**5. Limitations of the healthcare approach to health inequalities among the socially vulnerable**

#### **5.1 Paradigm shift from treatment to prevention: emphasis on prevention**

As we saw earlier, the approach to health from a healthcare perspective can be seen as an emphasis on the prevention paradigm, namely the formation of conditions that enable control and management of individuals' health and health determinants through the concept of health promotion centered on disease prevention and management. However, based on the view of the health belief model that describes an individual's practice of health behavior, the approach from a healthcare perspective emphasizes prevention of future illnesses and their healthcare management. The limitation of this approach, however, is that while it may increase the likelihood of screening an individual for disease prevention or healthcare, it does not enforce the practice of actual health behaviors. This means that based on perceived health risk factors, the final decision of whether an individual will practice healthy behavior or not is entirely their own [27, 28]. Moreover, given that the problem of health inequality is mainly a social problem experienced by the socially vulnerable, their diverse characteristics [12], such as low socioeconomic status and educational levels, are such that even if they have recognized factors that can negatively affect their health, they are not limited to leading to various tests for disease prevention or implementation of health behaviors for health management.

Therefore, if we look at the phenomenon of health inequality among the socially vulnerable today based on the health belief model, we can think of the healthcare approach that emphasizes the prevention of health inequalities as an approach that reveals its limitations at the point where, despite various efforts and attempts to resolve issues, it leads to health management practices for the prevention of diseases among individuals belonging to socially vulnerable groups. The above is illustrated in **Figure 1**.

#### **Figure 1.**

*Global Social Work - Cutting Edge Issues and Critical Reflections*

**4.1 Perceived susceptibility**

**4.2 Perceived severity**

behavior [25].

**4.3 Perceived benefit**

**4.4 Perceived barriers**

**4.5 Cue to action**

intention of action [20].

are less likely to have breast cancer [24, 26].

group can have a negative impact on the process itself of establishing a basis for subjective judgment, it is considered to be somewhat difficult to explain their health

The health belief model is a theoretical model developed in the early 1950s by social psychologists from the United States Public Health Service to explain the poorly examined phenomenon of disease prevention or early detection of diseases with no symptoms [19, 20]. Health belief models were subsequently studied by various scholars [20, 24–26], of which Janz and Becker [20] presented the following components

Perceived susceptibility refers to subjective judgments about how much one is exposed to health-threatening factors [20]. For example, the women who think they

Perceived severity refers to subjective judgments about how dangerous and serious the factors that threaten one's health or the consequences resulting from a disease are [20]. For example, women who believe that mortality increases without breast cancer screening are more likely to perform breast cancer screening [24, 26]. On the other hand, a combination of perceived susceptibility and perceived severity creates perceived threat, which is an influencing factor for predicting health

Perceived benefits refer to subjective judgments on the benefits of the following recommended actions [20]. The more positively a person evaluates the benefits of a health action, the less likely the threat is perceived. For example, a person who thinks that breast cancer screening is more accurate is more likely to go for a

Perceived barriers mean subjective judgments on the cost, time, and emotions in performing recommended actions [20]. Some people who do not undergo breast cancer screening acknowledge the benefits of the examination but do not act out of fear of the cost and time-consuming examination process [24, 26]. On the other hand, perceived benefits and perceived barriers have a direct effect on health

Cue to action refers to an internal or external stimulus that motivates an individual to perform their own health actions. In this case, internal cues refer to the self-awareness of the symptoms of one's health condition, and external cues refer to the messages sent through the media or by health experts [20]. These behavioral cues increase perceived susceptibility and perceived severity, thus, increasing the

In addition to the five factors discussed earlier, the health belief model includes perceived threat or demographic/social psychological variables that can affect a

checkup than someone who thinks it is less accurate [24, 26].

behavior, unlike the two factors discussed earlier [20].

behaviors. Therefore, this study focuses on the health belief model.

of health behavior practice for individuals to prevent and manage diseases.

**124**

*Basic elements of the health belief model (Janz and Becker [20]). Note: part of the figure has been modified to aid understanding of this study.*

**Figure 2.**

*Blind spot of recommended preventive health action.*

Of course, in order to cope with these problems, the government provides various healthcare services for the socially vulnerable, such as medical examinations, visiting care, and home visits, but the related resources are insufficient to cover all aspects of social vulnerability. This is also why communities emphasize on health promotion policies. Thus, the phenomenon of a prevention-oriented healthcare paradigm that emphasizes individual spontaneity for health promotion and a lack of healthcare resources to directly intervene in the practice of individual health behaviors can form a blind spot for the target population (**Figure 2**). Furthermore, such a blind spot regarding healthcare policy can be considered as a major factor for sustaining the phenomenon of health inequality among the socially vulnerable, despite various attempts and efforts to address this issue.

#### **5.2 Lack of understanding of the community: is the community a modern elixir?**

The Ottawa Charter, which produced a global consensus on basic strategies and areas of activity for the promotion of health, places specific emphasis on the role of communities in the process of prioritizing, deciding, planning, and carrying out health promotion activities to improve people's health level [17]. Further, the key functions and roles of the community for the promotion of health are to establish a system of related services for improving the health of local residents as well as to encourage active participation by the general public and local residents in local health-related issues and to enhance their ability to address them [16, 17]. On the other hand, the emphasis on communities here is that individuals and families are part of the community [29], that the healthcare paradigm from a past therapeutic perspective has not done much to address the adverse health phenomenon [30], and that health promotion requires collaborative approaches to various areas besides the healthcare sector [31]. Then, what does a community mean? There are many different views of the community, including:

First, to view the community as a unit of political collective action. From this point of view, local communities exist everywhere and proximity to various

**127**

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

pation and civic engagement, and access to mutual assistance [33].

activities in daily life is seen as a place where the majority of the members can have

Second, to view communities as functional units of production and exchange. The community is an activity space with a concentration of various social functions, including the production and use of social and commercial goods and services, socialization processes, social control mechanisms, opportunities for social partici-

Third, to view the community as a network of relationships or a structure of interaction between individuals. This view highlights two aspects. First, the intimate relationships, the degree to which you let people you know to know you [34, 35]. The other concerns the extent of the relationship, that is, the possibility of being connected to the network of relationships held by others beyond the scope of the community at the administrative district and the possibility of accessing various information, resources, and opportunities beyond the adjacent networks [36–38]. Based on the above, communities and its various possibilities could be considered as

On the other hand, the variety of possibilities that communities have means that in order to function as an elixir for the health promotion or address health inequality of local residents, they must be perceived as a concrete object, like a social problem, that can be addressed more specifically. In general, social problems mean that it becomes visible as a social phenomenon [40] or the social condition in which people perceive it as a serious problem and want to improve it [41]. However, as mentioned earlier, the prevention-oriented approach mainly addresses healthrelated issues that have not yet occurred or are expected to occur in the future, so it can be seen as exposing the limitations of using various resources in the community to enhance the participation and capacity of local residents and to encourage active implementation of individuals' health behaviors. Additionally, such a limit can be considered as another factor that escalates the phenomenon of health inequality,

**6. Educational strategies of social work to mitigate health inequalities** 

Traditionally, social work is primarily targeted at socially vulnerable groups, individuals experiencing exclusion, alienation, or rejection due to lack of productive forces in the capitalist economy. Then, what kind of educational content does

The International Association of Schools of Social Work (ISSW) and the International Federation of Social Workers (IFSW) adopted global standards for education and training of the social work profession through a general meeting held at Adelaide, Australia, in October 2004. The content of the standards to core curricula presented here suggests that students majoring in social work experience

The first area is the "Domain of the Social Work Profession," which includes the effects of socio-structural inadequacies; discrimination; oppression; social, economic, and political injustices on human functioning and development; knowledge of human behavior and development and of the social environment; critical understanding of the origins and purpose of social work; and the effects of social stability, harmony, interdependence, and collective solidarity on human development [42]. The second area is the "Domain of the Social Work Professional" that includes the development of self-reflective practitioner, the recognition of personal value systems, the recognition of ethical provisions, and sensitivity

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

an elixir in modern society [39].

especially among the socially vulnerable.

**among the socially vulnerable**

the social work that targets them highlight?

four core curriculums [42]:

political will [32].

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

activities in daily life is seen as a place where the majority of the members can have political will [32].

Second, to view communities as functional units of production and exchange. The community is an activity space with a concentration of various social functions, including the production and use of social and commercial goods and services, socialization processes, social control mechanisms, opportunities for social participation and civic engagement, and access to mutual assistance [33].

Third, to view the community as a network of relationships or a structure of interaction between individuals. This view highlights two aspects. First, the intimate relationships, the degree to which you let people you know to know you [34, 35]. The other concerns the extent of the relationship, that is, the possibility of being connected to the network of relationships held by others beyond the scope of the community at the administrative district and the possibility of accessing various information, resources, and opportunities beyond the adjacent networks [36–38]. Based on the above, communities and its various possibilities could be considered as an elixir in modern society [39].

On the other hand, the variety of possibilities that communities have means that in order to function as an elixir for the health promotion or address health inequality of local residents, they must be perceived as a concrete object, like a social problem, that can be addressed more specifically. In general, social problems mean that it becomes visible as a social phenomenon [40] or the social condition in which people perceive it as a serious problem and want to improve it [41]. However, as mentioned earlier, the prevention-oriented approach mainly addresses healthrelated issues that have not yet occurred or are expected to occur in the future, so it can be seen as exposing the limitations of using various resources in the community to enhance the participation and capacity of local residents and to encourage active implementation of individuals' health behaviors. Additionally, such a limit can be considered as another factor that escalates the phenomenon of health inequality, especially among the socially vulnerable.

## **6. Educational strategies of social work to mitigate health inequalities among the socially vulnerable**

Traditionally, social work is primarily targeted at socially vulnerable groups, individuals experiencing exclusion, alienation, or rejection due to lack of productive forces in the capitalist economy. Then, what kind of educational content does the social work that targets them highlight?

The International Association of Schools of Social Work (ISSW) and the International Federation of Social Workers (IFSW) adopted global standards for education and training of the social work profession through a general meeting held at Adelaide, Australia, in October 2004. The content of the standards to core curricula presented here suggests that students majoring in social work experience four core curriculums [42]:

The first area is the "Domain of the Social Work Profession," which includes the effects of socio-structural inadequacies; discrimination; oppression; social, economic, and political injustices on human functioning and development; knowledge of human behavior and development and of the social environment; critical understanding of the origins and purpose of social work; and the effects of social stability, harmony, interdependence, and collective solidarity on human development [42]. The second area is the "Domain of the Social Work Professional" that includes the development of self-reflective practitioner, the recognition of personal value systems, the recognition of ethical provisions, and sensitivity

*Global Social Work - Cutting Edge Issues and Critical Reflections*

Of course, in order to cope with these problems, the government provides various healthcare services for the socially vulnerable, such as medical examinations, visiting care, and home visits, but the related resources are insufficient to cover all aspects of social vulnerability. This is also why communities emphasize on health promotion policies. Thus, the phenomenon of a prevention-oriented healthcare paradigm that emphasizes individual spontaneity for health promotion and a lack of healthcare resources to directly intervene in the practice of individual health behaviors can form a blind spot for the target population (**Figure 2**). Furthermore, such a blind spot regarding healthcare policy can be considered as a major factor for sustaining the phenomenon of health inequality among the socially vulnerable,

**5.2 Lack of understanding of the community: is the community a modern elixir?**

First, to view the community as a unit of political collective action. From this point of view, local communities exist everywhere and proximity to various

The Ottawa Charter, which produced a global consensus on basic strategies and areas of activity for the promotion of health, places specific emphasis on the role of communities in the process of prioritizing, deciding, planning, and carrying out health promotion activities to improve people's health level [17]. Further, the key functions and roles of the community for the promotion of health are to establish a system of related services for improving the health of local residents as well as to encourage active participation by the general public and local residents in local health-related issues and to enhance their ability to address them [16, 17]. On the other hand, the emphasis on communities here is that individuals and families are part of the community [29], that the healthcare paradigm from a past therapeutic perspective has not done much to address the adverse health phenomenon [30], and that health promotion requires collaborative approaches to various areas besides the healthcare sector [31]. Then, what does a community mean? There are many differ-

despite various attempts and efforts to address this issue.

*Blind spot of recommended preventive health action.*

ent views of the community, including:

**126**

**Figure 2.**

based on diversity and their ability to address them [42]. The third area focusses on the "Methods of Social Work Practice," which include assessment, formation of relationships and aid processes, value, ethical principles, application of knowledge and skills, social work research and skills, and field training [42]. The last area is the "Paradigm of the Social Work Profession," which includes human dignity and values, advocacy, empowerment, respect for the rights of service users, tasks and crises along the life cycle, recognition of strengths and potential, respect and recognition of diversity [42].

Considering the above, the general social work education strategy can be thought of as a strategy that focuses on various areas, such as basic development process and socioeconomic support that can affect them through direct and indirect intervention and psychological support for re-entry into the capitalist economy, based on an in-depth understanding of individuals and families or specific groups. One point to be noted here is that the healthcare sector was not included, although social work has specified access to and involvement in various areas that affect their vulnerability as a core curriculum. Based on this, the academic boundaries [43] can be expected to exist, emphasizing healthcare centered on disease prevention and treatment and social work centered on social and psychological support for re-entry into the capitalist economic system. Furthermore, such academic boundaries also mean that healthcare issues, including various social factors, such as health promotion or health inequalities, simply approach health and medical issues in the same way as a team approaches, that does not help much in solving problems [44].

As we saw earlier, the limitations of the healthcare approach to reduce health inequalities have been found in the prevention-oriented policy keynote and lack of understanding of the function and role of the community, which presupposes the willingness of individuals to practice health behaviors. Further, the limitations of this approach to the phenomenon of health inequality can be considered as a factor that continues to this day, despite the various efforts and attempts in the past four decades to resolve it. Therefore, to overcome these limitations, it is deemed necessary to add healthcare-related subjects, such as public health or social epidemiology and etiology to the existing curriculum of social work, which are based on a deep understanding of the social environment and the human nature. Moreover, given that the issue of health inequality is a social problem experienced by the socially vulnerable, the main target of social work, the motivation and monitoring of these people to implement and maintain health behaviors and the possibility of improving the environment of the community and organizing related community resources through social problems can be found in the aforementioned academic and practical features of social work. This, in turn, can be expected to compensate for the limitations of the healthcare approach to reduce the health inequalities that the socially vulnerable experience.

#### **Acknowledgements**

The first author wishes to express his deepest gratitude to Eun Jin Lee, Ji Young Park, and Soo Hyun Sung for their support and guidance, who contributed tremendously to this article.

**129**

**Author details**

Jung Youn Park1

Seoul, South Korea

, Eun Jin Lee1

provided the original work is properly cited.

\*Address all correspondence to: eunjin6434@yuhan.ac.kr

\*, Ji Young Park<sup>2</sup>

1 Department of Health and Welfare, Yuhan University, Gyeonggi, South Korea

2 Department of Social Welfare, Sungkyunkwan University, Seoul, South Korea

3 Department of Public Policy, National Development Institute of Korean Medicine,

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

and Soo Hyun Sung3

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

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

### **Conflict of interest**

The authors declare no conflict of interest.

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