Public Health and Welfare
Health conditions have improved dramatically since the end of the Korean War. Between 1955 and 1960, life expectancy was estimated at 51.1 years for men and 54.2 years for women. In 1990 life expectancy was 66 years for men and 73 years for women. The death rate declined significantly, from 13.8 deaths per 1,000 in 1955-60 to 6 deaths per 1,000 in 1989--one of the lowest rates among East Asian and Southeast Asian countries.
Nevertheless, serious health problems remained in 1990. South Korea's infant mortality rate was significantly higher than the rates of other Asian countries and territories such as Japan, Taiwan, Hong Kong, Singapore, and peninsular Malaysia. Although practically all the inhabitants of Seoul and other large cities had access to running water and sewage disposal in the late 1980s, environmental pollution and poor sanitation still posed serious threats to public health in both rural and urban areas.
The main causes of death traditionally have been respiratory diseases--tuberculosis, bronchitis, and pneumonia--followed by gastrointestinal illnesses. However, the incidence and fatality of both types of illness declined during the 1970s and 1980s. Diseases typical of developed, industrialized countries--cancer, heart, liver, and kidney ailments, diabetes, and strokes--were rapidly becoming the primary causes of death. The incidence of parasitism, once a major health problem in farming communities because of the widespread use of night soil as fertilizer, was reported in the late 1980s to be only 4 percent of what it had been in 1970. Encephalitis, a viral disease that can be transmitted to humans by mosquitoes, caused ninety-four deaths in 1982. To reduce fatalities, the Ministry of Health and Social Affairs planned to vaccinate 17.2 million persons against the disease by 1988.
The tensions and social dislocations caused by rapid urbanization apparently increased the incidence of mental illness. In 1985 the Ministry of Health and Social Affairs began a large-scale program to expand mental health treatment facilities by opening mental institutions and requiring that new hospitals have wards set aside for psychiatric treatment. The ministry estimated the number of persons suffering from mental ailments at around 400,000.
South Korea has not been entirely immune from the health and social problems generally associated with the West, such as Acquired Immune Deficiency Syndrome (AIDS) and addictive drugs. A handful of AIDS cases was reported during the late 1980s. Seoul responded by increasing the budget for education programs and instituting mandatory AIDS testing of prostitutes and employees of entertainment establishments. An AIDS Prevention Law was promulgated in November 1987. In late 1989, the government drafted a law requiring AIDS testing of foreign athletes and entertainers intending to reside in South Korea without their spouses for more than three months. Previously, the majority of those infected with AIDS had been prostitutes working near United States military bases, oceangoing seamen, and South Koreans working abroad. In the late 1980s, however, homosexuals began to account for an increasing number of those infected with the AIDS virus. The traditional Korean attitude toward homosexuality, which was to deny its existence, made it extremely difficult to treat this part of the population. The 200-percent annual increase in the number of AIDS-infected persons (from one reported case in 1985 to twenty-two cases in 1988) worried health officials.
While the use of heroin and other opiates was rare in South Korea and the use of cocaine limited, the use of crystalline methamphetamine, or "ice," known in South Korea as hiroppon, had become a serious problem by the late 1980s. Estimates of the number of South Korean abusers of this illegal drug (known in the United States as speed) ranged from 100,000 to 300,000 people in the late 1980s. Because use of the drug was believed to involve just low-status members of society, such as prostitutes and gangsters, the problem of hiroppon abuse had long been ignored in South Korea. The problem received greater attention from police and other government agencies during the late 1980s as the drug increased in popularity among professionals, students, office workers, housewives, entertainers, farmers, and laborers. Some observers suggested the drug's popularity was caused in part by a high-pressure work environment, in which people used hiroppon to cope with long working hours. It also has been suggested that the tighter border controls imposed by Seoul have resulted in diverting the product to the domestic market and contributing to greater domestic consumption.
An estimated 2,000 to 4,000 kilograms of methamphetamine were produced within South Korea annually, much of this total destined for shipment to Taiwan, Japan, and the United States by South Korean and Japanese yakuza, or gangsters. Since the majority of users injected the drug intravenously (although smoking and snorting it were becoming popular), South Korean health officials were concerned that the drug could contribute to the spread of AIDS. In 1989 Seoul established a new antinarcotics division attached to the prosecutor general's office and increased almost fourfold the number of drug agents.
Health Care and Social Welfare
Source: Based on information from Edward S. Mason et al., The Economic and Social Modernization of the Republic of Korea, Cambridge, 1980, 402, 404; and The Statesman's Yearbook, 1988-89, New York, 1988, 775.
The traditional practice of medicine in Korea was influenced primarily, though not exclusively, by China. Over the centuries, Koreans had used acupuncture and herbal remedies to treat a wide variety of illnesses. Large compilations of herbal and other prescriptions were published during the Choson Dynasty: the 85- volume Hyangyak chipsongbang (Great Collection of Korean Prescriptions) published in 1433 and the 365-volume Uibang yuch'wi (Great Collection of Medicines and Prescriptions) published in 1445. Shops selling traditional medicines, including ginseng, a root plant believed to have strong medicinal and aphrodisiac qualities, still were common in the 1980s. Because of the expense of modern medical care, people still had to rely largely on such remedies to treat serious illnesses until the 1980s--particularly in rural areas.
The number of physicians, nurses, dentists, pharmacists, and other health personnel and the number of hospitals and clinics have increased dramatically since the Korean War. In 1974 the population per physician was 2,207; by 1983 this number had declined to 1,509. During the same period, the number of general hospitals grew from 36 to 156 and the number of hospital beds tripled from 19,062 to 59,099. Most facilities, however, tended to be concentrated in urban areas, particularly in Seoul and Pusan. Rural areas had limited medical facilities, because in the past there was little incentive for physicians to work in areas outside the cities, where the major of the people could not pay for treatment. Several private rural hospitals had been established with government encouragement but had gone bankrupt in the late 1980s. The extension of medical insurance programs to the rural populace, however, was expected to alleviate this problem to some extent during the 1990s.
The South Korean government committed itself to making medical security (medical insurance and medical aid) available to virtually the entire population by 1991. There was no unified national health insurance system, but the Ministry of Health and Social Affairs coordinated its efforts with those of employers and private insurance firms to achieve this goal. Two programs were established in 1977: the Free and Subsidized Medical Aid Program for people whose income was below a certain level, and a medical insurance program that provided coverage for individuals and their immediate families working in enterprises of 500 people or more. Expenses were shared equally by employers and workers. In 1979 coverage was expanded to enterprises comprising 300 or more people, as well as to civil servants and teachers in private schools. In 1981 coverage was extended to enterprises employing 100 or more people and in 1984 to firms with as few as 16 employees. In that year, 16.7 million persons, or 41.3 percent of the population, had medical insurance. By 1988 the government had expanded medical insurance coverage in rural areas to almost 7.5 million people. As of the end of 1988, approximately 33.1 million people, or almost 79 percent of the population, received medical insurance benefits. At that time, the number of those not receiving medical insurance benefits totaled almost 9 million people, mostly independent small business owners in urban areas. In July 1989, however, Seoul extended medical insurance to cover these self-employed urbanites, so that the medical insurance system extended to almost all South Koreans. Differences in insurance premiums among small business owners, government officials and teachers, people in farming and fishing areas, and those employed by business firms remained a divisive and unresolved issue.
Medical insurance programs for farming and fishing communities, where the majority of people were self-employed or worked for very small enterprises, also were initiated by the government. In 1981 three rural communities were selected as experimental sites for implementation of a comprehensive medical insurance program. Three more areas, including Mokp'o in South Cholla Province, were added in 1982. Industrial injury compensation schemes were begun in the early 1960s and by 1982 covered 3.5 million workers in most major industries.
During the 1980s, government pension or social security insurance programs covered designated groups, such as civil servants, military personnel, and teachers. Private employers had their own schemes to which they and workers both contributed. Government planners envisioned a public and private system of pensions covering the entire population by the early 1990s. In the wake of rapid economic growth, large sums have been allocated for social development programs in the national budget. In FY (fiscal year) 1990, total spending in this area increased 40 percent over the previous year. Observers noted, however, that serious deficiencies existed in programs to assist the handicapped, single-parent families, and the unemployed.
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