Once again principles of participation and self-determination are essential. In some of the earthquake relief Oxfam did in the Hui Areas, in the Muslim areas of China after the 2008 Sichuan earthquake, we needed to take into account of the special needs of the communities. In the case of women they have specific needs when they lose all belongings in an earthquake. They need things as simple as sanitary napkins. For Muslim communities, Halal food is important. In any humanitarian situation, you can look to the specific needs of minority groups. D 1 Oxfam also spends efforts on development education for young people who are not poor. We believe this is really important for the future in Hong Kong and the Mainland. China is growing to be a global superpower. It is going to have influence on the development of other people throughout the world, and in all international organizations and institutions. It will be increasingly important for Chinese people to realize that influence and understand the responsibility that will bring. Tomorrow s leaders in China will have a huge influence on the way the world goes, including whether or not we can end poverty. We hope the generations in China will have global awareness, in the sense of global citizenship. We hope they will not make some of the mistakes that perhaps the Europeans and Americans made when they had a dominant position in the world. That s why we believe development education on the causes of poverty and its solutions, on the interconnectedness of ordinary people s lives in the world is extremely important in mainland China and Hong Kong. I mentioned the importance of advocacy earlier. At Oxfam we advocate on a number of issues. We campaigned for some years on what we used to call conflict diamonds, and what Hollywood later called blood diamonds. Page 100

102 Oxfam has also campaigned on pharmaceutical companies for production of affordable medicines, to allow production of generic medicines to treat life threatening illnesses in poor countries, and for more research into diseases responsible for millions of deaths in poor countries rather than just more lucrative rich people s diseases. We have also advocated in an international coalition against the global trade in anti-personnel mines. That campaign and that was successful and there was eventually a global ban. And that joint campaign won the Nobel Peace Prize. We don t stand alone in asking companies to take responsibility for the social impact of their business activities. The GlobeScan surveys I discussed earlier, show that the expectations of people in 26 countries believe that companies should do a great deal on Corporate Social Responsibility. However, they rate performance on (CSR) way below expectations. This says there is a huge gap between the expectation by the public that companies should be doing more to win a social licence to operate and what companies are actually doing. Oxfam has also campaigned on fair international trade rules; against trade barriers stopping poor countries selling their goods to developed markets, and against rich countries dumping products in poor countries and hurting the smaller producers there. We worked with the Agricultural Ministry in China when China joined the WTO, to look at the impact of WTO membership on cotton production and the lives of cotton farmers. D 1 Another campaign was targeted garments and shoes produced in sweat shop conditions for sale as cheap goods in developed countries. Oxfam worked with textile retailers in Hong Kong, to ask them to report in a transparent way about their supply chains and conditions of the workers in the factories which make the recognizable Hong Kong brands that you see in every shopping centre. We also have continued a similar CSR reporting survey on Hang Sang constituent companies in Hong Kong. And of course we work on climate change. That s work very much going on this week in Durban, South Africa, where climate change talks are taking place. As I said at the beginning of this talk, poor people are hit first and hit hardest by the effects of climate change. We often use art and culture to promote campaigns. For example, a picture of drought by a student in Gansu Province and another picture on the waste of electricity by a Hong Kong artist were part of an international exhibition of art at the climate talks in Poland. We don t rule out campaigning in the streets. To be able to march in the streets and raise issues in the media can be effective sometimes. But a lot of our lobbying is directly Page 101

103 with governments. Meeting senior people where we can. Using sympathetic governments to make our case when they meet leaders from other countries, and taking part ourselves in international conferences where we are accredited participants able to advise and to talk to government delegations. We also do advocacy with coalitions of partners and allies. On climate change in Hong Kong we have worked with WWF, GreenPeace and many local organizations. We need to join together, we are not rivals when it comes to the big issues. We are all pushing for the same cause. D 1 You all know the expression: Give a man a fish and you feed him for a day, teach a man to fish and you feed him for a lifetime. Is this true? I don t think this is the whole picture, and here are some reasons why. The man is often a woman. She knows perfectly how to fish because her family has been surviving in this way for generations. But, the fishing rights have been sold to foreign companies who use industrial fishing techniques just off the coast which scoop up all the fish and deplete stocks. A rich man controls the supply of boats and nets. You can t buy them from anyone else, he has the monopoly and the prices are high. His brother controls the only truck to get the fish to market. Summers are hotter, and the guy who owns the truck also owns the only ice factory to keep the fish fresh and the price high. The coral fish breeding grounds are dying because the sea temperature is rising due to climate change, and because there s pollution from a new factory nearby. The roads to market are really bad, because the government spends most of its budget in the capital city. I saw many of these things in real life myself in a fishing community on the banks of Lake Victoria in Kenya. But let me continue: there is no bank in the village, so she has to borrow money at very high interest rates from a money-lender, and she has to hide the money when the fish is bought, from her drunk husband who will come and take all the cash and go off and spend it on alcohol. Anyway, the banks won t lend to women, they only lend to men. SHE KNOWS PERFECTLY WELL HOW TO FISH, BUT SHE S STILL POOR! The title of this talk is Poverty and Self-Sufficiency. Changes in the location of poverty, and increasing resource constraints present very new challenges to all of us working to end poverty. So transforming poverty into self-sufficiency requires not only economic change but also social change. The causes of poverty are inequality and human inaction. Those with power and wealth in today s unequal world can either defend their privileged position and prolong poverty, or they can use their influence to be part of the solution. Advocacy to change laws, policies and practices is essential and this should be targeted to those who control the most power and wealth in our society: business and government leaders. They can do more good and they can do less harm. And we can all help make sure they do that. That s why campaigns and public education create movements for Page 102

104 change among people who can influence their leaders. We must build dialog and understanding with leaders behind closed doors, and we must put pressure on them in public from the streets as well. Combined with practical programmes empowering poor people, we can achieve sustainable progress on poverty. D 1 Page 103

105 演說 Presentation D2 為扶貧項目開展的籌募工作 Revisiting the Implication of Fundraising for the Poor 講者 Speaker : 陳文良先生 Mr. Wen-Liang Chen 中華社會福利聯合勸募協會副秘書長 Deputy Secretary General, United Way of Taiwan 熟悉籌款工作的人們, 應該對於 Fundraising is friend-raising 這句話不陌生, 籌款尌是交朋友然而, 現今的社會, 隨著網際網路發展至今, 社交媒體讓朋友跨越了時區和距離, 因而, 籌款工作的方法與核心, 相較於過去鄰里與社群範圍內的拜訪遊說捐款三部曲, 現在將籌款廣義地看為資源動員 (resource mobilization), 其基本精神包括了捐款宣傳和志願服務的參與同時, 現今的捐款人對於所捐助款項的透明度 (transparency) 運用的責任信用度 (accountability) 等陎向的期待, 都遠比過去來得高許多 D 2 在我這篇報告裏, 主要以台灣的聯合勸募協會 ( 又稱中華社會福利聯合勸募協會英文名稱為 United Way of Taiwan) 為經驗基礎來分享探討首先我們看一下台灣的非營利組織的背景, 香港中文大學的關信基教授曾經做過比較, 港台兩地的非政府組織發展概況, 可以從他的研究中發現, 香港過去五十年來的非政府組織成長是相當穩定的, 從設立時間來看, 大約是 1970 年代前設立的組織佔了 45%,70 年代之後帄均每十年之間成立的機構都在 16% 以上, 台灣則是 1980 年代前設立的民間組織只占當時的個位數,80 年代後成立的佔了 75% 以上明顯的區隔尌在台灣遲至 1986 年才解除戒嚴法, 開放民間組織自由登記設立此後, 一方陎受到政府委外福利服務的提供, 一方陎家庭結構受到經濟型態變化的影響, 混合經濟的福利服務模式使得過去的福利服務提供者, 從家庭與非正式組織, 轉移成為政府補助而由非政府組織提供, 另一方陎, 近年來也由於大型企業外移, 製造業不再以台灣為基地, 於是, 由企業保障退休的型態不再, 從而使得非政府組織興貣, 成為福利服務提供的主流, 當政府的資源不足時, 為了完整提供服務的民間組織則開始擴大了籌款活動的規模, 激發各種募款創意, 企業也在這背景下, 展開各種公益行銷的活動台灣的公益募款規模, 近年來頗為引人矚目, 無論是台灣的 1999 年 921 地震, 台灣本地捐款募集了 251 億台幣, 中國大陸四川地震, 台灣民間募集了約 51 億, 乃至於日本 311 地震海嘯, 台灣募集了 62 億 Page 104

106 承帄時期, 台灣的慈濟基金會則是在各項調查中, 超過六成的台灣人曾經捐款給慈濟基金會, 年度募款總額則由於無從查詢貣, 較不得而知, 但一般估計每年至少在六十億台幣以上, 其慈善醫療教育與人文等四大志業的規模總營收, 則已經相當於一個大型企業體的運作規模其他依序為台灣家庭暨兒童扶助基金會的 33 億台幣, 台灣世界展望會 (World Vision Taiwan) 的 27 億, 以本人服務的聯合勸募協會來看, 近三年帄均募款金額則大約在 4 億台幣左右, 在台灣主要民間機構來看, 約排名第五足見公益籌款在台灣的盛行, 的確已經是相當重要的社會力量與資源來源豐富多元的公益參與管道是上述主要民間機構的成功之道, 這些方法主要集中在 : 公益捐贈志願服務生活體驗以及品牌經驗從募款的理由來看, 這些方法分別照顧了社會大眾來自理性 (Head) 感性 (Heart) 與靈性 (Spirit) 等三個層陎的需要理性層陎包括了關心捐款流向與效益感性陎包括了故事的動人之處, 需求的迫切程度, 靈性陎則是實踐了宗教與個人生活哲學的信仰理念, 追隨重要宗教領袖的嘉言懿行台灣的企業, 近年來尤其在推動事業的過程中, 不忘以企業核心理念回饋社會, 其中以美商花旗銀行為例〆 1990 年代, 仍被社會大眾普遍認為屬於外商, 在推動信用卡的過程中, 以信用卡捐款的便利性, 與聯合勸募協會 (United Way of Taiwan) 合作, 成為年底重要募款活動, 並配合中國生肖為年度卲祥物, 作為捐款贈品, 開創了每年年底持卡人參與公益的風潮, 十年來創造了十億台幣的公益捐款以及 39 萬人次的參與另外一家企業則是以其事業的創新及物流能力, 長期協助公益事業, 他們是台灣統一超商 (7-Eleven Taiwan), 在全台灣有 4,800 家便利商店, 每一家店結帳的地方都有個零錢箱, 募集零錢並且有系統地透過內部管道每天定時隨機請客人見證清點, 整理額度, 在募款季結束後, 將支票以統一超商全體消費者的名義捐贈給受益單位, 帄均每個月在全台灣可以募集超過一千萬台幣的零錢十年來募集超過十三億台幣同時, 運用其商品銷售的敏銳判斷力, 協助台灣身心障礙服務機構的庇護性產品進行商品化的設計, 教導這些機構定價的能力, 以企業的核心能力提升民間非營利組織的運作與公益銷售力, 連續三年在母親節檔期銷售庇護性商品, 成功創造型錄預購高達一千兩百萬台幣的銷售額度對於行銷身心障礙者尌業能力的正陎形象, 影響更是極為深遠 D 2 從這些不同案例的籌款經驗, 我們看見了新型態的扶貧籌款, 其背後的方法與訴求, 進一步應該反省的是, 作為教會機構, 的扶貧籌款工作應該兼具回應福音精神的邀請與參與, 轉換成專業的籌款溝通語言, 耶穌說〆我稱你們為朋友, 我再不稱你們為僕人, 因為僕人不知道主人所做的事 ( 若,15:15) 如果 Fundraising is friend-raising, 耶穌這句話也在告訴我們, 如何把扶貧的工作, 何善用這些工具, 在參與捐款者參與的體驗中, 將福音的訊息啟示給人們 Page 105

107 教宗本篤十六世也在在真理中的愛德通諭中提出公民社會是各種關係和資源的總和, 它的目標具有普世性, 因為它關乎大眾福祉 (Common Good), 而大眾福祉是每個公民都有權利各按其份所享有的公民社會具有計畫能力, 以促進更自由更公義的社會生活, 當中各組別的公民可以結社發展和表達他們崇尚的事, 以滿足他們的基本需要和保障它們合法的權益無論是以教友的身分參與公民社會的運作, 或是以教會機構的身分進入社會以服務貧窮者為標記從事社會事業, 促進公義, 提高大眾福祉, 是教會事業的終極目標, 也是教友服務天主子民的終極目標, 善用現世的資源與方法, 有計畫地達成這些目標, 是積極展現福音精神的具體實踐隨著時代的變遷, 資訊的取得與資源的掌握, 開始變得更為帄等, 尤其網際網路改變了少數人掌握資源與資訊的現象, 在公益籌款的過程中, 清楚明白地交代流向, 以高透明度, 高責任信用度吸引社會大眾的支持, 也已經是新時代必頇善用的工具因而, 公益慈善不再只是富人贖罪式的付出, 而是提出具體解決方法, 以推動長期正向的社會變陏為目的的公益投資過程, 這過程讓更多各個陎向的社會資源能夠在良好的規劃中, 參與社會創新的長期投資, 這才是未來無論經濟景氣如何變化, 擁有資源的社會大眾在此一世代中, 總會積極參與的社會工作 D 2 Page 106

108 演說 Presentation D3 貧窮與問題賭博的心理因素反思 The Psychology of Poverty and Problem Gambling 講者 Speaker : 陳智川博士 Dr. Chi-Chuen Chan 聖若瑟大學客席教授 Visiting Professor, University of Saint Joseph, Macau Since the turn of this century, the psychology of gambling has been widely researched in Hong Kong and Macau. The majority of the available literature in Hong Kong and Macau focused more on the prevalence of the problem gambling ( e.g. Fong & Ozorio, 2005; The Hong Kong Polytechnic University, 2002; The University of Hong Kong, 2005), the personality of the gamblers ( e.g. Chan & Ohtsuka, 2010; Cheng, 2006; Lam, 2005). Also, some researchers have placed much emphasis on how gambling impacted the gamblers spouses (Leung, Wong, Lau & Yeung, 2010). Other investigations emphasized on cultural issues such as superstitions of gambling (Ohtsuka & Chan, 2010) and gambling movies and culture (Chan & Ohtsuka, 2010). Pathological gambling is defined as the excessive and the pre-occupation of gambling to the point that it negatively affects one s daily living, occupation, familial relationships, social relationships, and more aspects of the person in question (American Psychiatric Association, 2000). The key issue is that the person loses conscious control of his/her gambling activities, which seriously causes harmful effects to his /her life. Pathological gambling is suggested to result in a lot of negative consequences including, but not limited to, familial conflicts, psychiatric comorbid disorders/conditions, alcohol and drug-related problems, suicide, interpersonal problems, financial problems, and even criminal-related behaviors (Shaffer & Korn, 2002). D 3 Not all gamblers can be considered as pathological gamblers. Chan and Ohtsuka (2011) have demonstrated that gamblers can be of several types according to their involvement in gambling. Usually all gamblers begin as recreational gamblers. Accessibility to family and family upbringing can contribute to the development of gambling in childhood (Blaszczynski & Nower, 2002). Recreational gamblers are characterized by their ability to control their investment of time and money in gambling. To these individuals, gambling is a fun activity shared by friends and relatives, especially during holidays and festivals. With more involvement in gambling, these individuals can develop problems. Chan and Ohtsuka (2011), in their excellent review of recreational gambling and pathological gambling, argue Page 107

109 that there are significant differences between these types of gamblers. Firstly, recreational gamblers have conscious control on their wagering and time in gambling. Good examples can be found among young recreational gamblers in Hong Kong. In their research, Chan and his students (e.g. Au Yeung, Lam & Chan, 2011) found that these gamblers often bet on soccer matches on weekends. Usually, they wager relatively small amounts of money and usually they would not borrow from others. Such is not the case with pathological gamblers, especially those with antisocial personality (Khatiani, Yick, Tse & Chan, 2011). Further, pathological gamblers lack the ability to control impulses on gambling and such can contribute to the negative consequences to their families and significant others (Dickerson & O Connor, 2006). Researchers in the University of Hong Kong (2005) undertook a telephone survey of 2093 persons aged 15 to % respondents had participated in gambling activities in the previous one year. The prevalence rates of "probable problem gamblers" and "probable pathological gamblers" were 3.1% and 2.2% respectively. In the literature of problem gambling, it is often found that, when compared to the wealthy, the poor often gambles more in their percentage of disposable income (Wardle et al., 2007). In Macau, Fong and Ozorio (2005) discovered that those respondents earned under MOP8,000 gamble more, by percentage, than the individuals who earn more than MOP8,000. Thus, it is not surprising to find that betting outlets are commonly found in low income areas in Hong Kong (Chan & Ohtsuka, 2010). D 3 So why do the poor people gamble more? In a sociological perspective, Edward Devereux (1968) argues that gambling serves three functions for the poor segment in our society. Firstly, gambling serves as a safety valve for the less fortunate members. In most developed countries, education, skill level and hard work are the fundamentals for one to acquire personal wealth. But for those who are unable to achieve these goals, gambling would provide a social ladder to achieve personal riches. Secondly, gambling gives hope for the poor. Ginakis and Ohtsuka (2005), in their empirical study in Australia, have demonstrated that gambling provides a short term hope for the poor. Everyone needs hope, long term and short term. Gambling provides the poor at least a short term hope. For example, for an unemployed factory worker, a $200 winning would mean a big meal ---a short-term hope that lasts three hours in the evening. Lastly, Devereaux (1968) suggests that gambling helps maintain the status quo in society as it renders opportunities for the less fortunate a chance of social mobility. A win in the lottery can help one to live in the luxurious apartment in an affluent neighborhood, enjoy the expansive cruises in the Caribbean and sending children abroad to studies. All these are the remote aspirations of the working class in any society which gambling can render. Page 108

110 The late Noble prize laureate Milton Freedman proposed an integrative theory for the usage of gambling in the modern society. The Friedman-Savage model of gambling and social climbing (Friedman & Savage, 1948) argues that gambling offers hope for the poor while insurance protects the wealth of the well-off. The model explains the different income levels and risk tolerance for individuals in the different social classes in our society. Those in the low end of the society are more inclined to purchase lottery tickets with the distant hope to climb up the social ladder. Those individuals already at the top echelon of society would pay the least attention to these instant card games. Instead, they are eager to protect the wealth they already have. Thus, they may take out insurance for their houses and children. In brief, it is the expected utility of gambling that attracts the poor (Hartley & Farrell, 2002). That s why in Macau, the poor often buy a lot more lottery tickets than the rich. Lastly, gambling can be an inexpensive game. While the rich can make expensive travels and spent millions on cars and luxury items, the poor can enjoy an inexpensive game of mahjong. For the majority of elderly gamblers in a poor neighborhood, they gamble with the money, not for the money (Chan & Ohtsuka, 2011). So what can we help the poor who are prone to develop gambling problems? Some jurisdictions have set limits the accessibility of gambling to the people on welfare. Barring these individuals to enter casinos might be a viable means to protect them to develop problems in gambling. In Vienna and in Singapore, for instance, charging an entrance fee for casino gamblers can deter poor people to enter casinos. In Vienna, the Vienna Casino charged an entrance fee of Euro 23 in Secondly, limiting the number of betting outlets, especially in the low-income housing areas in Macau, is a workable idea. The poor people usually do not travel a long distance away from their neighborhood because they want to save money on bus fare. So, keeping the betting shops away from the poor district would lower the rate of problem gambling among the poor. Lastly, providing inexpensive fun activities in the less privileged community can help the poor to develop a more diversified lifestyle in addition to gambling. D 3 Conclusion In an excellent sociological analysis of gambling among the poor, Carvion, Wong and Zangeneh (2008) write: This suggests that gambling maybe one of a general constellation of coping behaviors employed by marginalized groups, or, less pejoratively, is one of a cluster of historically condemned behaviors more easily or openly adopted by groups with weaker affiliation to the dominant power structure ( In the pursuit of winning, p ). In this vein of thought, gambling can be taken as a meaningful activity for those who feel alienated from the more affluent society. Thus, social work and counseling professionals Page 109

111 should identify the needs of the poor and how these can be met by innovative endeavors. Condemning gambling as a social vice can only pull away from the crust of the problems of the poor and their fundamental needs and yearnings. D 3 References American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.) (DSM-IV-TR). Washington, D.C.: Author. Au Yeung, C. S., Lam, P. Y. & Chan, C. C. (2011). Soccer betting in Hong Kong: A profile of young bettors. In Conference Proceedings of the International Conference on Gaming Industry and Public Welfare 2011, Beijing, China (pp ). ISBN: Blaszczynski and Nower (2002). A pathways model of problem and pathological gambling. Addiction, 97(5), Cavion, L., Wong, C., & Zangeneh, M. (2008). Gambling: A sociological perspective. In M. Zangeneh, A. Blaszczynski & N. E. Turner (Eds.). In the pursuit of winning: Problem gambling theory, research and treatment, (pp ). New York: Springer. Chan, C. C. & Ohtsuka, K. (2011). Pathways development of social gamblers and pathological gamblers: A summary of five qualitative studies. In Conference Proceedings of the International Conference on Gaming Industry and Public Welfare 2011, Beijing, China (pp ). ISBN: Chan, C. C., & Ohtsuka, K. (2010). All for the winner: An analysis of the characterisation of male gamblers in movies in Hong Kong. International Journal of Mental Health and Addiction. DOI: /s Chan. C. C., & Ohtsuka, K. (2009). Pai chai: Die-hard resident casino gamblers in Macau. Paper presented at the 14th International Conference on Gambling and Risk-Taking, Lake Tahoe, Nevada, USA. Cheng, W. K. (2006). From pathological gambling to help seeking: Cases of female pathological gamblers in Hong Kong. Unpublished master thesis. Hong Kong: the University of Hong Kong. Devereux, E. C. (1968). Gambling in psychological and sociological perspective, International Encyclopedia of the Social Science, 6, Dickerson, M., & O Connor, J. (2006). Gambling as an addictive behavior: Impaired control, harm minimization, treatment and prevention. New York: Cambridge University Press. Fong, K. C., & Ozorio, B. (2005). Gambling participation and prevalence estimates of pathological gambling in a far-east gambling city: Macao. UNLV Gambling Research & Review Journal, 9, Friedman, M., & Savage, L. J. (1948). The utility analysis of choices involving risk, Journal of Political Economy, 16, Page 110

112 Ginakis, S., & Ohtsuka, K. (2005). Problem gambling: An exploration of the role of global personal hopefulness, short-term gambling hope, and illusion of control beliefs, Gambling Research, 17, Hartley, R., & Farrell, L. (2002). Can expected utility theory explain gambling? The - American Economic Review, 92, 3, Khiatani, P. V., Yick, K. S. C., Tse, T. H. M., Chan, C. C. (2011). Pathways - development of problem gamblers with criminal background: Validation of Blaszczynski and Nower (2002) model. Paper presented at the 21th National Association for Gambling Studies Annual Conference, Melbourne, Australia. Lam, D. (2005). An observation study of Chinese baccarat players. UNLV Gaming Research & Research & Review Journal, 11, Leung, K. C., Wong, I. L. K., Lau, K. M., & Yeung, S. C. (2010). Stress, health and coping resources of Chinese pathological gamblers spouses. Asian Journal of Gambling Issues and Public Health, 1, 1, Ohtsuka, K., & Chan, C. C. (2009). Desperate housewives: An analysis of the characterisations of female gamblers portrayed in gambling movies in Hong Kong. International Journal of Mental Health and Addiction, 7, doi: /s Ohtsuka, K., & Chan, C. C. (2010). Donning red underwear to play mah-jong: superstitious beliefs and problem gambling among mah-jong players in Macau. Gambling Research, 22, Shaffer, H.J. & Korn, D. A. (2002). Gambling and Related Mental Disorders: A Public Health Analysis. Annual Reviews Public Health 2002, 23, doi: /annurev.publhealth The Hong Kong Polytechnic University (2002). Report on a study of Hong Kong people's participation in gambling activities. Hong Kong: The Hong Kong Polytechnic University. Retrieved 2nd July, 2010 from: The University of Hong Kong (2005). Report on a study of Hong Kong people's participation in gambling activities. Hong Kong: The University of Hong Kong. Retrieved 8th July, 2010 from: 4_e.pdf Wardle, H., Sproston, K., Orford, J., Erens, B., Griffiths, M., Constantine, R., & Pigott, S. (2007). British gambling prevalence survey, Retrieved July 8th, 2010 from: urvey% pdf D 3 Page 111

113 演說 Presentation D4 為孟加拉邊緣社群尤其無助婦女提升尊嚴的發展項目 The Activities of Caritas Bangladesh for the Development of Dignity of the Marginalized Groups Especially the Helpless Women in Bangladesh 講者 Speaker : Dr. Benedict Alo D Rozario 孟加拉明愛總幹事 Executive Director, Caritas Bangladesh INTRODUCTION Caritas Bangladesh was established in During the last Fiscal Year (July June 2011) Caritas implemented more than 70 projects to reach 1,204,594 persons directly with its 2,936 staff members and 4,566 volunteers. Total expense for the Fiscal Year was Tk 1,351 million (US$ 19 million): of the total amount about Tk. 525 million (41%) was from local income/contribution. Vision In the light of the Social Teachings of the Church, Caritas Bangladesh envisions a society, which embraces the values of freedom and justice, peace and forgiveness, to live as a communion and community of mutual love and respect. D 4 Mission Caritas Bangladesh tries to become a partner of people especially the poor and marginalized, with equal respect for all to attain integral development, to live a truly human life in dignity and to serve others responsibly. Caritas has Four Priorities: 1. Human Resource Development through Education, Formation and Capacity Building 2. Establishment of Social Justice and Human Rights through the Capacity Building of the Poor, of the Women and of the Ethnic Communities 3. Health and Care 4. Ensure Ecological Sustainability and Sustainable Livelihood through the Use and Preservation of Natural Resources and Capacity Building in Disaster Management and Climate Change Adaptation Page 112

114 Cross Cutting Issues: Community Participation Good Governance Gender Climate Justice Partnership Building Spirituality in Development Advocacy, Lobbying and Networking Inclusive Development Partners in Development: Extreme poor both rural and urban Marginalized community especially the ethnic groups Children Youth Women People with Disability Elderly People s Organizations (POs)/Civil Society Organizations Donors or funding partners from home and abroad Like-minded Organizations PROGRAMS OF CARITAS BANGLADESH Health Under health sector Caritas Bangladesh has a total of 10 projects. Principle: A healthy and responsible community is a pre-requisite for a developed nation. D 4 Objectives: Preventive and curative health services including safe water and sanitation, especially for the remotest areas and vulnerable groups. Promotion of pro-life reproductive healthcare. Preventive education on HIV/AIDS and drug abuse and care for the drug addicts and PLHA (People Living with HIV/AIDS). Care and capacity building for the people with disability and elderly. Family life education for promoting responsible parenthood and respect for procreation. Page 113

115 Education Caritas Bangladesh runs both formal and technical education projects. Caritas has seven formal education projects. Principle: Providing an opportunity of education for the children of disadvantaged and un-reached communities. Objectives: Quality education for children and youths especially those in need. Formation and training of teachers and capacity building of staff. Technical Education Caritas Bangladesh has four technical education projects. Principle: Promoting better human life of the families of graduates, youth and women. Objectives: To create employment/self-employment opportunity for the school dropout unemployed youth including women by offering technical skills training; To make school dropout learners skilled in different marketable trades; To make them value driven through moral and spiritual formation; and To mobilize local resources to achieve self-reliance of the school. D 4 Development for Indigenous/Ethnic Peoples Caritas Bangladesh has a total of ten Integrated Community Development Projects (ICDPs) to motivate and organize ethnic communities of different areas of the country by way of training, income generation and awareness on health and education for integral human development. Principle: Improvement of the quality of lives of the indigenous through integrated social, educational, economic and cultural activities of the projects. Objectives: To strengthen collaboration between and among self managed social organization of the adivasi (indigenous people) to protect their social, economic and cultural life. Page 114

116 Adivasi live on their own land with equal dignity and respect and are empowered to protect and defend their traditional and ancestral land rights in collaboration with like minded and civil society organizations. Farmers of the project area enjoy improved food security at household and community level through the practicing Farmer Led Approach. Natural Resources Management and Climate Change Adaptation Programs Caritas Bangladesh has a total of seven projects for natural resources management and climate change adaptation. Principle: Sustaining life and livelihood in harmony with nature. Objectives: To create awareness on natural resources and environmental changes; To increase technical skill and capacity; increase productivity; conserve natural resources; and increase income of the program participants through creating employment and self-employment opportunities by way of sustainable natural resources management and climate change adaptation practices; To increase adaptive capacity and coping mechanism; and To improve understanding and awareness of the project participants to take better adaptive actions to face impacts of climate change, associated risk, and vulnerabilities on their livelihoods. Disaster Management Principle: Humanitarian assistance to people affected by natural calamities and man-made disasters. D 4 Objectives: To capacitate the community people and provide them with structures to reduce the effect of disasters; To help disaster affected families for restoring their livelihoods; To improve access to safe water and sanitation; Shelter Caritas Bangladesh has built so far over 300,000 shelters for homeless poor families. Page 115

117 Principle: Every family must have a shelter to have their privacy respected and dignity enhanced. Objectives: To provide safe place of living for the poorest women headed families; To provide a new house for each of the poorest people who had no house or who were not able to rebuild their existing thatched houses by using their own means; and To establish the permanent address of the poorest women headed families with ownership; EXAMPLES OF A FEW PROJECTS 1. CORR - The Jute Works CJW is women s non-profit handicraft marketing and exporting project of Caritas Bangladesh working for rural destitute women. The CJW was established in Principle: Skill development and increase of income through the production of handicrafts for empowerment Objectives: To organize rural marginalized women and provide them with skill education for producing handicrafts as a supplementary source of income for their socio-economic development; To promote thrift, self-help and democratic practices among the handicraft producer groups in the management of their affairs and to make them self-reliant by group action; and To initiate welfare activities for poor people, such as housing, educational, recreational and health care facilities for better living conditions. D 4 Achievements: CORR - The Jute Works became self reliant in 1984 and till now run from its own income. It has a total of 137 Artisan Groups consisting of 3,530 Members covering 39 sub-districts of 19 districts. It produces bag, basket, candle, card, handmade paper, home décor, musical instrument, etc. It is an export oriented project. During the Fiscal Year CJW exported to 49 companies in 20 countries around the Globe with an amount of Tk. 55 million. Page 116

118 2. Prevention of Trafficking of Women and Children Through Awareness Raising and Capacity Building The project stated in Since inception the project has been implementing in the operational areas of Caritas Bangladesh, with a special focus on the North Western to South Western boarder areas. These areas are known as high risk trafficking zone. Principle: The project envisions a society where women and children are protected from the horrors of trafficking. Objective: The main objective of the project is to protect women and children from exploitative conditions of trafficking through capacity building and strengthening local networks. Achievements: Participants who attended workshops can explain the causes, consequences and techniques of trafficking. They also show their concern, take individual initiative and participate in the advocacy campaign to prevent trafficking. Youth and students of the Chittagong Hill Tracts who have attended workshop become very alert after noticing any stranger in the area. The parents are also more aware about their children. Leaders in the high risk zone, carry out local level advocacy on specific anti trafficking issues like development of billboards, introduction of one hour class in school, make functional of local committees for prevention of trafficking and strengthen border security. 3. Under Five and Maternity Clinic Project (UFMCP) Since 1979 Under Five and Maternity Clinic Project (UFMCP) has been continuing its services, both curative and preventive among 4000-targeted families in 31 villages under four Unions of Bakerganj Upazila under Barisal district. D 4 Principle: Immunization for all and improvement of mother and child health can greatly contribute to health for all. Objectives: To transform charity-driven UFMCP to community owned self-reliant health service; and To reduce mortality and morbidity rates of the target community. Page 117

119 Achievements: During the period of July 2010-June 2011 a total of 1,456 new clients were registered under the central clinic. Besides, 3,174 mothers came to have Antenatal Care and Prenatal Care whereas 3,986 under five babies attended the central and mobile clinics. Twelve mobile clinics were operative for 144 mobile clinic days. In total 458 mothers and 1,989 babies were immunized. Mortality and morbidity rates of mothers and children among the target families have been decreased. 4. Reproductive and Child Health Development Project (RCHDP) The project started in This project renders services (such as reproductive health training, counseling, youth training, sebok service) to Caritas projects, other network, forums and peoples organizations. The project area included 808 villages of 56 unions in 16 upazila of 15 districts under one Area and seven Regional Offices of Caritas. Principle: A healthy and responsible community is a pre-requisite for a developed nation. Objectives: To increase psychosocial life skills among adolescents and youths in the area of reproductive health and replicate these skills in the working areas; To practice reproductive health and gender issues by the beneficiaries of the project areas; and To increase access to the health infrastructure. D 4 Achievements: A total of 65% Peer Educators (girls) were able to negotiate with their parents and stop early marriage when they were pressurized by their parents. Peer Leaders have stopped eve teasing of young girls. They have succeeded in preventing their friends from teasing girls. They are more responsible in their reproductive health. A total of 70% trained male group members share domestic work with their wives. A total of 1,128 peer educators participated in the workshop on Adolescent Reproductive Health and Family Life Skill Education (FLSE). Life skill workshops and training courses for Peer Leaders were organized for the first time where 355 leaders participated. A total of 3,815 adolescents and youth attended Human Sexuality and Pre-marriage Training. Page 118

120 5. Safe Motherhood Project (SMP) This project started in January1999. Through this project Caritas Bangladesh trained Village Midwives (VMs). Traditional Birth Attendants (TBAs) were provided with basic training on conducting safe, clean deliveries. Principle: Live, healthy mothers and babies. Objectives: To decrease the rate of maternal mortality and morbidity; To decrease the rate of infant mortality and morbidity; To increase extended family participation in maternal and infant care; To decrease the incidence of pregnancy before 18 years of age; and To improve the health of women and children within the community. Achievements: In total 5,319 ante-natal checks, 1,444 deliveries and 2,333 postnatal checks on mothers and babies were performed in period of July 2010 to June About 10% of the women with complications were referred to hospital, thus surely saving their lives. In total 6,640 participants attended health seminars organized by SMP during the reporting period (July 2010-June 2011). Maternal and infant mortality/ morbidity in all the working areas has decreased. Women and children are getting better care, exclusive breast feeding for six months has increased and maternal anemia decreased, while the number of underage pregnancies has decreased by almost 50%. Now the women trained by the SMP will also focus more on the rights of women and children, following strategies to empower and help them to cope with the negative effects of climate change. D 4 6. Reconstruction of Building of Domestic Training Centre for the Poorest Women In 1972, the sewing centre was established in a small room of the building of the Congregation of Sisters of Charity Convent with 12 women in Borni Parish of Natore under Rajshahi Diocese. Later as the demand for the training increased, the training centre was shifted to a separate building of the Sisters Convent which was constructed in 1964 at low cost profile due to financial incapacity of the Parish Authority. As a result the building was damaged and cracked dangerously and was in urgent need of reconstruction. The reconstruction of the building started in October 2010 and the two-storied building construction was completed in November Page 119

121 Objective: To educate the poorest and the most needy women, specially the widows, orphans, divorced and single women of the project area so that they become able to contribute to form self-reliant family and just society by ensuring socio-economic development. Achievements: A total of 120 women will get an opportunity to receive training at a time from this centre. Moreover, they will also be capable of earning through sale of their own products. 7. Shelter for the Tea Garden Workers Shelter for the Tea Garden Workers project started in January This is a new initiative of Caritas to provide a safe and dignified home for the shelterless tea garden worker. Principle: Every family must have a shelter to have their privacy respected and dignity enhanced. Objective: To provide a safe and dignified home for the shelterless tea garden workers. Achievements: 65 shelters were constructed and 65 sets of water sealed latrines were installed against the target of 51. A two-room secure shelter for each family protects the members privacy specially women and marriageable girls are explicitly benefited. D 4 The specious verandas of shelters are used for rearing cattle, goats, sheep and domestic birds like chicken and ducks. So now the owners of the shelters have more income and they are dignified in society. A shelter also contributes to child education, reduce dropout and good family bond. Each shelter including a water-sealed latrine allows the family members to lead a healthy life. IMPACT OF PROGRAMS During these years different program focusing women has brought the following impacts: Women leadership as well as their mobility in the society has significantly increased. Women can raise their voice against any injustices. The presence and active participation of women in any social gathering have remarkably increased compared to the previous situation. Page 120

122 Grassroots level gender mediated People s Organisations have developed their abilities and become change agents on gender issues. Women are engaged in diversified occupations such as small business, eco-friendly cultivation, marketing of crops and manufacturing activities. They are now livelihood earners and risk bearing entrepreneurs. As a result, traditional perception about women is changing. The positive changes found at the level of the primary samities (groups) are accentuated at the POs. The leaders felt that their position in society has changed and they are not poor anymore. Their leadership is recognized in the community. Self confidence of adivasi women farmers has increased after receiving training on land rights, advocacy and gender courses. They are motivated to take active participation in decision making process in regards to issues like land, health, wage, legal rights, household chores and others. They are also aware about tapping resources from the local government and NGOs. The school dropout boys and girls of both adivasi and non-adivasi after attaining skills through training have got employment in different mills, factories and workshops or involved in small business/enterprises and some had utilized the opportunities of overseas jobs. The service recipients follow preventive and curative health care measures by the doctors, nurses and health workers. As a result, mortality and morbidity rates of mothers and children among the target families have been decreased. CONCLUSION Caritas Bangladesh strongly advocates the primacy & dignity of the human person and the integral development of women and men. Caritas therefore wants to bring about change in existing power relationships so that women and men gain equal opportunities to develop themselves and so that just development is furthered. D 4 Page 121

123 演說 Presentation E1 澳門的貧窮問題與社會保障 Social Security and Poverty Problems in Macau 講者 Speaker : 鄧玉華博士 Dr. Yuk-Wa Tang 澳門社會保障學會監事長 Chairman of the Supervisory Committee, Macau Social Security Society 澳門理工學院澳門聖若瑟大學兼任講師 Visiting Professor, Macao Polytechnic Institute and University of Saint Joseph 澳門的貧窮問題〆爭議相關概念邊緣人澳門特區自成立以來, 社會發生急劇的變化成立初期, 經濟低迷, 政府財政緊々其後因開放賭權, 加上中央的政策支持, 經濟狀況出現大翻身, 本地生產總值在十年間增加 3.4 倍, 然而個人每月收入中位數只有約一倍增加 ( 見表 1), 有認為從中見到中低層未能很好地分享經濟成果, 貧富之間的差距擴大了表 1 澳門在過去十 (2001 至 2010) 年一些社會經濟數據變化項目 2001 年 2010 年十年變化本地生產總值 ( 當年價 ) 百萬元百萬元 +334% 人均生產總值 ( 當年價 ) 114,864 元 398,071 元 +247% 個人月入中位數 4,655 元 9,000 元 +93% E 1 的確在經濟大幅增長時, 社會矛盾卻不見減少, 其中被歸咎的原因之一是貧富差距問題, 坊間多認定貧富差距不斷擴大, 然而數據卻出現不一致的情況按澳門統計暨普查局最近一次所作的家庭住戶收入調查 (2007/2008), 反映貧富差距的堅尼系數 (Gini index) 明顯回落至 0.4, 成十多年來最低同一調查, 若按家庭收入分成五等份, 收入最高的五分一與最低五分一比例為 1 〆 8.2, 與之前多次調查結果相比, 貧富差距有縮小 ( 見表 2) 表 2 過去十年澳門的貧富差距變化時期 ( 年份 ) 家庭收入最高的 20% 比最低的 20% 堅尼系數〆〆〆〆資料來源〆澳門統計暨普查局, 多次的家庭住戶收入調查 Page 122

124 貧富差距屬相對性, 全世界每個角落都有, 只是差距大小的問題無論如何, 澳門今天算是一個富裕地區, 很難見到食不裹腹衣不蔽體的情況, 早年在紅街市附近有一名男子偷取人家的飯盒以供家人充飢的案例畢竟是個別事件對於生活貧困者, 社會是樂於伸出援手的, 澳門如是, 世界各地也如是, 可以說是人類文明社會的普遍做法在澳門, 政府設定了最低維生指數 ( 歷年標準見表 3), 但不稱作貧窮線 (poverty line), 只是作為對貧困者的援助指標, 目前一人標準為 3,000 澳門元 ( 預期明年增至 3,200 元以下均指澳門元 ), 政府對處於這標準以下的個人或家庭以差額提供援助金及某些特別津助或許我們可以最低維生指數作為澳門的貧窮指標表 3 近十年最低維生指數的變化單位〆澳門元家庭成員人數自 2000 年 8 月自 2006 年 4 月自 2007 年 4 月自 2008 年 1 月自 2008 年 11 月自 2011 年 4 月 1 1,300 1,600 2,000 2,400 2,640 3, ,470 2,770 3,470 4,160 4,580 5, ,510 3,910 4,890 5,870 6,460 7, ,420 4,820 6,030 7,240 7,970 9, ,200 5,700 7,130 8,560 9,420 10, ,850 6,350 7,940 9,530 10,490 11, ,500 7,000 8,750 10,500 11,550 13, ,150 7,650 9,570 11,480 12,630 14, ,800 8, ,450 8, , , , , , 無論如何, 澳門一直以來未有明確的貧窮線計算方法, 若參考國際貧窮線標準, 一般以社會上收入中位數的 50% 至 60% 計算 26 過去十年, 澳門的最低維生指數尌介乎收入中位數的 23.9% 至 33% 之間 ( 見表 4), 明顯地, 澳門要一下子達到國際水帄並不實際, 也因此筆者在過去十多年來一直倡議以收入中位數的三分之一為當下追求目標, 也慶幸自 2008 年, 目標算能達成, 但仍未見有明訂科學的調整機制 E 澳門特區政府, 2012 年財政年度施政報告,11/2011,p.15 澳門理工學院社會經濟研究所, 澳門貧窮人士生活狀況及援助研究報告, 澳門社會工作局,2006 年,P.88 Page 123

125 表 4 近十年最低維生指數佔個人每月收入中位數的比例自 2000 自 06 年自 07 年自 08 年自 08 年年 8 月 4 月 4 月 1 月 11 月單位〆澳門元自預期 11 年 12 年 4 月 1 人最低維生指數標準 1,300 1,600 2,000 2,400 2,640 3,000 3,200 同期個人每月收入中位數 4,822 6,701 7,800 8,000 8,000 9,000 11,000 指數佔中位數之百分比 27% 23.9% 25.6% 30% 33% 33% 29% 究竟澳門有多少人 / 家庭處於貧窮境地〇在有限的資料底下, 這數一下子難計清尌按最近兩次的家庭住戶收入調查看,2002/2003 年的調查結果〆處於最低收入的五分一家庭帄均月入為 2,942 元, 而當年以 3 人計最低維生指數標準為 3,510 元, 因此, 可以估算當年有超過兩成的家庭處於貧窮境地々相比之下,2007/2008 年的情況有好轉〆處於最低收入的五分一家庭帄均月入為 6,633 元, 而當年以 3 人計最低維生指數標準為 5,870 元 ( 見表 5), 這相信得益於澳門的經濟走出低迷政府短期內多次調升最低維生指數和推出各項臨時性福利有關從以上數據看, 澳門處於貧窮的家庭可不少, 但大多數貧困家庭並沒有申請得援助金 ( 見表 5) 其原因有待進一步研究, 或許是不符合標準, 又或許是本人不求助表 5 綜合數據看貧窮家庭數目 2002/2003 年 2007/2008 年最低收入的五分一家庭帄均月入 2,942 元 6,633 元同期 3 人計最低維生指數標準 3,510 元 5,870 元當年向政府領取援助金的個人 / 家庭數 5,183(2003 年 ) 6,180(2008 年 ) 當年澳門人口 448,500 人 549,200 人當年澳門家庭數 ( 以每一家庭 3.1 人計 ) 144, ,161 當年五分之一家庭數 28,936 35,432 E 1 此外, 任何一標準都會有所謂臨界的情況出現, 對這些邊緣人是否同時應予關注〇筆者認為是肯定的, 因為澳門的最低維生指數大概相當收入中位數三分之一, 算是較低的標準以鄰區香港為例, 近年民間組織倡議的常按收入中位數的一半陎向邊緣群體, 澳門自 2009 年推出了一項工作收入補貼臨時措施, 當時對收入低於 4,000 元 ( 至 2011 年 1 月貣調整為 4,400 元 ) 的在職人士給予差額補貼, 對此可視為一種對在職貧窮 (working poor) 人士的支援 2009 年的 4,000 元, 約相當於當年個人月收入中位數的一半 (48.9%), 尌是 2011 年調整後的比例亦相同理論上對在職貧窮人士支援的做法是值得稱許的, 因為它既提供了改善生活的支援, 也認同個人努力工作的做法當然如能在第一次財富分配上做好, 根本尌不需政府太多介入作第二次分配說到工作收入問題, 澳門自 2007 年 9 月 1 日貣局部實行最低工資 ( 包括在政府外判清潔及保安服務合同實施 ), 當時訂定時薪 21 元日薪 Page 124

126 168 元或月薪 4,368 元々至 2011 年 4 月調整為 4,784 元 (23 元 / 時 ), 如同樣按個人月收入中位數計算的話, 這最低工資約為 55.5% 及 53.2%( 見表 6) 於筆者看這最低工資 (minimum wage) 應有較大的調升空間 ( 見圖 1) 由於早前筆者已撰文分析這問題 27, 在此不作詳述表 6 最低維生指數低收入補貼及最低工資佔月收入中位數的比例 ( 一人計 ) 單位〆澳門元 /% 項目標準水帄標準開始當季的收入中位數各標準水帄 ( 筆者倡議的標準 - 實施時間居收入中位按月收入中位數計 ) 數的比例最低工資 4,368 元 (21/ 時 ) 1/9/2007 7,867 元 (2007 年第 3 季 ) 55.5% (62.5%) 4,784 元 (23/ 時 ) 1/4/2011 9,000 元 (2010 年第 4 季 ) 53.2% 在職貧窮補貼標準 4,000 元 1/1/2008 8,200 元 (2008 年第 1 季 ) 48.9% (50%) 4,400 元初 ,000 元 (2010 年第 4 季 ) 48.9% = 最低維生指數 2,000 元 1/4/2007 7,867 元 (2007 年第 3 季 ) 25.4% (33%) 2,400 元 1/1/2008 8,200 元 (2008 年第 1 季 ) 29.3% 2,640 元 1/11/2008 8,000 元 (2008 年第 2 季 ) 33% 3,000 元 1/4/2011 9,000 元 (2010 年第 4 季 ) 33% = 70 佔個人收入中位數的百分比 60 現時水帄建議水帄最低維生指數在職貧窮補助最低工資圖 1 三個指標 ( 最低維生指數在職貧窮補助最低工資 ) 的水帄比較 E 1 概括而言, 有跡象顯示澳門的貧富差距在增加, 而若以最低維生指數作為貧窮指標, 澳門有一至兩成的家庭處於貧困處境 27 鄧玉華, 淺析澳門的貧困相關指標, 載於香港社會保障學會, 在貧富懸殊下的社會保障制度改陏,2009, p Page 125

127 助貧的政策措施〆需要多元的手法眾所周知, 導致貧窮的原因多樣, 例如個人喪失工作能力失業傷殘年老無依等同樣屬華人社會的台灣, 學者陸光早年的研究將貧窮成因作不同的分類, 如以病理學的觀點, 貧窮原因有生理方陎心理方陎習慣方陎才能方陎々以社會結構觀點, 則有因生而貧窮但得不到社會協助, 家庭人口過多, 缺乏尌業機會, 薪酬偏低, 產業轉型引致失業, 家庭結構變化導致削弱經濟功能, 社會福利制度不健全等 28 而筆者也曾嘗詴用另一種結構, 即個人因素社會結構因素和災難因素, 並作分類, 茲簡單列表如下 ( 見表 7) 〆表 7 貧窮成因分類災難個人社會結構火災水災風災意外盜竊 / 搶劫疾病傷殘偏差行為 ( 賭吸毒 ) 產業結構轉型 / 失業經濟不景 E 1 確實貧窮的成因多樣, 因此, 所需手法亦要多元, 而且往往要綜合治理除上文提到的援助金 ( 即社會救助, 一種形式的社會保障 ) 和低收入補貼外, 目前澳門政府對 29 弱勢群體提供的其他支援還有〆者的 - 三類弱勢家庭特別生活津貼 - 短期食物補助計劃 - 租金津貼 - 豁免社屋租戶租金 - 社屋輪候家團住屋臨時補助發放計劃 - 殘疾津貼 - 積極人生服務計劃 - 社區尌業輔助計劃 - 社會保險 ( 當中的養老金殘疾金 ) 等當然, 此間在政府和民間還有其他福利或服務項目, 也能直接或間接支援到貧窮尌扶貧問題, 筆者曾嘗詴按助貧工作 / 措施的時間和效果, 劃分成四方陎〆 1. 積極長期的〆乃一些具發展性的安排, 如良好制度的建立或完善, 有助對個人能力和社會關懷意識的提高 2. 積極短期的〆著重解決當前問題, 尤其基本生活所需, 提貣受助者的積極性, 助其度過難關, 盡快脫離貧窮 / 受助的境地 3. 消極短期的〆對於明顯缺乏自身條件者, 在積極短期的措施以外, 再要作額外的支援, 藉以減輕問題的損害性, 改善基本生活條件 4. 消極長期的〆對永久喪失能力者, 提供適切的援助和服務, 而各項措施主要為貣維持作用和減輕惡化的可能上述四方陎的扶貧工作, 當然以第一種最佳, 因為在有關制度完善下, 人們既維詹火生等編著, 當代社會變遷與問題, 國立空中大學,1990 年,p 政府新聞局題為傳承創新共建共享的報章廣告中對紓緩通脹措施 (2011 年 4 月貣 ),15/11/2011 Page 126

128 持積極性, 也不擔心一天失去謀生能力時而基本生活不計至於另三方陎的工作, 因應個別人士需要而提供, 畢竟我們深信人有積極進取心, 尌是消極長期的工作, 也得照顧少數有特別需求的人而繼續提供無論如何, 扶貧工作是需要多管齊下, 而一個良好的制度性安排, 也需按社會發展而不斷完善下表 8 詴簡列各式扶貧工作, 並期激發更多有創意具實效的設想表 8 按短期長期積極消極性作多方陎的扶貧工作積極短期 * 社會救助 ( 短期特別津貼交通津貼 ) * 轉業技能培訓 * 以工代賑 ( 臨時職位多推公共工程 ) * 教育 ( 對學生 )/ 學習 ( 對成人 ) 津貼 * 醫療保障 / 免費醫療 * 社會房屋 ( 低租金租金減免 ) 長期 * 完善社會保險制度 ( 含個人責任, 可與中央公積金或鼓勵私人退休金等配合 ) * 免費教育 ( 提升第二代教育水帄脫貧 ) * 完善醫療保障制度 * 社會互助 ( 風氣, 一種非正規教育, 如饑饉三十嚐貧富餐 ) * 社會互助 ( 尊重社區及鄰里關懷物資捐助 * 各類社會服務 ( 減少社會排斥 ) 義工協助 ) * 社會企業 ( 有多種形式, 可由不同部門辦 ) * 各類社會服務 ( 如家庭支援 ) * 企業的社會責任 * 理財教育 ( 收支增值長遠打算 ) * 扶貧基金兒童福利基金 * 企業的社會責任 ( 企業回饋社會, 如減公共服務收費〆水電電話巴士 ) 消極 * 理財訓練 ( 怎樣用有限的錢 ) * 特別津貼 ( 包括對特困家庭清貧學生增加津 * 免費醫療 ( 針對長期康復 ) 貼 ) * 社會房屋 ( 低租金 ) * 免費醫療 * 減費 / 減負 * 食物銀行 ( 明糧坊 ) * 實物捐助 * 社會救助 ( 長期 ) * 各類社會服務 * 各類社會服務 * 理財訓練 ( 協助分配有限開支 ) 概括而言, 貧窮的成因多樣, 扶貧的手法亦需多元各種方法應各有其價值, 最主要是用得其所而在眾多的扶貧方法中, 社會保障是為基本, 而澳門的社會保障方式包括了社會救助社會保險和相聯結的一些特別津貼, 甚至尚待成形的中央公積金下節會談談澳門的社會保障制度 E 1 社會保障在助貧上的價值及一些完善建議從宏觀經濟角度, 有所謂貧困循環 (the cycle of poverty) 理論, 指出人們由於貧困而沒法有儲蓄, 導致資本形成不足, 生產規模和效率難以提高, 經濟增長只能維持在低水帄, 最終出現進一步的低收入這一思路也適用於分析個體貧窮, 即窮產生 Page 127

129 窮對此, 可運用各種社會政策, 包括社會保障來打破貧窮的惡性循環又從政府通過對社會收入進行再分配 (redistribution of income), 理論上也能縮減貧富差距, 減少收入分配不公 30 依此, 社會保障看來在反貧上有其價值其實, 社會保障制度的建設, 歷來都存在爭議, 內地學者童星總括了各種對社會保障的支持和否定見解與貧窮相關的例如〆認同制度保障了大多數人的最低經濟要求々否定的見解如〆制度使人對政府產生依賴, 滋生社會寄生蟲 31 無論如何, 社會保障制度常被視作社會的穩定器經濟的潤滑劑, 對助貧和反貧貣到一定的作用筆者認同社會保障在助貧上的價值, 以下嘗詴對澳門的社會保障制度與助貧問題上提出一些看法首先要簡單一說澳門的社會保障制度如世界各地一樣, 濟貧式的社會救助 (social assistance) 由來已久, 直至 1990 年建立現代化的社會保險 (social insurance) 制度, 再到最近 (2010 年 ) 初步為另一種社會保障形式中央公積金 (central provident fund) 鋪建地基, 為合條件的澳門永久性居民開立了中央儲蓄制度個人帳戶至此, 澳門可謂形成以社會保險為基本中央公積金將作補充社會救助為最後防線的格局, 當然還有各式特別津貼, 主要都是暫時支援社會救助的不足整體而言, 澳門有關制度架構算是完備 ( 意指內裡安排仍有待完善 ) 表 9 為澳門的社會保障制度的現行法規表 9 澳門的社會保障現行法規制度貣始年份現行相關法例社會救助 1930 年第 6/2007 號行政法規向處於經濟貧乏狀況的個人及家團發放援助金制度社會保險 1990 年第 4/2010 號法律社會保障制度中央公積金 2010 年第 31/2009 號行政法規開立及管理中央儲蓄制度個人帳戶的一般規則 ( 經第 20/2011 號行政法規修改 ) E 1 接著是針對社會保障的不同方式與助貧之間作討論〆 ( 一 ) 對於助貧而言, 似乎主力應是社會救助, 普世均如是理論上, 除社會救助外, 其他各種社會保障方式都有達至保障基本生活需要的目的, 有助預防貧窮問題惡化對於常有擔憂社會救助會造成依賴, 出現所謂養懶人的問題筆者未找到澳門當局揭發騙取援助金的個案數字, 而以香港方陎的數據為例, 濫用綜援的約佔 0.3%, 從中反映濫用綜援的比例並不高反之要提醒一句, 尌是如相信社會救助制度對助貧有用的話, 無必要對受助者加以鞭撻, 因為這是法例賦予的一種權利李珍主編, 社會保障理論, 中國勞動社會保障出爯社,2001 年,p.159 童星, 當今社會保障制度存廢之爭及其啟示, 澳門社會保障學會出爯的社會保障改陏,2009 年,p Page 128

130 ( 二 ) 在實際操作上, 澳門的社會保險做法一開始尌有點變質, 具有相當高的福利性但少了點互濟性, 尌是說由於個人和僱主供款比例俱低, 主要靠政府的財政來支撐, 而相信這也是導致目前保障水帄偏低的主要原因尌以社會保險的主要項目養老金為例, 目前只 2,000 元 / 月 ( 全額計 ), 比最低維生指數的 3,000 元 / 月 ( 一人計 ) 低, 若單靠它來維持基本生活幾乎不可能尚幸最近情況出現了一點曙光, 尌是澳門的最高領導人上月於立法會上表示〆研究把養老金與最低維生指數掛鈎養老金有望達至保障基本生活水帄對於有意見認為對弱勢群體作金錢支援時, 可用以工代賑的方式, 以提升人的價值和培養積極性, 這觀點普遍受到認同其實社會保險與以工代賑也有異曲同工之妙, 只是其一作為事前準備, 而另一乃作事後補救的分別概言之, 社會保險尌是在人們發揮勞動價值的同時, 也為個人日後可能遇到的風險作準備, 這有助減少貧窮情況的出現 ( 三 ) 現代社會保障制度的最基本原則之一是權利與義務相結合, 尌是個人得到社會保障的各種權利, 同時也要對這種社會保障機制正常運作承擔一定的義務 32 目前澳門的社會保險並未在這方陎作很好的體現, 致使過於依賴政府的財政, 使制度的穩健性帶來隱憂在此, 期望澳門未來的中央公積金一開始尌要走正路, 尌是實踐個人責任原則, 為個人日後享用的儲蓄戶口作長遠供款當然政府也可在有能力的情況下作撥款支援, 以鼓勵人們關注自身未來的退休生活說到資金本源問題, 順帶可一提的是中央公積金的增值, 穩健投資增值固然是大原則, 但去年錄得 % 的利息收益實教人失望, 甚至可能打擊人們對中央公積金建設的信心, 這方陎行政部門應負有責任有人期望中央公積金未來可以有多元用途, 如買樓付醫藥費等當然在十劃未有一丿的情況下言之過早, 但日後當個人帳戶儲備較豐時, 中央公積金應可發揮多點功能, 如此, 也間接有助減少貧窮的出現筆者相信, 社會保障有助貧窮者維持基本生活所需, 亦能減少貧窮情況的出現以下謹提出幾點重點完善建議〆 ( 一 ) 完善澳門的社會保障制度〆 1. 社會救助方陎〆要訂定清晰而合理的援助指標 ( 也可稱貧窮線 ), 並設定科學而系統的調整機制々 2. 社會保險方陎〆要彰顯個人的義務, 逐漸提升個人和僱主供款至合適水帄, 同時也將保障水帄循序調升至能保障基本生活, 使制度更具可持續性々 3. 中央公積金方陎〆要真正建構貣以個人和僱主共同承擔為主的制度, 並以強制方式執行 E 1 32 丁建定, 從濟貧到社會保險, 中國社會科學出爯社,2000,P.2 Page 129

131 ( 二 ) 助貧應有多元措施, 除以社會救助方式作基礎外, 其他支援措施如醫療保障住房救助以及民間的各種靈活方案亦可配合, 如設扶貧基金擴展實物捐贈鼓勵企業聘用弱勢者等, 以利長遠脫貧 ( 三 ) 為避免貧困陷阱 -- 即領取援助金比打工好, 在研究助貧指標時同時要兼顧對在職貧窮的支援和最低工資之間的關係結語從本文討論分析, 大概得出以下結論〆貧窮是澳門陎對和要處理的問題, 但介定貧窮的指標仍需清晰, 與此同時要關注隱蔽貧窮部份和邊緣群體是否也需予支援顯然協助貧窮的方式要多元化, 當然本文只集中討論社會保障方式以助貧針對澳門現行的社會保障制度, 筆者重點地提出一些完善的建議, 最終對社會保障的各項建議, 應都離不開保障水帄和制度的可持續發展這些重點, 並帄衡公帄與效率的原則參考文獻 1. 鄧玉華, 淺析澳門的貧窮相關指標, 刊於香港社會保障學會, 在貧富懸殊下的社會保障制度改陏,2009 年,P 鄧玉華, 澳門的貧窮問題與對策, 刊於澳門基金會出爯的澳門研究第 28 期,2005 年 3. 鄧玉華, 澳門社會福利與社會保障 II, 2009 年 4. 澳門理工學院社會經濟研究所, 澳門貧窮人士生活狀況及援助研究報告, 澳門社會工作局,2006 年 5. 丁建定, 從濟貧到社會保險, 中國社會科學出爯社,2000 年 6. 李珍主編, 社會保障理論, 中國勞動社會保障出爯社,2001 年 7. 童星, 當今社會保障制度存廢之爭及其啟示, 刊於澳門社會保障學會出爯的社會保障改陏, 2009 年 E 1 Page 130

132 演說 Presentation E2 社會組織介入醫療扶貧社會工作的實踐與思考 Reflections on the Practice of Poverty Alleviation in Medical Sector 講者 Speaker : 薛新婭教授 Prof. Xinya Xue 西北大學社會學與社會工作系教授 Professor, Department of Sociology and Social Work, Northwest University 醫療扶貧社會工作是現代社會工作的重要組成部分隨著社會工作專業化職業化發展的進程, 將社會工作拓展到醫療扶貧領域是探索和加快現代社會工作專業化職業化的必要途徑之一在發達國家, 醫院內部大都設有社會服務部, 聘用專業的社會工作者, 專門從事醫療社會工作和醫療扶貧社會工作目前, 我國的各類醫院內基本沒有設立類似的部門, 也沒有開展醫療社會工作和醫療扶貧社會工作因此, 借助社會工作領域內社會組織的力量, 詴點醫療扶貧社會工作尌十分必要中國社會工作教育協會從 2010 年貣詴點推進的中國重生行動貧困患兒家長互助關愛小組服務專案尌是這樣一項非常有價值的既為醫療扶貧社會工作實踐一重生行動貧困患兒及家長互助關愛小組專案的緣貣 ( 一 ) 專案背景中國社會工作教育協會中國社會工作教育協會是一個以開辦社會工作專業的院校或專業以及社會工作領域資深學者和專家為會員, 其宗旨為推進社會工作教育和專業社會工作發展為目的全國性非營利組織々業務範圍包括社會工作專業的學術交流理論研究業務培訓國際合作諮詢服務 5.12 之後, 該協會在災後重建貧困老年人貧困兒童的社會工作實務方陎也做了大量富有建設性和卓有成效的工作 2010 年以來啟動的中國重生行動貧困患兒家長互助關愛小組服務專案尌是其中之一 33 本文中的社會組織即是指中國社會工作教育協會 2010 年中國社會工作教育協會與設在民政部的重生行動項目辦合作, 在北京針對重生行動的貧困唇齶裂患兒及家長群體開展了醫療扶貧社會工作的詴點 2011 年中國社會教育協會又在全國各地遴選了 10 個已經開辦社會工作專業的高校, 在重生行動專案辦的協調下與承擔該專案的 10 所醫療單位合作, 進一步拓展了對重生行動貧 E 2 33 重生行動全國貧困家庭唇齶裂兒童手術康復計畫簡稱重生行動, 是國家民政部與李嘉誠基金會在全國範圍內合作實施的大型公益項目重生行動第二期項目於 2010 年 4 月開始啟動, 專案資金總規模和第一期專案同樣為一億元, 其中, 民政部投入部本級福利彩票公益金 5,000 萬元, 李嘉誠基金會捐資 5,000 萬元, 在全國各地精選了 33 家專案承辦醫療單位, 為貧困家庭罹患唇齶裂子女實施手術治療和康復指導, 幫助他們解除疾患, 健康成長, 重拾尊嚴, 獲得新生該專案是一項嘗詴通過公開科學規範高效的運作與管理和集高品質醫療效果語訓康復指導預防教育義工參與於一體的綜合醫療救助模式, 為全國有需要救助的貧困唇齶裂病患兒童解除疾患重獲新生服務的醫療扶貧專案 Page 131

133 困患兒家庭實施醫療扶貧社會工作的詴點, 以更好的為貧困家庭的唇齶裂患兒及家長服務西北大學社會學與社會工作系有幸在中國社會工作教育協會的指導和安排下, 參與實施了這一專案的陝西子專案中國社會工作教育協會主持的中國重生行動貧困患兒家長互助關愛小組服務專案這一醫療扶貧社會工作模式, 持守以貧困唇齶裂患兒家庭需求為本的理念, 嘗詴整合社會工作學心理學醫學管理學社會學等多學科資源, 在貧困唇齶裂患兒接受醫療機構手術治療的過程中, 以社會工作的手法, 提供重生行動貧困患兒及家長互助關愛小組服務活動, 為貧困唇齶裂患兒家庭提供直接服務, 滿足患兒及家庭的心理情緒舒緩和社會穩定需要同時, 在直接服務的基礎上, 也詴圖構建一個有效的為貧困唇齶裂患兒及家庭服務的社會支援與互助網路再者, 在開展醫療扶貧社會工作實務過程中, 嘗詴為我國社會工作專業人才搭建一個充分發揮自身作用的帄臺, 以推動社會工作專業化職業化發展, 推動社會工作人才隊伍建設, 實現多贏, 創造更大的社會效益可以說, 在陝西省, 這一服務模式是扶貧社會工作中的一項新內容 ( 二 ) 專案的組織架構 2010 年, 中國社會工作教育協會在北京貣動了中國重生行動貧困患兒家長互助關愛小組服務專案, 設計了具體的服務模式和方案框架, 並與醫療單位一貣合作實踐了服務方案的實施評估經驗總結緊接著在 2011 年它尌將這項醫療扶貧社會工作服務專案拓展到全國 10 個城市中國社會工作教育協會著重進行組織協調基本資料和初步實施方案提供督導服務跟進服務資源提供等工作, 引領慎重遴選出來的具有良好社會工作專業教育基礎的 10 家高校在各自所屬地區共同實施這項服務專案, 將此項服務由 1 個城市拓展到全國 10 個城市在中國社會工作教育協會的具體指導和協調下,2011 年 1 月, 陝西省重生行動貧困患兒家長互助關愛小組服務專案正式啟動西北大學社會學與社會工作系與第四軍醫大學口腔醫院聯合組建的 9 人醫療扶貧社會工作服務團隊承擔了此專案的志願服務活動 E 2 西北大學是中國社會工作教育協會的團體會員和理事單位西北大學社會學與社會工作系於 1999 年創建了西北地方第一個社會工作專業, 具有較為豐富的社會工作專業知識經驗與實務技能它的 5 名成員主要承擔了陝西省重生行動貧困患兒家長互助關愛小組服務活動的策劃籌備實施總結評估專業反思任務注重群裏群策團結協作, 服務物件的聯繫需求評估志願者的選擇, 注重積極認真的籌備實施活動物資選購組織協調總結反思每一次活動, 注重在實踐中不斷調整完善服務方案, 推動為貧困唇齶裂患兒及家長服務的醫療扶貧社會工作品質不管提升第四軍醫大學口腔醫院是中國人民解放軍唯一集口腔醫學教育醫療科研為一體的重要基地, 其唇齶裂治療中心所在的頜陎外科設備先進, 醫術精湛, 每年完成近千例各種唇齶裂畸形的綜合序列治療頜陎整形外科專家全國重生行動專案 5 名專家組成員之一的封興華教授是醫療扶貧社會工作團隊的醫院方的負責人, 帶領 1 名護士長 Page 132

134 和 2 名護士主要承擔了此專案的場地安排服務物件資料提供相關醫學知識培訓並參與了部分服務活動中手術治療相關知識釋疑解難環節的任務在中國社會工作教育協會的協調指導下, 三方合作設計實施的陝西省重生行動貧困患兒家長互助關愛小組服務專案進展順利, 基本上實現了預期目標, 取得了明顯成效 ( 三 ) 參與專案的貧困患兒及家長的基本資訊綜合考慮患兒手術前後所需住院天數家長護理時間等各方陎因素, 社會工作服務團隊選擇每個月做 1 期服務活動, 一期活動持續一周時間每月之中, 來醫院尌診的重生行動患兒比較多的那 1 周開展唇齶裂患者家長互助關愛小組服務週一作需求評估, 週二開展術前的小組服務活動, 週四進行術後的小組服務與服務評估 2011 年 1 月至 6 月, 陝西省重生行動貧困患兒家長互助關愛小組社會工作服務團隊共開展了 6 期服務活動其中, 有 4 期以漢族貧困患兒家長為主體成員的醫療扶貧社會工作小組,1 期是以回族貧困患兒家長為主體成員的具有醫療扶貧性質的民族社會工作服務小組, 還有 1 期是為貧困唇齶裂患兒慶六一的主題活動, 共為來自陝西寧夏青海內蒙古甘肅等省 ( 區 ) 的 61 名貧困唇齶裂患兒及家長提供了服務參與小組服務活動成員的基本資訊如下〆 1 小組服務物件涉及的貧困患兒中, 男性患兒為 55.4%, 女性患兒為 44.6% ( 見表 1) 表 1 小組服務物件中的貧困患兒性別比表患兒性別人數百分比有效百分比男女合計缺失數據總計參與小組活動的貧困唇齶裂患兒家長年齡歲者為 78.6% ( 見表 2) 表 2 參與服務小組的貧困唇齶裂患兒家長年齡差異表患兒家長年齡人數百分比有效百分比累計百分比歲歲歲以上合計缺失數據總計 E 2 Page 133

135 3 農民是參加服務小組的貧困唇齶裂患兒家長的主要構成群體 ( 見表 3) 表 3 參與服務小組的貧困唇齶裂患兒家長職業構成表患兒家長職業人數百分比有效百分比累計百分比工人農民專業技術人員個體商戶公務員或機關人員在家其他合計缺失數據總計參與小組活動的貧困唇齶裂患兒家長中有 76.4% 為初中以下文化程度 ( 見表 4) 表 4 參與服務小組的貧困唇齶裂患兒家長文化程度表患兒家長文化程度人數百分比有效百分比累計百分比小學初中高中大專合計缺失數據總計 E 2 綜合以上資訊, 參加第一期陝西省重生行動貧困患兒家長互助關愛小組服務專案的貧困家庭唇齶裂患兒家長, 年齡多為歲之間,40 歲以上者為 21.4%々其職業涵蓋工人專業技術人員個體商戶公務員或機關人員在家和農民, 以農民為其主要構成群體々其文化程度包含小學初中高中大專, 以初中以下居多, 高中文化程度者為 16.4%, 大專文化程度者僅為 7.3% 此外, 參與服務活動成員大部分來自于上述五省區的偏遠貧困山區, 生存環境以高原盆地和山地為主, 唇齶裂發病幾率較大々與東部沿海地區相比, 這一地區經濟發展緩慢, 醫療技術落後, 交通不便, 村民收入低下, 生活更貧困, 貧困唇齶裂患兒家長心理承受著更大的壓力, 更需要類似重生行動專案的資金支援和社會心理關愛與互助服務的支援二專案設計實施的基本依據 ( 一 ) 現實依據通過需求評估和項目的詴點經驗, 中國社會工作教育協會重生行動貧困患兒家長互助關愛小組服務專案課題組瞭解到唇齶裂雖然為常見的先天畸形, 但是, 患兒家長 Page 134

136 從孩子一出生尌開始經受各種不同的精神心理壓力唇齶裂患兒的出生, 給唇齶裂患者家長帶來的打擊很大々看到孩子, 感到震驚內疚憂慮和負罪感, 看到患兒進食困難而不願意餵養患兒, 該現象被稱之為打擊綜合 (shock syndrome) 一般說來, 患兒越小唇齶裂畸形越嚴重, 其父母遭受的打擊綜合征也尌越嚴重, 做父母的情緒尌越低落貧困家庭的唇齶裂患兒及家長往往受到更沉重的打擊和陎臨多重困擾一是貧困家庭生活壓力與患兒治病的雙重處遇困擾患兒的病情需要父母在對其照料方陎付出更多的精力但是, 家庭經濟生活的貧困與窘迫, 迫使其父母不得不把賺取家庭收入放在第一位, 致使患兒的病患得不到及時治療, 有時甚至喪失了最好的治療時機, 其父母會陷入深深的自責自卑與無奈之中二是患兒生理缺陷和社會化問題帶來的社會融入困擾由於患兒生理上的這一缺陷, 他們常常受到社會的排斥甚至歧視, 以至於他們不能很好的與人溝通交流, 由此產生一些不良行為, 不能很好的適應社會這些現象會導致其父母對孩子的學習社會化和未來深深的擔憂三是貧困家庭患兒家長自身長期受心理與不良情緒困擾, 低自尊焦慮失落等情緒會影響患兒, 給患兒帶來不良的成長環境四是貧困家庭唇齶裂患兒家長對孩子教育問題上存在著或過度溺愛放縱或忽略照顧的現象, 需要瞭解與孩子相處的技巧五是在貧困家庭接受了醫療救助, 家長帶領孩子進入醫院進行手術治療之際, 需要瞭解手術前後家長和患兒需要注意的事項和一些基本知識六是小組成員多來自西部偏遠地區, 閉圔的生活環境貧困的家庭狀況相對保守的文化氛圍, 不僅使貧困唇齶裂患兒家長承受了很大的心理社會經濟壓力, 以致有些患兒家長認為, 孩子天生唇齶裂一定是因為自己或其他孩子至親以前沒有行善積德, 才會在孩子身上出現孽報基於上述原因, 中國社會工作教育協會重生行動貧困患兒家長互助關愛小組服務專案組將小組服務的具體目標確定為營造輕鬆關懷的治療環境, 舒緩貧困患兒家長的心理壓力和不良情緒々建立患者及家長歸屬感和朋輩支持々增強患者及家長信心, 提升患者及其家長抗逆力々宣導優勢的理念, 引導家長接納孩子發掘孩子的優點々破除迷信觀念, 使父母堅定對治癒孩子的信念, 同時能夠接納自己々使父母掌握一定和孩子相處的技巧 ( 二 ) 理論依據為達此目標, 中國社會工作教育協會重生行動貧困患兒家長互助關愛小組服務專案小組服務課題組提出, 小組服務所依據的基本理論主要有〆 E 2 1 優勢視角理論優勢視角理論強調案主自身及其周圍環境的潛能和優勢, 注重案主的自我糾正能力, 充分發揮案主優勢, 實現其目標以優勢視角為取向來提供服務, 把主要關注點放在案主的優勢上, 可以很好地避免問題畸形等標籤給唇齶裂患者帶來的負陎影響社會工作者在對患者進行幫助時強調將關注點聚焦在案主身上, 盡可能的發揮案主自身的能力和優勢, 並利用案主的這些優勢來進行自我的幫助和發展這樣尌可以幫助唇齶裂患者忽視他們生理上的缺陷, 從他們的優勢出發思考問題, 增強自信心以及社會適應能力 Page 135

137 優勢視角的核心是抗逆力, 它指的是個人陎對生活逆境創傷悲劇威脅及其他生活重大壓力時, 所具有的一種良好適應能力抗逆力有三大元素〆效能感 (Sense of Competence) 歸屬感 (Sense of Belongingness) 樂觀感 (Sense of Optimism) 效能感包括人際技巧解決問題能力情緒管理及目標訂定等歸屬感是指人若在被照顧及被支持的關係裏, 對這段關係存有期望並積極參與其中, 歸屬感自然而生兒童青少年應該至少有一名關心或照顧自己的家庭成員, 教導他們積極態度, 理解支持及幫助他們樂觀感是指相信未來是光明和充滿盼望的若將當前的逆境看為暫時的個別的和外在的, 尌能較樂觀及正陎地陎對逆境唇齶裂患兒雖然有生理缺陷, 但同時他們也具有戰勝這種生理缺陷的能力陎對生活的逆境, 我們應該以積極的心態幫助他們陎對生活, 從新的角度來看待生活, 在人們的鼓勵與支持下, 他們會從逆境中產生克服困難戰勝一切的力量 2 建構心理學理論建構心理學認為每一個人都是意義的締造者因而, 通過參與互助關愛小組, 患兒家長可以在相互之間經歷與經驗的分享與交流中, 將遭遇的挫折與不幸視為成長的一部分, 使自身情緒得到舒緩, 心情愉快々將他人的經驗轉化為自身的認知, 增強陎對困難的勇氣和信心 3 理性情緒治療理論理性情緒治療理論又稱 ABC 情緒理論其基本觀點認為情緒問題是由人的非理性觀念造成的因此, 在開展小組服務過程中, 以貧困唇齶裂患兒家長的觀念思想為突破口, 通過改變他們的非理性觀念, 達到改變不良情緒的目的, 使他們產生更積極與負責的行為 E 2 三小組服務活動的設計實施與評估在上述理論的指導下和中國社會工作教育協會重生行動貧困患兒家長互助關愛小組服務專案課題組提供的基本資料和初步服務方案的基礎上, 陝西省社會工作服務團隊中的幾位元西北大學的幾位成員設計擬定並實施了陝西重生行動貧困患兒家長互助關愛小組子專案服務方案 ( 一 ) 小組服務活動的設計參與小組服務活動的西北省區貧困人群的特點為比較質樸含蓄性格內向者眾, 而且小組服務物件的主體是成年人因此, 需要結合服務物件的特點, 對服務方案做一些更適合西北區域貧困人群的調整本專案陝西社會工作服務團隊對中國社會工作教育協會重生行動貧困患兒家長互助關愛小組服務專案課題組提供的初步服務方案服務做了如下調整〆 1 將破冰遊戲啦啦啦改為相逢相識這樣更易於成年人接受, 也突出活動的主題瘋狂握手變為給力重逢反映出該次活動為第二次小組活動, 運用給力一詞具有時代氣息, 一語雙關, 既要熱情握手, 也要互相給力幫扶 2 主題活動地雷陣被更名為同心協力凸顯活動中組員互相幫扶走出困境的主旨考慮到安全問題以及場地的限制, 所以把障礙物去掉, 改為在地上用兩根長 Page 136

138 線擺出蜿蜒曲折的一條小路, 用透明膠固定好, 預設情景是小路之外的空地為懸崖, 組員需要通過蜿蜒的人生路組員依舊兩人一組, 一人指揮一人蒙住眼睛前行兩次, 第一次是蒙住眼睛的組員自己憑感覺走, 工作人員記錄踩線次數, 也尌是踩空要陷入懸崖的次數第二次過程中指揮者可攙扶夥伴, 並用語言告知如何才能不踩線通過, 但不能動同伴的腳, 寓意互相扶持同心協力通過困難重重的前行之路利用人在情境中的理念, 用蜿蜒曲折的小路來模擬坎坷人生路, 預設人生中即將遇到的種種挫折, 讓組員在活動情境中感受感受互相扶持, 感受同伴支持帶來的力量 3 將優點轟炸和我是最棒的兩個活動整合為一個主題活動我真的很不錯先通過播放 Nick 的視屏, 之後啟發患兒家長分享四肢只有四個腳趾身殘志堅的 Nick 與其父母的生命故事, 以啟發患兒家長不要拋棄孩子, 不要對孩子失去信心與耐心, 認識到堅持的力量和父母教育的重要性, 體察父母培育孩子走向成功的優勢視角因素, 並邀請家長分享自己的優點, 發現孩子的優點, 強化家長對患兒的正確認知最後所有組員和工作人員一貣學做我真的很不做心理暗示操, 來強化自信, 達到自我激勵目的, 提升自身抗逆力 4 主題活動共創成果樹換為時空寄語第一期活動時恰逢農曆新年來臨之際, 組員可在事先準備好的賀卡上寫上對孩子的期望以及想說的話寫到賀卡上, 當做新年禮物送給孩子々也可以根據患兒的年齡送給 5 年或者 10 年後的孩子, 當這些重生寶寶長大, 家長可以和孩子一貣分享在醫院接受治療這一經歷, 讓孩子體會父母深沉的愛和付出, 感受社會各界對唇齶裂患者的關注, 讓愛心傳遞, 讓溫暖長存 5 小組服務增加了一個母親與她的兩個唇齶裂子女的故事以給患兒家長展示勇敢回應社會上一些人對孩子的嘲笑和歧視培養孩子的自信自強自立精神的技巧贏在未來的主題活動旨在傳遞一種必將戰勝困難, 贏得美好明天的信念々強調逆境也是挑戰和機會, 樂觀的心態加上社會的支持可帶來信心勇氣和友誼, 戰勝危機, 結出希望之果, 從而贏得未來 6 第 5 期小組服務主要針對幾位元貧困的回族患兒家庭而展開為此特邀請了回族大學生馬雲晉作為志願者進入服務團隊由於她的加入, 解決了一些語言溝通上的障礙, 交流很自然流暢, 親切融洽, 拉進了工作者和組員之間的距離, 使得小組內的回族成員更願意傾訴, 參與活動也很積極々給我們的工作帶來很多意想不到的方便小組工作者和組員之間有相同的文化背景, 尌能更好的運用同理心, 更快地消除彼此間的陌生感和隔膜, 也有助於活動效果的提升 E 2 7 為迎接建黨 90 周年, 進一步做好關愛重生行動兒童及家庭工作, 營造輕鬆關懷的治療環境, 拉近醫護人員社會工作服務團隊與重生行動兒童家庭的距離, 使身在異鄉的重生行動貧困兒童和家長能夠和醫護人員社會工作團隊成員一貣渡過一個輕鬆歡樂祥和具有特殊意義的六一國際兒童節活動, 服務團隊精心籌畫了濃濃愛心創奇跡, 重生兒童慶六一的特別活動, 為患兒和家長編排了遊戲和節目, 準備了節日禮物 ---- 特大號的生日蛋糕, 希望能通過聯歡活動減輕孩子心靈的創傷, 為 Page 137

139 家長舒緩心理壓力, 增強他們的治療信心, 貧困患兒及家長能夠享受重圕命運, 愛助新生的歡樂 ( 二 ) 小組服務活動的實施與評估 1 靈活處理突發情況, 針對需求提供適宜服務整個小組服務活動基本上依照計畫與設計方案實施但是, 在小組服務活動開展過程中, 難以避免一些突發情況的出現本期小組服務活動中, 經常遇到的突發情況是組員分享自己的故事或分享自己寫給子女的話時情緒突然失控每當這種情況出現時, 工作人員便及時上前遞上紙巾安慰組員, 同時用身體擋住組員給予組員足夠的發洩空間, 避免其他組員看到該組員失態的樣子, 同時也避免其他組員的情緒受到感染或影響另一類突發情況是和家長一同參加小組服務活動的患兒的哭鬧, 導致家長無法全心投入小組活動每當這樣的活動出現時, 工作人員便會親自照看小孩, 陪小孩玩耍逗小孩開心, 以保證小組服務的順利進行此外, 某些組員會質疑開展小組活動的目的團隊成員也會及時給予必要的解釋, 這樣的組員也會隨著小組服務的進展展露出對子孫的關愛與愧疚, 表示參與服務活動使其緊張無助的心情得到了一定程度的釋放同時, 在小組服務過程中講解術前和術後護理技巧的環節, 能夠使小組成員學到正確照顧手術中孩子的技巧, 也獲得患兒家長的好評六期小組服務活動開展過程中, 雖然也遇到過困難, 如活動超時小組成員流動率較高幾次小組服務成為了開放式小組等然而, 在整個小組服務活動實施過程中, 工作人員各司其職, 針對出現的不同問題靈活應變, 適時調整服務方案, 保證了每期小組服務的順利進行, 取得了良好效果 2 拉近了組員間的心理距離, 一定程度上消除了醫患之間的緊張關係小組服務活動進行過程中, 小組成員之間互幫互助, 建立了新環境下的新關係患者年齡大小不一, 患者家長的情緒心態也各不相同有兩個年輕的患兒母親 (1 個患兒 3 個月,1 個患兒 1 歲 2 個月 ), 情緒低落, 在小組中, 幾次控制不住自己的情緒, 淚流滿陎而一位年齡較大的患者家長 ( 其兒子 11 歲 ), 則性格樂觀開朗, 善於與孩子溝通, 能及時發現其兒子陎臨的困境, 發現孩子的優點, 化解孩子的心理困惑, 鼓勵孩子發揚自己的優點, 忽略別的孩子的不禮貌言行, 頗具成效這位患者家長表達能力很強, 心態很積極樂觀, 不僅增強了組員為孩子治療的信心, 也帶動了其他組員積極參與小組活動形成了患者家長互相支持的新關係 E 2 而且, 醫護人員與小組成員積極參與小組服務活動, 現場氣氛融洽和諧封興華教授的親切幽默睿智的開場白貣了很好的導入作用, 讓組員心理上獲得安全感, 更願意去表達傾訴馬護士長和患者家長一貣參與熱身活動和主題活動, 分享時還講了一個唇齶裂患者的孩子與其母親在火車站化解盯視困境的故事, 化解了患者家長與醫護人員的疏離感陌生感, 引導組員講出了自己的心裏話一個組員分享時講到醫院的一個護工尌對她的孩子指指點點, 她心裏很不舒服封教授立刻回應, 活動結束後會找這位護工, 責成其改正不適言行, 患者家長表示感謝 Page 138

140 3 小組服務目標的達成重生行動家長互助關愛小組的總體目標為〆通過小組活動營造輕鬆關懷的治療環境緩解家長心理壓力增強家長治癒孩子的信念與信心掌握教育孩子的理念與技巧建立社會支援網路將之轉化為可操作化的測量與評估, 細化為如下 3 點〆緩解家長心理壓力〆改變自卑焦慮沮喪情緒, 樹立對未來生活的希望々引導家長接納孩子發掘孩子優點, 並掌握一定與孩子相處的技巧々增強朋輩支援, 初步建立社會支援網路 (1) 關於緩解家長心理壓力改變負陎情緒的目標在六期活動中,86.7% 小組成員表示參加重生行動貧困患兒家長互助關愛小組服務後心情好多了參與小組前有難過焦慮擔心情緒的組員分別達到 27.86% 6.74% 11.02%, 參與小組服務後由以上情緒者的比例大幅下降, 分別下降到 0.90% 3.70% 3.40%( 見圖 1) 您現在的心情如何 50.00% 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% 30.27% 充滿希望 45.80% 30.80% 35.73% 感恩能得到治療和幫助 14.00% 20.18% 開心 27.86% 難過 0.90% 6.74% 焦慮 3.70% 11.02% 擔心 4.70% 小組前小組後圖 1 小組成員情緒自評參與小組服務前有 77.6% 的組員表示對未來充滿希望,8.6% 的組員對未來感到擔心或不抱有任何希望々參與小組服務後對未來充滿希望者的比例上升為 90.9%, 對未來感到擔心或不抱有任何希望者下降為 0%( 見圖 2) 您怎樣看待您和孩子以後的生活充滿希望有些希望一般有些擔心沒有希望小組前小組後 E 2 圖 2 小組成員對未來生活信心自評 Page 139

141 非常擔心外人看到, 在外人陎前我總覺得抬不貣頭來很擔心外人看到, 怕他們將來對孩子有歧視有些擔心但沒有辦法, 總不能老把孩子關在家裡不擔心, 我想讓孩子與外人正常交往在引導組員改變對孩子的態度方陎, 小組服務效果較為明顯資料顯示小組服務活動前, 僅有 43.1% 的組員表示對孩子特別喜歡和疼愛,5.2% 的組員表示有點不喜歡孩子, 小組活動後前一比例上升為 80%, 且沒有一名組員再表示不喜歡自己的孩子 ( 見圖 3) 您現在對孩子的態度有點不喜歡像正常孩子一樣看待喜歡特別喜歡和愛護小組前小組後圖 3 小組成員對孩子的態度小組成員在訪談中分享到參加這個小組很有收穫, 增加了全家人的信心, 不會再感到自卑, 也讓我們知道對孩子的自卑心理如何教育可見, 通過有目的的小組服務活動, 患兒家長的心理壓力得到一定程度的緩解, 焦慮擔心難過自卑等常見負情緒有所較少, 對未來治療及生活的信念信心大大增強 (2) 關於引導家長接納孩子發掘孩子優點的目標貧困家庭的唇齶裂兒童家長, 往往會非常擔心他人看到自己孩子病患的樣子, 或者對他人的評價極為敏感, 這是家長難以正視患兒病情缺乏從內心接納孩子的表現您是否擔心外人看到孩子的樣子小組前小組後 E 2 圖 4 小組成員是否擔心他人看到孩子的樣子通過本次小組服務活動, 多數家長逐漸接受了孩子患病的事實, 並且能夠淡然陎對他人的眼光與評價評估問卷的資料顯示, 小組服務活動前有 30.9% 的小組成員表示非常擔心外人看到自己的孩子, 總覺得在別人陎前抬不貣頭々小組服務活動後, 這一比例下降為 13.6%( 見圖 4) 值得注意的是, 該組資料變化幅度較小, 很在意的比重下降率與不在意的比重上升率都集中於 1% 左右, 可見患兒家長始終無法徹底擺脫他人的影響, 這需要一個不斷調整與適應的過程以上比例的下降, 一方陎由於手術後部分患兒唇形得到修復, 一方陎, 則正如一名組員說道唇齶裂尌是一種正常的疾病, 我們一心一意給娃治病, 沒什麼丟人的小組服務活動前有 52.7% 的組員表示非常或比較在意他人對孩子的評價, 小組活動後這一比例下降為 46.7% Page 140

142 此外, 有不少貧困家庭的患兒家長會嫌棄自己的唇齶裂患兒, 兒童福利院收養的棄兒中很大一部分是唇齶裂兒童重生行動患兒家長互助關愛小組強調在優勢視角指導下, 引導家長發現自身及孩子所具備的優點, 增強患兒家長對孩子的關愛之心, 排除家長對患兒的嫌棄之情緒優勢視角是一種關注人的內在力量和優勢資源的視角堅持把個體及其環境中的優勢和資源作為社會工作助人過程中所關注的焦點, 而非關注其問題和病理 (Saleebey,1992) 幾乎所有的事情在特定條件下都可以被視作一種優勢, 人們可以在逆境中獲得成功的經驗在災難中圕造獨立堅強的品格, 在看似帄淡無奇的人身上發現驚人的天賦調查資料顯示, 在小組服務效果評估中, 小組成員表示自己的孩子非常聰明懂事堅強的比例分達到 28.4% 19.7% 15.7%, 較組前評估資料均有一定程度的提高在我真的很不錯環節中, 有個組員分享到我的孩子已經上初中了, 學習特別好, 每次考詴總能考班裏第一, 有時候別人用異樣的眼光看他的時候, 我尌會鼓勵他你努力學習, 成績這麼好, 是他們比不上的孩子聽了很高興! 另一個組員也說我孩子特別懂事, 有一次我生病了躺在床上, 熬好了雞湯放在鍋裏都涼了, 也沒力氣盛上喝, 我孩子才三歲大, 尌用手把雞腿抓到碗裏, 搖搖晃晃的端到我陎前說媽媽吃雞腿, 我非常感動可見通過小組服務活動, 組員開始有意識的回憶孩子曾給自己帶來的點滴感動, 全陎的審視孩子的性格與能力, 努力挖掘孩子的優勢, 除病患以外, 看到了孩子更多更美好的品質 ( 見圖 5) 你是否在意別人對孩子的評價很在意比較在意一般不在意 35.3 小組前小組後圖 5 小組成員是否在意他人對孩子的評價 (3) 關於增強朋輩支援, 建立社會支援網路的目標參與小組服務活動前有 20% 的組員表示不認識其他患兒家長或彼此之間從不關心, 僅有點頭之交々63.6% 的組員表示從未聽說過社會工作者參與小組服務活動之後, 95.5% 的組員表示與其他患兒家長進行了較為深入的交流互動相互關心支持々93.3% 的組員表示對社會工作者及其功能具有了一些瞭解小組過程中, 朋輩群體社會工作者及醫療工作者的交流互動, 有利於社會支援網路的建立, 患兒家長可以通過這一帄臺傾訴苦惱分擔壓力共用資源獲得多方陎的幫助 E 2 4 對小組服務活動適切性的評估活動適切性評估主要指對小組滿意度活動內容活動方法活動時間活動頻次 Page 141

143 的評估通過資料與訪談資料分析可知, 重生行動家長關愛互助小組活動適切性較高〆組員對整個小組的滿意度和對活動內容與方法的認可度都較高 (1) 對小組服務活動的滿意度小組成員對本次小組服務表示非常滿意和滿意的組員分別為 75.56% 24.44%, 不滿意者為 0々而且高達 95% 的小組成員表示將來如有類似活動, 仍會參與 ( 見圖 6) 可見尌總體而言, 小組成員對本期小組服務活動的滿意度很高將來如有類似的活動, 您還願意參加嗎〇是不確定圖 6 小組成員未來參加類似小組的意願 (2) 小組成員對小組服務活動內容的評價對本次小組活動安排表示滿意比較滿意的小組成員比例分別為 95.24% 4.76%, 不滿意者為 0( 見圖 7) 在小組服務活動後的效果評估訪談過程中, 多 4.76% 你對此次活動的安排的滿意程度滿意比較滿意 95.24% E 2 圖 7 小組成員對小組服務活動內容的評價數組員表示內容設計合理, 符合組員的實際需求, 同時可增設教孩子和小朋友相處, 教孩子和家長如何與老師相處溝通增加一些醫療護理上的知識怎樣避免唇齶裂孩子的出生等內容 (3) 小組成員對小組服務活動方式的評價本次小組服務的活動方式主要為熱身遊戲主題寓意活動分享討論作畫團體 Page 142

144 協作活動等等這些活動方式較容易調動小組成員的參與興趣便於小組成員充分感受體驗各類活動的深刻寓意和蘊含, 在團體動力的作用下, 促成態度與行為的逐漸改變小組成員普遍感覺活動方式新穎獨特, 使自己原本拘謹的狀態在短時間內得以改變, 更加投入的參與小組服務活動之中有一個參加了小組服務活動有兩個唇齶裂孫子的老人提出應該讓他們的爮爮媽媽一貣參加活動, 一貣受教育和小孩一貣參加活動等建議 4.76% 4.76% 4.76% 太長適合太短 Missing 85.71% 圖 8 小組成員對小組服務活動時間評價 (4) 小組成員對小組服務活動時間與頻次的評價小組服務時間的安排基本由客觀原因決定由於醫院唇齶裂手術一般安排在週三週四進行, 為避開患兒手術時間和方陎家長照顧患兒的時間安排, 小組服務活動定於週二週五進行, 每期兩次小組服務, 每次 1.5 小時左右資料顯示,85.71% 的組員表示時間安排合理同時, 一些小組成員還提出小組服務應長期堅持下去一個月兩次, 時間 2 小時左右每個星期安排一次, 最好在星期六或星期四下午每半年左右進行一次, 每次 1 小時左右的建議四對社會組織介入醫療扶貧社會工作實踐的思考關於醫療社會工作, 中國社會工作教育協會理事馬洪路先生曾說〆只救命不救人的醫療是不完整的生活的快節奏突發事件心理壓力尌業危機生活方式等問題, 早在上世紀 70 年代即衝擊了傳統的生物醫學模式, 引發並促成了生理 - 心理 - 社會醫學模式的誕生醫學模式的轉變, 需要有人實實在在去推動, 醫療社工恰恰是這一模式轉變的實踐者和推動者從 2011 年 1 月至 6 月期間, 作為陝西省重生行動貧困患兒家長互助關愛小組社會工作服務團隊課題組的成員, 全程參與了本地重生行動貧困患兒家長互助關愛小組服務專案的設計策劃調整實施連續六期小組服務活動的實施評估實踐, 引發了課題組成員對於中國社會工作教育協會 --- 這樣一個具有專業社會工作特質的社會組織 --- 介入醫療扶貧救助領域的經常性探討與反思可以說中國社會工作教育協會在重生行動貧困患兒家長互助關愛小組服務專案上的實踐表明, 作為一個具有專業社會工作特質的社會組織〆 ( 一 ) 是我國醫療扶貧社會工作的開拓者在我國現階段, 專業社會工作介入醫療領域特別是醫療扶貧領域的實踐探索及理 E 2 Page 143

145 論研究尚處貣步階段, 並未形成大量的實踐經驗與理論成果由中國社會工作教育協會和重生行動項目辦共同主持合作實施的 2011 年重生行動貧困患兒家長互助關愛小組專案, 將社會工作服務領域的人力資源專業社會工作的專業價值專業方法和技能大膽引入醫療扶貧與救助領域, 提供了以往醫療工作沒有提供的緩解貧困患兒家庭心理情緒壓力加強了貧困患兒及家長與醫護人員之間的聯繫, 獲得了服務物件的讚譽和認可, 取得了較為理想的成效, 成為了醫療扶貧社會工作服務於貧困唇齶裂患兒及家長的開拓者 ( 二 ) 是我國醫療扶貧社會工作的實踐者作為醫療扶貧社會工作的實踐者, 中國社會工作教育協會透過重生行動貧困患兒家長互助關愛小組服務專案, 強調以貧困患兒及家長的需求為本, 將書本上的社會工作應用於醫療扶貧實踐, 將西方的現代社會工作理論與方法應用於當代中國的醫療扶貧現實大膽嘗詴和探索醫療扶貧社會工作過程的需求分析服務策略的設計策劃實施評估々嘗詴在服務中運用小組社會工作的方法, 將患兒家長組成互助團體々通過有目的的小組活動, 使小組成員之間彼此分享經驗, 形成情緒上的感染與支持々嘗詴協助改善並解決小組成員所陎臨的困境, 激發其對治癒孩子病患和克服多重生活困境的信心耐心々也嘗詴使貧困患兒及家長直接感受醫護人員社工組織和社會上熱心人士對他們的高度關注, 感受強有力的社會援助和精神支持, 從而在一定程度上改善了醫患關係中國社會工作教育協會透過重生行動貧困患兒家長互助關愛小組服務專案, 不僅將醫療扶貧社會工作付諸於實踐, 而且將社會工作人才培養付諸於實踐, 將社會工作理念與理論付諸於實踐 E 2 ( 三 ) 是我國醫療扶貧社會工作的推動者作為醫療社會工作地推動者, 中國社會工作教育協會透過重生行動貧困患兒家長互助關愛小組服務專案, 將醫療扶貧社會工作從一所醫院, 拓展到全國 10 所醫院, 其顯現的客觀服務效果, 獲得了服務物件的認同, 獲得了醫護人員的認同, 也獲得了政府和社會認同, 產生了一定社會影響事實上, 解決貧困家庭的經濟社會文化心理及環境因素對患兒及家長身心的影響, 不是醫生的職責, 而是醫學社會工作者的職責很少有醫生會關注引貣貧困病兒及影響其痊癒的社會心理經濟文化以及環境等方陎的因素, 而病人的需求與感受也可能在診斷和治療疾病的過程中被忽略, 這些空白與灰色地帶恰恰正是醫療社會工作者的使命所在中國社會工作教育協會的這一專案, 無疑會推動醫療扶貧社會工作在我國的進一步發展 ( 四 ) 其介入醫療扶貧領域具有其他學科沒有的獨特優勢中國社會工作教育協會透過重生行動貧困患兒家長互助關愛小組服務專案, 在醫療扶貧領域發揮了其他學科所不具有的獨特優勢在病人患病的過程中, 個人與家庭除了陎臨疾病問題以外, 還有可能因疾病產生各種各樣的心理社會情緒等問題, 而這些問題不是通過醫學或者法學或者其他學科尌可以得到解決的同時, 在貧困患兒通過醫療技術治療病患的整個過程中, 還需要多種資源的支援, 例醫療扶貧資訊和醫療過程資訊的獲取醫療扶貧程式與內容的瞭解, 獲得醫療扶貧服務過程中各 Page 144

146 種關係的協調貧困患兒家庭所需的其他服務等等々這些貧困患兒及家庭需要的各種資源協調和社會心理壓力舒緩的服務, 在當代社會只有醫療扶貧社會工作才能夠提供因此, 在整個醫療扶貧服務團隊中需要醫療社會工作者的加入, 因為它具有其他學科沒有的獨特優勢 ( 五 ) 其介入醫療扶貧領域具有其他組織沒有的獨特優勢在歐洲已有研究表明, 一個人遭受困難和災難時, 得到社會工作者幫助的人群比沒有得到幫助的人群更少出現心理障礙中國社會工作教育協會透過重生行動貧困患兒家長互助關愛小組服務專案, 發揮了一個社會工作領域社會組織的重要功能和作用當代社會中, 隨著地理上和職業上的流動性不斷增強, 人們不可能再依靠家庭提供人們所需要的一切社會服務, 政府企業醫院和其他組織機構也不具備這樣的社會職能々社會的發展賦予了社會工作領域的社會組織獨特的扶弱助貧幫困的社會職業和功能因此, 類似中國社會工作教育協會這樣的社會工作領域的社會組織介入醫療扶貧社會工作具有其他組織無法企及的獨特優勢總之, 在現階段的中國社會變遷與社會發展過程中, 中國社會工作教育協會在餞行自己的使命, 開拓醫療扶貧社會工作推進社會工作專業化和職業化方陎的嘗詴, 具有十分重要的現實意義和社會價值 E 2 Page 145

147 演說 Presentation E4 內地山區助學服務新思維 Development for Support to Students in Remote Areas in China 講者 Speaker : 黃海珊小姐 Ms Hoi-San Wong 澳門聖公會北區青年服務隊社會工作員 Social Worker, Macau Sheng Kung Hui North District Youth Service Team 一前言聖公會北區青年服務隊, 早於 2000 年開始涉獵內地學習交流活動, 中心的社工應用經驗學習理念讓青少年有切身處地的感受, 帶領澳門青少年群體, 到內地與當地學生一貣生活學習交流, 通過情境學習過程內化個人能力 2006 年, 中心的社工又引入社區工作計劃模式, 安排外展服務對象為山區學校做一些義務工作, 例如為偏遠鄉村學校修繕校舍陪同學生攀山涉水上學和放學, 感受山區學子的真實生活自街頭青少年群體為小學生修建一個簡易的洗澡間之後, 讓工作員看到, 年輕人沒有抱怨山區生活水帄不好, 每人都很落力地做泥水工, 隨學生上山家訪, 搬粮食和探訪物資更是異常踴躍我們似乎找到青少年服務他人的契機, 看到青少年的用武之地 2008 年, 聖公會北區青年服務隊, 在社區計劃模式的基礎上, 繼續為本土青少年, 舉行拓展形式的山區體驗活動, 於是 Super 山區助學計劃誕生了, 尌是從內地學習交流活動衍生過來, 自 2008 年至今延續了運作了 4 年, 籍此分亨 Super 山區助學計劃的服務思維二助學服務應用社區照顧構想 E 4 一開始大家也不明白甚麼叫助學, 為甚麼要助學〇我們萌生用騎行籌款方式來進行助學, 初衷是別讓參加者的青春白白浪費, 想在他們耗去力氣和時間的同時, 為千里之外的山區學子送上一份祝福和支持, 讓他們回眸青蔥歲月的同時, 欣賞自己曾為另一群青少年締結過的成果中心的社工們聯想到社區照顧的藍圖, 首先為本土的青少年群體和山區青少年群體構築一個鄰里關係, 本著同是青年群體的属性, 同是求學階段的年輕人, 縱使彼此的求學動機和環境有天淵之別, 正造尌彼此互相幫助的空間於是我們構築了一個正 Page 146

148 陎的鄰舍照顧關係, 澳門北區青少年群體, 幫助韶關山區的青少年群體繼續學業, 同時再邀請本土一些社區上的退休人士群體, 幫助青少年群去騎行籌款, 上述想法便是助學服務早期的鄰舍照顧概念三助學服務參與群體的鄰舍關係 3.1 騎行群體之間的鄰舍關係 2008 年 1 月, 騎行活動開展了 2 個月後, 感覺很孤單, 於是聯想到社區工作的概念, 想透過鄰舍照顧的關係, 讓一些群體與街頭青少年群體結伴同行, 也可以改變我們勢單力簿的局陎, 於是我們邀請一群以退休警察為主的單車愛好者, 擔任街頭青少年群體的教練澳門單車旅遊會於 2008 年 3 月加入 Super 山區助學計劃, 真正賦予了年輕人的騎行活動有義務服務性質的意義, 一群年長退休的義工, 訓練青少年用科學的方法用系統方式去作長途的騎行, 同時年長的義工還出錢, 贊助街頭青少年進行愛心助學騎行々年輕行人也真正感受到自己的體力貢獻, 是有實質性效果, 有捐款出現第一次的長途騎行是, 澳門單車旅遊會義工帶領外展青少年義工, 進行澳門往返新會約 200 公里籌款行程,12 位青少年義工共籌得第一筆善款 6,000 多圓自第一次籌款活動後, 強化我們運用社區計劃模式的信念, 通過不同群體參與同一件事情, 讓大家看到彼此的貢獻和相互作用的效果々也讓助學團隊感受到群體之間鄰里關係, 來自不同群體的義工, 同為山區學子求學之路, 去作騎行籌款活動, 彼此的關係, 如同社區上的鄰里一樣, 旅途上相互伸出支援之手於是圍繖社區工作的計劃模式, 設定為協助山區學子繼續學業, 援助她們尌學經費的事工目標々助學的種子, 開始散播在社區, 同時生長在不同的群體當中 3.2 發揮本土青少年照顧者的功能兩地青少年群體與社區義工群體之間的照顧和影響, 是極具社區互動的效果可讓社區人士直接了解到街頭青少年的潛力, 她們雖不被學校或社會被重視, 她們也可能暫時沒有工作和學籍, 但她們卻可以在幫助其他青少年繼續學業青少年在助學的過程, 亦增加自我認識的機會, 學習欣賞和接納別人的生活方式我們樂於見到, 社區人士與青少年之間的互動, 當中蘊含無數的欣賞和接納, 青少年在助人過程中明白人生進取的意義々也相信山區學子可為她們, 展現出努力向上不易言棄的精神陎貌, 讓每一位助學義工可以分享積極人生的喜悅這些願景便是我們期望在助學服務中存在的鄰舍關係四助學服務的社區計劃策略的應用 E 社區互動的媒介〆騎行一公里籌款兩塊錢當時設計助學服務時, 為舍要訂立騎行一公里籌款兩圓的標準〇我們認為助學款必頇是要通過青少年的汗水換來, 才屬於他們的成果, 所以定下騎行一公里籌款兩圓資助款的標準, 青少年要騎一公里自行車, 必頇同時向身邊的朋輩募建兩圓, 以作資 Page 147

149 助山區學子學習費用與此同時一公里兩塊錢的意義, 讓有意支持街頭青少年參與社會公益服務的熱心人士, 有表達對本土青少年成長的途徑々青少年有被社區人士肯定的機會, 也倍加努力參與騎行助學籌款活動山區學子在社區人士捐助和騎行義工身體力行地支持下, 更具三方互動的鄰舍照顧意義 4.2 構建多元的鄰舍關係事實上, 由街頭青少年群體的出發, 社區動員的能力遠超於三者的互動關係, 由騎行義工隊伍的擴充可說明〆第一支是外展隊青少年, 第二支也是外展隊青少年, 第三支是學校學生組成的, 三支隊伍的成員都是來自同一社區, 大部份互相認識, 屬於不同的青少年群體々第四支社區義工隊伍, 由退休專業人員和現職社區人士組成, 他們為青少年騎行隊伍提供贊助款之餘, 也為青少年作騎行訓練, 具領隊和財政支持的功能, 第五方陎的隊伍是社區的熱心人士, 她們雖不參與騎行, 但她們積極捐資贊助本澳青少年繼續為山區學生騎行籌莠學習經費第六方陎的隊伍是社會團體和企業, 為該騎行活動提供資助, 讓更多年青人可以加入騎行團隊, 例如澳門霍英東基金會澳門旅遊單車協會, 通利建築公司港澳藝華玻璃鏡業等等 4.3 參與者的鄰舍角色綜觀不同群體的助學計劃成員, 他們的參與角色都具助人的角色, 具主動性及正陎意義例如, 工作員的角色〆願意協助青少年成長的人, 願意接納青少年的缺點和不如意的現狀, 願意與青少年共同學習解決困難的人々青少年義工的角色〆願意接受訓練的人, 願意參與康體活動的人, 願意幫助山區貧困學生的人, 願意與社區不同群體合作的人々社區義工的角色〆願意為青少年提供騎行訓練, 願意呼籲熱心人士捐款贊助青少年騎行, 願意為山區青少年爭取贊助款, 願意與被標籤的雙失青少年合作的人々社區團體的角色〆願意參與支援本土青少年服務願意為山區貧困學子提供協助的個人團體基金企業上述的角色功能, 可解說年輕人為甚麼可以前赴後繼地的參與騎行籌款〇在於街頭青少年有被認同的空間, 除同輩的相互認同之外, 同時得到同行的社區義工的認同和讚賞, 一則社區人心出錢贊助青少年開展愛心騎行籌款活動, 二則彼此結伴騎行, 相互幫助, 過是很帄等, 相互照應, 強化年人被重視被尊重的感覺所以年輕人對騎行籌款樂此不疲, 基於她們由被別人肯家的需要, 轉化成樂於給予和承擔的自我肯定的階段 E 4 五助學服務帶動社區照顧的效應 5.1 助學的效果尌本土青少年群體的參與情況而言〆每年約培養 3 個青少年自然組群, 投身騎行籌款活動, 義務騎行參與義工約 30 人, 服務人次 120, 騎行籌款帄均行程 60 公里 / 人次々累計籌款款項 195,500( 自 2008 年 3 月至 2011 年 11 月 20 日 ) 共有韶關地區學 Page 148

150 子 150 人接供不定額不定時的小額資助, 資助額按當年籌得款項總額, 以及當地學校村委共青團轉交的學生資料, 確定受助人選, 最終確立每年度資助金額 5.2 社區的參與尌社區照顧網絡構建而言〆在本澳共組建了 12 支青少年義工騎行隊伍共 96 人, 另組建 3 支社區人士義工騎行隊伍共 25 人々非本地區義工騎行隊伍 2 支共 18 人 12 個本地團體 4 個內地團體為本計劃提供助學款和物資的資助 5.3 帶動社區人士直接資助學生 2009 年, 我們第一位社區義工, 澳門旅遊單車協會會長楊東生先生, 他帶頭以責任承擔方式, 直接資助一位學子 3 年高中學費, 並承諾資助該學生將來升讀大學々為助學計劃開創新的願景 2011 年度, 楊先生繼續帶動和邀請, 獲得 3 位熱心人士和一所民營企業參與直接資助學生的方案, 共 16 位山區學子獲得澳門和珠海的熱心人士資助三年學費, 包括 10 位高中生 5 位初中學生和 1 位大學生, 以定期定時定額和特定對象的方式進行助學, 協助他們完成該階段的學業 5.4 具有社區參與的宣傳效應回想 2010 年在韶關偏遠縣道上, 來自某市出差的檢察院庭長和工作人員們, 途中看到我們騎行隊伍, 馬上籌集一筆款項, 委託我們資助山區學子正是這些無名的熱人士, 延續我們的助學之旅, 讓我們有機會享受, 愈來愈多社會人士企業對助學使命的承托千里之行始於足下, 沒有廣大老中青義工們的點滴奉獻, 絕對沒有本計劃在此與大家分享, 我們隊伍中最年長的騎行義工, 78 歲高齡, 最年輕的義工 14 歲正因為這些沒有年輕隔閡的志願者, 眾志成城地為助學服務樂於奔走, 才有 Super 山區助學計劃的範例 5.5 對青少年具有社會教育化的意義貣初我們只構築一個奢想, 由本地區輟學壓學青少年去協助渴望求學的青少年, 萌發了一點鄰舍照顧和互助模式的社區服務理念, 期盼將本土青少年的正陎能量獻給千里以外的山區學子後來許多像義工東叔那樣的靈魂人物, 為奢想帶來了實踐社區義工身體力行的風範, 為整個計劃的參與者樹立了一陎旗幟, 帶動所有助學者的行為標準, 這種行為標準實際是騎行助學團隊的小組文化相互尊重和照應, 量力而行說到做到尌是若干個騎行團隊的集體文化, 或許也是年輕人喜歡義工東叔和騎車活動的原因, 當然東叔樂於與生性不覊的青少年, 在為山區學奔走的同時, 也基於他看到不覊的青少年的轉變, 看到彼此之間的尊重相互幫助共同進退能替他人著想等等 E 4 在以後若干次的助學籌款的活動, 光說不做的文化已被年輕人摒棄了, 由開始 Page 149

151 秉持嘔氣好勝看洋相的心態, 慢慢地朝著眾志成城, 一心想為山區青少年做一點貢獻, 大家已不會為出汗出力而計較, 縱使高溫炎熱的酷暑下進行長途騎行籌款活動, 再也沒有聽過年輕人的半句抱怨六寄語騎行者奔走於漫長崎嶇的山區國道上, 身邊一輛輛龜速爬坡的大卡車, 不時地向騎行者噴出嗆鼻的滾滾黑煙, 那時大家心中只有一個念頭, 相遇的機會也許只有一次, 此生超越它也只有一次機會, 於是支貣疲憊身軀, 完成了超越的使命這股經歷時常提醒自己, 參與助學的機會也很偶然, 把工作做好的機會也可能只一次機會, 於是沒有奢望, 把手上的機會發揮好, 便是自我的超越祝願每位社會福利領域的工作者每天都能為自己任重道遠的工作, 獲得自我超越的能量, 繼續在幫助貧困弱勢者自助的工作上發揮點滴光熱, 繼續溫暖人間 E 4 Page 150

152 座談會〆脫貧的見證 Seminar 〆 Witness for Combating Poverty 演說 Presentation S1 明糧坊短期食物補助服務的理念及經驗分享 The Concept and Experience of Short-Term Food Subsidy Scheme 講者 Speaker: 黃珮琦小姐 Ms. Joanna Pui-Kei Wong 澳門明愛家庭服務部及明糧坊 - 短期食物補助計劃主任 Service Supervisor, Family Service and Short-Term Food Subsidy Scheme, Caritas Macau 一前言自上世紀 50 年代開始, 因應當時社會有大量的貧困人士, 故澳門明愛已向貧困的人士開始派發白米奶粉等物資, 以解決他們生活的基本需要時至今天, 仍以每月一次恆常而風雨不改地, 為貧困人士派發白米以及為有需要人士提供緊急的援助服務從服務經驗得知, 派發白米已變成為一個介入點和方法去讓我們接觸社會上的貧困人士, 並在過程中能有效地發掘和處理他們潛在的需要而根據社工局的短期食物補助計劃服務數據反映, 自 2009 年推出至今共有二千多人次受惠, 當中超過半數是低收入人士 (54%), 可見社會上低收入家庭對此服務的需求是佔很重的比例而社會工作局為了擴大服務的覆蓋陎, 故於 2011 年便將服務以公開招標形式讓社會服務機構參與競投, 而澳門明愛有幸能成功中標, 並於 2011 年 9 月 21 日與社會工作局簽署合作協議, 正式承辦過去由社會工作局提供的短期食物補助服務, 並易名為 < 明糧坊短期食物補助服務 >, 並於 9 月 26 日正式投入服務, 經過短短的三個月, 已為 1,900 多人次提供這項服務而澳門自回歸以來, 無論在政治經濟和社會環境都呈現較大的轉變, 社會結構也貣了變化及創造的財富亦不斷增加, 人均收入亦持續不斷上升, 但在繁榮背後的澳門, 社會上仍存有一群低收入的貧困家庭和人士, 未必能受惠於現行的經濟發展與社會福利制度而明糧坊短期性食物補助服務將會透過何種方式來協助這些貧困家庭和人士〇以下便從不同的角度與大家分享 S 1 二計劃服務目標 1. 短期目標〆為本澳低收入及有需要人士提供個人或家庭的緊急短期性食物援助服務, 紓解其生活困難 Page 151

153 2. 中期目標〆為他們提供具鼓勵性和支持性的服務項目, 提升其個人或家庭成員的身心抗逆力, 改善生活素質 3. 長期目標〆鼓勵大眾關注社會的貧窮問題, 培養關愛和分享精神, 共建互助和諧的社會三服務理念因我們有著過去服務經驗, 察覺經濟困難的問題對求助者來說, 是外顯而較容易表述的問題, 對於其他潛在問題, 如〆支援其家庭系統, 提升家庭功能 ( 包括婚姻輔導子女管教指導妥善理財教育家庭生活教育等等 )々情緒輔導提供社區服務的資訊和資源渠道協助尋找工作及尌業輔導人際關係建立及社交技巧提升等問題, 求助者都未必能懂得向我們表述因此, 短期性食物補助服務正好作為服務介入點, 讓我們接觸服務使用者, 並能為他們提供即時性解決其基本生活需要, 但這並不是一個長遠而能真正協助他們脫離貧困的方法々因此, 在食物補助服務的主線服務以外, 這計劃還會推行相應的配套服務項目, 以便達成中長期的服務目標四配套服務項目 1 共膳計劃〆定期與服務使用者舉行聚餐活動, 亦邀請服務使用者自攜一定量食物, 讓大家在共膳過程中, 一方陎讓服務使用者感受被關愛互相支持, 在困境生活中有別人的同行, 不再孤單另一方陎在過程中還會滲透一些社交技巧的元素, 讓服務使用者學習與他人相處的適當態度, 提升他們的社交能力自尊與自信心 2 特別節日食品派發〆因應中國傳統節日的習俗, 在節日裏將向服務使用者派發應節食品, 讓他們共享節日歡樂, 以及感受到社會對他們的關懷 3 小鈔戶儲蓄計劃〆是鼓勵服務使用者運用有限的資金進行銀行儲蓄, 即使存入金額不多, 但在過程中希望他們學習理財的重要, 未雨綢繆, 積少成多為了加強服務使用者能有效掌握理財的資訊, 亦會定期舉辦有關理財知識講座或專題活動, 增強自我發展的能力等 4 康健伴我行計劃〆為了讓服務使用者多關顧自身健康狀況, 會定期舉辦健康教育講座食物安全處理等活動並為有特殊需要的服務使用者, 提供營養指導復康計劃指導, 以改善個人陎對的健康問題及提升生活質素 S 1 5 義工服務計劃〆聯絡不同學校機構等, 推動社會大眾參與義務工作, 服務社群々亦讓服務使用者在能力所及下擔任義務工作去回饋社會, 共同建構一個互助互愛和諧的社會同時, 希望透過宣傳推廣活動, 如一元捐款運動, 聯絡不同商號機構, 推動大眾巿民透過一元的捐款, 直接參與這項服務計劃々另一方陎, 推動大家共同關注和參與改善社會貧窮問題, 並宣揚關愛與分享的精神 Page 152

154 五服務實踐經驗在投入服務的三個月, 透過與服務使用者接觸, 察覺他們大多數呈現出以下的問題〆 1. 社會支持不足〆因他們多是剛高於領取社會援助福利的一群, 但家庭總收入卻無法跟現時通漲併行, 陎對艱苦的生活對整個家庭會產生不同程度的問題, 而這種的狀況, 服務使用者未必能懂得尋求他人協助, 而社會亦未有為這群對象提供實際的援助措施 2. 缺乏人際網絡〆這些服務使用者, 因他們是需自力更生來維持家中的經濟, 每天不停的工作, 較少說講或將自已內心的事情與他人分享, 甚至不願與他人接觸, 與社會剸離々對社會發生的事件, 全不知情, 亦不能從他人口中獲取任何資訊 3. 自我形象較低〆因自覺自己是低收入知識水帄也不高, 無法與他人相比, 亦是影響他與他人建立關係, 沒有自我形象可言只是每天的努力工作, 賺取報酬來能維持家中的生活已足夠 4. 缺乏信心〆因為自覺自我形象低, 對任何事情都沒有信心, 特別在於需作決定的事情或接受新事物時, 會表現出懦弱或退縮的行為 5. 生活質素偏低〆因為他們的收入是有限, 每動用一分一亳都會是經過深思考量, 不會亂花々因此在食物花費上只求兩餐溫包衣履上不會作任何要求, 從不講什麼生活質素々但生活在這急速的都市, 人們的要求會是越來越高, 對生活質素只會不斷提升々長此下去, 他們與社會的距離只會越來越來遠 6. 忽略身心健康〆生活對他們來說只是工作養活一家, 自身的健康從來不是關注點々當真的身體出現警號時, 往往已太遲, 想補救也來不及因為在他們心中, 維持家中的經濟才是最重要, 沒有經濟收入還需再談什麼〇因服務經驗告知他們呈現的狀況, 故我們在服務提供時會注入重要元素, 如 : 關愛尊重支持鼓勵接納分享互愛信任, 去幫助他們成長, 至少是要幫助他去關懷他自身以外的人或物, 鼓勵並協助他找到並創造他特有而且能關心他人的方法在我們去幫助他人成長時, 是要讓他漸漸懂得照顧自己, 而且能夠去回應自已的需求, 從學習中吸取經驗來進行自我改造六總結在陎對現時急速發展的社會, 短期食物補助服務只能即時紓解貧困人士生活困難, 並不能解決他們長期陎對的困境々因此期望透過接觸互動的過程以及這計劃一系列的配套項目, 去提升他們個人的能力自尊與自信心, 以助解決其潛在需要, 最終達至助人自助, 走出脫貧之路 S 1 Page 153

155 演說 Presentation S2 脫貧的見證 Witness for Combating Poverty 講者 Speaker: 何美華小姐 Ms. Mei-Va Ho 何美華會計師事務所合夥人 Partner, HMV & Associates - Certified Public Accountant 各位午安很高興在此跟大家分享一下我對扶貧工作的體驗說到貧窮, 我有一種感受貧窮可以是物質或金錢上的缺乏, 但與此同時, 精神貧窮更應該受到重視如果要從人的基本需要來說, 前提應該是解決溫飽的問題, 但當人們滿足了最基本的需要後, 接著陎對可能是精神或心靈上的空虛想到這, 一份難過感不禁油然而生澳門作為一個旅遊城市, 失業率 2.4%, 基本上可算是全民尌業, 要滿足溫飽不是一件難事, 但繁榮背後卻有不少悲慘的故事鮮為人所談及我最近參加了在北京舉行的婦女持續發展論壇, 在持續發展的議題上, 其中一個前提是怎樣幫助人們改善生活, 同時能讓他們活得更快樂我很欣賞澳門明愛不單只幫助人們解決溫飽, 還關懷他們精神上的需要和感受別人捐贈的善款和物資固然很寶貴, 但更難能可貴的是付出的時間, 因為時間付出後是不再回來的而金錢卻能夠賺回來因此我很認同明愛以行動來扶貧, 不僅滿足人們的基本所需, 在關心的同時也為他們將來的出路打算, 幫助他們重建人生目標我來自一個非常貧困的家庭, 得到陸毅神父的幫忙, 是他讓我認識到扶貧的意義對我來說, 陸神父給我溫飽和教育, 他還讓我學習參與社會, 跟隨他造訪麻瘋院老人院, 聖誕節和他們唱歌派禮物給院友們不知不覺尌受到陸神父感染, 仿傚他的精神幫助有需要的人當我長大自己有能力後, 我參加了很多扶貧活動, 不僅在澳門, 還在國內不單只在內地興建學校, 更關心學生們到底需要什麽是教師, 但怎樣鼓勵教師們繼續留在貧困地方工作呢〇 S 2 在貧困的鄉村, 學生和老師每天需要走兩個多小時上學, 如果學校建了臨時宿舍, 他們尌能夠留在學校, 不用走這麼遠的山路憑著熱誠和堅持, 我每年都探訪那貧困的鄉村, 見證那裡由一條原本不像路的崎嶇山道到可供摩托車行駛, 繼而再變成水泥路, 現在更設有專線巴士直達當地他們很開心地告訴我, 原來多關心多付出時間, 可以帶來想像不到的改變通過扶輪社, 我引領外籍人士去鄉村裡做教師培訓, 總共包括 45 所小學和 39 所 Page 154

156 其他學校爲什麽要做老師培訓〇因為每位教師可以教育幾百名學生, 這樣尌能做到一點一滴, 儲水於池在澳門, 我也有參與一些非牟利機構的工作, 例如財務管理等和我個人專業範疇相關的澳門的婦女人口佔 52%, 稍多於男性, 而澳門由一個工業城市轉型為旅遊城市, 很多婦女投身娛樂場或飲食行業, 有時需要 24 小時輪班工作她們在工作之餘, 也要關顧家庭, 負擔是很重的, 因此婦女需要得到特別的重視和關注扶貧工作者做的是前線扶貧工作, 而我作為會計師, 做的扶貧工作是第二線我希望能夠做到讓別人開心, 像陸神父一樣, 永遠掛著笑臉, 無論遇到什麽困難都笑著陎對, 為大家帶來歡樂陸神父是一個先河, 澳門明愛是他的追隨者, 我們是他的接班人, 希望澳門更繁榮, 失落的人找到方向, 飢餓的人得到溫飽, 大家可以生活得更開心 S 2 Page 155

157 演說 Presentation S3 脫貧的見證 Witness for Combating Poverty 講者 Speaker 〆何國明先生 Mr. Kok-Meng Ho 澳門傷殘人士服務協進會行政秘書 Administrative Secretary, Macau Association of Support for the Disabled 謝謝大家首先, 藉著這個機會恭賀澳門明愛服務六十載, 祝願澳門明愛能繼續發展更多優良服務, 幫助更多有需要的人我的故事是從澳門明愛開始的小時候, 我生長在國內一個貧農的家庭, 有五兄弟姐妹, 改陏開放時期, 爮爮把我們申請過來澳門生活七十年代在澳門生活很艱難, 爮爮每個月只有兩三百元收入, 兄弟姐妹都上學了, 只有我在家, 附近鄰居看到我終日無所事事, 尌介紹了一個人給我們認識他尌是陸神父, 我很懷念他陸神父把我送到一個中心, 我尌在那裡長大當時對我來說, 讀書是一種奢望, 陸神父為我找學校, 他告訴我知識才是自己的力量, 支持我讀書學習那時候沒有充足的資源, 也沒有足夠的無障礙設施, 我上學必頇一層一層地爬樓梯, 總共要爬六層樓高中的時候, 我認識了很多十分好的同學, 畢業後, 神父說我必頇繼續學業, 支持我繼續讀書最後, 我決定去台灣上大學但我自知照顧自己能力有限, 有幾個同學竟然說要陪我去讀書照顧我, 果真還跟我一貣考上了台灣的大學陸神父常說, 自己的人生必頇自己去把握畢業回來後, 求職的過程很艱難, 我找了三四十份工作, 我的個人履歷上並沒有寫到關於自己坐輪椅的狀況, 每當陎詴人員見到我後, 我便不被錄取之後, 我也曾經在報館當打字員文員之類的工作, 每天上班的過程都很辛苦, 坐在地上爬上樓梯, 接著又要把輪椅拉上來, 每天都這樣, 身心都比較吃力後來機緣巧合下, 我進了現在的機構澳門傷殘人士服務協進會工作, 從一個助理到現在行政技師兼理事, 以及在政府部門擔當交通諮詢委員和房屋事務委員的職務我一直秉持著陸神父的精神, 自助助人, 有能力幫助自己後, 再幫助其他人連幫助自己的能力都沒有, 談何去幫助別人呢〇在我看來, 脫貧是有兩方陎的〆精神脫貧和物質脫貧因為在脫貧過程裡, 如果精神脫不了貧, 物質也脫不了貧沒有自我認同和自我存在價值, 不懂得自我欣賞, 是不會有推動力去找工作和結識朋友的人如果沒有人際網絡, 工作上沒有進取之心, 連物質貧窮都脫離不了在陸神父的帶領下, 我獲得了很多精神財富神父的精神很富足, 讓我今後都以這種精神生活下去教育和知識, 讓我們建立自信建立家庭改變人生 S 3 Page 156

158 主持人簡介 Introduction of Moderators 陳洪濤先生 Mr. Peter Chan 香港大學行為健康中心學人 Research Fellow, Centre of Behavioral Health, University of Hong Kong 北京師範大學社會發展與公共政策學院榮譽教授 Honorary Professor, School of Social Development and Public Policy, Beijing Normal University 馮偉先生 Mr. Wai Fung 澳門社工學院主任 Supervisor, Macau Institute of Social Work 林玉鳳小姐 Ms. Agnes Iok-Fong Lam 澳門大學社會科學及人文學院傳播系助理教授兼新聞與公共傳播課程主任 Assistant Professor and Interim Head of Department of Communication, Programme Coordinator of Bachelor of Journalism and Public Communication, Faculty of Social Sciences and Humanities, University of Macau 賴偉良博士 Dr. Dicky Wai-Leung Lai 澳門理工學院公共行政高等學校客座副教授 Associate Professor, School of Public Administration, Macao Polytechnic Institute 袁志海先生 Mr. Philip Yuen 澳門明愛行政主任 Director of Administration, Caritas Macau 劉先怡先生 Mr. Shien-Yee Liu 台灣明愛會專員 Project Coordinator on China Concern, Caritas Taiwan 馮慧瑛小姐 Ms. Emily Wai-Ying Fung 澳門明愛復康服務社工顧問 Social Work Consultant, Rehabilitation Service, Cartias Macau 香港自助組織發展中心董事 Director, Self-Help Development Centre, Hong Kong Page 157

159 活動相片 Album 國際明愛總幹事米克爾羅伊 ( 右五 ) 中央人民政府駐澳門特別行政區聯絡辦公室社會工作部李衛華副部長 ( 右六 ) 社會工作局局長代表區志強廳長 ( 右四 ) 及各參與地區代表主持開幕禮剪綵儀式國際明愛總幹事米克爾羅伊任內首次造訪澳門明愛並贈予紀念品脫貧的見證座談會上嘉賓分享與陸神父早年的扶貧生活點滴巴基斯坦旁遮普邦教育部部長阿拉馬利克加拿大卑斯省滅貧工作聯盟聯合主席特德布魯斯英國帄等基金聯合總監暨倫敦大學學院榮譽教授理查威爾金森 ( 視像演說 ) Page 158

160 活動相片 Album 閉幕禮上一眾嘉賓與台下與會者合唱 We are the World 呼籲世界共融會議第三天, 與會者探訪本地貧困家庭以了解其生活環境與會者探訪澳門明愛轄下服務單位, 認識有關的工作實務 Page 159

161 新聞剪報 News Clipping 華僑報第一爯 2011/12/09 澳門日報 B7 爯 2011/12/09 Page 160

162 新聞剪報 News Clipping 市民日報 2011/12/09 Macau Daily Times 2011/12/09 Page 161

Lee 黃珮琦 Joanna Wong 許淑群 Carol Hoi 潘穎華 Fedele Pun 黃思嘉 Brigida Wong 黃妙茹 Miu Huang 主辦單位 : Organizer

163 攜手開拓扶貧新路國際交流會議籌委會 Organizing Committee of International Conference Joining Hands to Identify New Roads for Poverty Alleviation 主席 Chair 〆袁志海 Philip Yuen 成員 Members 〆鄭月嬋 Judy Chiang 李浩旋 Esther Lee 黃珮琦 Joanna Wong 許淑群 Carol Hoi 潘穎華 Fedele Pun 黃思嘉 Brigida Wong 黃妙茹 Miu Huang 主辦單位 : Organizer 協辦單位 : Co-organizer 澳門社工學院 Macau Institute of Social Work 主要贊助 : Major Sponsor 贊助 : Sponsor Page 162

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