지방자치단체의 건강증진사업 활성화 방안 : An Educational Approach 교육적 접근을 중심으로

이명순 Korean Society for Health Education and Promotion 1999 International Symposium Vol.1999 No.-

This paper will discuss about how we can foster educational support mechanisms to facilitate health promotion programs at the local level. Health promotion in Korea is in the early developmental stage; it has only been since the Health Promotion Act was legislated in 1995, the health promotion programs have been planned and implemented. In the context of the recent decentralization process, local health departments have a major responsibility for developing and implementing health promotion programs at the local level. The short history of health promotion in Korea has meant that local public health departments have limited experience and organizational capacity for health promotion planning & practice. The results of one survey for investigating the progress of health promotion at the local level are instructive. The survey demonstrated that the public health workers recognized that the lack of personnels, insufficient budget, the lack of policy & the organizational support, the lack of skill & knowledge to be effective health promotors, the lack of guidance for health promotion practice were major barriers to implementing health promotion programs at the local level. The object of this paper is to suggest some ways of overcoming barriers to implementing health promotion programs at the local level This paper emphasizes on the importance of educational supports as well as environmental supports - legislative, policy, organizational, economical - in building the organizational capacity and infrastructure of local health department for health promotion. It suggests some ways of providing educational supports to the public health workers at the local level. and supports the positions that educational opportunities for training in health promotion can be better provided to the public health workers at the provincial level rather than at the national level. It argues that the educational & training programs should be developed and based on the educational need assessment; that the application of the main educational principles & theoretical models for health promotion be used to develop educational programs for the public health workers; and that professional health organizations should make plans to provide more educational programs at their annual conferences of at other convenient times. These kinds of educational supports facilitate the ability of public health workers to improve their capacity for health promotion practice at the local level and help to alleviate some of the pressure of state resources.

Coverage of Entry-Level CHES Responsibilities and Competencies Developed in the United States by Health Education-related Professional Preparation Programs in Japan

Sakagami, Keiko Korean Society for Health Education and Promotion 2006 보건교육건강증진학회지 Vol.23 No.5

This study assessed 1) the coverage of the entry-level responsibilities and competencies for certified health education specialists (CHES) developed in the United States (U.S.) by 140 current health education-related professional preparation programs in Japan, and 2) barriers and concerns related to the development of Japanese health educators. A cross-sectional survey study was conducted to Japanese professors teaching health education-related courses at 4-year universities/colleges in Japan. All entry-level CHES responsibilities and competencies were generally covered to different degrees by the study respondents. The top 3 responsibilities most emphasized by the respondents were Responsibilities I, related to need assessment skills, Responsibility II, related to planning health education programs, and Responsibility III, related to implement health education programs. The 3 competencies most frequently covered by the respondents were related to needs assessment skills (Competencies 1-3). The competencies least covered by the respondents were those related to Responsibilities V (Competencies 1619). Other competencies related to role modeling, cultural competencies, and planning youth health education programs, were recommended. In addition, the major concerns and opinions that the respondents reported for this topic pertained to 1) Professional training, 2) The need for well-defined professional roles, and 3) The importance of licensing. The results suggested that Japanese health education-related programs cover all CHES responsibilities and competencies developed in the U.S. to different degrees. However, they tend to focus more on needs assessment, planning and implementing health education programs. Although possible responsibilities for future Japanese health educators were recommended, further research to identify the most appropriate responsibilities and competencies for this profession is needed. Major barriers, concerns and opinions reported by the respondents should be discussed at future meetings for this profession.

Health Care Access and Utilization among Korean American Adults in Alameda County, California: 1994 and 2002

Kim, Young-Bok,Moskowitz, Joel M.,Lee, Hyun-Ju,Kazinets, Yevgeniy Korean Society for Health Education and Promotion 2006 보건교육건강증진학회지 Vol.23 No.5

Purpose: Since 1994, Asian Health Services, the Korean American Community Advisory Board, and the Center for Family and Community Health (University of California at Berkeley) have conducted periodic, population-based surveys on Korean American community health in Alameda County, California. The present study examines changes in health care access and utilization between 1994 and 2002 among Korean American adults in Alameda County, California. Method: We reanalyzed data from the 1994 and 2002 Korean Health Surveys. The primary variables of interest, health care access and utilization, were operationalized in terms of health insurance coverage, routine check-ups, a usual source of health care and reported barriers to health care. The frequency distribution of each indicator was calculated and its standard error was estimated using SUDAAN. The differences between 1994 and 2002 were examined with chi-square test. Results: Compared to 1994, Korean Americans in Alameda County were more likely to have health insurance coverage in 2002 (74.0% vs. 82.7%). Korean Americans in Alameda County were more likely to have received a recent (prior two years) routine health checkup in 2002 (50.4% vs. 57.2%). Health checkups increased over time for males, for adults with more than 12 years of education, and for employed adults. Also, compared to 1994, employed adults were more likely to have a usual source of health care in 2002 (66.5% vs. 78.4%). In both 1994 and 2002, high cost (58.0% vs. 47.8%) was the most commonly cited barrier to health care, and the next most frequently cited barriers were language (29.2% vs. 27.7%) and no time (29.2% vs. 30.3%). Conclusion: To improve health care utilization and health conditions, it is important to investigate factors related to health care and to monitor changing trends. Ongoing surveillance of health-related factors can contribute to the development of health education programs to reduce morbidity and mortality due to chronic disease, and thereby lead to improvements in health status among Korean Americans.

Health Improvement; Health Education, Health Promotion and the Settings Approach

Green, Jackie Korean Society for Health Education and Promotion 2005 보건교육건강증진학회지 Vol.22 No.3

This paper develops the argument that the 'Healthy Cities Approach' extends beyond the boundaries of officially designated Healthy Cities and suggests that signs of it are evident much more widely in efforts to promote health in the United Kingdom and in national policy. It draws on examples from Leeds, a major city in the north of England. In particular, it suggests that efforts to improve population health need to focus on the wider determinants and that this requires a collaborative response involving a range of different sectors and the participation of the community. Inequality is recognised as a major issue and the need to identify areas of deprivation and direct resources towards these is emphasised. Childhood poverty is referred to and the importance of breaking cycles of deprivation. The role of the school is seen as important in contributing to health generally and the compatibility between Healthy Cities and Health Promoting Schools is noted. Not only can Health Promoting Schools improve the health of young people themselves they can also develop the skills, awareness and motivation to improve the health of the community. Using child pedestrian injury as an example, the paper argues that problems and their cause should not be conceived narrowly. The Healthy Cities movement has taught us that the response, if it is to be effective, should focus on the wider determinants and be adapted to local circumstances. Instead of simply attempting to change behaviour through traditional health education we need to ensure that the environment is healthy in itself and supports healthy behaviour. To achieve this we need to develop awareness, skills and motivation among policy makers, professionals and the community The 'New Health' education is proposed as a term to distinguish the type of health education which addresses these issues from more traditional forms.

Health Status and Associated Health Risks among Female Marriage Immigrants in Korea

Kim, Hye-Kyeong,Yoo, Seung-Hyun,Cho, Seon,Kwon, Eun-Joo,Kim, Su-Young,Park, Ji-Youn Korean Society for Health Education and Promotion 2010 보건교육건강증진학회지 Vol.27 No.5

목적: 본 연구는 외국인 여성결혼 이민자의 건강위험 요인 및 문제점을 파악함으로서 향후 외국인 여성결혼 이민자의 건강증진 프로그램 지원 및 정책 수립의 기초 자료를 제공하고자 하였다. 방법: 연구의 대상은 지역 보건소 및 동.면사무소 등에 등록된 외국인 여성결혼 이민자 중보건복지가족부의 무료건강검진사업 참여자 3,069명이다. 건강검진은 한국건강관리협회 15개 지부에서 2008년 7월부터 11월까지 5개월간 실시하였으며, 기초, 소변, 간기능, 당뇨, 고지혈증, 빈혈 등 총 21개 검사항목으로 구성되었다. 또한 검진과 함께 자기기입식 설문을 통한 건강행태조사를 실시하였다. 설문은 인구사회통계학적 특성, 식습관, 흡연 및 음주 습관, 신체활동 및 정신건강상태에 관한 항목으로 구성되었으며, 국어, 영어, 중어, 베트남어로 제작되었다. 결과: 결혼이민여성들의 건강문제는 연령과 출신국가에 따라 달랐으며, 건강행태 또한 출신국가, 연령, 한국 거주기간에 따라 다른 양상을 보였다. 질환 의심률은 연령이 높아질수록 유소견율이 증가하는 일반적인 경향을 확인할 수 있었다. 출신국가별로는 필리핀 이주 여성의 질환의심율이 54.7%로 전체 평균인 43.6%를 크게 상회하였고, 베트남 여성의 질환 유소견율이 낮았다. 일본출신 여성이 다른 국가 출신에 비해 건강한 식습관을 지니고 있는 것으로 조사되었다. 여성결혼이민자가 주 1회 이상 음주하는 비율이나 현재 흡연율은 대체로 낮은 수준이었다. 그러나 땀이 베일 정도의 운동을 1주 동안 전혀 하지 않는다는 응답이 72.3%에 달해 평소 건강관리에 대한 관심이 더 필요한 것으로 보였다. 37.1%가 지난 한달 간 심한 스트레스를 경험한 것으로 응답하였으며, 국적별로는 중국출신(43.7%)의 스트레스 경험 비율이 높게 나타났다. 생활습관과 질환유소견율 관련성에서 규칙적으로 운동을 하는 경우 그렇지 않은 경우에 비해 비만(BMI) 및 고지혈증(총콜레스테롤) 유소견율이 높게 나타났다. 이러한 결과는 질환위험이 높다고 인식하는 사람일수록 생활습관 개선에 더 적극적인 것으로 보였다. 결론: 결혼이민자의 건강특성은 연령, 거주기간별, 출신국가별로 다양하므로 이러한 개인적 특성에 맞는 차별화 된 건강증진 프로그램과 정책이 개발되어야 한다. 또한 결혼 이민자의 건강위험과 생활습관 실태 및 이들 간의 관련성을 파악하는 지속적인 검진과 연구가 수행되어 보다 실제적인 건강증진 전략개발을 위한 기초정보가 제공되어야 한다. Objectives: This study aims to identify health status and health risks among female marriage immigrants to Korea and to provide a basis for public health strategies to address their health issues. Methods: The participants of the study were 3,069 immigrant wives. The health examination was conducted by the Korea Association of Health Promotion (KAHP) in 2008. The participants also completed self-administered questionnaires on demographic characteristics, health-related behaviors and mental health. Results: Patterns of immigrant women's health problems differed by age and country of origin. Behavior patterns also differed by their heritage, age, and years of residence in Korea. Generally Vietnamese women fell in lower ranges of disease prevalence and health risk factors in the participant group and Japanese women presented most healthy eating habits. Filipina women showed relatively high disease prevalence than any other group. Conclusion: Immigration to Korea by marriage is relatively a new phenomenon, thus continuing surveillance and research are needed to identify health risks, behavior patterns, and their relationships. Interventions and policies for the health of migrant wives, their children and families are required.

Roles for Public Education in Mental Health Promotion, Prevention of Mental Illness and Treatment of Mental Disorders in Canada

Nelson Connie H.,Nelson R. Neil Korean Society for Health Education and Promotion 2005 보건교육건강증진학회지 Vol.22 No.3

Objectives: The purpose of this paper is to describe the role for public education in mental health promotion, prevention of mental illness and treatment of mental disorders in Canada. Results: A brief history of the changing nature of the way we treat mental disorders in Canada argues for an increasingly critical role for public education. Furthermore, the new understanding of the role of social determinants in prevention of mental illness again necessitates a vital role for public education as the shift in focus moves from exclusively individual-focused health care treatments to creating supportive environments. The roles for mental health public education then become: advocacy for the social determinants of health approach, better understanding of the nature of mental health problems, useful information for self-management, and more knowledge about appropriate treatments. A brief discussion of the structure of the response in Canada provides an overview of national and provincial responsibilities in mental health care with a case study highlighting one community's response to addressing mental disorders. Conclusion : Finally, challenges regarding the most effective educators and the issue of professional expertise embedded in the status quo are discussed.

Unmet Needs for Mental Health Care and Its Implication for Health Education in Canada

Park, Jung-Wee,Nelson Connie H. Korean Society for Health Education and Promotion 2005 보건교육건강증진학회지 Vol.22 No.3

Objectives: Individuals' self-reported unmet needs are an important indicator of heath care of their society. Using data from the Canadian Community Health Survey (CCHS) Cycle 1.2, we examine unmet needs for mental health care in Canada and discuss its implications to health education. Results: The most frequently reported reason for unmet needs was barriers to acceptability issues, which stem primarily from lack of knowledge of mental health, negative attitudes towards mental disorder, and mistrust of mental health professionals. Unmet needs for mental health care appeared an especially serious issue among the young. Also, individuals who reported unmet needs tended to have some ill health behavior such as illicit drug use that could be their coping mechanism. On the other hand, emotional and informational support factors have shown an important mitigating effect on unmet needs. Conclusions: These findings of unmet needs pose a major challenge to health education. To effectively address unmet mental health care needs, it is recommended that the focus of relevant policies and programs should be on enhancing a multi-level mental health education strategy including efforts on individual, environmental and professional level education.

'Healthy Japan 21' : A New Perspective on Health Promotion Policy for Japan in the 21st Century

Hasegawa, Toshihiko Korean Society for Health Education and Promotion 2005 보건교육건강증진학회지 Vol.22 No.3

'Healthy Japan 21' is a new health policy that has been proposed for the 21st century: it embodies a totally new concept for its viewpoints and methods. To start with, for its goal, the focus is placed on the 'quality of life' or a life that is free of diseases, rather than mere prolongation of life. For its doctrine, the emphasis has shifted dramatically from improving the health of the entire population(the traditional approach for health improvement) to 'achieving an ideal health status for each individual. The ultimate aged society that arrives first in Japan is a society in its ultimate form for human being. Why did Japan become westernized, giving up her traditional culture? Why did she go through industrialization, sacrificing her nature? And why does she try so hard to industrialize the developing countries? These efforts are all preparation for the arrival of a ultimate aged society. During the 20th century, we believed in unlimited possibilities and expanded our social frontier. In the 21st century, on the other hand, a super-aged society(the ultimate society), a glimpse of which we have witnessed from time to time, will descend on us sooner or later. It is expected to arrive first in Japan. 'Healthy Japan 21' is intended to prepare for the arrival of the hitherto unheard of super-aged society by building the physiological basis of people. This policy is social experimentation on an immense social scale, in which questions are posed on the understanding of health, the relationship between individuals and society, the relationship between administration and citizens, the manner by which central and local governments operate, and the new relationship between prevention and therapy, 'Healthy Japan 21' may be summarized as an experiment on a huge scale directed to the ultimate form of human society, in which Japan and each of her citizens play a role and set an example for the rest of the world. Even just by considering various approaches newly suggested for this venture, one may be convinced that it is a policy with features suitable for a country that has already achieved the world's highest longevity.

The United States CHES Program: The Role and Development of the Modern Health Educator

Sohn, Ae-Ree,Burzo, Jamie Korean Society for Health Education and Promotion 2010 보건교육건강증진학회지 Vol.27 No.5

목적: 보건교육 분야는 상대적으로 새로운 영역이나 전 세계적으로 건강증진의 중요성에 대한 요구가 강조되면서 빠르게 발전되고 있다. 많은 나라에서 보건교육사 프로그램을 제도화하는 노력을 하고 있다. 본 연구는 미국의 보건교육사 제도를 고찰함으로써 국제적 보건교육사 제도의 개발 및 발전에 기여하는 데 있다. 방법: 본 연구는 문헌고찰을 통하여 미국의 자격증 제도, 보건교육사의 역사 및 다양한 현장에서 보건교육사의 역할과 특성을 파악하였다. 결과: 보건교육사의 역할과 기술은 현장에 따라 다르게 요구되나 크게 일곱 가지의 대영역으로 분류되며, 35개의 기술 분야에서 163개의 하위기술이 필요한 것으로 나타났다. 미국은 의료비의 증가로 인하여 만성질환의 조기발견과 예방사업을 위하여 미국의 보건교육사는 2006년에 2006명에서 2016년에는 78,000명으로 증가될 것으로 전망된다. 보건교육사는 다양한 분야에서 고용되고 있으며, 주로 지역사회 건강단체, 연구소, 보건센터(병원, 의원, 보건소), 학교, 정부공무원 및 사업체 등에서 활동하고 있다. 결론: 미국의 보건교육사 제도의 발전은 보건교육사 프로그램을 개발하고 발전시키고자 하는 여러 나라에 좋은 모델이 될 수 있다. 또한 미국 보건교육사의 다양성과 전문성은 한국의 보건교육사 제도의 발전에 도움이 될 것으로 여겨진다. Objectives: The field of health education is still relatively new and is therefore evolving and developing rapidly throughout the world. Many countries' certification programs are still being created. This paper will discuss on the US CHES system of regulation, accreditation, and implementation for the future development of international health education programs. Methods: This article focuses on the United States CHES credentialing program, specifically on its historical development and the roles, employment settings and socioeconomic demographics of current CHES professionals through literature review. Results: The roles and skills required vary by employment setting, with seven universally recognized responsibilities of health educators. There are also 35 key competencies which are crucial to the role of the health educator, with 163 sub-competencies performed by all health educators. The employment of health educators will increase from 62,000 in 2006 to 78,000 in 2016. As the costs of healthcare increase, employers are projected to hire more health educators to decrease healthcare costs through prevention and early detection of chronic illnesses. Community health non-profit agencies, academia, healthcare (hospital/clinic), schools, government/government contracting, and businesses are some of the most widespread employment settings for health educators in the United States. Conclusion: Better understanding of this longstanding and successful program will benefit countries developing their own certification system. The variety and specificity of the information on the US CHES program may be of value as South Korea continues to develop its Korean CHES program.

Regional Contextual Factors and Self-Rated Health: a Multilevel Study of Korean Adults

Lee Sang Gyu Korean Society for Health Education and Promotion 2004 보건교육건강증진학회지 Vol.21 No.4

Objectives: To examine whether the socioeconomic characteristics of communities (contextual effects) are related to the self-rated health of community residents after controlling individual characteristics (compositional effects). Methods: A linked data set including information on individuals from raw data of 1998 Korean National Health and Nutrition Survey(KNHNS) and information on the regions where the individuals lived from the socioeconomic statistical indices of Si-Gun-Gu (city-county-ward) in 1998 was established. The contextual factors of communities were generated from these socioeconomic indices through factor analysis. The contextual effects of community over and above the individual characteristics on the self-rated health were investigated using multilevel analysis. Results: The contextual factors of the community expressed as the factor scores have influence on the self-rated health of their residents above the compositional factors. When the communities were categorized into 5 groups (highest, high, middle, low, lowest) according to each of their factor scores, for factor 1 reflecting urbanization reversely, the residents of the communities that had the high, middle, and low factor scores showed significantly poor subjective health status than the residents of the lowest (most urbanized) group. For factor 2 reflecting community services and health resources, the subjective health status of the residents gradually became poorer when the group went from the highest to the lowest, and the low and lowest groups showed a significant difference. For factor 3 reflecting the manufacturing industry, as compared with the communities that have the highest factor scores, the other 4 groups showed significantly poorer subjective health status. And for factor 4 reflecting the scale of the regional government, as compared with the middle group, the rest of the 4 groups showed significantly better self-rated health. Conclusions: There existed regional contextual effects on their residents' health in Korean adults. To make policies tackling these contextual effects possible, more elaborate researches to find more specific factors and to explain the mechanisms of how health is influenced by the contextual factors are needed.