건강결정요인; 사회적 자본; 성공적 노화; 건강신념; 고령친화산업; 지방자치단체 건강영향평가
건강영향평가는 공공정책 수립을 위한 정보 제공 및 건강 결과를 예측하는 사업으로, 우리 원에서 수행하고 있는 건강영향평가사업의 목적은 건강영향평가를 우리나라에서 제도화하여 이를 통해 행정의 변화를 가져올 수 있도록 하는 데 있다. 이에 본 연구에서는 그간의 건강영향평가 추진 사업을 살펴보고, 지방자치단체에서의 건강영향평가 제도화 및 노화 관련 건강영향평가 도구 개발 등을 토대로 건강영향평가사업의 활성화 방안을 모색하였다. 연구결과, 지방자치단체의 정책을 대상으로 한 건강영향평가를 점차 확대하여 적용한다면 전국민의 건강에 긍정적인 영향을 줄 수 있을 것으로판단된다.
1. Background and purposes Health impact assessment (HIA) provides information to establish a health orientated policy and predict the health impacts of different policy alternatives. This study aims to institutionalize HIA in Korea. To achieve this, the following 3 different research projects were carried out as a ground work. First, introduction of HIA was prepared by conducting a pilot project against local and central governmental policies. The second research was the construction of infrastructure for HIA. Pilot project was also executed and HIA guideline was established according to the determinants of health and regional factors. Third, the policy research was performed to suggest strategies for institutionalization of HIA. This is intended to play a central role of HIA in Asia-Pacific region. Local governments are especially in need for implementation of HIA system, as they are first at the scene of public policy. Therefore, a collaborative research was conducted closely with Seocho-gu in Seoul for institutionalization in local government in 2016. HIA was implemented for Firefly center operation and Yangjae-stream integrated improvement projects and suggestions were made to maximize the positive impacts while minimizing negative effects. As Korea is becoming a super-aged society, investigation was conducted to create an index related to the health determinants of vulnerable populations such as senior citizens or the potentially vulnerable population. Required basic information for analysis of the health determinants of the aged group and the equity-focused health index were created. Further, HIA was executed on pedestrian improvement project for old age population and recommendations were drawn.
2. Results and Implications Based on Environmental Health Act, HIA should be conducted in Korea. However, its application is limited to certain development projects, and is not applied comprehensively to local and central governmental projects. There is no independent enactment of an Act regarding HIA at a governmental level. However, some local governments such as Muju-gun in Jeonbuk and Seocho-gu in Seoul implemented a comprehensive and independent HIA regulations and attempted its institutionalization. The first fundamental for development of a local governmental HIA institutionalization model is to develop an independent model, which is not a part of environmental impact assessment. The objective is to induce more direct impacts on health improvement through this model. Second, development of a comprehensive HIA institutionalization model that encompasses all-inclusive determinants of health(health, social, physical factors), subjected to laws, systems, plans and projects. All direct and indirect health impact factors should be included to execute a realistic health promoting policy, consequently the citizens can experience health improvement effects. The final goal of local governmental HIA model development is to create a sustainable HIA institutionalization model that transfer and implementation are easy. The model that has been developed as an outcome of this research, would be improved after pilot studies in 2017. This model will be distributed to local governments with a long-term goal of institutionalization at the central government. In 2012, the first survey on determinants of health that are related to successful aging was conducted against senior citizens in Seoul as a part of the infrastructure building research for HIA. A quantitative analysis subjected to senior citizens showed that a successful aging was associated with health and social related factors such as age, gender, and income level differences. An index for determinants of health was created for HIA. This index is expected to enable a multi-dimensional assessment of factors contributing to the improvement of personal maintenance and health. A trend analysis of Europe in OECD report showed that local social capital has a positive relationship with the level of health when transversal data were observed. On the other hand, there were some studies showing no relationship between them. Social capital including social participation revealed to influence the personal health management behavior or health life, directly or indirectly. Thus, policies and projects should be developed in such a way that it impacts positively on social capital during the planning stage. When social determinants of health are considered during HIA, areas where it can influence the social capital should be examined. Policies should be developed and implemented in a way that the influence of fixed factors on health inequality, such as demographic characteristics, is minimized. To obtain this, the elements of the policies that increase social capital should be generated, and this should be reviewed during HIA. As an effort to minimize the impacts on health inequality, social policies should support income and social activities for the low-income population. In Korea, to minimize health inequalities caused by demographic characteristics, health promotion goal by population group and a sub project were created as a part of the comprehensive plan for national health promotion. However, Korea’s senior wellness program focuses on prevention and management of chronic illnesses. Thus, further project development is needed for social health improvement policies. Korea’s major senior wellness program includes guaranteed income supplement, illness recuperation, and health insurance. Whereas the main social wellness program is an employment policy for seniors. Reviewing overseas’cases, their main characteristics are continuous governmental monitoring that ensures the penetration of their socio-economical support for the vulnerable populations. Monitoring index is also developed considering multi-dimensional aspects of health inequalities of socially vulnerable population. To expand social capital, social opportunities should be created to promote social participation. For the middle age and older populations to increase their social capital with diverse methods, their education opportunities should also be boosted. When HIA is conducted, successful aging and social capital factors should be reflected to the elements of the policies. To select the policies for seniors to apply HIA, awareness of senior friendly program amongst old age population was investigated. Amongst 1000 middle/old age group, 43% were aware of the senior friendly programs and have used the service. However, only 13.8% were willing to use the service again in the future, where females were more eager than males. Illness recuperation, housing, and medical equipment projects were the most recognized services, which are followed by supplies or an article, financial asset management, medicine and medical supplies, food, toiletries, and leisure and cultural services projects. Priority analysis revealed that medicine and medical supplies, illness recuperation, housing and food were at the top of the priority list. As part of the housing project, which has a high priority, pedestrian improvement project for seniors was selected for an evaluation through the expert advice from operating committee. Based on the results of HIA of pedestrian improvement project for seniors, recommendations were drawn. First recommendation to produce positive health impact is enforcing road traffic safety. This is achieved by means of regulation of traffic speed through implementing traffic signs and street lights at the entrance of the rural villages where a national highway passes. Second, as people get older, their perception of the length of the pedestrian crossing becomes shorter. Therefore, installation of a facility that can control the crossing time would be useful such as tactile paving and an alarm system implemented for the disabled. Third, 91.3% responded that a road safety education is required for elderly people, confirming that the majority agrees that the road safety education is necessary. Therefore, it is essential for police department to train professional elderly road safety educators to operate a systematic and unified road safety education program for senior citizens to promote the road safety for elderly people. Forth, precaution for green flickering light must be added to the road safety program, since high percentage of the respondents stated that they cross at the flickering light. Further, wearing bright color cloths should also be added to the program This study showed that only 21.5% of the seniors over 60 years old wear bright colors when they go out in the dark, whereas 65.3% wear the same cloths that they wear during the day. and wearing reflective safety gear should also be encouraged. For health equity, it is more suited to create and develop projects that are based on volunteers and voluntary corporation of elderly people, in contrast to high cost projects such as facilities renovation and maintenance. In conclusion, the road and traffic environment influences the health of senior citizens directly and indirectly. The survey showed that the current pedestrian environment is inconvenient for elderly people. Therefore, self-protection should be encouraged for the senior citizens from the road hazard via implementing the pedestrian environment improvement and road safety education projects.
Abstract 1 요 약 9 제1부 건강영향평가 추진 현황 제1장 추진 배경 및 필요성 17 제1절 건강영향평가 연구의 필요성 및 목적 17 제2절 건강영향평가 연구 목표와 내용 18 제2장 추진 사업 현황 19 제1절 추진 사업 개요 19 제2절 추진 사업 현황 분석 20 제2부 지방자치단체에서 건강영향평가 제도화 제1장 지방자치단체 건강영향평가제도 도입의 필요성 31 제2장 우리나라 영향평가제도 도입 현황 및 시사점 35 제1절 부패영향평가 35 제2절 성별영향분석평가 45 제3절 시사점 52 제3장 외국의 법제화 현황: 지방자치단체를 중심으로 55 제1절 미국 55 제2절 호주 104 제3절 영국 112 제4절 캐나다 113 제5절 소결 116 제4장 외국의 건강영향평가 도구 분석 117 제1절 건강영향평가의 기본과정 117 제2절 건강영향평가 단계별 『건강영향평가 도구』124 제3절 소결 159 제5장 지방자치단체 건강영향평가 모형 개발 163 제6장 서초구 정책사업에 대한 건강영향평가 187 제1절 서초구 지역사회 현황 187 제2절 반딧불이사업 건강영향평가 198 제3절 양재천 종합정비사업 건강영향평가 242 제3부 노화 관련 건강영향평가 도구 개발 제1장 중고령자의 노화와 사회적 건강결정요인 281 제1절 우리나라 중고령자의 성공적 노화 인식에 대한 설문조사 281 제2절 사회적 자본의 영향요인 308 제3절 중고령자의 성공적 노화 인식에 대한 질적 조사 328 제4절 시사점 374 제2장 고령자 대상 정책사업에 대한 건강영향평가 383 제1절 고령자 관련 제도와 산업 383 제2절 건강영향평가 대상 현황 및 선정 391 제3절 안전한 보행환경 조성사업 건강영향평가 400 제4부 결론 및 정책제언 제1장 결론 및 시사점 491 제1절 지방자치단체에서 건강영향평가 제도화 491 제2절 노화 관련 건강영향평가 도구 개발 501 제2장 정책제언 507 부 록 523 부록 1. 고령자 교통안전교육에 대한 설문조사 523 부록 2. 성공적 노화에 대한 건강영향요인 조사 527