Underestimated Burden: Non-Communicable Diseases in North Korea

There remains a misperception that non-communicable diseases (NCDs) are predominantly an issue for developed countries and are not major public health problems in low-income countries. North Korea is also often considered as a country with a disease structure that is typical of a low-income country. Infectious diseases and nutritional problems, including tuberculosis and pneumonia, are still major sources of medical discussion. The authors challenge this misperception by reviewing empirical data on epidemiologic and demographic transitions of North Korea and show that the current NCD burden is the main public health issue in North Korea. In result, it can be said that epidemiologic transition and demographic transition of North Korea preceded prior to economic hardship. It is necessary for the international community, including South Korea, to advance in a new direction of medical support for North Korea.

Wealth related inequalities in self reported morbidity: Positional objectivity or epidemiological transition.

Background & objectives: Morbidity is self reported at a higher rate among the rich than the poor. However, objective measures suggest the contrary. We examined the role of epidemiological transition in wealth related inequalities in self-reported morbidity (SRM). Methods: We analyzed data of two states, Bihar and Kerala, from 60th Round of National Sample Survey (NSS). Bivariate analysis was performed to study the associations between various socio-demographic variables and self-reported morbidity. A prediction model based on hierarchical logistic regression was developed to identify determinants of self-reported morbidity. Results: In Bihar, acute morbidities (26 per 1000) were reported more often than chronic morbidities (19 per 1000) while in Kerala the reverse was true (89 acute and 123 chronic morbidities per 1000 person). In both the states, the rate of SRM showed an increasing trend from the poorest to the richest quintiles. The rising gradient in the odds of SRM across increasing socio-economic strata was more pronounced in Bihar [OR (richest)=2.52; 1.85-3.42] as compared to Kerala [OR (richest) =1.66; 1.37-2.0]. Moreover, this gradient was more on account of chronic diseases [OR (richest) =2.7; 1.8-4.0] for Bihar; [OR (richest) =1.6; 1.26-2.0 for Kerala] than the acute diseases [OR (richest) =1.82; 1.1-2.9 for Bihar]; [OR (richest) =1.4; 1.1-1.8 for Kerala]. Interpretation & conclusions: The present analysis shows that the epidemiologic transition results in higher prevalence and reporting of chronic ailments by the rich than the poor. This phenomenon is more evident in the early stages of transition. In later stages of transition, positional objectivity plays an important role to explain wealth related inequalities in SRM.

Salud en los extremos: Escenario epidemiológico y sanitario en Tierra del Fuego, 1890-1930 / Health at the Extremes: Epidemiological and Sanitary Scene in Tierra del Fuego, 1890-1930 / Saúde nos extremos: Cenário epidemiológico e sanitario em Terra do Fogo, 1890-1930

Objetivo: Caracterizar epidemiológica y sanitariamente la ciudad de Ushuaia (territorio nacional de Tierra del Fuego) entre 1890 y 1930, momento clave en el que se profundizan paralela y articuladamente dos procesos: el contacto interétnico y la consolidación del Estado-Nación argentino. Materiales y métodos: Se analizaron todas las actas de defunción disponibles para el lapso 1890-1930, lo mismo que los documentos de la gobernación pertinentes y su cruce con fuentes secundarias a fin de obtener el perfil sanitario de la ciudad y su relación con el país en cuanto al tipo de fase epidemiológica, las tasas de mortalidad, la estructura demográfica y la estructura en la atención sanitaria. Conclusiones: Se concluye sobre la relevancia de las enfermedades infecciosas -y dentro de estas la tuberculosis-, en la ciudad, en general, y en la población indígena y penal, en particular. Dicho perfil epidemiológico evidenció las falencias de un sistema sanitario nacional aún no consolidado, especialmente en una región de dificultoso alcance.

Objective: To characterize the epidemiological and sanitary conditions of the city of Ushuaia (National Territory of Tierra del Fuego) at a key time in its history- a time in which interethnic contact and the consolidation of the Argentine nation-state were intensified as two parallel and related processes. Materials and methods: All death certificates available for the period 1890-1930 were analysed, as well as relevant government documents and secondary sources in order to obtain the health profile of the city and its relationship with the country in the following aspects: type of epidemiological phase, mortality rates, population structure, and the structure in healthcare. Conclusions: There was a great relevance of infectious diseases, and specially tuberculosis, among the population of the city in general, and among the indigenous and criminal population in particular. This epidemiological proile showed the shortcomings of a national health system that was trying to establish at the time, especially in a region difficult to reach.

Objetivo: Caracterizar epidemiológica e sanitariamente a cidade de Ushuaia (Territorio Nacional de Terra do Fogo) entre 1890 e 1930, momento em que o contato interétnico e a consolidação do Estado-Nação argentino se articularam de forma profunda. Materiais e métodos: analisaram-se todas as certidões de óbito disponíveis para o lapso 1890-1930, ao igual que os documentos do governo pertinentes e seu cruzamento com fontes secundarias a fim de obter o perfil sanitario da cidade e sua relação com o país em quanto ao tipo de fase epidemiológica, as taxas de mortalidade, a estrutura demográfica e a estrutura na atenção sanitaria. Conclusões: houve uma grande relevância das doenças infecciosas, e dentro destas a tuberculose, na cidade em geral e na população indígena e penal em particular. Dito perfil epidemiológico evidenciou as falencias de um sistema sanitário nacional que se estava tentando instaurar nesse momento, especialmente em uma região de diicultoso alcance.

Perspective on Population Characteristics and Health Problems of Koreans in 21st Century / 예방의학회지

In order to anticipate disease pattern and health problems of Koreans in the 1st part of 21st century(by the year 2020), transition of population characteristics, mortality and morbidity data during the last 30 years Koreans have experienced were reviewed. On the actual basis of epidemiolgic transition process that has undergone during last 30 years since 1960 along with socioeconomic development and successful implementation of selective national health policies(family planning, medical insurance and etc.), following changes can be expected in the 21st century in Korea, under the assumption that the current rate of progress is maintained. The population of South Korea alone will be doubled the population of 1960 by the year 2013;aged population older than 65 years will be increased from 3.3% in 1960 to 11.4% in 2020 with increased average age of the population from 23.6 year in 1970 to 39.2 year in 2020;urban population from 28% in 1960 to 83% in 2005. GNP/capita has increased tremendously from U.S. $120 in 1970 to $6,749 in 1992, and the government estimated it would be $19,350 in 2010 and $29,460 in 2020. Growth and developmental indices of children, educational achievement and social status of women also showed a remarkable improvement and anticipated to make further progress. Leading causes of mortality and morbidity have shown a striking change during the last 30 years, from infectious diseases to chronic degenerative diseases and man-made injuries. Occurrence of communicable diseases may become minimal although viral hepatitis, venereal diseases including AIDS, and well adapted herpes virus infections will maintain their endemic level. Newly evolving infectious agents, however, should be carefully monitored because of rapidly changing environments and human behaviors. Tuberculosis may increase up to the epidemic level when AIDS prevails. Ischemic heart diseases may increase steadily with increasing occurrence of hypertension and diabetes mellitus whereas cerebrovascular diseases may be decreased slowly. Musculaskeletal diseases which contribute a lot to the disability of aged people may be a major health problems due to increased aged population. Mental diseases, particularly that caused by alcohol and drug abuse, and senile dementia may become a prominent health problem. On the other hand injuries caused by traffic and industrial accidents that have shown most striking increase till now may be decreased considerably by intensive intervention. The health policies in the 21st century will be oriented to the health promotion for good quality life rather than life-savings.

Bases conceptuales de la nueva salud internacional / Conceptual basis of the new international health

La salud internacional ha adquirido mayor importancia debido a la creciente complejidad de las relaciones internacionales y su impacto en la salud y los sistemas de salud, así como a las implicaciones de ésta en dichas relaciones. A partir de las interacciones entre las relaciones internacionales y la salud se fundamenta la necesidad de desarrollar y consolidar una tradición académica e intelectual que dé sustento a la generación de conocimiento y guíe sus aplicaciones prácticas. La salud internacional está experimentando cambios conceptuales y estratégicos que deben tomarse en cuenta para lograr la integralidad y consistencia en el alcance, enfoque y énfasis de los programas educativos, los proyectos de investigación y las acciones de salud tanto nacionales como binacionales y multinacionales. En este artículo se identifican los cambios conceptuales y estratégicos, se proponen definiciones básicas, el universo de trabajo y la base disciplinaria de la nueva salud internacional. En concreto, se propone la transición hacia un nuevo concepto y una nueva práctica de la salud internacional

International health is becoming an important field of study and practice due mainly to the increasing complexity of international relationships which imply both changes in the epidemiologic profile of the population, and transformations of health care delivery systems. At the same time, the character of health problems does not recognize the geographical boundaries of nations; instead it may open or reinforce new areas of cooperation or conflict in the international arena. The many interactions between international relations and health impose the need to build and consolidate an academic and intellectual tradition of international health, which supports its efforts to generate knowledge and leads its practical applications. International health is experiencing important conceptual and strategic changes which have to be taken into account if educational programs, research projects, and national, binational and multinational health actions are to be comprehensive in their approach, scope, and focus. This article identifies those conceptual and strategic changes, proposes basic definitions, the universe for action, and the disciplinary base of the new international health. In short, the article proposes the transition to wards a new international health concept and practice.