Health ministry confronts culture ministry; doctors wrangle with industrialists

The World Health Organization's decision to put excessive gaming on the official list of disorders has divided Korea, among different government agencies as well as between medical professionals and industrialists.

On May 25, the World Health Assembly, the decision-making body of the WHO, unanimously approved the revised 11th International Classification of Diseases (ICD-11), which classified game addiction as a disease in the same category as substance abuse and gambling.

This country has since been experiencing the confrontation of contrasting views between government ministries on the one hand and between physicians and industrialists on the other over how to adjust the WHO decision to the reality here.

South Korea has the fourth-largest market for digital games in the world and is home to various globally renowned games such as Playerunknown Battlegrounds, Maple Story, and Lineage.

The nation is also known in the global community for its outstanding professional gamers making huge splashes in the international gaming stage such as Faker, a professional League of Legends player, and Lim Yo-hwan, the former professional player of the real-time strategy computer game StarCraft.

Such high gaming-related abilities have also been the source of pride to Korean adolescent, with professional gamer ranked ninth out of the top-10 dream jobs aspired by elementary school students in 2018.

Looking back, however, talks about classifying the phenomena of excessive immersion in the game as a disease are not an entirely new concept, even in Korea.

In the past, violence was the main reason. Media reports that a gun-wielding criminal had enjoyed first-person shooter games or a minor who committed murder was a mania of Japanese action role-playing games shocked the general public.

Whether these games were behind violent crimes is still not clear, and such claims were hardly persuasive as the media is overflowed with abundant violent contents itself.

That explains why the concerns have shifted from violence toward addiction recently.

At first, the split of opinion on the WHO decision came inside the government with the Ministry of Culture, Sports and Tourism rejecting the WHO conclusion, whereas the Ministry of Health and Welfare accepting it.

After the decision, the health ministry said it would establish a consultative body of private and public experts, discuss gaming disorder issues, and prepare follow-up measures by June.

The culture ministry, which is in charge of the game industry, however, said it would not participate in the consultative body, claiming discussions mean that the government would accept the WHO's decision and reflect it on policymaking.

The culture ministry delivered its opposition to the revision in a letter sent to the WHO in late April and is also participating in a joint committee for opposing the introduction of game disease codes, which consists of 88 organizations, including Korea Creative Content Agency (KCCA) and Korean gaming institutes, associations and institutions.

The ministry's primary concerns are that the WHO's disease classification can have a critical effect on Korea's gaming export industry. Korean games have long emerged as the most prominent cultural export item, including even other famous items such as K-pop and K-drama.

According to a report issued by the culture ministry and the KCCA, exports by local game creators came to $5.92 billion in 2017, up 80.7 percent from a year earlier.

With such strong growth, the government had been pushing to nurture the gaming industry even further based on new technologies such as virtual and augmented reality.

The Moon Jae-in administration is also moving to relax regulations on the gaming industry. Such moves include the removal of payment limits for in-game items and the gradual easing of the "shutdown system" – nighttime curfew on online gaming for teenagers. Also known as the Youth Protection Revision Act, the Shutdown Law keeps children under 16 from playing online games between midnight and 6 a.m.

The recent WHO decision could halt such an amendment, and the government is fully aware of the dampening factors.

Another front is being made between medical doctors, parents and educators on one side and the gaming industry on the other, exacerbating the division of the public opinion further.

Citizens' Network for Sustainable Digital Media Environment, composed of 21 activist groups, including Citizens' Solidarity for Internet Smartphone Reliance Prevention, released a joint statement on June 13, supporting the nation's adoption of gaming disorder.

"The WHO categorized the status of a person whose daily activities have been seriously impaired due to game addiction as a gaming disorder, which laid medical ground to provide appropriate healthcare services," the network said. "We welcome and support the WHO's decision."

The joint group criticized the culture ministry for failing to prevent game addiction and taking responsibility to build an alternative environment. It said the ministry took a biased stance, only focusing on scrapping the "shutdown system."

Major medical and health associations, including the Korean Pediatric Society and the Korean Neuropsychiatric Association, also said the WHO decision would help identify many pathologically addicted gamers and provide timely medical help for them.

"The WHO has made a proper decision that reflects the growing demand for health services for functional impairment stemming from additive game use," the medical groups said in a statement on June 10. "Heavy gaming could disturb the dopamine circuit same as gambling disorders and alcoholism."

On the other hand, the local game industry vehemently opposed Korea's adoption of gaming disorder.

The Korea Game Developers Association, Korea Indie Game Society, Nexon's labor union, Smilegate's labor union, and Smartphone Game Developers Group released a joint statement, opposing the national designation of gaming disorder as a disease.

"We oppose to psychiatrists' strange logic that games are good but are the cause of addiction requiring treatment. We will listen to various voices to reflect on ourselves and do our best to establish a sound and reasonable game consumption culture," the game industry said.

The industry cited a meta-analysis study on game overuse to claim that more than 89 percent of Korean studies on excessive game use from 2013 to 2018 began with a "framed" hypothesis that game was the cause of behavioral addiction.

Since the WHO's decision, gaming industry employees have also made a united move by changing the profiles of their online accounts with pictures or slogans that claim gaming is not a disease.

"The WHO's decision has made us conveyors of a disease," a game developer told Korea Biomedical Review, asking to remain anonymous. "I have spent the better part of my youth developing games for people to enjoy, and I cannot bear to see my achievements treated as a harmful medium that causes disease."

As ministries and the public have failed to come up with a unified stance, the Office for Government Policy Coordination, an administrative body under the prime minister, has launched a private-government consultative council in May to hear from the game industry, and medical experts in a bid to mediate them.

Korea has at least until 2026 to work out a new Korean Standard Classification of Diseases (KCD) through a compromise that is acceptable by everyone.

As of now, however, the process will likely be rocky and challenging, especially given the massive repercussions it could have on the gaming industry.

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