In 2000, the Lancet published an article highlighting the failings of North Korea’s health care system, ranking tuberculosis (TB) as the highest public health concern in North Korea. In 2010, the prevalence rate of TB in North Korea was 399 per 100,000 people, which is alarming given that Ghana, another developing country with the same population of 24 million, has a prevalence of only 106. The amount of infected individuals is more than three times higher than that of South Korea and China.
TB is a highly infectious disease needing professional diagnosis and treatment. The situation in the country only compounds the problem, as even 20 years after a famine reportedly killed about 3.5 million people, malnourishment is still rife. A weakened body increases susceptibility to the disease.
On a more positive note, North Korea’s history with international agencies and non-profit organizations to target the elimination and prevention of this disease has been cooperative. ‘One victory was the construction of a laboratory which has the capability to diagnose drug-resistant TB strains. This idea was formulated in early 2007 by John Lewis, a professor at Stanford University, who considered engaging with North Korea from a different angle, by helping them with their TB epidemic. Given the infectious nature of TB, this was undoubtedly a matter of international interest, and it received much positive reception worldwide.
Soon afterwards, public health officials from North Korea and experts at Stanford University met several times, initially at Stanford and then later at Pyongyang, North Korea’s capital. The project, led by epidemiologist Sharon Perry, was named the US-DPRK Tuberculosis Project, and its success was the result of collaboration between Stanford School of Medicine, Christian Friends of Korea (a U.S. non-governmental organization), the WHO South-East Asia Regional Office in Delhi, and North Korea’s Ministry of Public Health.
The willingness of North Korea to engage with US academics and specialists is a good sign. Not only has North Korea’s Ministry of Public Health chosen to engage the US in this issue, but it has also been working with the WHO South East-Asia Region Office in Delhi for over ten years. A grant from the Global Fund has cured 31,000 TB patients in North Korea since 2010, achieving the second highest performance rating available. The Eugene Bell Foundation, a non-profit organization registered in both South Korea and the U.S. has worked with North Korea for over 50 years to help control their TB epidemic.
This engagement is crucial not only because TB is infectious but also because drug-resistant strains are continuously evolving. The international community must continue to support North Korea with this issue as the consequences of ignorance are potentially catastrophic. If a drug-resistant strain unresponsive to current drugs were to evolve in North Korea, it could easily spread rapidly through the small channels of tourism and trade, as well as the sporadic flow of defectors across the border with China.
It is problematic that public health is routinely left out of any sort of discourse on North Korea. However, throughout the upcoming year, as countries with or without formal international relationships with North Korea re-evaluate their diplomatic stances, policymakers should keep in mind the dangers of ignoring the state of the health system. This knowledge can be a crucial factor in setting up a better framework for how humanitarian aid really affects the people of North Korea.
Involving public health in foreign policy is complicated, especially when it involves a process as delicate as persuading North Korea to phase out its nuclear capabilities. However there have been other cases of success by other countries, for example Brazil’s exportation of its successful HIV/AIDS combating model to other developing countries has increased its access to international markets.
At the very least, employing healthcare diplomacy in North Korea through official channels is a useful way of showing compassion to a people who are taught as schoolchildren that contact with the outside world should be avoided. It would be a small but positive step towards effective engagement with North Korea, one of the world’s most isolated countries, and could potentially cause negotiations to end more positively than they have done in the past.