2016년 건강영향평가 사업 운영 - 노화 관련 건강결정요인과 고령친화산업에 대한 건강영향평가 및 건강영향평가의 제도적 도입 지원 연구

김정선,서미경,최은진,오미애,이난희,윤시몬,강아람,정진욱,손애리,김성민,송기민,김민혜 한국보건사회연구원 2016 한국보건사회연구원 연구보고서 Vol.2016 No.-

1. 연구의 배경 및 목적 건강영향평가는 공공정책 수립을 위한 정보 제공 및 건강 결과를 예측하는 사업으로, 우리 원에서 하는 건강영향평가 사업의 목표는 건강영향 평가를 우리나라에서 제도화하는 것임. 이를 위한 준비 과정으로 다음의 세 가지 방향에 따라 연구 사업을 수행하고 있음. 첫째, 건강영향평가 도입 분위기 조성을 위해 지방자치단체, 중앙단위 정책에 대한 평가시범사업을 실시하고, 둘째, 건강영향평가 인프라 구축을 위해 건강결정요인별, 지역별 특성에 따라 건강영향평가 시범사업을 선정해 실시하고, 건강결정요인별 건강영향평가 가이드라인을 개발하며, 셋째, 정책연구 수행을 통한 제도화 방안을 제시하고, 아시아태평양지역 건강영향평가의 중심 역할을 수행함. 특히 공공정책의 현장에 있는 지방자치단체에서 건강영향평가 제도를 도입할 필요가 있음. 이에 따라 2016년도에는 지자체의 제도화를 위해 서울시 서초구와 긴밀하게 공동연구를 수행하였고, 반딧불센터 운영사업과 양재천 종합정비사업에 대한 건강영향평가를 수행해 긍정적 영향을 극대화하고 부정적 영향을 최소화할 수 있는 권고사항들을 제시함. 또한 초고령 사회로 치닫고 있는 우리나라의 현실을 고려해 고령자와 같은 취약인구집단 또는 잠재적 취약인구집단의 건강결정요인과 관련한 지표를 생산할 수 있는 조사를 실시하여 고령자의 건강 결정요인을 분석하는 기초자료와 건강의 형평성과 관련한 지표를 생산함. 한편 고령자 관련 보행환경 개선사업에 대한 건강영향평가를 수행하고 대상사업에 대한 개선방향을 제시함. 2. 주요 연구 결과 및 시사점 우리나라는 환경보건법에 따라 건강영향평가를 실시하기는 하나, 이는 일부 개발사업에 제한적으로 적용되며, 중앙 및 지방정부에서 수행하는 정책, 사업에 포괄적으로 적용되지 못하고 있는 실정임. 아직 정부 차원에서 독립적인 건강영향평가 법률 제정은 이루어지지 않았으나, 전북 무주군과 서울 서초구 등 일부 지방자치단체에서는 자체적으로 포괄적이고 독립적인 건강영향평가 조례를 만들고, 제도화하기 위해 노력하고 있음. 지방자치단체 건강영향평가 법제화 모형 개발의 원칙은 첫째, 환경영향평가의 일부가 아??독립적인 건강영향평가 법제화 모형 개발로, 건강증진에 직접적인 효과를 많이 도출하고자 하는 것임. 두 번째는 포괄적인 건강영향평가 법제화 모형 개발로서 포괄적인 건강 요인(건강, 사회, 물리적 요인)을 포함하며, 법, 제도, 계획, 사업을 대상으로 하고, 건강에 직간접적으로 영향을 줄 수 있는 모든 범위를 포함해야 실질적으로 건강친화적 정책이 수행되고 시민의 건강증진 효과를 볼 수 있을 것임. 건강영향평가 지자체 모형 개발의 최종 목표는 지속가능한 건강영향평가 법제화 모형 개발 및 수행이 용이하고, 확산이 쉬운 모형을 개발하는 것이며, 이번 연구 결과로 개발된 모형은 2017년 시범사업을 거쳐 수정 보완 후, 지방자치단체에 확산시키고, 장기적으로는 중앙단위의 법제화를 목표로 함. 건강영향평가 인프라 구축을 위한 연구로써 성공적 노화와 관련한 건강결정 요인의 설문 도구는 싱가포르국립대학과 공동으로 개발하여 2012년 서울시 중고령자를 대상으로 1차 조사를 추진한 바 있음. 중고령자 대상 양적인 조사에서는 연령별 차이, 성별 차이, 교육수준의 차이, 소득수준의 차이 등에서 성공적 노화와 건강 관련 요인, 사회적 자본 등의 요인이 관련성을 보여주는 것으로 평가할 수 있음. 본 조사를 통해서 건강영향평가의 건강결정 요인의 지표를 개발함으로써 개인의 건강 유지 및 건강증진을 도모하는 요인을 다양한 차원에서 평가할 수 있을 것으로 기대함. 경제협력개발기구(OECD)의 보고서에 나타난 유럽의 동향 분석에 의하면 횡단면 연구를 기준으로 볼 때 지역 수준의 사회적 자본과 건강 수준은 긍정적인 관계가 있는 것으로 보고된 바 있으나, 관련성이 없는 연구보고도 있음. 사회적 참여를 포함한 사회적 자본은 직접 또는 간접적으로 개인의 건강관리 행동 또는 건강생활에 영향을 주는 것으로 평가된 바 있음. 따라서 정책이나 사업의 계획단계에서 사회적 자본에 긍정적 영향을 주는 방향으로 개발해야 할 것임. 건강영향평가에서 사회적 건강결정 요인을 고려할 때 사회적 자본에 영향을 줄 수 있는 영역을 검토해야 하며, 인구학적 특성과 같은 고정적 요인이 건강 불평등에 미치는 영향을 최소화하는 방향으로 정책을 개발하고 추진해야 함. 이를 위해 사회적 자본을 증가시키는 방향의 정책요인을 개발해야 하고 건강영향평가를 통해 고려할 수 있도록 해야 함. 건강 불평등에 미치는 영향을 최소화하기 위해 취약계층을 지원하는 노력에는 저소득층의 소득이나 사회활동 지원을 위한 사회적 정책이 해당함. 우리나라는 인구학적 특성으로 인한 건강 불평등을 최소화하기 위해 국민건강 증진 종합계획의 정책 목표에 인구집단별 건강증진 목표와 세부사업이 개발된 바 있으나, 노인 건강과 관련한 사업은 만성질환의 예방관리에 초점을 두고 있어 사회적인 건강 증진을 위한 정책 과제를 더 개발해야 할 것임. 우리나라 정부의 노인복지 측면 정책으로는 노인소득보장, 요양 및 건강보장의 정책이 대표적임. 사회적인 측면의 정책으로는 노인 일자리 정책이 대표적인데, 외국의 정책 사례에서 보면 정부의 사회경제적 지원 정책이 취약계층에 충분히 도달할 수 있도록 지속적인 모니터링을 한다는 점이 특징임. 모니터링 지표는 건강의 다양한 차원을 고려하여 사회적 취약계층의 건강 불평등과 관련한 지표로 개발되고 있음. 사회적 자본을 향상하기 위해서는 사회적 참여를 증대시킬 수 있는 사회적 기회를 마련해야 함. 또한 중년 이후에도 다양한 방법으로 사회적 자본을 증대시킬 수 있도록 교육 기회도 더 늘려야 함. 건강영향평가를 시행할 때 성공적 노화 및 사회적 자본의 요인을 고려함으로써 이러한 정책요인을 반영할 수 있도록 해야 할 것임. 고령자 대상 정책사업들 중 건강영향평가 대상사업을 선정하기 위해 고령친화산업에 대한 고령자의 인식을 파악한 결과, 고령친화산업에 대한 중고령자의 인지도는 전체 1000명 중 43%가 인지하고 있고, 이용경험이 있었음. 그러나 향후 이용 의향은 13.8%로 낮게 나타났으며, 남성보다는 여성이 높았음. 고령친화산업 분야별 인지도는 요양산업, 주거산업, 의료기기산업이 상대적으로 높은 수준이었으며, 이어 용구용품산업, 금융자산관리산업, 의약품, 식품, 화장품, 여가문화산업 순으로 나타남. 또한 고령친화산업의 전반적인 우선순위 평가 결과 전체적으로 의약품, 요양, 주거, 식품이 우선순위 중 상위를 차지함. 이들 고령친화산업 중 우선순위가 높은 주거분야에서 운영위원회의 전문가 자문을 통해 고령자 보행환경 개선사업이 평가 대상으로 선정됨. 고령자 보행환경 개선사업에 대한 건강영향평가 결과에 근거하여 사업에 대한 권고사항이 도출됨. 긍정적인 건강영향을 증진할 수 있는 방안으로는 첫째, 교통안전활동 강화를 위해 농촌지역의 국도 통과 도로변 마을입구에 표지판, 가로등을 추가 설치해 운전자의 속도 조절을 지원할 필요가 있음. 둘째, 횡단보도의 길이에 대한 인식은 연령이 많을수록 짧다고 느끼고 있어 장애인용 횡단보도의 점자보도와 알람 등과 같이 횡단보도 시간 연장 욕구가 있을 시에 조절할 수 있는 시설 설치가 유용할 것임. 셋째, 고령자들의 교통안전교육 필요성에 대한 질문에는 91.3%가 필요하다고 응답함. 이에 비춰 볼 때 고령자 교통안전교육의 필요성에 공감하고 있는 것을 알 수 있음. 따라서 경찰 내에 노인교통안전교육 전문가를 육성하고 체계적이고 통일된 고령자용 교통안전교육 프로그램을 운영하여 노인교통안전을 도모할 필요가 있음. 넷째, 교통안전교육의 콘텐츠로는 횡단보도의 녹색 점멸등에서도 건넌다는 응답률이 높아 점멸등에 대한 경각심을 심어줘야 할 것임. 야간 외출 시 밝은 색상의 옷을 입을 것을 포함하여야 할 것이며, 야광 띠 사용도 적극 권장하며, 건강 형평성 차원에서는 지방자치단체의 예산 부담이 되는 시설 개보수와 같은 사업보다는 자원봉사자 또는 고령자의 자발적인 협조가 필요한 사업을 발굴하고 발전시켜 나가야 할 것임. 결론적으로 교통 환경은 고령자들의 건강에 직간접으로 영향을 미치게 되는데, 현재의 보행환경은 조사 결과에서 볼 수 있듯이 고령자들에게는 불편한 면이 있음. 따라서 보행환경 조성사업과 교통안전교육을 통해 고령자들 스스로 교통위험으로부터 보호할 수 있도록 유도해야 함. 1. Background and purposes Health impact assessment (HIA) provides information to establish a health orientated policy and predict the health impacts of different policy alternatives. This study aims to institutionalize HIA in Korea. To achieve this, the following 3 different research projects were carried out as a ground work. First, introduction of HIA was prepared by conducting a pilot project against local and central governmental policies. The second research was the construction of infrastructure for HIA. Pilot project was also executed and HIA guideline was established according to the determinants of health and regional factors. Third, the policy research was performed to suggest strategies for institutionalization of HIA. This is intended to play a central role of HIA in Asia-Pacific region. Local governments are especially in need for implementation of HIA system, as they are first at the scene of public policy. Therefore, a collaborative research was conducted closely with Seocho-gu in Seoul for institutionalization in local government in 2016. HIA was implemented for Firefly center operation and Yangjae-stream integrated improvement projects and suggestions were made to maximize the positive impacts while minimizing negative effects. As Korea is becoming a super-aged society, investigation was conducted to create an index related to the health determinants of vulnerable populations such as senior citizens or the potentially vulnerable population. Required basic information for analysis of the health determinants of the aged group and the equity-focused health index were created. Further, HIA was executed on pedestrian improvement project for old age population and recommendations were drawn. 2. Results and Implications Based on Environmental Health Act, HIA should be conducted in Korea. However, its application is limited to certain development projects, and is not applied comprehensively to local and central governmental projects. There is no independent enactment of an Act regarding HIA at a governmental level. However, some local governments such as Muju-gun in Jeonbuk and Seocho-gu in Seoul implemented a comprehensive and independent HIA regulations and attempted its institutionalization. The first fundamental for development of a local governmental HIA institutionalization model is to develop an independent model, which is not a part of environmental impact assessment. The objective is to induce more direct impacts on health improvement through this model. Second, development of a comprehensive HIA institutionalization model that encompasses all-inclusive determinants of health(health, social, physical factors), subjected to laws, systems, plans and projects. All direct and indirect health impact factors should be included to execute a realistic health promoting policy, consequently the citizens can experience health improvement effects. The final goal of local governmental HIA model development is to create a sustainable HIA institutionalization model that transfer and implementation are easy. The model that has been developed as an outcome of this research, would be improved after pilot studies in 2017. This model will be distributed to local governments with a long-term goal of institutionalization at the central government. In 2012, the first survey on determinants of health that are related to successful aging was conducted against senior citizens in Seoul as a part of the infrastructure building research for HIA. A quantitative analysis subjected to senior citizens showed that a successful aging was associated with health and social related factors such as age, gender, and income level differences. An index for determinants of health was created for HIA. This index is expected to enable a multi-dimensional assessment of factors contributing to the improvement of personal maintenance and health. A trend analysis of Europe in OECD report showed that local social capital has a positive relationship with the level of health when transversal data were observed. On the other hand, there were some studies showing no relationship between them. Social capital including social participation revealed to influence the personal health management behavior or health life, directly or indirectly. Thus, policies and projects should be developed in such a way that it impacts positively on social capital during the planning stage. When social determinants of health are considered during HIA, areas where it can influence the social capital should be examined. Policies should be developed and implemented in a way that the influence of fixed factors on health inequality, such as demographic characteristics, is minimized. To obtain this, the elements of the policies that increase social capital should be generated, and this should be reviewed during HIA. As an effort to minimize the impacts on health inequality, social policies should support income and social activities for the low-income population. In Korea, to minimize health inequalities caused by demographic characteristics, health promotion goal by population group and a sub project were created as a part of the comprehensive plan for national health promotion. However, Korea`s senior wellness program focuses on prevention and management of chronic illnesses. Thus, further project development is needed for social health improvement policies. Korea`s major senior wellness program includes guaranteed income supplement, illness recuperation, and health insurance. Whereas the main social wellness program is an employment policy for seniors. Reviewing overseas`cases, their main characteristics are continuous governmental monitoring that ensures the penetration of their socio-economical support for the vulnerable populations. Monitoring index is also developed considering multi-dimensional aspects of health inequalities of socially vulnerable population. To expand social capital, social opportunities should be created to promote social participation. For the middle age and older populations to increase their social capital with diverse methods, their education opportunities should also be boosted. When HIA is conducted, successful aging and social capital factors should be reflected to the elements of the policies. To select the policies for seniors to apply HIA, awareness of senior friendly program amongst old age population was investigated. Amongst 1000 middle/old age group, 43% were aware of the senior friendly programs and have used the service. However, only 13.8% were willing to use the service again in the future, where females were more eager than males. Illness recuperation, housing, and medical equipment projects were the most recognized services, which are followed by supplies or an article, financial asset management, medicine and medical supplies, food, toiletries, and leisure and cultural services projects. Priority analysis revealed that medicine and medical supplies, illness recuperation, housing and food were at the top of the priority list. As part of the housing project, which has a high priority, pedestrian improvement project for seniors was selected for an evaluation through the expert advice from operating committee. Based on the results of HIA of pedestrian improvement project for seniors, recommendations were drawn. First recommendation to produce positive health impact is enforcing road traffic safety. This is achieved by means of regulation of traffic speed through implementing traffic signs and street lights at the entrance of the rural villages where a national highway passes. Second, as people get older, their perception of the length of the pedestrian crossing becomes shorter. Therefore, installation of a facility that can control the crossing time would be useful such as tactile paving and an alarm system implemented for the disabled. Third, 91.3% responded that a road safety education is required for elderly people, confirming that the majority agrees that the road safety education is necessary. Therefore, it is essential for police department to train professional elderly road safety educators to operate a systematic and unified road safety education program for senior citizens to promote the road safety for elderly people. Forth, precaution for green flickering light must be added to the road safety program, since high percentage of the respondents stated that they cross at the flickering light. Further, wearing bright color cloths should also be added to the program1) and wearing reflective safety gear should also be encouraged. For health equity, it is more suited to create and develop projects that are based on volunteers and voluntary corporation of elderly people, in contrast to high cost projects such as facilities renovation and maintenance. In conclusion, the road and traffic environment influences the health of senior citizens directly and indirectly. The survey showed that the current pedestrian environment is inconvenient for elderly people. Therefore, self-protection should be encouraged for the senior citizens from the road hazard via implementing the pedestrian environment improvement and road safety education projects.

Social Determinants of Health and Health Inequality in South Korea

강우진 한일경상학회 2021 韓日經商論集 Vol.93 No.-

Purpose: Recognizing the social factors behind population health and health equity, the present study examines the role of locality in regional health and assesses the its contribution to local health inequality at municipality level in South Korea. Research design, data, and methodology: The present study investigates the association between a vector of municipal socioeconomic characteristics and population health, taking into account possible unobservable geographica fixed effects at metropolitan/province level, and quantifies the contribution of sources of inter-municipality health inequality by decomposing the disparity in life expectancy across municipalities. For empirical analysis, it draws upon life expectancy data at municipal level in South Korea estimated by The Korean Society for Equity in Health in 2018 and data obtained from various souces such as National Health Insurance Service (NHIS), Annual Local Tax Statistical Report of Ministry of the Interior and Safety (MOIS), National Election Commission (NEC) and Korea Statistical Information Service (KOSIS). Results: This study provides the empirical evidence to the importance of social determinants on local population health and health inequality within and between municipalities. Taking life expectancy as a proxy of municipal population health, we finds the different role of social determinants on local health and health inequality between the highest and the lowest income group within a municipality. While some variables (eg. income inequality among municipal population), for instance, are associated with both life expectancy and its gap, many of other factors such as municipal income level and the degree of financial self-reliance are not prone to life expectancy but the disparity of life expectancy in the context of population health. Implications: The study highlights three findings; (1) level of local autonomy contributed in reducing life expectancy gap across municipality; (2) Geography is closely associated with health inequality across municipalities. Approximately 40 % of inequality stem from non-residence in Seoul metropolitan area; (3) Given the universal population coverage of the national health insurance service, a positive association between the local health related resources and health disparity among municipal population might imply a discrepancy in the level of treatment of diseases. This may result from different household financial capacity and an unequal access to private health insurance.

Statistical Analysis of Social Determinants of Health: An Exploratory Study for Global Comparison

Ik-Whan Kwon,Sung-Ho Kim,David Martin KINFORMS 2017 Management Review Vol.12 No.2

The American healthcare system has become a whipping boy for many global health care professionals who contend that the United States spends more than any other similar countries on health care, yet the health outcomes measured by life expectancy and infant mortality rates of this country have been hovering at the bottom for industrialized nations (Bradley-Springer, 2012). Scholars and researchers in the health care and related fields have been arguing for many years that investment in the health care system alone cannot improve health outcomes (Butler, Bowen and Cabello, 2017). n the United States, another danger is that financial pressure, the decision makers in healthcare may look for a quick and short term solution (Kim and Kwon, 2015). These scholars and practitioners have developed a different hypothesis to explain health outcomes. They argue that “health” can be explained with a composite measure of medical as well as social determinants of health. Social determinants here are defined in this study as spends not directly tied to financial investment in the medical system. The implication for policy makers is that investment in the medical area alone cannot produce intended positive health outcomes. Rather, a nation’s health policy should address investment in the combined health “basket” (medical plus social agents) to achieve health goals. This study using a few industrialized countries similar to the United States in economic characteristics and political system to investigate statistically how much “social determinants” played a role in determining a nation’s health outcomes. Economic agents are also included in the model to investigate comparative contribution to nation’s health outcomes by these two sample groups. Findings show “social determinants” play a more significant role in determining the nation’s health outcomes compared to economic agents (spending in medical care). Policy implications are addressed at the end of this paper.

The Most Important Social Determinants of Slum Dwellers' Health: A Scoping Review

Nejad, Farhad Nosrati,Ghamari, Mohammad Reza,Kamal, Seyed Hossein Mohaqeqi,Tabatabaee, Seyed Saeed,Ganjali, Raheleh The Korean Society for Preventive Medicine 2021 Journal of Preventive Medicine and Public Health Vol.54 No.4

Objectives: Given the importance of social determinants of health in promoting the health of slum residents, this study was conducted with the aim of identifying the main dimensions and components of these determinants. Methods: This scoping review study was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A comprehensive search was performed of PubMed, ProQuest, Scopus, and Web of Science for articles conducted from 2010 to the end of 2019. Studies were selected based on inclusion criteria, with a special focus on studies dealing with the social determinants of physical and mental health or illness. Results: Thirty-three articles were selected to extract information on the social determinants of health. After reviewing the articles, 7 main dimensions (housing, socioeconomic status of the family, nutrition, neighborhood characteristics, social support and social capital, occupational factors, and health behaviors) and 87 components were extracted as social determinants of health among slum dwellers. Conclusions: This framework could be used by planners, managers, and policy-makers when making decisions affecting the health of these settlements' residents due to the common characteristics of slums around the world, especially in developing countries.

장애인의 건강형평성 증진을 위한 법적 과제 - 건강정의 이론을 중심으로 -

김은주(Kim, Eun Ju) 사회복지법제학회 2021 사회복지법제연구 Vol.12 No.2

건강정의 이론은 건강이 개인의 노력뿐만 아니라 그들이 살고 일하는 조건에 의해 형성된다는 것을 인식하고 법과 정책이 이러한 건강의 사회적 결정 요인에 대응해야한다는 것을 전제로 한다. 세계보건기구는 이와 같은 건강의 사회적 결정 요인을 “사람들이 태어나고 성장하고 일하고 생활하며 나이드는 조건 그리고 일상생활의 조건을 형성하는 광범위한 일련의 권력과 시스템”으로 정의한다. 이와 같은 건강의 사회적 결정요인은 다양한 인구집단에 대해 매우 상이한 영향을 미칠 수 있고 이는 인구집단 간의 건강 결과의 불형평성을 야기할 수 있다. 그런데 이렇게 야기된 건강의 불형평성은 불공정하고 피할 수 있으며 불필요한 것이기 때문에 형평성을 증가시키기 위해 정책을 개발할 필요가 있다. 다른 사회적 약자와 마찬가지로 장애인도 광범위하고 지속적인 건강 불평등을 경험한다. 종래 장애는 치료 또는 관리가 필요한 개인의 결함으로 인식되었으나 오늘날 장애에 대한 이전의 고정관념에서 벗어나 사회적 측면에서 이해하는 견해가 대두되고 있다. 이러한 견해는, 장애란 특정한 개인이 사회의 요구에 적응할 수 없는데서 비롯된 것이 아니라 그러한 개인의 필요와 요구에 적응하지 못하는 사회 환경의 실패에서 비롯된 것으로 본다. 이러한 시각에서 보면 장애인의 건강변화는 자신이 가진 특정 조건보다 사회적 결정요인에 영향을 받게 되기 때문에 장애인의 건강에 악영향을 미치는 고착화된 기존의 법제도를 개선하여 건강형평성을 모색할 필요가 있다. 결론적으로 장애인의 건강 불형평성을 해소하기 위하여 (1) 장애인의 실질적 참여 (2) 건강관리 및 의료시스템에서의 불형평성의 제거 (3) 적극적인 주거정책 (4) 경제적 안정성의 보장 (5) 교육접근성의 개선 등이 요구된다. Health justice theory recognizes that health is shaped not only by individual efforts, but also by the conditions in which they live and work. The theory also premises that law and policy must respond to these social determinants of health. The social determinants of health (SDH) are defined by the World Health Organization as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life”. The social determinants of health often lead to health inequities. If health inequities are unfair, avoidable, and unnecessary, it can be reduced or remedied through policy action. People with disabilities, like other socially disadvantaged people, experience persistent health injustice. In the past, it was recognized that disability is an individual defect and that it needs to be treated. Today, however, a new perspective understands disability in a social context. The social model implies that disability stems from the failure of a structured social environment to adjust to the needs and aspirations of disabled citizens, rather than from the inability of a disabled individual to adapt to the demands of society. From this perspective, the health status of the disabled is more affected by social determinants than their specific conditions. Therefore, it is necessary to achieve health equity for the disabled by improving the laws and systems that adversely affect the health of the disabled. Conclusionally in order to eliminate health inequities that disabled people are experiencing, the followings are required : (1) meaningful participation of persons with disabilities (2) elimination of Health Care Inequities (3) progressive housing policy (4) achieving economic stability (5) improvement of access to education.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Zahra Jorjoran Shushtari,Yahya Salimi,Sina Ahmadi,Nader Rajabi-Gilan,Marzieh Shirazikhah,Akbar Biglarian,Ali Almasi,Mohammad Ali Mohammadi Gharehghani 질병관리본부 2021 Osong Public Health and Research Persptectives Vol.12 No.6

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization’s conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

건강형평 정책의 국제 동향: 영국, 네델란드, 스웨덴, 세계보건기구의 경험으로부터의 교훈

윤태호 대한의사협회 2013 대한의사협회지 Vol.56 No.3

Health equity is not just concerned with health care; rather, it is an issue of fairness and social justice. Equity-oriented health policies have increasingly been recognized as important public health issues for the last decades. This study investigates the blueprints for health equity policy that have been made in several developed countries or international organizations. From the late 1990s, national committees in the UK, the Netherlands, and Sweden have proposed comprehensive policies to strengthen health equity. In addition, the World Health Organization and its European regional office have developed policies for their member countries. Several lessons can be drawn from a review of the major blueprints: 1) setting attainable and quantitative targets, 2) action across all the social determinants of health, not just health care services, 3)giving the best start in early life for all children, 4) building equity-oriented universal health care systems, 5) political commitment, 6) participation and democratic decision making at the local level, and 7) monitoring and evaluation of health inequalities and their determinants.

주관적 건강수준의 사회적 결정요인 -시군구 단위 분석-

정진영 한림대학교 생사학연구소 2021 생사학연구 Vol.2 No.-

Object : The study was conducted to study factors of a social community that affects self-rated health to evaluate the quality of health. Methods : The study was conducted on 253 cities and provinces that have a public health center on the basis of 2009. The materials were based on the secondary data such as health research in local communities, population and housing census, migration and population statistics, statistics of local governments, etc. to study the localized DB. Regional variation of self-rated health was analyzed by Multi-variate logistic regression. The dependent variable, which was self-rated health, was categorized into two groups on the basis of the median value(47.9%) and the independent variables were grouped by quartile range. The independent variables were selected by the following two methods. First, the study conducted a factor analysis considering the high relation among the variables and used each factor as the independent variables. Second, This study has been conducted by each variable in independent variables included in the factors. Results : The self-rated health in the 253 cities and provinces was 48.5% on average. When the provinces were categorized into city, gun and gu, gun showed higher index which was 50.4% than city and gu. In terms of variation factor, when the factors were analyzed as independent variables, the lower the urbanization level, mental health problem, medical service usage and chronic diseases and the higher chronic disease management level, the higher the self-rated health was. In terms of independent variables, the lower the consideration of suicide, non-treatment rate of necessary medical service and outpatient usage and the longer the average residential period was, the higher the self-rated health was. Conclusions : It can broaden the understanding of health in local communities and be a ground to establish local medical policies to define social factors of health. The study is significant as it included both structural and contextural factors of a local community as the first study that dealt with the difference self-rated health by region.

Identifying, Measuring, and Ranking Social Determinants of Health for Health Promotion Interventions Targeting Informal Settlement Residents

Farhad Nosrati Nejad,Mohammad Reza Ghamari,Seyed Hossein Mohaqeqi Kamal,Seyed Saeed Tabatabaee The Korean Society for Preventive Medicine 2023 예방의학회지 Vol.56 No.4

Objectives: Considering the importance of social determinants of health (SDHs) in promoting the health of residents of informal settlements and their diversity, abundance, and breadth, this study aimed to identify, measure, and rank SDHs for health promotion interventions targeting informal settlement residents in a metropolitan area in Iran. Methods: Using a hybrid method, this study was conducted in 3 phases from 2019 to 2020. SDHs were identified by reviewing studies and using the Delphi method. To examine the SDHs among informal settlement residents, a cross-sectional analysis was conducted using researcher-made questionnaires. Multilayer perceptron analysis using an artificial neural network was used to rank the SDHs by priority. Results: Of the 96 determinants identified in the first phase of the study, 43 were examined, and 15 were identified as high-priority SDHs for use in health-promotion interventions for informal settlement residents in the study area. They included individual health literacy, nutrition, occupational factors, housing-related factors, and access to public resources. Conclusions: Since identifying and addressing SDHs could improve health justice and mitigate the poor health status of settlement residents, ranking these determinants by priority using artificial intelligence will enable policymakers to improve the health of settlement residents through interventions targeting the most important SDHs.

지역의 건강결정요인 취약성 유형화 및 유형별 건강수준의 차이

박보현,이경희,최숙자,서수경,최선임 한국지역사회간호학회 2021 지역사회간호학회지 Vol.32 No.3

Purpose: This study examined health determinants at a community level and put forward to a typology of five different forms of community health vulnerabilities. We also investigated the differences in the prevalence of chronic diseases, self-rated health, and quality of life (EQ-5D) among the five types. Methods: Latent class analysis was applied to material, social capital, and health behavior vulnerability variables across 255 regions of South Korea. The data came from 2017 & 2019 Community Health Survey. Results: We found five types of community health vulnerabilities: Type 1 group had the highest material vulnerabilities compared to Type 5. The typology was found to be significant in all the regression analysis on the prevalence of chronic diseases (hypertension and diabetes), self-rated health status, and quality of life. In the regions with high material vulnerabilities, the material vulnerability appeared the most effective to the health status of individual’s. In the other regions with less material vulnerabilities, the social capital and health behavior resources were found to be effective. Conclusion: A comprehensive measure of vulnerability can be helpful to understand community health. Policy makers need to consider the level of material vulnerability when planning for a health promotion project.