促進醫療照護的公平、多樣及包容──以COVID-19為例

醫療照護機構的環境必須是公平、多樣及包容（equity, diversity and inclusion, EDI）。當機構出現不公平現象，則應研擬政策以因應。就在全球推動EDI之際，因COVID-19疫情再次出現社經地位差距而影響死亡率，這使得醫療照護實踐EDI的努力又面臨重大挑戰。有鑑於此，本文簡介EDI及分析國際推動EDI的現況，並以COVID-19為例，亦提出促進EDI的傳染病醫療照護策略。醫療照護環境中，公平意味著不論種族、性別、年齡、社經地位，病人都應獲得公平照護；多樣是醫療照護者能理解不同背景文化病人的獨特性與其會面臨的健康阻礙；包容是確保病人得到應有的重視及尊重。若逢傳染病大流行期間，則社會健康決定因素衝擊著病人的健康狀況，也影響EDI的實踐。就COVID-19帶來衝擊的反思，未來面臨傳染病健康不公平現象時，醫療照護體系可積極應用EDI在臨床實務上，提供病人都能夠有獲得公平健康機會及健康結果的醫療照護。實務策略建議醫療照護機構成立EDI委員會、監測相關數據及進行人員培訓，並持續關注特殊群體的社會健康決定因素及需求，以達到EDI的醫療照護。

Healthcare systems must embody equity, diversity, and inclusion (EDI) and, in the event of unfairness, appropriate policies / countermeasures should be enacted. The healthcare system response to the COVID-19 pandemic not only highlighted how socioeconomic disparities affect mortality risk but also posed significant challenges to the successful practice of EDI in healthcare. In light of this, this article was written to provide an overview of EDI, analyze the international efforts to promote it, and suggest strategies for promoting EDI in infectious disease healthcare using COVID-19 as an example. In healthcare settings, equity centers on ensuring patients receive fair treatment regardless of race, gender, age, or socioeconomic status; diversity centers on healthcare providers understanding the uniqueness of patients from different cultural backgrounds and the health barriers they face; and inclusion centers on ensuring patients are treated with respect and given the attention they deserve. During pandemics, social determinants of health (SDOH) greatly impact patient health outcomes and hinder the practice of EDI. Reflecting on the impact of COVID-19, healthcare systems can actively apply EDI in clinical practice to provide to all patients equitable access to healthcare opportunities and outcomes. Practical strategies include establishing EDI committees within healthcare systems, monitoring relevant data, conducting staff training, and continuously addressing the SDOH and needs of marginalized groups to achieve EDI in healthcare.