• 보건행정학회지
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• 제30권1호
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• pp.37-49
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• 2020

Background: Unmet healthcare needs have many advantages for measuring inequalities in healthcare use. However, the existing indicator is difficult to capture the reality of unmet healthcare needs sufficiently and is not quite appropriate in comparing regional inequality. The purpose of this study is to critically analyze the utilization of the unmet healthcare need indicator for regional healthcare inequalities research. Methods: We used the level of healthcare accessibility and healthcare need to categorize the regions that are known to cause differences in healthcare utilization between regions and verified how existing unmet healthcare need indicator is distributed at the regional level. Results: Four types of regions were classified according to the high and low levels of healthcare needs and accessibility. The hypothesis about the regional type expected to have the highest unmet healthcare need was not proved. The hypothesis about the lowest expected regional type was proved, but the difference in the average rate of unmet healthcare needs among regional types was not significant. The standard deviation of the rate of unmet healthcare needs among regions within the same type was also higher than the overall regional variation, which also disproved the whole frame of hypothesis. Conclusion: Failure to prove the hypothesis means the gap between the supposed meaning of the indicator and the reality. In order to understand the current state of healthcare utilization of people in various regions of Korea and to resolve inequality, fundamental research on the in-depth structure and mechanisms of healthcare utilization is needed.

• 보건행정학회지
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• 제33권2호
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• pp.118-128
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• 2023

Background: Personal socio-economic abilities are crucial as it affects health inequalities. These multidimensional inequalities across the regions have been structured and fixed. This study aimed to analyze health vulnerabilities by regional cluster and identify regional health 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 cluster analysis was applied to 250 si-gun-gu using administrative regional data. The clusters were based on three areas: physical environment, health-related behaviors and biological factors, and the psychosocial environment through the conceptual framework for action on the social determinants of health. And binary logistic regression analyses were conducted to examine the differences in self-rated health status by the regional clusters, controlling human biology, environment, lifestyle, and healthcare organization factors. Results: The most vulnerable group was group 3, the moderate vulnerable group was group 1, and the least vulnerable group was group 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 and individual levels. And these contribute to understanding the importance of specific and differentiated interventions like locally tailored support programs considering both individual and regional health determinants.

• 한국농촌간호학회지
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• 제1권1호
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• pp.11-20
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• 2006

Purpose: To compare of health inequalities between rural and urban areas in term of health status, health behaviors and medical care utilization by using national-wide data. Method: The data came from the 2000 and 2005 census data, 2004 death certification statistics and 2001 national health and nutrition survey. The health indicators used in this study were mortality, perceived health status, health related behaviors, morbidity, accidents and suicides, mental health-related factors, health care accessibility. Korean rural areas have been experiencing a rapid aging process and there are demographic differences between rural and urban populations. Thus, both of crude rates and age-adjusted rates were compared. Result: Although the degrees decreased after adjustment for age, health inequalities between areas still existed. The people who lived in rural areas suffer from higher mortality, morbidity and unhealthy behavior compared to people in urban areas. Especially, regional health inequalities for women were significant. Health care accessibility in rural areas was also lower and medical indirect costs for rural residents were higher than those of urban residents. Conclusion: To reduce health inequalities between geographical areas, political efforts to tackle health inequalities in the rural areas are required.

• 보건행정학회지
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• 제28권3호
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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.

• 지역사회간호학회지
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• 제29권1호
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• pp.21-32
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• 2018

Purpose: This study attempted to identify regional disparities of self-rated health among Korean wage workers and to investigate the influencing factors on them. Methods: The study subjects were 25,069 workers in 16 regions who were extracted from the 2014 Korean Working Condition Survey (KWCS). A multilevel analysis was conducted by building hierarchical data at individual and regional level. Results: In this study, 'financial autonomy rate' and 'current smoking rate' were identified as regional factors influencing the workers' self-rated health. When the socio-demographic and occupational factors of the workers were controlled, 'current smoking rate', a health policy factor, explained the regional disparity of workers' health status. Conclusion: We found that the health status of workers can be affected by the health behavior level of the whole population in their residential area. In order to improve the health status of working population and to alleviate their regional health inequalities, it is necessary to strengthen macro and structural level interventions.

• 보건행정학회지
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• 제22권1호
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• pp.85-108
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• 2012

One of the ways to achieve the principle of equal access for equal needs, availability and geographical accessibility of health care resources regardless of resident sites is important. The purpose of this paper is to measure socioeconomic inequities in distribution of health care resources among regions in the Republic of Korea (hereafter Korea). Data were extracted from regional statistics of National Health Insurance, Community Health Survey, Korea Social Science Data Archive, and Korean Statistical Information Services at the same period of 2009. The dependent variables were the number of health workforce and health care facilities in each region. The proxy indicator of regional socioeconomic status was local tax per person. To identify whether inequalities among regions, we examined the concentration index(CI) and indirectly standardized CI by controlling each region's demographics and need factors. Total observations were 232 districts in nationwide, and we analyzed separately Seoul(25 districts) and non-Seoul areas(207 districts). The standardized CI values of health care resources were positive(favoring the rich region) across the nation in almost all kinds of resources. Especially the number of specialist, dentist, dental clinics, clinics, oriental medical clinics, pharmacists, and pharmacies were statistically significantly favoring the rich region. But the CI for the number of long-term care hospitals, public health centers were negative(favoring the poor region). The tendency of CI presenting positive values were increased in Seoul area. But in the case of non-Seoul, the CI indexes were nearly zero. The results suggest that except the Seoul area, little regional socioeconomic-related inequalities were observed in the distribution of health care resources in Korea.

• Nutrition Research and Practice
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• 제14권6호
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• pp.679-690
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• 2020

BACKGROUND/OBJECTIVES: Concerns about regional disparities in heathy eating and nutritional status among South Korean adults are increasing. This study aims to identify the magnitude of regional disparities in diet and nutritional status among Korean adults who completed the 2017 Korea National Health and Nutrition Examination Survey (KNHANES). SUBJECTS/METHODS: The participants were a nationally representative sample of Korean adults aged 19 years and older from the 2017 KNHANES (n = 6,126). We employed the svy commands in STATA to accommodate the complex survey design. The relative concentration index (RCI), absolute concentration index (ACI) and index of disparity were used to measure regional nutritional inequalities. RESULTS: Overweight and obese adults were more prevalent among the poor than among the rich in urban areas (RCI = -0.041; P < 0.05), while overweight and obese adults were more prevalent among the rich than among the poor in rural areas of South Korea (RCI = 0.084; P < 0.05). Economic inequality in fruit and vegetable intake ≥ 500 g per day was greater in rural areas than in urban areas in both relative size (RCI = 0.228 vs. 0.091, difference in equality = 0.137; P < 0.05) and absolute size (ACI = 0.055 vs. 0.023, difference in equality = 0.032; P < 0.05). CONCLUSIONS: This study provides useful information identifying opposite directions in the relative concentration curves between urban and rural areas. Adult overweight/obesity was more prevalent among the poor in urban areas, while adult overweight/obesity was more prevalent among the rich in rural areas. Public health nutrition systems should be implemented to identify nutritional inequalities that should be targeted across regions in South Korea.

• 대한지역사회영양학회지
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• 제28권2호
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• pp.124-140
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• 2023

Objectives: This study examined the changes in dietary habits, the prevalence of chronic diseases, and mental health problems in the regional areas of the Republic of Korea before and after the COVID-19 pandemic to provide evidence of the status of regional health inequalities. Methods: This study analyzed Korean adults aged 19 or older who participated in the Korea Community Health Survey (n = 686,708) and Consumer Behavior Survey for Foods (n = 19,109) from 2018 to 2020. The participants were classified according to their residence area (Seoul metropolitan area, Metropolitan cities, Provinces); 2018-2019 were defined as before COVID-19, and 2020 as after COVID-19. The dietary behaviors, chronic diseases, and mental health problems were measured using a self-report questionnaire. Results: After COVID-19, the eating-out usage rate in the Seoul metropolitan area and Provinces decreased compared to before COVID-19 (P < 0.001), and when responding that they eat out, the frequency of eating out with household members in the Seoul metropolitan area increased (P = 0.024). The deliveries/takeout usage rate in the Provinces decreased after COVID-19 compared to before (P < 0.001). After COVID-19, the prevalence of obesity decreased in all regions (P < 0.001), and the prevalence of hypertension increased significantly in the Provinces (P = 0.015). The prevalence of diabetes mellitus increased continuously before and after COVID-19 in all regions (P < 0.002). High-risk subjective stress levels increased significantly in the Seoul metropolitan area (P < 0.001), and sleep duration significantly increased in all regions (P < 0.001). Major depressive disorder was reduced significantly in Metropolitan cities (P = 0.042) and Provinces (P < 0.001). Conclusions: After the COVID-19 pandemic, the prevalence of chronic diseases and mental health problems showed regional differences along with changes in dietary habits. It is necessary to reflect the regional differences in dietary habits in future policies resolving regional health inequalities.

• 농촌의학ㆍ지역보건
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• 제37권1호
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• pp.36-51
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• 2012

'건강 플러스 행복 플러스 사업'은 경상남도의 높은 표준화사망률을 감소시키고 지역 간 건강불평등을 완화하기 위하여 표준화사망비가 구조적으로 높은 40개 읍면동을 대상으로 수행되는 사업이다. 본 사업은 영국의 헬스 액션 존 사업의 방법론을 기반으로 하여 참여, 파트너쉽, 자원의 집중을 사업의 기본 원칙으로 설정하고 2010년부터 시작되었으며 2017년까지 진행될 예정이다. 총 사업비는 56억원이며, 2010년에는 17개 읍면동, 2011년에는 12개 읍면동, 2012년에는 11개 읍면동에 사업이 개시되었거나 개시될 예정이다. 2010년 사업의 경우, 사업대상지역인 17개 읍면동에 예산이 배정되었고, 관련 수단 및 지역 차원의 사업진행 틀을 만드는 과정을 거쳤다. 또한 사업대상지역의 건강결정요인을 파악하기 위하여 지역 사회조사를 실시하였으며 사업에 대한 교육훈련지원 및 기술지원을 위하여 교육훈련지원단과 사업운영지원단이 설치되었다. 그 결과 사업 인력들과 코디네이터에 대한 교육이 실시되었으며, 사업대상지역에는 사업팀과 사업추진위원회가 결성되었다. 지역사회조사 이후에는 지역사회조사결과 보고회를 통하여 지역의 건강결정요인과 건강수준을 지역주민들과 함께 공유하였으며 최종적으로 사업 관련 주민자치조직인 건강위원회가 17개 읍면동에서 출범하였다. 본 사업은 지역사회 참여 및 파트너쉽의 구축과 관련하여 아직 해결해야 될 과제들이 많으나 원칙에 근거한 사업이 지속적으로 진행될 수 있다면 경상남도의 건강불평등 완화를 통한 표준화사망률 감소 및 사업대상지역 주민들의 안녕 수준 향상에 기여할 수 있을 것으로 판단된다.

• Journal of Preventive Medicine and Public Health
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• 제39권1호
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• pp.46-52
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• 2006

Objectives: This study was performed to investigate the relationship between regional material deprivation and the standardized mortality ratios(SMRs) of community residents aged 15-64 in Korea. Methods: SMRs were investigated using the registered death data from 1995 to 2000 that was obtained from the Korean National Statistics Office with the denominators being drawn from the 1995 to 2000 census. Material deprivation was measured using the Townsend score that was calculated from the 1995 to 2000 census. The relationship between the regional material deprivation and the SMRs of the community residents aged 15-64 was investigated by using ANOVA, Spearman's rank correlation analysis and Pearson's correlation analysis. The trends in mortality inequality were investigated using the concentration index. Results: On the ANOVA, the SMRs of the men and women residents in the least deprived areas were the smallest and those in the most deprived areas were the largest. Spearman's rank correlation analysis, Pearson's correlation analysis and the concentration index revealed that significant positive relationships exist between the regional material deprivation and the SMRs of the community residents aged 15-64. Conclusions: This study suggests that there are mortality inequalities among the communities in Korea and part of this difference is due to the material deprivation of the community. Strategies aimed at reducing mortality inequalities among the communities will be needed to address economic inequalities. Further studies are needed to explore the mechanisms of how the regional deprivation influences on health and how the other factors of the community influence on the health of the community residents.