Annals of Occupational and Environmental Medicine最新文献

South Korea remains one of the few Organization for Economic Cooperation and Development countries without a statutory paid sick leave system or a public sickness benefit program. This paper examines the necessity of introducing statutory paid sick leave in South Korea and outlines key considerations for its implementation. The "right to rest when sick" is a fundamental health and labor right that ensures workers can recover from illness without risking job loss or income insecurity. A comparative review of international systems demonstrates that most countries have institutional mechanisms to support workers during non-work-related illnesses or injuries through paid sick leave and/or sickness benefits. In contrast, South Korean workers-especially those in small workplaces or non-regular employment-face limited access to such protections. The absence of these systems exacerbates social inequality and increases the risk of presenteeism and delayed medical care. Introducing statutory paid sick leave is not only a public health investment but also a measure to promote labor rights, reduce productivity losses, and prevent poverty caused by illness. The implementation of such a system must ensure universal coverage, prohibit employer retaliation, and be integrated with future sickness benefit programs to create a comprehensive social safety net.

Background: Polycyclic aromatic hydrocarbons are generated from the incomplete combustion of organic materials such as fossil fuels and wood. These compounds, often inhaled, cause respiratory issues like asthma and chronic obstructive pulmonary disease due to oxidative stress and inflammation. Pohang, South Korea's iron and steel hub, experiences significant polycyclic aromatic hydrocarbons emissions from extensive industrial activities and heavy truck movements. This study investigates the link between urinary polycyclic aromatic hydrocarbons metabolites and respiratory diseases among Pohang residents, considering their cumulative exposure and duration of residency.

Methods: Utilizing data from the National Environmental Research Institute's health impact assessment conducted between 2012 and 2015, this study included 1,189 participants from Pohang. Urinary concentrations of polycyclic aromatic hydrocarbons metabolites served as exposure indicators. The study assessed the correlation between these metabolite levels and self-reported respiratory diseases, considering variables such as duration of residence, smoking status, and occupational exposures. Statistical analyses involved logistic regression and fixed-effect meta-analysis.

Results: The findings indicate a significant association between elevated levels of polycyclic aromatic hydrocarbons metabolites and an increased risk of respiratory diseases, particularly among those in the highest exposure quartile. The study also found a notable dose-response relationship, emphasizing the heightened risk with longer residency durations near the industrial complex. Despite yearly fluctuations, the trend suggests a persistent risk associated with high polycyclic aromatic hydrocarbons exposure.

Conclusions: Elevated exposure to polycyclic aromatic hydrocarbons near industrial areas such as the Pohang Industrial Complex is significantly associated with an increased prevalence of respiratory diseases. The study underscores the importance of implementing public health strategies to reduce polycyclic aromatic hydrocarbons exposure, especially in industrial regions. Future research should broaden the scope of polycyclic aromatic hydrocarbons metabolites analyzed and consider comprehensive exposure histories to better understand the relationship between polycyclic aromatic hydrocarbons exposure and respiratory health outcomes.

The experience of the coronavirus disease 2019 pandemic has highlighted the importance of paid sick leave and sickness benefits, and is creating an international movement to introduce or improve real-world systems. The Organisation for Economic Co-operation and Development (OECD) countries except Korea and the United States already have statutory paid sick leave or sickness benefits, with the United Kingdom extending statutory paid sick leave to low-income workers in 2025, and Ireland introducing statutory paid sick leave in 2023. In the United States, 19 states, including Minnesota in 2024 and Alaska and Missouri in 2025, as well as the District of Columbia, have introduced statutory paid sick leave (as of December 2024). Furthermore, an analysis of 33 OECD countries with statutory paid sick leave or sickness benefits suggests that 21 countries comply with the International Labour Organization (ILO) Convention standards for adequacy of benefits and comprehensiveness of coverage, while six countries with social assistance have high comprehensiveness of coverage but low adequacy of benefits. There was not a single country with a program that had low levels of both benefit adequacy and coverage. In Korea, the pilot sickness benefit program has been extended until 2027, and the system has been delayed. The principles of benefit adequacy and coverage comprehensiveness must be upheld for the purpose and intent of the program to ensure adequate care and rest. Consequently, in addition to adhering to the standards outlined in the ILO Convention, the implementation of paid sick leave should be codified in legislation to enhance employer accountability.

Work disability evaluation plays a central role in medical certification in sickness benefit schemes. This guides effective decision making for return-to-work timelines. Countries that incorporate it have varied approaches. To improve fairness and consistency, Sweden adopted disease-specific guidelines, particularly for complex health conditions such as mental disorders, cancer, and neurological diseases, whereas in the United Kingdom, a fit note system highlights the ease of fitness-for-work assessments in clinical settings. For a successful implementation of the sickness benefit scheme in Korea, it is essential to review international acumen in work disability evaluation and medical certification. This study also examines challenges that physicians face in certification, factors influencing assessments, and the usefulness of disease-specific guidelines. In many countries, administrative burdens, uncertainty in diagnosis, and ethical conflicts complicate physicians' tasks. Countries such as Sweden, France, and Ireland, have addressed these issues by developing structured certification tools and support systems. Learnings from the recent Korean pilot programs, this review identifies the following core priorities: developing disease-specific guidelines, providing clinical support for physicians' decisions, and integrating occupational health expertise. These guidelines should function not only as administrative checklists, but also as potential clinical tools that consider both patient functionality and job characteristics. Finally, this study offers policy and practical insights to help design a consistent and fair medical certification system for Korea's sickness benefit program that encourages timely medical intervention, prevents presenteeism, and promotes sustainable workforce reintegration.

This study explores the theoretical foundations and practical applications of medical certification within the sickness benefit systems, particularly in the context of Korea's pilot program and its planned national rollout. While sickness benefit systems have long existed in many Organization for Economic Cooperation and Development (OECD) countries, Korea has only recently initiated pilot projects, largely prompted by the coronavirus disease 2019 pandemic. These systems aim to compensate for income loss due to illness or injury, and medical certification plays a central role in determining eligibility and work ability. This study defines medical certification as a two-stage process: clinical diagnosis and formal assessment of a worker's ability to return-to-work. The dual nature highlights the distinct objectives of the medical treatment and social security policies. Drawing on international practices, this study reviews the International Classification of Functioning, Disability, and Health (ICF) as a key global framework for assessing disability and work ability, although it acknowledges the limitations of its application to sickness benefits. The research emphasizes a shift in global trends toward return-to-work-oriented certification models, such as the UK's "fit note" system, which focuses on evaluating fitness-for-work rather than merely documenting illness. Sweden and Japan also offer models that integrate rehabilitation with flexible work accommodations. Three key issues were identified in Korea's system: the role of medical certification and concerns about moral hazard, the burden of proof and workload on physicians, and public perceptions of the program's purpose. We believe that medical certification should not only verify illness but also support early intervention and a healthy workforce. Ultimately, this study advocates for a balanced and efficient medical certification system tailored to Korea's healthcare context closely aligning with labor market policies to ensure long-term sustenance and integration of the sickness benefit program.

Background: Mercury, particularly in its methylmercury form, significantly affects neurological and developmental functions. In Gyeongsangbuk-do, Republic of Korea, blood mercury levels are elevated due to high fish consumption, especially shark meat. Vulnerable groups, such as pregnant women, are at increased risk as methylmercury can cross the placenta and accumulate in breast milk. This study aimed to investigate the risks of mercury exposure from shark meat consumption among young and middle-aged women in Gyeongsangbuk-do.

Methods: The data of women aged 19-55 years from the 2018 Gyeongsangbuk-do Community Health Survey were included. Survey questions focused on frequency and amount of shark meat consumption, as well as pregnancy status, recent childbirth, and breastfeeding status. The Complex Sample Analysis was used to determine the prevalence and risk of overconsumption. Weekly mercury intake was calculated for respondents who reported their body weight, and the population size exceeding Joint Food and Agriculture Organization/World Health Organization Expert Committee on Food Additives (JECFA) and Ministry of Food and Drug Safety (MFDS)'s threshold was estimated.

Results: Regions where the consumption rate of shark meat exceeds the average for Gyeongsangbuk-do are found to be distributed in the southeastern part of the province. Population estimates revealed that approximately 9,895 women aged 19-55, including 255 who had breastfed in the past year, consumed shark meat exceeding the recommended intake. Based on the maximum recorded mercury concentration (8.93 μg/g), an estimated 2,645 women surpassed the JECFA's mercury exposure threshold, while 845 exceeded the MFDS's threshold.

Conclusions: In young and middle-aged women of Gyeongsangbuk-do, approximately 7.1% exceed the single intake limit, while up to 1.9% exceed the JECFA's provisional tolerable weekly intake (PTWI) and 0.6% exceed the MFDS's PTWI, suggesting considerable risk that warrants monitoring and guidance. More stringent advisory measures regarding shark meat consumption and updated standards on mercury concentration in shark meat are essential for young and middle-aged women in the province.

South Korea's pilot sickness benefit program, launched in 2022 across six regions and currently operating in 14 regions as of 2025, represents a critical juncture in the country's social protection development. While ostensibly designed with inclusive eligibility criteria, the program reveals fundamental paradoxes that illuminate deeper structural inequalities within Korea's dualized labor market. This opinion piece examines how current design choices risk undermining universal health coverage goals by systematically excluding the most precarious workers. The program's design features-including low replacement rates (60% of the minimum wage) and extended waiting periods-created perverse incentives where the most vulnerable workers accepted the least favorable conditions. This pattern exemplifies what Korpi and Palme termed the "paradox of redistribution," where targeted approaches ultimately prove less effective than universal ones, with the second phase's restriction to the bottom 50% income bracket threatening to exacerbate this paradox. Successful implementation will depend on integrating equity, people-centered design, and gender-transformative perspectives into every phase-design, operation, evaluation, and reform. In doing so, South Korea has the opportunity to offer a model of sickness protection that does not simply patch gaps, but actively reshapes the structures that produce health and economic inequalities in the first place.

Background: Fishing is a physically demanding occupation with a high risk of musculoskeletal disabilities (MSDs). Although previous studies have focused on ergonomic risk factors, little attention has been paid to sex differences in the prevalence of MSDs among fishers. This study aimed to assess whether female fishers experience a higher prevalence of MSDs than male fishers and to examine whether this difference persists after adjusting for socioeconomic and occupational factors.

Methods: We analyzed cross-sectional data from 898 Korean fishers (513 men and 385 women) who participated in the 2021-2022 Fisher Health Survey. MSDs in the upper extremities, lower back, and knees were defined as scores in the top 25% of the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Oswestry Disability Index, and Western Ontario and McMaster Universities Arthritis Index Short Form (WOMAC-SF), respectively. Modified Poisson regression was used to calculate the prevalence ratios (PRs) by sex, with stepwise adjustments for age, socioeconomic factors, and occupational factors.

Results: Female fishers had significantly higher MSD risk than male fishers across all body regions (fully adjusted PRs: upper extremity, 1.59; lower back, 1.63; knee, 1.44). Sex disparities were most pronounced among those under 60 years of age and remained significant even in older age groups.

Conclusions: The elevated MSD risk among female fishers persisted despite adjusting for conventional risk factors, suggesting the influence of additional factors such as biological susceptibility, domestic labor, and gendered health reporting. Therefore, MSD prevention strategies should include sex-sensitive multidimensional approaches beyond ergonomic interventions.

Background: South Korean on-site workers in the public sector, fully covered by the Occupational Safety and Health Act, often perform hazardous tasks. However, their status and injury rates remain poorly documented. This study aimed to analyze changes in injury rates and the proportion of work-related diseases (WRDs) among on-site workers in basic local governments (BLGs) following workforce reductions between 2016 and 2018.

Methods: Data from two sources provided by the Ministry of Employment and Labor were analyzed: organizational data on the number of on-site workers, and cases of injuries, deaths, and diseases among on-site workers in 226 BLGs from 2016 to 2018; and workers' compensation claims data (individual data) for on-site workers in BLGs during the same period. Injury, mortality, and disease incidence rates were calculated and compared between BLGs with increased and decreased workforce. The proportion of WRDs among all the injuries was also examined.

Results: The total number of on-site workers in BLGs decreased by 18.1% in 2018 compared with 2016. The injury rate increased from 0.46% in 2016 to 0.62% in 2018. BLGs with workforce reductions showed higher injury rates, particularly in those with fewer than 1,000 on-site workers. The proportion of WRDs among all injuries increased by 1.34 times in 2018 compared with 2016.

Conclusions: Workforce reductions among on-site workers in BLGs are associated with higher injury rates and a great proportion of WRDs. These findings highlight the need for improved occupational safety and health practices within the public sector and serve as an important basis for establishing workforce management and injury prevention policies. However, limitations in the available data made it challenging to identify worker groups particularly vulnerable to WRDs. Further research is needed, as it is critical for the development of effective occupational safety and health policies.