한국의 건강불평등과 정책방향

이창곤(Lee Chang-gon) 고려대학교 아세아문제연구소 2006 亞細亞硏究 Vol.49 No.1

“An imbalance between the rich and the poor is the oldest and the most fatal ailment of all publics.” This is a saying of the old historian, Plutarch. Inequality has become and will be one of key issues more and more over times in Korea. The reason may be that health is one of the most significant elements for mankind to survive. The reason may be that inequality in health is the worst inequality of all. Actually, there is no more serious inequality than the fact that you’ll die sooner only because you’re poor.<br/> The causes of health inequalities are very diverse. Originally, these stemmed from structural contradictions in a society such as class inequalities. Factors such as income, wealth, gender and post-code have an impact on people’s ability to fight illness.<br/> This essay is an attempt to describe inequalities in health such as mortality and morbidity by socioeconomic status in Korea. Socioeconomic inequalities were studied in relation to education level, household income and employment status, smoking prevalence, and geography etc. Consequently, the purpose of this study was to examine the current inequality in health and explore the patterns and trends of present health inequalities in Korea. In particular, I will emphasize the fact that to reduce health inequalities economic inequalities such as poverty should be dealt with fundamentally by focusing on social class contexts. Poor health is a determinant of social exclusion along all its dimensions (Burchardt, 2002). In conclusion, I will comment the government’s health polices for reducing health inequalities and suggest some implications.<br/> In this easy, I revealed the fact that inequalities in health have been wider in the past century and still widening in Korea. For this, I showed historical and practical evidences about health inequalities with the emphasis of economic inequalities such as poverty. These trends of widening have followed and are following socioeconomic polarization in Korea. In fact, tackling health inequalities is very tricky issue to solve because this issue fundamentally stemmed from economic inequalities based on social class and lots of other factors such as unemployment. Moreover, today, income and wealth inequalities are widening.<br/> Actually and originally, some claim that inequalities are inevitable. Are these out of hands? My answer is definitely no. we can deal with this issue. Just we need more wisdom, more consensus, more accurate policies and our will for narrowing health inequalities. For this, the most important thing is that inequalities in health can only be effectively tackled by policies that reduce poverty and income inequality (Shaw, 2003). Public health goals and health promotion programmes should be developed to reduce socioeconomic gaps in health status and improve the health among those with low levels of income and education (Kim, 2003). Korean government should give priority to reducing health inequalities in the social policy agenda. Actually, all human beings have their social rights for adequate living standards, protection against income insecurity and proper health services as well.

Gender, Professional and Non-Professional Work, and the Changing Pattern of Employment-Related Inequality in Poor Self-Rated Health, 1995-2006 in South Korea

Kim, Il-Ho,Khang, Young-Ho,Cho, Sung-Il,Chun, Hee-Ran,Muntaner, Carles The Korean Society for Preventive Medicine 2011 Journal of Preventive Medicine and Public Health Vol.44 No.1

Objectives: We examined gender differential changes in employment-related health inequalities according to occupational position (professional/nonprofessional) in South Korea during the last decade. Methods: Data were taken from four rounds of Social Statistical Surveys of South Korea (1995, 1999, 2003, and 2006) from the Korean National Statistics Office. The total study population was 55435 male and 33913 female employees aged 25-64. Employment arrangements were divided into permanent, fixed-term, and daily employment. Results: After stratification according to occupational position (professional/nonprofessional) and gender, different patterns in employment - related health inequalities were observed. In the professional group, the gaps in absolute and relative employment inequalities for poor self-rated health were more likely to widen following Korea's 1997 economic downturn. In the nonprofessional group, during the study period, graded patterns of employment-related health inequalities were continuously observed in both genders. Absolute health inequalities by employment status, however, decreased among men but increased among women. In addition, a remarkable increase in relative health inequalities was found among female temporary and daily employees (p = 0.009, < 0.001, respectively), but only among male daily employees (p = 0.001). Relative employment-related health inequalities had clearly widened for female daily workers between 2003 and 2006 (p = 0.047). The 1997 Korean economic downturn, in particular, seemingly stimulated a widening gap in employment health inequalities. Conclusions: Our study revealed that whereas absolute health inequalities in relation to employment status increased in the professional group, relative employment-related health inequalities increased in the nonprofessional group, especially among women. In view of the high concentration of female nonstandard employees, further monitoring of inequality should consider gender specific patterns according to employee's occupational and employment status.

Gender, Professional and Non-Professional Work, and the Changing Pattern of Employment-Related Inequality in Poor Self-Rated Health, 1995-2006 in South Korea

김일호,강영호,조성일,천희란,Carles Muntaner 대한예방의학회 2011 Journal of Preventive Medicine and Public Health Vol.44 No.1

Objectives: We examined gender differential changes in employment-related health inequalities according to occupational position (professional/nonprofessional) in South Korea during the last decade. Methods: Data were taken from four rounds of Social Statistical Surveys of South Korea (1995, 1999, 2003, and 2006)from the Korean National Statistics Office. The total study population was 55435 male and 33 913 female employees aged 25-64. Employment arrangements were divided into permanent, fixed-term, and daily employment. Results: After stratification according to occupational position (professional/nonprofessional) and gender, different patterns in employment - related health inequalities were observed. In the professional group, the gaps in absolute and relative employment inequalities for poor self-rated health were more likely to widen following Korea’s 1997 economic downturn. In the nonprofessional group, during the study period, graded patterns of employment-related health inequalities were continuously observed in both genders. Absolute health inequalities by employment status, however,decreased among men but increased among women. In addition, a remarkable increase in relative health inequalities was found among female temporary and daily employees (p = 0.009, < 0.001, respectively), but only among male daily employees (p = 0.001). Relative employment-related health inequalities had clearly widened for female daily workers between 2003 and 2006 (p = 0.047). The 1997 Korean economic downturn, in particular, seemingly stimulated a widening gap in employment health inequalities. Conclusions: Our study revealed that whereas absolute health inequalities in relation to employment status increased in the professional group, relative employment-related health inequalities increased in the nonprofessional group, especially among women. In view of the high concentration of female nonstandard employees, further monitoring of inequality should consider gender specific patterns according to employee’s occupational and employment Objectives: We examined gender differential changes in employment-related health inequalities according to occupational position (professional/nonprofessional) in South Korea during the last decade. Methods: Data were taken from four rounds of Social Statistical Surveys of South Korea (1995, 1999, 2003, and 2006)from the Korean National Statistics Office. The total study population was 55435 male and 33 913 female employees aged 25-64. Employment arrangements were divided into permanent, fixed-term, and daily employment. Results: After stratification according to occupational position (professional/nonprofessional) and gender, different patterns in employment - related health inequalities were observed. In the professional group, the gaps in absolute and relative employment inequalities for poor self-rated health were more likely to widen following Korea’s 1997 economic downturn. In the nonprofessional group, during the study period, graded patterns of employment-related health inequalities were continuously observed in both genders. Absolute health inequalities by employment status, however,decreased among men but increased among women. In addition, a remarkable increase in relative health inequalities was found among female temporary and daily employees (p = 0.009, < 0.001, respectively), but only among male daily employees (p = 0.001). Relative employment-related health inequalities had clearly widened for female daily workers between 2003 and 2006 (p = 0.047). The 1997 Korean economic downturn, in particular, seemingly stimulated a widening gap in employment health inequalities. Conclusions: Our study revealed that whereas absolute health inequalities in relation to employment status increased in the professional group, relative employment-related health inequalities increased in the nonprofessional group, especially among women. In view of the high concentration of female nonstandard employees, further monitoring of inequality should consider gender specific patterns according to employee’s occupational and employment status.

고등학생의 건강 불균등 요인별 분해

안병철 (Byung Chul Ahn),정효지 (Hyo Jee Joung) 한국학교보건학회 2007 韓國學校保健學會誌 Vol.20 No.1

Purpose: With economic development and prolonged longevity, the level of health and health disparities have became growing concerns for individual and society as well. Since youth's health status are influenced by households' socioeconomic status and associated with heath status in later stage of life, assessing health inequality in the youth is a significant step toward lessening health disparity and promoting health. We measured health inequality in high school students and decomposed it into health factors. Methods: The subjects included 3,787 high school students of 12th graders from the Korea Education and Employment Panel (KEEP) in 2004. True health status was assumed as a latent variable and estimated by ordered logistic regression model. The predicted health was used as a measure of individual health after rescaling to [0,1] interval. Total health inequality was then measured by Gini coefficient and was decomposed into health factors. Results: Health inequality in high school students was observed. Of total health inequality, 44% was explained by biological factors such as body mass index (BMI) (32.5%) and gender (13.5%). Behavioral factors such as smoking, drinking, physical activity, hours in bed and hours of computer usage added to 11.7%. Household income and work experiences explained 5.6% and 8.8%, respectively. School satisfaction explained 14.6%. Other school related factors such as self-assessed achievement and experience of being bullied accounted for 15.5%. Conclusion: Among the health factors, biological factor was the most important contributor in health disparity. Other factors such as health behaviors, socioeconomic factors, school satisfaction and school related factors exhibited somewhat similar magnitude. For policy purposes, it is recommended to look into modifiable factors depending BMI, gender and school surroundings.

가족 구성원 건강과 투표 참여: 건강 및 정치 참여 불평등에서 나타나는 한국 가족의 특성

김용민 경북대학교 사회과학연구원 2019 사회과학 담론과 정책 Vol.12 No.2

The primary goal of this article is to investigate the relationship between health of family members and voter turnout of the respondent himself/herself. Although previous studies have explored the relationship between health and voting, little is known about the effects of family health. As South Korea is well known for the family-centeredness, this study assumes that health of family members would affect voter turnout in Korea. The analysis using Korean General Social Survey (KGSS) 2016 data validates the argument. The main empirical findings are as follows. It is verified that health of spouse affects voting. The predicted probability of voting increases as health status of spouse increases. It is more significant factor than health status of the respondent himself/herself. Dividing the whole sample into male and female, however, the effect is only significant for female respondents. Health status of each parent is also found to be significant in predicting voter turnout. However, each variable negatively affects voting. As health status of father or mother increases, the predicted probability of voting decreases. These results highlight the importance of understanding family health as an important factor in the relationship between health disparities and participatory inequalities. 본 연구는 가족 구성원(배우자, 부친, 모친)의 건강이 개인의 투표 참여에 미치는 영향을 분석한다. 건강이 투표 참여에 미치는 영향을 분석한 서구 학계의 연구가 있지만, 가족 건강을 고려한 연구는 부재했다. 본 연구는 한국 사회의 가족 특성을 고려하면 가족 건강이 응답자의 투표에 독립적인 영향을 미칠 것으로 예상했다. 본 연구는 KGSS 2016년 자료를 사용했고, 분석 결과 실제로 가족 건강은 응답자 투표 참여에 영향을 미쳤다. 주요 분석 결과는 다음과 같다. 첫째, 배우자 건강 변수가 응답자 본인 건강 변수보다도 유의미하게 나타나며 투표 참여 확률을 높였지만, 성별을 나누어보면 응답자가 여성일 경우에만 본인과 남편 건강이 유의미했다. 둘째, 부모님 건강 변수는 부친과 모친 각각 유의미했지만, 음의 방향으로 영향을 미쳐 투표 참여 확률을 낮추었다. 투표 참여라는 가장 기본적인 정치 참여에서 가족 구성원의 건강이 영향을 미친다는 점은 건강 불평등, 정치 참여 불평등 논의에서 큰 의미가 있는 발견이다.

외국에서의 건강불평등 개선을 위한 노력: 건강영향평가, 건강도시

유원섭,고광욱,김건엽,Yoo, Weon-Seob,Koh, Kwang-Wook,Kim, Keon-Yeop 대한예방의학회 2007 예방의학회지 Vol.40 No.6

In order to reduce the health inequalities within a society changes need to be made in broad health determinants and their distribution in the population. It has been expected that the Health impact assessment(HIA) and Healthy Cities can provide opportunities and useful means for changing social policy and environment related with the broad health determinants in developed countries. HIA is any combination of procedures or methods by which a proposed 4P(policy, plan, program, project) may be judged as to the effects it may have on the health of a population. Healthy city is one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and in developing to their maximum potential. In Korea, social and academic interest regarding the HIA and Healthy Cities has been growing recently but the need of HIA and Healthy Cities in the perspective of reducing health inequality was not introduced adequately. So we reviewed the basic concepts and methods of the HIA and Healthy Cities, and its possible contribution to reducing health inequalities. We concluded that though the concepts and methods of the HIA and Healthy Cities are relatively new and still in need of improvement, they will be useful in approaching the issue of health inequality in Korea.

건강불평등 영향요인 연구: 교육수준의 조절효과를 중심으로

김민,박선주 중앙대학교 국가정책연구소 2023 국가정책연구 Vol.37 No.1

This paper examines the relationship between health inequalities and education level as a proxy for health literacy. While income level has traditionally been the primary focus of efforts to reduce health inequalities, recent research has emphasized the importance of health literacy in improving health outcomes. Specifically, this study uses data from the 2020 Community Health Survey in Korea to explore how education level, as a proxy for health literacy, interacts with income level to impact subjective health status. The results suggest that higher education levels have a moderating effect in reducing the impact of income-based health inequalities. The paper emphasizes the need for a universal effort to improve health literacy for adults to reduce health inequalities, in addition to the tailored health management and education currently implemented by the government. The paper contributes to the literature on exploring the causes and framework of health inequalities and provides evidence-based policy implications for reducing health inequalities. 개인이나 집단 간 건강에서의 격차를 의미하는 건강불평등을 완화하기 위하여 세계 각국이 노력하는 가운데, 건강불평등 수준을 측정하고 그 원인과 경로를 탐색한 그간의 연구는 주로 소득수준에 초점을 맞췄다. 최근의 국제 연구는 개인의 인지적 요소, 특히 교육을 통한 건강인식 개선과 의료서비스 접근성의 강화 간의 관계에 관심을 가지며, WHO 등 국제기구를 중심으로 건강정보에 대한 이해능력(health literacy), 즉 ‘건강문해력’ 제고를 건강불평등 완화의 주요 정책수단으로 강조하고 있다. 한편, 우리나라에서도 제5차 국민건강증진 종합계획에 건강문해력 향상에 관한 내용을 포함하고 있으나, 건강문해력에 대한 지표 개발과 자료수집, 실증연구가 미흡하며, 근거에 기반한 정교한 정책 대응 노력이 부족한 실정이다. 본 연구는 2020년 「지역사회건강조사」 자료를 활용하여 개인 단위에서 건강문해력의 대리변수로서 교육수준이 소득수준과의 상호작용 하에 주관적 건강수준에 어떠한 영향을 미치는지 실증적으로 분석하였다. 단계적 회귀분석 결과, 교육수준이 높을수록 소득의 건강불평등 영향을 완화하는 조절효과가 나타나는 것을 확인하였다. 이는 현재 정부에서 실시하는 맞춤형 건강관리 및 교육에서 나아가 소득수준에 따른 건강불평등을 완화하기 위해 성인 대상의 보편적인 건강문해력 증진 노력, 학교교육에서의 건강 교육의 확대, 그리고 의료서비스 환경 개선 등이 필요하다는 정책적 시사점을 제시한다.

군집분석을 활용한 지역별 건강격차 연구: 주관적 건강수준을 중심으로

허민희,백세종,김영진,노진원 한국보건행정학회 2023 보건행정학회지 Vol.33 No.2

Background: Personal socio-economic abilities are crucial as it affects health inequalities. These multidimensional inequalities acrossthe regions have been structured and fixed. This study aimed to analyze health vulnerabilities by regional cluster and identify regionalhealth disparities of self-rated health, using nationally representative cross-sectional data. Methods: This study used personal and regional data. Data from the Community Health Survey 2021 were analyzed. K-means clusteranalysis was applied to 250 si-gun-gu using administrative regional data. The clusters were based on three areas: physicalenvironment, health-related behaviors and biological factors, and the psychosocial environment through the conceptual frameworkfor action on the social determinants of health. And binary logistic regression analyses were conducted to examine the differencesin self-rated health status by the regional clusters, controlling human biology, environment, lifestyle, and healthcare organizationfactors. Results: The most vulnerable group was group 3, the moderate vulnerable group was group 1, and the least vulnerable group wasgroup 2. The group 2 was more likely to have high self-rated health status than the moderate vulnerable group (odds ratio [OR],1.023; p<0.001). And the group 3 showed low self-rated health status than the moderate vulnerable group (OR, 0.775; p<0.001). However, the moderate vulnerable group had significantly higher self-rated health status than the most vulnerable group (group 2:OR, 1.023; p<0.001; group 3: OR, 0.775; p<0.001). Conclusion: These results demonstrate that community members’ health status is influenced by regional determinants of health andindividual levels. And these contribute to understanding the importance of specific and differentiated interventions like locallytailored support programs considering both individual and regional health determinants.

노인의 건강불평등: 교육불평등에 따른 건강불평등에 대한 사회참여의 매개효과

김동배 ( Dong Bae Kim ),유병선 ( Byung Sun Yoo ),이정은 ( Jeong Eun Lee ) 한국사회복지연구회 2012 사회복지연구 Vol.43 No.1

본 연구의 목적은 노인의 교육불평등에 따른 건강불평등(주관적 건강상태와 우울)에 대한 사회참여의 매개효과를 검증하는 것이다. 분석을 위한 연구 자료는 강남구 노인복지욕구 실태조사이다. 본 자료는 2009년 7월 30일부터 8월 15일까지 강남구 22개 각 동에서 60세 이상 노인을 대상으로 수집되었으며, 최종 분석에 총 631명의 자료가 사용하였다. 분석방법은 빈도, 백분율, 평균, 표준편차를 통해 대상자의 일반적 특성을 살펴보았으며, 변인간 가설검증을 위해 위계적 회귀분석을 실시하였다. 통계 프로그램은 SPSS 18.0을 이용하였다. 분석 결과 노인의 교육불평등은 노인의 건강불평등에 영향을 미친다는 것이 검증되었다. 또한 교육불평등이 노인의 건강불평등에 영향을 미치는 경로에 있어서 사회참여가 부분매개효과가 있음이 입증되었다. 사회참여 변인이 부분매개효과를 보인다는 것은 노인의 교육불평등이 심할수록 건강불평등(주관적 건강상태, 우울)도 심화된다는 직접적인 경로와 함께, 교육불평등은 사회참여를 통해 더욱 심화된 건강불평등(주관적 건강상태, 우울)을 이끌어낸다는 간접적 경로를 검증해 주는 것이다. 이러한 결과는 한국 사회에서 교육불평등이 건강불평등으로 연결된다는 것을 실증 분석했다는 점과 교육불평등으로 인한 건강불평등을 완화할 수 있는 사회복지적 실천방안으로 사회참여라는 개입방법을 사용할 수 있다는 메커니즘을 검증했다는 점에서 의의를 가진다. This research attempts to explain the influence of educational level inequalities on self-rated health and depression of the elderly. Also, we are focusing whether there is a mediating effect of social support between educational level inequalities and self-rated health·depression of the elderly. The data was collected from July, 30 to August, 15, 2009. 631 persons who live in Gangnam-Gu area over 60 years of age were recruited. Frequency, percentage, mean, standard deviation and multiple regression were employed using SPSS 12.0. The result of this study shows that educational level inequalities have a influence on the self-rated health and depression. It is also verified that social participation variable has a partial mediating effect between educational level inequalities and mental health(self-rated health and depression). This study carried out a positive linear relationship between educational level and health: the higher education, the better the health. And also, the results present the importance of developing adequate intervention programs for the elderly having low educational level to improve social participation and to enhance mental health(self-rated health and depression).

Health Inequities in Cancer Incidence According to Economic Status and Regions Are Still Existed even under Universal Health Coverage System in Korea: A Nationwide Population Based Study using National Health Insurance Database

장영수,황수희,조상아,이혜진,조은별,이진용 대한암학회 2024 Cancer Research and Treatment Vol.56 No.2

Purpose The purpose of this study is to determine the level of health equity in relation to cancer incidence. Materials and Methods We used the National Health Insurance (NHI) claims data of the National Health Insurance Service between 2005 and 2022 and annual health insurance and medical aid beneficiaries between 2011 and 2021 to investigate the disparities of cancer incidence. We calculated age-sex standardized cancer incidence rates by cancer and year according to the type of insurance and the trend over time using the annual percentage change. We also compared the hospital type of the first diagnosis by cancer type and year and cancer incidence rates by cancer type and region in 2021 according to the type of insurance. Results The total cancer incidence increased from 255,971 in 2011 to 325,772 cases in 2021. The absolute difference of total cancer incidence rate between the NHI beneficiaries and the medical aid (MA) recipients increased from 510.1 cases per 100,000 population to 536.9 cases per 100,000 population. The odds ratio of total cancer incidence for the MA recipients increased from 1.79 (95% confidence interval [CI], 1.77 to 1.82) to 1.90 (95% CI, 1.88 to 1.93). Disparities in access to hospitals and regional cancer incidence were profound. Conclusion This study examined health inequities in relation to cancer incidence over the last decade. Cancer incidence was higher in the MA recipients, and the gap was widening. We also found that regional differences in cancer incidence still exist and are getting worse. Investigating these disparities between the NHI beneficiaries and the MA recipients is crucial for implementing of public health policies to reduce health inequities.