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HOME > IGEE Proc > Volume 1(1); 2024 > Article
Article
 South Korea’s existential public health emergency: Tackling the low birth rate, loneliness, and suicide crisis
Peter J. Na1,2*, Hae-Won Ryoo3, Jim Yong Kim4
IGEE Proc 2024;1(1):50-53.
DOI: https://doi.org/10.69841/igee.2024.005
Published online: September 30, 2024

1VA Connecticut Healthcare System, New Haven, CT, USA

2Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

3MINDSOS, Seoul, Republic of Korea

4Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

*Corresponding author: Peter J. Na, peter.na@yale.edu
• Received: June 20, 2024   • Accepted: August 7, 2024

© 2024 by the authors.

Submitted for possible open-access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

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  • South Korea is facing a critical public health emergency characterized by a rapidly declining birth rate, increasing loneliness, and high suicide rates. The fertility rate dropped to 0.72 children per woman in 2023, significantly below the OECD average. This decline is attributed to economic burdens, gender inequality, and changing societal norms. If these trends continue, the youth population could halve by 2040 compared to 2023, severely impacting the nation’s economy and demographic structure. Simultaneously, loneliness has become a significant issue, with over a third of Koreans living alone and a rise in deaths from isolation, particularly among middle-aged and older men. South Korea also faces a severe mental health crisis, marked by high rates of depression and the highest suicide rate among OECD countries for the past 25 years. Troublingly, recent trends indicate an increase in suicides among younger age groups. Efforts to address these issues have included government initiatives for mental health support, but these remain underfunded and insufficient compared to international standards. Additionally, the stigma surrounding mental health persists. South Korea can learn from countries like Japan and the UK, which have implemented successful interventions focusing on social integration and mental health. Addressing these intertwined crises requires collective action and a robust policy response to ensure a sustainable future for South Korea.
In 2017, Christine Lagarde, the former president of the International Monetary Fund (IMF), shared her thoughts with Chang Yong Lee, who was then a professor at Seoul National University (Park, 2017) and has since become the president of the Korean Bank. This exchange occurred during Lagarde’s visit to South Korea, following a briefing on the low fertility rate (Park, 2017). At the time of her visit, the most recent fertility rate would have been 1.17 births per woman, as recorded in 2016. Since then, the fertility rate has decreased by approximately 40%, standing at a rate of 0.72 in 2023(KOSIS, 2024). We wonder, what would Lagarde say about the current fertility rate of South Korea?
South Korea’s fertility rate has been declining at an alarming pace. At 0.72 children per woman in 2023 (KOSIS, 2024), it is less than half of the OECD average in 2021 (1.58) (OECD,2024 and half of that of Ukraine in 2023 (1.44) (Macrotrends, 2024), a country engaged in active warfare. The most commonly considered reasons for not giving birth include the economic burden of home ownership, gender inequality, traditional perceptions of women’s roles, income disparity between men and women, increasing age of marriage, and low marriage rates (Mackenzie, 2024). South Korea is notorious for its high expenditure on child-rearing (Mackenzie, 2024). Indeed, the expenditure as a proportion of per capita GDP in South Korea is 7.8%, which is much higher than that in other East Asian countries, such as China (6.9%) and Japan (4.3%) (YuWa Population Research Institute, 2024). The declining trend in marriage rates has also been a concern, strongly contributing to the low birth crisis. For men in their 20s, the marriage rate decreased from 49% to 7% between 1985 and 2020 (Statistics Korea, 2022a). Women in the same age group also experienced a similar trend, with a decline in the marriage rate from 81% to 17% during the same period (Statistics Korea, 2022a). There was a strong correlation between income and marital status, while only 1 in 5 men in their 30s in the lowest income deciles were married, 86% of men in their 30s in the highest income deciles were married (Statistics Korea, 2022a).
If this trend continues, the current youth population is expected to decrease by half by 2040 compared with 2023 (Statistics Korea, 2024a). Furthermore, the national population is projected to decline to 37.7 million by 2070, relative to the current population of over 50 million (Statistics Korea, 2024a). The current median age of South Korea is 45 and is expected to increase to 50 by 2031 and then to reach 59.6 years by 2070 (Statistics Korea, 2024a). A decreasing working-age population, coinciding with an increasing dependent population, will be disastrous for the nation from an economic standpoint. Research suggests that a 1% decrease in the working-age population leads to a 0.59% decrease in GDP, whereas a 1% increase in the dependent population results in a 0.17% decrease in GDP (KERI, 2023). As a result, Korea’s GDP is projected to decline by 28.4% between 2022 and 2050 (KERI, 2023). Moreover, the country’s National Pension Fund is expected to be depleted by 2055 (KERI, 2023).
South Korea’s economic growth was driven primarily by the Baby Boomer generation, born after the Korean War. The fertility rates were as high as 6 children per woman in the 1960s (KOSIS, 2024). This population surge contributed to a combination of a motivated, educated population and high-quality, low-cost labor. Today, with a smaller workforce, companies continue to seek high-quality, low-cost labor, while the younger generation grapples with higher living costs and a desire for better work-life balance. Younger Koreans are known to prioritize personal fulfillment over childcare and education, often opting to use their limited time and resources accordingly. Currently, the Korean government offers cash bonuses for childbirth, child allowance support, childcare subsidies, extended maternity and paternity leave, free medical check-ups for pregnant women, and medical expense support for children. However, more drastic measures are desperately needed to address the existential threat posed by the low birth crisis.
Loneliness is another silent epidemic affecting Koreans. Research has shown that the negative health impact of loneliness is comparable to that of smoking 15 cigarettes per day or drinking six alcoholic drinks per day (Holt-Lunstad, 2015). In 2022, 34.5% of Koreans were living alone (Statistics Korea, 2024b). ‘Godoksa’ (i.e., dying alone in isolation) emerged as a new social problem, rising at an alarming pace of 8.8% per year; the death rate among men is four times higher than that among women (Ministry of Health and Welfare, 2022). Among these deaths, 56.5% occur among individuals in their 50s and 60s, whereas 6.5% occur among younger adults in their 20s and 30s (Ministry of Health and Welfare, 2022). Suicide accounts for 18% of such deaths (Ministry of Health and Welfare, 2022).
In a recent survey of 1,000 adults aged 19-59, 57% of the respondents reported that they had experienced loneliness on a regular basis (Survey on Perceptions of Loneliness, 2024). In the same survey, almost 3-4 adults reported that the government should intervene to combat loneliness basis (Survey on Perceptions of Loneliness, 2024). The UK and Japan have been at the forefront of addressing loneliness at the government level (Kristof, 2023). Both nations have a Ministry of Loneliness and Loneliness Ministers. Since 2018, the UK has spent 100 million US dollars addressing this silent epidemic (Kristof, 2023). They have a nationwide “Loneliness Awareness Week” and installed “Chatty Benches” in local parks where strangers are encouraged to sit and chat (Kristof, 2023). The UK also has a social prescription program, where general physicians prescribe ‘social connections’ to individuals who feel lonely (Roland et al., 2020).
The mental health crisis and suicide crisis have been enormous problems in South Korea. It is known that 1 in 4 Koreans experience at least one mental health condition in their lifetime. According to a study conducted in 2021, the prevalence of depression was 7.7%, which is higher than the OECD average of 4.2% (Ministry of Health and Welfare, 2021). The most commonly cited reasons for such high rates of mental health conditions are anxiety related to economic security, intense societal competition, school violence, addiction, and toxic social media culture.
The high prevalence of depression, along with other mental health conditions, is closely related to the high suicide rate in South Korea. South Korea’s suicide rate has been the highest among OECD countries for the past 25 years (OECD, 2023). Suicide is one of the deaths associated with the highest economic burden on the country. The societal cost of suicide is estimated at 4.9 billion US dollars (Hyun, 2015). The high suicide rate has been attributed to suicide in older adults. For example, the suicide rate in older Koreans aged 70 or older is comparable to the suicide rate of Jews living in Germany under the Nazi regime (Goeschel, 2009). Although still staggeringly high, the rate has been dropping in recent years. However, there is one worrisome trend in the suicide rate of South Korea. Paralleling the steep decline in the fertility rate since 2017, the suicide rate among Koreans in their 10s and 20 s has increased by more than 50% and 40%, respectively, between 2017 and 2021 (Statistics Korea, 2022b). During the same period, the suicide rate among Koreans in their 30s has increased by more than 10%(Statistics Korea, 2022b).
Many of the causes of the high suicide rate (e.g., competitive culture and the environment for younger adults, socioeconomic stressors) overlap with the potential causes of the low birth crisis. With respect to suicide in older adults, the lack of a solid welfare system and the resulting high poverty rate are among the leading causes of suicide. Emile Durkheim, a sociologist and the first scholar to study suicide as a social phenomenon, posited that suicide is inversely associated with the cohesiveness of a society (Durkheim, 1951). Given that South Korea’s suicide rate has substantially increased since the financial crisis in 1997, it could be hypothesized that the changes in social structure and the cohesiveness of society caused by that event contributed to the high suicide rate in addition to economic stressors.
To address the high suicide rate, the Korean government established the Korean Suicide Prevention Center in 2003 as a national resource for research, education, and intervention. Since the 2010s, the government has adopted a more comprehensive approach, bolstering mental health support, social welfare programs, media guidelines, and monitoring internet and social media content that may increase the risk of suicide. Consequently, the suicide rate in South Korea decreased by approximately 20% from 2011--2017 (34.70 vs 23.80 per 100,000 persons) (OECD, 2023). Individuals with lived experiences of mental illness, along with mental health professionals, have continued to raise awareness of mental health and diminish the stigma surrounding mental illness and mental health services. However, such stigma still persists and is a barrier to help-seeking behavior. Furthermore, the budget for mental health and suicide prevention is insufficient to adequately address the magnitude of the problem (National Mental Health and Welfare Commission, 2023). Despite the recent increase in the national budget for mental health care, only 1.9% of total health expenditure is spent on mental health relative to the OECD average, which is 5% (National Mental Health and Welfare Commission, 2023). With respect to suicide prevention, South Korea spends only 1/20 of Japan’s annual budget on suicide prevention (Joint Cooperation of Related Departments, 2018).
Japan is known to have successfully mitigated the suicide rate by 40% from 2003-2019 (OECD, 2023). The Japanese government, in collaboration with NGOs and politicians, has spearheaded national initiatives aimed at limiting overtime work hours and mandating annual stress assessments for large company employees. They have also enforced the responsibility of suicide prevention at all levels of society; encouraged collaboration between mental health professionals and civic groups; provided education for business owners, educators, and school staff; and promoted mental health awareness in schools (Okamura et al., 2021). Furthermore, their suicide prevention policy was revised to focus on life-enhancing factors and prioritize child and youth suicide prevention, with the goal of reducing the suicide rate by 30% between 2015 and 2026 (Okamura et al., 2021). Reducing the global suicide rate by one-third by 2030 is a target for the United Nations (UN) Sustainable Development Goals (SDGs), and South Korea is falling behind.
Overall, we argue that deteriorating mental health and despair are common factors underlying phenomena such as low birth rates, loneliness, and high suicide rates. All of these indicators are markers that show that the current society of Korea is unsustainable. This is the time when our collective efforts are needed. During previous challenges in history, such as the financial crisis in 1997, South Koreans demonstrated incredible courage and resilience. We must start the challenging conversation of addressing this public health crisis in South Korea. The time to act is now.

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