Social Determinants of Health and Health Inequality in South Korea

Abstract

Purpose: Recognizing the social factors behind population health and health equity, the present study examines the role of locality in regional health and assesses the its contribution to local health inequality at municipality level in South Korea. Research design, data, and methodology: The present study investigates the association between a vector of municipal socioeconomic characteristics and population health, taking into account possible unobservable geographical fixed effects at metropolitan/province level, and quantifies the contribution of sources of inter-municipality health inequality by decomposing the disparity in life expectancy across municipalities. For empirical analysis, it draws upon life expectancy data at municipal level in South Korea estimated by The Korean Society for Equity in Health in 2018 and data obtained from various souces such as National Health Insurance Service (NHIS), Annual Local Tax Statistical Report of Ministry of the Interior and Safety (MOIS), National Election Commission (NEC) and Korea Statistical Information Service (KOSIS). Results: This study provides the empirical evidence to the importance of social determinants on local population health and health inequality within and between municipalities. Taking life expectancy as a proxy of municipal population health, we finds the different role of social determinants on local health and health inequality between the highest and the lowest income group within a municipality. While some variables (eg. income inequality among municipal population), for instance, are associated with both life expectancy and its gap, many of other factors such as municipal income level and the degree of financial self-reliance are not prone to life expectancy but the disparity of life expectancy in the context of population health. Implications: The study highlights three findings; (1) level of local autonomy contributed in reducing life expectancy gap across municipality; (2) Geography is closely associated with health inequality across municipalities. Approximately 40 % of inequality stem from non-residence in Seoul metropolitan area; (3) Given the universal population coverage of the national health insurance service, a positive association between the local health related resources and health disparity among municipal population might imply a discrepancy in the level of treatment of diseases. This may result from different household financial capacity and an unequal access to private health insurance.