**1. Introduction**

The rapid development of capitalism due to industrialization has improved socioeconomic levels around the world as well as increased the nation's interest in the level of people's health. The concept of health inequality that emerged from this process has served as an opportunity to establish and implement healthcare policies based on it, along with increasing global interest in the relationship between health and socioeconomic inequalities since the 1980s.

Although the concept of health inequality varies from scholar to scholar, the concepts of Whitehead [1] and the International Society for Equity in Health (2002) are generally used. According to Whitehead [1], "Inequality in health is a term commonly used in some countries to indicate systematic, avoidable and important differences" [1]. On the other hand, according to the definition by the International Society for Equity in Health, health inequality is "The absence of systematic and potentially remediable differences in one or more aspects of health across populations of population subgroups defined socially, economically, demographically, or geographically" [2]. In other words, health differences or gaps among individuals or groups can be caused by various socioeconomic factors, such as income, occupation, education, gender, and residential areas, in addition to the biological characteristics of individuals.

This view of health gradually spread to European countries in the 1990s, and in 2008, the World Health Organization published "Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health," which emphasized that the issue of health inequality should be addressed as a worldwide issue, and developed a strategic interest in healthcare policies and policies based on the current state of health inequality around the world [3–5]. Through these efforts, some countries have achieved partial reductions in health inequality problems, such as maternal-infant mortality [6], child and family health [7], and non-inflammatory diseases [8]. However, despite various efforts and attempts by the healthcare sectors of the world, the problem of health inequality seems to persist [9–11].

On the other hand, considering that the issue of health inequality is mainly a social problem experienced by the socially vulnerable, understanding social work that targets them is believed to provide insight into alleviating health inequalities. In modern society, social vulnerability generally means a group of individuals or such individuals who are excluded, marginalized, or left behind in a capitalist economic system [12]. Therefore, social work strategies for them are focused on socioeconomic support to address or alleviate their current difficulties by direct and continuous interaction with individuals or groups or various training and support programs for re-entry into a capitalist economy. In other words, in addition to direct and indirect support through various policies, support is needed in other community-based ways through direct and continuous relations with the socially vulnerable.

Therefore, in this study, we would like to consider the role of social work to complement the limitations healthcare approaches in order to mitigate the problem of health inequality among the socially vulnerable.

#### **2. Methodology**

In this study, we would like to explore the limitations of the existing healthcare approach to health inequality of socially vulnerable group through a literature review and present the role of social work to complement it. To that end, we will first look at the WHO's view of health and its transformation process. This is because it has a huge impact on health-related policies of individual countries by forming healthcare paradigms.

On the other hand, the key to healthcare policies is to encourage an individual to practice health behaviors to maintain or enhance their current health [13]. In the case of South Korea, various efforts have been made to reduce disparity in the 3rd Health Plan 2011–2020 that includes smoking, high-risk drinking, physical activity, and prevalence of obesity and hypertension as indicators to address health inequality based on income levels [14]. The results showed that the gap between the smoking rate and the high-risk drinking rate has somewhat eased, but the gap has widened for the physical activity rate and obesity rate [14]. Based on this, a healthcare approach alone is difficult to induce individuals to practice their health behaviors. Therefore, we would like to explore the theories involved in order to understand the health behaviors of individuals.

#### **3. A healthcare perspective on health**

In 1978, the WHO set all human health goals as the attainment by "all the people of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life" [15] and began to discuss in earnest the

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individual's health behavior.

**4. Health belief model**

*Mitigating Health Inequalities of Socially Vulnerable in South Korea: Role for Social Work*

need for the Alma-Ata Declaration, which centers on the activation of primary healthcare as well as intersectoral collaboration at various levels of society to address health inequalities [16]. The concept of health promotion, which began to be emphasized during this process, started to be perceived as a new strategy to realize people's social responsibility for a healthy future by arbitrating or mediating

As health promotion was being highlighted as a new approach to healthcare, the traditional approach to healthcare that centered on the treatment of diseases in the past began to change to prevention of diseases [13, 16]. Based on this paradigm shift, the WHO and its members held the first International Conference on Health Promotion in Ottawa, Canada, in November 1986 to establish and publish the Ottawa Charter for Health Promotion [17]. In the Ottawa Charter, health promotion is defined as a process that allows people to control and manage their health and health determinants, thereby improving their health. It presents three approach strategies to realize health promotion: "Advocate," "Enable," and "Mediate" as well as the five main areas of activity: "Build healthy public policy," "Create supportive environments," "Strengthen community actions," "Develop personal skills," and "Reorient health services" [17]. The Ottawa charter lays the groundwork for efforts to promote health in all the countries around the world, even today, more than 30 years later [16]. The WHO has since held a world conference on health promotion to reconfirm the basic principles and methodologies of health promotion, and through continuous discussion, it seeks effective and sustainable health promotion approaches to address health issues that are newly encountered with global environments, such as lifestyle and environment changes due to the development of

between individuals and the environment surrounding them [16].

globalization and information and communication technology [16, 18].

Conversely, this shift in the healthcare paradigm, centered on health promotion, also represents a shift from the past paradigm centered on the treatment of acute diseases to a paradigm centered on the prevention and management of chronic diseases [13]. This means that the problems of health inequalities experienced by the socially vulnerable today persist in a paradigm centered on the prevention and management of chronic diseases. So, despite these efforts by the healthcare sector, why does the phenomenon of health inequality persist? To this end, the following section looks at the health belief model, a theoretical framework that describes an

As national interest in health increased from the 1970s, various models and theories were proposed to predict and explain individual health behaviors. The health belief model describes health behaviors based on individuals' belief in perceived susceptibility, severity, benefits, and barriers to disease [19, 20]. The theory of rational behavior and the theory of planned behavior described health behaviors under the assumption that individuals use relevant information reasonably and systematically before doing anything [21, 22]. The precaution adoption process model explains that individuals go through seven stages of unaware of issue, unengaged by issue, deciding about acting, decided to act, acting, and maintenance until they act to protect their health [23]. On the other hand, the health belief model emphasizes aspects of subjective judgments for individuals to practice health behaviors. However, in contrast, other theories highlight the systematic collection and interpretation of health-related information for subjective judgments of individuals, opinions of others, and the process of decision-making based on it [21–23]. However, considering that the characteristic of the socially vulnerable

*DOI: http://dx.doi.org/10.5772/intechopen.89457*

#### *Mitigating Health Inequalities of Socially Vulnerable in South Korea: Role for Social Work DOI: http://dx.doi.org/10.5772/intechopen.89457*

need for the Alma-Ata Declaration, which centers on the activation of primary healthcare as well as intersectoral collaboration at various levels of society to address health inequalities [16]. The concept of health promotion, which began to be emphasized during this process, started to be perceived as a new strategy to realize people's social responsibility for a healthy future by arbitrating or mediating between individuals and the environment surrounding them [16].

As health promotion was being highlighted as a new approach to healthcare, the traditional approach to healthcare that centered on the treatment of diseases in the past began to change to prevention of diseases [13, 16]. Based on this paradigm shift, the WHO and its members held the first International Conference on Health Promotion in Ottawa, Canada, in November 1986 to establish and publish the Ottawa Charter for Health Promotion [17]. In the Ottawa Charter, health promotion is defined as a process that allows people to control and manage their health and health determinants, thereby improving their health. It presents three approach strategies to realize health promotion: "Advocate," "Enable," and "Mediate" as well as the five main areas of activity: "Build healthy public policy," "Create supportive environments," "Strengthen community actions," "Develop personal skills," and "Reorient health services" [17]. The Ottawa charter lays the groundwork for efforts to promote health in all the countries around the world, even today, more than 30 years later [16]. The WHO has since held a world conference on health promotion to reconfirm the basic principles and methodologies of health promotion, and through continuous discussion, it seeks effective and sustainable health promotion approaches to address health issues that are newly encountered with global environments, such as lifestyle and environment changes due to the development of globalization and information and communication technology [16, 18].

Conversely, this shift in the healthcare paradigm, centered on health promotion, also represents a shift from the past paradigm centered on the treatment of acute diseases to a paradigm centered on the prevention and management of chronic diseases [13]. This means that the problems of health inequalities experienced by the socially vulnerable today persist in a paradigm centered on the prevention and management of chronic diseases. So, despite these efforts by the healthcare sector, why does the phenomenon of health inequality persist? To this end, the following section looks at the health belief model, a theoretical framework that describes an individual's health behavior.
