젠더와 건강: 성인지적 보건정책을 위한 시론

천희란 ( Hee Ran Chun ),정진주 ( Jin Joo Chung ) 한국보건행정학회 2008 보건행정학회지 Vol.18 No.2

This review paper is to provide theoretical background and empirical evidence for gender sensitive health policy in Korea. We explore how sex and gender are implicated in health disparities. After reviewing major concepts regarding sex, gender, and health, the study moves on to describe the ways in which gender interacts with other social determinants (socioeconomic position, workplace, stress, social support, and violation) to show disparate health outcomes. Next, suggested health models considering gender and social process are introduced. The article concludes by suggesting the necessity of gender sensitive policy consorted with social programs in tackling health equity.

부모의 사회경제적 위치에 따른 자녀의 출생 성비 추이: 1981년부터 2004년까지

천희란,김일호,강영호,Chun, Hee-Ran,Kim, Il-Ho,Khang, Young-Ho 대한예방의학회 2009 예방의학회지 Vol.42 No.2

Objectives : South Korea has experienced unprecedented ups and downs in the sex ratio at birth(SRB), which has been a unique phenomenon in the last two decades. However, little is known about socioeconomic factors that influence the SRB. Employing the diffusion theory by Rogers, this study was undertaken to examine the trends in social variations in the SRB from 1981 to 2004 in Korea. Methods : The data was taken from Vital Birth Statistics for the period from 1981-2004. We computed the annual male proportion of live births according to the parental education(university, middle/high school, primary) and occupation(non-manual, manual, others). Logistic regression analysis was employed to estimate the odds ratios of male birth according to social position for the equidistant three time periods(1981-1984, 1991-1994, and 2001-2004). Results : An increased SRB was detected among parents with higher social position before the mid 1980s. Since then, however, a greater SRB was found for the less educated and manual jobholders. The inverse social gradient for the SRB was most prominent in early 1990s, but the gap has narrowed since the late 1990s. The mother's socioeconomic position could be a sensitive indicator of the social variations in the sex ratio at birth. Conclusions : Changes in the relationship of parental social position with the SRB were detected during the 1980-2004 in Korea. This Korean experience may well be explained by diffusion theory, suggesting there have been socioeconomic differences in the adoption and spread of sex-detection technology.

노년기 예방검진에서 사회경제적 불평등

천희란,김일호,Chun, Hee-Ran,Kim, Il-Ho 대한예방의학회 2007 예방의학회지 Vol.40 No.5

Objectives: Due to the assumptions of homogeneity as well as challenges in the socioeconomic position of the elderly, they have been relatively neglected in studies of health inequalities. Therefore, this study was conducted to investigate the social inequalities in preventive services among elderly men and women. Methods: Data were obtained from a nationally representative sample of 342 men and 525 women aged 65 and over collected during the 2001 National Health and Nutrition Examination Survey. Age adjusted proportions and logistic regression were used to identify the social patterning of preventive services among elderly Koreans using various social position indicators. Results: The findings of this study generally supported the presence of social gradients in preventive services among the Korean elderly. The likelihood of using the service becomes progressively higher with social position. Educational level, income, and self-rated living status were significantly associated with increased medical checkups and cancer checks. In addition, logistic regression detected educational inequalities only among older women receiving BP checks. After being stratified based on health status and chronic disease status, social disparities still existed when educational level and self-rated living status were considered. Among unhealthy individuals, place of residence was observed as a barrier to medical checkups. Conclusions: This study demonstrated strong and consistent associations between socioeconomic position and preventive services among the elderly in Korea. The results indicate that public health strategies should be developed to reduce the barriers to preventive services encountered by the elderly.

기혼 여성의 직업이 신체적, 정신적 건강에 미치는 영향

김일호,천희란,Kim, Il-Ho,Chun, Hee-Ran 대한예방의학회 2009 예방의학회지 Vol.42 No.5

Objectives : The aim of this study was to investigate whether working married women in different occupational classes affected diverse health outcomes. Methods : We used data for married women aged 25-59 (N=2,273) from the 2005 National Health and Nutritional Examination Survey. Outcome measures included physical/mental and subjective/objective indicators (selfrated poor health, chronic diseases, depression, and suicidal ideation from reported results; metabolic syndrome dyslipidemia from health examination results). Agestandardized prevalence and logistic regression were employed to assess health status according to three types working groups (housewives, married women in manual jobs, married women in non-manual jobs). Sociodemographic factors (age, numbers of children under 7, education, household income) and health behaviors (health examination, sleep, rest, exercise, smoking, drinking) and a psychological factor (stress) were considered as covariates. Results : Non-manual married female workers in Korea showed better health status in all five health outcomes than housewives. The positive health effect for the non-manual group persisted in absolute (age-adjusted prevalence) and relative (odds ratio) measures, but multivariate analyses showed an insignificant association of the non-manual group with dyslipidemia. Manual female workers showed significantly higher age-adjusted prevalence of almost all health outcomes than housewives except chronic disease, but the associations disappeared after further adjustment for covariates regarding sleep, rest, and stress. Conclusions : Our results suggest that examining the health impact of work on married women requires the consideration of occupational class.

동북아시아 4개국의 양,한방 의료협진체계 비교

문옥륜 ( Ok Ryun Moon ),김은영 ( Hae Young Kim ),신은영 ( Eun Young Shin ),김혜영 ( Eun Young Kim ),천희란 ( Hee Ran Chun ) 한국보건행정학회 2003 보건행정학회지 Vol.13 No.2

Since 1990s, the use of Complementary and Alternative Medicine(CAM) has been rising rapidly all of the world. In 1983, WHO recommended that the traditional medicine actively be utilized. At the end of 20th century, as chronic and intractable diseases increased in western countries, traditional medicine has attracted considerable attention. COWM shows possibilities of new approaches for these intractable diseases. Thus, we try to show our proper approach of COWM through the international comparative study. In order to fulfill the objectives, we applied the following methodology: 1) Literature review on previous study, 2) Local survey using self-administered questionnaire, and 3) FGI(Focus Group Interview) with local experts. The results were as follows ; Three Asian countries, China, Korea and Taiwan, are very active in implementing COWM policy. Japan, however, has independent system of unified medicine. In regards to the combined care policy and system, China has the most advanced COWM system among four countries. In respect to combined care education, it is needed to increase the COWM education contents and the amount of cross educational curriculum. Based on the current COWM system, Chinese, Japanese and Taiwanese doctors can prescribe both oriental and western drugs. But, Korean medical law prohibits western doctors and oriental doctors from prescribing the counterpart`s medicine. So, the revision of current medical law is urgent for COWM in Korea. And when it comes to patient satisfaction, more than fifty percent responded positively in China, Korea and Taiwan. To achieve the goal of COWM; 1) mutual understanding and recognition of COWM is essential. 2) institutional and legal support system for COWM is desperately urgent. 3) possible international collaboration and cooperation should be sought to untangle these complex cultural dilemmas.

여성 노인의 건강인식에 관한 질적 연구

천희란,강민아,정최경희,조성일,조성일 이화여자대학교 한국여성연구소 2010 여성학논집 Vol.27 No.2

이 연구는 실증주의적이고 계량적 연구방법에 치우쳐 온 건강과학분야에서 노년기 건강에 관한 일반적 연구방법의 한계를 보완하고자 시도되었다. 반-구조화된 질문과 심층면접을 통해 생애단계별로 수집된 구술 자료를 분석하여, 여성 노인들이 자신의 건강을 어떻게 평가하고 있으며 현재의 건강을 결정하는데 중요하다고 인식하는 사건이나 요인은 무엇인지 살펴보고자 하였다. 대상은 기준표본방법(criterion sampling)에 의거해 서울거주 67-79세 여성 노인 12명을 모집하였고, 기초생활수급자 및 비수급자를 비례적으로 포함하였다. 분석은 colaizzi의 현상학적 분석 방법을 사용하였다. 연구에 참여한 여성 노인들은 ‘젊어서 고생’, ‘자식 사망’이나 ‘사업 실패’와 같은 충격적 사건이나 ‘화병’, ‘유산, 출산, 산후조리와 같은 여성특이적 경험’, ‘어릴적 영양상태’와 같이 “생애사유인(誘因)적”으로 건강과 질병의 원인을 찾는 경향이 있었다. 더불어 질병이나 노화를 필연적 인생과정으로 인식하거나, 타고난 체질로 받아들이는 “인생순응(順應)적” 범주도 나타났다. 여성 노인들에게 현재의 건강과 질병은 의학적 진단명이나 임상적 수치로만 표현할 수 없는, 일생동안 축적된 슬픔과 한의 간접적 표현이기도 하고, 사회적 관계의 건전성과 관련된 포괄적 삶의 질 지표이기도 하다. 노인의 입장에서 건강의 의미를 찾고 문제를 검토하는 다양한 연구가 필요하다. This phenomenological study describes how older women evaluate their health and what they perceive attributes to their current health status. Despite recent growing recognition of the need for qualitative methods, there has been little literature on the health of older Korean women from their own subjective perspective. In an effort to fill this gap, we conducted semi-structured, face-to-face in-depth interviews with 12 women aged 67 to 79, residing in Seoul. Each woman was interviewed for 50 to 120 minutes regarding her life course and health perception. We found that, in the case of older females, health and illness might be an expression of accumulated sadness/anger and that their perceptions of health were influenced by life trajectory events according to ‘her lived experience’. Moreover, an individual’s health status in old age seemed to reflect the overall quality of life, particularly in regards to the soundness of social relations. This analysis, following Colaizzi's method, revealed such ‘life experiences’ categories as ‘overwork in younger ages,’ ‘death of a child,’ ‘business failure,’ ‘abortion or post-partum care’ and ‘wha-byung (culturally bounded mental illness due to suppressed anger).’ At the same time, the women interviewed seemed to accept diseases and frailty as ‘part of being old,’ or a ‘natural process.’ For a deeper understanding of health and the meaning of health in later life, further studies should take into consideration, and explore in more details, not only what is answered, but the unique perspective, from which it is said.

인구센서스자료의 영유아 연령자료 평가

천희란,이시백 서울大學校保健大學院 1999 보건학논집 Vol.36 No.1