Master’s Thesis

Development Studies

An Analysis of South Korea’s Response to COVID-19 The Changing Dynamics of Urban Space with a Focus on Older People

Sungkyung Kang

Supervisor: James Gordon Rice June 2021

An Analysis of South Korea’s Response to COVID-19 The Changing Dynamics of Urban Space with a Focus on Older People

Sungkyung Kang

Final thesis submitted in partial fulfilment of a MA degree in Development Studies Supervisor: James Gordon Rice 30 ECTS

Faculty of Sociology, Anthropology and Folkloristics School of Social Sciences, University of Iceland June 2021

An Analysis of South Korea’s Response to COVID-19: The Changing Dynamics of Urban Space with a Focus on Older People

This final thesis is submitted in partial fulfilment of a MA degree in Development Studies. The thesis may not be copied in any form without the author’s permission. © Sungkyung Kang, 2021

Reykjavik, Iceland, 2021 Útdráttur

Undanfarið ár hafa viðkvæmir hópar, einkum aldraðir, staðið frammi fyrir mörgum erfiðum áskorunum vegna heimsfaraldursins COVID-19. Í Suður-Kóreu hefur COVID-19 haft mikil áhrif á þróun samfélagsgerðar. Fólk eldra en 65 ára er stór hluti þjóðarinnar og mun fjölga verulega í þeim aldurshópi á næstu áratugum. Jafnframt hefur orðið hröð þéttbýlismyndun í Suður-Kóreu. COVID-19 faraldurinn hefur haft mikil áhrif á lífsstíl eldra fólks sem býr í þéttbýli. COVID-19 og takmarkanir á ferðalögum hafa haft neikvæð áhrif á félagsleg samskipti, tengslanet og aðgang að nauðsynlegri umönnunarþjónustu. Viðtöl við umönnunaraðila leiða í ljós þarfir eldra fólks og áhrif sem aðgerðir vegna heimsfaraldurs hafa á líðan þeirra. Fjöldi skjala, tilkynninga, greina og myndskeiða (frá ríkisstofnunum og dagblöðum) og gögnum frá samfélagsmiðlum (Facebook og YouTube) á netinu, voru skoðuð til að greina orðræður sem tengjast eldra fólki í sambandi við COVID- 19. Að lokum fjallar þessi ritgerð um þann lærdóm sem Suður-Kórea dregur af reynslu sinni á heimsfaraldri og afleiðingar þess að hanna ný þéttbýlisrými sem svara til þarfa aldraðra og gætu gagnast framtíðaraðgerðum vegna farsótta.

Lykilorð: COVID-19, faraldsfræðilegar aðgerðir, aldraðir, Suður-Kórea, þéttbýli

i Abstract

Over the past year, vulnerable populations – especially older people – have struggled in the face of many challenges posed by the COVID-19 pandemic. This thesis looks at the situation in South Korea. COVID-19 has played out against the backdrop of a rapidly evolving society where older people form a significant proportion of the population. Based on a review of the literature and some interviews carried out with professionals working closely with older people, this thesis examines how the lives of older people have changed. Drawing on anthropological theories, it is argued that older people living in a densely populated urban space have faced enormous changes to their lifestyles during the pandemic. South Korea has gone through a dynamic social transition and a process of rapid urbanisation. COVID-19 and associated government-led restrictions on movement, have had a negative impact on social interaction, networking and access to essential care services. Older people can be further excluded and marginalised in a society that is increasingly dependent on and managed through digital space. A range of materials, harvested from Facebook and YouTube and government statements were analysed using discourse analysis in order to explore how the public of different generations and the government view older people. In conclusion, there are some lessons afforded by the South Korean pandemic experience and the implications for designing new urban spaces that are responsive to the needs of older people and which might provide a template for responding to future epidemics or emergencies.

Keywords: COVID-19, epidemic’s measures, older people, South Korea, urban space

ii Acknowledgements

First of all, I would like to thank my supervisor, Professor James Gordon Rice for helping me interpret my interest in urban anthropology to a current social phenomenon. Learning and exploring a journey of urban anthropology was a precious moment to expand new insights to understand a variety of cultural and social factors and pay attention to vulnerable populations. This master’s thesis was funded as a part of the Rannís project. I appreciate the Mobilities and Transnational Iceland to give me an opportunity for the fund.

I also would like to thank Rose Barbour who committed to proofreading and had helpful discussions with me, as I completed this work. I express thanks to Eva María who helped abstract in Icelandic. This thesis was also completed with continuous encouragement from those taking part in interviews, my parents Aekyung and Seokki, my sister Chanmi, my partner Alasdair, and his parents who supported my work in a new home.

iii Table of Contents

Útdráttur ...... i Abstract ...... ii Acknowledgements ...... iii List of Tables ...... vi List of Figures ...... vii List of Abbreviations ...... viii 1 Introduction ...... 1 1.1 Research Design ...... 6 1.1.1 Research Questions ...... 7 1.1.2 Research Methods ...... 8 1.1.2.1 Interviews ...... 11 1.1.2.2 Discourse Analysis ...... 12 1.1.2.3 Content Analysis ...... 12 1.1.3 Thesis Structure ...... 12

2 The South Korean Context for COVID-19 Responses ...... 13 2.1 Measures Relating to Older People in an Aged Society ...... 23 2.1.1 South Korea: An Aged Society Moving to a Super-aged Society ...... 23 2.1.1.1 ‘Dynamic Korea’ to ‘Dying Korea’ ...... 32 2.1.2 Seoul as an Urban Space for Older Adults ...... 33 2.2 Cultural Narratives about Older People ...... 36 2.2.1 Generational Divisions in South Korea ...... 39

3 Urban Space and the Lived Environment ...... 41 3.1 Urban Space in Anthropology ...... 42 3.2 An Ageing, Aged and Super-aged Society ...... 46 3.3 Impacts of Epidemics Measures on Older People in Urban Spaces ...... 49 3.3.1 An Online Panopticon ...... 52 3.3.2 Digital Urban Space for Older Adults ...... 55 3.3.3 Digital Images of Older Adults ...... 59

4 Perspectives of Aged-care Practitioners with Regard to Older People and the Pandemic ...... 62 4.1 A Vulnerable Population and Essential Workers ...... 64 4.1.1 Vulnerability of Older Adults ...... 64 4.1.1.1 Fear of Infection ...... 65 4.1.1.2 Older Adults Who Expect to Be Protected ...... 66 4.1.1.3 Increased Difficulties Due to Lower Income ...... 67

iv 4.1.1.4 Increased Difficulties Due to Disabilities or Dementia ...... 69 4.1.1.5 Worries of Family Members about Older Adults Coming to Facilities . 71 4.1.2 Depression in Older Adults Living Alone and Staying at Care Facilities ... 73 4.1.2.1 Solutions of Depression: Mental Health Care Service Provided by the Government ...... 74 4.1.3 Recognition and Adaptation of Older Adults ...... 75 4.1.3.1 Thoughts of Younger Generations ...... 77 4.1.3.2 Political Perspectives of Older Adults Towards the Government ...... 77 4.1.4 New Changes in Older Adults’ Lives: Technological Culture ...... 78 4.2 How the Environment in Which Professionals Working with Older People Has Changed ...... 81 4.2.1 New Care Service Needs ...... 82

5 Design of New Urban Space ...... 83 5.1 The Public and the Government ...... 85 5.1.1 Discourses around Older Adults ...... 87 5.1.1.1 How the Public Views Older Adults ...... 89 5.1.2 Perspectives of the Government and Its Response to Older Adults During the Pandemic ...... 92 5.1.2.1 How the Government Views Older Adults ...... 93 5.2 An Urban Space Designed to Meet the Needs of Older People in Future Epidemics ...... 97

6 Discussion and Conclusion ...... 99 6.1 ICT Infrastructures and Early Response ...... 100 6.1.1 Older Adults Struggling with Inequality of Information Access ...... 101 6.1.2 Inclusion of Older People in Society ...... 101 6.2 New Ageing Culture ...... 102 6.2.1 Care Service System: Community-based from Facility-based ...... 103 6.3 Conclusion ...... 104

References ...... 108

v List of Tables

Table 1. COVID-19 cases by age group in South Korea until the 3rd of May 2021 ...... 20 Table 2. Projection of medium growth in the South Korean population ...... 24 Table 3. Older adults in the LTCIS between 2015 and 2019 ...... 31 Table 4. The number of older adults living in Seoul in 2020 ...... 35 Table 5. The number of older adults living alone in Seoul in 2019 ...... 35 Table 6. Items harvested from the CDMH for content analysis ...... 93

vi List of Figures

Figure 1. A COVID-19 webpage in English provided by the KDCA and the MOHW ...... 15

vii List of Abbreviations

BPS Basic Pensions Scheme

CDC Centres for Disease Control and Prevention

CDMH Central Disaster Management Headquarters

CDSCH Central Disaster and Safety Countermeasures Headquarters

COVID-19 Coronavirus disease 2019

GPS Global Positioning System

HALE Healthy life expectancy

ICT Information and Communication Technology

KCDC Korean Centres for Disease Control and Prevention

KDCA Korean Disease Control and Prevention Agency

KOSIS Korean Statistical Information Service

LTCIS Long-term Care Insurance System

MA Medical Aid

MERS The Middle East respiratory syndrome

MOHW Ministry of Health Welfare

NBLS National Basic Living Security

NHIS National Health Insurance System

NPS National Pension Scheme

OECD Organisation for Economic Cooperation and Development

UN United Nations

WHO World Health Organisation

viii 1 Introduction Coronavirus disease 2019 (COVID-19) has spread globally and offers an interesting context in which to study new social and cultural patterns in anthropology. Taking account of the various relationships between people and their living environments and how an epidemic (e.g. Inhorn & Brown, 1995) and its preventive measures bring about changes to human lives, depending on people’s vulnerability and living conditions, anthropological perspectives can provide insights into understanding these impacts. Urban anthropology has been of interest to many anthropologists (e.g. Toulson, 2015) who have explored present, past, and future urban structures, together with the diverse behaviours of people living in urban spaces/places. COVID-19 has led to numerous unpredictable changes in urban spaces, and also for their residents, including vulnerable populations, such as the elderly.

In the contemporary era, South Korea has seen dynamic developments with regard to social, cultural and political dimensions, and has frequently been identified within the discipline of development studies. It now occupies a place amongst the most successful countries in terms of world economics. However, as recently as the 1960s, its Gross Domestic Product (i.e. GDP) was similar to that of some of the poorer countries of Africa and Asia (The World Bank, 2019). It has, therefore, experienced a dramatic economic rise over the space of a few generations. Moving away from the agriculture-based economy of the 1960s to its current situation, South Korea’s economic success has been achieved through a period of rapid industrialisation (Kang, 1998). This has led to multi-dimensional changes to the space in which people live and the associated process of urbanisation and increased population mobility have impacted particularly on older people, highlighting significant generational differences in South Korean society.

The past 14 months have seen South Korea hailed for its success in managing the COVID-19 pandemic, having departed significantly from the approach taken from most other countries, both in terms of its successful strategy and the ability to put this into practice (e.g. You, 2020). The pandemic has been proactively managed from an early stage, with effective governance and through a convenient and efficient medical system, focusing on prompt responses (S. Lee & D. Lee, 2020). Additionally, individuals taking responsibility for adopting preventative measures in order to reduce the spread of the

1 virus have been positively evaluated in the global context (e.g. Our World in Data, 2021; Schwak, 2020). Nevertheless, South Korea has experienced risks and waves of infections (Independent News, 2020) during the pandemic period. The pandemic, too, has highlighted the vulnerability of older people, who have been shown to be more susceptible to severe illness and death through contracting the virus. Due to urbanisation in the 1980s and 1990s, the population has become concentrated around Seoul and its surrounding satellite cities (Kang, 1998), consequently people living in cities are inevitably exposed to the risk of infectious diseases that spread from person to person. Older people, in particular, are placed in a vulnerable position (e.g. Daoust, 2020) from those external risk factors.

While South Korea’s success in managing the pandemic is amply demonstrated in statistical/epidemiological records (e.g. Dighe et al., 2020; Han et al., 2020), important questions remain as to what the impact of the pandemic, and associated measures to curtail its spread, have been for older people – in addition to the many disruptions and changes to their lives that have occurred, due to rapid industrialisation and urbanisation. This thesis, therefore, uses South Korea as a case study to examine the implications of COVID-19 for the lives of older people in a context of far-reaching change – including their experience of reconfigured urban spaces.

As soon as the rise in COVID-19 cases appeared in 2020, large-scale lockdown 1 schemes were introduced, and many people were panicking. There have been several historical experiences of lockdown due to pandemics. In the Renaissance period in the 17th century, the plague outbreak led Florence to introduce lockdown measures to deal with this health emergency. John Henderson2(2019) wrote about how the government in Florence confronted the plague and how people suffered from the epidemic (Khadilkar, 2020). Four hundred years later lockdowns have resurfaced as a response to the latest pandemic: that of COVID-19. The concept of ‘lockdown’ calls for revision in the 21st

1 Lockdown involves shutting down the borders in a specific space to restrict movements to guard against massive risks, such as terror and disaster, following emergency security practice. It is usually enforced by central governments in order to protect public health. In a narrower context, shutdown might involve the closing of a particular factory or shop for a short time. Lockdown, therefore, involves a stronger action than does a shutdown. 2 See the book, Florence Under Siege: Surviving Plague in an Early Modern City, for more details on the plague in Florence in the 17th century.

2 century context, as compared to the 17th century. Advancements regarding travel pose greater risks for rapid and extensive spread of infections, and advances in technology can offer additional tools to deal with an epidemic. Lockdowns due to COVID-19 have occurred over a period of a year, with variations between – and even within – countries (Centres for Disease Control and Prevention [CDC], 2021a). Since every nation has recognised the severity of medical system disintegration caused by COVID-19’s contagiousness, many countries have implemented either lockdown or shutdown (e.g. shutting down airports, imposing travel restrictions, or completely sealing their borders). In a pandemic, lockdown is a response to a high risk situation, intended to protect the country, society and residents, and may involve closing the country’s borders to prevent infection from other countries, coupled with shutting down places where viruses can spread. A shutdown differs in that only some facilities and places (e.g. bars, clubs, restaurants, theatres) are prevented from operating. Whereas shutdowns might be voluntary, lockdown can be enforced by the state power. Approaches to dealing with COVID-19 across the world have varied and have further changed as the situation has evolved (e.g. Government of Iceland, 2021; Government of the United Kingdom, 2021). Lockdown could not be viewed as being likely to be a temporary measure in a situation where the status of vaccines and treatments are uncertain and public health measures have not yet completely secured immunity.

The COVID-19 pandemic has had a significant impact on human life and has generated multi-dimensional changes to the space in which people live. It began as an epidemic that has spread over multiple countries with variations in range and coverage. COVID-19, which was named by the World Health Organisation (WHO) as a novel coronavirus, SARS- CoV-2 (i.e. the severe acute respiratory syndrome coronavirus 2) on the 11th of February 2020, was initially detected in Wuhan, China (Mo et al., 2020) and reported to the WHO in December 2019. It was declared a public health emergency of international concern in January 2020 and the WHO ended up characterising it as a pandemic (WHO, 2020). The virus has caused large economic losses (e.g. recession, unemployment) (e.g. Nam & Lee, 2020) and negative impacts on the mental health of individuals by rapidly spreading all over the world. According to the Department of Health and Human Services in the United States (CDC, 2021b), COVID-19 is a pandemic of respiratory disease, spreading from person to person by a coronavirus and is damaging to health, with its impact ranging from

3 mild symptoms (e.g. fever, cough, dyspnoea, myalgia, fatigue, olfactory dysfunction) to severe illness (e.g. pneumonia, acute respiratory distress syndrome, septic shock, organ failure) – and, even, death. People aged 65 and over and those with serious medical conditions (e.g. diabetes, cancer, high blood pressure, heart and lung disease), for instance, are known to be at higher risk of severe illness from the virus. Since older people are also more likely to have serious medical conditions, the impact for them is likely to be even greater.

Older people regularly have to visit medical/health centres and hospitals due to physical (environmental or psychological) vulnerabilities and difficulties. Infectious diseases such as COVID-19 pose a greater risk for their visits, and urgent and essential medical care is likely not to be provided on time. Medical personnel and resources may focus on infectious diseases and this can cause an imbalance and burden on the healthcare system in general. Under these circumstances, the vulnerable can be overlooked, despite their health being more likely to be threatened. In addition to infection prevention, management during and after infection also requires close attention and care. Early access to medical care following infection, therefore, is vital for improving the chances of survival of individuals in this category (Khafaie & Rahim, 2020).

Most countries have experienced lockdowns during the pandemic (e.g. Brazil, Britain, Italy, Greece, South Africa), but the South Korean government has not instituted any lockdowns (Han et al., 2020) relying on individuals’ infection prevention and responsibility, and the capabilities of medical staff and systems, and has continued to allow people to cross the border – although a number of confirmed infectious cases have constantly occurred, including instances where infections through a mutated strain of the virus have been recorded. From an early stage, the South Korean government promptly shared essential information (via media, official websites, etc.) and actively cooperated with the Korean Disease Control and Prevention Agency (KDCA) to provide information and resources for all residents, including those staying temporarily or briefly visiting South Korea (D. Lee & J. Lee, 2020). The government and the organised medical system have thus worked in tandem to reduce the potential for the spread of infection and to address concerns about infection and treatment. The way the South Korean government took action against the virus demonstrates that avoiding both lockdown and shutdown

4 (maintaining an ‘unclosed’ space) can have a positive impact on individuals and the community (Dighe et al., 2020) and that the response can be adjusted in order to return to normality.

Older people living in South Korea have had a particularly difficult time during the pandemic period (e.g. Lee et al., 2020), despite the country avoiding lockdowns (although some facilities for older age groups have had to implement have shutdowns). Those who need to work may have lost their jobs and, as a group, are likely to have become more vulnerable, having to rely on reduced income or external support from the government (associations, organisations, charities or privatised companies). COVID-19 has threatened their livelihoods over the long term for more than a year and, in addition to financial problems, has led to many difficulties in respect of their psychological health. In 2020, low income seniors in South Korea also suffered serious damage from heatwaves, typhoons (e.g. Bavi, Maysak), heavy rains, floods in Summer, and cold conditions and snowfalls in Winter. If they live with their family, they would be cared for by their children (or daughters-in-law). However, many elderly South Koreans live alone in an isolated or poor environment. With fear of infection, they would, for example, suspend meetings with neighbours or friends and may avoid going out altogether (Daoust, 2020). Sustaining the basic life requirements of eating and living alongside financial and physical difficulties can present a greater burden for them. Seniors living in nursing homes, nursing hospitals, or those visiting day and night care facilities may experience the pandemic in a different way than do seniors living alone. Due to the government’s infectious disease policy, facilities have restricted access by outsiders (including family members) and have instituted various preventive measures inside facilities, in order to prevent the spread of infection (Y. Kim & S. Park, 2020). Older people who live or visit facilities may experience less financial difficulties, mainly due to the support of their children, but have still been exposed to the risk of group infection through visiting facilities or staying with others.

COVID-19 has led to thoughts about how older people’s care should be managed – a new paradigm of operation of aged-care facilities’ operation, with community-based care provided in cooperation with local governments and the state, seeking to develop the most appropriate support models, that also cover the preparation of future epidemics/pandemics. Drawing on virtual focus groups with 21 practitioners (who have

5 worked at facilities for 16 years on average) Y. Kim and S. Park (2020) explored how services at aged-care facilities have been run during the COVID-19 period and have identified the most difficult issues, also suggesting alternative solutions in order to provide a better service, through non-face-to-face focus group methods. They argue that experiences and lessons learned from COVID-19 should be applied to inform services schemes and approaches taken by aged-care facilities.

This thesis explores how older people in South Korea have been affected by the pandemic of COVID-19 and how the South Korean government and other members of the public have treated them during this period, based on analysis of government statements (policy, guidelines) and wider cultural narratives/discourses. Focusing on older people living in an urban space – Seoul – the thesis analyses differences in how those living alone and those living in facilities have faced the pandemic. Furthermore, the thesis goes on to make suggestions for an ideal urban design which can be responsive to vulnerable populations in the event of future epidemics/pandemics. This research, based on South Korea, will provide a case study with regard to how a country, as a whole, and an urban area, in particular, can effectively respond to vulnerable populations – especially older people – during a period of epidemic. The term, ‘older people’ is used throughout, rather than ‘the elderly’, but the terms, ‘older people’, ‘older adults’, ‘seniors’ and ‘the elderly’ are, in practice, interchangeable.

This thesis is focused on findings of secondary data as well as of primary data such as interview, discourse, and content analysis. During the initial research period, the COVID- 19 situation was not allowed to carry out participant observation and face-to-face interviews for safety reasons (e.g. risk of infection, social/physical distancing rule) of the researcher and participants. This unpredictable and unstable circumstance led the research to reflect findings of literature and ‘phone-based interview, discourse and content analysis.

1.1 Research Design The focus of this thesis is an analysis of what spatial restrictions mean and how these have operated for elderly populations in urban centres during the global COVID-19 pandemic. It will also seek to examine how older people have been viewed and how they have been treated in terms of responses by the general public, professionals, social media

6 commentators and government spokespersons. The thesis will be theoretically set in the context of urban anthropology and development studies, and the analysis is based on data generated through interviews, and selected materials relating to public discussions and government policies. The research is mainly focused on older people living in Seoul as a representative urban space in South Korea. In addition to the spatial analysis, the thesis will consider how the COVID-19 outbreak has laid bare certain social or generational divisions in the country, as well as identifying some features that are specific to the South Korean response to the global pandemic. It examines how older people, as a vulnerable population, have been treated in these emergency circumstances. The thesis, finally, addresses lessons from the South Korean experiences and how these can be applied to future epidemic responses, caring for older people.

1.1.1 Research Questions Although demographic information about the population, its age profile, the numbers living in urban spaces, infection and death rates, can provide a broad picture of the South Korean context for discussing the implications of COVID-19 for older people, this does not explain how such factors affect the experiences and living environment of older people. In order to explore these issues, this thesis has adopted a qualitative research design. It will address the research questions outlined below:

1.) What has been the impact for older people of COVID-19 and the South Korean response? The thesis will consider what this shifting backdrop of lockdowns, closures, partial and full re-openings means and how its various manifestations operate for vulnerable populations – particularly elderly people living in institutional settings, such as aged-care facilities. These populations, who are at particular risk due to the effects of COVID-19, already live within a quasi-public/quasi-private setting, and questions remain as to how they, and the staff members, are affected by these ongoing events and what the responses may mean for the future of such facilities.

2.) Is the concept of ‘urban space’ helpful in understanding the impact of COVID-19 on older people? ‘Space’ is a common feature of urban anthropology. However, the COVID-19 pandemic has created the need to conceive of space in different ways, as cities grapple with ever-shifting responses to the pandemic, resulting in varied responses to the

7 opening and closing of public and institutional spaces. Data analysis will explore what this means for how urban anthropology understands space in the light of this pandemic.

3.) How does the pandemic highlight existing discourses of generations within South Korean society and how are older people viewed? Interviews with professionals working directly with older people in Seoul and the surrounding district were carried out in order to identify the main issues for older people and the care systems designated to support them. Through an analysis of South Korean media and public discourses (in a variety of formats), this thesis will study how older people are represented and how such representations may be reflected in the COVID-19 measures.

4.) What are the wider implications of this study? Finally, the thesis will address what lessons can be learned from the South Korean experience and how this may inform COVID-19 or future pandemic responses to elderly populations residing in large urban spaces.

1.1.2 Research Methods This thesis employs qualitative methods to study the impact on the day-to-day lives of older people. It seeks to explore how professionals working in the field view the situation and how members of the public, politicians, government spokespersons and policymakers have viewed older people throughout the pandemic. Qualitative methods afford a lens through which it is possible to understand how people experience and understand their world (Brinkmann & Kvale, 2018). Qualitative data analysis, which is based on inductive reasoning, thinking and theorising, aims to gain a deeper understanding of the data generated and to refine interpretations, identifying themes and developing concepts and propositions (Taylor et al., 2016).

Different qualitative methods research design has been employed in this thesis, combining interviews with discourse analysis of selected materials (in various formats) pertinent to the topic of older people in the context of COVID-19. Semi-structured interviews were carried out with four key workers in a range of roles, all of whom worked closely with older people, in a variety of capacities. Interviewees were women and men of varying ages and with different roles, all of whom have all worked with older people in South Korea throughout the pandemic. The interviews were carried out during the pandemic period. Interview questions were developed in order to identify those issues of

8 the pandemic considered by those working with older people to be important in assessing the impact on this group. The semi-structured nature of interviews, used as an initial approach, allowed for the interview schedule to be used in a fluid way, with the possibility of including new questions along the way, and which gives interviewees an opportunity to raise other issues and provide alongside further insights (Brinkmann & Kvale, 2018). The initial content analysis and thematic analysis of interview transcripts identified issues for further exploration in the more detailed discourse analysis, which was carried out later.

Qualitative data (from interviews and discourse analysis of a range of selected materials) drawn upon in this thesis were analysed using thematic analysis (e.g. Braun & Clarke, 2006) – the most common approach taken by qualitative researchers (Gibbs, 2018). This involves identifying the topics or ‘themes’ that arise. Some of these come from the interview questions or templates used for discourse and content analyses, but others are what Gibbs refers to as ‘in-vivo’ codes (Glaser & Strauss, 1967). These are coding labels that use words or expressions/terms (maybe colloquial ones) used by interviewees or that appear in documents or other materials. Building on themes and making comparisons in order to identify patterning in the data, “the ground theory approach allows researchers to discover theories, concepts, hypotheses, and propositions directly from data rather than from a priori assumptions, other research, or existing theoretical frameworks” (Taylor et al., 2016, p. 164).

A variety of documents, statements and discussion threads were selected for the discourse analysis and were subjected to an in-depth analysis, involving the assignment of sections of text/discussion to themes, and which focused on the use of language, including both explicit statements and underlying/hidden assumptions. For the purposes of discourse and thematic analyses, data were gathered from pre-existing external archives created by an individual, a group or an organisation – such as contents and comments on social media platforms, online newspapers published in the Korean language, and statements and official announcements by the South Korean government or its relevant organisations (departments). Materials analysed consist of the South Korean government statements/announcements, content uploaded by official websites managed by the government and its relevant departments and online articles released

9 via the national newspapers. To ensure the validity and credibility of the materials for analysis (Elo et al., 2014), materials that were officially distributed to the public were gathered and were selected to provide a window on the ways in which different segments of society think about older people and, in particular, what their views are as to how these vulnerable groups should be treated in terms of managing the epidemic and paying attention to their specific needs. Using broad themes, developed from an initial analysis of interviews, these materials were subjected to a more rigorous discourse analysis (Rapley, 2018).

Michel Foucault defined discourse as a group of statements, which amount not to a language, but constitute a practice (Foucault, 1972). This gave rise to the development of Foucauldian discourse analysis. This discourse analysis method has been applied in order to critically analyse texts and other materials in many research contexts, helping researchers from different disciplines (including specialisms such as gerontology – e.g. Powell, 2009) to carry out a critical analysis. Willig (2014) says that discourse analysis is concerned with the way in which language both constructs and mediates social understandings and communication. It also focuses on the use of language (whether terms are positive or negative), and it looks for underlying assumptions or hidden meanings. Recognising the important role of language in the construction of social and psychological phenomena, this analysis aims at gaining a better understanding of the various dimensions of speakers’ meaning-making activities. It is, therefore, able to show, in the present context, how older people are perceived by individuals and groups participating in producing discourse and taking part in discussions.

An initial content analysis was carried out on a range of documents (e.g. articles, newspapers, statements), broadcasts, online discussion forums, etc. Using this as a basis for further thematic analysis, it was then possible to take account of words and expressions used, allowing for meanings to be interpreted and, through an inductive method, for patterning in the data to be identified. Discourse analysis aimed to illuminate patterns in the ways in which the public thinks in relation to the government’s response to the pandemic – for example, which demographic subgroups are introducing or adopting certain discourses.

10 The research, then, uses different qualitative research methods in order to address the research questions. It can present a multi-faceted picture of social and cultural patterns. The 1st research question with regard to how the South Korean government has responded to COVID-19 and how the lives of older people have been in an aged society are discussed in Chapter 2. The 2nd research question with regard to urban anthropology is discussed in Chapter 3. Interview data is drawn upon in order to address the 1st research question – i.e. how professionals, in this case an assistant programme manager, social workers, and a care assistant view older people during the COVID-19 situation in South Korea (see Chapter 4). Discourse data gathered from Facebook and YouTube is applied to the 3rd research question in order to grasp how the public talks about and understands the COVID-19 measures of the South Korean government (see Chapter 5). Furthermore, data from the government’s statements are analysed in order to address the 3rd research question. Analysis of all sources of data will be brought to bear on considering the 4th research question: what an ideal response to older people might look like and how this might inform future policy and practice (see Chapter 5).

1.1.2.1 Interviews In terms of interviews, four research participants were selected for the purpose of the research – in order to gain an insight into older people’s lives during the pandemic, as viewed through the lens of staff working closely with them. The interviewees are individuals who are living and working in Seoul City or Gyeonggi Province (e.g. Yongin City, Goyang City) and are practitioners or experts working for vulnerable populations – especially older people. They comprise two women and two men, with participants of different ages (from their late 20s to early 60s). Two people are working at day and night care facilities, one person is working as a care assistant visiting older people’s houses and the other is working in the policy sector. Interviews had been carried out (June to December 2020) during the 3rd, 4th and 5th waves in South Korea (Ministry of Health Welfare [MOHW], 2020c) and were conducted by ‘phone (in accordance with the South Korean government guidelines on COVID-19, and protection of both interviewees and interviewer). All interviews were semi-structured. In terms of ethical concerns, interviews were not carried out with older people or any vulnerable populations, and these research participants took part in this research voluntarily. Before starting the interviews, the

11 purpose and intended uses of the interview were explained by the interviewer and informed consent was obtained. They were given appropriate and accessible information about how interview data will be treated (e.g. anonymisation), etc (Equality Challenge Unit, 2017). Initial interviews were carried out without voice recording to build rapport and then each research participant took part in at least one voice recording with their agreement. All interviews were carried out and processed in the Korean language.

1.1.2.2 Discourse Analysis Discourse analysis is applied to look at how the COVID-19 outbreak is portrayed and discussed based on data harvested on social media platforms. Since data harvested from Facebook and YouTube was applied, relevant ethics of social big data are mentioned in Section 5.1. The analysis aimed to identify patterns in the ways in which the public thinks in relation to the government’s response to the pandemic – for example, which demographic subgroups are introducing or adopting certain discourses. In addition, how the public views older people during the pandemic, is analysed. This illuminated both social and generational divisions in South Korean society.

1.1.2.3 Content Analysis Content analysis is sourced from government statements about COVID-19 written by the MOHW as open content uploaded on the official website of the MOHW, to see how the government views older adults during the pandemic. Furthermore, to figure out images of older adults, press releases in online newspapers are applied with some keywords. All materials for this analysis were written in the Korean language.

1.1.3 Thesis Structure The thesis begins by providing an account of how the South Korean government has responded to COVID-19 and how South Korea as an aged society has generated cultural narratives with different generations as to older people (see Chapter 2). The South Korean context is characterised by dynamic social and cultural changes. Chapter 3 provides a theoretical background, including and anthropological perspectives on urban space and older people. This chapter also introduces how older people living in urban spaces have been affected by epidemics’ measures and how new digital life which is promoted by non- face-to-face cultural and social suggestions has been an impact on their life. Chapter 4 is

12 concerned with specific and practical situations of older people, documenting how their lives have been changed and challenged, drawing on commentaries from experts as well as practitioners working closely with older people. In addition to the lives of older people, this chapter examines how the environment in which social workers, care assistants, etc. are working with older people has been adjusted during the pandemic. Chapter 5 presents how the public of different generations and the government view older people during the period of COVID-19, based on discourse and content analysis of social media data and government statements. Chapter 6 draws together all of the insights from reviewing the literature and those afforded by findings from interview data and discourse and content analysis. It concludes by making suggestions about what a new urban space might look like and how it could best be configured in order to take account of vulnerable populations and to ensure that appropriate preparations are made for tackling the challenges of future epidemics/pandemics.

2 The South Korean Context for COVID-19 Responses As soon as a Chinese woman from Wuhan landed in South Korea on the 19th of January 2020, the quarantine station at the Incheon Airport classified her as a COVID-19 symptomatic patient on the 20th of January, after which the KDCA conducted an infectious disease test (KTV Kookmin Broadcasting, 2020). The KDCA was elevated from the KCDC (i.e. Korean Centres for Disease Control and Prevention) starting on the 12th of September 2020 since the KDCA was recognised as best placed to manage the COVID-19 response system and was accorded expanded authority from the MOHW to act as an independent and comprehensive infectious disease response organisation (Yonhap News, 2020b). In order to avoid confusion, in this thesis, the term KDCA is referred to regardless of the timeline. Following this, the KDCA raised the infectious diseases risk alert level (Organisation for Economic Cooperation and Development [OECD], 2020a) from that of attention (blue; an infectious disease occurred overseas) to caution (yellow; an infectious disease was reported) (KTV Kookmin Broadcasting, 2020). Since then, the central government has been closely co-operating with the KCDC and local governments to strengthen continuous monitoring and responses. On the 27th of January 2020, when the

13 fourth infectious patient was confirmed, the MOHW raised the infectious disease level from that of attention to alert (orange; restricted spread of an infectious disease in local communities) (JTBC News, 2020). The Central Disaster and Safety Countermeasures Headquarters (CDSCH), which is managed under the Ministry of the Interior and Safety, has actively supported prevention measures by allocating personnel, holding video conferences in real-time, and sharing information and situation updates. In order to strengthen its quarantine capabilities, the CDSCH sought to actively block the influx to local communities, thereby limiting the spread of infection, detecting suspected COVID- 19 patients at an early stage, and managing epidemiological investigations in order to identify contacts (Chang et al., 2020; D. Lee & J. Lee, 2020; Lee et al., 2021). Besides preventing the spread of COVID-19 infections to medical institutions and communities, in order to strengthen countermeasures, the government organised designated specialised clinics, located close to public health centres, local medical centres, tertiary and general hospitals (Kang, Jang, et al., 2020). The government has provided relevant statistics, updated on a daily basis, via an intuitive visualisation webpage, which shows confirmed cases, numbers released from isolation/quarantine, self-isolating, and deceased (see Figure 1).

The datasets have been aggregated from the 3rd of January 2020. South Korea has carried out 8.91 million COVID-19 tests, with confirmed cases of around 123 thousand (by the 3rd of May 2021) (MOHW, 2021e). There was a significant increase in confirmed cases, due to the summer holiday, Christmas periods and related infectious clusters (MOHW, 2020e). By that date, Seoul City was recorded as having the highest number of cases of COVID-19 (38,341) and Gyeonggi Province (which is clustering of cities around Seoul as an administrative district) followed (34,661). These two areas in the Korean peninsula are densely populated. Daegu City which had a high rate of infections due to the Shincheonji group (a cult) in February 2020 recorded a high number of cases (9,385) (M. Kim, J. Lee, et al., 2020; S. Lee & D. Lee, 2020; MOHW, 2021c). These statistics are presented in the infographic reproduced, which has been provided in Korean, English and Chinese. The Korean webpage has more details (e.g. by regions, districts).

14

Figure 1. A COVID-19 webpage in English provided by the KDCA and the MOHW

Since the 12th of February 2020, the South Korean government (Korean Medical Association, Ministry of Food and Drug Safety) has recommended that people use face masks in order to prevent the spread of COVID-19 emphasising that this was not only for personal protection but also to safeguard family, neighbours and country (Korea Policy Briefing, 2020a). The government has, throughout, made official announcements as to how individuals and communities can prevent the spread of the virus and has provided guidance (in Korean, English, Chinese, Japanese, Russian, and Arabic) as to the most effective preventive actions (KDCA, 2020). The government had also, from the 9th of March to the 11th of July 2020, introduced a public mask system (Korea Policy Briefing, 2020b; Yonhap News, 2020a) to meet the demand and ensure supply of masks (e.g. KF94, KF80). Due to this regulated public system, the cost of masks has not significantly increased. Individuals are allowed to buy only a fixed quantity of masks on a specific day of the week (allocated on the basis of their year of birth). This day of the week system has been applied to various public services, with the bulk of these systems having been introduced as a response to the COVID-19 outbreak.

The South Korean government raised the risk level of infectious disease (OECD, 2020a) from a warning to severity (red; ongoing spread of an infectious disease in the country) – the maximum level – on the 23rd of February 2020 (MOHW, 2020a). Since that point,

15 South Korea has started to see the COVID-19 outbreak in terms of a ‘disaster’. Even on the street, subway stations, buses, shops, and restaurants, hand sanitisers are provided. People can, however, continue to go to work and to meet their friends and family, while wearing face masks. Although some countries have seen opposition from some quarters with regard to mask-wearing, this has not been a factor in South Korea, as most people were accustomed to wearing masks because of fine dust (i.e. pollution). On the last week of February, South Korea established the drive-through test facility (Chang et al., 2020; D. Lee & J. Lee, 2020) and initiated this method in North Gyeongsang Province and some other areas. South Korea held elections to the 21st national assembly in April and the election provided the first large-scale test in the world of public opinion, regarding the effectiveness of COVID-19 measures. Compared to other countries, there are fewer restrictions (Dighe et al., 2020; Han et al., 2020), since reliance is placed on measuring body temperature, checking symptoms, and using hand sanitisers. However, due to the high risk of group infection associated with churches, cafés, gyms, pubs and schools in Seoul, the social distancing rule in Seoul (and Gyeonggi Province) has been adjusted to take account of the seriousness of virus spread, with continuously monitoring by MOHW (2021b) with daily updates.

The rules of social distancing in South Korea initially involved 3 levels and then were revised to encompass 5 levels (adding the level 1.5 and 2.5) on the 7th of November 2020 (i.e. level 1: distance in daily life; level 1.5: the beginning of the regional epidemic; level 2: the rapid spread of the regional epidemic; level 2.5: the beginning of the nationwide epidemic; level 3: nationwide epidemic). From this date, geographical categorisation was re-clustered from 3 to 2 levels (Seoul Metropolitan Government, 2020g). In August, November and December 2020, South Korea was judged to be in level 2.5, avoiding raising the categorisation to the maximum level, in order to protect the economic impacts on local communities (Kang, Kwon, et al., 2020; MOHW, 2020c). As the effects of the social distancing rule on the ongoing pandemic were monitored, the rule was revised to cover 4 levels (i.e. level 1: keep the constant warning – individuals and each facility should keep their preventive rules, level 2: local infection – restrict the number of people in facilities, level 3: increasing rate of infections – prohibit meetings, level 4: nationwide epidemic – stay at home) on the 5th of March 2021 to allow for a flexible respond in the face of a long-term epidemic, with the adoption of more advanced rules (MOHW, 2021b).

16 COVID-19 led to infections in various groups, communities and regions. Unlike most of the European Countries (BBC News, 2021) – where only essential shops (e.g. supermarkets, pharmacies) were open during a lockdown – in South Korean restaurants, cafés, and cinemas have all been open during the pandemic – although certain schools, gyms, singing rooms, clubs, etc. (which involve close contact between people) have sometimes had to close, in accordance with the levels of the social distancing rule. For this reason, collective infectious units have been continuously occurring, and various facilities and churches have been major places where the virus has spread. In May 2020, there were more than 100 confirmed cases originating from gay clubs in Itaewon (Time, 2020) and this ignited homophobia and discrimination against sexual minority groups. In September 2020, the Sarangjaeil (its meaning is ‘love is the first’) Church recorded more than 1,000 confirmed cases, having taken part in the Gwanghwamun rally on the Liberation Day in August 2020 (The New York Times, 2020). In addition, group infections of the virus occurred in various places, such as Gosiwons (a low-cost housing scheme), call centres, private institutions, and nursing homes/hospitals.

The South Korean government carried out strong preventive measures from an early stage (Lee et al., 2021) and these have been positively evaluated in the global contexts (e.g. Yu et al., 2020). The measures were immediate and powerful, with provision for all people in South Korea, including foreign residents and visitors. Those who are landing in South Korea have to go through clinical screening processes, and quarantine/isolation (including monitoring for 14 days) is mandatory. The government implemented a clinical diagnosis system (Chang et al., 2020) which was initiated at the beginning of the virus spread, managing people entering the border as well as those staying/living in South Korea, in order to identify asymptomatic to confirmed cases to minimise a range of the spread in local society. With an impressive number of tests performed (Nature, 2020; Statista, 2021) and an advanced and efficient medical system, the South Korean government has led and responded to a variety of COVID-19 situations from the front, alongside preventive measures, tracing infection routes and cases based on information and technology, specified treatment processes which are categorised by degree of symptoms (e.g. asymptomatic, mild, moderate, severe), (Kang, Jang, et al., 2020), etc. In addition, the government also has focused on cluster-based – as well as cased-based –

17 interventions, to fundamentally investigate the infection routes, since group infections have been shown to have triggered increases in the spread of the virus (Dighe et al., 2020).

The reason the government carried out active and steady prevention measures from such an early stage can perhaps be explained with reference to two historical events: the Sewol Ferry Disaster in 2014 and the Middle East respiratory syndrome (MERS) coronavirus outbreak in 2015 (e.g. Park & Chung, 2021). In the first case, the ferry disaster gave rise to hatred and anger over the incompetence of the government (i.e. the Gunhye Park Administration) then in power. On the 16th of April 2014, a ferry called Sewol was overturned and sunk on the way to Jeju island. There were 476 passengers and most of them were high school students (i.e. 16 or 17 years old). The initial government response was slow and was judged to have resulted in deaths many of which could have been prevented (You & Park, 2017). A total of 172 passengers, including a captain and sailors, survived, with 299 deaths and 5 people reported as missing (Lee et al., 2018). Of the casualties, 250 passengers were students. The search had continued for 209 days (The Hankyoreh, 2014) and was hampered by heavy tides, cloudy underwater vision, low water temperature, etc. There were further accidents during the search for missing bodies and the ferry.

In May 2015, the government’s initial response to MERS was evaluated as having been inadequate. Prior to the COVID-19 outbreak, MERS had been the largest epidemic. It rapidly spread throughout the country, with 186 confirmed cases and 38 deaths reported (WHO, 2015). The South Korean government showed a limited response capacity with regard to MERS and did have poor communication with the public. It caused losing people’s trust forward the government’s infection crisis management and its policies (S. Lee & D. Lee, 2020). Lee et al. (2021) mention that South Korea learned the importance of clear roles and responsibilities between the central and local governments via the KDCA and the CDSCH; accurate epidemiologic investigations of the first confirmed case; the optimal central management of medical institutions and hospitals; quick and accurate distribution of up-to-date information. After the MERS outbreak, South Korea strengthened the functions of the KDCA, implemented effective systems with regard to infection control in hospitals, and enhanced nursing systems to prevent infections in hospitals and healthcare facilities.

18 These two incidents (the Sewol Ferry Disaster and the MERS response), led South Koreans to question the government’s competencies, with numerous massive candlelight protests taking place throughout 2017 and culminating in the impeachment of the 18th president (who was a daughter of Chunghee Park being in charge for 16 years as the 5th to 9th president) (The Guardian, 2016). Through the experience of the Sewol Ferry Disaster, the MERS outbreak, and the impeachment of the 18th president, people recognised the power of collective action in strengthening citizens’ rights and challenging inequalities. Moreover, “a political standard was set in South Korea by the public that does not allow political leaders to survive without demonstrating competency in crisis management” (Park & Chung, 2021, p. 4).

Since the 19th president was elected in 2017, the Jaein Moon Administration has presented itself as working closely with and for all the people of South Korea, including the marginalised. The government has provided a range of social services for people (e.g. disaster grants, cultural coupons, increasing job offers in public sectors, expanding the range of employment insurance) (Korea Policy Briefing, 2021). When COVID-19 broke out, all official announcements for disasters were reported using sign language (from the 4th of February 2020) to avoid social alienation and to ensure that all residents could get access to essential and up-to-date information (e.g. The Kyunghyang Shinmun, 2020). Additionally, face masks and food were supplied to vulnerable populations.

The South Korean government did not institute lockdown when most other countries did, but there was a partial shutdown in museums, exhibitions, clubs and so on. The government did not seriously limit the movement (e.g. travel) of people and relied on trusting the responsible citizenship that has been cultivated through participatory democracy as a major achievement of contemporary Korean history (Schwak, 2020). The focus, therefore, was on prevention rather than punishment. In South Korea, residents have experienced various cases of group infection within an environment where daily life has been possible, although there have been specific social distancing rules (e.g. schools, workplaces, small and medium enterprises, religious services) (Kang, Kwon, et al., 2020). At the same time, the virus spread has occurred alongside the rapid and transparent provision of information throughout the country, relying on the constant efforts and fast responses of medical staff. In 2020, COVID-19 had 5 waves/periods. According to the

19 MOHW (2020c), the first period identified a new infectious disease, recording 30 infection cases, with people coming from foreign countries. The second period saw several infectious clusters (e.g. Shincheonji group), recording 10,774 cases with an increasing number of infections in young generations. The third period recorded various small groups of collective infectious units (e.g. logistics centre, private meetings), with 3,856 reported cases. The fourth period showed a significant increasing pattern in infections – mainly in churches, protests, and multi-purpose community facilities with 13,282 cases. The fifth period saw a significant increase in the infection rate with 31,831 cases and facilities managed by churches, care facilities and between families were shown to be the highest risk environments for infections. At the beginning of the virus, the spread of infection occurred due to the activities of younger generations, and the rate of infection among older people subsequently increased over a long period of more than a year, through with family contact, visiting or residing in facilities, with the fatality rate among older people also increasing.

Table 1 (MOHW, 2021d) shows a significantly higher death rate for older people (aged 60s and over) as compared with younger generations. Older people, then, are particularly vulnerable in relation to the virus. The quantitative analysis in Lee et al. (2020) shows, furthermore, those who are 80 years old and older have a high proportion of requiring mechanical ventilation or high-flow nasal cannula for treatment of the virus symptoms, with a high mortality rate.

Table 1. COVID-19 cases by age group in South Korea until the 3rd of May 2021 Age groups Confirmed cases Deceased cases Mortality rate Over 80s 5,387 (4.35%) 1,009 (55.02%) 18.73% 70-79 8,928 (7.22%) 523 (28.52%) 5.86% 60-69 19,022 (15.37%) 216 (11.78%) 1.14% 50-59 22,909 (18.52%) 62 (3.38%) 0.27% 40-49 18,356 (14.84%) 14 (0.76%) 0.08% 30-39 16,698 (13.5%) 7 (0.38%) 0.04% 20-29 18,405 (14.88%) 3 (0.16%) 0.02% 10-19 8,655 (7.00%) 0 (0.00%) - 0-9 5,368 (4.34%) 0 (0.00%) - * Mortality rate (%) = Deceased cases / Confirmed cases X 100

As already stated, the South Korean government has been committed to ensuring that everyone could benefit from social and medical services in this situation of public

20 health threat. The government has made significant efforts to screen asymptomatic patients and has provided accurate and real-time information to the public (Kang, Kwon, et al., 2020). This has been done through sending emergency disaster text messages to individual mobile phone numbers and via official briefings on television and the Internet, in order to raise the awareness of residents. These mobile messages include information about confirmed cases in specific residential areas, reminders of safety regulations and warnings about risks to personal safety (using an alarm sound). These messages are tailored, so that people living in Seoul receive different disaster messages from those living in Daegu. The Global Positioning System (GPS) has been employed in order to assign tailored messages to individuals, utilising current locations determined via their mobile phones (Our World in Data, 2021). The disaster message system was initially designed for earthquakes, but the COVID-19 outbreak was deemed to call for the activation of emergency messages. Since most South Koreans have smartphones – even older people – communication via mobile phones was viable. In the light of this extensive system of communication and, given the low mortality rate as compared to confirmed cases, South Korea was in a position to choose less restrictive measures and to avoid lockdown in response to COVID-19.

How has Seoul City responded to COVID-19? As the capital of a country with a high population density (9.98 million total population, 0.26 million foreigners) (Seoul Solution, 2020), Seoul has been actively and promptly working with the government for the public health of the citizens of Seoul to take action against an infectious disease presenting a challenge to the modern society. Seoul has the highest population density level in South Korea (i.e. 15.9 thousand population per square kilometre) (Statista, 2019), consisting of 25 ‘Gu’ districts (i.e. a basic local government unit that takes care of its assigned affairs and autonomous duties and provides administrative services that are closely related to the lives of citizens) (Seoul Solution, 2020).

Seoul has tried to provide accurate information about COVID-19 on official websites (e.g. https://www.seoul.go.kr/coronaV/coronaStatus.do) or social media platforms (e.g. Facebook, KaKaoTalk, YouTube). The city has developed a system of financial support based on age, job and income levels and the support provided as part of a new public welfare policy marked a departure from the approach taken by previous governments.

21 Since Seoul has a particularly large inflow of population from other provinces and cities, this opens up the possibility of infection through various routes. The COVID-19 tests are, therefore, conveniently provided free of charge to citizens of Seoul (regardless of nationality), who have symptoms suspected to be caused by the infection, those who belong to a specific (higher risk) employment group, or who wish to be tested. The locations where tests are provided are categorised into three types: temporary (e.g. at metro stations, car parks, local parks); regular (e.g. near the public health centres, hospitals) and, thirdly, mobile screening clinics (e.g. drive-through, container on a truck). Seoul, where large-scale university hospitals and enhanced technological resources are concentrated, provides emergency livelihood support for critically damaged households experiencing difficulties to whom belonging to the range (a median income3 of 75% or less4) and have difficulty living due to a decrease of 25% or more in their income. Seoul has provided various emergency welfare policies, such as supporting living expenses, housing expenses, medical expenses, etc. to citizens with a median income of 100% or less5 who have difficulty living due to the virus. The city also provides various financial and material supports for people on unpaid leave, merchants’ financially damaged after shutdowns (due to customers having been infected by the virus), households of students in primary, middle, or high school and special school students, and so on (Seoul Metropolitan Government, 2021d). Each Gu (district) has slightly different policies in place.

The responses to COVID-19 raise many questions about the changing nature of urban space in Seoul and other large cities. COVID-19, with the constant outbreaks of infection and numerous waves, presents challenges as to how to cope with the threat of existing epidemics and poses important questions with regard to the need for a new paradigm for

3 According to the E-National Indicators (2021), the median income of the scale of households has increased since 2015. In 2021, the median income records are introduced: single-person households 1,827,831 KRW (207,756 ISK); 2-people 3,088,079 KRW (350,999 ISK); 3-people 3,983,950 KRW (452,826 ISK), 4-people 4,876,290 KRW (554,251 ISK); 5-people 5,757,373 KRW (654,398 ISK); 6-people households: 6,628,603 KRW (753,424 ISK). The currency between KRW (South Korean Won) and ISK (Icelandic Kronur) is based on the rate (1 KRW = 0.113663 ISK) of 11th of April 2021 (https://www.xe.com/). 4 The median income of 75% or less means that single-person households‘ income should be 1,370,873 KRW (155,820 ISK) or less; 4-people households’ income should be 3,657,217 KRW (415,697 ISK) or less. 5 As Footnote 3 mentioned, the median income of 100% or less means that single-person households’ income should be 1,827,831 KRW (207,756 ISK) or less; 4-people households’ income should be 4,876,290 KRW (554,251 ISK) or less.

22 future infectious diseases. This will most likely result in some rethinking about how urban spaces are designed and managed in the long-term – in part linked to how the population responds to these changes. This chapter introduced how the South Korean government has responded to COVID-19 since the first case was confirmed, using the wider historical and social context to explain why the government carried out the strong prevention measures from the beginning of the epidemic. As the representative urban space in South Korea, cases in Seoul City showed how urban spaces deal with epidemics that pose a threat to public health. The next Section 2.1 shows how the lives of vulnerable populations – especially older adults (who are more likely to face the most challenges during the pandemic) – have been affected in urban space (Seoul) and the ways in which they are treated by the government. Section 2.2 focuses on how the public views older people in general, and in the light of the pandemic, as well as considering how their narratives can be interpreted through the lens of the Korean cultural and social context. These broad narratives are analysed in depth to explore generational divisions and other features giving rise to different perspectives.

2.1 Measures Relating to Older People in an Aged Society In an ageing, aged, and super-aged society, social, cultural and political attentions forward older adults are in need. This section explains how South Korea – as an aged society having an expeditiously increasing pattern of older people (due to advanced medical technology and decreasing birth rates) – needs to prepare for the social problems occasioned by rapid ageing (see Section 2.1.1) and how Seoul, as a densely-populated urban space, must consider how it will respond to the needs of vulnerable populations – especially older adults (see Section 2.1.2).

2.1.1 South Korea: An Aged Society Moving to a Super-aged Society On a global scale the section of the South Korean population aged 65 and over is growing faster than all other age groups. The United Nations (UN) defines an ‘ageing society’ as one where 7% of the population is 65 or over; with an ‘aged society’ being one where this group accounts for more than 14% of the population; and a ‘super-aged society’ as one where the proportion of over 65s exceeds 20% (see UN, n.d.). South Korea has a rapidly ageing population profile. South Korea’s ageing has occurred more rapidly than Japan’s ageing (Chee, 2000). Statistics Korea (2019) has published a population projection

23 scenario based on data from the census survey. Table 2 shows that, in 2017, the proportion of the population aged 65 and older was 13.75% and the old-age dependency rate was 18.8%. By 2030 the proportion of the population aged 65 and older is estimated to reach approximately 25% with an estimated old-age dependency rate of 38.23%. However, in 2067, it is anticipated that this age group will account for approximately 46.5% of the population (with an estimated old-age dependency rate of 102.4%). This suggests that South Korea will experience an even greater increase in the elderly population – constantly decreasing younger populations, so that they will come to out- number those in other age groups. South Korea is already an ‘aged society’ and is close to becoming a ‘super-aged society’.

Table 2. Projection of medium growth in the South Korean population 2017 2030 2067 6,724 5,000 3,181 Population aged 0-14 (13.09%) (9.62%) (8.09%) 37,572 33,947 17,842 Population aged 15-64 (73.15%) (65.37%) (45.40%) 7,066 12,980 18,271 Population aged 65 or older (13.75%) (24.99%) (46.49%) Old-age dependency rate (%) 18.80% 38.23% 102.40% * Old-age dependency rate (%) = Population aged 65 or older / Population aged 15-64 X 100

The life expectancy in South Korea is over 80 years, and women’s life expectancy is higher than men’s. Moreover, it is expected that life expectancy in South Korea will shortly exceed 90 years (Gaind, 2017). The rapid ageing that South Korea has experienced is, however, a social problem/phenomenon which negatively affects a large number of people. Choi (1996) highlighted that the major aspects of the ageing problem in South Korean society are the sharp decline of income and the economic dependence on children, role loss and difficulties in leisure activities, and social-psychological conflicts and feelings of alienation. After modernisation, many older adults are no longer supported by their children and suffer from financial difficulties due to their children’s inability or unwillingness to provide economic support. Furthermore, the number of older people with disabilities who need assistance in daily life is increasing in ageing society. In this society, parental abuse, avoiding care of older parents, etc. may occur and older people thus seek separate living accommodations.

24 The retirement age is around 65 years, but many people choose to work after this point. This can be because they want to cover their living costs and, thus, manage their own lives without anyone’s help. After retirement, people are exposed to greater financial insecurity and may be concerned about their basic living status and covering medical costs. This, paradoxically, leads to many seniors working in low-paid jobs (e.g. picking up wastepaper, cleaning, working as caretakers at apartment blocks) with low levels of stability and security. Yoon (2013) said that older people who continue to work after the mandatory retirement age are more likely to have a financial need, but well-off people retire earlier. Although the South Korean government has encouraged older people to work longer and created jobs for them, in reality, structural constraints in terms of gaining re-employment and undesirable working conditions have presented severe obstacles for older adults who are job-seeking.

Although South Korea has a high elderly employment rate, many seniors struggle with their living circumstances in an ‘aged society’. According to the OECD (2019a), the older people’s poverty rate in South Korea was recorded as 43.8% (the poverty rate of those who are between 66 and 75: 35.5% and that of those who are over 75: 55.9%) and the rate was the highest amongst OECD countries. Older women (49%) are more likely to struggle with poverty than older men (37.1%). A high rate of poverty amongst the elderly is a severe social problem in South Korea (The Korea Herald, 2018).

In South Korea, historically being influenced by the Confucian culture, caring for older people typically has been seen as the responsibility of their children or other family members (Chee, 2000). While society progresses and younger generations enjoy more educational opportunities and social activities, the burden on families in relation to supporting their elderly parents has, nevertheless, increased. In contemporary society, rather than living with married children, many older people experience enormous changes (e.g. to family structure, due to modernisation) in their lives, now, perhaps receiving some support from their families, while living separately in their original place of residence, or, alternatively, moving home to be near the homes of their children. Those who do not have a supportive relationship with their children are dependent on subsidies provided by the government or their residential area. If they are able to work, they may, therefore, choose to follow this route. Seniors who do not have financial difficulties or

25 who can receive support from their children are much better-placed than those who rely on government or local subsidies, who are likely to choose to stay or spend time in day and night care facilities, nursing homes, etc. Many such facilities have been privatised, although partially supported by the government’s resources and national insurance. Older people who need special medical treatment live in nursing/caring hospitals. Since the state does not assume full responsibility for them, senior adults – particularly those living alone – may find it difficult to receive help from their children or neighbours. While their local community provides support from social workers or care assistants (who visit older people in their homes) they may experience a lack of information and be adversely affected by the limitations of administrative processing.

According to the MOHW (2021a), the current government (including the MOHW) has implemented a range of policies for older people. Firstly, the dementia screening service identifies, through early screening, seniors who are aged 60 or older at high risk of dementia. Local public health centres cooperate with local hospitals. Secondly, the dementia treatment support service provides early treatment of dementia in order to manage, improve or prevent severe symptoms. Those over the age of 60 who have been diagnosed with dementia are targeted by local public health centres. Thirdly, the blindness prevention service provides rehabilitation treatment for older people (aged 60 and over) with impaired vision and offers free eye check-ups and specialised medical treatment to those in need of surgery, due to cataracts or glaucoma. This is being carried out by local public health centres and is supported by the Korean Foundation for the Prevention of Blindness. Finally, for those who require care (e.g. those living alone, those who cannot receive proper care or have been abused) the elderly customised care service (its service fee is calculated by the income level, etc.) can be accessed at the community centre.

In 1981, the Welfare of Senior Citizens Act was first enacted to improve the lives of older people being in cultural and social transition and their welfare (e.g. specified aged- care facilities for healthy or unhealthy older adults). The act’s fundamental purpose was both the nation, local communities and families are in charge of older people’s lives (aged 65 and older) – especially those in a low income level, encouraging privatised institutions to take part in the welfare service. This act defines the types of aged-care facilities and

26 the qualification/regulation of recipients of social benefits, etc. The act was revised in 1989 (The Korean Law Information Centre, 1989). In the same year, the national health insurance for all citizens was applied. Since then, universal access to health care for all citizens including older adults has been provided (Jeon & Kwon, 2017). The insurance system has ensured less of a financial burden for those on low income.

The National Basic Living Security (NBLS) Act, which replaced/revised the Living Protection Act, was first enacted in 1999 (Encyclopedia of Korea Culture, n.d.). The NBLS system, which is evaluated as public aid, has contributed to protecting low income class as a social right. After the economic crisis in 1997, the act was designed to support people who were unemployed or with low incomes. The system ensures the basic level of living and helps self-sufficiency from the grant to the basic unit, household. The supports provided through the system are categorised into livelihood, housing, education, medical, funeral, etc. (The Korean Law Information Centre, 2020a). Most of the South Korean welfare systems including NBLS are calculated by the median income of the households’ scale.

The National Pension Scheme (NPS) as a social/public insurance was discussed in the 1970s and first enacted in 1988 (the Youngsam Kim and Daejung Kim Administrations). People who can apply to the scheme are citizens or residents who are 18-60 years old and are living in South Korea (The Korean Law Information Centre, 2020b). The Basic Pensions Scheme (BPS) which is a part of the NP is a social benefit for older adults. The scheme came into force in 2008 (first discussed in the Moohyun Roh Administration). The BPS is applied for older people (aged 65 and older) with South Korean nationality living in South Korea (Seok, 2015). Yoon (2013), however, pointed out that there is a significant variation among beneficiaries, with disparities between salaried and self-employed workers in terms of the NPS. The low level of coverage and small payments for the self- employed increase the risk that the NPS will not reduce poverty amongst older people.

The amount of Basic Pensions has been increasing (in 2021, the maximum threshold is 300,000 KRW for a single-person household and 480,000 KRW for a married-people household) (Bokjiro, 2021) and the range of the scheme’s recipients have been enlarged, but many older people are still struggling with poverty. As to policy, some people point out that there is still a blind spot in national pension provision, and the actual subscription

27 period is likely to be of limited duration, due to the instability of the labour market and the economic conditions of those who do not benefit from employers’ pension schemes (e.g. workers with a contract, temporary workers, freelancers, those who are unemployed) (Pressian, 2019).

In common with social welfare systems enacted or revised in the late 1990s, the South Korean National Health Insurance System (NHIS) in 1989 made provision for all citizens to have universal health insurance coverage. In 2000, all health insurance societies were integrated into the NHIS. The Medical Aid (MA) System, which was established in 1979 is, however, applied to low income households. Under this system, the government helps patients who are unable to cover the costs of health/medical diagnoses, check-ups, and treatments, to pay medical expenses (Health Insurance Review and Assessment Service, 2017). In 2004, the MA system was expanded to cover patients with rare, intractable and chronic diseases (Song, 2009). Yoon (2013) criticised that the NHIS provides relatively comprehensive but shallow protection in case of illness. It may pose barriers to access for the poor or those with chronic health problems, since all diseases or diagnostic procedures are not covered by the NHIS.

The South Korean medical system is well-organised and operates using advanced digital technology. This allows for a quick and convenient approach that ensures that all citizens have equal access. South Korea also has a highly developed system of medical specialties and the cost of individuals’ medical expenses are, for the most part, covered by the national insurance service (OECD, 2020a). Regular specialised medical support is available for all age groups. Although the absence of personal or family doctors impacted negatively on the response to MERS – being overly dependent on secondary or tertiary facilities instead of primary facilities, the advanced medical system in South Korea undoubtedly contributed to the lower mortality rate of COVID-19 (Our World in Data, 2021). Only authorised medical/healthcare professionals can provide medical/health services in South Korea. Many private medical facilities are located in mainly urban spaces (Song, 2009), and this regional disparity causes problems for people living in rural areas (many older generations live in the areas compared with younger generations) to have a lack of medical access. Especially older adults are more likely to experience

28 inconveniences (e.g. in relation to transport, or accessing information). This, also, is related to modernisation, urbanisation and dynamic social industrialisation.

Since the 1st of July 2008, the South Korean government (the Moohyun Roh Administration) and the MOHW proposed and implemented the Long-term Care Insurance System (LTCIS) for older people, so that the responsibility for providing medical care for ageing-associated diseases (e.g. dementia, cerebrovascular disease including stroke) – previously a burden for each individual’s family – could be transferred to the state and local communities. Since the NHIS excluded long-term care benefits, the LTCIS is a policy response to ageing population and the weakening of the informal care mechanism for older adults. The LTCIS is an approach of transforming informal unpaid care by family members into formal paid care that costs will be shared by all social members (Shin, 2014). This system is funded by LTCIS contributions paid by the insured, government subsidies, and co-payments by beneficiaries (Song, 2009). The system is being rolled out in response to social changes, with the intention of providing a range of professional nursing services, and the aim of alleviating the physical and mental burden for family members and improving the health status of the elderly population. Those with diseases (e.g. non-lethal chronic illness such as diabetes, post-stroke disabilities, hypertension, heart diseases and Alzheimer’s) are eligible for long-term care and receive home-based benefits, such as mental health and nursing care, access to facilities, and specialised financial provisions. The government encouraged to establish more privatised long-term care facilities through the policy of minimising regulation. This approach has raised a number of quality-related problems in those facilities.

According to the MOHW (2007), the benefits of LTCIS are categorised. Firstly, the home-based benefit can be provided by care assistants and nursing assistants at home to help with requirements such as preparing meals, washing faces, bathing, communicating, and housekeeping services, for example, cleaning, or grocery shopping. In addition to basic nursing services, other day and night care facilities are available that can be used by non-residents for a period of time. Other specialised services supported by the national insurance system include support provided by social workers, nurses (or nurse assistants), care assistants, physiotherapists, dental hygienists (or dental assistants) in order to maintain and improve the physical and mental functions of older people. Secondly, there

29 is provision for long-term admission to an elderly care facility equipped with specialised facilities and personnel/customised for nursing care. Thirdly, the specialised financial benefit system is provided for seniors living in residences that do not have proper care facilities. Those who are aged 65 years or older or those under 65 with age-associated diseases (e.g. dementia, cerebrovascular disease), who are in need of long-term care, are eligible to use the system. When applying through the NHIS, home visits are carried out in order to assess eligibility, to examine the state of individuals’ physical and mental functions and to determine the level of care required. Referrals are managed through committees from each city or district and take account of doctors’ medical statements.

The costs of aged-care facilities via the LTCIS are 20% out-of-pocket payment for general applicants and 7.5-10% out-of-pocket payment for beneficiaries qualifying on grounds of medical disabilities (Rhee et al., 2015). Those who want to receive support from care assistants or social workers coming to their place do 15% out-of-pocket payment. The benefits of the LTCIS help older populations avoid high costs associated with inpatient care or emergency services, and these payments are expected to consequently mitigate payments on the NHIS. However, those benefits may lead older people to seek more health services, which, in turn, may generate a greater burden of payment on the NHIS (Shin, 2014). In addition, the LTCIS led to an over-supply of service providers, because they require a shorter period of education and training than do registered nurses and doctors. The rapid increase in the supply of the providers is not necessarily accompanied by a rise in quality of care and equitable distribution by region (Jeon & Kwon, 2017). In terms of caregivers, the LTCIS encourages women to get back to work, instead of providing informal care for their parents or parents-in-law. A well- designed LTCIS, which perfectly fits policymakers’ goals and the fiscal and economic situation of the nation, promotes a more efficient allocation of resources for taking care of older populations and leads to high public satisfaction (Rhee et al., 2015).

30 Table 3. Older adults in the LTCIS between 2015 and 2019 2015 2016 2017 2018 2019 The elderly population 6,719,244 6,940,396 7,310,835 7,611,770 8,003,418 Applicants 789,024 848,829 923,543 1,009,209 1,113,093 Recipients 467,752 519,850 585,287 670,810 772,206 The rate of recipients per the elderly 6.96% 7.49% 8.00% 8.81% 9.64% population (%) * The rate of recipients per the elderly population (%) = Recipients / The elderly population X 100

According to the National Health Insurance Sharing Service (2020), the elderly population has been increasing and the number of applicants and recipients for the LTCIS is also increasing. It means that South Korea has witnessed a rapidly ageing population and the government has expanded welfare benefits. In 2015, approximately 7% of the elderly population was in receipt of benefits. In 2019, the rate increased up to 10% (see Table 3). The same report showed that the rate of older people using day and night care facilities has increased from 13.2% in 2015 to 23.9% in 2019. The way of caring for older people has, therefore, changed significantly.

There have been some criticisms, however, of the way that the caring system has taken over from family’s internal mechanisms (e.g. through financial support from the government, provision for residing in aged-care facilities and access to care service practitioners). It has been suggested that suppliers of care facilities tend not to regularly review the quality of their programmes and management procedures. Most of them have been privately run with partial support from central or local government. Resources and policies can vary with the result that a sustainable environment cannot always be provided and service quality may not be enhanced.

In such facilities, there may be numerous conflicts between older people and care providers due to intense labour pressures, coupled with a gap between the recognition of problems with cognitive capacities and appropriate responses. Kim and Kwon (2021) propose that health care services provided by a professional workforce need to be strengthened, since the majority of the current workforce are care assistants with limited training, while the beneficiaries of services have complicated conditions and clinical needs in addition to requiring basic care. Improvements could be achieved by increasing competency, revising job descriptions, changing work environments for care assistants,

31 and developing the existing LTCIS model, which should be more localised, diversified, suitably tailored and better coordinated to respond to the needs of older people and their families. The South Korean government has expanded the coverage and benefits of care services to meet the needs of more people, but this system should constantly be reviewed in the light of dynamic social and demographical changes. Such measures should result in more appropriate and practical policy guidance, in order to ensure an effective approach. Regular inspections should be carried out, and better management models within aged- care facilities should be developed. Making opportunities for feedback and suggestions from people related to the system is also important.

2.1.1.1 ‘Dynamic Korea’ to ‘Dying Korea’ According to the OECD (2019b), South Korea had the highest elderly poverty rate recorded among OECD countries from 2015 to 2019. Moreover, the country is experiencing much faster growth in the ageing population than any other OECD country. After ending their core career in their early 50s, most older people in South Korea have poor-quality jobs, with low earnings and insecure social protection. With the extremely rapid ageing rate, South Korea is now at a serious point for the future of the country and in a few hundred years, South Korea may look very different.

Korea has traditionally been a family-centred society (patriarchy), with the traditional form operating through marriage and the sacrifice of women in assuming the burden of housework, thereby boosting the economic capacity of men. However, more recently, women’s high level of education and desire to participate in society have proved difficult to integrate into the monogamous family form and the conservative social system. The increasing number of women participating in the labour market has, therefore, brought changes to traditional ideas about women’s role in South Korean families and society (Sung, 2003). Even if women have pursued careers, marriage or childbirth has usually led to obstacles in their careers. The fertility rate in South Korea was 0.977 in 2018 and the rate has been a decreasing trend for the last 60 years (The World Bank, 2018). Many young women, therefore, have avoided marriage or childbirth, due to the male-centred family and work culture. Furthermore, there is a new term called ‘Mum Choong’ for mothers who are seen as placing too much value on their children, giving rise to various social problems (e.g. mother’s excessive educational passion, neglect of children in public

32 places, and noise disturbance in apartments, etc.). The new term was coined from the word for ‘mum as mothers’ and ‘choong’ as a bug in Chinese characters. It is an expression conveying the idea of demanding parents who do not know how to be ashamed – even when they have young children watching them. As a result of all of these developments, many young women do not relish motherhood, and it is unlikely that the birth rate will increase in South Korea. Although, previously, many developed Western countries – including France (e.g. active family policy) (Toulemon et al., 2008) – also experienced the problem of a low birth rate, this was resolved, to some extent, through reforming the social welfare system and improving the workplace culture.

Traditionally, in Korea, the family assumed full responsibility for caring for the elderly. Due to changes in the structure of the nuclear family (Chee, 2000)6 and an ageing society, changes have also occurred with regard to the family-centred care system. In an ageing society, care for the elderly is shifting from private to public provision, and thus the role of nursing homes and specialised facilities is becoming more important. In the past, women (e.g. daughters or daughters-in-law) took responsibility for caring for the elderly, but now, as women’s educational level and socio-economic activities are expanding, a paradigm shift is required in relation to caring for the elderly. South Korea’s ageing society has placed a considerable burden on each elderly person and their families, but a growing perception is emerging that society should take communal responsibility for caring for the elderly. South Korea, hence, faces a dying demographic structure, with a low birth rate and an extended life expectancy that may come from less progressive policy not reflecting social changes completely and out-of-date cultural and social awareness. Section 2.1.2 introduces how Seoul has responded to ageing urban space and suggested and carried out policies for older adults.

2.1.2 Seoul as an Urban Space for Older Adults The elderly population in Seoul exceeded 710 thousand people in 2005, so this group was already close to reaching 7% of the total population. This represents an increase of

6 As a family structure type, it is called elementary family and consists of ties of partnership or parenthood with children. It does not exceed two different generations. Before this nuclear family, “the traditional multi-generational and extended family household unit provided a context for mutual support and inter- generational care which was underpinned by reciprocity and reinforced and legitimated by filial piety“ (Oh & Warnes, 2001, p. 706).

33 approximately 75% compared to statistics collected 10 years previously. Notably, Seoul has already passed from being an ‘ageing’ urban space and is moving rapidly towards the ‘aged’ category (The Seoul Research Data Services, 2013). In 2020, the senior population was recorded as 1.53 million and their dependency ratio was 20.7 (Seoul Solution, 2020). By 2026 Seoul (with a high-density population that is greater than other South Korean administrative districts), together with the metropolitan area surrounding it, is expected to become a ‘super-aged’ urban conglomeration. According to the Korean Statistical Information Service (KOSIS) (2016), the average population density in administrative areas in 2015 was 509.2 (the unit for measurement being person per kilometre), whereas Seoul had 16,364. The second-highest density administrative area, Busan, had a population density of 4,479. This means that Seoul has the highest population density in the entire Korean peninsula. Moreover, Seoul has a diversified population structure. Since all age groups live in this high-density area, Seoul has been able to develop a model for designing policies and services relating to older people.

Seoul is the heart of South Korea and, as the representative urban/metropolitan space, provides a vantage point for understanding what is happening in the rest of the country. As the capital of South Korea, the Seoul Metropolitan Government provides various welfare services and support to all age groups (e.g. infants, children, teenagers, middle-aged people and seniors) and to vulnerable groups (e.g. women, foreigners, people with disabilities). The provision takes account of the diversity of the population in terms of age, health, occupation, educational level, and financial circumstances.

The Seoul Metropolitan Government (2021b) published quantitative data of older adults living in Seoul as open source. Table 4 shows that older adults accounted for 15.82% of all residents including different nationalities (calculated by the total number of all types of older adults / the total number of all age groups X 100) in Seoul in 2020. At the present time, the ‘Baby Boomers’ generation group (currently in their 50s and 60s) constitutes the largest group within older generations, in terms of the overall population. More older women live in Seoul compared with older men, but as to registered foreigners aged 65 and older, more older men live in Seoul. Seoul already is an aged society and is predicted to become a super-aged society in a decade. This requires consideration to be given to what appropriate future systems and urban space will look like.

34 Table 4. The number of older adults living in Seoul in 2020 Age groups Category Count All age Total 9,911,088 All types of residents groups Women : Men 5,094,566 : 4,816,522 Total 1,568,331 All types of residents Older Women : Men 875,072 : 693,259 adults (65 Total 1,561,139 South Koreans years and Women : Men 871,711 : 689,428 older) Total 7,192 Registered Foreigners Women : Men 3,361 : 3,831 * All types of residents = South Koreans + Registered Foreigners

Many older people are likely to live alone. Table 5 shows the number of older adults living alone in Seoul in 2019 (Seoul Metropolitan Government, 2020f). Older adults with low income or in need of the government’s financial support (the NBLS recipients) are categorised as the poor. Table 5 also shows that 29.25% of older adults living alone (calculated by the sum of the NBLS recipients and older adults with low income / the total number of all types of older adults living alone) are suffering from severe financial difficulties or poverty. Older women are more likely to live alone (67.78%) compared with older men.

Table 5. The number of older adults living alone in Seoul in 2019 All types of older Older adults with The rest of groups Groups NBLS recipients adults living alone low income of older adults Total Total Total Total Category (Women : Men) (Women : Men) (Women : Men) (Women : Men) 343,567 80,376 20,131 243,060 Count (232,903 : 110,664) (52,553 : 27,823) (15,066 : 5,065) (165,284 : 77,776) * All types of older adults living alone = the NBLS recipients + older adults with low income + the rest of groups of older adults

Seoul Metropolitan Government (2021c) has recently introduced various welfare policies for older adults living in Seoul. Given the rise in the retirement age, jobs for middle-aged people and the elderly population are seen as desirable, since employment has the potential to improve social experiences and participation. In order to expand the infrastructure to provide suitable jobs for seniors in the labour market, 25 regions/districts in Seoul have provided, via local job centres, a variety of supports and welfare services designed especially for older adults. Drawing on information from 361 institutions, a computerised system, that integrates and processes data on the population and resources, is used to direct provision for people living alone. The data archive has

35 been used in order to improve long-term care insurance and Seoul has strengthened the basic welfare infrastructure to protect seniors with ageing-associated diseases (e.g. dementia). This, together with public elderly care facilities (which also provide health and medical care), reduces financial and mental burdens for individuals and their family members. Seoul has also planned to provide more housing infrastructures, public facilities and related services for seniors. In addition, leisure and culture programmes have been initiated in order to revitalise communication within and between generations in parks, public places, community centres, etc. Particularly for the sake of seniors’ healthy ageing, rich local welfare resources have been developed, along with various cultural programmes for the enjoyment of older people, allowing them to network and meet up to share their life experiences.

Throughout the outbreak of COVID-19, the government sought to provide personalised care services for senior groups. These services were set up in January 2020 and were designed to address the social disconnection and loneliness experienced by older people (MOHW, 2020a). By reflecting on the diverse needs of individuals, it can be concluded that seniors require constant access to elderly care services. Throughout the COVID-19 outbreak (based on the records until the end of June 2020), Seoul provided care services for more than 30 thousand seniors. With the input of around 3 thousand social workers and volunteers, seniors’ rates of depression and concerns about the virus were reduced. As part of these services, older people can benefit from personalised care services (e.g. birthday celebrations, food kits, handwritten letters, video calls, and online activities) (Seoul Metropolitan Government, 2020b). To understand ageing society and its changes, background knowledge of that country – including generational divisions (see Section 2.2.1) – of the specific historical period and cultural context is necessary. Section 2.2 explores how older people are viewed within South Korean culture.

2.2 Cultural Narratives about Older People South Korea has a structure that is stratified by generations. Of older age groups, those who were born before the 1940s and are in their 80s and older are referred to as the Japanese Colonial Generation. They experienced the Japanese colonial era, characterised by acute oppression and fear. Those who were born in the 1940s, and are in their 70s, are known as the Liberation Generation, because they experienced the end of the colonial

36 era. They are accustomed to the idea of sacrifice for the nation and their family and contributed to the national economic development (e.g. the Vietnam War dispatch, the migration of South Korean nurses and miners to Germany). Those who were born in the 1950s and are in their 60s are called Baby Boomers (Kang, 2013) or the Yusin Generation. They experienced dictatorship under the Chunghee Park Administration (the dictatorship continued in the Doohwan Chun Administration in the 1980s).

Older people who belong to the Liberation Generation are struggling with economic problems, feelings of alienation, loss of role, and health problems. Social problems associated with ageing include income insecurity, medical issues, need for nursing care, dementia, suicide, loneliness, crimes against the elderly and making funeral arrangements (e.g. burial, cremation). Baby Boomers who have made a significant contribution to the nation through immense income, savings and investments have become as a backbone of the national economy. As they are starting to retire in recent years, the South Korean economy would slow down with the greater welfare burden (Kang, 2013). Elderly loneliness, although perhaps not life-threatening, generally occurs due to poverty (Lee, 2014), changes in family structure (e.g. moving from large families to the nuclear family), disconnection and isolation from social networks. Over the years from 2000 to 2019 it was calculated that, on average, 16% of all elderly people (over 65) were living alone in South Korea and this trend is now in greater evidence. By 2019, the rate had increased to 19.5% (E-National Indicators, 2019). Based on data from the KOSIS (2020), single-person elderly households accounted for 7.2% of the population, for the country as a whole, and for 5.8% in Seoul (see Table 4). Leaving behind the dynamic life of youth in the past, many seniors of the Japanese Colonial Generation, Liberation Generation, and Baby Boomers/the Yusin Generation are living unstable and have lonely lives after retirement.

The suicide rate of the elderly in South Korea is the highest in OECD countries – based on data collected in 2010 (OECD, 2014) – and the elderly also have the highest suicide rate of all age groups in the country. The depression and psychological anxiety of older adults tend to be overlooked in society. Lee and Kim (2019) said that their loneliness and isolation are highly correlated to their mental health and quality of life. The research also shows that the quality of older adults’ life is related to their financial situations (e.g.

37 chances to work) and health condition (leading to social participation), and is determined by how they live after retirement. Many older adults are getting active in various social participation (e.g. religious activity, hobbies, volunteer works) and trying to find their value through their friends, divorce (or graduation of marriage life called ‘Jolhon’).

Healthy life expectancy (HALE) is an indicator that estimates how many years people can live in a healthy state and is an important measure of a population’s health status. HALE projections at birth (unit: years) in South Korea were for a life expectancy of 68.1 years in 2000 (for the population as a whole), but by 2016 this had risen to 73 years. Women can expect to live longer than men (with women’s life expectancy in 2000 calculated at 70.8 years and 75.1 years in 2016 – as compared to 65.2 years and 70.6 years for men at these respective time points). South Korea’s HALE has, therefore, been increasing both for men and for women, although women’s HALE has been consistently higher than that of men. In 2016, HALE in Iceland was 73 years, 73.4 years in France, and 74.8 years in Japan. The country with the highest HALE was Singapore at 76.2 years (WHO, n.d.). Based on these findings, older women are more likely to live alone, but also enjoy their life in HALE in comparison with older men in South Korea.

Living a happy life is important not only for older adults but also for all age groups. In South Korea, the elderly who have already retired, but who continue to work, do this mainly for economic reasons. For them, cultural leisure activities and the arts are not considered a priority for living. Current cultural and social policies, however, target the entire group of elderly people, rather than taking account of the needs of elderly individuals. In an ageing society, national and local communities must cooperate to view preparation for retirement in the context of the entire human life cycle. Conditions could be improved in order to alleviate the financial burden for families and lessen the physical and mental suffering of elderly people. The Liberation Generation – who experienced the turbulent period of Korean society in the 20th century and witnessed the horror of the Japanese colonial era, the sorrow resulting from the Korean War, and the industrialisation of South Korea – are being overlooked and are becoming the most vulnerable group in society, due to the lack of appropriate preparation for retirement and inadequate financial support. In 2021, this group is now over the age of 75 years. People in Baby Boomers have a higher level of education than their parents in the Liberation Generation

38 and may set higher importance on social participation and continuing work-related activities. For them, their ageing life can be very different from that of their parents. Taking into account the characteristics of generations, the central and local governments should play a role in supporting more people to prepare for and enjoy successful ageing by developing policies that are segmented and tailored to generations. Building a community-centred and community-oriented culture (Jeon et al., 2016) rather than reliance on the state could be a useful direction to follow.

This discussion has already introduced the topic of generational divisions affecting older people in the South Korean context. The next Section 2.2.1 will seek to tease out the influence of generational characteristics on the experience of older people in general, and, in particular, with reference to COVID-19, providing a useful background against which data can be interpreted.

2.2.1 Generational Divisions in South Korea South Korea has different generation structures reflecting social changes: the Japanese Colonial Generation (those who were born before the 1940s and are their 80s and older); the Liberation Generation (those who were born in the 1940s and are their 70s); Baby Boomers or the Yusin Generation (those who were born in the 1950s and are their 60s); the 386 Generation (those who were born in the 1960s and are their 50s) (Park, 2011); the X (new) Generation (those who were born in the 1970s and are their 40s) (Park, 2007); the 880,000 KRW or Sampo Generation (those who were born in the 1980s or 1990s and are their 30s or 20s) (Park, 2017); the Millennial Z Generation (those who were born in the 1990s or 2000s and are their 20s or 10s). Each generation is featured on the time when their 20s or 30s were (e.g. the 386 Generation experienced democratization movements against military regimes, X Generation experienced cultural changes and started to pursue personal identities, Sampo Generation experienced persistent a low economic growth generating high unemployment and unstable labour market and active digital life, Millennial Z Generation created the most valuable and efficient lifestyle). Since South Korea experienced rapid industrialisation and modernisation in a short period (Kang, 1998) after the Korean War, generational divisions and conflicts between different generations have been raised and become a social issue.

39 Lee and Kim (2019) said that families living with older adults tend to experience more generational divisions or conflicts in daily life and older people can feel deprived in this living situation. As time has passed, the proportion of older adults living with their children has decreased (from 1998 to 2002), and more children avoid offering material supports (Peng, 2011). Park et al. (2005) state that perspectives on intergenerational relationships show a significant difference between middle-aged and older adults. The situation of those who live in rural areas (working at farms or in fishery occupations and are the eldest child in a family) is different compared with that of those who are highly educated and younger. Intergenerational relationships interpreted from the perspective of older adults are seen as more straightforward compared with younger generations’ perspectives. Elderly parents in traditional relationships (i.e. they are more likely to have no partner and poorly educated) often live with one of their children and receive regular support from them.

South Korea, where traditional Confucian culture has had a significant influence, still has a hierarchical order, stratified by age groups as well as gender (women are subordinated by men). Being older means younger people should respect them, learning their experiences and accepting their advice. However, some older people take this culture (Confucian order) for granted and young generations complain about the elderly’s behaviours and stubborn thoughts. Many older adults for whom the Korean War has been a significant moment in their life think that young people who have not experienced any wars need to be awakened. Shin (2016) said that such internalised convictions can accentuate generational conflicts.

The generational gap and associated conflicts present a serious problem in modern South Korean society and influence the images of older adults that are reflected in the media (e.g. variously as aggressive, poor, weak, or lonely elderly people requiring support from younger generations) (M. Kim, S. Lee, et al., 2020). Lee (2018) analysed how language (e.g. informal or formal communication delivery) provides a window onto relationships between older women staying in (care) hospitals and their care providers. In a gendered society, older women who need consistent help are vulnerable. Lee’s research shows that female elderly patients are being cast in a compromising or receptive position, where they are forced to accept the unhelpful (and possibly discriminatory)

40 informal language (treating them a baby or child, not an old lady) – regardless of their requirements, or position. The use of this kind of informal language is sometimes viewed as an efficient and caring communication strategy but can also lead to a stressful situation for care providers. If care providers have a close relationship (built on trust) with older people, informal language is less likely to be a sensitive issue, but this may not be the case when unfamiliar care workers are assigned to an older person – particularly one who likes to be independent.

The COVID-19 outbreak has highlighted the social and generational divisions in South Korea – especially in online spaces where most of the information is sharing and being discussed during the pandemic. Chapter 3 explores how an urban space and its features are understood by anthropologists (see Section 3.1). It then proceeds to describe also how the situation of older adults in an ageing, aged and super-aged society has been studied in the gerontological context (see Section 3.2). Furthermore, in relation to COVID- 19, Section 3.3 explores how epidemics and prevention measures affect urban (digital) spaces and the experience of older adults within such spaces.

3 Urban Space and the Lived Environment From the 1960s to the 1980s, South Korea experienced a radical change in the industrial structure, moving from light industry to the heavy chemical industry. As a number of jobs were created and manpower gathered in industrial-related regions, cities developed rapidly. As a result, migration from rural to urban areas caused an economic growth gap between these areas to occur. With this surge of urbanisation, the population was concentrated in the greater Seoul metropolitan area – consisting of Seoul, Incheon and Gyeonggi Province, which includes 28 cities. According to article 7 of the local autonomy law, in order to be designated a city (‘Si’) a defined area must have a resident population of 50 thousand or more, and each city includes lower-level administrative districts (e.g. Eup, Myeon, Dong) (The Korean Law Information Centre, 2019). South Korea, therefore, has, as its most significant city, the capital (i.e. Seoul), with 6 metropolitan cities (i.e. Busan, Incheon, Daegu, Daejeon, Gwangju, Ulsan), a special self-governing city (i.e. Sejong) and 77 other cities (KOSIS, 2020). As such, the country has constructed numerous

41 urban spaces that continue to change in keeping with the distribution of population, and the characteristics of the city, and the categorisations employed by the administrative hierarchy.

As the centre of economic and cultural activities, Seoul has seen a massive growth of satellite cities throughout the 20th (Kang, 1998) and 21st century. Seoul, as the representative urban space in South Korea and a global city, has dramatically developed and changed due to the national development of urbanisation and the large influx of population. A variety of age groups have lived or spent time in Seoul. Younger generations want to stay in Seoul to complete their higher education and, thereby, to have more chance of getting a job. Middle-aged generations prefer to stay in Seoul for their children’s educational life, or the housing (investment) market. Older people, as a vulnerable group, are sometimes excluded or isolated in an urban space like Seoul. The lifestyle of those who are in Seoul is different as compared with that of those who live in rural areas. Seoul is, therefore, an interesting place to explore how vulnerable populations – especially older adults – live and how they are treated within the urban structure and policy context.

This chapter reviews relevant theories, drawn from the anthropological literature, concerning the features and functions of ‘urban space’ (see Section 3.1) in relation to vulnerable and marginalised populations – particularly older people (see Section 3.2) – during periods of epidemics (see Section 3.3). The global pandemic highlighted various aspects of modern life and exacerbated gaps, in terms of both social and cultural dimensions. Urban space is more intense than rural space, which is usually characterised by higher levels of social connection. Many elderly people have relocated to the city from rural areas, which may make them particularly aware of differentiation/stratification (e.g. in terms of socio-economic status; gender, age, income and educational level) and its implications in a more complex society.

3.1 Urban Space in Anthropology The industrial revolution in the 19th century led to rapid urbanisation in Europe, which continued throughout the 20th century, leading to an increase in the number of cities in countries around the world. The growth of these urban spaces (e.g. modern metropolises, cities) – and the social, cultural, political and economic changes associated with these

42 developments – have attracted the attention of anthropologists. The city is a regional centre of power, and provides a focus where political, economic, cultural and religious activities converge (Jaffe & Koning, 2015). The public places (e.g. major streets, plazas), which are a feature of urban spaces, offer a space where a range of protests are currently occurring (e.g. anti-mask protests, anti-government protests). Workers can avail themselves of these spaces to fight for labour rights, for example, and religious or political meetings can be held, allowing citizens to express their opinions. Lefebvre (1976), reflecting on the politics of space, said that “space has been shaped from historical elements and has been experienced as a political process” (p. 31). Especially in urban environments, people tend to engage in a wide variety of social relationships, including political interactions. The interlinkage and interdependency of social relations are explained through network analysis, which allows for an understanding of daily experiences (Boissevain, 1979).

‘Space’ is sometimes regarded as an abstract phenomenon, whereas ‘place’ is used to refer to a bounded form of space, which has specific physical features and is transformed by human experience (Jaffe & Koning, 2015). As a result of advanced technology and the cultural life on offer in the modern global era, urban space has been attracting people with the promise of experiencing new values and the perceived possibility of enjoying a more opulent life. Thus, people of different classes, races, educational and income levels may gather in urban spaces to form places (e.g. a city). They sometimes form socially distinct clusters, sharing the same religion, educational background or nationality. Moreover, it is possible for them to build their social and political identities via membership in these clusters.

According to Low (2009), the social production and social construction model of space argues that ‘space’ can be constructed both culturally and historically, through the layering of meaning by participants. Low (2009) talks about “lived space, in which spatial practices elude the discipline of urban planning”, and terms this “embodied space” (p. 34). Space is constructed through social functions, such as people’s social exchanges (Low, 2014), whereas spatiality is defined by social movements. Exchange activities also happen in urban space, constituting social networks. Social connection is important for human well-being and interactions – such as kinship ties (e.g. Young & Willmott, 1957) or

43 social class (e.g. Kalb, 2014) – and these are significantly transformed by the environment of urban space. The concept of space can be applied to understand online environments, and this thesis draws on resources accessed via online spaces where a variety of people partake of virtual social relationships (e.g. sharing experiences, opinions, practices with unknown others).

While some commentators seek to distinguish between the concepts of ‘space’ and ‘place’ others use these terms interchangeably, sometimes referring to pre-existing physical localities and sometimes emphasising the significance of the meanings conferred by those using a ‘place’ or ‘space’. Aucoin (2017) concludes that “the anthropological study of space and place recognises that landscape, space and place represent important sites for cultural meaning, social and political memory, and public discourse” (p. 407). It is this broader definition that I have chosen to use in this thesis.

Space can contribute to the reproduction of the interests of those in power, and urban spaces, in particular, can assume charismatic status, due to the convergence of embedded history, power, and both pre-existing and emergent frames of reference (Hansen & Verkaaik, 2009). Charisma in urban spaces may be enacted via (unstable and unpredictable) networks, connectedness, etc. Whereas urban planners may design spaces or places with particular activities in mind, their actual use depends on how they are perceived by members of the public and may not reflect the usage envisaged by planners. Some segments of the population may use appropriate spaces and places for particular purposes, while other individuals or groups may use these same spaces or places in different ways. These spaces or places can be exclusive as well as inclusive, and this can have critical consequences for vulnerable groups, such as older people.

Compared to rural areas, urban space differs with regard to mobility, anonymity, relationships, diversity, complexity, and the pace of life. Movement in cities can be seen as having a political aspect. Restricted mobility within urban spaces may lead to social and economic exclusion, with diminished opportunities for social participation, which can lead, in turn, to residents becoming marginalised. There is a relationship, then, between the degree of mobility and inequalities in an urban setting. People in an urban space build up new relationships in various ways and relationships are often formed for economic, social and political reasons. Even on the street, people constantly foster relationships in

44 space through anonymous contacts. An urban space reveals socio-cultural diversity, which, although it may enrich residents’ experiences, can also become the focus of ethnic, religious and cultural tensions (Jaffe & Koning, 2015). Cities can also provide a diverse neoliberal environment where global networks are organised and can flourish – although such developments may also bring challenges. As the city grows, human life becomes ever more differentiated and complex. In an urban space, social values have shifted markedly from those of communal living to those of individualism and personal autonomy (Mohamad & Hj Ayob, 2013). In terms of these features of urban spaces, if infectious diseases start to spread, how would residents in the communities be affected and how would (urban) society be changed? Infectious diseases, as external factors, can change the existing flow and unseen relationships in that urban space. Focusing on the case of COVID-19 in Seoul, this thesis addresses this question and explores the ways in which the population – especially older people – are affected and how society is challenged by an epidemic.

How, then, is the urban space functioning during a lockdown? In the case of a lockdown, the social connection in external spaces (e.g. streets, public plazas, or parks) is restricted and is transformed into virtual space. Since urban space is characterised by flows/movements (McDonogh, 2014), lockdown severely restricts – even stops – circulation and mobility. While strong intervention from the government or another relevant organisation can sometimes be helpful (Susser, 1993), control of places has, historically, been a central component of the exercise of power by the state (Raco, 2003). Lockdown can be recognised as incorporating a fear of global urban space (e.g. Low, 2001), and extended lockdown schemes with the ongoing invasion of an external factor threatening public health may aggravate fears. South Korea, for example, has not implemented any lockdowns during the COVID-19 pandemic, protecting the local economy (e.g. small shops, businesses) and people’s livelihoods. Non-essential shops, therefore, can remain open. This country, thus, from the start of the epidemic, has chosen other strong preventive measures, expanding opportunities for COVID-19 testing and tracking infectious cases, using information technology (e.g. records of credit and debit cards, footage from surveillance cameras/closed-circuit television camera [i.e. CCTV] on the street, buildings, shops) (Dighe et al., 2020; D. Lee & J. Lee, 2020; Lee et al., 2021; Schwak, 2020). Rather than choosing a formal lockdown which can counteract a lack of a

45 sense of responsibility, South Korea has, throughout the COVID-19 period, permitted various types of mobility that demand a high level of responsibility from residents. This has involved active preventive measures and policies, combined with continuous communication, reflecting the public’s response, and which have maximised the capacity both of the government and medical staff. Although South Korea accepted such those mobilities during the pandemic, older people living in aged-care facilities or living alone are more likely to face severe difficulties, resulting from a lack of preparation in the context of this unpredictable situation (e.g. shortage of masks, poverty, access of information up-to-date), physical vulnerability (e.g. immunity), increased needs for enhanced care, etc. The next Section 3.2 explores how an ageing, aged or super-aged society like South Korea has carried out research in anthropology and gerontology.

3.2 An Ageing, Aged and Super-aged Society The global population has been growing older. In many countries, including the United States, the United Kingdom and Japan, the elderly, aged 65 and over, account for 15% of the population (Crews & Zavotka, 2006). The combination of advances in medical technology, longer life expectancy, and falling birth rates, means that this increase is likely to be a long-term trend. Where there is high gender inequality and a lack of social welfare systems to prevent women’s career disruption, the burden of supporting the elderly, nevertheless, still falls predominantly on women. The age structure has been transformed from a triangle-shaped curve (e.g. expanding) to a bell/urn-shaped curve (e.g. stationary, contracting) in countries where the fertility rate is decreasing as life expectancy increases, auguring significant changes in terms of a country’s future development.

Ageing is inevitable because it is a natural process. While individuals may not be happy about getting old, being old is not necessarily a negative label. There is an old African proverb: ‘when an old man dies, a library burns to the ground’. It can be argued that, with the experience and knowledge accumulated over the length of their lives, each older person has the right to be respected as a member of society. Older people are, nevertheless, considered as one of the most vulnerable groups in society (and certainly the largest). Older people are often excluded from social participation and relegated to a marginalised position, but, as their numbers grow, this may not be a tenable situation in

46 ‘ageing’, ‘aged’ and ‘super-aged’ societies. How to age well has become a key preoccupation and theories and interventions are proposed in order to foster successful ageing. Havighurst (1961) stated that successful ageing depends on the conditions of individual and social lives, which, in turn, determine the level of satisfaction and happiness that can be attained. Regular physical and social activity is known to play an important role in successful ageing and local governments and communities, as well as individuals, can facilitate this process.

The successful ageing movement in North American countries emphasises independence, productivity, self-maintenance and self-care (Lamb, 2014). Ageing may, to some extent, be culturally determined, depending on the situation in different countries. In South Korea, older people have traditionally been respected, as a result of Eastern countries’ notions of courtesy and the formative influence of Confucian culture. However, the move to a more individualistic culture, coupled with what is often seen as the conservatism of the elderly and their resistance to change, has led to a situation where tensions are becoming more apparent. It is frequently alleged that older people do not understand the younger generation and the perception of the elderly is shifting, with older people being viewed more negatively. Despite the historical framing of the elderly as meriting respect, the social system is not equipped to counter this more recent development, which has no precedent. Gerontophobia, sometimes evolving into hatred of the elderly, has led to the abuse of older people, which has become a serious social problem in South Korea. Older people may be viewed as a burden rather than an asset and may be deemed not to have any worth, whereas, in Western countries they are often recognised as constituting an important consumer group/segment of the population, who can, thereby, make a contribution to the economy.

Many older adults want to remain in their homes where they have lived safely, independently and comfortably. This is described as ‘ageing in place’: an idea that gained prominence in the 1980s. Providing care in the home and community (i.e. community can be defined as to spatially bounded social relations around common interests) (Clarke, 2014). This idea has been recognised as offering a more cost-efficient way of caring for elderly groups in their later years (Penney, 2013). The situation where an older person is living in a nursing/care home or hospital, being looked after by the staff, is seen as a less

47 desirable option, in comparison to the situation of an individual who is living independently in their own home and maintaining communication with neighbours and family. The living environment of older adults in aged-care facilities during the pandemic can be categorised as a ‘gated community’ (Low, 2001). In this situation older people struggle with meeting their friends or family members outside of their residence, since this is strictly controlled under regulations (e.g. safety, separation) put in place to protect public health – particularly for vulnerable populations. Policy and practice initiatives have paid more attention to older people and have sought to remove physical barriers (Crews, 2005; Crews & Zavotka, 2006) with the aim of improving activity patterns, thereby enhancing autonomy, independence and self-perceptions of well-being amongst the elderly. The environment experienced over the life-course, therefore, has been shown to significantly affect the ageing process (Rehak, 2019) and is a key component in successful ageing.

October 2nd is the day for older adults in South Korea. This date was assigned in order to raise social interests and respect for older people. The MOHW has carried out quantitative research (e.g. survey) every three years (e.g. in 2014, 2017) which is targeted at older adults living in South Korea. This was done in cooperation with the KOSIS, and collected data, including details of how each elderly person is spending time and what welfare services they need. It provides a useful sample for the periodic consultation with a view to understanding older adults’ life. The KOSIS (2011) data shows that 52.3% of older adults want to have a healthy life as they age. Nearly a fifth (19.6%) of older adults want to spend time earning more income over the years that remaining to them. Only 4.1% of older adults want to spend time with their hobbies in their life. The data reflects that most older adults in South Korea take account of healthy ageing but shows that they are not completely free from economic burdens.

An ageing society tends to focus on chronological age (Kim, 2014) and, thus, to overlook features of individuals’ situations, considering them as a single group (65 years and older). This may lead to ageism (i.e. discrimination against individuals or groups based on their age) (Higgs & Gilleard, 2021; OECD, 2020b). Seoul Welfare Foundation (2018) conducted an annual survey of 3034 older adults living in Seoul, and the report found documented that 13.4% of the total respondents had experienced ageism – especially

48 those living alone or in central Seoul, with no formal educational qualifications and in a lower income of older age group. Older adults who secured a job after their 60s faced more difficulties at workplaces, such as lower salaries, ageism, poor working environments and conditions, etc. During the COVID-19 period, ageism has worsened and even older adults who were institutionalised were found to have a lower resilience in terms of psychological or emotional levels. Based on the power relation conceptualised by Michel Foucault, older adults living in aged-care facilities cannot avoid constant monitoring and assessment in the name of protection and security. This surveillance aspect emphasises the protective role of practitioners or professionals rather than the substantive requirements of older adults (Powell, 2009).

In the present context interaction is not confined to face-to-face communications, but, increasingly, in the 21st century, involves many digital platforms. This presents a new model for understanding and constructing society and, alongside the benefits this can confer, some concerns have been raised as to the properties of online spaces and the potential uses – and misuses – of the information digitally stored, both in terms of its content and accessibility. The following sections consider whether digital space can be viewed as a ‘panopticon’ (see Section 3.3.1) to see how epidemic measures affect older people in (digital) urban spaces (see Section 3.3; Section 3.3.2) and how older people have been expressed their images in digital space (see Section 3.3.3).

3.3 Impacts of Epidemics Measures on Older People in Urban Spaces In urban spaces, an infectious disease/epidemic highlights a variety of risk factors, which threaten to damage the existing socio-ecological order and structure or which interrupt the settled flow of everyday life and interactions. It changes, for example, the system of food production and livelihoods. The impact of infectious diseases (e.g. plague, smallpox, Avian and Swine influenza) has been researched with regard to their effects alongside that of urbanisation. Reyes et al. (2013) point out that urbanisation has contributed to the spread of infectious diseases in both developed and developing countries. D. Wallace and R. Wallace (2008) argue that outbreaks of epidemics affect various socio-economic groups to differing degrees and can exacerbate existing inequalities (e.g. different rates of infection and varying access to medical care) in densely populated and overcrowded urban spaces. For example, poorer areas may face greater risks of infection.

49 Anthropologists have researched various epidemics (e.g. Cholera, severe acute respiratory syndrome [i.e. SARS] in 2002-2004, Ebola virus in 2013-2016, Zika virus in 2015-2016). Medical anthropologists also have started to examine the material and technological aspects of epidemic control. Recent studies have been shifted from focusing on public health and prevention to concentrating on preparation (Lynteris & Poleykett, 2018). Epidemiologists contribute by developing statistical and mathematical models that incorporate demographic characteristics in order to predict epidemics’ transmission and evolution, as well as to estimate the likely impact of interventions designed to control the spread (Reyes et al., 2013). It is important that a proactive response is applied, taking a multidisciplinary approach to public health emergencies. The case of the Ebola epidemic showed that anthropologists, studying epidemics and their wide-ranging impacts, can work in a variety of capacities, providing valuable new insights (Stellmach et al., 2018).

Inhorn and Brown (1995) categorised infectious diseases – including the human immunodeficiency virus (i.e. HIV) – and analysed the ways in which such diseases have changed human behaviour in the ecological context. They state that “it is impossible to build impenetrable epidemiological borders between populations, so that constant surveillance and political willingness to protect populations proactively from new diseases will remain an important challenge for the future” (p. 5). Lynteris and Poleykett (2018) also said that the development and mobilisation of surveillance, modelling, simulation and technology can help to prepare for the unpredictable in seeking to respond to and to control epidemics.

New infectious diseases are constantly appearing, together with mutations of viruses. People cannot avoid the risks and impact of these new diseases. Globalisation accelerates the spread of infection via interconnected networks. Wilkinson et al. (2017) highlighted the importance of the role during the Ebola epidemic period. As the epidemic progressed, response tactics changed and communities and community-level action (i.e. community- based/centred/led) were emphasised as central features of the response. Although there is a lack of clarity about what exactly constitutes a community, locally-based action has proved to have a remarkable effect on resilience and this approach has been widely used by practitioners working in public health. Local knowledge and engagement help in

50 understanding social dynamics, providing a basis for designing robust interventions and identifying priorities in public health and emergency planning. During an epidemic outbreak, community-based action, in addition, is good for improving communication (which depends, in turn, on the state of urban social structure and the authenticity of authorities’ messages) (D. Wallace & R. Wallace, 2008).

In the face of an epidemic older adults become more vulnerable and it is recognised that providing care is crucial for older people (Buch, 2015) – since elderly people are more likely to require continuing care. A lockdown due to the pandemic causes more serious problems for the elderly than it does for other groups. They are at a greater risk from infection and the consequences for their health and are constantly induced to be more careful. How can they manage and negotiate self-isolation in this situation? Being housebound, however, is more commonly the result of biological deterioration, rather than being enforced. Involuntary lockdown, however, could have the effect of making older people feel more isolated (e.g. Daoust, 2020), depressed and frustrated. Support networks, where these exist, can assist housebound individuals with both existing and emergent needs and problems, getting groceries, travelling to the hospital, arranging input from additional carers, etc.

Access to digital life has become even more important with the arrival of COVID-19, in order to say abreast of developments, to be able to assess risks, and to access advice as to what measures can be taken to reduce the spread of the virus. Kaplan et al. (2015) carried out research into the relationship that older people have with technology, since familiarity with social media, for example, can allow better communication and may promote intergenerational interaction. Some technological models have been developed, which relate specifically to ageing and older adults’ lives (e.g. Lynch, 2015). Despite this, however, many older adults still face difficulties with regard to using technology with confidence. These needs could, perhaps, be met through efforts at a local level, including the development of locality-sensitive systems (Suzuki, 2012). In a lockdown situation, the locality assumes great importance and could also provide, through concrete interventions, the impetus for optimising older people’s well-being. Technology provides numerous non-face-to-face opportunities in a lockdown and the application and benefits of these technologies should be equally available to older people.

51 When infectious diseases break out, older people in urban spaces can face more difficulties (e.g. risk of infection, depression in closed space) than those living in rural areas. Urban space is a space where people are exposed to numerous diseases, violence, and dangers, because diverse people live within this area and are interconnected. COVID- 19 has challenged ideas about existing urban spaces and various discourses have moved to digital (urban) spaces. Even during the epidemic, urban spaces need to remain resilient, and better governance is needed in order to maintain the beneficial features of urban spaces, while considering how to develop those spaces to provide a better environment. Even with the development of vaccines and treatments, new infectious diseases will continue to occur in the short or long-term and will have a profound impact on urban spaces, and this is an opportune moment to explore new types of urban space. The next Section 3.3.1 introduces the concept of the online Panopticon firstly discussed by Foucault, and Section 3.3.2 explores the reasons why older people have struggled, throughout the pandemic, with negotiating digital life and suggests how digital urban spaces for older adults might usefully be developed. In addition, Section 3.3.3 describes how older adults are represented through images and discussions in online media (e.g. press releases in newspapers).

3.3.1 An Online Panopticon Foucault (1995) analysed architectural structures using the concept of the ‘Panopticon’ (designed by Jeremy Bentham in 1791). The central power conferred on the Panopticon facilitates easy access, allowing for the supervision of individuals, using a small number of surveillants to monitor many individuals. Couch et al. (2015) discuss how Foucault’s ‘Panopticon’ can be applied to current mass media and social media, and argue that the concept of the ‘synopticon’ (Mathiesen, 1997) – which involves the surveillance of ‘the few by the many’ and which turns the idea of the ‘Panopticon’ on its head – is a useful way of understanding the exercise of social control in this arena. It has even been suggested that social media may function as an ‘omniopticon’ (the surveillance of ‘the many by the many’, where everyone is both observer and observed) (Mitrou et al., 2014). The idea of the omniopticon is particularly useful for understanding the influence of social media and its role in repeating, creating and perpetuating certain discourses. Of course,

52 sites which are public, but which afford anonymity, may offer a way of reducing the impact of such surveillance. Online/Internet space can be viewed as one aspect of the Panopticon. In South Korea, the culture of online commenting and engagement began in the early 2000s, when the Internet was introduced and became popular. South Korea has had the highest-speed Internet network and widest Internet coverage in the world (Statista, 2020). Moving away from the previous offline environment-centred communication method, the online environment provided a new democratic public sphere. The culture of comments online, however, became malicious in the context of discussants not having been educated with regard to healthy commenting culture and individuals’ failure to recognise the potential harm that can arise from hiding behind the anonymity of the space afforded by the Internet. Traditionally, South Korean education is not based on discussion. In the Japanese colonial era, the Korean language and identity were suppressed by Japanese soldiers, who inflicted both physical and mental violence. From the 1960s to the 1980s, due to the long-term power of the military regime, the South Korean school and further education system did not have sufficient time to devote to forming a mature discussion culture, because of the excessive educational power of teachers and the hierarchical relationship between teachers and students combined to provide a very one-sided version of information delivery.

People created virtual communities online, according to their interests or circumstances (e.g. women-oriented, men-oriented, mothers-oriented), and developed a new information-sharing culture. However, this produced various social problems due to the possibility of anonymity and an immature consciousness of the implications of non- face-to-face exchanges. In particular, the inclusion, on the portal site (e.g. Daum, Naver, Nate) of news from the press, led to an unhelpful focus on antisocial, and potentially damaging individuals and groups and an emphasis on celebrity culture (e.g. Reuters News, 2019). Therefore, alongside its functions of sharing information and knowledge, an online discourse has created serious social problems through enabling and even encouraging expressions of misogyny, hate for men, hatred of irresponsible mothers, the creation and spreading of rumours, use of abusive language and even sexual crimes. In the online space, some patterns of exchanges are characterised by hatred towards the elderly (e.g. Yeongeum Choong: those who receive the pension and reduce the amount of national

53 pension reserves used in a mocking sense, or Hal Maemi: those who speak loudly like a cicada). When an older woman who had been a victim of sexual slavery under the Japanese imperial army occupation in the 1900s spoke at a press conference about the embezzlement of donations from the Korean Council for Justice and Remembrance, there were many rude comments – from the same political party of politicians belonging to the organisation – blaming and mocking her (The Korea Economic Daily, 2020). Younger generations and middle-aged generations have reported seeing some older people queue-jumping in line or pushing others on public transportation. While there is agreement that expressions of hate towards older people should be avoided, such comments still have reflected a negative image of older people (Yonhap News, 2019). To resolve this culture of disdain that can exist between different generations, Seoul has, for example, designed the annual generational integration programme called ‘Generation Ieum Madang’ which means connect generations – mainly via social and cultural activities mixing youth and older generations. This programme aims at creating an aged-friendly city where all generations can live together and enjoy a positive relationship (Seoul Welfare Foundation, 2019).

‘Comment culture’ can be defined as a subset of discussion culture on the Internet. People who are socially renowned and highly educated can often behave badly and irresponsibly online. People who are timid outside and are lacking in self-assertion, also, may behave differently online. Comments on the news section of the portal site are literally a place where a large number of unspecified publics gather (albeit in a virtual environment). Anyone can meet anonymously and participate in commenting there, irrespective of their educational level and political orientation. This is why participants have no choice but to listen to the voices flowing in the comment window of the portal site, whether this relates to personal, political or business issues. Moreover, online news items that have attracted a lot of comments engender social attention. Particularly when the purveyors of online news are financed through revenue from commercial advertisements, they can use the interest that generates to produce and share provocative articles written without investigating the facts. This comment culture in South Korea may, ultimately, even be seen as contributing to the highest suicide rate of OECD countries (OECD, 2018) and the effects of online commenting can extend to have an impact on politicians – even, at times, influencing their political beliefs, actions and

54 policies. However, as some portal sites have recently blocked the comment service on news, damaging comments have now moved to personal social accounts of celebrities, etc.

An aspect of South Korean culture, called Nunchi, means figuring out the subtle mood of others, or gaining insights into their self-awareness. This may well be a characteristic of a relationship-centred culture that was developed in order to adapt to what was previously a traditional collectivist society. Anonymised individuals think of the Internet as a space to relieve their stress through so-called bad comments. As with Foucault’s Panopticon, which integrates power and knowledge for efficient control, social media is a platform where users’ status (e.g. what people leave comments, how they express their opinions, which contents they mostly click ‘like’) on these online spaces can be monitored. In this thesis, discourses harvested from social media (e.g. Facebook, YouTube) are analysed to explore how the public views older adults during the COVID-19 period (see Chapter 5). The next Section 3.3.2 looks at how older adults’ lives are embedded in digital urban space and how they experience the challenges of digital communication, which have been triggered due to COVID-19.

3.3.2 Digital Urban Space for Older Adults COVID-19 has highlighted the importance of Information and Communication Technology (ICT) and its practical usages. South Korea utilised ICT effectively in the process of responding to the virus spread (Schwak, 2020). Prior to COVID-19, data analysis and research using personal information had been limited throughout the country – for various legal reasons. Nevertheless, the epidemiological investigation support system has been able to use big data (such as GPS location tracked and recorded on mobile phone and credit card information) during the COVID-19 outbreak, and this has improved the quality of the information and made it possible to accurately pinpoint the movements of people who have been confirmed as positive for COVID-19. This information has been used as a means of identifying the need for quarantine, in order to help prevent further confirmed cases. Based on the Geographic Information System (i.e. GIS), it has been possible to trace the geographical route by timeline for people with a confirmed positive result for the COVID-19 test. In addition, this system also allows for the provision of information, such as that relating to the location of the clinical centre providing the

55 COVID-19 tests or Shincheonji Churches, and details of which pharmacies provide masks – and, even, the level of their stocks.

Utilising a strategy congruent with the idea of the Panopticon, geographical recording and tracking on phones (showing where a person has been, and which places they have visited) can also provide an effective tool for ensuring public health in the context of the COVID-19 outbreak. However, the use of such measures has also been viewed as a violation of human rights (invasion of privacy). D. Lee and J. Lee (2020) mentioned that the government already debated and legislated how it would balance privacy rights against public demand for contract tracing information at a policy level before the COVID- 19 outbreak. In South Korea, when a COVID-19 test confirms their positive status, individuals’ location information – based on the timeline, residential address, age and gender – is officially shared by the KCDC (on the COVID-19 webpages); this information also being provided to each city administration (operating at the level of residential areas), and this detailed information is also accessible via social media (e.g. Facebook, KakaoTalk) (D. Lee & J. Lee, 2020). Due to the excessive disclosure of personal information and different formats by local governments, the system has recently been modified. In the wake of a limited period in late 2020, when such information was routinely shared, this practice has now been discontinued.

Ryan (2020) has criticised the Korean digital contact tracing method (use of privacy- infringing digital contact tracing) during the period of COVID-19 as contravening ethical principles outlined by the European Court of Human Rights. Sharing with the public specific information may allow individuals to be identified and outed, causing possible psychological harm to the individual or harassment. The South Korean government created a centralised public database system in cooperation with local governments to record relevant information, on a daily basis – such as how many COVID-19 tests have been carried out; how many people have been infected via which routes, and which locations they visited prior to the infection being confirmed by a COVID-19 test result, etc. The central and local government, the MOHW, and the KDCA have contributed to recording this information, and some (young) citizens and institutions have created and managed mobile applications/apps (e.g. Coronamap, Corona Now, Corona Alimi) allowing

56 people to conveniently check real-time records, alongside infographics provided by the government.

The usages of ICT have, thus, had a positive impact in terms of managing the virus spread and providing information during COVID-19. However, social media platforms have allowed some commentators to put the blame on those who were infected and have been seen as responsible for spreading the virus to many others. The approach of digital contact tracing that the South Korean government chose may not be appropriate for countries which adopt a more relaxed prevention policy, or those where privacy/personal information has been strongly defended and observed – even in a disaster situation.

The Quick Response (i.e. QR) code from applications (e.g. KakaoTalk, Naver) on mobile phones also extends to restaurants, churches, clubs, libraries, and other relevant places. However, people who are not familiar with using applications (particularly older people) need more time to learn how to use the system and may prefer to write down their personal information on paper. Older adults, who have their smartphones but who use mainly limited functions – such as phone calls or text messages – can be fearful and have difficulty in negotiating a digital non-face-to-face society, made up of people and technology transformed from a society of human-to-human interactions.

In this 4th industrial revolution era, older people might be resistant with regard to adopting and engaging with the smart digital life, the progress of which has been accelerated as a result of the COVID-19 outbreak. Although the average use of smartphones for all age groups in South Korea was recorded as being 92.9% in July 2018, the average percentage of the elderly using smartphones was only 77% at the same timepoint. However, there has been a sharp increase (over a relatively short 6-year period) in smartphone use amongst older people, as only 13% were using these in January 2012 (Gallup, 2018). Within the elderly group in South Korea, men are more likely to use smartphones than are women. The use of smart devices is spreading in the daily lives of the majority of people in a hyper-connected society with marked influences via various networks, but older adults seem to be reluctant to step into a hyper-connected society, meaning that there exists a digital divide. The digital alienation of the elderly may be intensifying amid continuous changes in society, including the growing reliance on smartphones and the proliferation of unmanned stores (e.g. kiosks) in various stores.

57 Some elderly people are frightened to touch their smartphones, being afraid that photos or contact information would disappear if these were to malfunction. Some of them are also worried about being accidentally overcharged for calls and Internet bills on smartphones.

K. Lee and S. Lee (2019) mention that older adults take time to learn how to use smartphones at the beginning, although some do use these devices for watching YouTube, listening to music, searching for information, taking photos, in addition to sending messages, or calling someone. Especially for older South Korean women in their 70s or 80s – who have sacrificed their lives for children and husbands in a traditionally male-dominated society – smartphones offer an active communication tool allowing them to interact with their friends, neighbours, children, and partners and to enjoy a richer cultural and social life. However, for older women living with their husbands or married children, smartphones do not appear to have such a significance with regard to enhancing cultural and social lives. While many older adults are able to use a smartphone, they may be reluctant to buy these for themselves, or to replace these, even when they encounter a problem with an existing phone. Society, as a whole, and younger generations, in particular may be too impatient should, perhaps, wait for older people to adopt digital life at their own pace and could consider how best to provide more opportunities for them to adapt to this new environment.

Ageing is not a uniform process, but, instead, is seen as being profoundly shaped by social relations and local environments (Buch, 2015). Although most of the cities in South Korea have tried to create more spaces for older people’s daily and cultural life, not many suitable spaces are, in fact, provided. These spaces appear to be segregated by generations – resulting in older people not having much opportunity to interact with younger generations. South Korea’s older people like to gather in community centres, shelters, and parks to talk with their friends. They may have a walk, do yoga, have a dance or go out to eat. They also can learn how to use social media on their mobile phones (K. Lee & S. Lee, 2018), and it is possible to use computers provided in the community in order to communicate through emails, for example, or to search the Internet. They like to interact with people by taking part in outdoor social activities, but, as a consequence of measures introduced to deal with the pandemic, their activities and mobility are

58 restricted, with the opportunities on offer depending on where they live. The unfortunate result may be that some older people experience deeper social isolation and, even, depression. Local governments can play a key role in addressing mental as well as physical health problems, perhaps through introducing a ‘phone service or enabling online meetups as an alternative option during COVID-19 (Y. Kim & S. Park, 2020). Another role for local government could be to provide, for older adults in need, digital education with regard to accomplishing a range of tasks (e.g. how to use kiosks, how to order food or materials online or mobile applications, how to have a face talk with their friends or families). The next Section 3.3.3 goes on to explore, through content analysis, how images of older adults are reflected in online press releases in South Korea.

3.3.3 Digital Images of Older Adults Images reflected in various types of media (e.g. television, radio, newspaper, social media) have changed with the passage of time. Han (2012) suggested that positive images of ageing were transformed into negative images after the process of Western modernisation began. Medical technological development, for example, introduced the idea of anti-ageing (e.g. having no wrinkles on one’s face) and made older adults have an important target as potential consumers. In addition, the media has contributed to creating images of older adults via advertisements, documentaries and dramas (e.g. the confident older man in his work vs. the passive older woman). People who are exposed to such discriminatory portrayals of older adults via the media are sensitised to intergenerational conflicts. The media, in its various forms, has the power to protect a particular – and perhaps negative – image of groups, such as older adults (M. Kim, S. Lee, et al., 2020). Older adults may be evaluated by their financial status, and this shows that society views them based on productivity. Jung (2015) investigated images of South Korean elderly in a range of materials published between 1990 and 2015. In the 1990s, most of the television advertisements represented older adults as unhealthy or as causing problems (e.g. being a burden on their children or society). In the sphere of drama, older women living alone were presented via optimistic, happy, and productive images, but this was an isolated case. Jung (2015) also mentioned that, while older adults think of themselves as wise and intelligent, they are dependent on others. Younger generations

59 may have a more positive view of older adults than do middle-aged groups, who place more value on economic contributions. However, Lee and Kim (2019) employed web crawling to analyse social big data. In 2004, the keywords they used were retirement (older adults are worried about financial difficulty after retirement) and dementia (older adults are afraid of the possibility of dementia). In 2008, discourses in social big data converged on topics related to ageing, such as how families or society treat older adults and how they can survive (e.g. senior jobs) and its negative aspects (e.g. deaths due to isolation or depression). By 2011, discourses had moved to focus on systems or resolutions, so the relevant keywords were prevention of dementia, care assistants, etc. As Baby Boomers started to retire from work, an interest in active, successful, and productive ageing emerged. The image of older adults is important to plan and devise welfare policies as well as individuals’ social identity. To improve images, ageing issues expressed in media should be delivered in a balanced way reflecting a variety of social life, with consultations of professionals. Aged-care facilities should have a better programme for older adults to look after their images and actively respond to ageism.

Online newspapers have appeared as a new transitional media platform (paper to digital paper). South Korean online newspapers are, for example, provided by three press outlets with differing political perspectives: Hangyoreh, Joongang and Kyunghyang. Most of the articles from these three press outlets have not reflected different political views during the COVID-19 period. These newspapers tend to use the term, ‘the elderly’ rather than ‘older adults’. However, usage of the terms, ‘older adult’ and ‘the elderly’ turned out, on closer examination, to vary between individual writers/reporters, rather than the different newspapers. The items included are broadly similar in the ways in which they describe older people as a group who should be protected and are most vulnerable; reporting on how poor their life is; how they are struggling with isolation due to the epidemic; how they are isolated in aged-care facilities with a risk of infection; how funerals are affected due to the virus and the risk of infection, etc. Some articles also focus on how third parties, including privatised companies, can help them with their products, materials or donations – for example, reporting on how older people are trying to use an automatic alarm based on ICT to remind them what time they are supposed to take medicines. The company designing and providing the system also has an opportunity to advertise their services and products through such mentions and articles can indirectly

60 refer to how technology (e.g. wearable devices) is helpful for old people’s lives – although technology completely cannot solve all of the difficulties experienced by older people. When relevant experts or professionals engage in the articles the quality is improved and such items often provide helpful insights into the issues affecting older people in an aged society.

Content analysis was carried out on 66 press releases published via Hangyoreh, Joongang and Kyunghyang between January 20th and December 28th, 2020 – filtered by options (press releases, keywords) provided in Naver News (https://news.naver.com/). These extracted press releases mainly cover news about materials (e.g. masks, sanitisers, meals) or financial support from privatised companies with photos provided (e.g. showing boxes of products piled up, or including a banner with the company logo). Keywords used for this analysis were ‘the elderly, COVID-19’ and ‘older adults, COVID-19’. Most of the press releases tend to use ‘the elderly’ rather than ‘older adults’ during the pandemic period. However, Naver News may not necessarily cover all press releases from these three press outlets. As compared to Hangyoreh and Kyunghyang, Joongang has published more press releases – especially those advertising privatised large-scale companies and Hangyoreh did not publish any press releases related to privatised companies, taking a more cautious approach. One Hangyoreh press release featured an older woman in her 80s, who recently had surgery, and who applied to an emergency care service provided in Seoul City, with help from a neighbour in her 50s.

COVID-19 has deprived many older people of a range of opportunities, including a reduction in places to eat and rest. South Korean subways are operated free of charge for people who are 65 and over, so many older people may just sit on the subway without a destination in mind. Those who normally spend a day chatting and playing games with others of similar age groups in parks or community centres have experienced a major change in their lives due to the virus. Given the situation in relation to COVID-19, the media could engage in more work with experts or professionals, in order to present a more sympathetic image of older adults and ageing. The resulting articles could ensure higher quality reporting with accurate scientific information and qualitatively philosophical discussion, rather than simply focusing on conveying the facts. While press releases may be used as promotional material advertising external companies, but there

61 is also some content that publicises policies, and which clarifying positions/opinions, perhaps using cases to illustrate the points being made. Rather than simply writing and exporting an article to make a particular political point, articles should consider respecting the essence of the media, by carefully checking the facts and thinking about how content is likely to be received. This has become even more important during the period of COVID-19.

The transformation to digital life accelerated by COVID-19 can constitute a huge burden for older adults. Thus, older people may also be excluded from participating fully in digital urban space, in addition to the restrictions they experience with regard to urban space more generally. As COVID-19 may not be the last infectious disease to affect current or future generations, a new digital urban space that encompasses vulnerable groups including older adults will be crucial to have substantive policies and systems that can actively prevent and respond to various infectious diseases. In comparison with the Japanese Colonial Generation and the Liberation Generation, the elderly generation of Baby Boomers, who are familiar with the Internet and mobile phones, requires a new paradigm for the digital (urban) space. Chapter 4 is based on interviews with experts and practitioners working with older adults and seeks to explore how COVID-19 has affected the lives of older adults, whether living alone, with family members, or in aged-care facilities (see Section 4.1). It also describes the ways in which these professionals, as essential workers, have worked with older people during the pandemic, as well as looking at how the government has treated them (see Section 4.2).

4 Perspectives of Aged-care Practitioners with Regard to Older People and the Pandemic The OECD (2020b) provided guidelines on COVID-19 for older people and caregivers who are working at aged-care facilities (including long-term care services). In particular the organisation recommended that a primary caregiver should determine whether an alternative care plan or facility is needed and that, in addition, they take preventive measures such as self-isolation when they are with older adults.

62 This chapter is informed by semi-structured interviews with four participants between January and December 2020 and is based on thematic analysis. All of the interviewees have worked closely with older people living in urban spaces (e.g. cities) – either directly and indirectly (in an administrative/policy capacity) – throughout the COVID-19 pandemic and they have observed, first hand, the challenges that older people have faced in the 21st century. Since the epidemic broke out, their work has changed, depending on the severity of its spread, with constant updating/revision of policies – both externally and internally. All of them are experts and practitioners who have worked for more than a year in their professions related to vulnerable populations in South Korea. Choi (a pseudonym) (in her late 20s) is working in the policy sector, focusing on older people with disabilities. Yoon (in his mid-30s) is employed as a social worker at a day and night care facility. Hwang (in his mid-40s) is a social worker and the head of a day and night care facility. Han (in her early 60s) is a care assistant, visiting the houses of older people who live alone. The day and night care facilities consist of older adults who do not live in the facilities.

Although the urban spaces connected to the places where they are working are different, all have worked for vulnerable populations, especially older people, and actively understand the elderly welfare policies and systems, which have been changing rapidly during the pandemic. On a professional level, they have had to cooperate with the constantly revised community and national restrictions and quarantine regulations. Interviews were carried out during the period of the COVID-19 pandemic, so that these were conducted by ‘phone. In order to reduce the risk of a lack of rapport with participants during telephone interviews, they were selected/recruited on the basis of recommendations through personal networks. The interview participants’ names are presented, throughout the thesis, as pseudonyms in order to protect personal information (Equality Challenge Unit, 2017).

The next Section 4.1 describes the lives of older people during the pandemic through the lens of experts and practitioners working with them and highlights the impact of the epidemic on their vulnerability. Section 4.2 shows how the environments in which experts and practitioners are working with older people have changed during the pandemic and how the government has treated these professionals as essential workers.

63 4.1 A Vulnerable Population and Essential Workers Already having experienced a period of rapid industrialisation and its attendant disruptions, older people have had to adapt to further changes, with the arrival of COVID- 19, including a switch to different lifestyles. Since massive group infections broke out in Daegu City and North Gyeongsang Province (i.e. Gyeongsang City, Cheongdo and Bongwha Counties) in February and March 2020, these areas have been designated as specialised disaster areas. Accordingly, the government expanded the budget to support local communities and aged-care facilities (e.g. care hospitals, care homes) that were considered to present a high risk of infection (MOHW, 2020b). Many older adults and staff in those facilities became infected, and the facilities had to stop running for a certain period (shutdown). Since then, a fear of infections arising in aged-care facilities has increased and many older adults have begun to avoid attending such facilities during the pandemic period. Essential workers, such as social workers and care assistants working with older people, have seen first-hand the impact of these changes. Their observations are used to structure the sections (see Section 4.1.1 – the vulnerability of older adults during the COVID-19 period; Section 4.1.2 – the differences between the ways in which older adults living alone and those staying at aged-care facilities have dealt with depression during the pandemic, Section 4.1.3 – how older adults view their lives during COVID-19, and how they are seen by younger generations and the government. Section 4.1.4 – how they have experienced the changes triggered by the COVID-19 outbreak).

4.1.1 Vulnerability of Older Adults The Seoul Metropolitan Government (2020a) said that 590 cases of abuse of older people were reported in 2005, compared to 1963 cases reported in 2019. For around 15 years, the number of abuse cases reported had been increased. In 2019, 81.5% of the older people that were abused were women and, in most cases, this involved victimisation by their sons or husbands, with who they were living. Most cases involved physical and psychological abuse (40.3%). Older people also fall victim to ‘phone scams (texts or calls) or shopping fraud. Cases abuse, however, may not be fully reported, due to older people’s vulnerability and a lack of access to reporting processes, etc. Furthermore, older people with disabilities are more likely to be exposed to abuse. During the pandemic, it is estimated that more abuse cases will occur, due to restrictions on mobility.

64 COVID-19 and its extended epidemic period have deepened existing vulnerabilities of older people. In addition to the physical and mental vulnerability associated with old age, restrictions on mobility have presented further practical – as well as psychological – issues. Many older people are struggling with their physical ageing and, perhaps, associated chronic pain and they are likely to regularly attend clinics or hospitals in order to receive treatment. The epidemic has restricted their mobility to essential journeys, due to the fear of infection on public transportation.

4.1.1.1 Fear of Infection Whenever they hear news of an increase in the number of infection cases and fatalities, older adults are likely to become more fearful. Although they appreciate the efforts of medical staff during the pandemic, they may be worried about continuing virus spread (Lee & Kang, 2020). Those living with their children or families are at higher risk of infection from their cohabitants. Esteve et al. (2020) emphasise that reducing or avoiding transmission of the virus to older adults within households is important, in order to reduce mortality caused by COVID-19. Hwang, working as a social worker at a day and night care facility in Seoul also mentioned that:

"In Seoul, most of the older people were infected by their families, who go to work or commute by public transportation. Family members should look after their own health status and older people who feel ill should not come to facilities. Those living in apartments can get infected inside elevators where ventilation does not work and lots of people are using the same buttons."

Han, as a care assistant visiting older people living alone in an urban area, has worked closely with 16 older adults. She described how older people are careful to avoid COVID- 19 infection:

"It seems that older people are more careful than the young generation. One reason is that they think their immune system is weak, so they think they will have a serious problem if they get infected. Since South Korea is a Confucian society, their funerals would be compromised if they died as a result of COVID-19. They accept that they may die, but they want to die after COVID-19."

As Han points out, many older people recognise that they should avoid infection because they have weak immunity. They also want to have a proper funeral for their children to attend. Funerals are of great significance for South Koreans’ lives – along with wedding ceremonies and births of children. Many older people who were born into the

65 Japanese Colonial, Liberation and Baby Boomer Generations still expect that their funeral should be well prepared and that it will allow for greetings from significant others – their families, children, neighbours, friends and others. They are also worried about death from COVID-19. People who have died from the virus cannot have a proper funeral and ritual and they are disposed of without ceremony and without their family being present. Seoul Welfare Foundation (2018) reported that many older adults have made arrangements for their funerals through registering for bereavement associations, cemeteries/charnel facilities, writing a will, and/or taking a death-related course, etc. Of 3034 respondents 25.3% wanted to be in charnel facilities after the cremation, although 22.2% had not specified their funeral requirements.

In the course of her interview, Han also said that older people today know that they need to be careful and that their social awareness has increased. This is related to the findings of Moon et al. (2021) – older adults are more significantly afraid of the COVID-19 infection in comparison with younger and middle-aged groups. When older adults have a higher sense of belonging to the local community and higher trust in their families, they are more likely to feel fear with regard to the virus. One reason for older people being more careful during the pandemic may be that they do not want to infect anyone else, including their loved ones, and thereby harm their local community.

The COVID-19 mortality rate of older people is, however, considerably higher than that of other generations (e.g. Daoust, 2020), and there are many documented cases of infection from family members or cohabitants, belonging to younger generations, which ultimately can lead to deaths. The prospect of death from COVID-19 and the consequently suppressed funeral arrangements give rise to regrets about leaving the world and feelings of guilt on behalf of their loved ones.

4.1.1.2 Older Adults Who Expect to Be Protected Hwang, working as a social worker at a day and night care facility, pointed out how older people want to be treated at an aged-care facility when they become ill. Their behaviour pattern is mostly influenced by their health status, rather than gender. Older people who do not feel comfortable receiving professional care are prone to poorer health status. Those who expect to be protected and to be treated well, may be more likely to be critical

66 of the services they receive – and may even behave rudely – since their families pay fees for them to access care facilities and the services.

"Older people say they should be protected and being old is like being a baby. Babies should be protected. However, most of them think that it should be taken for granted that they should be protected. Some of them say that you do not need to do that for us, and then they do things for themselves. It means that they are not comfortable with being treated as being dependent. However, currently, there are lots of older people who think they should be protected."

Many members of younger generations complain about how older people expect to be protected and treated politely in society. It sometimes leads to generational divisions or negative images of older adults. Older people want to be called ‘older adult’ or ‘senior’ (Uhruhsin) rather than an ‘elderly person’ (Noheen). The word Noheen came literally from the Chinese (Hanja) for an older person. Although they know they are old, they do not want to be described in this way. Some of them like to be called ‘boss/leader’ (Sajangnim) or ‘teacher’ (Sunsengnim) – even if these terms do not actually describe them – and, even after retirement, they may prefer to be referred to by the positions they previously occupied. The word Nim means sir and shows respect. However, discourse analysis showed that many departments working closely with older people still use the term Noheen in discussions related to the welfare of older people – due to the strong influence of Chinese usages and its unquestioning acceptance in the existing system. The use of language is an important factor in relationships between older adults and care providers (e.g. Lee, 2018). Higher emotional intelligence and sensitivity to the vocabulary used can have a positive effect on the quality of nursing care for older adults (Kim, 2019).

4.1.1.3 Increased Difficulties Due to Lower Income COVID-19 globally has caused unstable employment status, and many people have lost their jobs. People running their own small businesses have seen a large fall in income and many unemployed people have had to familiarise themselves with the processes involved in obtaining unemployment benefits during the COVID-19 outbreak in South Korea (Nam & Lee, 2020). Elderly South Korean people working in low paid jobs have faced severe difficulties with regard to affording meals. Due to the potential for virus spread, provision of free meal services has been reduced and homeless people and older people, who cannot prepare meals themselves, have had to find other means of obtaining meals, even

67 this means choosing places at some distance from their homes. It became difficult for them to have nutritious meals (Shin et al, 2020). Furthermore, older people with low income cannot afford to frequently replace face masks. Yoon, working as a social worker at a day and night care facility in an urban area, however, made a different point:

“Older people at our facility have been financially supported by their children, no matter how difficult the economic situation is. They may not feel that there is a big economic challenge compared with the economic crisis in the late 1990s. At that time, they were of working age, so they would have experienced greater difficulties.”

Many older people staying at aged-care facilities are financially supported by their children or another family member as well as the LTCIS. They do not work for their livelihood. They have different living situations as compared to older adults living alone who are responsible for their own financial status. Older adults at aged-care facilities may feel less frustrated than they were in the economic crisis in the late 1990s (i.e. requiring funding by the International Monetary Fund [IMF]) since they would at that point have been middle-aged with primary responsibility for the household economy. Han, working as a care assistant visiting homes where older adults live alone in an urban area, said most of the older adults with whom she is working cannot work, due to their health issues and old age.

“It is sad that older adults, who are not the NBLS recipients because they have their children, cannot receive the care service. They are in need of the service, so there is a blind spot in the welfare policies. ... Older people aged between 70 and 85 may be self-sufficient because they have their own garden. Those aged 85 and over cannot do household, so they have difficulty doing their grocery shopping. They sometimes take the bus to get to the shops and they return by taxi with a large amount of shopping. Taxi fares constitute a significant financial outlay.”

Most older people frequently attend clinics/hospitals due to aged-related aches/pains (e.g. back or leg pains). They have no cars, so they struggle with transportation to go to the clinics or local markets, especially during the COVID-19 period. Since they avoid going out unnecessarily, they are likely to stay at home for most of their time. Han also pointed out that the government welfare policy (e.g. NBLS) – calculated by income levels and the existence of children with income or capacities to care for their older relatives – has a blind spot meaning that people who need the care service that is provided by the central government or local governments may sometimes be excluded

68 on the basis of criteria used to determine eligibility. COVID-19 has exacerbated such inequalities, in the light of existing, and unmodified, welfare policies and standards.

4.1.1.4 Increased Difficulties Due to Disabilities or Dementia Older people with disabilities or dementia have faced increased difficulties during COVID- 19. In South Korea most older people with disabilities are more likely to have a poor living status, relying on support from government or local communities. Choi, working in the policy sector for people with disabilities in Seoul, is worried that older people with disabilities are more likely not to receive proper care, due to social/physical distancing rules and the practice of avoiding face-to-face contact. As they stay at home alone for the most part, and even when they live with others, they will be vulnerable due to these changes. Older people with mental disorders, in particular, need constantly to have access to a social network via their contact with care facilities. If they end up staying at home for a long time, they may struggle with worsening symptoms.

“Disability should be understood as involving multi-dimensional perspectives, not just a condition affecting poor or weak people. Older people with disabilities face more difficulties. I am worried that older people with disabilities staying at aged-care facilities have been exposed to higher risk of infection, due to activities requiring more human contacts. Older people with disabilities living alone struggle with reduced care services during the pandemic. Those who need to go somewhere may face mobility restrictions because call taxis for people with disabilities may not be available during COVID-19. … The government has assigned a sign language interpreter in regular press briefings about the COVID-19 situations. Although many people may believe that adding captions is enough to meet the needs of persons with hearing disabilities, most people highly rely on sign language interpretation.”

Seoul City, however, has extended the supply of call taxis for people with disabilities, and those using the service are satisfied with this expanded service, since waiting time has been reduced and vehicles are appropriately dispatched, taking account of whether wheelchair access is required. The waiting time on average was 55 minutes in 2019, but 30 minutes in 2020. In 2021, the aim is to provide a taxi within 20 minutes. Of the total 39,421 registered users of the service 70.3% are people with wheelchairs, as compared with 29.7% who do not use wheelchairs. Seoul has developed this service using ICT infrastructure (e.g. a mobile application for requesting the call taxi and finding out the estimated waiting time, providing a simplified online registration process) (Seoul Metropolitan Government, 2021a).

69 COVID-19 has called for social attention to be paid towards vulnerable populations. Sign language has been provided in television broadcastings during disasters or national events, but this has consisted of a sign language interpreter being placed on the small bottom right corner of the screen. Many people with disabilities are likely to face difficulties in understanding sign language due to the small screen, making it difficult to determine expressions, etc. Broadcasts about COVID-19 have involved changes, a sign language interpreter placed next to announcers (The Kyunghyang Shinmun, 2020). Some local governments (mainly in large urban areas) have provided a 24-hour sign language service via ‘phone or online (e.g. Daejeon Metropolitan City, 2018), but there is still a lack of sign language interpreters and numerous difficulties for people with disabilities. Baek (2020) emphasised that no vulnerable group – especially people with disabilities – should be excluded from having access to essential information during national disasters such as COVID-19. Compared with the response to MERS, the societal and policy treatment of those with disabilities has not improved significantly (e.g. there is no backup care provision for when their families become infected, or for providing essential information if they need to move clinics due to infection). Although the government started to provide social services that can be accessed in urgent cases (e.g. Care SOS Service in Seoul which has been carried out to 25 districts since August 2020) (Seoul Metropolitan Government, n.d.), older people with disabilities have faced numerous challenges during the pandemic.

The Moon Administration has emphasised that dementia is a social issue in an aged society and individuals’ dementia should be treated by the government policies and welfare systems, such as the LTCIS, in order to enhance ageing healthy lives (MOHW, 2021a). Dementia is recognised by the government as a critical agenda, and it has emphasised the need to move the burden of care from that of the household to that of national social care for older people. Those with dementia have been highlighted as a group experiencing a particularly challenging existence in old age facilities/centres during the period of COVID-19. The government has, therefore, been cooperating with various care facilities in identifying and addressing the needs of older people with dementia.

Hwang, working as a social worker at a day and night care facility in Seoul, spoke about how difficult he has found it working with older people with dementia during the pandemic period. Depending on the level of dementia, their responses to COVID-19 vary

70 greatly. At his facility, he reported, men who did not participate in activities or programmes provided tend to wear a mask properly. Women who had joined programmes and had been active in socialising with others are, in contrast, likely not to wear a mask when staff members are not present:

"Older people with a low level of dementia learn what they need to do during the COVID-19 situation from the education provided – wearing a mask and washing hands – which should be followed as the best approach for individuals. However, older people with dementia just pull down their masks after 5 seconds. The pattern is not related to gender. Although staff keep saying to wear a mask, while they often recognise that they need to wear a mask, they end up not appreciating the current situation for themselves, once they start to show dementia symptoms. They do not know what the current COVID-19 situation is. They were educated at the point when they first put on a mask, but there is no correlation, in their minds, between wearing a mask and COVID-19."

Daoust (2020) found that older people tend to follow government regulations to reduce the scale of the infectious disease, avoiding taking public transport, having small gatherings and inviting guests over, but they are less likely to wear a mask (especially those who are in their 80s and 90s). As with Daoust’s findings, older adults in aged-care facilities may choose to take personal preventive measures such as wearing a face mask, but due to their cognitive level, older people with dementia need continuous instruction from staff working with them.

4.1.1.5 Worries of Family Members about Older Adults Coming to Facilities Older people who are living with families or children are reluctant to go to aged-care facilities during the COVID-19 period – especially since many facilities have had group infections. Yoon, working as a social worker at a day and night care facility in an urban area said that:

“Since COVID-19 has been an ongoing epidemic for a long time, older people are worried about coming to and staying in our facility. Most of the older people who have not come to the facility are affected by their families or guardians being sensitive. However, older people want to come to facilities, because they like to stay here rather than staying at home alone. … We understand that there are worries about lives-based groups, but we have managed the facility well through daily disinfection.”

Yoon acknowledged that older people’s children worry about their parents coming to facilities but pointed out that older people enjoy spending time in aged-care facilities.

71 Families who worry about infection in facilities do not want their older people to spend time there. Hwang, working as a social worker at a day and night care facility in Seoul, also mentioned the same issue as Yoon highlighted:

“At the beginning of COVID-19, 20% of the total older people did not come to our facility. I guess that they thought the facility responded well to the epidemic – daily health check-ups such as body temperature twice, and most of the aged-care facilities in Seoul have had responded to the virus infection through isolation/separation of people with suspicious symptoms, so they decided to come to the facility. In addition, if older people do not come to facilities, no one can care for them. Most of the family members living with older people go to work, so older people with dementia may have a risk of accidents during cooking, going to the toilet, etc. ... Older people living alone also come to the facilities because of the quality of life.”

Hwang’s facility has 20 older people living alone or living with family members and 9 staff (e.g. social workers, care assistants, drivers). Those who are living with children are usually picked up by their children in the evening. Based on interviews with Yoon and Hwang, both of whom are working at day and night care facilities, older people want to attend the facilities, although their families or children are worried about them spending time at these centres. Those whose families or children express concerns do not come to the facilities in order to avoid any infection. Moreover, many older people in aged-care facilities are financially dependent on their families. Although they would like to spend time at facilities – perhaps for hours – they cannot do it without their families’ permission. During an epidemic period, independent life for older age groups has been constrained by the concerns of their families, leading to them not being able to spend time with their friends or neighbours.

However, Yoon and Hwang emphasised that care facilities have been managed professionally, with procedures and modifications to these environments introduced with the aim of preventing infection – in terms both of transmission from staff to older people and between older adults. With constantly revised policies for care facilities specified by the government and the city to which their facilities belong, the facilities have been ventilated every two hours (although older people complain about this), with body temperatures of older people taken every day, and the COVID-19 tests for all being carried out. Both Yoon and Hwang are of the view that it is better for older people to come to facilities, having care from staff, spending time with others, and building up social

72 networks, although there are risks of infection in facilities during COVID-19. Older people coming to aged-care facilities usually do not work, so they end up spending time at home if they do not come to facilities, which may cause more negative impacts on their lives.

4.1.2 Depression in Older Adults Living Alone and Staying at Care Facilities Depression is not unusual amongst older people and is recognised as being higher due to the extended COVID-19 situations. G. Kim, M. Jo, et al. (2020) found that, between 2002 and 2013, the prevalence of depression was higher in women than in men for most age groups and depression levels rise with age. COVID-19 caused isolation, leading to mental anxiety, referred to as ‘Corona Blues’. In common with most of the population, many older people also experienced a psychological change. For example, older women living alone showing symptoms of mild depression during the pandemic are more vulnerable, due to their age (their 80s), low income and the death of their partners. Han, as a care assistant visiting older people living alone in an urban area, said that:

“Older people I have met have felt very isolated because they cannot go to the community centres and even neighbours’ houses. Older men spend most of their time at home and they even do not go out of their house. Older women sometimes meet their 2 or 3 neighbours to have a chat or have a lunch together, but they do not go to community centres.”

Han, who has worked with 16 older adults – most of them are in their 80s said that many older people living alone usually stay at home and avoid going out during COVID- 19 (Lee & Kang, 2020; Shin et al., 2020), although they can go for a walk with a mask. Prior to the pandemic, older people used to spend their time at community centres with their friends or neighbours in the same generations, but COVID-19 has restricted their social life. They feel bored staying at home. Hwang, working as a social worker in a day and night care facility in Seoul, said:

“I think depression arises when people are not able to meet each other. In my facility, some older people who lived with their working children had thought about suicide, due to severe depression from staying at home, with one person having been in this situation for two years, with the additional problem of visual impairment. After they started to come to the centre, their symptoms have improved considerably. ... Older people living alone should keep in touch with friends, families or neighbours via ‘phone.”

73 At aged-care facilities, older people are less likely to feel depressed or isolated, as they have more opportunities to keep socialising with others belonging to their own generation or with staff members in younger generations. He pointed out that the phone is a good means for them to feel less isolated during COVID-19, in a context where people are supposed to avoid face-to-face contact. Likewise, Yoon, working in a different care facility, agreed that aged-care facilities help to reduce older people’s depression levels.

“Older people can communicate with others in a similar age group and do look much happier, singing songs, joining various social activities, having a walk together.”

Older people who can have help from children or neighbours – such as purchasing masks – are less exposed to depression or frustration, compared with those living alone during the pandemic. However, based on interviews with Han and Hwang, older people’s depression level is improved by contact with their friends, participating in social networks, or meeting those in a similar situation. This is related to the findings of Shin et al. (2020) – that having social networks reduces the risk of depression. Older people who are socially isolated have experienced higher depression levels compared to those who are not in this situation and the gap has, therefore, widened between those living alone and those regularly attending care facilities.

4.1.2.1 Solutions of Depression: Mental Health Care Service Provided by the Government Since the 29th of January 2020, the South Korean government has provided the mental health care service in cooperation with the National Centre for Disaster Trauma and local mental health care centres. Up until the end of November 2020, 1.05 million cases of mental health consultation were recorded (Korea Policy Briefing, 2020c). Prior to COVID- 19, there was not an official service for mental health during epidemics or disasters in South Korea. The provision of mental care services varies, depending on local governments and welfare policies. Han, as a care assistant visiting older people living alone in an urban area, explained that a specialised mental health care service for old age groups in the urban areas she covers has only recently been introduced (late 2020).

“This service is designed for older people who experience severe depression or have suicidal thoughts. Before that, the city conducted a survey for older people and social workers, including myself, together with other staff, helped people to complete this.

74 The aim is for the service to be systematised to a greater extent, in order to help a wider range of older people who are in need.”

She hopes that the service will have a positive impact on older adults living alone. Many local governments have provided older adults living alone with indoor plants or a kit to grow bean sprouts, in order to alleviate their isolation and depression (e.g. Seoul Metropolitan Government, 2020c). Older people in the Japanese Colonial Generation and the Liberation Generation may not express their feelings although they may be depressed or frustrated. Especially, those living alone – who are more vulnerable to depression – may not find a way to ask for help with their mental health. The work of care assistants or social workers, who have visited older adults’ homes during the pandemic, is important in addressing levels of depression and isolation. The central government and local governments can, also, arrange a variety of mental health care programmes to encourage older people to feel positive. In addition, daily communications with families, friends and neighbours are helpful for their mental health.

4.1.3 Recognition and Adaptation of Older Adults Older adults have had a difficult time since COVID-19 broke out. COVID-19 has been a feature of daily lives for more than a year, and has had a significant impact on older people. Han’s work as a care assistant visiting older people living alone has involved phoning them two to four times per week and sometimes visiting them every week during the COVID-19 period, although her work schedule has changed according to government guidelines relating to the epidemic. Her work includes asking older people about their daily lives, difficulties experienced and trying to find a solution for these, based on the local community’s guidelines and the services that are available.

“At the beginning of COVID-19 – for approximately three months – they had a difficult time, but they have tried to deal with the situation. ... Their children may not even call them, but they are pleased to have this kind of service managed by the city, regularly receiving calls from care assistants or social workers and meeting with them.”

Older adults, with whom Han has worked, have been satisfied with the service provided in urban areas and they have more chances to speak with care assistants or social workers about their life and difficulties. These staff, thus, having consulted with older people, can provide more suitable care. Hwang, working as a social worker at a day

75 and night care facility, also highlighted the importance of continuous communication for older adults’ daily life.

“At the beginning, two months in COVID-19, older adults did not know what they should do, so they wore a mask outside, but not inside. Since COVID-19 has lasted for more than 10 months, wearing a mask has become part of daily life, although they complain about the inconvenience. They sometimes even sleep, wearing a mask. Older adults also complained that it is too cold with frequent ventilation of facilities, although we explained why. They sometimes did not want to be bothered about using a sanitiser.”

COVID-19 has markedly changed life in aged-care facilities and older adults have often not felt comfortable following the new rules and constant changes. They, have however, started to adapt to the reality, after a confusing time in the beginning. Hwang also explained how there have been different patterns within old age groups:

“I think biological age is a better way to explain old age groups rather than chronological age. Those with a body in their 60s do exercise to look after themselves. Those with a body in their 70s do things slowly, but they also look after their hygiene. If someone suggests something to them, they do things happily. However, those with a body in their 80s and 90s are physically weak and tired. They are afraid of trying new things. Although someone suggests something, they are the last to try it, after other age groups. They do not want to be alone, but they do not want to be the first to do things.”

Hwang emphasised the importance of taking account of biological age – which may vary depending on lifestyle such as diet, exercise, etc. Those in their 60s or 70s in biological age still have the capacity to have an independent life, but those in their 80s and older in biological age may need some person or a group to spend time with, in order to enjoy successful ageing. This finding, however, may be related to the features of specific generations, currently in these older age groups.

Hwang also mentioned that Seoul has revised regulations for aged-care facilities, in accordance with the level of virus spread in local communities (e.g. providing the COVID- 19 tests for older people and staff in facilities, or perhaps restricting laughter therapy). This laughter therapy is usually provided in aged-care facilities and is considered to help older adults to have a positive mood and higher life satisfaction (Song et al., 2013). The pandemic, however, led to the cessation of several programmes, including laughter therapy, which has affected the lives of older adults. Yoon, working as a social worker at

76 a day and night care facility, as does Hwang, also outlined the options available for older adults in his facility:

“During COVID-19, older adults may sing a song, wearing a face mask, and eat meals at the table separated by partitions. They also can take part in the rehabilitation and cognitive therapies using computers, calligraphy, drawing, physical activities, and so on. ... The cognitive therapy which was designed by a company, using a computer programme consists of several games.”

The interviews with social workers working at facilities for older age group – Yoon and Hwang – suggest that facilities have provided older people with a range of care services and that these services have been continuously available – even during the pandemic, as a result of carefully responding and adapting to restrictions and public health regulations.

4.1.3.1 Thoughts of Younger Generations How do older adults think of younger generations who have not experienced wars? Yoon, working as a social worker at a day and night care facility talked about how older adults in his facility have spoken about younger generations:

“Some older adults in their 70s think younger generations are rude and do not respect old ages. They sometimes told us about their married life and how they looked after older people when they were younger. Making comparisons with their own lives, they grumbled about younger generations.”

Based on Yoon’s interview, older adults reflect on their own earlier lives when they see younger generations. They had been forced to follow the Confucian social ideology, with its prescriptions about social order and age groups, but current younger generations (e.g. the Sampo Generation, the Millennial Z Generation) have been less influenced by these ideas. Yoon, however, mentioned that there are sometimes conflicts between care providers and older adults in aged-care facilities (discussed in Section 4.2).

4.1.3.2 Political Perspectives of Older Adults Towards the Government The current government has developed various welfare care policies for older people and a broad range of those in need have taken up these services, with customised care being provided by local communities in 2020 as a trial service (MOHW, 2021a). The policies for older adults have been continuously revised, reflecting changes in the ageing population and taking account of the different demands of each generation. Nevertheless, some

77 older people do not like the Moon Administration because of lasting resentments based on the Korean War in the 1950s against North Korea. The Korean War has been a significant moment for their lives – assuming even greater importance than COVID-19. Those who belong to the Japanese Colonial Generation and the Liberation Generation experienced the war and this, for them, is still a traumatic memory. They are also highly committed to the country‘s well-being, because of their experiences in their youth. While working at a care facility, Yoon reported having often heard critical comments from older people about the current government:

"The Korean War is the most awful experience in older people’s life. Unfortunately, the war is mentioned during the treatment of dementia. They do not think the war was necessary. So, I think they prefer the opposite side of the government. Kill the Bbalgaengi7! They do not like North Korea because they experienced the war."

Older people have negative images of North Korea because of the Korean War in the 1950s when they were young. Most of them lost their families, friends and neighbours during that time (e.g. separation, death). Han, as a care assistant visiting older people living alone, also thinks older adults do not like the government and has noted some of the reasons that they give for this view:

“Older people think the government is too generous to North Korea. They are highly interested in the nation’s success and wellbeing, because they experienced severe poverty and difficult times.”

Most of the older people she met were very critical of the current government and the political party they represent – for instance, viewing the government‘s response to North Korea as too sympathetic. Park and Chung (2021) also explained that the Moon Administration has positioned himself as more pro-North Korea and closer to China than previous administrations, while taking a stronger stance against the United States and Japan. Despite such views, those who Han met do not take part in protests against the government, the main reason being the lack of transport for the elderly.

4.1.4 New Changes in Older Adults’ Lives: Technological Culture COVID-19 has imposed a lifestyle change on older people. The penetration rate of smartphones in South Korea is very high and many older people have smartphones

7 A slang term for communists or communism

78 (Gallup, 2018). COVID-19 highlighted the importance of avoiding face-to-face contact and emphasised the need for a broad digital society, making it possible to experience a new culture supported by various technologies – regardless of gender, age, race, etc. Hwang, working as a social worker at a day and night care facility, said that he brought older adults to a shop where self-service facilities were, but observed that they did not use the machines provided.

“Most of older adults coming to our facility have dementia. There was an older person in their 70s using a smartphone well. Those living alone use a smartphone and answer the calls, but do not call someone. Those living with families do not use a smartphone, because their children look after them.”

Speaking about his work at a care facility, Hwang said that older people with dementia rarely use phones and that most of the older people at his facility do not consider that they need mobile phones, because their families help them. Those who come to his facility have only minor illnesses, so they rely on their family members. Han, as a care assistant visiting older people living alone in an urban area, also raised a similar point, echoing Hwang’s experience:

“Older people do not use kiosks, but most of them have mobile phones. Their children helped them to use shortcuts on their phones, so they click the button. Most of the older adults usually answer the calls, but do not call someone themselves. When a missing call is shown, they do not call back. ... I saw an older person using a computer. Not many older people with whom I am working, use a computer.”

Based on interviews with Hwang and Han, it would appear that many older people are not familiar with using machines or self-service facilities in shops. Most of them have mobile phones, but they may use these only to answer calls. Even when missed calls are registered, they generally do not return calls.

Choi, who is employed in the policy sector for people with disabilities in Seoul, is worried that technology is designed with the majority in mind, rather than those with disabilities. Most of the kiosks established in shops in South Korea are not suitable for those with disabilities, as they may not be able to reach out to use the machines.

“Older people with disabilities may not reach the kiosks in shops. ICT should include all populations to provide a universal environment. Many people with disabilities are excluded from this ICT development. They need more assistance to use such services as well as help to improve their life at home and I think that ICT considering their needs could contribute to the quality of their life.”

79 Choi also highlighted that Seoul already had a great infrastructure of ICT which could respond to the COVID-19 situation. This can offer a useful model for developing countries, where ICT is generally not used to manage welfare systems during a disaster. The OECD (2020b) encouraged the use of ICT which is supposed to strengthen social support networks so that people do feel socially isolated, and this system also allows for monitoring and identifying ways to improve their health status. During the COVID-19 period, Seoul City has held various cultural events, such as the senior film festival (Seoul Metropolitan Government, 2020d), performances of dance, chorus and music to try to recover dementia (Seoul Metropolitan Government, 2020e) and an event focused on sharing storybooks (Seoul Metropolitan Government, 2020h) for older adults via online space. These events show how older adults enjoy life and what active ageing is like. Using the medium of digital space, these initiatives also aim to understand how older generations interact with other generations. Likewise, Shin et al. (2020) showed that many older adults started to use smartphones for watching videos, listening to music, searching for information, etc. during the pandemic. If friends or families help them to use mobile phones or digital devices, they are more confident about using this aspect of ICT.

This section introduced an outline of how the lives of older people have been affected during the pandemic, and findings from interviews and demonstrated the ways in which the outbreak of COVID-19 and associated impacts on their lifestyles and living conditions. Those living in aged-care facilities may be given priority for the COVID-19 tests and vaccines, but those who are living alone and suffering from chronic respiratory illness have a high risk of infection (Cohen & Tavares, 2020). In addition, staff members working with older adults have also been affected by fear of infection and difficulties encountered in facing unpredictable situations (Kim & Lee, 2020). The following Section 4.2 introduces the topic of how the environments of staff working with older people have changed during the pandemic and which aspects cause the most difficulties for them as essential workers.

80 4.2 How the Environment in Which Professionals Working with Older People Has Changed Senior-sector workers are essential personnel in an ageing, aged and super-aged society, but social awareness and policy responses have neither recognised their input, nor have been proportional to the degree of mental and physical fatigue that arises in this field of work. As the elderly population increases and various facilities related to old age multiply, treatment of these workers will become even more important. In addition to social workers or nursing assistants working in facilities, and care assistants visiting the homes of the elderly, change is required in terms of societal awareness of the social situation of older people and the necessity for structural improvement (e.g. labour environment, working hours, salaries).

Yoon, working at an aged-care facility, suggested that caring for older people in a facility is difficult, because, as people get older, physical and cognitive levels decline, but they may not recognise this and may expect to be treated as they previously were in social contexts:

"Their mentality or mind is not old, but their body is getting old. Their cognition and body are like those of a kid, but we should not treat them like that. They are weak, so we should be more careful. ... We have cared for their safety at our facility."

Although she enjoys working for older people, as a care assistant, and likes to pay attention to their needs, the demands can be cumulative and, Han reports that she sometimes feels tired due to her work:

"We often experience a kind of burnout. Older people we meet are old and ill. So we sometimes feel down because we meet too many ill or sad people. We also sometimes aware that our energy is reduced."

Workers in facilities are relatively young and care assistants visiting homes of the elderly living alone are often women in their late 50s or early 60s. Female care assistants working with older adults are, unfortunately, facing various conflicts (e.g. with the families or guardians of elderly individuals) or even find themselves facing abuse or sexual harassment from the elderly (Rim & Lee, 2013). There are many reported cases of conflicts and abuses between social workers and older people (or older people’s families) (e.g. Kim & Kwon, 2013). Although most of the cases are not officially reported, due to the emotional burden involved or fear of damaging the reputation of institutions, etc.,

81 new cases have continuously appeared and provision of social and legal supports are urgently required, in order to protect both parties. In many social welfare facilities, legal services for situations such as assault and damage are often not available or readily accessible. Seoul City is, however, attempting to provide legal services with respect to these issues (Seoul Welfare Foundation, 2020). Moreover, for many older people there can be a significance between biological/physical age and chronological age, so that workers may be required to provide them with extra care. In many instances, the protection system for staff working with older people is weak.

4.2.1 New Care Service Needs COVID-19 has raised questions about existing facility-oriented care services in South Korea. According to Kim and Park (2020), each aged-care facility and institution cannot make decisions about the direction of care services during the pandemic, as they do not have the authority to do. Staff working at facilities/institutions have had to wait for responses from local governments before any changes can be put into place. Because COVID-19 is an unprecedented pandemic in modern society, specific regulations and policies were not in place in every sector throughout the country. Local governments were not responsive to making available rapid and suitable social welfare benefits for older people in need, instead often relaying ambiguous messages. Han, as a care assistant visiting older adults living alone, said that:

“The city did not give us specialised regulations. Just to wash hands and use sleeves to cough. … The village I visit was well managed by the head.”

Han’s urban area did not give care assistants or social workers visiting older adults specialised preventive rules or equipment for essential workers’ protection. The protection was only focused on individuals’ preventive measures and their responsibility. Hwang, as a social worker in an aged-care facility in Seoul, commented that support has focused on materials, with Seoul City providing sanitisers, masks, and thermometers. In the absence of clear guidance, many staff members working at aged-care facilities have been confused about the situation. The non-face-to-face working environment, necessitated by COVID-19 restrictions is a new aspect of welfare provision. Care services, however, cannot be delivered in a fully digital or contact-free manner. Han still had to visit older adults’ places although her work could often be phone-based.

82 “I usually call older adults when the COVID-19 situation is getting worse. However, I visit their places because I need to deliver donated stuff like bread to them and I take a photo to record this.”

Although delivering stuff is not a work for care assistants, they sometimes deliver items (e.g. masks, sanitisers, meals) that have been donated for older adults by (privatised) companies or institutions. There are rarely volunteers to deliver these, due to the risks associated with the virus, so that social workers, care assistants, etc. have done this. They usually take a photo to make sure that goods have been received (and press releases frequently include photos of donations). Care services cannot be switched to be entirely contact-free, so combined and flexible care service is required.

There have been different responses to COVID-19, depending on local governments. Although South Korea has quite a number of aged-care facilities designed to meet social demands. Y. Kim and S. Park (2020) highlighted that community-based care services (i.e. ageing in place) and self-care should be given more consideration. Since the COVID-19 outbreak, many volunteers and workers have left work and reduced manpower has caused a greater physical and mental burden on remaining workers. Care services should not rely exclusively on facilities. The central government and local governments could do more to help older adults to look after themselves and, thereby, enhance their health status (self-care) (C. Kim & S. Park, 2020; OECD, 2020b). The role of local communities with regard to ageing care should be considered, based on lessons from COVID-19 cases. The next Chapter 5 – includes reflections on how new urban spaces could be designed to better respond to the next epidemics to occur, and, in particular, how such developments could assist in caring for vulnerable populations. Findings from the discourse and content analysis are presented (see Section 5.1) highlighting how a well-thought-out urban space could simultaneously provide the opportunity for different generations to reside alongside each other and when a range of care services and welfare policies can be actively combined (see Section 5.2).

5 Design of New Urban Space

COVID-19 has engendered a greater interest in health at the individual and community level and has led to a growing awareness of the need to better support vulnerable

83 populations, including older people (OECD, 2020b). The South Korean government has actively responded to COVID-19, in cooperation with medical professionals, since the beginning of the outbreak and the public’s perception of the government’s COVID-19 responses and policies have reshaped the political environment (Park & Chung, 2021). The COVID-19 situation in South Korea provides lessons for designing new urban spaces as part of a strategy for preparing or responding to future epidemics – and, in particular, emphasises the importance of avoiding the marginalisation of older people.

Older people who live in facilities, or who spend most of their time there, may experience less social and mental depression, due to interactions with others, but meetings with outsiders, including family and friends, are not permitted. They are likely, therefore, to face another type of dislocation, as a result of blocked connections and communication with the outside. Those who live in nursing hospitals in order to receive expert medical treatment cannot live independently, so that they have little control with regard to protecting themselves from infection. As such, older people living in or visiting a facility cannot be free from the risk of infection, posed by workers at the facility or by other residents living alongside them or using the facility. Older people living alone may face smaller risk of infection from others living at facilities, but may also be vulnerable, because of a lack of essential information and mental anxiety, caused by COVID-19 and fear of infection.

Most of the older people living alone in South Korea belong to the lowest income level (OECD, 2019a). They were already – prior to COVID-19 – receiving financial, material and mental health support through customised social welfare services provided by the central government and local communities, and these have continued to have been provided. Most of the elderly facilities in South Korea operate privately with some governmental support (e.g. expenses, subsidies, insurance) provided for facilities and their target population. During the pandemic period, facilities have operated according to the management of each local community (determined mainly by the city where they live), in addition to the government’s guidelines, and the facilities, themselves, have worked with staff in order to prevent (or minimise the risk of) infection. Since infections from COVID-19 have spread rapidly in facilities, such as group-dense living environments and treatment facilities, this has highlighted the need to revitalise (smaller-scale)

84 community care, in which local resources are linked to area characteristics/particular needs, rather than providing generic group-focused services in ‘ageing’, ‘aged’ and ‘super-aged’ societies.

This chapter aims to understand how the South Korean public views older people, through examining materials and discussions posted online during the pandemic. This includes a content analysis of how the government has considered older people, drawing on official documents which present government statements and announcements (see Section 5.1). Besides, Section 5.2 suggests what an ideal new urban space might look like and identifies those features that would be most valuable, allowing for effective preparation for future epidemics and the protection of vulnerable populations in general – and older people, in particular.

5.1 The Public and the Government To examine how the public views older adults during the COVID-19 period and how the government has responded to the virus, social media platforms such as Facebook and YouTube and the government website have been studied. The materials selected for analysis are those which provide free access. Facebook is an online space for South Koreans to leave their comments freely, as compared with other domestic online spaces. That is because the signing up process is easy and does not require too much personal information. To use a domestic online forum, people are required, at the very least, to register their phone numbers. In the past, the provision of national identity numbers was mandatory when people signed up for a domestic website. Like Facebook, YouTube is an online space mainly supporting videos, and the South Korean government and many local media outlets have embarked on (live) streaming of their announcements about COVID- 19 situations. People can have free access to watch the broadcasts and follow access updated information whenever they want and can also register their opinions. Users on Facebook or YouTube can, however, set up their name and profile in anonymous or counterfeit ways. In comparison with Facebook accounts, YouTube accounts do not include many personal interests – which can be referred to individuals’ basic demographic aspects (e.g. age, gender, region, education levels, political perspective). Social media has provided a new online platform allowing plenty of information and data to be generated, regardless of budget, time, or place – thus overcoming the

85 restrictions of limited materials and resources. It is an open space offering flexible access. The possibility of mining social media data for research purposes is a fairly recent development and appears to offer considerable advantages. This social media data, however, raises particular issues, including concerns about informed consent, protection of personal information, and invasion of privacy. Townsend and Wallace (2016) identify four areas that are particularly challenging with respect to social media research: the distinction between what is public and what is private, the issues of obtaining informed consent, maintaining anonymity, and minimising the risk of harm. In this thesis, material for discourse data was harvested from public pages of official institutions or departments, that are related to the central government and local government where all content, including comments, can be accessed as open information. The data used for discourse analysis has been presented anonymously or pseudonyms have been used, in order to minimise the risk of revealing personal information. Tildenberg (2018) says that classic ethical concepts such as confidentiality, anonymity, privacy, publicity and harm, and informed consent can be difficult to be observed in the socio-technical context of social media platforms.

Social media platforms organise their massive data archive using hashtags. The hashtag (#), effectively, provides keywords, through which many people can access the flow of posts designated by these labels and these allow social media data to be categorised ready for analysis, in much the same way as qualitative researchers code thematically (e.g. Caliandro, 2018). Besides, comments as dynamic data linked with the mention code (@) or the reply option and contents as static data in social media show how discussions are flowing and how ideas are developing (Marotzki et al., 2014). These resources can be mined via keywords, providing an initial field-map which can help narrow down, from a mass of data, those that are most significant and can subsequently inform interpretive analysis (Seale & Charteris-Black, 2010).

Content analysis of government statements is considered that they should be treated with reference to COVID-19. These existing documents have been “routinely written, produced, read, consumed, stored, circulated, and used in everyday social life and practice” (Coffey, 2014, p. 367). Section 5.1.1 is based on discussions extracted from four Facebook pages and two YouTube channels, which are managed by government-related

86 departments, and presents findings from discourse analysis. Section 5.1.2 presents findings from content analysis of government statements and official announcements about COVID-19 and older adults, compiled for broadcasts aimed at the public.

5.1.1 Discourses around Older Adults Discourse data has been harvested from four Facebook pages – Seoul City, the KDCA, the MOHW, the South Korean government (i.e. Cheongwadae, the Blue House) and two YouTube channels such as the KDCA and the KTV Kookmin, which are managed by government-related departments. Content released between the 20th of January and 28th of December 2020, was filtered by the two keywords of ‘the elderly’ and ‘older adults’, and comments are also analysed. If there are the keywords in the comments, the following contents are also included. In Facebook, a total of 124 items was included in the analysis (i.e. 7 on the Seoul City page, 48 on the KDCA page, 33 on the MOHW page, and 36 from the government page). These Facebook pages provide a channel for members of the public to access new information (e.g. the current situation about COVID- 19, presented via card news or posters, information about vaccines, social distancing rules, etc.) and other news related to COVID-19. Before the pandemic, these pages also were already regularly updated and shared with the public. In YouTube, a total of 52 items was included in the analysis (i.e. 41 on the KDCA, and 11 on the KTV Kookmin). These YouTube channels provide the government’s official announcements about COVID-19. Most of the contents harvested from the KDCA YouTube channel consist of summarised 6 minutes videos of the full version of the announcements, so that people can quickly catch up with regard to important issues and developments. Most of the contents harvested from the KTV Kookmin, however, consist of 80 minutes of videos and these were recorded as live streaming.

Based on the discourses harvested from Facebook pages and YouTube channels, the South Korean government and the public have tended to encourage each other throughout the pandemic, subscribing to ‘the value of unity’(e.g. “the South Korean government believes in citizens”, “we can overcome crises when we all act together”). It appears that there is a strong belief that South Koreans can overcome the crisis together. This pattern may be historical and fuelled by the economic crisis in the late 1990s. For example, the economic crisis still marks a significant moment, invoking citizens’ pride for

87 people who are their 50s and over, who experienced this crisis first-hand. In general, the majority of the public have been satisfied with the government’s responses during the period of COVID-19 and have appreciated their efforts and the constant commitment of medical staff (i.e. ‘satisfaction, appreciation and recognition of efforts’). This discourse is often weighted by fans of the Moon Administration, many of whom are women, who unconditionally praise the political path he has taken. In the beginning, the public felt thankful for the current government’s active and timely response to the infectious disease, in marked contrast to the previous government’s response to MERS. As the deaths after the Influenza vaccines in October and November 2020 occurred, the public strongly criticised the government, the MOHW, and the KDCA, and such criticisms were sometimes directed towards individuals, such as the president or the heads of various departments. People were also critical of the state’s cautious attitude towards importing COVID-19 vaccines manufactured by overseas pharmaceutical companies and were worried about supply. Nevertheless, the public, overall, has appreciated the contribution of the government, relevant departments and medical staff.

Some groups who do not belong to the same political party represented by the government, however, blame the Moon Administration and their complaints are related to their disappointment with the president’s political path, policies (e.g. housing, stock market, the governmental authority), etc., rather than being concerned with the government’s response to the virus. Others criticise the government response as being influenced by a particular political perspective, rather than addressing the virus itself (i.e. ‘blame the government’s response due to its adherence to its particular political perspective’). Some people even believe that the virus was deliberately spread by the president or the government. Most of the complaints which appear on the government Facebook page are expressed emotionally and aggressively. In comparison with other Facebook pages, the government page has many comments – including complaints – from various socio-economic groups. The page features a number of political debates which are not directly related to COVID-19, but this evidences the public’s desire to build a strong political online space. People who have strong opinions or leave comments that irrelevant to the page content tend to be aged in their 40s and over and living in Gyeongsang Province. For South Koreans, online spaces – particularly Facebook pages –

88 have become a convenient and effective bridge to easily find other people who share the same political perspective.

At the beginning of COVID-19, some people complained and questioned the government admitting people from China, following the first infection in South Korea, which involved a woman travelling from China in January 2020. They were upset that people who were making only a short stay in the country were accorded the same service and treatment as South Koreans. People also suggest that the government should have implemented more strict regulations to reduce infection rates in local communities, combined with robust punishment of people who failed to follow recommended preventive measures, such as self-isolation for 14 days, or who participated in spreading fake news. This response is related to a discourse on the ‘critique of lack of restrictions’. However, such responses have become less common and less strident as the pandemic has been prolonged.

5.1.1.1 How the Public Views Older Adults People whose online contributions show empathy or worry about older adults are prone to use the term, ‘older adults’ rather than ‘the elderly’. People who empathise with the vulnerable population, and those who are closely related to older people, are more likely to leave suggestions with regard to putting in place a better system for older age groups (e.g. highlighting how they are struggling with buying face masks, given the rapid introduction of the new public mask system, and related limitations of the elderly welfare service and difficulties in complying with specified dates arranged for purchasing public masks). Most of the people making such comments are in middle-aged groups and some middle-aged women empathised with older people who wear worn-out masks, pointing out the obstacles they encounter in trying to source fresh supplies. Such commentators strongly suggest that the government should more carefully examine infections of groups in aged-care hospitals or that they need to revise the public mask system managed by the central power for vulnerable populations (older adults, those with disabilities or with poverty). Likewise, such comments point out that the life of older people is hard and they need to be helped. This is correlated to ‘empathy and care’, and people who express such views have a greater emotional attachment with older generations.

89 Many people expressed extreme anger to the South Korean government including the MOHW and KDCA on Facebook pages, when it comes to older people’s deaths of Influenza vaccines in October and November 2020 (i.e. ‘anger of older people’s deaths due to Influenza vaccines’). Their anger and aggressive expression, however, tend to be used as an excuse to blame the government, rather than taking older people into consideration. Their behaviour was negatively triggered by the government’s recommendation of the vaccines which older people can take for free of charge as a priority and announcements that deaths are not highly correlated to the vaccine itself. Some people strongly suggest older people should have the COVID-19 test when group infections occurred in care hospitals. However, their suggestion tends to report the case and call for more social attention of group infections in aged-care facilities, rather than sincerely caring for older people based on how they deliver their opinions (i.e. ‘report cases of group infections in aged-care facilities’). These public discourses are spoken about older people but formed by stakeholders’ benefits or attracting social attention – rather than considering older people’s lives during the COVID-19 period.

Discussion data gathered from Facebook pages show that most South Koreans follow the rules of the government guidelines recommended during the COVID-19 period. They do think these are responsibilities which individuals should take on board. However, a young boy, Ryu (late his 10s or early 20s) (pseudonym) provides an example of a small, but insistent, group of commentators who contest this idea. He posted his comments on the Seoul Facebook page, criticising the government guideline which stated that the whole population – covering all age groups – should not meet or take part in gatherings. He thinks people taking part in social activities do not pose a risk and that there is no reason for them – including himself – to stop meeting with others. He also thinks that older people are a risk group and they should stay at home, avoiding meetings with anyone else. His opinion reflects a belief in an extreme level of freedom without individual responsibility and supports self-centred behaviour that dismisses or ignores the risk of spreading infection and the associated threats for the vulnerable, effectively putting the onus on older people to stay at home. Several young boys (in their 20s), however, disputed his arguments and highlighted the importance of individuals’ responsibility during the pandemic (i.e. ‘individual responsibility for taking preventive measures’). Ryu’s comments were posted in relation to discussions about Halloween Day

90 (usually involving face-to-face parties – when others were suggesting that people should have an online, virtual party instead). His comments seem to derive from disappointment and frustration at being prevented from having a party, as would have been possible prior to the pandemic. In common with Ryu’s comments, those belonging to younger generations, who like meeting friends and engaging in various social activities, have been stressed and frustrated by the restraints on their social and cultural activities imposed during the prolonged COVID-19 period. The fatigue and disappointment of these individuals were triggered by a rule prohibiting any offline parties on Halloween Day – this being a popular forum for the expression of exotic culture and freedom. The rather extreme views expressed by Ryu, however, were rare, although there were many who said they missed taking part in normal social and cultural life (i.e. ‘frustration of lack of freedom in the ongoing pandemic’). Most people belonging to young generations, however, prefer to tag their friends, sharing content with them, rather than taking part in extreme discourses in those Facebook pages.

On the KDCA channel on YouTube, some people attribute rises in infection to protests against the current government, in which many older people took part, or to attendance at chapels or meeting people in churches. One person pointed out, on the KTV Kookmin channel, that many facilities used by older people are related to religious groups, and those places that have continued to hold religious rituals may lead to an increase in group infections. Some people also criticised the current government’s focus on older people, saying, “it’s ironic, and Teulddak8 who blame the Moon Administration get the most benefits” and “the Moon Administration accepts all people who blame him and his political party”, mocking the government for its perceived preferential treatment of older people. On the government Facebook page, some men shared worries as to whether younger generations will be able to receive the national pension in due course, despite paying high taxes in an aged society. Commenting on the government’s mindful approach to the vulnerable, (constantly mentioning the need to protect them), some people were critical of the response whereby state benefits are provided to those individuals who were most vocal in blaming the government. These views can be summarised as

8 A slang term to depreciate the elderly that has spread around online communities, means, ‘the elderly wearing dentures’.

91 presenting older people as an ‘increasing financial burden on younger generations in an aged society’.

In general, most of the people on Facebook and YouTube did not discriminate against vulnerable populations, including older adults, during the pandemic period. Some of them, however, complained about the increasing benefits of the BPS and questioned the existing threshold of old age (65 years old) in an aged society. People who live with older adults or those with disabilities are more likely to suggest that a better service should be provided via the existing social welfare system and request that it be revised based on their own experiences and those of their friends and relatives. During COVID-19, Facebook pages and YouTube channels have been an important space where people can communicate with others, as well as obtaining up-to-date information. With its rapid growth and pervasive reach, social media has provided a unique tool for public use in modern society, since it allows people to share whatever they want and to initiate quick responses. Prior to COVID-19, people tended to post their thoughts on online domestic community pages, which are closed and involve clusters people with the same tastes or interests. The government has emphasised active communication with the whole population and has created an online space where people can suggest or complain about something, providing a direct channel for raising issues of concern, including calls for others’ votes to pressurise the government into making changes to policies (such as the petition for citizens on the government website). An environment where people can freely express their thoughts online has become more common since the advent of the Moon Administration. COVID-19 has drawn more attention to the global society and people are not afraid of leaving comments online. Facebook and YouTube, therefore, constitute a flexible and open space where South Koreans release their emotions – including appreciation, satisfaction, frustration, anger, etc. about the government and social phenomena – enabling the public to shape a variety of discourses, reflecting their different perspectives and values via integrated or disintegrated voices.

5.1.2 Perspectives of the Government and Its Response to Older Adults During the Pandemic The South Korean government, including the MOHW and the KCDA, has made official government statements, which have been released almost daily, since the first confirmed

92 case of COVID-19. Since February 2020, the government has more frequently and continuously delivered official announcements, and people can have access to this information online as an open source. This section is based on findings from a content analysis of government statements related to COVID-19, which are available as press releases. A total of 237 government statements written by the Central Disaster Management Headquarters (CDMH) which belongs to the MOHW – was used for the analysis and the data were initially analysed using the keywords of older people/the elderly, caring, etc. (see Table 6). On average, the government provided details of the COVID-19 situations almost every day throughout 2020 – such as what contributions relevant government departments were making, how each local community was responding to group infections, and to what extent new regulations or policies were carried out.

Table 6. Items harvested from the CDMH for content analysis Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec. Count 1 25 30 29 29 21 18 25 19 14 13 13

Based on the content analysis, the South Korean government has emphasised the importance of delivering precise and clear materials and has seen this as a crucial media role – especially in the context of epidemics. It has also warned against creating fake news or causing discrimination against an individual or a certain group. The ethics surrounding media coverage and content have received considerable attention, since the Sewol Ferry Disaster. Whenever fake news has caused social problems and people have started to believe the news and, even, act upon it, the government has, for example, tried to correct fake allegations or information via its press releases.

5.1.2.1 How the Government Views Older Adults The government has categorised older adults, pregnant women, those with chronic diseases as a high risk group. However, this term could be seen as inferring that older people, themselves are dangerous beings, so that it would be prudent to revise this description to ‘a group with the highest risk of infection’ (i.e. ‘paying attention to selecting the most appropriate term’). Most of the terms used in the government or office materials are very much influenced by Chinese words or the cultural preference for abbreviation. However, the government considered it appropriate to designate the

93 Shincheonji group as a high risk infection group, when it appeared to be a locus of infection.

While usage of terms can be intentional, and, even, useful, the government chose to issues only generic guidance to this high risk group, advising against ‘going to crowded places’ and recommending ‘wearing a mask when you go to medical clinics or outside’. Moreover, the advices to the high risk infection group have not been as detailed as those directed at the population in general. For the rest of the population (not in the designated high risk group) more rules were suggested: ‘wash your hands with soap carefully’, ‘block your nose and mouth with your sleeve when you cough’, ‘do not touch your face with dirty hands’, and ‘avoid being with those who have COVID-19 symptoms’. Regulations outlined in press releases were neither specific nor clear relying on urging individuals to accept responsibility for taking preventive measures (i.e. ‘lack of clear explanation about the epidemic measures’).

According to the MOHW (2020c), South Korea went through five periods of COVID- 19 in 2020. The first period was between the 20th of January and the 17th of February, when reporting new cases of infection were recorded. The second period was between the 18th of February and the 5th of May, and when group infections were reported in Gyeongsang Province, beginning with Daegu City. The third period was between the 6th of May and 11th of August, with group infections in small groups and Itaewon clubs. Summer holidays and spending time indoors with air-conditioning triggered more cases of infection. The fourth period was between the 12th of August and the 12th of November, when massive protests led to a high number of cases of infection cases, together with those in religious facilities and aged-care facilities. The fifth period was between the 13th of November and the 31st of December, with the ongoing nationwide spread of infection. During the first period, masks funded by privatised companies were provided to older adults in receipt of the customised care and to their care providers. The government decided that outsiders should not be allowed to enter residential aged-care facilities and recommended that care providers in these settings take extra care to prevent infection. During the second period, the government introduced specialised preventive measures for aged-care facilities and care providers. Due to the risk of infection, the government temporarily allowed representatives to acquire repeat prescriptions for some older

94 adults, who had taken medicines for a long time – provided that health professionals agreed to this arrangement. Aged-care facilities managed by the government started to close from the 28th of February. Privatised aged-care facilities started to close from the 5th of March, but decisions about the operation of each facility were taken autonomously depending on factors such as social distancing rules based on the infection status of local communities. Since older adults were no longer attending suspended privatised aged- care facilities, such as day and night care centres, this caused financial problems for their operators. In spite of the fear of infection, many facilities have remained open throughout the pandemic although having repeated temporary closures, in accordance with government regulations. When a massive group infection broke out in Daegu City, the government initiated an urgent care service, showing a ‘high commitment to provide a care service’ for those in need. However, the government designated aged-care facilities – especially care hospitals with older adult residents who are physically or mentally ill – as high risk infection spaces, requiring regular monitoring. Following the recognition that densely populated areas with high levels of commuting (i.e. Seoul and Gyeonggi Province) have recorded higher numbers of infections in comparison with other areas in South Korea, each local community has since compiled a list of the aged-care facilities in operation, which is available on its customised page.

In the third period, the government implemented more strict regulations on aged- care facilities in order to minimise the virus spread (i.e. ‘revised regulation to aged-care facilities’). COVID-19 tests have been available to workers and older people, and the tests are mandatory for older adults wishing to register at a facility. As the number of infection cases in older adults increases, the government has extended its focus to include a broader range of vulnerable populations and risk groups. Nevertheless, group infections arising in aged-care facilities have continued to be regularly reported. This is highly related to the facility-dominated care culture, which shifted from family-oriented care over a relatively short period of time.

Based on the government statements analysed, the South Korean government has taken steps to prevent the exclusion of vulnerable populations during the pandemic and has continuously revised its existing regulations and policies. It has responded when, for example, the petition for citizens gained a number of votes or when a significant number

95 of people complain about the same things online or via some other routes (i.e. ‘continuous consideration of vulnerable populations’). During the pandemic, the government has tried to figure out the thoughts of the public through online surveys and has continued to elicit feedback from the public. However, there is room for improvement in government statements, even though statements were written by individuals working with the government and were checked by several people prior to dispatch. These could be more carefully worded in order to enhance the public’s understanding, rather than focusing on fast delivery or quantity of information provided. Since the outbreak of COVID-19, the South Korean government has continuously emphasised the importance of care services for those in need – especially older adults. Although both aged-care facilities fully managed by the government (e.g. the centres of social welfare) and some privatised facilities closed for some periods during COVID-19, the government has promoted the principle of continuous care for those in need. The government also stressed that social workers, care assistants, assistant nurses, etc. maintaining contact by ‘phone, should monitor the circumstances of older people, questioning them about any difficulties they are experiencing or organising the distribution of donated items to individuals in need.

The Moon Administration has provided a variety of social welfare services to vulnerable populations. Schwak (2020) said that the government has focused on providing support to the most vulnerable segments of the population, maintaining a high level of transparency and efficient communication. You (2020) highlighted that South Korea has conducted accurate and extensive epidemiological investigations of the virus cases with the provision of ICT to alleviate people’s fear and prevent panic in relation to both public health and the economy. In addition, the centralised public health governance has been efficient in managing numerous cases of infection of COVID-19 in South Korea. The following Section 5.2 introduces a discussion and some suggestions as to how an urban space could be designed to ensure that older adults are not excluded and that fosters the capacity to prepare and to mount appropriate responses to future epidemics.

96 5.2 An Urban Space Designed to Meet the Needs of Older People in Future Epidemics COVID-19 is unlikely to be the last epidemic which people will face in the 21st century. Experiences from COVID-19 provide a valuable basis for thinking about how our lives will be changed as a result of the impact of various epidemics. Particularly, findings from qualitative data materials used in this thesis suggest how an urban space might be designed to be responsive to future epidemics and their implications for vulnerable populations, including older people.

In terms of the central government’s rule, the state needs to have a proactive response system in place in order to act quickly in a high risk situation. Infectious diseases, where it is difficult to predict the timing, scale and spread of outbreaks, have highlighted limitations in terms of reliance on the traditional market system (based on supply and demand), which emphasised the role of public health care. The COVID-19 outbreak brought into sharp focus on the lack of resources assigned to public medical institutions, which are charged with mounting a response to emergent infectious diseases. It has also underlined the consequent limits in terms of the possibilities of expansion within the system, in order to deal effectively and efficiently with an increasing number of patients, while simultaneously protecting the community from viruses. When the number of patients increased dramatically over a short period of time (e.g. in the face of group infections), the system for distributing resources was shown to be insufficient and inefficient. The state needs to have a defence system that can respond in a timely manner – even when faced with unpredictable situations that threaten public health. Reviewing and reflecting on the experience accumulated through responding to COVID-19, South Korea should lead to a re-consideration both of the funding and the provision of the national health care system, in order to improve the safety system for the benefit of citizens and residents.

Since the South Korean government chose to avoid lockdowns, essential services – including elderly care – have continued to have been provided. If the government did not allow the opening of care facilities for older people during the pandemic, this would have resulted in serious problems for older people who are in need (e.g. those living alone with disabilities). With uncertainty about the duration or development of a pandemic still the object of ongoing research and unfolding events, it is important to monitor the situation

97 of the vulnerable, including older people, and to anticipate which services they are likely to require in the event of a disaster.

Facility-based care services in South Korea show the need for a community-based care culture where older adults continue to live at home (i.e. ageing in place) and enjoy their ageing life with neighbours and friends as well as with people from other generations. This approach supports the continuous efforts that older people can look after themselves through self-care (C. Kim & S. Park, 2020) and enjoy a successful and active ageing life. Oh and Warnes (2001) pointed out that facility-based care services have been warned in Western countries. Due to dynamic social changes and changing family types, the facility-based care service in South Korea has been experienced as being both efficient and convenient. However, this type of care service makes older people have less responsibility for healthy ageing. Chang (2013) said that older people usually do not want to stay in a nursing home, but often have no choice. If they feel that they are forced to live there, they may be more likely to become depressed. Although they may encounter difficulties with social workers or care assistants at facilities, they do not share their feelings with their children, because they worry about how employees would treat them and know there is no choice but to stay at the facility, since older adults need constant care. Ideally, it should be better – rather than living in a tiny room of a facility – for them to stay in their own homes, alongside neighbours and friends, and sharing their experiences with younger generations. Community-based care can enhance older people’s capacity and confidence to lead positive ageing lives. A community can help to identify older people at risk and to provide safety and protective networks for them, improving access to essential and useful information (OECD, 2020b).

Urban spaces responding to the scenario of emergent epidemics should be equipped and prepared with long-term sustainable response strategies to minimise the damage of infection (Kang, Jang, et al., 2020). In an urban space, older adults are vulnerable – particularly if they have low income, struggle with chronic diseases and have no support network. When an epidemic breaks out, well-resourced urban spaces could promptly identify people in need of help and support and should be well-placed to take appropriate measures. Systems for monitoring and developing epidemic responses should be strengthened, as the combinations of rapid, early detection and diagnosis are critical to

98 addressing any infectious disease outbreak (Reyes et al., 2013). The response of the South Korean government to COVID-19, capitalised on ICT infrastructures which were already set up (e.g. D. Lee & J. Lee, 2020) and were further developed for post-pandemic implementation. Such applications include the mobile-enabled facility to collect data on individuals’ body temperature or symptoms during self-isolation, a band linked with Bluetooth and mobile phones to detect non-compliance with self-isolation and have been key to supporting people’s lives. South Korea’s responses to COVID-19 may not be feasible in some countries where there is a lack of ICT infrastructures. South Korea’s data- driven agility has led to an active and proactive response which has been globally lauded (Our World in Data, 2021).

Urban spaces could usefully operate a system whereby patients infected with the virus can be categorised by infection status such as mild, moderate, severe, and critical (as currently happens in some countries which have taken a geographically-based approach to determining infection rates). This approach would allow individuals to be matched with appropriate facilities, using their infection status label. Each patient should be involved in daily self-monitoring and cared for by health/medical professionals. S. Lee and D. Lee (2020) suggest that residential centres are the best way to achieve these goals, basing this on the South Korean experience. The residential centres should be operated flexibly encompassing both hospitals and clinic centres. The centres require accurate triage of confirmed cases, active participation from residents/patients, and strict compliance with the care policies and regulations within the centre, following the central governance of public health. Furthermore, central governance overseeing work with relevant departments should be systemised post-epidemic in order to enable a proactive response to future epidemics. The final Chapter 6 speculates further on what such a response might involve and includes whole findings from qualitative data as primary data and literature as secondary data.

6 Discussion and Conclusion COVID-19 has been an ongoing pandemic for more than a year and infection cases continuously have occurred with a mutation of the virus although the vaccines were

99 developed and preventive measures have been carried out at individual, institutional and national units. The world is interconnected and numerous mobilities are continuously generated, since space consists of social functions and networks. Infection of epidemics such as MERS and SARS between people has been more typical in modern society. Most appropriate epidemics’ preventative measures are, therefore, required and society should have the capacity to respond to these epidemics. In this society where various factors are intricately connected – especially urban space, older people who are supposed to have low immunity become more vulnerable. Older people living in urban space, in particular, have faced challenges of their existing lifestyle due to COVID-19. This chapter reviews research questions (introduced in Section 1.1.1) (see Section 6.3) throughout whole chapters in this thesis, discusses interesting findings based on qualitative data analysis as well as literature, and suggests points which can be applied to future epidemics in the lessons of South Korean experiences of COVID-19 (see Section 6.1; Section 6.2).

6.1 ICT Infrastructures and Early Response South Korea has attracted praise throughout the world for its timely response and management of COVID-19. It has focused on the epidemiological tracing of all infection routes, employing the ‘K-model’ of ICT application, based on cumulative data to measure virus spread and to accurately pinpoint sites of infection. These digital policy actions, which have been developed and systemised for a short period of time of the COVID-19 outbreak, are converged to minimise the risk of infection and protect local communities. The government has avoided lockdowns – the approach taken by many other countries – instead of relying on continuous monitoring and an early detection system to identify infection clusters and instigating localised temporary shutdowns in order to contain virus spread. The successful monitoring of epidemic spread has been facilitated by technology and the widespread acceptance and use of smartphones, allowing for accurate tracking of individuals’ movements and high interest of information (or data) up-to-date, which is shared as open source.

Seoul, as a representative urban space, has functioned via digital space and has had various and enhanced ICT infrastructures to responded to epidemics. During the COVID- 19 period, Seoul proactively responded to the epidemic with the benefits of existing ICT

100 environments. However, this has raised some concerns (e.g. invasion of privacy) about the power of the state and the other potential uses to which such technology could be put.

6.1.1 Older Adults Struggling with Inequality of Information Access In an increasingly digital society, older adults may be disadvantaged and even marginalised – particularly if they do not possess smartphones or are reluctant to use these. There may also be physical barriers in relation to using digital devices that are increasingly being introduced into the retail environment and this can be a source of further frustration and worry for older people, many of whom share problems experienced by the disabled.

Based on the findings of this thesis, most of the South Korean elderly use smartphones in a restricted range, although they have mobile phones. Older people living with their families are more likely to rely on their children. Most of these older people put their children as the main guardian who contacts aged-care facilities or hospitals. However, older people living alone have had more responsibility for their lives and they use mobile phones, with help from their neighbours, children, etc. Since older generations such as the Japanese Colonial and the Liberation Generations are not familiar with digital devices, Baby Boomers are expected to use a smartphone more actively.

6.1.2 Inclusion of Older People in Society The population has been kept abreast of the continuously evolving situation through daily broadcasts and updates and the government has, from the outset, been responsive, introducing grants to provide financial support to people throughout this crisis, and providing necessary supplies of items such as face masks or sanitisers. Welfare policies have also been revised to take account of the new situation – to provide older people in need with a basic social safety net. Nevertheless, the pandemic, and its associated government-initiated restrictions, have posed challenges for the population in South Korea – as elsewhere.

Vulnerable groups, including older people, have borne the brunt of the pandemic, in terms of a having higher risk of infection and being more likely to become seriously ill or to die once infected. Those who struggle with poverty or are with dementia or disabilities

101 face more difficulties in their livelihoods or daily life to protect themselves from the threat of public health. As mentioned in the content analysis of Chapter 5, the South Korean government has tried to include all populations – not marginalise any groups. There is, however, a blind spot of being excluded. During the period of epidemics, social attention to older people should be required and the state and local communities should have a constant interest in their lives.

6.2 New Ageing Culture The COVID-19 pandemic has occurred against a backdrop of far-reaching changes to South Korean society, which have been extensively documented. With a significant proportion of the population aged 65 or over, South Korea can be classified as an aged society, and projections of future growth in this age group suggest that it will become a super-aged society over the next few decades – principally as a result of increasing life expectancy. South Korea has also undergone a rapid transformation, evolving from a predominantly rural society to one characterised by huge metropolises with high occupancy levels. Urbanisation has also had a marked impact on older people, many of whom have moved from the countryside to live in cities – perhaps to be near their adult offspring, who have pursued job opportunities in the centres of the population. This involves a fundamental shift, likely to involve considerable dislocation and disruption to individuals’ life stories and sense of self.

Anthropological theories stress the importance of conceptual as well as physical space and this was also reflected in the accounts provided by key workers. South Korean society was traditionally based on Confucian principles, which emphasised respect for older people and was viewed as part of the responsibilities of younger relatives, the duty of looking after their aged parents, or other family members. Alongside the exodus from the countryside to urban centres, many more South Korean women are now part of the workforce and, thus, face other competing demands. This has implications for the provision of social care and welfare services, as workers interviewed reported that individuals frequently feel ‘between the gaps’ of these systems, since some criteria regarding qualification for receiving services or benefits are still based on assumptions underpinning the older notions of familial obligations, including obligations to provide financial support.

102 Ageing is a social issue not only for older adults but also for all social members. The increase in life expectancy has also come about alongside a significant fall in the birth rate. They can be lonely, spending long periods of time at home alone – even when living with family members, as these younger relatives are likely to spend a considerable amount of time in commuting to work. Their ageing life should not be dependent on their children’s care but should aim at successful and active ageing. This pattern can reduce ageism and biases of ageing or older people.

In terms of resolving ageism, it is important not to treat older people as a single entity with universal needs, but biological age. Although some difficulties or needs are common to many older people, this can mask the variety of their requirements and the issues that affect them. There is considerable variety within the older population, with the over-65s comprising several generations (e.g. the Japanese Colonial Generation, the Liberation Generation, Baby Boomers), with different worldviews and preoccupations and historical memories.

6.2.1 Care Service System: Community-based from Facility-based South Korea as an aged society has had a variety of welfare policies (e.g. BPS, NBLS, LTCIS) for older adults. However, these policies are focused on older adults who struggle with financial status and age-related health issues. There is a blind spot where many older people still do not receive social benefits due to a legal range but need support. South Korean older adults are not happy about ageing and are worried about how they survive in this country. Why do they have that negative feeling although various welfare policies have continuously improved? While some recognition is accorded the idea of ageing in place, South Korea’s care system is based on aged-care facilities, despite the fact that many older people do not want to spend the last part of their lives in such places (Chang, 2013), where they are not able to connect with the outside world or their families (Jeon et al., 2016). The typical care system which is centred on aged-care facilities has faced a new shift due to the impacts of the COVID-19 outbreak, promoting a digital care space which is more flexible to respond to infectious diseases.

Facility-based care services have been dominated in South Korean contemporary society due to increasing social participation of women who were traditionally care provider of old ages, and different value of younger generations. Since aged-care facilities

103 have categorised a high risk infection space and older adults living in care hospitals have been infected, facility-based care service has been questioned and a new caring model is required. Community-based care, where older adults can manage their ageing life in their place (ageing in place) and aim at successful and active ageing with their friends and neighbours as well as other young generations, should be taken into consideration. Since existing facility-based care service did not support non-face-to-face care or self-care which can lead to happy ageing life and enhance biological age and the service has been confused during the pandemic, more flexible care service which adapts digital equipment’s benefits and highlights self-care management for older people themselves should be called for epidemics in the future. If community-based care service is adopted and developed, the successful ageing model can be suggested with a positive image of older adults and accomplish fewer conflicts between younger generations.

A community-based care service system can be positively and efficiently managed during future epidemics, providing essential information and identifying the most vulnerable group within old age groups. In addition, essential workers at aged-care facilities may not struggle with local governments’ different policies and conservative responses to epidemics and its confusion of administration and management to determine a direction of care service during urgent circumstances, in this community- based care environment. Based on interviews, many older people did not come to aged- care facilities due to fear of infection and worries of their families. As older people decided not to come to aged-care facilities where are operated privately with support of the government (e.g. LTCIS), these facilities can face financial difficulties of operation. Community-based care service may not rely on privatised operation which most of the aged-care facilities in South Korea have had and may flexibly and systematically respond to epidemics.

6.3 Conclusion This thesis presented how the lives of older people living in urban spaces in South Korea have changed and how the government and the public of different generations view older people, since the COVID-19 outbreak. Interviews with key workers highlighted the level of anxiety that affects many older people, as they attempt to protect themselves from the threat of the virus. Older people are already vulnerable, due to the higher incidence

104 in this group of chronic conditions, mobility problems and general deterioration in health status and cognitive ability, as part of the ageing process. Thus, COVID-19 has added to pre-existing problems and has given rise to new ones. Professionals working with older people recognise the threat that attending hospitals, clinics, or care facilities can pose for older people and the potential for their health conditions to deteriorate if they are not able to regularly take advantage of the services that are provided. South Korea did not implement lockdowns and this has been pros and cons for older people: older people can still receive medical services, but they cannot avoid the risk of infection from different generations and its impact.

Based on qualitative data introduced in this thesis, the South Korean government has tried not to exclude vulnerable populations and revised social welfare systems to enlarge the range of recipients of benefits during the pandemic. However, in government statements as press releases, the government tended to focus on older adults living or staying at aged-care facilities rather than those living alone. The statements did also not mention specialised protection for essential workers such as social workers and care assistants working closely with older adults beyond individuals’ responsibility. The public shown on Facebook and YouTube did not (extremely) discriminate against older adults, but some younger generations blame the government’s policies and express a financial burden which their paid tax goes to old ages in aged society. During the period of COVID- 19, the media also did not attack certain groups of older adults to generate negative images since the government has emphasised the media’s ethics and role.

An analysis of a range of documents, including government statements and digital newspaper coverage, together with that of materials harvested online via social media platforms, confirmed that, although the vulnerability of older people is recognised, some sources continue, in the discussion of the need for protection, to stress the responsibility of older people, themselves, rather than that of other members of the public, policy directives, and government agencies. Older people are sometimes portrayed negatively, particularly with regard to their alleged reluctance to embrace change and their inability to embrace the digital world. They are, also, sometimes, represented as a complaining and dissatisfied sector of the population.

105 This thesis examined changes in the lives of older adults during COVID-19 in the context of South Korean society from an anthropological perspective, which expects a deeper understanding of social phenomena with various factors. The experiences of South Korea introduced in this thesis will provide a basis for systematic and practical preparation and response to future epidemics. Older people living in urban spaces have different living environments such as living in facilities, living with families, or living alone, so they have different ways to cope with infectious diseases. However, it is difficult for most of them to proactively respond to these diseases. The state and local communities should help older adults who are vulnerable and manage their status from the beginning of the epidemic, so that they can respond flexibly to new changes as well as the risk of infection. Above all, older adults also need a habit of taking care of themselves – at least to a new generation of older ages who have had different lifestyles in an ageing, aged and super-aged society.

While COVID-19 has fundamentally changed society, both globally, nationally and locally, it has thrown many issues and inequalities knot sharp relief. The situation of older people in South Korean society is one such area, onto which the spotlight has shone. Despite the multiple challenges involved, it is possible that the pandemic may indirectly lead to significant changes that will benefit, in the long-term, not just older people, but society – and South Korean society, in particular.

Some over-arching recommendations relate to the need for the government and various relevant agencies to critically review policies and systems to take account of the changing requirements and multiple disadvantages that older people face – particularly in the context of a pandemic, or other future emergencies. Urban space can be experienced by many older people as a bewildering, alien and hostile space and recognition should be given to this aspect, in addition to considering their more obvious health and social care needs. While government departments and agencies have their own specific remits, it will also be important to engage and collaborate with other constituencies – such as town planners, architects, politicians and pressure groups. In addition to reviewing provisions in terms of urban space, there could be substantial benefit in looking in greater depth at the ways in which digital space could be made more user-friendly for older age groups, and how it might be modified or developed in order to

106 match its capacities with the requirements of older people. At a more local level, care provision and other services could be enhanced and more accurately targeted, through regular and extensive consultation with key workers, service managers, relatives and older people, themselves.

______Sungkyung Kang

107 References

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