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Systematic review of evidence on public health in the Democratic People’s Republic of Korea
  1. John J Park1,
  2. Ah-Young Lim2,
  3. Hyung-Soon Ahn2,
  4. Andrew I Kim3,
  5. Soyoung Choi2,
  6. David HW Oh4,
  7. Owen Lee-Park5,
  8. Sharon Y Kim6,
  9. Sun Jae Jung1,7,
  10. Jesse B Bump1,
  11. Rifat Atun1,3,
  12. Hee Young Shin2,
  13. Kee B Park1,3
  1. 1 Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Institute for Health and Unification Studies, Seoul National University College of Medicine, Seoul, Republic of Korea
  3. 3 Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Tufts University School of Medicine, Boston, Massachusetts, USA
  5. 5 University of Maryland School of Medicine, Baltimore, Maryland, USA
  6. 6 University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7 Yonsei University College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr John J Park; john.park{at}mail.harvard.edu

Abstract

Background 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.

Methods 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).

Findings 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.

Conclusion 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.

  • public health
  • systematic review
  • North Korea
  • DPRK

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0

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Footnotes

  • HYS and KBP are joint senior authors.

  • JJP and A-YL are joint first authors.

  • Handling editor Douglas James Noble

  • Contributors JJP, KBP, HYS, AYL, SYC and HSA conceived and designed the study. JJP, OLP, DHO, AYL, SYC and HSA searched the literature. SJJ offered statistical support. JJP, DHO, OLP, AIK, SYK, AYL, SYC and HSA extracted, analysed and interpreted the results. JJP drafted the initial report. AYL, SYC and HSA commented on the first draft, and RA and JBB revised the draft. All authors critically commented on and revised subsequent versions of the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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