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B. The Goals of the North-South Cooperation in the
establishing the basis of medical services such as facilities, human powers, equipment, and technologies that are necessary to recover and maintain public health services in DPRK. For the purpose of supplying continuous medical resources, the strategy also focuses on developing the capacity of the DPRK and building product lines so that the North Korean authorities can manage public health services in DPRK through North-South cooperation based on a market economics perspective. When and if Japan, China, and Russia cooperate for realizing a health community in Northeast Asia, and if international organizations such as WHO, UNICEF participate in the cooperation, synergy effect will increase.
(1) Cooperation for Addressing Health Priorities in DPRK Nevertheless, the North-South exchanges or cooperation have been implemented when they contributed to solving North Korea’s economic crisis, or at least provided economic benefits to North Korea. When it comes to health problems, which have heavily damaged the North Koreans, the North have cooperated with South Korea irrespective of domestic or international political envi- ronmental change. In addition, North Korea flexibly approaches cooperation with South Korea in the fields that do not affect its regime maintenance; for example, art.
Thus, North and South Korea need to cooperate for control, surveillance and prevention of communicable diseases, such as malaria, tuberculosis, etc. It is urgent to take preventive measures against epidemics particularly at the Gaesung Industrial Complex, through which communicable diseases might spread into South Korea in that South Korean workers frequently come in contact with North Korean people at the Complex. NGOs cannot afford to establish health services for control, surveillance and prevention of
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communicable diseases such like malaria prevailing on the North- South Korea border area, due to a lack of expertise and funding.
North-South cooperation is required to deal with the problem.
(2) North-South Cooperation in the Field where North Korea Possesses a Competitive Advantage
North Korean authorities manifested a strong will to develop Oriental Medicine and to grow medicinal herbs. It could be a good approach to help North Korea gain sustainable momentum based on the North-South cooperation in building up medicinal herb gardens and producing health supplementary food, which North Korea possesses a competitive advantage in.
(3) Market-Oriented Health and Medical Cooperation for Sustainable Development
If North Korean authorities remain inclined to maintain public health services in a way that depends on humanitarian aid from South Korea without efforts to revise their internal systems or self- support activation, it is not likely that the two Koreas expect co- prosperity for the future because North Korea will be more reliant on South Korea. In the long term, the two Koreas should introduce a model of North-South economic cooperation so that they can cross the threshold into peace, co-prosperity, and unification on the Korean peninsula.
After making a foundation for self-supported development in the fields of health and medicine, it is necessary to leap up to the next level of the cooperation project; that is, joint investment pro- jects, according to which equipment and raw materials are provid- ed by a loan, for modernizing hospital facilities, medicine factories,
etc. For the purpose of both enhancing the North Korean health situation and facilitating economic development for the two Koreas, the market-oriented health and medical cooperation aims at build- ing product organizations able to bring in financial returns by combining South Korean capital and raw materials with North Korean labor. As the health industry grows in DPRK, the South transfers technology to the North.
Initially, the two Koreas will cooperate in producing injectors, sterile sponge, toothpaste, toothbrush, crutches, etc. which require low skills, and then expand products into medical instruments and equipment. In the meantime, it is plausible that Japan, China, or international organizations may cooperate with North Korea in the name of Northeast Asian health cooperation by providing capital and technology; thereby activating exchanges and cooperation with North Korea.
(4) The North-South Health Cooperation Linked with the Environmental Field and Agricultural Field for Enhancing Efficiency
Almost 80% of infant and child mortality is attributable to acute respiratory infection and diarrhea.8 Waterborne epidemic; for example, diarrhea is caused by water pollution, unsanitary toilets, and lack of hygiene. Constant diarrhea, complicated with malnu- trition, suppresses the immune system, causes respiratory infec- tion, and finally makes it a life-threatening disease.
In order to prevent dermatosis, food poisoning, and water- borne epidemic, it is necessary to promote a multi-disciplinary approach including the environmental hygiene field; for example,
8 _ http://www.relief web.
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drinking water development and water quality management.
Besides, the rate of contracting disease increases as malnutrition, caused by food shortage, makes people vulnerable to infection by reducing immunity. In this light, it is urgent to help North Korea secure self-survival ability through agricultural development along with humanitarian food aid. In summation, it is essential to implement a comprehensive project in which health, environment and agriculture are merged together.
(5) North-South Cooperation Linked with Northeast Asian Health and Medicine for Human Security in Northeast Asia
The pattern of epidemic outbreak in DPRK is similar to that of China. Considering that HIV spreads quickly on the North Korea- China border area where more and more people come and go, it is not exaggerating to say that people are exposed to HIV/AIDS as well as sexually transmitted diseases. Health cooperation with China is required because of the possibility of a great number of people becoming infected but not identified. Given that North Koreans are vulnerable to life-threatening Severe Acute Respirato- ry Syndrome (SARS), avian influenza, etc. international coopera- tion for inspecting and managing the border area should be car- ried out so that not only North Korea but also its neighboring countries can respond earlier to communicable diseases through preventing new epidemic outbreaks, tracking diseases, dissemi- nating new information for epidemiology response, and strength- ening the epidemiology response ability of disinfection staff.
6. Conclusion
Northeast Asia is an area where the degree of economic devel- opment changes greatly depending on the country or areas. There- fore, if Japan tries to perform international cooperation in the med- ical care field in this area, you have to take the system of different cooperation for every country or area.
Northeast Asia has many countries where the social system in the medical care field was comparatively ready. However, there is a case that a social system is not fully functioning by the economic conditions of each country.
The following can be said from experience of the international cooperation in the medical care field, which Japan has so far per- formed. It is appropriate to carry out international cooperation about precautions against infectious disease, maternal and child health, and reproductive health through the grants-in-aid from Japan to DPRK and Mongolia.
It becomes a precondition of offering ODA to the DPRK of Japan that a bilateral pending problem is solved and bilateral rela- tion is normalized. After this condition is fulfilled, Japan promotes modernization of the technical conditions (namely, hardware) of the medical care field of the DPRK. Simultaneously, you should participate also in establishment of the medical care system for all the residents of the DPRK to lead wholesome and cultured living positively.
Given the different levels of economic development in North- east Asia, Japan is required to implement different cooperation programs based on countries or regions when it carries out international cooperation.
A number of Northeast Asian countries have well-established social systems in the field of medicine. However, there are many
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cases where the social systems do not work well due to each coun- try’s economic situation. When it comes to international coopera- tion in the field of medicine, Japan has played a significant role. It is appropriate that Japan carries out international cooperation with national subsidy to North Korea and Mongolia for preventing epi- demic, child and maternal health, and reproductive health.
Addressing deadlocked Japan-North Korea problems and Japan-North Korean normalization are prerequisite for Japan’s Official Development Assistance (ODA). Then, Japan modernizes technical conditions, so called hardware, for the North Korean medical field. At the same time, you should participate in estab- lishing medical systems in order to induce North Koreans into a life with sanitation and culture. The North-South cooperation in the fields of health and medicine will be successful only when it reflects the needs and thoughts of the North Korean authorities
Under the short-term and long-term plans to recover and main- tain public health services in DPRK, a project providing both knowledge and technology, aiming at reducing mortality and dis- ease contraction, and a project giving economic benefits to North Korea are likely to be relevant, effective, and sustainable.
Given recent international situations in and around the Korean peninsula, U.S.-North Korean relations and the North-South rela- tions are expected to improve. When the exchange of activities with North Korea are activated in the field of economy, energy, environment, etc. neighboring countries; for example, China and Russia, might suffer from communicable diseases unless they cooperate to deal with epidemics derived from North Korea.
Patients with SARS have yet to be detected in DPRK. However, North Korea banned the entry of foreigners into the country in the spring of 2003 in that it adjoins China along with its bad medical situation. Epidemic outbreaks in and around North Korea may be
major obstacles to Northeast Asian exchange and cooperation because they are fatal to not only the resuscitation of North Korean economy but also Northeast Asian economy. In this light, North- east Asian countries need to create a roadmap that is expanded from the North-South cooperation into Northeast Asian health cooperation based on human security.
In the meantime, it is necessary to introduce an economic coop- eration strategy, aiming at realizing mutual benefits between the two Koreas, in the filed of health industry in order to continuously carry out the cooperation for product facilities, raw materials and technical assistance. It is stable and effective to open up coopera- tion channels between the two Koreas in the fields where sizable funds are needed, or a multi-disciplinary approach is required; for example, agriculture, environment.
When it comes to technology cooperation, health and medical projects in DPRK will be effectively implemented if education or training programs are activated through setting up sisterhood rela- tionships by job classification, and setting up sisterhood relation- ships between medical institutions for the sake of providing med- ical supplies and equipment.