1. Vladivostok Harbin Seoul Eun Jeong Chun(M.D, M.P.H) Seoul University Republic of Korea Jinhee, Kim 1), Ok Ryun, Moon 2), Eun Jeong, Chun 1) 1)Seoul National University 2) Inje institute for Advanced Studies Institutionalizing HIA in Korea

2. Contents 2. Background 3. Strategy 4. Conclusion 1. Introduction of Korea Jeju Gangwon Chungbuk Gyeongnam Chungnam Jeonbuk Jeonnam Gyeongbuk Hambuk Pyeongbuk Hwanghae Hamnam Pyeongnam Gyeonggi

3. Location

4. Korea at a Glance Population: 48.456 million (2007. OECD) Area: South Korea(99,000 ㎢ ) Geographical Location: Eastern Asia, southern half of the Korean Peninsula, bordering the East Sea and the Yellow Sea Climate: distinctive 4 seasons, with rainfall heavier in summer Busan Gwangju Daegu Ulsan Daejeon Incheon Seoul Administrative divisions: 9 Provinces (do) + 7 Metropolitan Cities (gwangyoksi, tukpyolsi) Local Self-Government System (June, 1995)

5. Statistics of Korea  GDP per capita: 23,038 $  Life expectancy at birth: 78.5(OECD, 2005)  Total fertility rate: 1.24 (2005)  Infant mortality rate: 4.7 (2005)

6. The Korean Health Care System Central Village (Community Health Post) Township (Community Health Subcenter /Community Health Post) County (Community Health Center Public Hospital) Province (Department of Health) TEXT NHIC Branch office/ a hospital NHIC Regional head quarter National Health Insurance Corporation (NHIC) : Head quarter People Ministry of Health, Welfare and Family Affairs (MIHWAF) Center for Disease Control & Prevention (CDC) Public InstitutePrivate Organization Private Hospital /Clinic/Solo practitioner Private Voluntary Agency Province local village

7. Vladivostok Harbin Seoul Why Health Impact Assessment? Background

8. Other Impact Assessment TransportPopulationDisasterEnvironmentGender Main Ministry Ministry of Land, Transport and Maritime Affairs Ministry of Public Administrati on and Security Ministry of Environment Ministry of Gender Equality Start from 19871984199619812002

9. The Environmental Health Act  The Environmental Health Act (Mar 28, 2008) Established to implement HIA in 2010 Ministry of Environment ->plans to conduct HIA within the existing EIA ->kind of Health Risk Assessment Ministry of Health, Welfare and Family Affairs ->looking for opportunities to conduct independent HIA Some conflict is expected

10. Seoul

11. Health inequality  Health inequality is constructed regionally and by social class in Korea Citizens living north of the Han River have a 30% higher death risk than those who live in the South within Seoul. Lower 20% income group spend 1/3 in medical expenses compared to those of the higher 20% income group. A family with a total income of less than 500,000KRW per month has 2.37 time higher risk of death than a family with 2,500,000 KRW per month. -> Use HIA to reduce health inequalities

12. Vladivostok Harbin Seoul Strategy

13. HIA within EIA  more efficient  faces less resistance in the institutionalization process

14. Independent HIA  EIA : conducted for projects -> difficult to run an HIA on policies  EIA’s methodologies and tools are sophisticated and well developed -> HIA can be lost in the vast volume of the EIA report

15. Conflict  Until now HIA has been under developed and considerations for social determinants of health were underscored.  Health professionals and the Ministry of Health, Welfare and Family Affairs Advocated the implementation of an independent HIA, separate from the EIA process  However New administration is pro-market economy and against government regulations HIA has little chance to be institutionalized

16. Cooperation Model  MoE - major agency  MIHWAF - support on the health sector This will minimize redundancy Practical strategy  The two ministries Should minimize their self interest Research on establishing this cooperative relationship is required

17. Vladivostok Harbin Seoul Conclusion

18. Action Plan (1) Pre-step conducting pilot cases and research projects HIA center ↓ Step 1 Policy Policy of MIHWAF ->Other policy ↓ Step 2 Project Public financed project ↓ Step 3 Private project Large scale project

19. Action Plan (2)  Main Responsibility to conduct HIA MIHWAF -> policy/project conductor  HIA as mandatory Add on the regulation of HIA to existing law  Preparation -> comprehension -> regulatory  Start from what we can do now! Policy of MIHWAF Desktop or rapid HIA