Park John J, Lim Ah-Young, Ahn Hyung-Soon, Kim Andrew I, Choi Soyoung, Oh David Hw, Lee-Park Owen, Kim Sharon Y, Jung Sun Jae, Bump Jesse B, Atun Rifat, Shin Hee Young, Park Kee B
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Institute for Health and Unification Studies, Seoul National University College of Medicine, Seoul, Republic of Korea.
BMJ Glob Health. 2019 Mar 9;4(2):e001133. doi: 10.1136/bmjgh-2018-001133. eCollection 2019.
Engaging in public health activities in the Democratic People's Republic of Korea (DPRK, also known as North Korea) offers a means to improve population health for its citizens and the wider region. Such an engagement requires an understanding of current and future needs.
We conducted a systematic search of five English and eight Korean language databases to identify available literature published between 1988 and 2017. A narrative review of evidence was conducted for five major categories (health systems, communicable diseases (CDs), non-communicable diseases (NCDs), injuries, and reproductive, maternal, newborn and child health (RMNCH) and nutrition).
We found 465 publications on the DPRK and public health. Of the 253 articles that addressed major disease categories, we found under-representation of publications relative to proportion of disease burden for the two most significant causes: NCDs (54.5% publications vs 72.6% disability adjusted life years (DALYs)) and injuries (0.4% publications vs 12.1% DALYs), in comparison to publications on the third and fourth largest disease burdens, RMNCH and nutrition (30.4% publications vs 8.6% DALYs) and CDs (14.6% publications vs 6.7% DALYs) which were over-represented. Although most disease category articles were on NCDs, the majority of NCD articles addressed mental health of refugees. Only 165 articles addressed populations within the DPRK and among these, we found publication gaps on social and environmental determinants of health, CDs, and NCDs.
There are gaps in the public health literature on the DPRK. Future research should focus on under-studied, significant burdens of disease. Moreover, establishing more precise estimates of disease burden and their distribution, as well as analysis on health systems responses aimed at addressing them, can result in improvements in population health.
在朝鲜民主主义人民共和国（朝鲜）开展公共卫生活动为改善该国公民及更广泛地区的民众健康提供了一种途径。这种参与需要了解当前和未来的需求。
我们对五个英文和八个韩文数据库进行了系统检索，以识别1988年至2017年间发表的现有文献。对五个主要类别（卫生系统、传染病、非传染性疾病、伤害以及生殖、孕产妇、新生儿和儿童健康与营养）的证据进行了叙述性综述。
我们找到了465篇关于朝鲜与公共卫生的出版物。在涉及主要疾病类别的253篇文章中，与疾病负担比例相比，我们发现关于两个最主要病因的出版物代表性不足：非传染性疾病（出版物占54.5%，而伤残调整生命年占72.6%）和伤害（出版物占0.4%，而伤残调整生命年占12.1%），与之相比，关于第三和第四大疾病负担，即生殖、孕产妇、新生儿和儿童健康与营养（出版物占30.4%，而伤残调整生命年占8.6%）和传染病（出版物占14.6%，而伤残调整生命年占6.7%）的出版物则代表性过高。尽管大多数疾病类别文章是关于非传染性疾病的，但大多数非传染性疾病文章关注的是难民的心理健康。只有165篇文章涉及朝鲜国内的人群，在这些文章中，我们发现关于健康的社会和环境决定因素、传染病和非传染性疾病方面存在出版空白。
关于朝鲜的公共卫生文献存在空白。未来的研究应关注研究不足的重大疾病负担。此外，对疾病负担及其分布进行更精确的估计，以及对旨在应对这些负担的卫生系统反应进行分析，可改善民众健康。
