Health care system and dilemma in North Korea

Health care system and dilemma in North Korea

For the past half-century, after the war in 1953, South and North Korea has been divided and South Korea has grown to become one of developed countries, with an average annual income of more than $31,950 per person (compared with $18,000 in North Korea). North Korea, on the other hand, has been in severe poverty due to economic decline or even collapse, which causes public health problems. Economic depressions and public health problems combined with natural disasters in the early 1990s (1). A ‘snowball effect’ of economic downturn was initiated with an inordinate number of natural disasters like foods, malfunction and drought and it aggravated overall public health infrastructure in the country. 

In North Korea, states manage and control public health system adopted from Soviet model (2). The state-oriented health care system manages public health care facilities with delivery of care at no direct cost to people. The system was once considered to be exceptional among developing countries, and United Nation ranked it highly on the health assessments (2). While the basic healthcare infrastructure that was developed in the 1950s continues to exist today, the extent of the medical services available has been a major source of uncertainty and concern. The economic and health decline has been constrained the operation of healthcare system with a lack of medications, resource deficiencies and limitations of clean water and food provision since 1990s (3).

The economic and health declines of the 1990s created a considerable strain on the present healthcare system. Specifically, resource deficiencies, a lack of medications, vaccines, power and heat, and limitations of clean water and food severely diminished the quantity and quality of available services.8 From 2001 to 1994, rate of vaccination coverage for under one year old children decreased 63% for combined diphtheria, 23% for polio and 95% for a two-dose tetanus toxoid. Moreover, the case of infectious diseases like tuberculosis (TB) and malaria has steadily increased (3). Many people in North Korea have a daily diet with substitute foods like noodles and cakes, made from a mix of plants and brasses such as soybeans, potatoes, grasses and corn husks. North Korea’s officials say one person takes around 600g per day from such foods administered by public distribution system. But in reality, the amount of foods is only 40% of total food intake (4).

In the past several years, North Korean Government has shown their willingness to involved in outside world, which shows the increasing number of international supports from NGOs have been entered into the North Korea. After the wide spread flood, which damaged lots of lands, farms and mines, The North Korea got helped from United Nations (UN) food emergency program. According to the close observers of North Korea, the number of death caused by natural disaster and malnutrition is approximately between 800000 and 1·5 million (3). Hoverer, North Korea is still make themselves be isolated and they are against to release health statistics, which makes them being with international community uncertainty of the precise extent of the public health devastation.

1. Sigal L. Disarming strangers: nuclear diplomacy with North Korea. Princeton University Press; 1998, p. 1–254.

2. Eberstadt N, Banister J. The population of North Korea. University of California: Berkeley; 1992, p. 38–62.

3. Davies J. North Korea’s public health tragedy. Lancet 2000; 357:628–30.

4. Macfarlane S, Racelis M, Muli-Musiime F. Public health in developing countries. Lancet 2000;356:841–6.