The 3rd International Joint Conference on Korean Studies and Thai Studies

402Furthermore, in the future a registered trademark for the main local dishes will be launched inorder to expand its market into the international level. All levels of both public and private educational institutes are encouraged to includetraditional culinary into their curriculum. Creative Culinary Institute of Korea and BibimbapGlobalization Foundation were established through innovative partnership. Moreover, there areseveral food-related institutes established. These institutes include Jeonju Bibimbap ResearchCenter, Woori mat Society, Jeonbuk Native Food Development Research Society, North JeonllaProvince Bio Food Material Development & Industrialization Research Center, Jeonju BioMaterial Institute, and Jeonju International Korean Food Cooking School. Tourist Destinations: Jeonju Hanok Village (전주 한옥 마을) is designated as one of thetop places to visit in 2011. It is a cluster of 776 traditional Korean houses (Jeonju CulturalTourism, 2015). Some homestays in Jeonju Hanok Village are always available for guests tolearn Korean culture and food cooked by the host, sleep in Ondol room (온돌 방 -Korean floorheating system) and cook Korean cuisine by themselves. Other famous destinations areGyeonggijeon (경기전)—a shrine worshiping King Taejo who is the founder of the JoseonKingdom (1392-1910), Jeondong Cathedral (전동성당)—a hundred-year-old catholic church, andJeonju Nambu Traditional Market (전주 남부시장)—a local market where tradition food andunique dishes are sold.Phuket (ภูเกต็ ) Phuket, a mountainous island in the Andaman Sea, is located in Southern Thailand.Around 200 years ago, Phuket was an important port on the west coast of the Malay Peninsulawhere Chinese people migrated to Phuket for trading, agriculture and tin-mining. Also,European, especially the British were more interested in tin-mining in Phuket. The geographical area of Phuket Island is full of mountains and sources of fresh waterfor adequate agriculture and consumption. After the cancellation of mining industry in the past,the area is occupied by pineapple plants and various native vegetables that can only be foundin Phuket. Raw materials and local products are available in local markets in various districts.Although Phuket is a city of great natural resources and infrastructure, there are some problemsconcerning the limited arable land due to the expansion of the tourism industry and thedamage from the tsunami in 2004. This called for restoration from agencies and stakeholders inPhuket.

403After Phuket city’s efforts to collate recipes and historical information of local culturewith the rich of culinary history and unique cuisine, Phuket has officially become a member ofUNESCO Creative City of Gastronomy as the first creative city in Thailand, in December 2015(Tanthavanich, 2015). Diversity of cuisine and culinary arts are available everywhere as part ofgood health. Spoon and fork symbolizes diet. Phuket City of Gastronomy Logo The upper part of the spoon’s and fork’s handles is adapted from the old building with the Sino- Figure 3: UNESCO Phuket Gastronomy Logo Portuguese architecture. Source: http://phuketgastronomy.com The bottom part of the spoon and fork is created from the intersecting colorful lines representing the Baba culture which represents cultural diversity. The color blue means the Peranakan culture and tradition. Different shades of color represent a variety of raw materials, tastes and processes in creative cooking and eating in Baba culture.Food and Traditional Culture:Phuket has culture from its own development. Firstly, when Chinese merchants and laborerssailed from China and landed to work for European mining in Phuket, they brought theirChinese culture with them and they conserved it. Secondly, the intermarriage between theancestries of Chinese married with local Thai people in Phuket which were called “Baba”(Skolnick & Bush, 2010, p. 14; Thai Peranakan Association, 2015). However, the term“Peranakan” signifies locally born or the offspring of intermarriage between a local and aforeigner (Ying & Karim, 2016, p. 1). Thus, in Phuket the word “Baba” is more commonly used,while the word “Peranakan” is used for international communication in Southeast Asia(Wongmongkondate, 2011, p. 67). As a result, Baba-Peranakan culture is a mixture of Thai,Chinese, Malay, and Western culture.

404Figure 4: Baba food- oh-aew, mee hokkien, moo hong, and nam chub yamSource: http://www.phuketcity.go.th Phuket’s Baba food combines recipes from Royal Thai cuisine, common Thai dishes,Hokkien Chinese food and Malay cuisine. Baba food is a unique blend of delicate flavors thatare not too spicy, not too sweet and not too salty. The taste of the local flavor Phuket arefrom three tastes blended together—(1) the taste of native natural ingredients, (2) local flavorsfrom the traditional cooking process of Thais and local coastal Thais, and (3) taste of“multicultural-society” with diverse groups of population (Phuket: City of Gastronomy ofUNESCO, 2009). The representative Baba recipes are Moo hong (หมูฮอง-salted boiled pork), Oh-aew (โอเอว-white jelly made from squeezed Chinese herb and bananas, served with boiled redbean and shaved ice), Mee hokkien (หม่ีผดั ฮกเกยี้ น-stir-fried Hokkien noodle), Mee hun (หมห่ี นุ -stir-fried white noodle served with spare ribs soup), Nam chub yam (นํ้าชุบหยํา-spicy shrimp pastesauce) and Bue tord (เบอื ทอด batter-fried grass with small shrimp). Cultural Experience: There are many activities about food in festivals such as TourBoat Biggest Pot in the World and the competition of Phuket toasted coconut salad. There arethe demonstration of Phuket local cooking in Phuket Local Food Festival and thedemonstration of red turtle cake in Por Tor (Hungry Ghost) Festival. Moreover, there areactivities in Baba wedding which is traditionally held annually to preserve the beauty of theancient ceremony. Food-related Festival: Phuket has organized many food festivals, for example, PhuketLocal Food Festival with the objectives to develop and promote the tourism on food culture(Phuket Times Newspaper, 2014). Also there are important international festivals which are Old

405Town Festival, Baba Wedding Ceremony, and Phuket Vegetarian Festival. The important localfestivals are Chinese New Year, Thai New Year, Sunday food market, Halal food, Moon cake,Ghost worship (both Thai and Chinese), etc. The Cooperation of All Sectors: Phuket became a member of the UNESCO CreativeCity of Gastronomy due to the cooperation of municipality representatives, educationalinstitutions, NGOs, Phuket Chamber of Commerce, media specialist and civil society. The mottois “Good Food, Good Health, Good Spirit in Phuket” (NNT, 2015). Phuket has a strategic plan fordeveloping Phuket into “the International Tourism Based on the Sustained Development”.Tourism development has focused on the coastal tourism and the cultural history based onthe local identity conservation. The non-government agencies, that are parts in driving Phuketinto creative city, consists of Phuket Chef’s Association, Phuket City Restaurant Club, ThaiPeranakan Association, Phuket Old Town Foundation, Phuket Old Town Community, PhuketTourist Association, Thai Hotel Association and Thai Travel Agent Association. In the educational institute part, Phuket Rajabhat University is the main institute inconducting the process in becoming UCCN member by collecting the organization data andorganizing community meetings. There are 103 schools and 3 international schools providing acooking courses associated with traditional food. High educational institutes have providedprogram in food science and technology. For Phuket people, although the society is amulticultural-society with a variety of races and religions (Phuket City Municipality, 2015), theycan be blended altogether. Phuket people have Thai hospitality. They are ready to welcomethe visitors and cooperate with other agencies. Moreover, the local chefs who are Baba, andother businesses and services are also important parts in driving Phuket to be the UNESCOCreative City of Gastronomy. International Cooperation: Phuket Municipality has longstanding relationship withPenang Municipality in the field of culture, education and economy. They jointly carried outSawaddee Thailand Project in 2005. There are cultural exchange project between The PhuketOld Town Foundation and Penang Heritage Trust. They have operated the corporation in Halalfood for Phuket as gateway to Indonesia and Middle Eastern countries. Moreover, theFederation of Peranakan Association roles for cultural exchange among all 15 memberedcountries. Tourist Destinations: The famous destination is Phuket Old Town with the buildingin Sino-Portuguese style. Those buildings were built in 1903 with the blend of Western andEastern art. They created the unique identity of Phuket City. There are many activities and food

406festivals had been organized in this destination. Thep Kasatri and Si Sunthon HeroinesMonument is the Talang women victory monument. Chalong Temple and Prathong Temple arefamous temples in Phuket. Also Promthep Cape is the most beautiful sunset spot in Thailand.Moreover, there are beautiful beaches and islands such as Patong beach, Kata beach, Karonbeach, Rawai beach, Mai Khao beach and Hae Island.Discussions and conclusions From the aforementioned information, Jeonju and Phuket are successful in becomingmembers of the UNESCO Creative City of Gastronomy. We summarized the characteristics ofcreative city of gastronomy in Jeonju and Phuket according to the Table 3. There are similarand different factors. By considering all factors that make Jeonju and Phuket into members of the UCCN inthe creative field of gastronomy, we found that they have mostly different (1) identities of food(Korean food VS Baba food), (2) local culture based on its physical and historical contexts(Yangban culture VS Baba-Peranakan culture) and (3) characteristics of society (monocultural-society VS multicultural-society). However, both cities have created creatively unique identity oftheir own which can lead to competitive advantage.Table 3: Characteristics of Creative City of Gastronomy: Jeonju and PhuketContent Jeonju (Republic of Korea) Phuket (Thailand)Area 206.22 km2 574 km2UCCN Member since May, 2012 December, 2015Creative City LogoSlogan Hanbatang Jeonju (한바탕 Good Food, Good Health, Good Spirit in PhuketType of Cultural Society 전주)Cultural Identity Monocultural-society Multicultural-societyCharacteristics of Food Yangban Culture Baba-Peranakan CultureCulture Homemade food preparation style Diversity of food from multiculture Korean traditional food mostly derived from Chinese food

407Content Jeonju (Republic of Korea) Phuket (Thailand)Traditional food Korean Food: Baba Food:Food-related Festivals Jeonju Bibimbap (전주 비빔밥), Moo hong (หมูฮอ ง), Oh-aew (โอเ อว ),Food Activities Kongnamul Gukbap (콩나물국밥), Mee hokkien (หมีผ่ ดั ฮกเกยี้ น), Mee hun Dolsotbap (돌솥밥), Hanjeongsik (หม่ีหุน),Creative Products (한정식), Nam chub yam (นาํ้ ชบุ หยํา), Bue tordRelated Links Kimchi (김치) (เบือทอด) The Jeonju Bibimbap Festival Phuket Local Food Festival The International Fermented Food Old Town Festival Expo Baba Wedding Ceremony Phuket Vegetarian Festival Kimchi Experience (김치 체험) Sunday food market Bibimbap Experience (비빔밥 체험) Ghost worship (both Thai and Chinese) Ddeok (rice cake) Experience (떡 Tour Boat Biggest Pot in the World 체험) Phuket Toasted Coconut Salad Traditional Liquor Cooking Experience(전통주체험) The demonstration of Fermented food or side dishes -Phuket local cooking Hanji (한지-traditional Korean paper) -Thai dessert http://www.jeonju.go.kr -Vegetables and Fruits Carving http://unesco.jeonju.go.kr/ -Red turtle cake , etc. http://unesco.jeonju.go.kr/eng/ Handicraft rubber products such as pillows and beds http://www.phuketcity.go.th http://phuketgastronomy.com http://phuketbaba.com In addition, Jeonju and Phuket have similar proceeding steps. (1) The cooperation of allsectors–the success of two cities is due to the efforts of all agencies. However, Phuket hasmore international cooperation while Jeonju has focused on the cooperation with local sectors.Jeonju has efforts to add more value to products and services by food innovation andtechnology more than Phuket. (2) The creative tourism development–two cities similarly haveguidelines and policies for the development of the creative tourism. The promotion of culturalidentity, especially in city positioning, makes a difference to each city. In Jeonju, visitors canlearn the cultural activities by practice in the food-related institutes and tourist attractions

408around Jeonju where are always available. While in Phuket, visitors can participate in food orcultural activities mostly in the festivals. In summary, it can be seen that although both citieshave developed the similar proceeding steps to become the creative city of gastronomy, yetthey are slightly different contexts. Despite being a member of the UCCN, it is only the first step toward success withoutguarantee to the success in a long term. However, the implementation of the UCCN inexchanging the experience learning of creative city development helps members to achievesustainable urban development. In addition, the aim of creative city is not only to develop thelandscape or the tourism, but also to develop urban with “Human Capital” followed by theconcept of Thailand Creative and Design Center: TCDC (2012)—human development andurban development are the same thing. Beside the city development in various aspects, thereshould also be a support to the intellectual infrastructure such as libraries, museums,specialized knowledge institutions and quality laboratory in order to nurture and create anatmosphere for making people creative in the cultural advantage, historical and socialknowledge. They are fused together to create “value added” for competitive advantage ofeach city. These will lead to sustainable urban development.

409 ReferencesChung, K.R., Yang, H.J., Jang, D.J., & Kwon, D.Y. (2015). Historical and biological aspect of bibimbap, a Korean ethnic food. Journal of Ethnic Foods, 2015(2), 74-83.Howkins, John. (2009). The Creative Economy: How People Make Money from Ideas. (Khunakon Wanitwirun, Translator). Bangkok: Thailand Creative and Design Center (In Thai)Hwang, Dana. (2012). Korean cities put on creativity. Retrieved April 30, 2016, from http:// www.korea.net/NewsFocus/Culture/view?articleId=100503Jeonju Bibimbap Festival Organizing Committee. (2015). Jeonju Bibimbap Festival. Retrieved May 10, 2016, from http://www.bibimbapfest.com (In Korean)Jeonju City. (2012a). Jeonju Food Experience. Retrieved May 5, 2016, from http://unesco.jeon ju.go.kr/eng/html/sub2/index3.phpJeonju City. (2012b). Representative Jeonju Foods. Retrieved May 5, 2016, from http://unesco. jeonju.go.kr/eng/html/sub2/index2.phpJeonju Cultural Tourism. (2015). Jeonju Hanok Village. Retrieved May 2, 2016, from http://tou r.jeonju.go.kr/index.9is (In Korean)Kakiuchi, Emiko. (2015). Culturally creative cities in Japan: Reality and prospects. City, Culture and Society. Retrieved May 15, 2016, from http://dx.doi.org/10.1016/j.ccs.2015.11.003Komutsakunee, Reutinan. (2014). Competitive Growth–Creative Economy for Globalization. Retrieved April 25, 2016, from http://sesc.ocsc.go.th/filemanager/userfiles/uploads/read /Growth_&_Competitiveness_Book.pdf (In Thai)Lee, Young-Eun. (2015). Characteristics of soybean sprout locally cultivated in the Jeonju region, used for Bibimbap and Kongnamul-gukbap. Journal of Ethnic Foods, 2015(2), 84-89.NNT. (2015). Phuket named first creative city in gastronomy in ASEAN. Retrieved April 15, 2016, from http://www.pattayamail.com/thailandnews/phuket-named-first-creative-city- in-asean-54286#sthash.pvxB9DTH.dpufOnoparatvibool, Piyanit (2003). Creative Economy: the Way of Creative Economy. Retrieved April 5, 2016, from http://www.thaiprint.org/thaiprint/index.php?option=com_zoo&view =item&item_id=592&Itemid=54 (In Thai)Paik, Susan J. (2001). Introduction, background, and international perspectives: Korean history, culture, and education. International Journal of Educational Research, 2001(35), 535- 607.

410Phuket City Municipality. (2015). “UNESCO” announced Phuket 1 of 18 creative cities of gastronomy and it is the 1st UCCN creative city of Thailand. Retrieved April 25, 2016, from http://www.phuketcity.go.th/tournews/detail/10 (In Thai)Phuket: City of Gastronomy of UNESCO. (2009). Phuket City. Retrieved April 20, 2016, from http://phuketgastronomy.com (In Thai)Phuket Times Newspaper. (2014). Phuket Provincial Administrative Office held “The 6th Phuket Local Food Festival”. Retrieved April 30, 2016, from http://www.facebook.com /media/set/?set=a.736202883058112.1073742407.286272814717790&type=3 (In Thai)Skolnick, Adam & Bush, Austin. (2010). Phuket Encounter. China: Lonely Planet PublicationsTanthavanich, Sukawin. (2015). UNESCO dubs Phuket ‘City of Gastronomy.’ Retrieved April 30, 2016, from http://www.phuketgazette.net/phuket-news/UNESCO-dubs-Phuket-City-Gastr onomy/62698#ad-image-0Thai Peranakan Association. (2015). Phuket Baba. Retrieved May 10, 2016, from http://phuket baba.com (In Thai).Thailand Creative and Design Center: TCDC. (2012). Creative City: When Prosperity Is Built from City Growth. Bangkok: TCDC. (In Thia).UNESCO Creative Cities Network. (2015). Membership Monitoring Guidelines. UNESCO Creative Cities Network Annual Meeting. Kanazawa, Japan, Retrieved May 7, 2016, from http://en. unesco.org/creative-cities/sites/creative-cities/files/UCCN%20Membership%20Monitoring %20Guidelines_ENG%20N.pdfUNESCO Creative Cities Network. (2016). List of UNESCO Creative Cities. Retrieved May 5, 2016, from https://en.unesco.org/creative-cities/sites/creative-cities/fieles/List%20of%20 UNESCO%20Creative%20Cities_January%202016.pdfWongmongkondate, Suthi. (2011). Cultural Landscape Study of the Old Phuket Town. Independent Study, Master Degree of Arts, Architectural Heritage Management and Tourism, Silpakorn Univeristy.Ying, N.C., & Karim, S.A. (2016). A historical and contemporary perspectives of the nyonya food culture in Malaysia. Journal of Ethnic Foods. Doi: 10.1016/j.jef.2016.05.004

411The Future of Elderly Care in South Korea in the Context of Ageing Societyอนาคตของการดแู ลผูสงู อายใุ นประเทศเกาหลใี ตภ ายใตบรบิ ทสังคมสูงวยั Piyanuch Buathong1 ปย ะนุช บวั ทองบทคัดยอ ประเทศเกาหลใี ตถอื เปนประเทศหนึง่ ที่มคี วามมงั่ คง่ั ทางเศรษฐกิจตดิ อันดับโลก แตในขณะเดียวกันก็เปนประเทศท่ีมีภาวะเจริญพันธุ (Fertility) และอัตราการตาย (Mortality) ตํ่า ทําใหโครงสรางอายุของประชากรในประเทศมีแนวโนมสูงขนึ้ อยา งตอเนื่อง ซ่ึงมีการคาดการณว า ในปค .ศ. 2060 ประเทศเกาหลใี ตจะมีสัดสวนประชากรผูสูงอายุถึง 40.1% ทั้งน้ีการดูแลผูสูงอายุจึงเปนปญหาและประเด็นท่ีทาทายที่ตองเผชิญอยางหลกี เลย่ี งไมไ ด งานวิจัยนจี้ ึงมวี ตั ถุประสงคท ่ีจะศกึ ษาแนวโนม ในอนาคตของการดแู ลผูสูงอายุในประเทศเกาหลีใต โดยเฉพาะอยา งยงิ่ การดแู ลผสู งู อายรุ ะยะยาว โดยใชการศึกษาในเชิงคุณภาพในการวิเคราะหขอมูลและเนน ไปทก่ี ารศึกษาขอมลู ผานแหลงขอมูลทุติยภูมิ ผลจากการศกึ ษาพบวา แมวารัฐบาลเกาหลีใตจะมีการพฒั นาระบบการดูแลผูสูงอายุระยะยาวท่ีเนนการดูแลผูสูงอายุโดยครอบครัว หากแตการดูแลระยะยาวโดยสถาบันยังคงมีความสําคัญในฐานะท่ีพ่ึงพิงสําหรับผูสูงอายุในอนาคต โดยเฉพาะอยางย่ิงกับผูสูงอายุที่เปราะบาง (frail) และมภี าวะทพุ พลภาพ (disability)คาํ สาํ คญั : ผูส งู อาย,ุ การดูแลผสู ูงอาย,ุ การดูแลระยะยาว, สวัสดิการสงั คม, เกาหลีใตAbstract South Korea has been ranked as one of the most prosperous countries in the world.However, the success still has a downside. Korean society has faced a problem about achange of its population toward ageing society, which has been caused primarily bya long-term decline in fertility and mortality. Moreover, it is projected that the proportion ofelderly will rise up to 40.1% by 2060. Therefore, caring for the elderly has inevitably becomea major challenge in Korean society. This research aims to study the future trend of elderlycare in South Korea, long-term care services in particular. The qualitative approach was usedto examine and analyze data, mainly looked at secondary sources. The results of this 1 Student of Master of Arts in Korean Studies Program, Graduate School, Chulalongkorn Universityนิสิตหลกั สตู รศลิ ปศาสตรมหาบัณฑติ สาขาวิชาเกาหลศี ึกษา คณะบัณฑิตวิทยาลัย จุฬาลงกรณม หาวิทยาลัย

412research indicated that even though governments have been promoted and supportedfamily-based care, the institutional care continues to play an important role as a shelter forelderly in the future, in particularly, for frail and disabled elderly.Keywords: Elderly, Elderly Care, Long-term Care, Social Welfare, South KoreaIntroduction The population ageing is a worldwide phenomenon that has begun several decadesago. This phenomenon is defined as an increasing proportion of elderly person in the society(Ghazy, 2006, p. 1). Although the definition of elderly may vary, the chronological age of 65years was generally accepted as a definition of elderly person in most developed worldcountries (WHO, 2015). South Korea, like other countries, is also one of many countries that encounteredwith the demographic transition. On the one hand, South Korea was named as the worldfastest growing economies from the early 1960s to the late 1990s. It has achieved incrediblesuccess in economic development and become one of the biggest powers in the worldeconomy. On the other hand, while successful in economic and technological development,it also confronts with an increasing of ageing populations, which has been caused primarilyby a long-term decline in fertility and mortality supporting by the rise of life expectancy. Asa result, the population structure has been rapidly changing over the last few decades. Theproportion of Korean elderly increased from merely 2.9 percent in 1960 to 13.1 percent in2015 and is estimated to rise up to 40.1 percent of its total population by 2060 as depicts inFigure 1. With this rapidity, South Korea will become the fastest ageing society in the worldby spending only 18 and 8 years to shift from ageing society to aged society and super-agedsociety, respectively (Florence, 2009). Furthermore, the increasing proportion of eldest oldwill grow more rapidly in the future. In 2000, there were 459,815 eldest old persons;however, there are projected to increase to 7,547,889 persons by 2060 (Statistics Korea,2015).

413Figure 1 Actual and estimated elderly populations, % of the total population, 1960 – 2060 KOREAN ELDERLY POPULATION 45 40 35 30 25 20 15 10 5 0 1960 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2030 2040 2050 2060 ELDERLY POPULATIONS TOTAL, % OF THE TOTAL POPULATIONSource: OECD, 2015; Statistics Korea, 2015 Alongside the growth of eldest old population, elderly health has become a crucialconcern. Most of elderly require long-term care due to the fact that ageing is accompaniedby biological changes that increase likelihood of chronic illness and disability, such ashypertension, arthritis, diabetes, osteoporosis, stroke, as well as the impairments of mentalabilities as dementia. Moreover, the socio-demographic has been changing lately and has agreat effect to the need of formal care. For instance, the multi-generational family graduallychanged to nuclear family because the young workforces have migrated to urban areas andanother reason is that women tend to delay motherhood and have fewer children than thepast (Choi, 1992; Florence, 2009). Additionally, a large number of elderly has suffered fromeconomic insecure due to the decline of family financial support and the insufficient socialpension and public assistance (Ahn & Chung, 2008). With these crucial challenges, the needfor elderly long-term care will rise sharply in the future. Consequently, to meet growingneeds of cares, numerous formal services have been developed in South Korea, includinglong-term care system. Since 2008, the long term care Insurance (LTCI) was implemented and become animportant part of elderly care in Korean society, especially for the frail and disabled elderly.Nevertheless, some of formal long-term care services are deemed to be less accepted byKorean people and government at this present time, as the Asian traditional norm,filial piety, has contributed Koreans' reluctance to use some long-term care services,

414specially the institutional care such as nursing home or home for the aged. However, whenproportion of elderly is rising to almost half of its total population, those long-term careservices could become more important for elderly in the future. In this research, the main purpose is to examine the trend of elderly care,in particular institutional long-term care services as it will underpin the nature of provisionfor elderly in the future. Secondly, is to study the development of elderly care, especiallylong-term care services for elderly persons.Literature Review I. A Historical of Korean Elderly Policies The social programs for elderly persons in South Korea can be traced back to aJapanese colonial period as stated by Choi (2002). Before 1970s, the policies for elderlypersons were associated with the poverty. In 1944, even though the social policy was not amajor priority in this colonial period, a public assistance system was established by theKorean Relief Order under the instructions of Japanese government in order to help poorelderly. Almost 16 years after the liberation, the Government Employees Pension (GEP) andthe Military Servicemen’s Pension (MSP) were introduced in 1960 and 1963, respectively. In1975, the Private School Teachers Pension (PSTP) was also established. Nevertheless, due tothe fact that these three pensions are occupation-specific pensions, a great proportion ofthe population is still not covered by these pension programs. The social and welfareservices were unheeded by the government in this period as the government focused oneconomic development and poverty eradication. Therefore, only little social protection tothe workforce was offered under Park Chung-hee’s government (Hong, Kim, Lee, & Ha, 2013).It was not until the beginning of 1980s during Chun Doo-hwan’s government, the ElderlyWelfare Law was firstly enacted as the ageing issues became more serious social problems.A few years later, a National Pension Scheme was instituted in 1988 as well as the ElderlyJob Bank and the Elderly Workshop, which providing employment counseling and locateemployment for elderly. Throughout the past few decades, the Korean social policies can be categorized as aresidual model of social welfare. The policies are based on economic growth thendistribution ideology in which highlights on the role of family in providing a social safety net,especially for elderly (Choi S.-J., 2002). However, after the Asian financial crisis in late 1990s,Kim Dae-jung and Roh Moo-hyun governments have attempted to reform the social security

415system and widely expanded the social programs, such as the National Basic LivelihoodSecurity System (NBLSS), the Basic Old-Age Pension (BOP) and a new significant socialinsurance was first introduced and implemented in 2008, the Long-term Care Insurance(LTCI). As of lately, social policies are used as a political tool by the politicians, for examplethe Elderly Long-term Care Insurance (LTCI) emerged as a presidential electoral promise ofthe Roh Moo-hyun administration in 2002 as well as Park Geun-hye who has promised in her2012 election campaign to increase the Basic Old-Age Pension benefits (UNESCAP, 2016). For health security system, the Medical Insurance Act was legislated in 1963. In thisperiod an issue relating to elderly was not only poverty, but also included other issues suchas economics and health care problems. As a result, the medical insurance programs werecreated in this phrase. The first medical insurance program for general public was set in1977, followed by the launching of medical insurance program for government employees,private school teachers and for the poor in 1979, including the Medical Aid Program for low-income families. South Korea has widely expanded health insurance and has achieveduniversal health insurance coverage in 1989. Almost 11 years later, in 2000, all healthinsurance programs were integrated into a single insurer, the National Health InsuranceService (NHIS). The single insurer was implemented to improve the administrativeeffectiveness and to achieve equity in healthcare. In 2008, the Long-term Care Insuranceprogram (LTCI) was introduced in South Korea. Despite widely expand social policies, a large number of elderly could not benefitfrom those programs. For instance, many of Korean people could not benefit or receive lessthan the full rate from the National Pension (NP) because it was established relatively lateand required 10 or 20 years of contribution (Choi S.-J., 1992). In 2015, only 32.1 percent ofelderly benefited from the National Pension and the benefits were only 23.5 percent of theKorean average wage (OECD, 2016). Even though government had tried to compensate theinequity by launching other programs, the problem still continues to persist. For example,the National Basic Livelihood Security System (NBLSS) was instituted to guarantee an elderlyminimum living standard in 2000; however, a lot of poor elderly are not eligible since theyhave a possibility of assistance by family, even though they might have not received anysupport from them. While, the Basic Old-Age Pension (BOP) was doubled to 200,000 KRWand covered approximately 70 percent of Korean elderly since 2014, but it providesresources very thinly over the large segment of elderly population (OECD, 2016).

416 II. The Long-term Care Insurance in South Korea South Korea is the second Asian country to introduce universal Long-term CareInsurance (LTCI), after Japan. The program has implemented in South Korea as of July 2008in order to help elderly persons maintain the best possible quality of life and to relievingthe burden of family care (Kang, Park, & Lee, 2012). As a matter of fact, Lee and Cho’s study(as cited in UNESCAP, 2015, p. 8) demonstrated that the elderly long-term care was firstlydiscussed and began to examine the possibilities of the plan since 1999, during the Kim Dae-jung government. Until the 16th presidential election in 2002, the Roh Moo-hyunadministration has promised to establish the long-term care system. Therefore, the plan wasdiscussed several years after the election and eventually implemented in 2008 (Won, 2013). The long-term care insurance was organized and planned by the Ministry of Healthand Welfare and operated by the National Health Insurance Service (NHIS, 2014). Thisprogram provides in three broadly defined settings; home-based care, institutional careservices and cash benefits for the approved elderly. The home-based care consists of homevisit care, home visit bathing, home visit nursing, day and night care, short-term respite careand welfare equipment service, while the institutional care comprises nursing homes andelderly group homes (NHIS, 2015). Cash benefits are rarely provided due to a possibility ofelder abuse and the potential for the misuse of money provided by informal caregivers. Forinstance, it will be provided to elderly who living in remote areas where in-kind services arenot accessible (Kim H. , 2015). This insurance is funded through the contribution paid by the insured (60-65%),government subsidies (20%) and copayment of users in general 15-20%, with discounted orcost-exempted for low income populations. Benefits are available for elderly aged 65 andabove or less than 65 years but suffered from geriatric diseases, based on the level of careneeds. According to the 2014 National Health Insurance System of Korea (NHIS, 2014), thenumber of long-term care beneficiaries have doubled from 146,643 elderly persons in 2008to 355,727 beneficiaries in 2013. For the expenditure, home-based care services used approximately 48.2 percent oftotal long-term care insurance expense in 2013. It was lower than the past years as in 2009,56.7 percent of total long-term care insurance expense was used for home-based careservices, whereas, the institutional care expenditure increased from 43.3 percent in 2009 to51.8 percent in 2013. According to Choi (2015), the statistics point out that the costs of

417institutional care increased because elderly persons are progressively using institutional carerecently. III. Predictors of Institutionalization in Elderly Despite familism remains strong in South Korea, the situations in Korean society havebeen changed, especially after the industrialization and modernization. The demographicand social changes have challenged the family-based care system. In 1999, family memberstook a charge of providing informal care and support to older persons (Chung, 1999).However, informal care for the elderly is diminishing and was also proved to be a burden onfamily caregivers, especially a long-term care for disabilities or chronically ill elderly (Choi-Kwon, Kim, Kwon, & Kim, 2005; Choi H., 1993; Kim & Lee, 2003; Lee & Kolomer, 2008; Lee,Yoon, & Kropf, 2007; Yoon, 2003). For instance, a cross-sectional study by Choi-Kwon, et al. (2005) has shown that themain factors related to caregiver burden were caregiver anxiety, elderly poor health. While,Kim and Lee (2003) conducted a study examining the level of depression and physicalhealth of 120 Korean daughter and daughter-in-law caregivers who cared for cognitively orfunctionally impaired elderly. Findings from this study indicated that, caregivers have higherrates of depression and regarded themselves as being in poor health. Furthermore, several studies stated that family members, particularly a son and adaughter-in-law, were found to be the most frequent abuser to elderly in South Korea(Kim M.-H. , 2013; Lee & Kolomer, 2008; Oh, Kim, Diane, & Kim, 2006). For example, a studyof Elderly abuse by Oh, et al. (2006), has drawn attention to the fact that there were 6.3percent of elderly persons who experienced at least one category of abuses. The emotionalabuse happened more frequently, followed by economic abuse and verbal abuse.Additionally, this study revealed that the personal characteristics such as age, gender,educational level, and economic dependency, health status and family characteristics tendto be associated with the elder abuse. It also rightly points out that a son and a daughter-in-law were found to be the most frequent abuser, respectively. Recently, a number of studies have paid much attention on the factors thatinfluencing the institutionalization in elderly. There are many different factors that caninfluence residential care placement. Several studies claimed that demographiccharacteristics and health of elderly are associated with long-term care use and nursinghome placement (Black, Rabins, & German, 1999; Gupta, 2002; Liu & Tinker, 2001; Miller &

418Weissert, 2000; Ryan & Scullion, 2000), including self-perceived health(Jang, Kim, Chiriboga, &Cho, 2008 ) and awareness of in institutional care services (Choi, Ziebarth, Hwang, & Koh,2012). For instance, Liu & Tinker’s study (2001), examined the influential factors of nursinghome entry by using data based on a survey of 378 elderly people who registered in nursinghomes and a sample of 19,638 families in Taiwan. The findings shown that nursing homeplacement was associated with advanced age, gender and dependency levels of elderlypeople, as 76 percent of elderly people in nursing homes were reported to rely financialsupport from family and most of them have difficulty in Activities of Daily Living (ADL).As 80 percent of elderly who live in nursing homes revealed that families had arranged thenursing home placement due to their poor health. Black, et al. (1999) used Andersen’s behavioral model to predict the nursing homeplacement among elderly public housing residents and found that the risk of nursing homeentry is linked to functional status and mental status. Whilst Gupta (2002) demonstrated thatthe significant reason to arrange nursing home placement in South Asian families are the roleconflicts the caregiver experienced and elderly mental health status, including elderly whowere lack of social support such as unmarried and living alone. Moreover, caregiver burden is proved to be associated with the nursing homeplacement in few studies (Gold, Reis, Markiewicz, & Andres, 1995; Ryan & Scullion, 2000).For instance, Gold, et al. (1995), has studied caregivers' decisions to end home care forrelatives with dementia. The finding has shown that caregiver exhaustion is linked to endhome care due to elderly deterioration condition.Methodology and Data This research used a qualitative approach, mainly looked at secondary sources.All the literature selected for use is relevant to the research topic and content analysis isused as a method of this research in order to find out the complete overview of Koreanageing situation and social elderly caring’s trends in South Korea. A number of previous studies will be explored in several issues within which toconsider the future trend of elderly care in South Korea in the context of ageing society.The factors associated with the likelihood of the use elderly care services were examined inthis study. For instance, the development of elderly care, the contextual factors, such as theseriousness of ageing issues and the challenges faced by family caregivers, the personal

419characteristics factors, such as gender, income, living arrangement and health status ofelderly.Result and Conclusion Social policies in South Korea were developed based on economic growth thendistribution ideology in which family pay a crucial role in providing a social safety net forelderly. However, the demand for long-term care has been increasing recently due to thesocio-demographic change such as a rapid aging, a change in family structure and anincrease of women in the workforce. Furthermore, a number of family caregivers havestretched to their limits, which result in their experiencing high burden of caring for elderly.The statistics also revealed that Korean elderly are more likely to suffer abuse or neglect byfamily caregivers, especially son and daughters-in-law. The Korean long-term care has been developed and promoted as the alternativesources of care for elderly during the last few years, which mostly provides bothhome-based care and institutional care services. Institutional care can be alternatives forolder Korean, particularly elderly with the frail and disability. The predictors ofinstitutionalization in elderly have indicated that the role of institutional care is stillimportant in the future as a shelter for Korean elderly because the socio-demographics andpersonal characteristics of elderly have an influence on Korean people’s needs towardlong-term care. According to the statistics from NHIS (2015), in 2014, the Korean elderly who wereclassified as moderately or severely disabled have resided in the aged care facilities morethan other types of long-term care services, which means that the elderly who suffer withsevere health problems and require full or substantial assistance in daily tasks are morelikely to rely on some kind of institutional care services. As previous mentioned that thereare many factors influence the use of institutional care, especially a rapid increase inproportion of Korean elderly who suffer from physical and mental illness, thus it seemspredictable that the institutional care will remain one of the predominant forms of care forKorean elderly in the foreseeable future.

420Discussion The major objective of this study was to examine the trend of Korean elderly care, inparticular institutional long-term care services. The trends of elderly care service werepredicted through two main factors; first, the strengths and weaknesses of the currentelderly care, which this study has focused on the Long-term Care Insurance system (LTCI).Secondly, the challenges of the elderly care, supporting by contextual factors. The study has found that the roles of institutional care will remain important in thefuture as a shelter for Korean elderly, particularly for frail and disabled elderly. Thecontextual factors such as rapid ageing of Korean population, elder health and economicstatus as well as social changes will have an influence on Korean people’s needs towardformal long-term care. It cannot be denied that some type of institutional care will alwaysbe necessary for elderly, especially elderly persons with multiple health problems andsignificant functional limitations who require continuous or around the clock nursing care. However, the long-term care services, institutional care in particular, have beenunder criticism for some reasons, for instance, the issues about quality of care, equity andsustainability of the system. The integration of elderly care is needed as Korean elderly aremore likely to require continuous care due to the chronically ill and disability as well as theprevention strategies to reduce demand for long-term care services are also necessary suchas the development of healthy ageing and active ageing policies, which will become a keyto reduce cost in long-term care systems (Colombo, Llena-Noza, J., & Tjadens, 2011;WHO/Europe, 2012). Therefore, the integrative approach to health care and social careseems particularly important to develop Korean elderly care services in the future.

421ReferencesAhn, K. C., & Chung, K. H. (2008). Ageing and Ageing Policies in the Republic of Korea. In H. G. Lee (Ed.), Ageing in Southeast and East Asia: Family, Social Protection, Policy Challenges (pp. 40-65). Singapore: Institute of Southeast Asian Studies.Black, B. S., Rabins, P. V., & German, P. S. (1999). Predictors of nursing home placement among elderly public housing residents. Gerontologist, 559-568.Choi, H. (1993). Cultural and Noncultural Factors as Determinants of Caregiver Burden for the Impaired Elderly in South Korea. The Gerontologist, 8-15. doi:10.1093/geront/33.1.8Choi, S.-J. (1992). Ageing and Social Welfare in South Korea. In R. P. David (Ed.), Ageing in East and South-East Asia (pp. 148-166). London: Edward Arnold.Choi, S.-J. (2002). National Policies on Ageing in Korea. In R. P. David, & C. M. Alfred (Eds.), Ageing and Long-Term Care: National Policies in the Asia-Pacific (pp. 68-106). Singapore: Institute of Southeast Asian Studies.Choi, Y.-e., Ziebarth, A., Hwang, E., & Koh, S.-h. (2012). Intentions of Nursing Home Entry Among Elderly Residents in Jeju, Korea,. Housing and Society, 29-49. doi: 10.1080/08882746.2012.11430599Choi, Y.-j. (2015, 12 14). Long-term care for older persons in the Republic of Korea Development, challenges and recommendations. Retrieved 5 26, 2016, from http://www.unescap.org/sites/default/files/Item%203%20%28a%29%20Long- term%20care%20in%20ROK_0.pdfChoi-Kwon, S., Kim, H.-S., Kwon, S. U., & Kim, J. (2005). Factors affecting the burden on caregivers of stroke survivors in South Korea. Archives of Physical Medicine and Rehabilitation, 1043–1048.Chung, K. (1999). Living profiles of older persons and social policies on ageing in Korea. Seoul: Korea Institute for Health and Social Affairs.Colombo, F., Llena-Noza, A., J. M., & Tjadens, F. (2011). Help wanted? Providing and paying for long-term care Paris: OECD Health Policy Studies. Paris: OECD Publishing. doi:http://dx.doi.org/10.1787/9789264097759-enFlorence, L.-L. (2009). Is Korea Ready for the Demographic Revolution? The World's Most Rapidly Aging Society with the Most Rapidly Declining Fertility Rate. Retrieved from Korea Economic Institute of America: http://www.keia.org/sites/default/files/publications/04Exchange09.pdf

422Ghazy, M. (2006). Population ageing in east and southeast Asia: current situation and emerging challenges. Bangkok: UNFPA Country Technical Services Team for East and South-East Asia.Gold, D. P., Reis, M. F., Markiewicz, D., & Andres, D. (1995). When home caregiving ends: a longitudinal study of outcomes for caregivers of relatives with dementia. Journal of the American Geriatrics Society, 10-16. doi:10.1111/j.1532-5415.1995.tb06235.xGupta, R. (2002). Consideration of Nursing Home Care Placement for the Elderly in South Asian Families. Journal of Immigrant Health, 47-56.Hong, J.-s., Kim, Y.-s., Lee, N.-y., & Ha, J.-w. (2013). Understanding social welfare in South Korea. In S. B. Furuto (Ed.), Social Welfare in East Asia and the Pacific. New York: Columbia University Press.Jang, Y., Kim, G., Chiriboga, D. A., & Cho, S. (2008 ). Willingness to Use a Nursing Home: A Study of Korean American Elders. J Appl Gerontol, 110–117.Kang, I.-o., Park, C.-y., & Lee, Y. (2012). Role of Healthcare in Korean Long-Term Care Insurance. Journal of Korean Medical Science, 41-46. doi:10.3346/jkms.2012.27.S.S41Kim, H. (2015, 11 7). Community-Based Long-Term Care in Korea: Current Status and Future Agenda. Retrieved from UNESCAP: http://www.unescap.org/sites/default/files/Session4_Ms.KimHongsoo_RoK.pdfKim, J.-S., & Lee, E.-H. (2003). Cultural and Noncultural Predictors of Health Outcomes in Korean Daughter and Daughter-in-Law Caregivers. Public Health Nursing, 111–119.Kim, M.-H. (2013). Ageism and Elder Abuse In Korean Society. In S.-J. Choi, J.-N. Bae, K.-J. Min,Y.-K. Roh, & Y.-H. Won (Eds.), Ageing in Korea: Today and Tomorrow, Third Edition (pp. 304- 327). Seoul: Federation of Korean Gerontological Societies.Lee, M., & Kolomer, S. (2008, 09 08). Caregiver Burden, Dementia, and Elder Abuse in South Korea. Journal of Elder Abuse & Neglect, 61-74. doi: 10.1300/J084v17n01_04Lee, M., Yoon, E., & Kropf, N. P. (2007). Factors Affecting Burden of South Koreans Providing Care to Disabled Older Family Members. International Journal of Aging and Human Development, 245-262.Liu, L.-F., & Tinker, A. (2001). Factors associated with nursing home entry for older people in Taiwan, Republic of China. Journal of Interprofessional Care, 245-255.Miller, E. A., & Weissert, W. G. (2000). Predicting Elderly People's Risk for Nursing Home Placement, Hospitalization, Functional Impairment, and Mortality: A Synthesis. Medical Care Research and Review, 259-297.

423NHIS. (2014). 2014 : National Health Insurance System of Korea – Universal Health Coverage for the world. Retrieved 05 10, 2016, from COOPAMI: http://www.coopami.org/en/countries/countries/south_korea/social_protection/pdf/s ocial_protection05.pdfNHIS. (2015). 2014 National Health Insurance Statistical Yearbook. Seoul: National Health Insurance Service (NHIS).OECD. (2015). Elderly Populations Indicator. Retrieved 10 19, 2015, from https://data.oecd.org/pop/fertility-rates.htm#indicator-chartOECD. (2016). OECD Economic Surveys: Korea 2016. Paris: OECD Publishing.Oh, J., Kim, H. S., Diane, M., & Kim, H. (2006). A Study of Elderly Abuse in Korea. International Journal of Nursing Studies, 203-214.Ryan, A. A., & Scullion, H. F. (2000). Nursing home placement: an exploration of the experiences of family carers. Journal of Advanced Nursing, 1187-1195.Statistics Korea. (2015, 9 24). 2015 Statistics on the Aged. Retrieved 11 21, 2015, from http://kostat.go.kr/portal/english/news/1/23/2/index.board?bmode=read&bSeq=&aSe q=349205&pageNo=1&rowNum=10&navCount=10&currPg=&sTarget=title&sTxt=UNESCAP. (2016, 01 27). Income Security for Older Persons in the Republic of Korea. Retrieved 05 10, 2016, from UNESCAP: http://www.unescap.org/resources/income- security-older-persons-republic-koreaUNESCAP. (2015, 12 14). Long-term care for older persons in the Republic of Korea: Development, challenges and recommendations. Retrieved 04 10, 2016, from UNESCAP: http://www.unescap.org/sites/default/files/Longterm%20care% 20for%20older%20persons%20in%20the%20Republic%20of%20Korea.pdfWHO. (2015, 12 27). Definition of an older or elderly person. Retrieved 04 10, 2016, from World Health Organization: http://www.who.int/healthinfo/survey/ageingdefnolder/en/WHO/Europe. (2012, 9 10). Strategy and action plan for healthy ageing in Europe, 2012– 2020. Retrieved 6 16, 2016, from WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR EUROPE : http://www.euro.who.int/__data/assets/pdf_file/0008/175544/RC62wd10Rev1-Eng.pdfWon, C.W. (2013). Elderly long-term care in Korea. Journal of Clinical Gerontology and Geriatrics, 4(1), 4-6. doi:10.1016/j.jcgg.2012.11.00

424 Effectiveness of Health Policy in South Korea regarding the Prevention of Liver Fluke Infection: Comparative Study of South Korea and Thailand ประสทิ ธผิ ลของนโยบายสขุ ภาพเก่ียวกบั การปองกนั การระบาดของโรคพยาธใิ บไม ในตบั ที่ไดร บั มาจากอาหาร : กรณศี ึกษาเปรยี บเทยี บระหวางเกาหลีใตและไทย ศดิ าวดี พูลศริ วิ ิทย* Sidawadi PulsiriwitABSTRACT Foodborne Trematodiases still attack in many countries globally either poor ordeveloped countries. In South Korea, although the overall parasitic infection has beendecreased significantly, the South Korean government’s effort of controlling Clonorchiasis donot seem to well succeed since the Clonorchiasis still remains its prevalence along the riversideareas where the highly endemic area is. In Thailand also, the Opisthorchiasis is still beingactively transmitted in northern and northeastern regions and considered as a major healthproblem since it contributed to the high mortality among the northerners and northeasterners.Both of countries governments have been implemented the national control measures. Butsince the prevalence is still not sustainably decreased as well as the case of reinfection hasfound out, the effectiveness of policy and strategies implemented by these two countries is stillquestionable. Thus, this study has assessed the health policy and strategy in focusing on itseffectiveness as well as the factors influencing its outcome then compare between the cases oftwo countries.Keywords: Effectiveness of liver fluke infection policy, factors, comparison, Thailand, South Korea * นสิ ิตหลักสตู รศิลปศาสตรมหาบัณฑิต สาขาวิชาเกาหลศี ึกษา คณะบัณฑติ วทิ ยาลยั จุฬาลงกรณมหาวทิ ยาลยั Student of the Master of Arts in Korean Studies, Graduate School, Chulalongkorn University

425บทคดั ยอ โรคพยาธิใบไมที่ไดรับมาจากอาหารยังคงเปนปญหาในหลายๆ ประเทศทั่วโลก ในประเทศเกาหลีใตถงึ แมวา การระบาดของโรคพยาธติ างๆ โดยทวั่ ไปจะลดลง แตค วามพยายามของรฐั บาลที่จะควบคมุ การระบาดของพยาธิใบไมตบั ท่ีไดรบั มาจากอาหารกลับไมป ระสบความสาํ เร็จเทาท่ีควร และยังคงมีการระบาดตามหมูบานหรือชุมชนในพ้ืนที่ใกลแมนํ้าซ่ึงถือวาเปนพ้ืนท่ีที่เปนแหลงร ะบาดของประเทศ ในขณะท่ีประเทศไทยการระบาดของพยาธิใบไมตับท่ีไดร บั มากจากอาหารยงั คงมอี ยา งชกุ ชุมในแถบภาคเหนอื และภาคอสี าน และยังถือเปน ปญหาสขุ ภาพหลักของคนในพน้ื ท่ีเนื่องจากกอใหเกดิ โรคมะเรง็ และนาํ ไปสูก ารเสียชวี ิต ซง่ึ ทง้ั สองประเทศไดมีมาตรการในการจัดการกับการติดเชื้อของพยาธิใบไมต ับ แตส ถติ กิ ารระบาดของโรคกลบั ไมล ดลงอยางตอเนอื่ งและยังมีรายงานของผูติดเชื้อ ดวยสาเหตุน้ี นโยบายและมาตรการที่ท้ังสองรัฐบาลใชจึงควรไดรับการศึกษา ดังนั้นงานวิจยั ฉบบั นจี้ ึงไดถูกทําข้ึนเพ่ือศึกษาประสิทธิภาพของนโยบายดานสุขภาพและมาตรการตอการปองกันและควบคุมโรคพยาธใิ บไมตบั ของทง้ั สองประเทศ รวมทั้งปจจยั ทมี่ ีผลตอ การดาํ เนนิ การ และนาํ มาเปรยี บเทยี บคาํ สาํ คญั : ประสทิ ธผิ ลของนโยบายโรคพยาธใิ บไมในตบั , ปจจัยท่สี ง ผลกระทบ, การเปรียบเทยี บ, ไทย, เกาหลีใตINTRODUCTION Foodborne Trematodiases are a group of parasitic infections caused by Trematodes,which are commonly known as Flatworms or Flukes that are contracted by the ingestion offood contaminated with the larval stage of the parasites (World Health Organization, 2015). Dueto the polyphyletic group of the trematodes, the type of Foodborne Trematodiases in eachcountry would be different. The WHO states that at least 56 million people throughout theworld have suffered from at least one Foodborne Trematodiases and the diseases are mostprevalent in the East Asia and South America, even though medications are now available(World Health Organization, 2015). In Korea, Foodborne Trematodiases or liver fluke called Clonorchiasis is highly endemicparticularly in riverside areas (Hong et al., 1998, p. 249). With regards to the national surveyconducted by the Government and related agencies, we could see the trend of theClonorchiasis in the general population in South Korea has remarkably decreased as follows:4.6% in 1971, 1.8% in 1976, 2.6% in 1981, 2.7% in 1986, 2.2% in 1992, 1.4% in 1997, and 2.9% in2004. This reduction of the infectious rate could be the result of the nationwide controlprogram run by the government as well as the information acquired through research which haspromoted the source of knowledge for combat with the worm. However, the infection statusstill fluctuates despite the availability of anthelminthics.

426 In Thailand, Opisthorchiasis is highly endemic in the northeastern and northern region. Inparticular, it is a major health problem of the northeastern region. Thailand was in the first rankof having the most cholangiocarcinoma patients worldwide. This phenomenon is directly linkedto the prevalence of Opisthorchiasis. From the data of the Bureau of Epidemiology under thedirection of the Department of Disease Control, the prevalent ratio of infection tended todecrease. The prevalence rate nationwide was 22.1% in 1966, 14.7% in 1981, 15.2% in 1991,11.8% in 1996 and 9.6% in 2001. However, the prevalence rate in Northeastern region tendedto be higher as increased from 12.4% in 1996 to 15.7% in 2001 (P Jongsuksuntigul and TImsomboon, 2003, p. 231). And the rate of cholangiocarcinoma patients is persistently high. Based on the facts mentioned above, there is a need to examine health policycontrolling liver fluke infection of these two countries. Thus, this study is focused oneffectiveness of health policy and strategy as well as find out the factors behind its success orfailure and compare cases of South Korea with Thailand.LITERATURE REVIEW South Korea According to Shin, Guk, Kim, Lee and Chai (2008), Clonorchiasis was recognized incausing significant morbidity and mortality by its causative agent of bile duct inflammation andcancer, particularly in villagers living along riverside areas such as the area of Nakdong River.Many studies have also proven this significance in the same direction that the disease is a veryimportant problem in public health dimension. Hong et al. (1998) confirmed this by presentingthe high prevalence of Clonorchiasis from the national surveys of overall egg positive cases inKorea in 1971, 1976, 1981, 1986 and 1997. From these provided data, they concluded that thisliver flukes infection is the most prevalent parasitic infection. Cho et al. (2008) made the samestatements in their studies. Clonorchis sinensis is still the most important helminth species inthe aspect of South Korea’s public health because it still remains at a relatively high level, andrepeated infection was detected in the same endemic areas, even though the endemicity hasdeclined to light or moderate levels. According to Rim (1997) and Cho et al (2008), we could clearly specify the high endemicareas which are concentrated all over the country along riverside areas and the highest infectedrate was found in the Nakdong River basin. However, Seo, Lee, Cho, Chai and Hong (1981)further suggested that the rate in each area along the Nakdong River differed due to the waterstream and distribution of the intermediate hosts. Cho et al. (2008) has also compared their

427work with the study of Seo, Lee, Cho, Chai and Hong (1981). They observed that the positiverate in the Geum, Yeongsan, Seomjin and Nakdong River basins has decreased remarkably.However, the most consistently endemic area is still the Nakdong River basin. On the otherhand, the results obtained in 2009 by K.J. June et al. (2013) presented differently the highestprevalent area, concentrated around the Seomjin River basin, while the Nakdong River basin fellto second place. This evidence was markedly different from the areas presented by Rim (1997),and Cho et al. (2008). However, Nakdong River basin is still relatively higher, compared to therest of the river basins. According to the questionnaire distributed to each participant in the study June, Cho,Lee, Kim and Park (2013), the rate would be higher not only in residents who consumed rawfreshwather fish, but also in people with smoking experience, drinking four or more times perweek, and in those with a history of Clonorchiasis. Females are much less exposed to the risk ofClonorchiasis since they more infrequently participated in social gatherings. Therefore, we canunderstand why the higher infectious rates usually were detected among males in an older agegroup because they tended to regularly carry on the risk factors written above. Apart from hygiene and other general infrastructural development, medicine is used forClonorchiasis treatment. A mass treatment project was then driven by the government during1984-1990, which led to a remarkable decrease in the egg positive rate of people in the projectareas. This made the improvement of the Clonorchiasis status, not only the infected rate butalso the proportion of heavy infectious cases. Therefore, this could evidently prove that themedication was rapid and really effective control particularly when it was used together witheither health education or governmental aid (Rim, 2005). However, Hong et al. (1998) and Ohet al. (2014) were on the other side by stating that Clonorchiasis prevalence still remains at highlevels because of the difficulty in case detection due to people’s low levels of cooperationwith fecal examination. In addition, the treatment failure due to incomplete or inadequatedoses of medication was also involved. Moreover, the improvement of the status ofClonochiasis might be a result of changes in traditional lifestyle, economic development, andchemical used, not only control (Rim, 2005, pp. 277-278). Thailand According to the study of P Jongsuksuntigul and T Imsomboon (1998), Opisthorchiasishas been recognized as a major local public health problem in the northern and northeasternregions of the country for many decades. The epidemiological surveys during the past 30 years

428indicated a high infectious rate in the northeastern region from years 1953 to 1981. However,the nationwide evaluation in 1996 showed that the most concentrated area was the northernregion. When we compared the results of 1981 with 1996, the overall infected rate in allregions has declined. If we focus separately on each region, the prevalence of the condition inthe northeastern region remarkably dropped but the prevalence in northern and central regionsconsiderably rose. Nevertheless, in 2003-2006, the northeastern region rose to the first rank.Although the prevalence in the northeast was higher than the north, the morbidity rate in thenorthern region was relatively higher (Natthawut Kaewpitoon, Soraya Kaewpitoon and PrasitPengsaa, 2008). The nationwide control operation was firstly started since the sixth health developmentplan (1987-1991) (Picha Suwannahitatorn et al., 2013). According to both P Jongsuksuntigul andT Imsomboon (1998) and Picha Suwannahitatorn et al. (2013), the main strategies of thenational control program were contained by three approaches based on control and prevention.These were stool examination and treatment with praziquantel to eliminate the human hostreservoir, health education focusing on avoiding the consumption of raw and undercooked fishto interrupt an infection of liver flukes and environmental sanitation development for hygienicdefecation to interrupt transmission of disease. To do so, several activities, including theorganization of mobile stool examination team, community preparation, and mobilization ofindividuals, family members, community participation, and continuing effective healtheducation were eventually designated. In the study of P Jongsuksuntigul and T Imsomboon (1998), the overall prevalence innortheastern population and the intensity they have assessed in 1994 was comparatively lowerthan in 1981 and 1991. They assumed this reduction might be the effect of sustaining controlprogram in the northeastern region. However, they also found some evidence of reinfection inthe treated cases and the infectious rate remained considerably high in some areas. Theyclaimed that it was because of a lack of follow-up stool examination as well as the weaknessand ineffective management of healthcare services and public health workers on many levelssince they have been taking part in control programs.RESEARCH METHODOLOGY This study has been designed as the descriptive research by using the qualitativeapproach. This study will focus on the concerning literature survey and content analysis.However, the semi-structured interview based on the concept of the information-rich-case with

429a Thai governmental officer will be applied to work together to complete information for theanalysis. Nevertheless, the interview of the South Korean respondents might be difficult to beaccomplished. Therefore, the Korean documentary search will be also emphasized in additionto the English literature. In this study, the effectiveness of the policy regarding liver fluke control will bedetermined based on its implementation and the infectious rates from either nationwide orregional survey of the endemic areas since around 1970s will be used to evaluate theeffectiveness of the policy in terms of minimization the liver fluke infection. And some of theperceptional index will assist the understanding so that we will be able to comprehensivelyevaluate the infection to determine whether the policy is effective or not. Meanwhile, many crucial factors surrounded and influent its implementation will alsobe examined within three aspects insist of the actors which will further divided into states andagencies and civil society, context such as cultural factor or political factor, and content andprocess of policy and strategy. For the comparison, two countries will be compared in terms ofsituation and the effectiveness of the policy and its surrounding factors.RESULT South Korea 1 From the figure 1, it has shown a pattern of declination of Clonorchiasis rate measured as the percentage from 4.6 percent in 1971 to 1.9 percent in 2012. This can beconcluded that the control project run by government has efficiently carried out. However, theresult of the survey actually did not reveal the steady and impressive declination of theprevalence since the infectious rate was quite fluctuated by decreasing and increasing of the

430rate since 1976 particularly after 1984. Especially in 2004, it increased to more than half of therate in 1971 which is the year that the medication and control program was not yetimplemented. And the infection rate in 2012 was also higher than 1976 and 1997 althoughmedical technology and economics of the country seems to be more develop. From the figure 2, we also can see the decreasing of the infection if we look superficially.However, this figure has manifested a clearly unstable infectious rate of the endemic areas. Theinfection rate obtained in 2009 was again higher in every river areas. In particular, Seomjin,Geum and Han rivers have obviously shown an increasing of the infectious rate especially theSeomjin river where the rate was become higher 11.8 percent in year 2009 (21.3 percent)compared with year 2007 (9.5 percent) and even worse than the rate obtained in year 1979-1980 (17.3 percent). From analysis of implementation of the liver fluke infection control, South Korea hasreached sanitary coverage as well as system of waste and sewage management provided fortheir people. However, the control program by screening and treatment still did not significantlyreduce the prevalence and it was conducted only in some localities (June, Cho, Lee, Kim andPark, 2013, pp. 22-26). The health educational effort also was not yet succeeded because it’susually provided to the mass and mainly aimed at changing risk eating habit. So, it was notpowerful and was inability to motivate the people in endemic areas to change their eatingbehavior. So based on the information, the policy still was not effective. This ineffectivenesshappened due to the habit of raw freshwater fish consumption formed by the long traditionaldietary of Korean culture (June, Cho, Lee, Kim and Park, 2013, pp. 22-23). Also, the residents inthe endemic areas did not concern even though they knew that eating raw fish will causeinfection. This might be because it is usually asymptomatic infection. They also have wrongbelief that the infection can be easily treated by the medication and it will not lead to theserious complication (Oh et al., 2014, p. 1100). In addition, the government’s management ofpublic health facilities seems to be other barrier since the number of the public health facilitieswas considerably lower than private owned facilities that seek for profit and do not focus onpreventive care.

431Thailand If we look at the big picture of the whole country, the infectious rate been decreasedconsiderably. From the figure 3, we can see that the prevalent rate of liver fluke infection wasmuch declined from 11.8 percent in 1996 to 5.1 percent in 2014. And it is clear that thesituation of the infection is now in control which generally means the policy and controlprogram of the government is effective. But based on the data from the Department of DiseaseControl, the infection rate as high as 85 percent was detected in some villages in year 2009.Furthermore, the prevalence has not been substantially decreased in northeastern regions(figure 4). The prevalence in 2009 (16.6 percent) in the northeastern region was higher than theprevious survey in 1966 (12.4 percent) and 2001 (15.7 percent) although it would decrease inthe next survey. In terms of the control program, the screening of positive case, health education andsanitation have been provided for the people in the endemic areas. But the policy and strategyregarding liver fluke infection was not gained much attention from the government. So, therewere no supports for the implementations. The related agencies in the endemic areas did notset the liver fluke infection as their main priority and did not take the duty. As a consequence,the screening and surveillance system is not efficient. The active service was changed to passiveservice provided in the hospitals. The health education also was out of the concern. Themethod used for communication and its promoting material were either inappropriate orineffective since it cannot motivate the safely eating habit among the people. In addition, theproblem of poor management of disposal human waste and unhygienic defecation still remaindespite the sanitary coverage achievement.

432 Since the policy lack of effectiveness, there are several factors influencing to thisoutcome. The cultural factor seems to play an important role since it contributed to the eatinghabit of raw freshwater fish consumption among the people in the endemic areas and madepeople feel less concern since they enjoyed and craved for raw fish. The people also lacked ofthe proper knowledge towards infection. They did not know the severe complication since itwas not included in the health education provided by the government. And they hadoverconfidence in medication against parasite (Ram Rangsin et al., 2009, p. 154). Nevertheless,the government’s unconcern and working system were very important factor since it directlyaffected to its agencies and the policy implementation. Comparison From the prevalence rate between 1990s and 2000s (figure 1-4), Thailand seems to havebetter progress in reducing the prevalent rate than South Korea. The prevalence in Thaipopulation was sustainably decreased to only half of year 1996 in 2014. Meanwhile, the overallprevalence in South Korean population has shown only small change if compared with thedeclination of Thai prevalent rate because the prevalent rate in 2012 was decreased only 0.3percent from rate obtained in 1992. And it was unstably decreased since the rate has gone upand down. The situation in the endemic areas of the two countries was also different. ForSouth Korea, the prevalent rate in the endemic areas was not decreased. Although the situationwas better in year 2007 by showing the declination, the prevalent rate of every area was againhigher in year 2009. On the other hands, the prevalence in endemic areas of Thailand showedbetter reduction particularly the northern regions where the rate was continuously decreased. If compare the policy and strategy operated by the two governments, it do not seemdifferent because both South Korea and Thailand have been focused on the same thingincluding treatment and health education as well as the improvement of the hygiene andsanitary condition provided for the population in the endemic. And their control program gavethe similar outcome since both governments do not seem to be successful in decreasing theprevalent rate of the liver fluke infection among the target population. Both Thailand and South Korea has paid their attention to the screening and treatment.And it seems to be actively operated in the first period. However, after the declination of theprevalent rate, both countries reduced the intensity of the implementation to some degree andlimited to only some areas. Moreover, it was not continuously operated in Thailand. So, ifcompare with South Korea, the problem of lack of continuity of the implementation was

433clearer to see. For health education, Thai government seems to be less concern. Nevertheless,the health education of both countries was ineffective to change the eating habit because bothcountries emphasized on the promoting of cooked fish consumption. So, the people in theendemic areas did not be aware since the severe complication of the infection was notcommunicated. Moreover, Thailand still has the problem related to the sanitation while SouthKorea seems to have good management of the sanitary system. In terms of the factors influencing the effectiveness of the policy, two countries seem tohave the same barriers. The most common factors found out from the study is directly relatedto the people in the endemic areas lacked of concern and their cultural factor which presentedin form of the habit of raw freshwater fish consumption. This can be called as the mostsignificant factor and its impact towards the liver fluke infection policy is really strong. And it’svery difficult to be destroyed especially when some contextual elements such as the localeconomic or the environmental factors which affected the people’s daily life also involved.However, the government and its agencies also are the important factor in both countries.Although the situation related to problem of health care service in South Korea and Thailandwas somewhat different, it happened because the governments lacked of concern.CONCLUSION AND RECOMMENDATION From all the data, we are able to conclude that the implementation of bothgovernments was not that different even though the situation of two countries was somewhatdifferent in some points. Importantly, the policy of their countries was not effective. Both SouthKorea and Thailand still have not succeed in the prevention of the liver fluke infection andsustainably decreased its prevalence in the endemic areas especially in terms of trying tochange the eating habit of their people in the endemic areas since the consumption of the rawfish still remain as the great factor and the people still lack of health concern and awareness. To reduce the prevalence of liver fluke infection, the strong policy is very important.Above all, the government and its great concern are the most essential to strengthen the policyand its enforcement. Also the liver fluke policy should be pushed to be the important policy ofthe government settings. So, there is potentiality to stimulate all sectors to recognize and beaware of its prominence as a major problem of public health. To draw the attention from thegovernment, it needs for the drives from an intermediary such as health assembly or NGOs inorder to push the liver fluke infection to be as the national agenda. Furthermore, it should beincluded in the function of various governmental departments.

434 In addition, the top-down governance approach of the policy seems to be crucial weakpoint since it could not resolve the problem according to its social characteristic, needs and theunderstanding of each area. This is because the situation or problem of each area was notreflected. So, only sending the policy decided by the government to the endemic areas did nothelp to decrease the infectious rate especially could not make change of the people’s eatingbehavior since the policy and its control program did not suit with every endemic areas.Therefore, the bottom-up model should be applied by operating the control program based onthe community. Apart from the bottom-up model, the participation of the community should beencouraged. Giving the opportunity for them to design and operate themselves will help tocreate the motivation and awareness among the residents. Furthermore, it can reflect theineffective control program of the government and contribute to new idea which can be usedto improve the governmental control program from the idea of the community. To do this, thelocal governmental units and staffs should remain their function as the supervisor andsupporter based on their needs. The central government also should actively take mainresponsibility in supporting of budget, knowledge and facilities so that the implementation willbe operated smoothly and sustainable. This might be the better solution for Thai governmentto deal with the liver fluke infection. And South Korean government might be able to apply thisin their country and develop their owned suitable model in the future. REFERENCESนายแพทยอ าํ นวย กาจนี ะ (อธบิ ดีกรมควบคมุ โรค).นโยบายการดาํ เนนิ งานกาํ จดั พยาธใิ บไมตบั ลดมะเร็งทอ นํา้ ด,ี [สไลด]Cho, Lee, Lee, Cho, Cheun, Hong, Sohn and Kim. (2008). Prevalence of Clonorchiasis in Southern Endemic Areas of Korea in 2006. Retrieved May31, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553343/Hong, Yoon, Lee, Seo, Choi, Sim, Ihn, Choi, Yun and Lee. (1998). Control of clonorchiasis by repeated praziquantel treatment and low diagnostic efficacy of sonography. Retrieved May 31, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732964/pdf/kjp-36-249.pdf

435June, Cho, Lee, Kim and Park. (2013). Prevalence and Risk Factors of Clonorchiasis among the populations Served by Primary Heathcare Posts along Five Major Rivers in South Korea. Retrieved May 31, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747674/pdf/phrp-4-1-21.pdfKim, Cheun, Cheun, Lee, Kim, Lee, Lee and Cho. (2010). Prevalence of Clonorchis sinensis Infections Along the Five Major Rivers in Republic of Korea, 2007. Retrieved May 31, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766887/pdf/main.pdfNatthawut Kaewpitoon, Soraya J Kaewpitoon and Prasit Pengsaa. (2008). Opisthorchiasis in Thailand: Review and current status. Retrieved July 7, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705081/pdf/WJG-14-2297.pdfOh, Lim Yun, Cho, Park, Choi, Shin and Hong. (2014). Control of clonorchiasis in Korea: effectiveness of health education for community leaders and individuals in an endemic area. Retrieved June 2, 2015, from http://onlinelibrary.wiley.com/doi/10.1111/tmi.12338/pdfP Jongsuksuntigul and T. Imsomboon. (1998). Epidemiology of opisthorchiasis and national control program in Thailand. Retrieved May 31, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/9886122P. Jongsuksuntigul and T. Imsomboon. (2003). Opisthorchiasis control in Thailand. Retrieved July 7, 2015, from http://www.sciencedirect.com/science/article/pii/S0001706X03002225Picha Suwannahitatorn, Saranapoom Klomjit, Tawee Naaglor, Paanjit Taamasri, Ram Rangsin, Saovanee Leelayoova and Mathirut Mungthin. (2013). A follow-up study of Opisthorchis viverrini infection after the implementation of control program in a rural community, central Thailand. Retrieved July 7, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689608/pdf/1756-3305-6-188.pdfRim. (1997). Epidemiology and control of clonorchiasis in Korea. Retrieved May 31, 2015, from http://www.tm.mahidol.ac.th/seameo/1997-28-1-suppl/11-47-50.pdfRim. (2005). Clonorchiasis: an update. Retrieved May 31, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/16153321Ram Rangsin, Mathirut Mungthin, Paanjit Taamasri, Somporn Mongklon, Pote Aimpun, Tawee Naaglor and Saovaanee Leelayoova. (2009). Incidence and Risk Factors of Opisthorchis viverrini Infections in a Rural Community in Thailand. Retrieved July 7, 2015, from http://www.ajtmh.org/content/81/1/152.full.pdf+html

436Seo, Lee, Cho, Chai, Hong, Han, Sohn, Cho, Ahn, Lee, Chung, Kang, Shim and Hwang. (1981). An Epidemiologic Study On Clonorchiasis And Metagonimiasis In Riverside Areas In Korea. Retrieved June 2, 2015, from http://parasitol.kr/upload/pdf/kjp-19-137.pdfShin, Guk, Kim, Lee, Chai. (2008). Trends in parasitic diseases in the Republic of Korea. Retrieved June 2, 2015, from http://www.cell.com/trends/parasitology/abstract/S1471- 4922(08)00028-7World Health Organization. (2015). Foodborne trematode infections. Retrieved June 2, 2015, from http://www.who.int/foodborne_trematode_infections/infections_more/en/