Purpose: The purpose of this study was to explore ways to define the concept of health inequality. Methods: The concept analysis process by Walker and Avant was used to clarify the meaning of health inequality. Results: Defining attributes of health inequality included differences in health status between individuals or groups, infringement of fundamental rights to health, unfair use of medical services, and social discrimination. The antecedents of health inequality included differences in demographic characteristics (age, gender, education, occupation, residential location), limitations in accessibility to health care, and social exclusion. Consequences of health inequality were increased costs for medical care, decreased health-related quality of life, and lack of ability to cope with health problems resulting in crisis situations, increases in morbidity and mortality, and shortening of life span. The concept was clarified through presentation of model, borderline, related, and contrary cases. Conclusion: Results of this study can be used to guide the direction of future studies through concept analysis in which conceptual attributes in the context of health inequality are examined. Also, based on the result of this study, development of standardized tools to measure health inequality is recommended as well as development of educational programs to reduce health inequalities.
행복한 삶을 영위하기 위해 건강은 필수적이며 인간이 누려야 할 가장 기본적인 권리이다. 건강은 단순히 질병이 없는 상태뿐만 아니라 사회 및 환경과 결합하여 발생하는 것으로, 건강에 대한 기본권이 보장받지 못하게 되면 개인의 행복은 물론 지역사회의 발전과 국가의 경쟁력에도 부정적인 영향을 미치게 된다. 개인이 어려운 환경에 처해있을 때 건강이 위협을 받으면 의료서비스 제공과 이용 시 불평등이 발생하며, 건강할 수 있는 기회가 감소될 수 있다[2,3].
Kim HY. Community inequalities in health: The contextual effect of social capital. Korean Journal of Sociology. 2010;44(2): 59-92.
Kim MH, Lee JH. Current status of policy developments in tackling health inequalities and the next steps to be taken in Korea. Journal of the Korean Medical Association. 2013;56 (3):206-212. http://dx.doi.org/10.5124/jkma.2013.56.3.206
House JS, Lantz PM, Herd P. Continuity and change in the social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002(Americans' Changing Lives Study). The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2005;60(S2):S15-S26. http://dx.doi.org/10.1093/geronb/60.special_issue_2.s15http://dx.doi.org/10.1093/geronb/60.Special_Issue_2.S15he social stratification of aging and health over the life course: Evidence from a nationally representative longitudinal study from 1986 to 2001/2002(Americans' Changing Lives Study). The Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2005;60(S2):S15-S26. http://dx.doi.org/10.1093/geronb/60.special_issue_2.s15
Lee KO, Yoon HS. Relationship between inequalities in health and inequalities in socioeconomic status. Journal of Korean Community Nursing. 2001;12(3):609-619.
Kim SY, Yoon KC. An analysis of the regional differences of health inequality and the exploration of the factors causing the differences. The Korean Journal of Local Government Studies. 2012;15(4):31-57.
Marmot M. Social determinants of health inequalities. The Lancet. 2005;365(9464):1099-1104. http://dx.doi.org/10.1016/s0140-6736(05)71146-6http://dx.doi.org/10.1016/S0140-6736(05)74234-3lities. The Lancet. 2005;365(9464):1099-1104. http://dx.doi.org/10.1016/s0140-6736(05)71146-6
Schroeder SA. We can do better-improving the health of the American people. New England Journal of Medicine. 2007; 357(12):1221-1228. http://dx.doi.org/10.1056/nejmsa073350http://dx.doi.org/10.1056/NEJMsa073350ing the health of the American people. New England Journal of Medicine. 2007; 357(12):1221-1228. http://dx.doi.org/10.1056/nejmsa073350
Walker LO, Avant KC. Strategies for theory construction in nursing. 4th ed. Upper Saddle River, NJ: Prentice Hall; 2005.
Encyclopaedia Britannica online Korea. Health [Internet]. Encyclopaedia Britannica online Korea. 2013 [cited 2013 April 24]. Available from: http://preview.britannica.co.kr/bol/topic.asp?article_id=b01g2163a
Neufeldt V. Guralnik DB. Webster's new world college dictionary. 3rd ed. New York, NY: Macmillan; 1996.
Encyclopaedia Britannica Online Korea. Equality [Internet]. Encyclopaedia Britannica Online Korea. [cited 2013 April 24]. Available from: http://preview.britannica.co.kr/bol/topic.asp?article_id=b23p2636a
Park EO, Song HJ. Differences and inequalities in health status among social class classified by occupation and job status. Korean Journal of Occupational Health Nursing. 2003;12(2): 171-176.
Laaksonen M, Talala K, Martelin T, Rahkonen O, Roos E, Helakorpi S, et al. Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: A follow-up of 60,000 men and women over 23 years. European Journal of Public Health. 2007;18(1):38-43. http://dx.doi.org/10.1093/eurpub/ckm051
Kim HR. Implication of health behaviors in socioeconomic health inequalities and policy directions. Health and Welfare Forum. 2009;149:36-47.
Watts RJ. Race consciousness and the health of African Americans. The Online Journal of Issues in Nursing. 2003;8(1):4
Byun S-W. Difficulties in health behavior of migrant intermarriage women. The Journal of Digital Policy and Management. 2013;11(12):631-637. http://dx.doi.org/10.14400/JDPM.2013.11.12.631
Atkinson R. Davoudi S. The concept of social exclusion in the European union: Context, development and possibilities. Journal of Common Market Studies. 2000;38(3):427-448. http://dx.doi.org/10.1111/1468-5965.00229
Adams JS. Inequity in social exchange. In: Berkowitz L, editor. Advances in experimental social psychology. New York, NY: Academic Press; 1965. p. 267-299.
Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN, Manderscheid R, et al. Health disparities and health equity: the issue is justice. American Journal of Public Health. 2011; 101(S1):S149-S155. http://dx.doi.org/10.2105/ajph.2010.300062http://dx.doi.org/10.2105/AJPH.2010.300062eist T, Borrell LN, Manderscheid R, et al. Health disparities and health equity: the issue is justice. American Journal of Public Health. 2011; 101(S1):S149-S155. http://dx.doi.org/10.2105/ajph.2010.300062