Ewha Med J.  2025 Jan;48(1):e7. 10.12771/emj.2025.e7.

Challenges from 14 years of experience at Workers' Health Centers in basic occupational health services for micro and small enterprises in Korea: a narrative review

• KMID: 2567554
• DOI: http://doi.org/10.12771/emj.2025.e7

Abstract

Health and safety issues in micro and small enterprises (MSEs) are recognized as a global challenge. This study aimed to examine Workers' Health Centers (WHCs) as a representative public organization providing occupational health services to MSEs in Korea. WHCs were established in 2011 after a trial period aimed at addressing occupational diseases in MSEs with limited resources. As of 2024, there are 24 WHCs, 22 branch offices, and 23 trauma counseling centers for workers. These health centers are managed by the Korea Occupational Safety and Health Agency, with their actual operation delegated to private organizations. Each WHC employs an average of 13 staff members and is organized into four specialized teams: cardiovascular disease prevention, workplace environment improvement, musculoskeletal disease prevention, and occupational stress management. These centers also offer common basic programs along with region-specific specialized initiatives. In 2023, the total cumulative number of users reached 203,877, with employees from MSEs comprising approximately 88.5% of the total. WHCs can thus be seen as playing a pivotal role as case managers of health requirements in the workplace by fostering strong relationships with MSEs and linking them to other relevant programs through a problem-solving-oriented approach. Given the limited resources of these enterprises, proactive policies and the equitable application of safety and health regulations are essential. A balanced strategy that combines regulatory enforcement with practical assistance is critical to ensure the success of WHCs in improving health and safety conditions in MSEs.

Figure

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  Fig. 1. Distribution of Workers' Health Centers (WHCs) in Korea.

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  Fig. 2. The number of Workers' Health Centers (WHCs), branch offices, and users by year.

Reference

References

1. Kok JD, Berrios M. Small matters: global evidence on the contribution to employment by the self-employed, micro-enterprises and SMEs. Geneva: International Labour Organization (ILO);2019.

2. Walters D, Wadsworth E, Hasle P, Refslund B, Ramioul M. Safety and health in micro and small enterprises in the EU: final report from the 3-year SESAME project. Luxembourg: Publications Office of the European Union;2018.

3. Walters D. Health and safety in small enterprises: European strategies for managing improvement. Brussels: Presses Interuniversitaires Européennes;2001.

4. Serrano MR, Xhafa E. Industrial relations in micro and small enterprises: patterns, trends and prospects. Geneva: International Labour Organization (ILO);2024. DOI: 10.54394/XJHF2363.

5. Kim I, Min J. Working hours and the regulations in Korea. Ann Occup Environ Med. 2023; 35:e18. DOI: 10.35371/aoem.2023.35.e18. PMID: 37928375. PMCID: PMC10622248.

6. Our World in Data. Data page: fatal occupational injury rates [Internet]. Oxford (UK): Our World in Data;c2024. [cited 2024 Nov 10]. Available from: https://ourworldindata.org/grapher/fatal-occupational-injuries-among-employees.

7. European Agency for Safety and Health at Work. Contexts and arrangements for occupational safety and health in micro and small enterprises in the EU: SESAME projects. Luxembourg: Publications Office of the European Union;2016.

8. Park H, Ha E, Kim J, Jung H, Paek D. Occupational health services for small-scale enterprises in Korea. Ind Health. 2002; 40(1):1–6. DOI: 10.2486/indhealth.40.1. PMID: 11926509.

9. Ministry of Employment and Labor. 2022 Industrial accident status. Sejong: Ministry of Employment and Labor;2023.

10. Yang M, Myong JP, Lee J, Park MY, Kang MY. Association between irregular working hours and work-related musculoskeletal pain: results from the 6th Korean Working Conditions Survey. Ann Occup Environ Med. 2023; 35:e21. DOI: 10.35371/aoem.2023.35.e21. PMID: 37928371. PMCID: PMC10622252.

11. Park J, Park J, Han B, Kim Y. Vulnerability of employees in businesses with fewer than five workers (micro-enterprises) to occupational safety and health problems. Am J Ind Med. 2017; 60(12):1056–1065. DOI: 10.1002/ajim.22783. PMID: 29063618.

12. Yi Y. Development of health management for small business workers. Korean J Occup Health Nurs. 2021; 30(1):28–35. DOI: 10.5807/kjohn.2021.30.1.28.

13. Kang D. Problems and suggested improvement plans for occupational health service in Korea. Ann Occup Environ Med. 2023; 35:e10. DOI: 10.35371/aoem.2023.35.e10. PMID: 37342826. PMCID: PMC10277204.

14. Ministry of Employment and Labor. Number of establishments and workers by region, industry, gender, and size [Internet]. Sejong (KR): Ministry of Employment and Labor;c2022. [cited 2024 Nov 10]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=118&tblId=DT_118N_SAUPN50&conn_path=I2.

15. Park J, Kim Y. The history of occupational health in South Korea. Arch Environ Occup Health. 2019; 74(1-2):50–57. DOI: 10.1080/19338244.2018.1541859. PMID: 30585530.

16. Presidential Advisory Council on Policy Planning. Response to low birthrate and aging society. Seoul: Presidential Advisory Council on Policy Planning;2008.

17. National Archives of Korea. Major policy records guidebook: welfare section (National Archives of Korea). Daejeon: National Archives of Korea;2015.

18. Kim JS, Kim DS, Gil HJ, Park YS, Sin HH, Park JT. The significance and prospects of the Workers’ Health Center. J Korean Med Assoc. 2014; 57(2):159–166. DOI: 10.5124/jkma.2014.57.2.159.

19. Lee SU, Kim DS, Gang SG. Regional Occupational Health Promotion Center in Korea for the purpose of promoting health of small-scale industry workers-assessment of the first year's results. Ind Health. 2008; (8):54–55.

20. Nam KC, Park JS, Koh JW, Kim JS, Park JT, Kim HJ, et al. An assessment of the needs and the affecting factors for small scale enterprise Worker’s Health Centers. Korean J Occup Environ Med. 2011; 23(4):407–419. DOI: 10.35371/kjoem.2011.23.4.407.

21. Korea Occupational Safety and Health Agency. 2016 Workers' Health Center establishment and operation comprehensive results. Ulsan: Korea Occupational Safety and Health Agency;2017.

22. Korea Occupational Safety and Health Agency. 2012 Workers' Health Center work performance guide. Ulsan: Korea Occupational Safety and Health Agency;2012.

23. Korea Occupational Safety and Health Agency. 2018 Comprehensive results of Workers' Health Center and branch operations. Ulsan: Korea Occupational Safety and Health Agency;2019.

24. Korea Occupational Safety and Health Agency. 2023 Comprehensive results of Workers' Health Center and branch perations. Ulsan: Korea Occupational Safety and Health Agency;2024.

25. Korea Legislation Research Institute. Occupational Safety And Health Act. Sejong: Korea Legislation Research Institute;2013.

26. Ministry of Employment and Labor. Notification No. 2013-6 of the Ministry of Employment and Labor. Sejong: Ministry of Employment and Labor;2013.

27. Korea Legislation Research Institute. Occupational Safety And Health Act. Sejong: Korea Legislation Research Institute;2019.

28. Ministry of Employment and Labor. Notification No. 2020-19 of the Ministry of Employment and Labor. Sejong: Ministry of Employment and Labor;2020.

29. Korea Occupational Safety and Health Agency. 2022 Comprehensive results of Workers' Health Center operations. Ulsan: Korea Occupational Safety and Health Agency;2023.

30. Korea Occupational Safety and Health Agency. 2017 Workers' Health Center establishment and operation comprehensive results. Ulsan: Korea Occupational Safety and Health Agency;2018.

31. Chung HJ, Kim SH, Rheu HC, Park JH, Lee JH, Yoo BH, et al. A study on developing improvement plans for the commissioned operation of Workers' Health Centers. Ulsan: Korea Occupational Safety and Health Agency;2022.

32. Han BS, Kim SK, Choi EH, Kim HR, Jung TS, Lee JS, et al. A study on developing mid- to long-term development plans for Workers' Health Centers. Ulsan: Korea Occupational Safety and Health Agency;2018.

33. Korea Occupational Safety and Health Agency. 2020 Comprehensive results of Workers' Health Center and branch operations. Ulsan: Korea Occupational Safety and Health Agency;2021.

34. Korea Occupational Safety and Health Agency. 2021 Comprehensive results of Workers' Health Center and branch operations. Ulsan: Korea Occupational Safety and Health Agency;2022.

35. Korea Occupational Safety and Health Agency. 2019 Comprehensive results of Workers' Health Center and branch operations. Ulsan: Korea Occupational Safety and Health Agency;2020.

36. Ryu J, Lim KH, Ryu DR, Lee HW, Yun JY, Kim SW, et al. Two cases of methyl alcohol intoxication by sub-chronic inhalation and dermal exposure during aluminum CNC cutting in a small-sized subcontracted factory. Ann Occup Environ Med. 2016; 28:65. DOI: 10.1186/s40557-016-0153-9. PMID: 27891239. PMCID: PMC5111284.

37. Choi SM, Kim CW, Park HO, Park YT. Association between unpredictable work schedule and work-family conflict in Korea. Ann Occup Environ Med. 2023; 35:e46. DOI: 10.35371/aoem.2023.35.e46. PMID: 38148922. PMCID: PMC10751215.

38. Laird I, Olsen K, Harris LA, Legg S, Perry MJ. Utilising the characteristics of small enterprises to assist in managing hazardous substances in the workplace. Int J Workplace Health Manag. 2011; 4(2):140–163. DOI: 10.1108/17538351111143312.

39. Rantanen J. Basic occupational health services. 3rd ed. Geneva: International Labour Organization (ILO);2007.

40. Rantanen J. Basic occupational health services: their structure, content and objectives. Scand J Work Environ Health Suppl. 2005; (1):5–15.

41. Joo YS, Noh SC, Lim J, Lim HJ, Jung YK, Bang YW, et al. A study on establishing operational models and developing performance indicators for the expanded installation of Workers' Health Centers. Ulsan: Korea Occupational Safety and Health Agency;2013.

42. Yang SH, Kang DM, Kang MY, Kim W, Kim JI, Rheu HC, et al. A study on improvement plans for the roles and functions of Workers' Health Centers. Ulsan: Korea Occupational Safety and Health Agency;2016.