A country report: impact of COVID-19 and inequity of health on South Korea’s disabled community during a pandemic

Abstract

The South Korean media boasts of its leading success–during the escalation of the coronavirus outbreak–in flattening of the curve thereby mitigating the grave outcomes of the public health crisis. Much of the success is reportedly attributed to the rapid and advanced development of test kits, essential equipment and implementation of protocols in precautionary measures. However, it has been an arduous task to stay afloat for one particular vulnerable community. The disabled citizens of Korea were confronted by the realities of health inequity during this disastrous period. Pre-existing the pandemic onset, the disabled community have faced stigmatization and under many circumstances de-prioritization by their own society. Through the lense of a visiting physician, my hope is to poignantly and respectfully share personal experiences and thoughts on these realties impacted by the COVID-19 pandemic in South Korea.

Keywords:

• Disability
• health inequity and disparity
• pandemic
• S. Korea

The coronavirus outbreak has profoundly impacted many arenas of public health throughout the world. It has set the global stage for unveiling of disheartening realities in health disparity among the marginalized: impoverished, elderly and disabled communities. While frontline health care workers were threatened by heightened exposure risks considering the lack of PPEs and essential supplies, test kit shortages have limited the testing of select individuals. Those with less severe symptoms or inability to afford testing were precluded in what may have been perceived by many as a race to survival. Preferential provision of critical care to those presumed to have a ‘higher rate of success in treatment outcome’ owing to lack of mechanical ventilators, became a viable solution to mitigate case fatalities during the crisis.

Evidence dating back to as early as the 1918 ‘Spanish flu’ reveals that health inequity is profoundly increased during an infectious disease pandemic (Taubenberger and Morens 2006). During the peak of COVID-19 we have observed global practices in health rationing and its consequential realities with grave clinical outcomes among certain populations. Giving special preferences to others while de-prioritizing the vulnerable have been the driving sources of accentuation in health inequity during the current pandemic. These realities have escalated a public health crisis within the crisis of COVID-19, in particular, among the disabled community in the Republic of Korea (S. Korea).

As schools and businesses were shutting down with majority of commuters being mandated to resume work duties at home, S. Korea’s disabled community was rendered with even greater vulnerability. The lack of critical information pertaining to health services with appropriate accommodations further widened the gap in a pre-existing health disparity within the community of disabled Koreans. This was most evident among the intellectually disabled, most of whom reside in assisted living facilities and require constant supervision with physical assistance in activities of daily living. In the absence of caregivers, these individuals are placed in a real bind facing difficulties in bathing, dressing, feeding and toileting needs. Physical contact is unavoidable under these circumstances and thus adherence to distancing measures or isolation precautions are nearly unachievable.

The disability workforce in South Korea—caregivers and personal care attendant blue collar workers—serve as bridges to many existing gaps within the disabled community. Majority of them are from minority ethnic backgrounds and are employed on a casual basis and simultaneously by multiple agencies. As the coronavirus outbreak escalated many caregivers reluctantly cancelled work shifts, which left clients in helpless situations without contingency plans. Furthermore, the disability workforce shortage pre-existed the pandemic onset. Despite the untoward realities, the ‘no work, no pay’ disposition for others, became a temptation to take on multiple shifts. Risking their own health, and even that of family or loved ones, for the sake of financial security was undeniable during a dire economic recession impacted by the pandemic. The situation viciously begets the crisis within a crisis thereby impacting the disabled communities at large.

In the capital city of Seoul, media drew attention upon a case of a disabled citizen, accompanied by a caregiver, who presented to an emergency center. The caregiver had been exposed, presumably via contact with members of another assisted living facility where virus transmission had occurred. The individual who presented with severe respiratory compromise died on the following day adding to the nation’s rapidly rising case fatalities. Immediately, the facility was forced to shut down leaving a panic-stricken frenzy among other residents and staff. The incident stirred up commotions and further widened the pre-existing margin among the disabled community. Concerned disabled citizens, fueled by fears amidst the unveiling realities of COVID-19, protested and demanded solutions for provision of appropriate services and accommodations. Nevertheless, their voices remained inaudible to those in authority positions.

The underlying stigmatization of people with disabilities is exacerbated by cultural mindsets of the country’s long history spanning over 5,000 years that inherently marginalize this community by virtue of their impairments and physical appearances. The marginalization exists within the Korean educational, professional and other social arenas. Architectural barriers and inappropriate accommodations in public areas infused with a homogeneous Korean culture prohibits disabled citizens from equitable community participation even during a pandemic crisis.

Following the aftermath of COVID-19, S. Korea’s National Human Rights Commission conducted a nationwide poll. Among the 1,000 surveyed, 27.2% of respondents themselves have experienced social discrimination in the past year, irrespective of the pandemic crisis (The National Human Rights Commission 2020). The specified socioeconomic domains included: gender, age, educational status, place of birth and physical condition. Herein, ‘physical condition’ includes people with disability.

Furthermore, 91.1% of respondents indicated that they could be a target of discrimination whilst 69.3% indicated their awareness of various social groups—religious sectors, foreigners and immigrants—that have become targets of discrimination as a direct result of the COVID-19 spread (The National Human Rights Commission 2020). Other groups mentioned, facing discrimination were the impoverished, the elderly and the disabled.

An overwhelming majority (82%) of those polled said discrimination in S. Korea is ‘serious’ (The National Human Rights Commission 2020). Historically, in Korea, discrimination against people with disabilities was mainly visible as it pertained to environmental and physical barriers as well as underlying social systems which ignored disability (Park 2017). Over time social models and anti-discrimination laws established by leading countries—as in the USA, ADA or Section 504 of The Rehabilitation Act—swiftly emerged and thereby enhanced the scope of community participation for the disabled along with awareness of their rights in society (Park 2017). The unfortunate reality is that there are no such laws in S. Korea. And thus, as countermeasures against discriminatory acts, policymaking and legislation of anti-discrimination laws, were proposed by 88.5% of respondents, as potentially the only viable remedies to this grave and ruminative situation (The National Human Rights Commission 2020).

Testing and accessibility to sites have not been without provocations for the disabled community. Sites were set up proximal to emergency centers following multiple cluster outbreaks during the initial stages resulting in shut down of these facilities. These sites are not easily accessible to wheelchair users. Most disabled Koreans do not own vehicles and getting to these sites were near impossible. The limited use of para-transit system complicated matters by enforced restrictions in efforts to mitigate spread of infection. Fleet of vehicles were prohibited from driving through test sites owing to potential contamination of vehicles. Their limited availability on demand with enforced destination restrictions discouraged use by disabled passengers. Concerns of drivers and their fears of exposure risks–resulting in mandatory self-isolation without pay–further ostracized the disabled community. These circumstances undoubtedly pre-empted the vulnerable from pursuing equitable health care and services. The realities were depressing and perceived as insurmountable by many in the disabled community.

The WHO has made some efforts to provide guidelines for the disabled community during the COVID-19 pandemic (World Health Organization 2020). Unfortunately, they were general in nature and may have limitations in applicability across different cultural settings. Ideally, individual nations should address respective areas of specific needs and demands posed by disabled citizens. Disability services organizations must implement contingency plans for caregiver absenteeism in this workforce. Setting up mobile testing centers with accommodations or the disabled or designated transportation systems for testing purposes for the disabled would be highly advantageous.

Perhaps the most universally resourceful of efforts to alleviate health inequity among disabled communities during a pandemic is the utility of telemedicine and e-health. Lurie and Carr (2018) have reported the beneficial role of telehealth during disasters and public health crises (Lurie and Carr 2018). Evidence in the literature shows its established role within populations that reside in remote locations (Dallolio et al. 2008).

Data also reveals respective levels of satisfaction with telerehabilitation among specialty providers, patients with disabilities rendered by spinal cord injury and their caregivers (Dallolio et al. 2008). Telehealth application foreseeably alleviates challenges presented during a pandemic—upholding precautions in social distancing, quarantine or isolation protocols—while addressing barriers to cost burdens of transportation and health services. However, the paucity of data in the literature with regards to its cost effectiveness (de la Torre-Díez et al. 2015) deters policymakers in implementing telehealth practices throughout Korea. The bigger challenge at hand with respect to implementation is that of privacy issues and personal identification theft. South Korea’s leading advancement in the field of information technology also fosters a myriad of highly skilled tech-savy criminals to access personal information via advanced hacking operation schemes. Furthermore, the practicalities of owning and operating the required technologies from remote locations are added challenges and unlikely to overcome in the immediate near future.

While some disabled citizens perceive that there is higher likelihood of mortality during a pandemic by virtue of having an underlying disability, others are hopeful and expect a prevailing outcome. Health maintenance should not be a byproduct of privilege or an exclusivity reserved for the wealthy or upper class in society. Thus, policymakers must concede to the realities of unprecedented demands in public health crises during a pandemic within the battle against inequity of health among the disabled and other vulnerable communities globally.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This manuscript was made possible by the Korea Health Industry Development Institute (#HI18C0552) and Brain Pool Scholar's Program of the National Research Foundation of Korea (#2019H1D3A2A01101579).