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The North Korean healthcare system

The official name of the country, chosen for the analysis, is the Democratic People’s Republic of Korea (DPRK), also known as North Korea. The rationale behind this particular selection is that there is a good reason to believe that the functioning of the country’s healthcare system provides many insights into what to account for the benefits/drawbacks of organizing such a system according to the Socialist principle.

Location/Geography

DPR Korea occupies the northern part of the Korean Peninsula with the size of this country’s territory accounting for 120,538 sq. km. The terrain of DPR Korea is mostly mountainous, which features many narrow valleys. The country’s climate is best defined as temperate (comparatively hot summers and cold winters). DPR Korea is a resource-rich country. Among the country’s most important natural resources are iron ore, copper and coal. It is being estimated that only 19.5% of land in DPR Korea is arable. Administratively speaking, the country is divided into nine provinces and two municipalities (The World Factbook: KOREA, NORTH, 2015).

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Population

As of July 2015, the population of DPR Korea was estimated to account for 24,983,205. This population is essentially racially homogeneous (consisting of Koreans), although it features a small percentage of the ethnic Chinese. The average rate of life expectancy in DPR Korea is 70.11 years (66.26 years among males and 74.16 years among females). The fertility rate among North Koreans is 1.97 (children per woman). The bulk of the country’s population (about 40%) consists of individuals aged between 25 and 54 years. The rate of literacy among North Koreans is 100%. Close to 60% of the country’s citizens reside in urban areas. The population of DPR Korea grows at the rate of 0.53% per year (The World Factbook: KOREA, NORTH, 2015).

Government

In the formal sense of this word, the form of political governing in DPR Korea is best defined as democracy – the members of this country’s Government (including the ‘Supreme Leader’ Kim Jong Un himself) are being elected during the all-national political elections, held every five years. The Constitution of DPR Korea proclaims the independence of the Government’s legislative, judicial and executive branches. However, the de facto type of political governing in North Korea is a one-family (one-party) dictatorship – the country’s ruling party (Korean Workers’ Party) exercises total control over the Government’s functioning and over the qualitative dynamics in the public sphere of the DPR Korea. Throughout the course of their lives, North Korean citizens never cease to be subjected to the most extreme forms of political indoctrination – something made possible by the fact that they are being denied any access to alternative sources of information (Park, 2014). The political ideology in DPR Korea is Juche (loosely translated as ‘self-sustainability’), which is the extremely militarized form of Socialism with the elements of Communism (Armstrong, 2014).

Economy

The functioning of the economy of DPR Korea is centrally planned, with the means of production (as well as land and natural resources) being owned by the state. As of 2013, the country’s GDP has been unofficially estimated to account for $28 billion. The heavy industry’s share of the GDP (47.6%) is the highest compared with the other sectors of the economy. In the same year, the affiliated GDP per capita was calculated to amount to $1.800. The country’s labor force is about 15 million people. The industrial sector of DPR Korea primarily specializes in the production of military equipment, chemicals and heavy machinery. Among the agricultural products of DPR Korea, there can be named soybeans, rice, corn and potatoes. The country’s most important trade partners are China and South Korea. Even though the officials from DPR Korea claim to have succeeded in eliminating the problem of unemployment altogether, at least 25% of North Koreans are believed to be de facto unemployed (The World Factbook: KOREA, NORTH, 2015).

State of Health

Even though the rate of vaccination in DPR Korea reaches 90%, the country’s population is far from being considered healthy. One of the reasons for this is that, as time goes on, more and more citizens end up affected by a number of non-communicable diseases (particularly cardiovascular ones). Among them can be listed: CAD (coronary artery syndrome), which contributes 19.4% towards the overall mortality rate, IHD (ischemic heart disease) and lung cancer, with the associated mortality rates of 11.8% and 5.5% respectively (Democratic People’s Republic of Korea: WHO statistical profile, 2015, p. 3). In its turn, this can be explained by the high rate (54.5%) of cigarette addiction among North Koreans. According to the 2009-2013 report WHO Country Cooperation Strategy: Democratic People’s Republic of Korea, “Some of the persistent health issues (in the DPR Korea) include high maternal mortality and rates of abortion; high prevalence of low birth weight and childhood malnutrition; TB, malaria and hepatitis B” (p. 6). Partially, the mentioned health issues in DPR Korea are being caused by the lack/absence of medical equipment in the hospitals (due to the economic sanctions, imposed against North Korea by the West) and by the fact that at least a good half of the country’s population suffers from undernourishment. Information about violence/accidents in DPR Korea is not available, due to the Government’s policy of secrecy, in this respect.

Culture/Traditional Medicine

One of the most notable aspects of the functioning of the healthcare system in North Korea has to do with the fact that, even though the Government deploys a rational approach towards designing its healthcare policies, it nevertheless continues to apply much effort into popularizing Korean traditional medicine Koryo. This medicine is concerned with the deployment of ‘holistic’ strategies for combating/preventing diseases. In fact, the country’s Ministry of Public Health (MoPH) operates the so-called National Academy of Traditional Koryo Medicine in the capital city of Pyongyang. The popularity of traditional medicine in DPR Korea can be explained by the apparent cost-effectiveness of this type of medicine, on one hand, and by the fact that the Ministry’s top officials recognize the importance of making people less prone to succumbing to diseases (especially the non-communicable ones), on the other hand. It is also believed that prescribing patients with traditional remedies is fully consistent with the spirit of collectivism – the main qualitative feature of North Korean society, as a whole.

Healthcare System and Delivery

In DPR Korea, health affairs are being addressed/regulated by the Ministry of Public Health. The Ministry’s main agenda is concerned with implementing the main health-related provision of the country’s Constitution – to provide citizens with free and universally available medical care. Within the context of addressing this task, the Ministry collaborates with a number of international NGOs specialized in helping to rebuild healthcare infrastructures in the Third World, such as the World Health Organization (WHO) and UNICEF. The organization in charge of implementing the directives of MoPH is called Central Hygiene and Anti-Epidemic Institute (CHAEI). This organization’s other important responsibilities include enforcing hygiene-related rules and regulations across the country and monitoring the epidemiological situation in DPR Korea (WHO Country Cooperation Strategy, 2009-2013).

As for the population of 24 million, the overall number of hospitals in the DPR Korea is rather impressive, “There are more than 800 hospitals at central, provincial, and county levels, and about 1000 hospitals and 6500 polyclinics at the (rural) level” (Barrett, 2011, p. 2). The overall number of healthcare workers is estimated to account for 300.000, which sets the doctor/citizen proportional ratio at 32 against 10.000. The number of physicians in North Korea is 75.609, with the number of certified nurses accounting for 90.369 (Democratic People’s Republic of Korea: WHO statistical profile, 2015, p. 22). This, of course, implies that the number of nurses in DPR Korea is rather inadequate, as it barely exceeds the number of physicians.

The particulars of the system of nursing education in DPR Korea remain largely unspecified. Nevertheless, there are at least six fully operational nursing schools in the country. It will be logical to assume that nursing education is also provided at each of the country’s ten medical colleges. The lack of relevant information, in this respect, does not allow us either to confirm or to refute the existence of nursing associations in North Korea. It is most likely, however, that they do not exist, as the government strives to prevent society’s stratification along the professional lines.

Health Priorities

In light of what has been mentioned earlier, the main priorities for the Ministry of Public Health in DPR Korea can be formulated as follows:

  • Reducing the high rate of birth-mortalities and the rate of malnourishment among children – a rather challenging task, given the shortage of food in the country.
  • Encouraging citizens (especially males) to quit smoking, as the instrument of addressing the prevalence of tobacco consumption among them. In its turn, this should have a slowing effect on the ‘epidemic’ of cardiovascular diseases in this country.
  • Acquiring up-to-date medical equipment and educating physicians/nurses on how to operate it.

Conclusion: Nursing Implications

Nurses should come as a particularly valuable asset, within the context of MoPH addressing specifically the first two of the mentioned priorities. The reason for this is apparent – nurses are not only required to assist women through the baby-delivering process but also to oversee the sub-sequential phases of mothers/newly born children being provided with nourishment. Tackling the second priority, on the part of MoPH, can hardly be proven executable without nurses, as well. After all, while on the line of taking care of their primary responsibilities, nurses are also being often required to educate patients about the most common effects of smoking/alcohol drinking. Given the fact that the proposed priorities are not the least concerned with the ‘humanization’ of the healthcare sector in DPR Korea, increasing the number of nurses in the country will definitely help to implement the suggested measures. This alone allows us to conclude that the participation of nurses in helping to boost the effectiveness of the healthcare system in North Korea is one of the main preconditions for the concerned undertaking to be successful.