歌頌慈善 別忘了挑戰不公 -- 曾育慧、鄭雅文

這幾天台灣的媒體與社會，上至總統，下至市井小民，簇擁著被《時代》雜誌冠以英雄光環的陳樹菊女士。一介平凡女子對其家庭、鄰里、社會的愛心與無私奉獻，著實令人動容，也為長期以來陷入政治紛擾的台灣社會，注入一股暖流。然而，在整個社會為之風靡的現象背後，有一些議題值得深入省思。     　首先，我們感到好奇的是，這個獎是怎麼選出的？甄選機制如何進行？國外媒體如何得知台灣一個平凡民眾的善行？我們並不質疑陳女士得到各界肯定本身的正當性，但只要上網搜尋即可發現，陳女士被人推薦給《富比士》雜誌，由其編輯群審查後入選為亞洲地區四十八個慈善英雄之一，之後又被《時代》雜誌推選為世界最具影響力的百人之一。     　《富比士》雜誌乃以財經界人士為主要讀者群，專為世界富豪名人排名。我們好奇的是，為什麼這個標榜創業致富、崇尚財富與地位聲望的雜誌，會對陳女士給予青睞？透過這些排名，凸顯又是怎麼樣的價值觀？     　擁有財富與地位聲望的人，往往喜愛歌頌慈善行為，卻厭惡那些動輒質疑財富分布、挑戰不公平社會權力結構，甚至意圖進行社會改革的人。在許多例子中，皆可看到類似現象。例如，在貧窮問題嚴重的孟加拉，就出了一個廣受國際社會讚揚的二○○六年諾貝爾和平獎得主尤努斯，但卻很少人知道有一個致力於公衛改革的賈福拉醫師。     　尤努斯創辦窮人銀行，鼓勵貧窮婦女貸款創業，是個具有人道關懷與社會責任的銀行家，但他不挑戰造成貧窮的權力結構，且鼓勵個人創業，相當符合西方主流社會的資本主義邏輯，因此也成為了國際發展政策的座上賓。     　相對地，賈福拉醫師致力於推動平價藥品的普及，在參與國家藥品政策的改革過程中，牽動了藥品涉及的龐大利益，屢遭既得利益者打壓，差點被暗殺，在國際媒體中也較少受到關注。如同上述例子，在許多社會中，既得利益者似乎都傾向於讚美個人主義式的慈善美德，但卻往往忽略，甚至刻意壓制，那些積極改善不公平權力結構的人。     　在我們給予陳女士喝采之餘，更需要思考的是，若有學校籌不出經費蓋圖書館，是否教育資源的分配出了問題？當有些學童的學費仰賴善心人士捐助，是否社福與教育體系需要改善？若有民眾的健保費得仰賴捐款，是否需要檢討保費制度？我們期待的是促進互助合作的社會制度，而非更多的慈善家。

本文刊登於中國時報2010-5-13

曾育慧為台大衛生政策與管理研究所博士生，鄭雅文為台大衛生政策與管理研究所副教授

Charity does not change the system

By Yawen CHENG and Mayeesha Yuhwei TSENG 

Published on Taipei Times, Thursday, May 20, 2010, Page 8

Over the last few days, we have seen people in Taiwan, from the president down to the person on the street, fall over themselves praising Chen Shu-chu (陳樹菊) after Time magazine placed her on their 2010 Most Influential list under the “Heroes” category for philanthropy. Her picture has been splashed all over local newspapers. There’s no denying that the selfless contribution this unassuming woman has made to her family, neighborhood, and the wider society is very moving.

The attention given her, however, brings up several points that might be worth considering for what they tell us about Taiwanese society.

The first question we might ask is how the winners of this award were actually chosen. How did the international media get wind of the philanthropy of this Taiwanese woman? This is not to say that she is undeserving of the accolade given to her. A simple Internet search will tell you that she was originally recommended to Forbes magazine, after which the editors decided to include her in their list of the 48 top philanthropists for Asia. Time then named her as one of the top 100 most influential people of the year.

Forbes is known for its annual rich list and its readership is composed primarily of people involved in finance. The magazine is most at home with moneymaking and obsesses over wealth, status, power, and prestige. Given that, what it is about Chen they found so interesting? After all, the rich list is, surely, exclusively focused on money.

The rich and powerful just love to praise charitable actions but balk at those who question the current distribution of wealth and challenge unfair social power structures, not to mention people who try to bring about social reforms.

For example, look at poverty-stricken Bangladesh. Muhammad Yunus received international acclaim and the Nobel Peace Prize in 2006 for his work in economic and social development from below, but hardly anyone knows about public health activist Zafrullah Chowdhury, who has been involved in public health reforms in that same country.

Yunus is the founder of Grameen Bank and has been instrumental in providing poor women with microcredit so they can improve their circumstances. As a banker, he is notable for his compassion and social responsibility, but he has never actually challenged the power structures that created the poverty in the first place. Also, by encouraging people to create personal wealth, he is subscribing to the Western mainstream capitalist paradigm, which goes some way to explaining why he has become the darling of international development policy.

By comparison, Chowdhury has worked hard to make inexpensive medicine universally available. He has done much to improve the national drug policy, but people with vested interests have constantly obstructed him to the point that an attempt was even made on his life. The international (that is, Western) media have also more or less turned a blind eye to his work.

In many societies, vested interests are quite happy to heap accolades on charity work done at the individual level, but have a habit of ignoring, or even blatantly obstructing, anyone who actively tries to change existing unfair and oppressive power structures.

We would like to applaud Chen for her work At the same time, however, it is important to keep a perspective on what is happening in our society.

We should be asking whether there are deeper issues such as the current allocation of education resources when schools cannot afford to build libraries; whether we need to take another look at our social welfare and education systems when some school children rely on charitable donations to pay for their tuition fees; and whether there is something wrong with our health insurance system when there are people out there who rely on handouts to keep up with their health insurance payments. What we would like to see is a social system that promotes mutual cooperation, instead of relying on more philanthropists.

Cheng Yawen is an associate professor at the Institute of Health Policy and Management at National Taiwan University. Mayeesha Yu-hwei Tseng is a doctoral student at the institute.

TRANSLATED BY PAUL COOPER 

禁止派遣並不矛盾

    　「時論廣場」五月三日呂紹煒先生〈禁止派遣很矛盾〉一文，指出勞工團體要求政府禁用派遣勞動的矛盾。筆者有不同的看法。

    　其一，有關穀賤傷農、穀貴傷民的說法，將農民與消費者簡化地對立起來，在帕特爾的《糧食戰爭》一書中即清楚指出，世界糧食體系就像一只沙漏，上下兩端分別是為數眾多的生產者（農民）與消費者，溝通兩者的是大型食品企業與貿易商。細細的沙漏瓶頸，正是糧食產銷體系的權力所在，支配了產地的收購價格與市場上的銷售價格；而在規模經濟的趨勢下，自由市場只會加速沙漏瓶頸的窄化。對於生產物品或服務的勞工與消費者而言，也正是處在沙漏兩端。呂先生的二元對立論點忽略了掌控食物價格的產銷體系，也忽略了掌控勞動薪資的權力結構機制。

    　其二，所謂「派遣」，乃是由要派公司、派遣公司、工作者形成三角關係，工作者先與派遣公司簽訂勞雇契約，再由派遣公司派至企業（或政府單位）任職；派遣公司則與要派公司簽訂商業契約並收取服務費。企業（或政府單位）使用派遣人力的主要目的是為了降低人力成本，並規避勞動法令規範的雇主責任。

    　在政府機構，派遣工作者的處境與一般約聘制工作者大不相同，後者雖不是公務人員，但仍由政府聘人單位負擔勞健保、職災保費、保障職場安全健康等雇主責任，留任者也可累積年資。而派遣工作者則與政府聘人單位全無勞雇關係，一旦發生職災或其他勞動爭議，一律與政府無關。此外，更可能因政府委託的派遣公司年年更換，而必須年年當新人。呂先生認為「政府單位若不使用派遣勞動，代表納稅人要多養非常多薪資較高、福利較好、工作又受保障的公務員」，此推論相當誤導。

    　其三，呂先生認為政府因為官僚特性，薪資高福利好的正職員工效率與生產力一定不會太好，納稅人將當冤大頭，因此「我們該要求政府禁止僱用派遣人力嗎？」此論點相當缺乏說服力。一個缺乏就業保障、缺乏勞動權益保障、屬於政府聘雇機構化外之民的工作者，如何能對此份工作保有歸屬感與認同感？政府行政效率的提昇的確是重要議題，但政府人力素質問題的改善，應從人才晉用、考核、汰換，以及行政管理等機制著眼。使用派遣勞動除了降低政府人事成本之外，看不出如何改善既有的人事制度問題？如何提昇政府行政效率？

    　在職場安全健康領域上，國際已有不少研究指出，缺乏保障的工作、缺乏民主參與、受僱者權力不對等的職場環境，乃是導致工作者職場疲勞問題的重要成因。近年來政府將彈性工作視為解決結構性失業的方案，政府部門也在節約人事支出的考量下，大量聘用彈性員工。筆者認為，政府鼓勵勞動派遣，將「人力派遣業」列為重點發展產業，甚至帶頭使用大量派遣勞工，乃是製造不穩定就業的重要推力，伴隨而來將是工作者勞動條件與職場安全健康問題的普遍惡化。

本文發表於中國時報 2010-05-06

作者為台灣大學衛生政策與管理研究所副教授