Seoul-Pyongyang health care cooperation is a health security issue that directly affects the lives and livelihood of North and South Koreans. Seoul, the world's leading city and capital, will experience explosive contact from many people at home and abroad during and after the unification process. This will increase the spread of infectious diseases and illness, threatening the health security of citizens. As can be seen in COVID-19 situation, the Seoul-Pyongyang health care the cooperation is a precautionary work for the health security of citizens of the Korean Peninsula. West and East Germany were the first to sign a health agreement to prevent social chaos and to promote integration after the reunification. Although West and East Germany had relatively smaller economic gap compared to the two Koreas at the time of the reunification, they still deal with social conflict today. The large health care gap between the two Koreas can potentially cause social conflict in the unified Korea. Sanctions against North Korea, COVID-19 and natural disasters are exacerbating North Korea's economic hardship. The severe economic hardship actually collapsed North Korea's health care system. Half of North Korea's population do not have access to basic sanitation facilities or quality health care services. Food shortages are also deteriorating the health of North Korean people due to various diseases. Thus, external health and medical support and cooperation are essential to resolve this situation. For Seoul-Pyongyang health care cooperation, the Seoul Metropolitan Government should set a clear goal considering the strengths, weaknesses, opportunities and threats. It also needs to accommodate the needs and acceptability of North Korea. With such consideration, we suggest that Seoul-Pyongyang Cooperation should work towards accomplishing the following four goals: 1) to treat and prevent diseases and promote health of North Koreans; 2) to improve and enhance North Korean health and medical environment; 3) to establish a health and medical cooperation system between Seoul and Pyongyang; and 4) to realise a healthy community on the Korean Peninsula.
With these four goals, the Seoul Metropolitan Government should set a strategy in three directions: 1) strengthening disease treatment; 2) ensuring disease prevention and health enhancement; and 3) strengthening health care capabilities.
Short-term task for Seoul-Pyongyang cooperation should focus on supporting the treatment of infectious diseases and emergency nutrition. Detailed projects (programs) include: 1) Seoul-Pyongyang Joint Analysis and dispatch of experts to understand the status of health and medical care in North Korea; 2) Support treatment of infectious diseases; and 3) Aid emergency nutrition and hygiene products. 
Mid- to long-term task should aim to improve the health care environment in North Korea for disease prevention and health enhancement. Projects could include: 1) support for non-infective disease treatment and improvement of such health care services; 2) improve natural and living conditions to prevent diseases and maintain health; and 3) expand and modernise health care infrastructure. 
The long-term task should aim to normalise North Korea's basic health care system. Projects could include: 1) improve access to basic health care services; 2) exchange researchers and related workers in the health care field between Seoul and Pyongyang; and 3) establish a sustainable Seoul-Pyongyang health and medical cooperation governance.