This challenge resembles that facing western researchers in the post-war period who were seeking information on the Soviet health system.
Given the nature of the regime, it is difficult to assess their validity and representativeness.
There are obvious problems in obtaining direct access to the North Korean population and the few sources of data are extremely sparse. Perhaps unsurprisingly, there has been relatively little published by the UN and other international organizations working in North Korea. A rare exception was a widely publicized case of extensive parasitic worm infection in a defector, reported as indicative of health system failings, although commentators noted that generalization from a single case is unwise. Yet, while the worsening economic situation and, especially, the intensification of sanctions has attracted media attention, especially in relation to food supply, the consequences for healthcare are much less clear. These changes are almost certain to have impacted adversely on the experiences of North Koreans in need of healthcare. In addition, a nascent informal market in healthcare has expanded although the government still presents the socialist health system as the only one. Meanwhile, a rapidly expanding informal market mechanism has resulted in parallel economic systems for commercial distribution of essential items and the informal generation of household income mostly through an informal system of local markets, termed Jangmadang (literally translated as “market grounds”) filling the gaps created by the deteriorating Public Distribution system. An analysis of data from two censuses, in 19, suggests that life expectancy has fallen substantially, with the greatest contribution from rising deaths in childhood and late middle age. The result is that the public distribution system (PDS), which allocated food along with goods such as clothes and household appliances to the population, has become dysfunctional, and the centralized health system has been weakened from a chronic shortage of funds and a lack of essential medicines and medical supplies. The economy, a large share of which is now devoted to the military, has weakened further under pressure from international sanctions.
Soon after, shortages of fuel and fertilizer, combined with widespread flooding, contributed to large scale famines. A further blow came in 1991, when the collapse of the USSR cut of economic support on which it depended. Although the country initially outperformed its Southern neighbor economically, by the 1970s its economy was struggling and, in 1979, it defaulted on many of its international debts. It has, in theory, provided universal coverage but the reality is now somewhat different. Created as a state entity, it is funded by government revenues and delivered within an extensive network of well-staffed health facilities. The health system in the Democratic People’s Republic of Korea (DPRK, or North Korea) shares many features with those in place in other parts of the pre-1989 Communist bloc. The scope to use these findings to bring about change is limited but they can inform international agencies and humanitarian organizations working in this unique setting. There are large disparities in health and access to healthcare in North Korea, associated with political and economic inequalities. Respondents who could not enjoy political and economic rights were substantially more likely to report illness and extremely reduced access to care, even with life-threatening conditions. In multivariate logistic regressions, party membership was associated with better access to healthcare (Adjusted OR (AOR) = 2.34, 95%CI, 1.31–4.18), but household income (AOR = 0.40, 95%CI 0.21–0.78) and informal market activity (AOR = 0.29, 95%CIs 0.15–0.50) with reduced access. High informal costs (53.8%, 95%CI, 45.1–60.8%) and a lack of medicines (39.5%, 95%CI, 33.3–47.1%) were reported as major healthcare barriers resulting in extensive self-medication with narcotic analgesics (53.7%, 95%CI, 45.7–61.2%). Of the respondents, 55.1% (95%CI, 47.7–63.7%) had received healthcare for the most recent illness episode.
#Life in north korea free#
ResultsĪlthough the Public Health Act claims that North Korea provides the comprehensive free care system, respondents reported high levels of unmet need and, among those obtaining care, widespread informal expenditure. MethodsĪ retrospective survey using respondent-driven sampling conducted in 2014–15 among 383 North Korean refugees newly resettling in South Korea, asking about experiences of illness and utilization of healthcare while in North Korea, analyzed according to measures of political, economic and human rights indicators. To gain insights into the socio-economic and political determinants of ill health and access to healthcare in North Korea.
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