This report is the third in the OECD’s series of reports reviewing public health policies across selected OECD countries. Health care systems across OECD are increasingly under pressure from social changes – including demographic changes and aging populations – and emerging new health challenges – from a growing burden of chronic disease, to re-emerging and new communicable diseases, or a growing burden of mental ill-health – which demand a strong public health response.

The time is now for Korea to turn full policy attention towards strengthening its public health system, tackling key behavioural risks, and preparing for potential technological change in the health sector – notably the growing importance of precision medicine – and preparing for public health emergencies. At present Korea’s population is relatively young, compared to OECD peers, but is aging very rapidly. Rates of tobacco and alcohol consumption are just below the OECD average, with Koreans consuming 8.7l of pure alcohol per capita in 2017 (about two bottles of wine per week), compared to the OECD average of 8.9l), and obesity rates well below the OECD average. These figures hide, however, a complex picture. Korean men are heavy smokers, alcohol consumption is relatively high and ‘binge’ drinking is a widespread and growing concern, with Korean men, and younger Korean women, drinking heavily at least once a month. Child overweight levels (at 31.8% of 5-9 year olds) are just above the OECD average of 31.4%. Compounding this potentially challenging picture is Korea’s health care system design which is, for the moment, still strongly orientated towards specialist and hospital-centric care delivery. Korea’s rapidly aging population, combined with risky health behaviour amongst some population groups, and high rates of obesity amongst children, now risk endangering many of the significant achievements Korea has made in increasing life expectancy and population health outcomes over the past decades.

Compared to the OECD average, the Korean population is relatively young and rate of behavioural risk factors relatively low. The system has, up until now, been focused on curative, rather than preventive care. However, rapid demographic shift, emerging risk factors linked to lifestyle, and an increasing burden of chronic diseases mean that prevention and public health should be a decisive policy priority sooner rather than later. The proportion of frail elderly is still low compared to OECD peers, with just 13.8% of the population over 65, and 3.0% over 80, in 2017. But Korea’s population is aging very rapidly, and by 2050 Korea is projected to have the largest over-65 population in the OECD, with 38% of people aged 65 years or over up from 13.8% in 2017, and 15.1% of the population 80 or over, up from 3.0% in 2017. While alcohol consumption and tobacco use are both slightly below the OECD average, and adult obesity is well below the OECD average, men are both heavy smokers and drinkers and child obesity rates are above the OECD average.

In Korea, where compared to the OECD average the population is relatively young and rate of behavioural risk factors comparatively low, the system has perhaps been understandably focused curative, rather than preventive care. However, shifting demographics including rapid aging, key risk factors especially amongst certain population groups notably males, and an increasing burden of chronic disease mean that prevention and public health should be a focus sooner, rather than later. This chapter outlines some of Korea’s strengths when it comes to public health policy, notably a collaborative governing approach and rich data infrastructure, as well as areas for strengthening, including stronger primary prevention policies, and scope for more robust chronic disease management.

Harmful alcohol use is a considerable public health issue in Korea. Alcohol plays an important part in daily life and binge drinking is common. While some policies have been introduced to reduce harmful alcohol consumption – including taxation, labelling, drink-driving regulation and education in universities – there remains scope to improve. Implementing a comprehensive policy package, which includes stricter marketing regulation, regulation on the sale and consumption of alcohol, education and public awareness programmes among all levels of society as well as improved pricing policies, can help tackle harmful alcohol consumption in Korea.

In Korea, genomic medicine is a fast-growing and popular field: genomic research, genetic testing and precision medicine, and direct-to-consumer genetic testing, are significant areas of policy attention, while in terms of genomic research, Korea has one of the biggest biobanks in the world. Genetic testing is widespread and increasing, both for hereditary (mostly infant) diseases, and following cancer diagnoses to personalise treatment. A regulatory framework has been developed for these tests, but quality assurance of private testing laboratories and training for health professionals are less well-developed and, most importantly, health coverage does not appear to be keeping pace with demand from patients and clinicians, and the cost-effectiveness of widespread use of genetic testing to personalise treatment (in particular cancer) does not appear to have been established. The area which generates the most concern when it comes to genomic medicine in Korea is the booming field of direct‑to‑consumer tests genetic tests.

Recent disasters and infectious diseases outbreaks have led Korea to reconsider the importance of its preparedness for public health emergencies. This chapter looks at how Korea sets-up and implements public health emergency policies and at how it builds the resilience of its health system, in accordance with the OECD Recommendation on the Governance of Critical Risks and other international guidelines. The chapter suggests that despite the usefulness of policy reforms and new capabilities, strengthening emergency preparedness in Korea remains an unfinished agenda, and more work is needed to address some key areas of weakness.