Prospects for Health Cooperation: Changing Health Priorities for the Democratic People’s Republic of Korea
Four years after the World Health Organization (WHO) officially declared COVID-19 a pandemic, humanitarian engagement in the Democratic People’s Republic of Korea (DPRK or North Korea) has yet to fully return to pre-pandemic normalcy. Offers of aid from China, Russia and South Korea following the most recent devastating floods in the northwestern part of the country, and subsequent rejections from the DPRK, highlight the ongoing challenges North Korea faces in balancing its autonomy with the need for external assistance. Although there have been significant steps toward reopening its borders in the last month, such as allowing tourists from Russia and inviting Swedish diplomats back to the country’s embassy, progress in resuming humanitarian work by international nonprofits has remained slow and fragmented.
Given this context, a thorough, up-to-date understanding of what health issues the DPRK considers to be the domains of highest priority is crucial. Based on our review of its previous medium-term strategic plans and the evolving trends in the country’s national health priorities, this analysis outlines the most critical areas in health likely to be emphasized in the forthcoming edition of the WHO and DPRK’s Country Cooperation Strategy (CCS). North Korea’s health system strengthening strategy is expected to focus on several key areas, including communicable disease control, technological advancements and modernization, maternal and child health, the growing burden of non-communicable diseases, and ecological health impacts. Bolstering these efforts will be vital for improving the country’s health outcomes and resilience.
Renewed Emphasis of Communicable Diseases Control
The health needs of the North Korean people have undergone significant changes over the years, driven by various internal and external factors. Although the DPRK has historically prioritized preventive measures to safeguard public health, the pandemic has highlighted limitations in its infrastructure.
While North Korea had a seemingly successful response to COVID-19, the next pandemic could arise with a higher transmission rate, increased resistance to treatments, or any other unpredicted challenges. At a time when the WHO has just declared that the upsurge of mpox constitutes a public health emergency of international concern, it is imperative that North Korea glean lessons from the pandemic to reinforce its healthcare systems.
To address the vulnerabilities exposed by COVID-19, the DPRK is expected to focus on several areas to enhance its health system concerning communicable disease control. According to the “DPRK’s Voluntary National Review on the Implementation of the 2030 Agenda for Sustainable Development,” published in 2021, one of North Korea’s standing strategic priorities is to reinforce its hygiene and anti-epidemic sectors. The limitations in diagnostic capacity were demonstrated by North Korea’s practice of using fever cases as proxy indicators for outbreaks due to its lack of PCR testing capabilities. Through a sanctions exemption granted to the WHO until August 2025, North Korea is projected to expand its essential laboratory capacity with additional equipment supplies.
A health system’s efficacy is judged not just by its ability to detect diseases, but also to treat them promptly. This involves the availability of PPEs like masks as well as oxygen supply, antibiotics and other essential medical supplies.
According to Chinese customs data, North Korea purchased approximately $45 million in pharmaceuticals alone in 2022 with no signs of slowing down. It has been estimated that at least 150 invasive ventilators were imported that same year, which far exceeds the number needed just in Pyongyang. This suggests that the DPRK is keen to equip not just the capital, but also all of its provincial hospitals with the capability to respond in the case of a serious disease outbreak.
North Korea’s latest vaccination campaign, launched following the United Nations Children’s Fund’s (UNICEF) delivery of over 4 million vaccine doses earlier this year, marks a substantial effort by its government to address the significant gaps in immunization rates, which fell from 96 percent to below 42 percent during the pandemic. Low immunization coverage not only makes the North Korean population vulnerable to vaccine-preventable diseases, but also carries serious implications for global health security. UNICEF, Gavi, the Vaccine Alliance, and the WHO should ensure that vaccine supplies are accompanied by essential field assistance for effective deployment, a capability historically demonstrated by North Korea through the Ministry of Public Health (MoPH). Sustained efforts should also go toward combating other diseases of high burden, such as tuberculosis (TB) and hepatitis. However, previously established programs, including those run by the Eugene Bell Foundation and Christian Friends of Korea (CFK), are presently on hold due to geopolitics—US-based NGOs are not being invited back into the country at this moment. Furthermore, the DPRK should not neglect the elimination of malaria and maintain its said HIV-free status.
Integrating Technological Advancements for Strengthening Robust Health Systems
As the DPRK seeks to modernize its healthcare system, it must continue to build its capabilities in epidemiological research, especially given the limited number of domestic programs and peer-reviewed journals that currently exist in the country. Strengthening the control of communicable diseases in North Korea should be carried out in tandem with the building of epidemiological capacity that balances both investigative and emergency response efforts.
While North Korea officially has a universal health coverage policy, the ground reality suggests that the quality of access to treatments and health facilities varies considerably. Integrating the latest technological advancements across all channels of a health system can help overcome this limitation. Telemedicine provides an excellent avenue for extending healthcare services to remote areas. It also allows for virtual training with international experts, offering an alternative to external aid and fostering “self-reliance,” an important theme for the North Korean leadership. Technological improvements extend to enhancing the quality of more specialized medical care, including surgical procedures, which can greatly benefit from the import of advanced imaging.
Concurrently, North Korea must improve the health literacy of its general population. Citizens should not only be aware of the availability of services, but also how to access and utilize these services effectively. North Korea’s existing section doctor system, where physicians are assigned to specific geographic regions or communities, provides a robust framework for healthcare delivery that could integrate digital record-keeping and systematic knowledge dissemination. Strengthening leadership, management, and human resource capacities are additional steps toward making the healthcare system more robust and self-sustaining.
Moreover, the DPRK has a rich history of Koryo traditional medicine, which could be integrated more seamlessly into the modern healthcare system. This would require research documentation as well as the implementation of standard treatment protocols.
Continued Prioritization of Maternal, Newborn and Child Health
North Korea has made notable strides in reducing both maternal and infant mortality rates in recent years. The South Korea-funded maternal and child health project, led in collaboration with the WHO and UNICEF from 2006 to 2015, carried a budget of $65 million. This remains the largest international health cooperation project implemented in North Korea.
While the achievements from those years of targeted interventions can be seen as successful, the goal to continue improving other indicators, such as the prevalence of wasting in children under five years of age, should not be neglected.
Chronic malnutrition has long-term impacts on a child’s cognitive and physical development and remains a key metric in evaluating the success of child healthcare programs. Comprehensively addressing reproductive health and nutrition is vital for the well-being of mothers and children. There is a continued need for more extensive services, including family planning, prenatal and postnatal care, and nutritional guidance for pregnant and lactating mothers. Such services would be of interest to North Korea now more than ever, whose leader expressed concern about its population decline last year.
With the DPRK joining the Executive Board of the WHO in 2023, we would likely see the DPRK pay more attention to the implementation of the World Health Assembly (WHA). Leaders are expected to set a good example. Specifically, with international partners and funding, the DPRK may choose to implement the recommendations to fortify with micronutrients like folic acid to prevent neural tube defects, as recommended by WHA resolution 76.19.
Focused Measures Toward Addressing Non-Communicable Diseases (NCDs)
As North Korea takes significant steps toward improving its overall healthcare, the epidemiological landscape has also naturally shifted toward non-communicable diseases (NCDs). According to the WHO’s NCD 2018 Country Profiles, NCDs account for 84 percent of deaths in North Korea. Effective management of NCDs requires a population-level approach that extends beyond merely treating individuals who are already affected. Preventive measures, including innovative lifestyle modification campaigns and early screening programs, need to be implemented.
To strengthen chronic disease management in the long term, North Korea can benefit from adopting and tailoring global strategies that incorporate diverse perspectives on complex health issues, such as the WHO’s Intersectoral Global Action Plan on Epilepsy and Other Neurological Conditions. Early efforts to identify unmet surgical needs in North Korea to minimize disability-adjusted life years (DALYs) will significantly improve future health outcomes at the population level.
Lastly, cancers are a significant subset of NCDs that require complex policy interventions, whether it be the incidence of lung cancer associated with smoking or hematological malignancies with a more genetic basis to its cause. The DPRK is already a signatory of the WHO Framework Convention on Tobacco Control. In addition to strengthening diagnosis and treatment options, it is equally important to build capacity for palliative care. Public awareness campaigns about the risk factors and palliative support associated with cancers can contribute to early diagnosis and improved quality of life outcomes.
Climate Resilience and Environmental Determinants of Health
The DPRK has shown a commitment to tackling climate change, evidenced by its membership in the UN Framework Convention on Climate Change (UNFCCC) and active diplomatic participation in international forums, including the 28th Conference of the Parties (COP28) in 2023. North Korean State media often highlights environmental concerns such as deforestation and natural disasters affecting crop production, in addition to spotlighting global issues. Their official communication on the 2016 Nationally Determined Contribution (NDC) makes it clear that North Korea recognizes the cross-cutting importance of climate resilience, which, in turn, also affects the country’s public health landscape.
A 2022 UN report stated that undernourishment among North Korea’s population of 25 million reached 41.6 percent from 2019 to 2021 compared to 33.8 percent from 2004 to 2006. Its frequent exposure to typhoons, flooding, and droughts compounds existing vulnerabilities in its healthcare system. For instance, in 2020 alone, the country experienced five major typhoons within a span of a few weeks, causing widespread damage to infrastructure, including hospitals, roads, and water systems, and displacing thousands of citizens. These events pose an imminent threat beyond just access to clean water and food security by increasing the risk of waterborne diseases, injuries, and long-term mental health burdens.
North Korea needs to integrate these environmental factors into its broader healthcare strategy, implementing resilience measures through improved water irrigation systems, sustainable agriculture, and food distribution networks that can withstand the volatility of a changing climate. Existing protocols for implementing the One Health approach, incorporating veterinary considerations, can guide the reduction of disease spillover risks from animals to humans.
Building Trust Through Health Cooperation
Given North Korea’s current position of refusing external aid, health cooperation based on fundamental humanitarian principles can serve as a non-contentious entry point for broader engagement with the DPRK. However, this should occur within a framework that ensures multi-year programming is protected from disruptions by political motivations. A comprehensive health system strengthening approach that includes workforce training, infrastructure improvement, and technology transfer for vaccine development facilitated through neutral entities, such as the WHO vaccine hub, if taken in an enduring manner, could help build trust between North Korea and the international community while improving the lives of ordinary North Koreans.
Conclusion
With the COVID-19 pandemic now seemingly long behind us, North Korea stands at a critical juncture for making decisions on how it will allocate resources toward advancing its health system. Given the interconnected nature of global health, it is imperative for the international community to build cooperative measures, not only in areas of mutual interest, including disease control and climate resilience, but also for improving fundamental indicators of quality of life, such as maternal and child health. The Country Cooperation Strategy (CCS), together with the WHO, should provide a clear sense of direction to encourage sustainable long-term efforts in the years to come.
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