“1997 financial crisis and inequality in Korean society 

explained through tuberculosis and poverty”

Persons of low socioeconomic position less likely to escape poverty if diagnosed with tuberculosis

Social consequences aggravated by IMF

Haejoo Chung’s team publishes results in PLoS One

A study has demonstrated, for the first time, how diseases in Korean society are related to inequality and fundamental changes in social mobility following the financial crisis.

A research team led by Haejoo Chung, a professor of the Department of Health Policy and Management under the College of Health Science, showed that persons of low socioeconomic position during childhood are less likely to escape poverty if diagnosed with tuberculosis, and that this was aggravated by the 1997 East Asian financial crisis. The results were presented in PLoS One, a U.S. journal published by the Public Library of Science.

Persons of low socioeconomic position during childhood can become poorer if diagnosed with tuberculosis, and such circumstances were worsened by the IMF crisis in 1997.

Members of the joint international study included Hongjo Choi, head of the Korean Institute of Tuberculosis under the Korean National Tuberculosis Association, and Carles Muntaner, a professor at the University of Toronto. The team analyzed 1980-2012 data obtained from the Korea National Health and Nutritional Examination Survey on tuberculosis patients who received treatment. Persons of low socioeconomic position during childhood, as determined by parental educational attainment, were more likely to have a lower household income at present if diagnosed with tuberculosis. This probability remained more or less the same in the 1980s, and doubled after the 1997 financial crisis. However, persons of high socioeconomic position during childhood did not become poorer even if they suffered from tuberculosis. The team pointed out that tuberculosis is both a cause and consequence of poverty, but tuberculosis patients belonging to higher income groups did not see any significant change in income level. That is, diseases like tuberculosis may be a factor causing persons from low income groups to remain poor.

Focus on historical time

Tuberculosis is known as a factor contributing to poverty, but not many studies have shown that the disease can result in a vicious cycle of low income. This study examines this aspect over different historical periods, paying attention to the varying strength of the relationship. Korea experienced a financial crisis around the end of 1997, and the impact of restructuring programs was seen across society. Companies went bankrupt, and many became jobless, which also sent quite a number to the streets. At this time, persons suffering from tuberculosis or other diseases had to take a sick leave or retire, and the resulting unemployment implies that the Korean economy did not recover for a long time. The fact that the negative impact of the disease worsened after the 1997 financial crisis, especially among persons of low socioeconomic position, can be traced to Korean society undergoing dramatic changes in polarization, economic inequality, and social mobility at that time.

Many articles on tuberculosis focus on the fear of contagion, yet fail to examine the lives of tuberculosis patients. The law protects tuberculosis patients by ensuring that they do not face disadvantages in the workplace when their health is restored. However, a significant number of patients quit their jobs after getting diagnosed. The team suggests that this may be an indicator that the disease is one cause of unemployment. After the financial crisis, many patients did not have a job to return to, or faced challenges in getting employed.

Health policies must expand with labor and social policies

Lastly, the team emphasized that health policies related to tuberculosis have to be implemented in consideration of social and labor policies. While the treatment of diseases is essential, strategies that alleviate negative social consequences such as unemployment, loss of income, and property disposition are more closely tied to social policies, not health policies.

The third pillar of the World Health Organization’s End TB Strategy (2015-2035) is to reduce the number of tuberculosis-affected families facing catastrophic medical costs to zero. As a solution, the organization emphasizes medical insurance and social protection. Korea’s tuberculosis incidence and death rate are still the highest among OECD countries, and the burden of disease is not low. However, the country has yet to implement strategies aimed at alleviating the related social consequences.

Moreover, recent discussions on sustaining livelihoods in relation to contagious diseases in Korea have called for a more thorough review of sickness benefits and paid sick leave. Disease-induced difficulties of sustaining livelihoods and the exacerbation of poverty should not be overlooked. The study shows that this problem has been present in Korean society since the 1997 financial crisis, and has grown more severe over the years.

Professor Chung’s study highlights the need for policymakers to make prospective decisions, so as to reduce the negative impact of economic crises.