• 월간산업보건
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• s.368
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• pp.17-17
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• 2018

• Health Policy and Management
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• v.28 no.3
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• pp.240-250
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• 2018

By the end of 2017, in a world of 7.6 billion people, there were inequalities in healthcare indices both within and between nations, and this gap continues to increase. Therefore, this study aims to understand the current status of regional inequalities in healthcare indices and to find an action plan to tackle regional health inequality through a geo-economic review in Korea. Since 2008, there was great inequality in life expectancy and healthy life expectancy by region in not only metropolitan cities but also districts in Korea. While the community health statistics from 2008-2017 show a continuous increase of inequality during the last 10 years in most healthcare indices related to noncommunicable diseases (except for some, like smoking), the inequality has doubled in 254 districts. Furthermore, health inequality intensified as the gap between urban (metropolitan cities) and rural regions (counties) for rates of obesity (self-reported), sufficient walking practices, and healthy lifestyle practices increased from twofold to fivefold. However, regionalism and uneven development are natural consequences of the spatial perspective caused by state-lead developmentalism as Korea has fixed the accumulation strategy as its model for growth with the background of export-led industrialization in the 1960s and heavy and chemical industrialization in the 1970s, although the Constitution of the Republic of Korea recognizes the legal value of balanced development within the regions by specifying "the balanced development of the state" or "ensuring the balanced development of all regions." In addition, the danger of a 30% decline or extinction of local government nationwide is expected by 2040 as we face not only a decline in general and ageing populations but also the era of the demographic cliff. Thus, the government should continuously operate the "Special Committee on Regional Balanced Development" with a government-wide effort until 2030 to prevent disparities in the health conditions of local residents, which is the responsibility of the nation in terms of strengthening governance. To address the regional inequalities of rural and urban regions, it is necessary to re-adjust the basic subsidy and cost-sharing rates with local governments of current national subsidies based mainly on population scale, financial independence of local government, or distribution of healthcare resources and healthcare indices (showing high inequalities) overall.

• Journal of Preventive Medicine and Public Health
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• v.50 no.5
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• pp.303-310
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• 2017

Objectives: The aim of this study was to evaluate socioeconomic inequalities in the prevalence of dental caries among an urban population. Methods: This study was conducted among 2000 people 15-40 years of age living in Kurdistan, Iran in 2015. Using a questionnaire, data were collected by 4 trained dental students. The dependent variable was the decayed, missing, and filled teeth (DMF) index. Using principal component analysis, the socioeconomic status (SES) of families was determined based on their household assets. Inequality was measured using the concentration index; in addition, the Oaxaca analytical method was used to determine the contribution of various determinants to the observed inequality. Results: The concentration index for poor scores on the DMF index was -0.32 (95% confidence interval [CI], -0.40 to -0.36); thus, poor DMF indices had a greater concentration in groups with a low SES (p<0.001). Decomposition analysis showed that the mean prevalence of a poor DMF index was 43.7% (95% CI, 40.4 to 46.9%) in the least privileged group and 14.4% (95% CI, 9.5 to 9.2%) in the most privileged group. It was found that 85.8% of the gap observed between these groups was due to differences in sex, parents' education, and the district of residence. A poor DMF index was less prevalent among people with higher SES than among those with lower SES (odds ratio, 0.31; 95% CI, 0.19 to 0.52). Conclusions: An alarming degree of SES inequality in oral health status was found in the studied community. Hence, it is suggested that inequalities in oral health status be reduced via adopting appropriate policies such as the delivery of oral health services to poorer groups and covering such services in insurance programs.

• Journal of Preventive Medicine and Public Health
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• v.56 no.1
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• pp.50-58
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• 2023

Objectives: Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran. Methods: This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middleaged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CI_n) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants. Results: The proportion of MetS in the sample was 41.1%. The CI_n of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%). Conclusions: Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.

• Korean Journal of Health Education and Promotion
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• v.27 no.1
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• pp.61-69
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• 2010

Objectives: The aim of this study was to examine socioeconomic inequalities in oral health and to investigate the extent to which socioeconomic disparities in oral health are attenuated by oral health related consciousness and behaviors. Methods: We used data from the third 2006 Korea National Oral Health Survey(KNOHS) and a total of 3,457 subjects aged over 18 years were analyzed. The dependent variable was periodontal conditions which is devided into dichotomy, that is, health and ill-health, using the Community Periodontal Index(CPI) in KNOHS. Socioeconomic status(SES) were measured by educational attainment, income and residential area. Age, gender, oral health consciousness(self-assessed oral health status, concern about oral health and self-perceived dental treatment needs and behaviors(brushing, use of dental floss and dental visits) were adjusted in binary logistic regression analysis. Results and Conclusion: The results show that oral health consciousness and behaviors do not mediate the relationship between SES and periodontal health and there might be limitations to attenuate socioeconomic disparities in oral health only by changing of either oral health consciousness or(and) behaviors. Our findings suggest that more definite oral health policies and dental health education among adults with lower education will need in order to improve oral health.

• Journal of Korean society of Dental Hygiene
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• v.24 no.1
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• pp.17-26
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• 2024

Objectives: This study aimed to analyze the relationship between the socioeconomic status and oral health of adults. Methods: Data from the 7th Korea National Health and Nutrition Examination Survey (2016-2018) were analyzed, and 13,199 adults aged 19 years or older were selected as study subjects. Various oral health indicators were used to analyze the effect of socioeconomic status on oral health. Disparities in oral health according to socioeconomic status were analyzed using the complex sample chi-squared test and multiple logistic regression analysis. Results: A statistically significant difference was observed between income level, medical aid, and all oral health indicators, which indicated that the lower the income level, the lower the oral health level (p<0.001). Furthermore, all oral health indicators displayed statistically significant differences, with the exception of the prevalence of dental caries and education level. The lower the education level, the lower the oral health level (p<0.001). Therefore, the oral health level of adults presented significant differences according to different socioeconomic status indicators. Conclusions: To prevent oral health inequalities, the government and local governments need to intervene not only in the field of health care but also in the social determinants. Additionally, concerted efforts should be made to eliminate oral health disparities by improving policies and systems.

• Journal of Preventive Medicine and Public Health
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• v.46 no.4
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• pp.155-164
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• 2013

Noncommunicable diseases (NCDs) are the most important causes of premature mortality and disability-adjusted life years in Korea. NCDs are also the main contributor to socioeconomic inequalities in mortality and life expectancy. Reduction of NCDs and NCD inequalities would result in significant improvement in healthy life expectancy and health equity in Korea. Major NCD risk factors such as dietary risks (including salt intake), alcohol consumption, cigarette smoking, and high blood pressure were found to be the leading modifiable risk factors of disability-adjusted life years in Korea, based on the 2010 Global Burden of Disease Study. Several Korean studies have shown that these risk factors play an important role in creating socioeconomic inequalities in NCD mortality and total mortality. Current international discussions on NCD policies in the United Nations and the World Health Organization would provide better opportunities for developing aggressive population-wide policy measures in Korea. Considering the paucity of population-wide policies to control major NCD risk factors in Korea, rigorous population approaches such as taxation and regulation of unhealthy commodities as well as public education and mass campaigns should be further developed in Korea.

• Safety and Health at Work
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• v.8 no.4
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• pp.371-377
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• 2017

Background: Social status might be a determinant of occupational health inequalities. This study analyzed the effects of social status on both work environments and health outcomes. Methods: The study sample consisted of 27,598 wage employees aged 15 years and older from among the Korean Working Condition Survey participants in 2011. Work environments included atypical work, physical risks, ergonomic risks, work demands, work autonomy, social supports, and job rewards. Health outcomes comprised general health, health and safety at risk because of work, the World Health Organization-5 Well-being Index, work-related musculoskeletal disease, and work-related injury. Multivariable logistic-regression models were used to identify the associations between social status and work environments and health outcomes. Results: Employees in the demographically vulnerable group had lower occupational status compared with their counterparts. Low social status was largely related to adverse work environments. Especially, precarious employment and manual labor occupation were associated with both adverse work environments and poor health outcomes. Conclusion: Precarious and manual workers should take precedence in occupational health equity policies and interventions. Their cumulative vulnerability, which is connected to demographics, occupational status, adverse work environments, or poor health outcomes, can be improved through a multilevel approach such as labor market, organizations, and individual goals.

• Journal of Preventive Medicine and Public Health
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• v.54 no.1
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• pp.1-7
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• 2021

The Korean government's strategy to combat coronavirus disease 2019 (COVID-19) has focused on non-pharmaceutical interventions, such as social distancing and wearing masks, along with testing, tracing, and treatment; overall, its performance has been relatively good compared to that of many other countries heavily affected by COVID-19. However, little attention has been paid to health equity in measures to control the COVID-19 pandemic. The study aimed to examine the unequal impacts of COVID-19 across socioeconomic groups and to suggest potential solutions to tackle these inequalities. The pathways linking social determinants and health could be entry points to tackle the unequal consequences of this public health emergency. It is crucial for infectious disease policy to consider social determinants of health including poor housing, precarious working conditions, disrupted healthcare services, and suspension of social services. Moreover, the high levels of uncertainty and complexity inherent in this public health emergency, as well as the health and socioeconomic inequalities caused by the pandemic, underscore the need for good governance other than top-down measures by the government. We emphasize that a people-centered perspective is a key approach during the pandemic era. Mutual trust between the state and civil society, strong accountability of the government, and civic participation are essential components of cooperative disaster governance.

• Safety and Health at Work
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• v.13 no.1
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• pp.117-125
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• 2022

Background: External-cause mortality is an important public health issue worldwide. Considering its significance to workers' health and inequalities across industries, we aimed to describe the state of external-cause mortality and investigate its difference by industry in Republic of Korea based on data for 2018. Methods: Data obtained from the Statistics Korea and Korean Employment Information System were used. External causes of death were divided into three categories (suicide, transport accident, and others), and death occurred during employment period or within 90 days after unemployment was regarded as workers' death. We calculated age- and sex-standardized mortalities per 100,000, standardized mortality ratios (SMRs) compared to the general population and total workers, and mortality rate ratios (RRs) across industries using information and communication as a reference. Correlation analyses between income, education, and mortality were conducted. Results: Age- and sex-standardized external-cause mortality per 100,000 in all workers was 29.4 (suicide: 16.2, transport accident: 6.6, others: 6.6). Compared to the general population, all external-cause and suicide SMRs were significantly lower; however, there was no significant difference in transport accidents. When compared to total workers, wholesale, transportation, and business facilities management showed higher SMR for suicide, and agriculture, forestry, and fishing, mining and quarrying, construction, transportation and storage, and public administration and defense showed higher SMR for transport accidents. A moderate to strong negative correlation was observed between education level and mortality (both age- and sex-standardized mortality rates and SMR compared to the general population). Conclusion: Inequalities in external-cause mortalities from suicide, transport accidents, and other causes were found. For reducing the differences, improved policies are needed for industries with higher mortalities.