Strategy for the prevention and control of Non Communicable
Diseases in the Democratic People’s Republic of Korea 2014-2020
Ministry of Public
Health
May,
2014
Contents
1 Introduction
1. Background
2. Situation of Noncommunicable
diseases in the DPR of Korea
3. Strategic goal and targets
4. Guiding principle for the
implementation of the strategy
5. Priorities and activities
6. Resources for the implementation of
the strategy
7. Monitoring and evaluation
8. Implementation stages
2
Introduction
The Great Leader
Comrade Kim Jong Il instructed as follows.
“An important task in combating disease is to
take proper steps to prevent the diseases that affect the cardiovascular
system, cancerous diseases, disease of the metabolism and others which have a
high rate of incidence and are very destructive to a man’s ability to work.”
(Letter to the National Conference of Health
Workers April 21, 1985)
The
Strategy for the Prevention and Control of Noncommunicable Diseases in the DPR
of Korea 2014-2020 was adopted in the Multisectoral Consultation for the
Prevention and Control of Noncommunicable Diseases that took place in Pyongyang
in , 2014.
This
strategy is a country strategy to effectively prevent and control
noncommunicable diseases according to the high demand of the government to
bring the health of the people in line of global level, basing on the Global
Strategy for Prevention and Control of Noncommunicable Diseases 2013-2020,
Strategy of South-East Asia Region 2013-2020 and Political Declaration on the
Prevention and Control of Noncommunicable Diseases signed by governments’heads at High-Level Meeting of the General
Assembly held in September, 2011.
This
strategy is also very meaningful in protecting and promoting the lives and
health of people as well as making all people receive splendid benefits of free
medical care system by rasing the work for prevention and control of
noncommunicable diseases up to a higher stage on a basis of current global
activities related to prevention and control of noncommunicable diseases and
achievements of and lessons learnt from the work for
prevention and control of noncommunicable diseases in our
country.
We
will actively endeavor to reduce prevalence of and mortality from
noncommunicable diseases through achieving the goals of this strategy by all
means and, further, to realize successfully grandiose goal of the government to
break through the global level
of main health indicators including life expectancy.
Ministry
of Public Health
May,
2014
1. Background
Today,
noncommunicable diseases that consist mainly of cardiovascular diseases,
cancer, diabetes and chronic respiratory diseases is becoming a major health
issue in all countries of the world for its high prevalence and mortality. In
2008 only, 36 million people died in the worldwide due to noncommunicable
diseases, which covers 63% of total worldwide death and a quarter of which, 9
million people, died prematurely, that is, before 60 years of age. According to
the estimation of the experts, the death rate due to noncommunicable diseases
will continue to be increased and, by 2030, will cover 75% of all worldwide
deaths. Noncommunicable diseases are being increased in almost all regions of
the world and, particularly, south-east Asia belongs to regions of highest
burden of noncommunicable diseases for this region covers 22% of all worldwide
deaths from
noncommunicable disease.
Since
the prevention and control of noncommunicable diseases emerged as an issue of
priority, WHO adopted a Global Strategy for Prevention and Control of
Noncommunicable Diseases at fifty third World Health Assembly in May, 2000.
Beside of this, many other global strategies were adopted, which includes WHO
Framework Convention on Tobacco Control(2003), the Global Strategy on Diet,
Physical Activity and Health(2004), the Global Strategy to Reduce Harmful Use
of Alcohol(2010) and Action Plan of South East Asia Region for Prevention and
Control of Noncommunicable Diseases 2013-2020.
The
Moscow Declaration of the First Global Ministerial Conference on
Noncommunicable Diseases which was held in April, 2011 addressed that
prevention and control of noncommunicable diseases should involve multisectoral
interventions and collaborations on a large scale.
At
the High-Level Meeting of General Assembly of September, 2011, heads of
governments signed the Political Declaration on the Prevention and Control of
Noncommunicable Diseases. This declaration branded noncommunicable disease as a
greatest risk that impedes the socioeconomic
development of 21st century and challenges the effort of humankind
to achieve the new millennium development goals. And it stressed also that
governments of all countries, international communities and sectors of society
must be involved and collaborate in the prevention and control of
noncommunicable diseases. The declaration proposed the establishment of a
mechanism until the end of 2012 so as to monitor and evaluate the activities
regarding the prevention and control of noncommunicable diseases. The meeting
served as an important opportunity that promoted global struggle to face
noncommunicable diseases as well as a turnover that mobilized governments of
all countries and multisectoral organizations to the
struggle against noncommunicable diseases.
The WHO recommended all member countries to establish and
implement the strategy in compliance with their situation in order to fulfill
the Global Strategy for the Prevention and Control of Noncommunicable Diseases
2013-2020.
The
main noncommunicable diseases include cardiovascular diseases, cancer, diabetes
and chronic respiratory diseases. These four main diseases occur by four main
common risk factors such as smoking, heavy drinking, lack of physical activity
and unhealthy diet. As the above mentioned noncommunicable diseases, once
occurred, are expensive in the treatment and difficult to get complete cure and
tend to result in death, the most cost effective and rational way is to
establish measures for the common risk factors before getting the diseases so
as to prevent these diseases and control them to not be
aggravated if occurred.
Many
factors related to the occurrence of noncommunicable diseases lie outside of
health sector. Therefore, the effort of health sector alone can not bring due
success. Only the cooperation and collaboration of all related sectors such as
education, commerce, sports, agriculture, finance, traffics, city administration,
legislation, social organizations and mass media can bring due success.
2.
Situation of Noncommunicable diseases in our country
The
mortality from noncommunicable diseases is 637 per 100,000 population in our
country. Among them, the mortality from cancerous diseases is 144, the
mortality from cardiovascular diseases and diabetes 284 and the mortality from
chronic respiratory diseases 26.5. As for the prevalence, the prevalence of
hypertension is 20.4% and 17% in men and women respectively, and the prevalence
of cardiovascular diseases 172.1 per 10,000 population, the prevalence of
chronic respiratory diseases 26.5 per 10,000 population, the prevalence of
cancerous diseases 144 per 10,000 population and prevalence of diabetes is 1.9 per 10,000 population.
The
noncommunicable diseases including cardiovascular diseases, cancerous diseases
and diabetes constitute main causes that provoke loss of working ability and
premature
deaths in our country also, as they are so in many other
countries.
In order for the
prevention and control of noncommunicable diseases, the government defined the
preventive medicine as the fundamental of socialist medicine and put the
struggle against noncommunicable diseases as one of main health policy from
long time ago. The government is strengthening the function and role of the
section doctor system, an advanced residents’health care system well
established at the primary health care level, and actively administrating the
work for the prevention and control of noncommunicable
diseases. As one household doctor takes charge of 130 families in average in
our country, the government, through enhancing the role of household doctors,
is strengthening the preventive communication and promoting healthy lifestyle
among people. The government is also strengthening and improving preventive
health care, so as to carry out actively periodical screening and registration
of and medical service delivery for patients with chronic diseases including
cardiovascular diseases, cancer and diabetes. This preventive health care
system for chronic patients, in which household doctors detect chronic patients
among their residents in charge as early as possible, register them correctly
and treat them under systematical observation, is a most advanced residents’ health care system that can only be found in our
country.
The
health of people is also being improved day by day, as the government is taking
measures to promote healthy lifestyle and physical activity among people.
The government presented a policy to
popularize physical culture and sports and make them part and parcel of life,
according to which the government has set the second Sunday of each month as
Sports Day and says to it that everyone participates in sports activities, and
normalizes the campaign for walking 10,000 steps and organizes various sports
games on each occasion. The government has also taken active measures to
promote breast feeding
and is paying special attention to children’s health care.
The
prevention and control of noncommunicable diseases was defined as one of health
priorities in Country Cooperation Strategy 2009-2013 and Mid Term Strategic
Plan 2010-
2015.
Multisectoral consultations for the prevention and control of noncommunicable
diseases were held several times and the Strategy for the Prevention and
Control of Noncommunicable Diseases 2011-2015 and the Multisectoral Action Plan
2012-2013 were
developed and are being actively implemented.
The
government made “Tobacco Control Law” newly in 2005 and is strengthening the regulation
for all people to abide this law, which was amended in 2009. And also, the
government signed Framework Convention on Tobacco Control in 2005 and is
carrying out an active campaign against smoking, a main risk factor.
Surveys
of risk factors regarding noncommunicable diseases were conducted in 2008 and
2010 in collaboration with WHO. According to the survey that was conducted in
selected areas of Pyongyang City regarding risk factors of noncommunicable
diseases, the smoking rate and drinking rate among male adults were 55.8% and
20.9% respectively, and the proportion of high blood pressure among men and
women was 19.4% and 18.6% respectively. The proportion of normal body mass
index was 60%. There were no cases of chewing tobaccos and female smoking at all in our country.
From
2014, in collaboration with WHO, the pilot introduction of WHO Package of
Essential Noncommunicable diseases Interventions(PEN) for main noncommunicable
diseases(cardiovascular diseases and diabetes) has been started at primary
health care
level in selected areas of Pyongyang City.
3. Strategic goal and targets
-
Strategic goal
The
goal of the strategy is to prolong life expectancy in our country in the period
of 2014-2020 by reducing the prevalence of and mortality from noncommunicable
diseases
and improving people’s health.
In detail, to reduce socioeconomic burden of noncommunicable
diseases through;
l
Reducing prevalence of noncommunicable diseases
and proportion of premature
death and loss of working ability due to noncommunicable
diseases
l
Reducing the frequency of risk factors of
noncommunicable diseases
l
and conducting multisectoral activities to
fight with main risk factors of noncommunicable diseases and improve the
quality of medical services
- Main targets
1. To
establish a mechanism that strengthens inter-sectoral cooperation to increase
the effectiveness of the prevention and control of noncommunicable
diseases
2.
To strengthen the research on and evaluation of
main noncommunicable
diseases and risk factors at primary health care level
3.
To reduce the influence of common risk factors
of noncommunicable diseases
including smoking, unhealthy diet and heavy drinking
4. To
improve the treatment and management of noncommunicable diseases at all levels
of health care services
5.
Principals for the implementation of strategy
In
order for effective prevention and control to reduce socioeconomic burden of
noncommunicable diseases, the following principals should be sustained in the
implementation of strategy.
First: The
prevention and control should be done preferentially at primary health
care level
Second:
Various risk factors should be managed in an integrated way and the general
management should focus on the four main noncommunicable diseases, that is,
cardiovascular diseases, cancerous diseases, chronic obstructive respiratory
diseases and diabetes.
Third: The preventive communication and activities should
be carried out throughout
lifespan.
Fourth:
Residents and patients themselves should actively participate in the prevention
and control of noncommunicable diseases and they should raise
their responsibility for health of themselves, their family
and relatives.
Fifth:
Multisectoral collaboration for the prevention and control of noncommunicable
diseases between governmental organizations, social organizations and
relevant sectors should be strengthened.
6. Priorities and activities
1)
To establish effective policy to strengthen
multisectoral collaboration
for the prevention and
control of noncommunicable diseases
It
is important to establish effective policy to create an environment that
enables individuals, families and communities to select healthy lifestyle and
enjoy healthy life. First of all, the capacity and qualification of policy
makers should be enhanced. And a mechanism to strengthen the collaboration with
all sectors of society
should be established.
Acitivities:
1.
Organize a coordination committee for the
prevention and control of noncommunicable diseases that consists of staff of
sectors related to the
prevention and control of noncommunicable diseases.
2.
Establish measures to reduce the influence of
main risk factors of
noncommunicable diseases and to prevent diseases.
3.
Implement actively the requests of WHO
Framework Convention on Tobacco Control in order to reduce smoking rate, one of
the risk factors of
noncommunicable diseases.
4.
Establish and implement regulations to reduce
heavy drinking rate.
5.
Establish measures to reduce salt intake
6.
Make people maintain healthy diet
2)
To conduct research on and evaluation of main
noncommunicable diseases and their risk factors at primary health care level
It
is important to make correct evaluation of current epidemiological status by
conducting a survey on the level of noncommunicable diseases and risk factors,
provided that no such surveys were conducted with detail among people in recent
years. And also, it is necessary to study and introduce WHO recommended
methodology to integrate and manage main noncommunicable diseases at
primary health care level.
Activites:
1.
Conduct a survey to evaluate the level of
prevalence of main noncommunicable
diseases and their risk factors at primary health care level.
2.
Evaluate the capacity of concerned primary
health care level for the
prevention, control and management of main noncommunicable
diseases.
3.
Detect, at primary health care level, groups
vulnerable to main
noncommunicable diseases and take due measures.
3)
To conduct activities to prevent and control
the risk factors of main noncommunicable diseases among individuals and all
population.
It
is most effective way to raise awareness of people about smoking, heavy
drinking, unhealthy diet and lack of physical activities as main risk factors
of noncommunicable diseases and to strengthen the communication on the
necessity of promoting healthy lifestyle. This must be done under close
relation with public
health and primary health care.
Activities:
1.
Enhance the role of health workers and
volunteers including household doctors as well as the awareness of people about
the prevention and control of noncommunicable diseases and risk factors through
mass media, public
health reference books and IEC materials.
2.
Promote healthy lifestyle throughout lifespan
starting from infant period.
3.
Make people participate actively in the health
promotion and the prevention
and control of noncommunicable diseases.
4)
To improve the quality of medical services on
noncommunicable diseases at all health care levels
Improving the quality of the prevention, diagnosis and
treatment of
noncommunicable
diseases at all health care levels is the decisive way to reduce the prevalence
and proportion of premature death and loss of working ability due to
noncommunicable diseases.
Activities:
1.
Activities for improving the quality of medical
services at all levels, particularly at primary health care level, must focus
on the early detection
and control of groups vulnerable to noncommunicable
diseases.
2.
Introduce actively WHO recommended methodology
to integrate and manage
the main noncommunicable diseases at primary health care
level.
3.
Improve the supply of and access to the
essential drugs and equipments needed to diagnosis, treatment and management of
main noncommunicable
diseases in the health facilities.
4.
Enhance the qualification of health
professionals in order to improve the
prevention, early detection and treatment of main
noncommunicable diseases.
7.
Finance of Strategy implementation
The implementation of the strategy for the prevention and
control of noncommunicable
diseases will be financed by following sources.
l
State budget
l
Donations of institutes, enterprises and social
organizations
l
Support fund of international donors and
international organizations
8.
Monitoring and evaluation
The
Political Declaration adopted at High-Level Meeting of General Assembly proposed
the establishment of an international mechanism to control noncommunicable
diseases as one of the goals in the prevention and control of noncommunicable
diseases. The country strategy for the prevention and control of
noncommunicable diseases also aims at achieving this goal.
The WHO recommends the following monitoring and evaluation
indicators.
l
The level of risk factors of noncommunicable
diseases (Monitoring and evaluation
of risk factors)
l
Prevalence of and mortality from
noncommunicable diseases (Monitoring and
evaluation of the consequence of noncommunicable diseases)
l
Monitoring and evaluation of health care system
for the prevention and control of noncommunicable diseases (Monitoring and
evaluation of methodology and
capacity)
In
order to prevent and control successfully the noncommunicable diseases, the
implementation process must be monitored and evaluated thoroughly and be
improved according to the result. The Ministry of Public Health takes the
responsibility of controlling entire process of strategy implementation,
reports the result to Multisectoral Coordination Committee and takes necessary
measures. The implementation bodies besides of the Ministry of Public Health
communicate annually to the Ministry of Public Health about their activities.
The
monitoring of risk factors and determinants of noncommunicable diseases and the
monitoring of diseases may be done in a way of collecting periodical screening
data and patient clinical chart data through routine health statistic system.
In order for the success in monitoring, it is important to ensure the quality
of statistics in primary health care facilities and district and county
hospitals as well as the continuity of patient registration. As for the death
data, it must be collected using national death reporting system and compared
with data aggregated to the Ministry of Public Health, Public Security Agencies
and resident administration institutes in order to ensure its quality.
Goals
by indicators
Basing on the strategic
goals proposed in the Global Strategy for the Prevention and Control of
Noncommunicable Diseases 2013-2020 adopted at World Health Assembly and the
goals of South East Asia Action Plan 2013-2020 signed at WHO South East Asia
Regional Meeting, goals by indicators to be achieved until 2025 are as follows.
1. Reduce
the total death rate from cardiovascular diseases, cancer, diabetes and chronic
respiratory diseases by 25%.
2.
Reduce the smoking rate among men of 15 years
of age and above by 30%.
3.
Reduce by 10% the heavy drinking rate.
4.
Reduce the proportion of lack of physical
activities by 10%.
5.
Reduce the salt intake by 30%
6.
Reduce the incidence of hypertension by 25%.
7.
Make the number of residents who are treated
with medicines and by doctors in
order to prevent heart attack and cerebral apoplexy reach
to 50%
8.
Provide more than 80% of all medicines and
equipments needed for the treatment of
noncommunicable diseases at health facilities
9.
Maintain current incidence of obesity and
diabetes.
10. Increase
early detection rate of cancerous diseases by ensuring 90% of periodical
screening rate among men and women of 40 years of age and
above
Action plan for strategy implementation
Detailed
action plan in order to ensure the general implementation of the Strategy for
the Prevention and Control of Noncommunicable Diseases 2014-202 in the DPR of
Korea
will be developed.
Action
plan by risk factors
Activities for tobacco control
Content
|
Implementation body
|
1. Amend
the National Tobacco Control Law, and supervise and monitor its
implementation.
|
Standing Committee, Cabinet, Ministry of Public Health,
Committee of Education
|
2. Conduct
active communication about the Tobacco Control Law and IEC activities about
the risk and consequences of direct and indirect smoking through mass media.
|
Working
People’s organization, Publication and press sector, Ministry of Public
Health,
Committee of Education
|
3. Put
No Smoking marks and posters at all nosmoking places indicated by Tobacco
Control Law
|
Ministry of Commerce, Ministry of Public Health,
Committee of
Education
|
4. Ensure
that the image warning about the risk and harm of tobacco will cover more
than 70% of the surface of cigarette box
|
Standing
Committee, Ministry of Commerce, Ministry of Food and Daily Necessities,
Ministry of
Public Health
|
5. Conduct
periodical survey on smoking status and disseminate findings of surveys
|
Ministry of Public
Health,
Committee of Education
|
6. Carry
out communication activities to generalize the experiences of the people who
stopped smoking as well as to disseminate various stopsmoking method
|
Ministry of Public
Health, Committee of Education, Research and Dissemination Center of
Nosmoking
|
7. Include
a subject on the harm of tobacco in the school course and strengthen the
education of students
|
Committee
of Education, Ministry of
Public Health
|
8. Offer
residents periodical consultation on stopsmoking at the primary health care
level.
|
Ministry of Public Health
|
9. Collaborate
actively with international organizations concerned with tobacco control
|
Ministry of Public Health
|
Activities for heavy
drinking control
Content
|
Implementation body
|
10. Include
activities for heavy drinking control in national policy and strategy for the
prevention of noncommunicable diseases
|
Ministry of Public
Health, Ministry of Commerce, Ministry
of Food and Daily Necessities
|
11. Publish
and distribute communication materials on the harm of heavy drinking and its
influence to diseases occurrence and actively carry out communication
activities through household doctors
|
Working People’s organization, Publication and press
sector,
Ministry of Public
Health,
Committee of Education
|
12. Strengthen the legal
regulation on driving drunk and working drunk
|
Public security Agency
|
13. Prohibit
illegal production and sale of alcoholic beverage and establish the rule to
sell alcoholic beverage at designated places
|
Public
security Agency, Ministry of Food and Daily Necessities, Ministry of
Commerce, Ministry of
Public Health
|
14. Strengthen
the survey and information dissemination on heavy drinking among adults
|
Ministry of Public Health
|
Activities for control
of unhealthy diet
Content
|
Implementation body
|
15. Include
activities for promoting healthy diet in national policy and strategy for the
prevention and control of noncommunicable diseases
|
Ministry of Public Health, Ministry of Food and Daily
Necessities
|
16. Communicate actively
for Increasing the usage of iodine salt and promoting breast feeding
|
Ministry of Public
Health, Ministry of Food and Daily Necessities, Ministry of Commerce
|
17. Communicate
actively for promoting folk dishes and maintaining healthy diet
|
Ministry of Food and
Daily Necessities, Working People’s organization, Publication and press
sector, Ministry of Public Health
|
18. Strengthen
researches to provide scientific inspection of produced foodstuff
|
Ministry of Food and
Daily Necessities, Ministry of Public Health
|
19. Educate
children on the harmful effect of processed and instant foods in various
forms and ways
|
Committee
of Education, Ministry of Public Health
|
Activities for control of lack of physical activity
Content
|
Implementation body
|
20. Include
activities for control of lack of physical activity in national policy and
strategy for the prevention and control of noncommunicable diseases
|
Ministry of Public
Health, Ministry of Physical Culture and Sports
|
21. Develop
and disseminate activities for health including rhythmic gymnastics and
health Taekwon-do in order to create atmosphere in which everybody likes
physical culture and sports
|
Ministry of Physical
Culture and Sports, Publication and press sector
|
22. Carry
out activities to create a heat wave of physical culture and sports all over
the country through operation of monthly Sports Day
|
Ministry of Physical
Culture and Sports, Publication and press sector
|
23. Convert
the affair of building and using many more places for physical culture and
sports into a nationwide affair
|
Standing
Committee, Ministry of
Physical Culture and Sports
|
24. Organize
widely folk games on the occasion of holidays and make schools organize
physical culture and sports activities after school
|
Ministry
of Physical Culture and
Sports, Committee of Education
|
25. Communicate
actively about the importance of physical culture and sports and their
influence onto health through mass media
|
Ministry of Physical
Culture and Sports, Publication and press sector
|
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