KIHASA has released the KCI-listed Health and Social Welfare Review, Vol. 43, No. 4. This issue carries 17 peer-reviewed articles and an editorial by Kim Yong Deug, Professor of SungKongHoe University on "Changes in the Concept of Publicness and Personalization in Social Services: From Conflict to Alliance."

Summary of the EDITORIAL: Changes in the Concept of Publicness and Personalization in Social Services: From Conflict to Alliance

Consider the two statements: 'The provision of social services must be public' and 'Social services must be personalized to the needs of the individual user.' They combine into the proposition: 'Social services must be public in provision and personalized to the needs of the individual user.'

Publicness has taken root as a key concept in efforts to restore public values and counter the trends of privatization and marketization. In pursuit of this goal, researchers have explored the 'puzzle of publicness' through various approaches, including the core publicness, dimensional publicness, and normative publicness models. These efforts indicate a shift in the focus of prublicness from ownership to public values.

The personalization of social services has progressed over the years through the notions of dependency, independence, and interdependence. Until the 1980s, it was the dependency model that was predominant in the social service sector. In the 1990s, with the adoption of the independence model and the infusion of market forces, the social service sector came to emphasize consumer choice. Then, as criticisms arose that the independence model renders provider-user relationships too contractural and lacks community participation, the need was proposed for a second wave of personalization. The social services of this period are characterized by individualized support and, at the same time, an emphasis on community.

Publicness and personalization are not in conflict but in alliance, as long as social services are delivered and used in ways befitting the concepts.

Article I: "A Comparative Study of Nursing Institutions: Legal Systems in the United Kingdom, France, and South Korea," Shin, Yukyung, Seoul National University & Park, Daeseung, Seoul National University

Nursing professionals are currently regulated by the Medical Act in South Korea. Separating nursing regulations into an independent Nursing Act has been a fiercely debated issue. Both sides of the debate cite examples of foreign countries to support their arguments. However, the legislation of an independent nursing law depends on the health legal system of each country. Each legal system operates around certain principles, yet these principles have been mostly neglected in the health policy debate. This study carries out a comparative analysis of nursing institutions, particularly the legal systems in the United Kingdom (UK), France, and South Korea. Through this method, we aim to find ways of improving the Korean nursing institution. The UK model legislates independent acts or statutory instruments for nursing professionals as well as other health professionals. The French model unifies regulations for all health professionals under a single Code. Despite such formal differences, these two models share several commonalities. First, the health legal system is systematic and consistent. Second, specific rules regulate the scope of work for each health professional. Third, relationships between health professionals are not hierarchical and are instead based on the principles of cooperation, delegation, and responsibility. These common features of the UK and French models provide policy implications for reconstructing the Korean nursing institution.

Article II: "Association between Media Usage and Body Image of Elementary Students before and after Covid-19: Focusing on Gender Comparison," Lee Hearan, Ewha Womans University; Kim, Nae-young, Ehwa Womans University; and Chung, Ick-joong, Ewha Womans University

The purpose of this study is to examine the impact of media use on body image among elementary school students before and after COVID-19 and to explore gender differences in this relationship. Data from the Panel Study on Korean Children (PSKC), conducted by the Korea Institute of Child Care and Education (KICCE), were used for the analysis. Multiple regression analysis was conducted using data from 1,412 participants in the 12th survey (2019) and 1,397 participants in the 13th survey (2020). The independent variables were information-oriented, entertainment-oriented, and relationship-oriented media use types, while the dependent variable was body image, analyzed separately by gender. The results showed that in 2019, before the outbreak, children who consumed more relationship-oriented media were more likely to have a negative body image, while those who consumed more entertainment-oriented media were more likely to have a positive body image. However, in 2020, after the pandemic emerged, only relationship-oriented media use had an impact on body image, suggesting a correlation between increased media use and negative body image. When comparing the results by gender, the negative relationship between relationship-oriented media use and body image was found among girls in 2019, but this association was found among boys in 2020. These findings shed light on the complex relationship between media use, body image, and gender, showing that different types of media have different effects on gender in contactless and face-to-face societies. In particular, the findings suggest that relationship-oriented media work differently for different genders, providing a basis for further research to inform the direction of media literacy education for elementary school students in the post COVID-19 era and to raise awareness of the causes of gender differences.

Article III: "The Effect of Occurrence of Catastrophic Health Expenditure on Child Problem Behavior," Byun, Joonsoo, Seoul National University & Lee, Tae-jin, Seoul National University

Previous studies have shown that economic hardship negatively affects children’s health by reducing investment in children. Therefore, this study analyzes the impact of catastrophic health expenditure, one type of economic hardship, on children’s problem behaviors in households using data from the 4th (2009), 7th, 10th, 13th, and 16th waves of the Korea Welfare Panel Study. The population was children under the age of 18. The threshold of catastrophic health expenditure was set at 10%, and child problem behavior was measured using the K-CBCL indicator. The results showed that catastrophic health expenditures had a negative effect on delinquency among five different problem behaviors. When the subgroup was divided by parental education level, delinquency and some problem behaviors were negatively affected by catastrophic health expenditure only when parents had a low level of education. Through these results, this study demonstrated that household financial strain, such as catastrophic health expenditures, adversely affects children's mental health and related problem behaviors. Furthermore, this study found that problem behaviors were more prevalent among children whose parents were less educated, raising the possibility that the occurrence of catastrophic health expenditures may lead to intergenerational transmission of socioeconomic status in the long run. This study is significant in that it provides a policy rationale for supporting households facing catastrophic health expenditures.

Article IV: "Effects of Multidimensional Relief Service Provision on Social Adaptation of Disaster Victims: Moderating Effects of Relief Service Satisfaction," Park, Hyung-Joo, Jeonbuk National University & Song Dohun, Jeonbuk National University

This study aimed to investigate the effect of multidimensional relief services on the social adaptation of disaster victims and the moderating effect of relief service satisfaction. A total of 1,046 disaster victims aged 19 and older who responded to key variables in the Disaster Victims’ Life Change Tracking Survey (2018) were selected for analysis. Through hierarchical regression analysis using Stata/MP 17.0, we found that, first, the higher the number of relief services provided, the lower the social adjustment; second, relief service satisfaction moderated the relationship between multidimensional relief services and disaster victims’ social adjustment. This suggests that service provision without sufficient quality assurance has a negative impact on disaster victims’ social adjustment and that it is important to ensure that disaster victims are satisfied with the services they receive. Based on this, we discuss policy and practical measures to improve relief services to enhance the social adjustment of disaster victims.

Article V: "Factors Associated with Awareness of Warning Symptoms of Cardio-Cerebrovascular Disease in Young Adults," Song, Hyunsook, Pusan National University Hospital & Kim, Yunhee, Pukyong National University

The purpose of this study is to determine if young individuals’ awareness of symptoms of cardio-cerebrovascular disease is associated with cardio-cerebrovascular disease prevention attitudes and health behaviors. For this study, data was collected from a total of 190 young adults aged 20 to 39 at workplaces and other locations. The data was collected at workplaces, etc., from January to March 2023. Hypertension education, knowing someone close who has experienced a stroke, and having preventive attitudes for cardio-cerebrovascular diseases were found to affect awareness of warning symptoms of myocardial infarction. In addition, knowing someone close who has experienced stroke, having preventive attitudes toward cardio-cerebrovascular diseases, and having healthy habits affected awareness of the warning symptoms of stroke. The results of this study showed that preventive attitudes towards cardio-cerebrovascular disease were significant factors associated with awareness of cardio-cerebrovascular disease and that healthy habits were significant factors associated with awareness of stroke in young adults. The findings provide a basis on which strategic programs can be built to improve awareness of warning symptoms of cardio-cerebrovacular disease.

Article VI: "Factors Affecting Unmet Healthcare Needs among Disaster Victims: Using Andersen's Healthcare Utilization Model," Kim, Yire, National Disaster Management Research Institute & Kwon, Jina, National Disaster Management Research Institute

This study examines the factors affecting unmet healthcare needs among disaster victims, using Andersen’s healthcare utilization model (predisposing factors, enabling factors, and need factors). By doing so, the study intends to propose strategies for alleviating and preventing unmet healthcare needs among disaster victims. For this purpose, this study used data from the 2nd wave (2017) to the 4th wave (2019) of the disaster victim follow-up data from the National Disaster Management Research Institute and employed a panel logit model with random effects. The results are as follows: First, it was found that the higher the age and household income of the disaster victims, the greater the support from the national healthcare service, and the better the subjective health status, the lower the likelihood of experiencing unmet healthcare needs. On the other hand, it was found that in cases of injuries due to the disaster or physical and mental damages that hindered their social adaptation, the likelihood of experiencing unmet healthcare needs was higher. Based on these findings, the study discussed institutional improvements to address unmet healthcare needs among disaster victims.

Article VII: "Self-Perceived Health among Older Adults Participating in Social Activities: Subjective Health Status and Health Satisfaction," Jung, Heejoo, Korea University & Ahn, Byeong-il, Korea University

This study aims to estimate the relationship between the degree of participation in social activities and subjective health status and health satisfaction among older adults by using an ordered logit model. We used data from ‘A Survey of the Elderly 2020’, conducted by the Ministry of Health and Welfare. We categorized older adults through cluster analysis using questions related to social activity participation. As a result of the cluster analysis, three clusters were identified: individuals who ‘actively participate,’ ‘usually participate,’ or ‘rarely participate’ in social activities. The estimation results showed that older adults who actively participated in social activities rated their subjective health more positively and had the highest health satisfaction. Based on these results, we can emphasize the importance of establishing elderly welfare policies that can increase subjective health levels among older adults.

Article VIII: "Psychosocial Challenges among Men Who Undergo Infertility Treatment," Moon, Eun Mi, Sungkyunkwan University & Kim, Min Ah, Sungkyunkwan University

Despite the increasing prevalence of infertile couples undergoing infertility treatment, there has been a dearth of attention to the psychosocial challenges encountered by men experiencing infertility. This study aimed to understand the psychosocial challenges of men diagnosed with male-factor infertility who underwent fertility treatment. Through purposive sampling, eight men who had undergone infertility procedures were recruited for in-depth interviews. The case analysis revealed five overarching themes (complex emotions experienced following an infertility diagnosis, heightened stress in family dynamics, difficulties in spousal relationships during infertility treatment, stress and burden associated with disclosing infertility treatment in social relationships, and absence of social support systems during infertility treatment) and 16 subthemes related to challenges faced by infertile men. The findings of the study confirmed the personal, relational, and societal challenges experienced by men during infertility diagnosis and treatment. This study confirmed the importance of implementing interventions at the individual and societal levels to address the psychosocial challenges encountered by infertile men undergoing infertility treatments.

Article IX: "A Study of Factors Affecting the Implementation of Workplace Safety and Health Risk Assessment: Focus on Manufacturing and Service Industries," Park, Cheonsoo, People Foundation

Recently, on-site industrial accidents have been occurring at an increasing rate, highlighting the growing importance of risk assessment in preventing such incidents. I used data from the Occupational Safety and Health Survey (2021) to analyze factors affecting risk assessment participation among manufacturing and service industry workplaces. Among workplaces with 20 or more employees with risk factors in 2020, 72.4% conducted risk assessments, with 51.5% on a regular basis and 20.9% irregularly. The proportion of implementation is higher in the manufacturing industry (81.0%) than in the service industry (60.7%). The fewer the employees, the lower the rate of implementation. Among workplaces with 20-49 employees, 32.4% had never conducted a risk assessment. Regression analysis revealed that risk factors such as noise, explosion, and falling increased the implementation of risk assessment, but harmful rays, keeping a sitting posture for a long time, and emotional labor decreased the implementation of risk assessment. While whether or not having in place an in-house group tasked with the safety and health of employees did not contribute to any significant difference, the presence of an Occupational Safety and Health Committee and safety-and-health education and training increased the likelihood of risk assessment implementation. Employers’ interest in safety and health issues had minimal impact, but supervisors' safety and health management capabilities increased risk assessment implementation. Based on the analysis findings, policy implications were presented to strengthen support for small businesses, promote practical measures such as the Occupational Safety and Health Committee, and increase policy interest in identifying hidden risk factors.

Article X: "A Study on the Relationship between Fertility and Gender Equality according to Socioeconomic Development," Lee, Jesang, Institute of Making Family Happy & Song, Yoomee, Daegu Cyber University

As fertility rates in advanced countries rebound in the 21st century, theories studying this phenomenon state that the relationship between fertility rates and gender equality has a U-shaped relationship. However, this paper suggests that the relationship between fertility rate and gender equality is closer to inversely J-shaped than U-shaped, based on research showing that factors affecting fertility rates differ depending on the stage of socioeconomic development. The subjects of this study are 34 developed countries in the post-industrial stage and 111 developing countries in the industrial stage, and correlation and regression analysis are conducted on the two groups to find variables that affect fertility rates, and then to find out the determinants of fertility rates. The study found that women’s education level exhibited a strong negative relationship with the fertility rate in the industrial stage and a weak positive relationship in the post-industrial stage. The level of gender equality was not statistically significant in the industrial stage, and there was a strong positive relationship with the fertility rate in the post-industrial stage. Consequently, it was revealed that the level of education among women in the industrial stage and the level of gender equality in the post-industrial stage were the determinants of fertility rates, and that the relationship between the level of gender equality and the fertility rate was inversely J-shaped.

Article XI: "Discussion on the Distribution of Social Welfare Tasks and Financial Burden Sharing between Metropolitan and Local Autonomous Entities: Focusing on the City of Busan," Oh, Young Sam, Pukyong National University & Lee, Jaewon, Pukyong National University

We need to propose effective improvements in line with the principle of strengthening the roles of local autonomous entities and expanding their autonomy in South Korea. The purpose of this study is to analyze the allocation of social welfare tasks and the relationship of welfare finance between metropolitan and local autonomous entities. Then, this study proposes new directions for improving these relationships. This study focuses on Busan as a case study to analyze the welfare-finance relations between metropolitan municipalities and their autonomous districts. In this research, differences were observed in the scale of local tax revenues among the autonomous districts (Gu’s) of Busan, each displaying a fragile revenue structure. Most spending projects in these districts were social welfare programs funded by subsidies. The proportion of social welfare expenses in Busan's autonomous districts has continually increased over the past decade, while financial independence and autonomy have decreased. The rise in mandatory social welfare expenditures was likely a major factor in the decrease in financial independence. Reforming the welfare finance sharing system requires adjustments to the metropolitan autonomous entity’s budget, enhancing welfare finance in autonomous districts, and restructuring administration and finance in those districts. Mediumto long-term efforts and innovations are required to reform the welfare administration and fiscal sharing system in local autonomous entities.

Article XII: "Validating the Factor Structure and Measurement Invariance of the AUDIT-K Scale: Focusing on the Use of RMSEAD Index for Nested Model Comparison," Park, Byung-Sun, Gangneung-Wonju National University & Lee, Sun-Young, Gangneung-Wonju National University

This study was conducted to verify the validity and utility of the AUDIT-K by examining its factor structure and measurement invariances across gender and age groups, and longitudinal measurement invariance using data from the Korean Welfare Panel. In this process, RMSEAD, which has recently attracted attention, was used to verify any differences with the existing nested model comparison method. The data used in the analysis ranged from the 4th year to the 16th year. The main results of this study are as follows. First, AUDIT-K was found to be suitable for both two-factor and three-factor structures. Second, measurement invariance across gender and age groups was found to be maintained up to the weak invariance model. Third, longitudinal measurement invariance over 5 years at 1-year intervals was maintained up to the strict invariance model, and longitudinal measurement invariance over 13 years at 4-year intervals was found to be maintained up to the strong invariance model. Fourth, when comparing △RMSEA and RMSEAD for nested model comparison, it was confirmed that there were differences in results when comparing some models, suggesting that caution is needed in applying nested model comparison standards. Finally, the implications and limitations of this study were presented.

Article XIII (in English): "Does Fine Particulate Matter Affect Parental Childcare Time?: The Gendered Effects of Air Pollution," Choi, Mihyang, Korea National Council on Social Welfare

This study examines whether fine particulate matter affects parental childcare time, particularly focusing on the difference between mothers and fathers. Fine particulate matter pollution threatens children’s health and can shorten operational hours of childcare centers and educational institutions. Given these conditions, fine particulate matter is likely to increase parental childcare time. Combining the 2019 Korean Time Use Survey with fine particulate matter data, this study employs random effects Tobit models for analysis. The results show no significant relationship between fine particulate matter levels and parental childcare time. However, the impact of fine particulate matter on parental childcare time exhibited gender disparities, with increased fine particulate matter levels correlating with more time mothers spend on primary and simultaneous childcare activities and being with children. Conversely, fathers’ caregiving time decreased. These findings highlight that fine particulate matter can worsen existing gender inequality in childcare. This study concludes by discussing implications for policy and methodology and suggesting future research directions.

Article XIV: "Climate Change and Health Resilience in South Korea: An International Comparison from a Health System Perspective," Lee, Hansol, Myongji College; Park, Ye-In, Myongji College; Kim, Jaehee, Myongji College; and Lee, Yuri, Myongji College

Climate change is emerging as a significant global health risk. While previous studies have highlighted the health impacts of climate change, there remains a limited understanding of the adaptation strategies remains limited within the healthcare system in South Korea. This study, grounded in the World Health Organization’s framework for building climate health systems, evaluates South Korea's health resilience to climate change from an international perspective. Drawing insights from major countries like the UK, Germany, and Japan, we assessed how the South Korean health system responds to climate change and identified areas for improvement. Our findings indicate that the recognition of the link between climate change and health in South Korea is relatively low, and there is a lack of systematic response strategies. To address these challenges, we propose the following: enhance public education and promotional activities to raise awareness of the health implications of climate change; invigorate research to establish a systematic response strategy; incorporate diverse stakeholder opinions to develop a comprehensive response strategy; strengthen inter-departmental collaboration for efficient strategy implementation; and bolster international cooperation to integrate global standards and experiences into the strategy. Through these systematic responses, we anticipate that South Korea’s ability to address the health implications of climate change will be strengthened, thereby safeguarding the health of its citizens.

Article XV: "Solitary Deaths in the Republic of Korea: An Autopsy-Based Study," Na, Joo-Young, Pusan National University

The Ministry of Health and Welfare announced the results of a solitary death survey in 2022. Forensic autopsy data not only includes police investigative records but also comprehensive information regarding the postmortem examination of the deceased, making it the most suitable data for mortality-related research. This study conducted a sociological and forensic analysis of solitary death occurrences in the Republic of Korea using forensic autopsy data. Out of 664 forensic autopsies, 128 were solitary deaths, with the number of men being more than five times that of women. Solitary death was most prevalent among men in their 40s to 60s, with a particular peak in the 50s. It was primarily observed in divorce or separation cases, which accounted for nearly half of the cases, indicating an association with the breakdown of traditional family structures. In 50.9% of cases, neighbors, building managers, or landlords discovered the bodies due to the foul odor resulting from decomposition. The average time between death and the discovery of the body was 26.6 days. Most bodies exhibited Stage 2 decomposition, characterized by full-body discoloration and bloating. The average alcohol concentration in these cases was 0.074%. Among the 116 death certificates issued, the manner/cause of death could not be determined in over 80% of cases; however, following forensic autopsy, the manner of death was established in 93.0% of cases. Some causes recorded in the death certificates were later revised after forensic autopsy. Suicides accounted for 7.8% of cases (n=10). Based on the results of this study, characteristics of solitary death in the Republic of Korea were confirmed, and I recommend modifying the definition of solitary death by establishing a standard time of 7 days.

Article XVI: "Effect of Coming Out on the Self-Stigma in Persons with Mental Illness: Mediating Effect of Perceived Others' Reactions and Social Support," Seo, Mi-kyung, Gyeongsang National University; Lee, Min-hwa, Mokpo National University; and Lee, Jin-hyang, Changshin University

The purpose of this study was to show that coming out is an effective strategy to overcome self-stigma among individuals with mental illness. The purpose of this study was to explore the levels of coming out and to verify how coming out affects self-stigma mediated by perceived others’ reactions and social support among 236 persons with mental illness using community-based mental health facilities. The findings were as follows. First, coming out was highest to medical service providers, followed by relatives, friends, and coworkers, and lowest to neighbors and religious groups. Second, perceived others’ positive reactions were significantly higher than negative reactions. Third, coming out was statistically significantly affected by a longer treatment period and a higher social function of persons with mental illness. Fourth, coming out was significantly predictive of self-stigma mediated by perceived others’ reactions and social support. Specifically, the higher the coming out, the higher the perceived others’ positive reactions, the more increased social support, and the lower the self-stigma. Based on these findings, we emphasized the importance of programs supporting coming out in various situations and raising awareness about coming out among service providers.

Article XVII: "Determinants of Welfare Attitudes: A Focus on Perceptions of Current and Future Inequality Levels," Byeon, Young Joo, Seoul National University & Ko, Kil Kon, Seoul National University

This study explores determinants influencing welfare attitudes, with a focus on perceptions of current and anticipated future levels of inequality. Using data from the Korean Public Finance Panel Survey 2016~2021 (waves 9~14), panel analysis was conducted, and a one-way fixed effect was chosen to estimate the effects. The welfare attitudes under investigation can be broadly conceptualized as follows: 1) acceptance of welfare policies; 2) attitudes toward universal welfare provision; 3) views on government responsibility to reduce differences in income levels; and 4) willingness to accept fiscal expansion. The results show that those who perceive the current level of societal inequality as high are more accepting of welfare policies. They also recognize the need for targeted concentration of welfare benefits on socially vulnerable groups and tend to believe in the government's significant responsibility in alleviating inequality. As for perceptions of future inequality levels, a positive relationship was confirmed with perceptions of the government's responsibility. This study offers insights into the factors influencing welfare attitudes over multiple time points, focusing not only on the present but also on perceptions of future inequality levels.