• Journal of agricultural medicine and community health
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• v.1 no.1
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• pp.5-9
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• 1976

The categories of national health problems may be mainly divided into health promotion, problems of diseases, and population-economic problems which are indirectly related to health. Of them, the problems of diseases will be exclusively dealt with this speech. Rurality and Disease Problems There are many differences between rural and urban areas. In general, indicators of rurality are small size of towns, dispersion of the population, remoteness from urban centers, inadequacy of public transportation, poor communication, inadequate sanitation, poor housing, poverty, little education lack of health personnels and facilities, and in-accessibility to health services. The influence of such conditions creates, directly or indirectly, many problems of diseases in the rural areas. Those art the occurrence of preventable diseases, deterioration and prolongation of illness due to loss of chance to get early treatment, decreased or prolonged labour force loss, unnecessary death, doubling of medical cost, and economic loss. Some Considerations of Innovative Approach The followings art some considerations of innovative approaches to the problems of diseases in the rural Korea. 1. It would be essential goal of the innovative approaches that the damage and economic loss due to diseases will be maintained to minimum level by minimizing the absolute amount of the diseases, and by moderating the fee for medical cares. The goal of the minimization of the disease amount may be achieved by preventive services and early treatment, and the goal of moderating the medical fee may be achieved by lowering the prime cost and by adjusting the medical fees to reasonable level. 2. Community health service or community medicine will be adopted as a innovative means to disease problems. In this case, a community is defined as an unit area where supply and utilization of primary service activities can be accomplished within a day. The essential nature o the community health service should be such activities as health promotion, preventive measures, medical care, and rehabilitation performing efficiently through the organized efforts of the residents in a community. Each service activity should cover all members of the residents in a community in its plan and performance. The cooperation of the community peoples in one of the essential elements for success of the service program, The motivations of their cooperative mood may be activated through several ways: when the participation of the residents in service program of especially the direct participation of organized cooperation of the area leaders art achieved through a means of health education: when the residents get actual experience of having received the benefit of good quality services; and when the health personnels being armed with an idealism that they art working in the areas to help health problems of the residents, maintain good human relationships with them. For the success of a community health service program, a personnel who is in charge of leadership and has an able, a sincere and a steady characters seems to be required in a community. The government should lead and support the community health service programs of the nation under the basis of results appeared in the demonstrative programs so as to be carried out the programs efficiently. Moss of the health problems may be treated properly in the community levels through suitable community health service programs but there might be some problems which art beyond their abilities to be dealt with. To solve such problems each community health service program should be under the referral systems which are connected with health centers, hospitals, and so forth. 3. An approach should be intensively groped to have a physician in each community. The shortage of physicians in rural areas is world-wide problem and so is the Korean situation. In the past the government has initiated a system of area-limited physician, coercion, and a small scale of scholarship program with unsatisfactory results. But there might be ways of achieving the goal by intervice, broadened, and continuous approaches. There will be several ways of approach to motivate the physicians to be settled in a rural community. They are, for examples, to expos the students to the community health service programs during training, to be run community health service programs by every health or medical schools and other main medical facilities, communication activities and advertisement, desire of community peoples to invite a physician, scholarship program, payment of satisfactory level, fulfilment of military obligation in case of a future draft, economic growth and development of rural communities, sufficiency of health and medical facilities, provision of proper medical care system, coercion, and so forth. And, hopefully, more useful reference data on the motivations may be available when a survey be conducted to the physicians who are presently engaging in the rural community levels. 4. In communities where the availability of a physician is difficult, a trial to use physician extenders, under certain conditions, may be considered. The reason is that it would be beneficial for the health of the residents to give them the remedies of primary medical care through the extenders rather than to leave their medical problems out of management. The followings are the conditions to be considered when the physician extenders are used: their positions will be prescribed as a temporary one instead of permanent one so as to allow easy replacement of the position with a physician applicant; the extender will be under periodic direction and supervision of a physician, and also referral channel will be provided: legal constraints will be placed upon the extenders primary care practice, and the physician extenders will used only under the public medical care system. 5. For the balanced health care delivery, a greater investment to the rural areas is needed to compensate weak points of a rurality. The characteristics of a rurality has been already mentioned. The objective of balanced service for rural communities to level up that of urban areas will be hard to achieve without greater efforts and supports. For example, rural communities need mobile powers more than urban areas, communication network is extremely necessary at health delivery facilities in rural areas as well as the need of urban areas, health and medical facilities in rural areas should be provided more substantially than those of urban areas to minimize, in a sense, the amount of patient consultation and request of laboratory specimens through referral system of which procedures are more troublesome in rural areas, and more intensive control measures against communicable diseases are needed in rural areas where greater numbers of cases are occurred under the poor sanitary conditions.

• Journal of the Korean Geographical Society
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• v.29 no.2
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• pp.166-182
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• 1994

Kyonggi Province in the late Chosun dynasty was a center of superior government offices including 'Han' River water-road transportation and was located in the middle of an 'X'-shaped arterial road network. Because of these reasons, Kyonggi Province had a faster inflow of commodities, informations and technics compared with the other province. At this period of time, every local 'Eup' (name of administrative district) had not been affected by their above administrative districts and had their own autonomy. For this reason, every 'Eup' could be developed as a town, even if its size was small when it had sufficient internal growing conditions. Moreover, the markets ('Si-Jon') in big towns and periodical markets which were spread over the Kyonggi Province played role of commercial functions of town. And because military bases for the defence of the royal capital in Kyonggi Province also took parts of a non-agricultural city role, Xyonggi Provinc had much more possibilities of growing as a town rather than the other provinces. The towns of the late Chosun Dynasty were, except the capital and superior administrative districts which were governed by the 'You-Su', small towns which had only about 3, 000-5, 000 people. Most of the town dewellers were local officials, nobles, merchants, craftmen and slaves. And the farmers who lived near town became a pseudo-towner through suburb agriculture. Among these people, the merchants were leaders of townization. The downtowns were affected by the landform and traffic roads. The most fundamental function of towns were administrative. The opcial's grade, which was dispatched to the local administrative district ('Kun' or 'Hyun'), was decided by the size of population and agricultural land of each county. Large county which was governed by a high ranking opcial had more possibilities to develop as a large town. Because they supervised other opcials of lower rank and obtained more land and population for the town. The phonomena of farm abandonment after the Japanese Invasion of Korea in 1592-1598 stimulated the development of towns for commercial function. The commercial functions of towns were evident in the Si-Jon or Nan-Jon (names of markets) in the big cities such as Hansung and Kaesung, meanffwhile in the local areas it was emerged in the shape of periodical market networks as allied with near markets (which were called as Jang-Si) or permanent markets which were grown up from periodical markets. These facts of commercial development induced the birth of commercial town. Kyonggi Province showed the weak points of its defense system during both wars (Japanese Invasion in 1592 and Manchu's Invasion in 1636). The government reinforced its defense system by adding 4 'You-Su-Bus' and several military bases. Each local districts ('Eup'), where Geo-Jins were established, were stimulated to be a town while Jin-Kwan system were, adjusted and enforced. Among Dok-Jins(name of solitary military bases), Youngjongjin was grown up as a large garrison town which only played a role of defense. The number of towns that took roles of non-agricultural functions in Kyonggi Province was 52. Among these towns, 29 were developed as big towns which had above 3, 000 people and most of these towns were located on the northwest-southeast axes of 'X'-shaped arterial trafic network in the Chosn Dynasty, This fact points out that the traffic road is one of the important causes of the development of towns. When we make hierarchy of the towns of Kyonggi Province according to its population and how many functions it had, we can make it as 6 grades. The virst grade town 'Hansung' was the biggest central town of administration, commerce and defdnse. The 2nd grade town includes 'Kaesung' which had historical inertia that it had been the capital of the Koryo Dynesty. The 3rd grade towns include some 'You- Su-Bus' such as Soowon, Kanghwa, Kwangju and also include Mapo, Yongsan and from this we can imagine that the commercial development in the late Chosun Dynasty extremely affected the townization. The 4th-6th grade towns had smiliar population but it can be discriminated by how many town functions it had. So the 4th grade towns were the core of administration, commerce and defense function. 5th grade towns had administrative functions and one of commercial and defense functions. 6th grade towns had only one of these functions. When we research and town conditions of each grades as the ratio of non-agricultural population, we can find out that the towns from the 1st grade to 4th grade show difference by degree of townization but from the 4th grade to 6th grade towns do not show big difference in general.