In December 2008, the office of the US Director of National Intelligence issued a report titled, “Strategic Implications of Global Health (ICA 2008-10D).” In this report, the DNI made the following comments about the state of public health in the DPRK and its effects on economic growth and military preparedness:
North Korea (p.46)
WHO Ranking of Health Systems (out of 190 countries rated): 167
NCMI Ranking of Health Care Capabilities: 5 (Unsuitable)1. Economic crisis and famine of 1990s fueled breakdown of once-efficient health-care system.
2. Lack of medicine, equipment, sanitation, and reliable energy supplies make quality healthcare virtually unobtainable outside of Pyongyang.
3. Persistent refusal of international health expertise and assistance makes significant short-term improvements unlikely.Most Urgent Health Problems:
1. TB, scarlet fever, and measles particularly prevalent, although Pyongyang’s secretiveness makes outbreaks extremely difficult to verify and track.
2. Chronic diseases account for an estimated 40 percent of deaths.
3. Even after the widespread famine of the 1990s, prolonged and severe malnutrition persisted; more than half of North Korean children are stunted or underweight, while two-thirds of young adults are malnourished or anemic. The World Food Program currently warns that a new food crisis is in the making as the result of floods and North Korea’s refusal to accept food aid from a new South Korean government that is highly critical of Pyongyang.Other:
1. North Korean-manufactured illicit drugs—an effort to earn hard currency—increasingly used by citizens of that country as substitutes for scarce medicines or to relieve hunger or boredom.
2. HIV/AIDS prevalence is negligible.Strategic Considerations:
1. Widespread malnutrition and accompanying physical and cognitive disabilities among DPRK children and young people likely inhibitors of economic growth—with or without opening to the outside world or reunification with the South.
2. If reunification occurs, South Korea will face costs not only of incorporating an economic void, but also those of a huge health-care burden. Seoul could look to other countries or to multilateral organizations to help defray expenses.
3. Poor health is weakening military readiness because capable new recruits are in short supply. Loyalty may also erode over time, according to Eurasia Group; even when soldiers are well fed, they may be concerned about their malnourished family members.
4. The famine of the 1990s destroyed absolute state control of food rationing, internal movement of citizens, and information as North Koreans were compelled to defy state restrictions in their struggle for survival—and as those who had escaped to China in search of food and work returned with news of the outside world, according to Human Rights Watch.Potential Opportunities:
1. Health cooperation (amelioration of North Korea’s heavy health burden) could serve as a means of “diplomacy through the back door.”Other Comments:
Widespread ill health in the youth cohort may reduce a country’s pool of healthy and capable military recruits, a phenomenon that is currently playing out in Russia and North Korea. Deployed military forces will continue to be vulnerable to the ravages of infectious diseases, and the capability of a government to provide adequate health protection for its troops will significantly impact its ability to project force abroad. (p.5)
Malnutrition-related cognitive disabilities among North Korean children and young people likely will impact future economic growth in that country regardless of when Pyongyang opens to the outside world or reunifies with the South. Nationwide malnutrition has compelled Pyongyang to lower minimum height and weight requirements for military service, and an estimated 17 to 29 percent of potential North Korean military conscripts between 2009 and 2013 will have cognitive deficiencies disqualifying them for service. (p.6)
Along these lines, it is likely that malnutrition-related cognitive disabilities among North Korean children and young people—resulting from the 1990s famine, as well as the widespread hunger that persists to this day—will inhibit future DPRK economic growth, with or without opening to the outside world or reunification with the South. (p.24)
As a consequence of early childhood malnutrition, an estimated 17 to 29 percent of potential North Korean military conscripts will have cognitive deficiencies severe enough to disqualify them for service by US standards (This figure does not include individuals who are mentally capable but have physical conditions disqualifying them from service). The National Center for Medical Intelligence estimates that mental fitness of North Koreans subject to military conscription will be at its weakest during the period 2009-2013 as children born during the severe food shortages and famine of the 1990s reach military age. (p.28)
For the record, the UN WHO ceased publishing the Ranking of Health Systems in 2000 due to the “complexity of the task.” My suspicion is that it was actually ended because member governments did not appreciate being ranked in this field. However the DPRK’s score of 167 dates from the final publication eight+ years ago. I am unable to investigate the DPRK’s score from the NCMI because this report is not publicly available (as best I can tell).
Although this report offers a decent summary projection of the effects of poor health on the DPRK’s strategic options, there is not much new, or newsworthy, about the report (at least as it pertains to the DPRK). Most of this information has been floating around the public domain for some time. In fact, I probably never would have heard of this study if the North Korean’s had not publicly complained about it in KCNA. (Click here to read KCNA story)
Quoting from Yonhap:
“They floated the cock-and-bull story,” the KCNA said, “It is an open secret that the ill-famed intelligence and plot-breeding institutions of the U.S. including the CIA are hell-bent on releasing false reports about its hostile countries.”
“It is the unpopular healthcare system in the U.S. which should be overhauled or replaced by a new one,” the report said.
“However, they released the false report, finding fault with the advantageous healthcare system in the DPRK in a bid to hurt the prestige and dignity of the DPRK in the international arena and stir up ‘ill feelings’ in society,” it said.
This report is 55 pages long and the portions on North Korea (listed above in full) barely fill two pages. I am not sure why the North Korean’s chose to draw attention to it by complaining in KCNA.
You can read the Yonhap story here:
N. Korea condemns U.S. intelligence report on its combat ability
Yonhap
1/24/2009
