This presentation reviews key health statistics of North Korea with available data sources and draws key implications to public health authorities in South Korea.

1. Current Public Health Issues
in north Korea
Armed Forces Medical Command
Republic of Korea
Cpt. Yoon, Chang-gyo
This presentation contains the presenter’s personal opinion, it can be differ from AFMC official opinion

2. Avg. height of South Korean soldiers > Avg. height of North Korean soldiers + 2cm
Disparity in physical development
between South Korean soldiers and North Korean soldiers
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3. • Unexpected conscription
– Application to KOICA international cooperative physician
– Hoping to be a global health specialist of Korea
– Preventive medicine officer in ROK army : another way to achieving the goal
• Motivation & my future dream
– Stabilizing operation in north Korea during ‘13 Key Resolve exercise
– Limitation to know about actual situation on public health problems in nK
– Meeting with COL. M. Burnett @ 2013 APMMC
– Contribution for my own country, when ONE KOREA making up
• Post-disaster relief and control of communicable diseases
• Any other public health contribution to north Korean people
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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4. • The major problems on public health data of nK
– Closed national system : nK itself, National Security Law of sK
– Maybe poorly formed public health system
– Limited references for accurate estimation
– Low reliability of data, out-dated data
• Collecting and analyzing nK’s data is essential for unification
– For implementing most public health interventions
– To protect nK peoples from communicable disease
– Also protecting sK people and our military personnel from any public
health threats by nK situations
• BUT, WE DON’T KNOW WELLABOUT NORTH KOREA
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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5. • Objectives of this presentation
– Focusing our attentions on public health problems in nK, mostly
communicable disease
– To bring us back to reality which exists in this peninsula
– Reviewing major issues in nK : CD, vaccination, NCD, malnutrition
– Figuring out the CONCEPT of post-disaster preventive medicine
measures
• Limitations
– Reliance to the official statistics : possibilities of under-estimation
– Only descriptive manner
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
5/17

6. The official Journal of Korean Society for Preventive Medicine
In May 2013, it contains some articles related to public health issues in nK
Visit website : www.JPMPH.org
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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7. • Major Public Health Indicators
Mortality indicators
World
SE Asia
region
sK nK
Crude mortality rate by age group (per 100 000 population)
< 15 519 515 38 244
15 - 59 377 429 170 336
≥ 60 4412 5265 2760 4160
Infant mortality rate (per 1000 live births) 61 77 4 26
Under-five mortality rate (per 1000 live births) 51 55 5 33
Cause (%) World
Low-income
countries
SE Asia
region
sK nK
Communicable, maternal
and nutritional conditions
27.5 57.6 34.7 6.1 29.1
Non-communicable
diseases
63.5 33.3 54.6 82.3 65.1
Injuries 9.0 9.1 10.7 11.6 5.8
(YH Lee et al., 2013)
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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8. • Tuberculosis indicators
(YH Lee et al., 2013)
Indicators World
SE Asia
region
sK nK
Mortality (per 100 000 population)
1995 24 44 5 20
2000 22 43 4 17
2005 19 37 4 14
2011 14 26 4 6
Prevalence (per 100 000 population)
1995 269 468 202 738
2000 257 445 184 669
2005 221 370 167 582
2011 170 271 149 422
Incidence (per 100 000 population)
1995 148 217 101 344
2000 148 218 79 344
2005 142 212 88 344
2011 125 189 100 345
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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9. • Malaria indicators
(World Malaria Report, 2012; Malaria Control Manual, 2012; JW Park, 2010)
0
50000
100000
150000
200000
250000
300000
350000
0
500
1000
1500
2000
2500
3000
3500
4000
4500
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
sK
nK
“In nK, malaria is diagnosed by observed symptoms by physician, not by microscope.
Also, in those data, incidences among military personnel were excluded.” JW Park
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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10. • Nutritional indicators
(MN Hwang, 2011)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
1998 2000 2002 2004 2006 2009
Wasting
Stunting
Underweight
“1 of 3 children are risk at chronic malnutrition, 1 of 5 children are underweight status”
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
10/17

11. • Immunization indicators among 1-year old, 2011
(UNICEF, THE STATE OF THE WORLD’S CHILDREN, 2013)
BCG DPT1b DPT3b Polio3 MCV HepB3 Hib3 Tetanus
98 95 94 99 99 94 - 93
(%)
• Annual immunization indicators (2002~2011)
0
20
40
60
80
100
120
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DPT 3
HepB 3
MCV
(WHO, country profile, 2013)
DPT : Diphtheria-Pertussis-Tetanus; HepB 3 : Hepatitis B, 3 doses; MCV : Measles-containing-vaccination
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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12. • Although reliability issues remains, it seems that
immunization coverage is quite higher than expectations
• Sustaining vaccine-cold-chain problem
– Sustainable cold chain is essential for effective, safe vaccination
– In 2008, UNICEF investigated cold chain status in nK. Majority of all cold
chain were severely deteriorated and sixteen percent were found out as
non-function
– Main cause of non-function was power-shortage
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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13. • Mortality indicator seems to be relatively low, compared to other
economically similar countries
• Tuberculosis, child malnutrition will increase the disease burden in the
future, remains great in now
• Some authors argue that nK can be understood as a country with the
‘double-burden’ of disease, due to high burden of non-communicable
diseases
• Huge health disparity between nK and sK should be mitigated for the
smooth unification and human security establishment
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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14. PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
(YH Lee, 2013)
Role of military team
-Supporting disaster relief phase in
humanitarian perspective
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15. • Considerations in epidemic in natural disaster(Watson, 2007)
– War : disaster by mankind, not by nature
– After war time, entire environment will be totally destructed
– Risk factors of outbreak after disaster
• Displacement : refugees, IDP
• Crowding, poverty it self
• Shortage of clean water, improper management of trash
• Deficiency of shelters, food
• Interruption of services : power cuts
• Lack of preparedness of public health and health care systems
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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16. • nK people suffers tuberculosis and malaria infection
– Should we manage a population who are at risk of tuberculosis in disaster?
– “TB care and control are not a priority in the acute phase of an emergency
when mortality rates are high due to acute respiratory infections, diarrhoeal
diseases, measles, malaria in endemic areas, and malnutrition”
(WHO, TB interagency field manual, 20)
• nK children are at risk of malnutrition
– Malnutrition at an early age leads to reduced physical & mental development
– Susceptible to epidemic diseases during disaster period
• Immunization status among nK children
– Fortunately, immunization among infant remains quite high
– But, we should prepare the outbreak of vaccine-preventable-diseases in
advance
PERSONAL INTEREST CONCEPT OF STRATEGYCURRENT SITUATIONOVERVIEW CONCLUSION
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17. • References
– YH Lee et al., Overview of the Burden of Diseases in North Korea, JPMPH,
2013 May 46
– Watson, 2007. Epidemics after Natural Disasters, Emerging infectious disease
13(1)
– NM Hwang, Strategies for the Health and Food Assistance on the Crisis in
North Korea, 2011
– WHO, World Malaria Report 2012
– KCDC, Malaria Control Manual, 2012
– YH Lee et al., A Strategy Toward Reconstructing the Healthcare System of a
Unified Korea, JPMPH, 2013 May 46
– JW Park, Status of Plasmodium vivax Malaria in the Republic of Korea after
Reemergence, Han-yang Medical Review, 2010
PERSONAL INTEREST
CONCEPT OF
STRATEGY
CURRENT SITUATIONOVERVIEW CONCLUSION
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