Annals of Occupational and Environmental Medicine

Original Article

Factors affecting heat-related illness symptoms among school food service workers: a cross-sectional study in Korea: Nahyun Kim, Dongwhan Suh, Jia Ryu, Woo Chul Jeong, Yun-Keun Lee, Jinwoo Lee, Hyunjoo Kim; Ann Occup Environ Med 2025;37:e30. Published online September 2, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e30

Abstract Abstract in Korean PDF Supplementary Material: Background
School food service workers are highly likely to develop heat-related illnesses because of their work environment. However, studies that have examined the risk of heat-related illnesses among them are limited. The purpose of this study was to investigate the status of heat exposure, implementation of heat wave countermeasures, and prevalence of heat-related illness symptoms among school food service workers in Korea, and to explore the relationship between them.
Methods
A cross-sectional study was conducted through an online survey of school food service workers from May 25 to June 12, 2023, via three labor unions. We analyzed 6,244 valid responses. We assessed general characteristics, heat-related illness symptoms (heat rash, heat cramps, heat edema, heat exhaustion, heat syncope), duration of heat exposure during heat waves, and heat wave preventive measures. Multiple logistic regression analyses were performed, with adjustments for age, occupation, hypertension, diabetes, and school type.
Results
More than one-third of school food service workers reported heat exposure between May and September exceeding 4 hours daily, and 94.6% experienced at least one heat-related illness symptom during the last year. A dose-response relationship was observed between heat exposure duration and heat-related illness symptoms (p for trend < 0.001). School food service workers who did not have increased rest periods or did not reduce high-heat prepared foods showed significantly higher odds ratios for heat-related illness symptoms.
Conclusions
School food service workers experience substantial heat exposure and a high prevalence of heat-related illness symptoms. The risk of heat-related illness symptoms was associated with extended duration of heat exposure. Increasing rest periods and reducing high-heat food preparation were effective preventive measures. These findings underscore the need for improved heat exposure management and implementation of effective preventive measures to protect the health of school food service workers, with particular attention to appropriate rest periods.; 학교 급식 종사자의 온열질환 증상 위험요인
목적
학교 급식 종사자는 다수의 열원이 존재하는 협소한 공간에서 근무하기 때문에 온열질환 발생 가능성이 높다. 학교 급식 종사자의 작업 중 열 노출 현황, 폭염 대응책 시행, 온열질환 증상 유병률을 조사하고 이들의 관계를 탐구하고자 하였다.
방법
2023. 5. 25- 6. 12까지 학교 급식 관련 3개 노동조합을 통해 온라인 설문조사를 실시해 6,244개의 유효한 응답을 얻었다. 일반적 특성과 온열질환 증상 경험, 폭염 시 근무 중 고온노출 시간, 폭염피해 예방 조치 경험을 조사했다. 온열질환 증상 경험에 관련된 요인을 확인하기 위해 연령, 직종, 고혈압, 당뇨병, 학교 유형을 보정한 다중 로지스틱 회귀분석을 수행했다.
결과
학교 급식 종사자의 3분의 1 이상이 5월부터 9월 사이 일일 4시간을 초과하는 열 노출을 보고했으며, 94.6%가 지난 1년 동안 적어도 하나의 온열질환 질환 증상을 경험했다. 하루 중 고온 노출 시간에 따라 온열질환 증상 경험의 위험은 양반응 관계로 증가했다(P for trend<0.001). 폭염 피해 예방 조치를 경험한 것에 비해 그렇지 않은 경우 온열질환 증상 경험의 위험은 휴게시간 증가(OR=1.86), 고열 제조 반찬 줄임(OR=1.59)에서 통계적으로 유의하게 증가했다.
결론
학교 급식 종사자들은 상당한 열 노출과 높은 온열질환 증상 유병률을 보였다. 온열질환 증상의 위험은 고온 노출이 심할수록 증가하는 것으로 확인되었다. 휴식시간 증가와 고열 제조 음식 조리 감소가 효과적인 예방 조치였다. 이러한 결과는 학교 급식 종사자들의 건강을 보호하기 위한 개선된 열 노출 관리와 효과적인 예방 조치 시행의 필요성을 강조하며, 특히 적절한 휴식시간에 특별한 주의를 기울여야 함을 시사한다.

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[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Review

Introducing statutory paid sick leave in South Korea: necessity and key considerations: Jinwoo Lee; Ann Occup Environ Med 2025;37:e22. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e22

Abstract Abstract in Korean PDF Supplementary Material: South Korea remains one of the few Organization for Economic Cooperation and Development countries without a statutory paid sick leave system or a public sickness benefit program. This paper examines the necessity of introducing statutory paid sick leave in South Korea and outlines key considerations for its implementation. The “right to rest when sick” is a fundamental health and labor right that ensures workers can recover from illness without risking job loss or income insecurity. A comparative review of international systems demonstrates that most countries have institutional mechanisms to support workers during non-work-related illnesses or injuries through paid sick leave and/or sickness benefits. In contrast, South Korean workers—especially those in small workplaces or non-regular employment—face limited access to such protections. The absence of these systems exacerbates social inequality and increases the risk of presenteeism and delayed medical care. Introducing statutory paid sick leave is not only a public health investment but also a measure to promote labor rights, reduce productivity losses, and prevent poverty caused by illness. The implementation of such a system must ensure universal coverage, prohibit employer retaliation, and be integrated with future sickness benefit programs to create a comprehensive social safety net.; 한국에서의 법정 유급병가 필요성과 도입 시 고려할 지점
한국은 법정 유급병가 제도 및 공적 질병수당 제도가 없는 몇 안 되는 OECD 국가 중 하나이다. 본 논문은 한국에서 법정 유급병가 제도의 도입 필요성을 검토하고, 제도 설계 시 고려해야 할 주요 사항들을 제시한다. ‘아플 때 쉬는 권리’는 노동자가 질병으로부터 회복할 수 있도록 보장하는 기본적인 건강권이자 노동권이다. 국제 비교를 통해 다수 국가들이 유급병가와 질병수당 제도를 통해 업무 외 질병 또는 부상 시 노동자를 지원하는 제도적 장치를 갖추고 있음을 확인할 수 있다. 반면, 한국의 노동자들—특히 소규모 사업장 종사자나 비정규직—은 이러한 보호로부터 배제되어 있는 경우가 많다. 이로 인해 사회적 불평등이 심화되고, 프리젠티즘(presenteeism) 및 의료 이용 지연의 위험이 증가하고 있다. 법정 유급병가 제도의 도입은 공중보건에 대한 투자일 뿐만 아니라, 노동권을 증진하고 생산성 손실을 줄이며 질병으로 인한 빈곤을 예방하는 수단이다. 제도 도입 시 보편적 적용, 사용자 불이익 조치 금지, 향후 수병수당 제도와의 연계를 통한 포괄적 사회안전망 구축이 핵심적으로 고려되어야 한다.

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[Special Collection] Paid Sick Leave and Sickness Benefits: Toward the Right to Rest When Sick

Review

The status and implications of paid sick leave and sickness benefits in OECD countries: Jaehoon Lee, Jinwoo Lee, Sang Baek Koh; Ann Occup Environ Med 2025;37:e21. Published online July 28, 2025; DOI: https://doi.org/10.35371/aoem.2025.37.e21

Abstract Abstract in Korean PDF Supplementary Material: The experience of the coronavirus disease 2019 pandemic has highlighted the importance of paid sick leave and sickness benefits, and is creating an international movement to introduce or improve real-world systems. The Organisation for Economic Co-operation and Development (OECD) countries except Korea and the United States already have statutory paid sick leave or sickness benefits, with the United Kingdom extending statutory paid sick leave to low-income workers in 2025, and Ireland introducing statutory paid sick leave in 2023. In the United States, 19 states, including Minnesota in 2024 and Alaska and Missouri in 2025, as well as the District of Columbia, have introduced statutory paid sick leave (as of December 2024). Furthermore, an analysis of 33 OECD countries with statutory paid sick leave or sickness benefits suggests that 21 countries comply with the International Labour Organization (ILO) Convention standards for adequacy of benefits and comprehensiveness of coverage, while six countries with social assistance have high comprehensiveness of coverage but low adequacy of benefits. There was not a single country with a program that had low levels of both benefit adequacy and coverage. In Korea, the pilot sickness benefit program has been extended until 2027, and the system has been delayed. The principles of benefit adequacy and coverage comprehensiveness must be upheld for the purpose and intent of the program to ensure adequate care and rest. Consequently, in addition to adhering to the standards outlined in the ILO Convention, the implementation of paid sick leave should be codified in legislation to enhance employer accountability.; OECD국가의 유급병가와 상병급여 현황과 시사점
코로나19팬데믹의 경험은 유급병가와 상병급여의 중요성을 재조명하는 계기가 됐으며, 실제 제도를 도입하거나 개선하는 국제적 흐름을 만들어지고 있다. 이미 한국과 미국을 제외한 OECD 국가가 법정 유급병가나 상병급여를 운영하고 있으며, 영국은 2025년부터 저소득노동자에 대한 법정 유급병가 적용을 확대했으며, 아일랜드 역시 2023년 법정 유급병가제도를 도입했다. 미국 역시 2024년 미네소타와 2025년 알래스카, 미주리를 포함해 18개 주와 워싱턴DC에서 법정 유급병가제도를 도입했다(2024.12월 기준).
또한 법정 유급병가나 상병급여를 시행 중인 OECD 33개국 분석 결과, 21개국이 ILO협약에서 제시하고 있는 급여 적절성과 대상 포괄성 기준을 준수하고 있으며, 사회부조 유형의 6개국은 대상 포괄성은 높지만 급여 적절성은 낮았다. 특히 제도를 시행 중인 국가에서 급여 적절성이나 대상 포괄성 모두 낮은 국가는 하나도 없었다.
한국은 상병수당 시범사업이 2027년까지 연장됐고, 제도 도입 역시 늦춰진 상태다. 충분한 치료와 휴식을 보장하는 제도 목적과 취지를 위해서는 급여 적절성과 대상 포괄성의 원칙이 지켜져야 하며, 이를 위해 ILO 협약 기준 준수와 함께, 유급병가 도입과 함께 사용자의 책무를 강화하는 내용을 법률에 명시할 필요가 있다.

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[Special Collection] Working hours as a social determinants of workers' health

Opinion

Statement by the Korean Society of Occupational and Environmental Medicine on the proposed reform of working hours in South Korea: Hee-Tae Kang, Chul-Ju Kim, Dong-Wook Lee, Seung-Gwon Park, Jinwoo Lee, Kanwoo Youn, Hwan-Cheol Kim, Kyoung Sook Jeong, Hansoo Song, Sung-Kyung Kim, Sang-Baek Koh; Ann Occup Environ Med 2023;35:e17. Published online July 5, 2023; DOI: https://doi.org/10.35371/aoem.2023.35.e17

Abstract PDF Supplementary Material

The current 52-hour workweek in South Korea consists of 40 hours of regular work and 12 hours of overtime. Although the average working hours in South Korea is declining, it is still 199 hours longer than the Organisation for Economic Co-operation and Development average of 1,716 hours per year. In view to this, the South Korean government has now proposed to reform the workweek, mainly intending to increase the workweek to 69 hours when the workload is heavy. This reform, by increasing the labor intensity due to long working hours, goes against the global trend of reducing work hours for a safe and healthy working environment. Long working hours can lead to increased cerebrovascular and cardiovascular diseases, industrial accidents, mental health problems, and safety accidents due to lack of concentration. In conclusion, the Korean government’s working hour reform plan can have a negative impact on workers’ health, and therefore it should be thoroughly reviewed and modified.

Citations

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Research Article

Workers’ experiences with compensated sick leave due to musculoskeletal disorder: a qualitative study: Min Choi, Hyoung-Ryoul Kim, Jinwoo Lee, Hye-Eun Lee, Junsu Byun, Jong Uk Won; Ann Occup Environ Med 2014;26:33. Published online November 4, 2014; DOI: https://doi.org/10.1186/s40557-014-0033-0

Abstract PDF

Objectives

The most common occupational disease that is compensated by Industrial Accident Compensation Insurance (IACI) in Korea is musculoskeletal disease (MSD). Although complaints about the workers’ compensation system have been raised by injured workers with MSD, studies that examine workers’ experiences with the Korean system are rare. This paper is a qualitative study designed to examine injured workers’ experiences with the workers’ compensation system in Korea. The aim of this study is to explore the drawbacks of the workers’ compensation system and to suggest ways to improve this system.

Methods

All workers from an automobile parts factory in Anseong, GyeongGi province who were compensated for MSD by IACI from January 2003 to August 2013 were invited to participate. Among these 153 workers, 142 workers completed the study. Semi-structured open-ended interviews and questionnaires were administered by occupational physicians. The responses of 131 workers were analyzed after excluding 11 workers, 7 of whom provided incomplete answers and 4 of whom were compensated by accidental injury. Based on their age, disease, department of employment, and compensation time, 16 of these 131 workers were invited to participate in an individual in-depth interview. In-depth interviews were conducted by one of 3 occupational physicians until the interview contents were saturated.

Results

Injured workers with MSD reported that the workers’ compensation system was intimidating. These workers suffered more emotional distress than physical illness due to the workers’ compensation system. Injured workers reported that they were treated inadequately and remained isolated for most of the recuperation period. The compensation period was terminated without ample guidance or a plan for an appropriate rehabilitation process.

Conclusions

Interventions to alleviate the negative experiences of injured workers, including quality control of the medical care institutions and provisions for mental and psychological care for injured workers, are needed to help injured workers return to work earlier and more healthy.

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