Health and healthcare in North Korea: a retrospective study among defectors

Hayoung Lee; Courtland Robinson; Jaeshin Kim; Martin McKee; Jiho Cha

doi:10.1186/s13031-020-00284-y

Health and healthcare in North Korea: a retrospective study among defectors

Confl Health. 2020 Jun 29:14:41. doi: 10.1186/s13031-020-00284-y. eCollection 2020.

Authors

Hayoung Lee¹, Courtland Robinson², Jaeshin Kim³, Martin McKee⁴, Jiho Cha⁵

Affiliations

¹ Independent Consultant, Seoul, South Korea.
² Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
³ Dankook Center for Dispute Resolution, Dankook University, Yongin, Republic of Korea.
⁴ London School of Hygiene and Tropical Medicine, London, UK.
⁵ Humanitarian and Conflict Response Institute, University of Manchester, Manchester, UK.

Abstract

Background: To gain insights into the socio-economic and political determinants of ill health and access to healthcare in North Korea.

Methods: A 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.

Results: Although 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. Of the respondents, 55.1% (95%CI, 47.7-63.7%) had received healthcare for the most recent illness episode. 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%). 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. 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.

Conclusions: There are large disparities in health and access to healthcare in North Korea, associated with political and economic inequalities. 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.

Keywords: Access to healthcare; Health disparities; Health system; North Korea; Political inequality.