North Korea claimed a dramatic improvement in the health and longevity of its population with the creation of a state-funded and state-managed public health system based on the Soviet model. According to North Korean statistics, the average life expectancy at birth for both sexes was a little over thirty-eight years in the 1936-40 period. By 1986 North Korean statistics claimed life expectancy had risen to 70.9 years for males and 77.3 years for females. According to UN statistics, life expectancy in 1990 was about sixty-six years for males and almost seventy-three years for females. North Korean sources reported that crude death rates fell from 20.8 per 1,000 people in 1944 to 5 per 1,000 in 1986; infant mortality, from 204 per 1,000 live births to 9.8 per 1,000 in the same period. Eberstadt and Banister report that these mortality figures were probably understated (they estimate infant mortality at around 31 per 1,000 live births in 1990); they conclude, however, that the statistics "suggest that the mortality transition in North Korea over the past three decades has not only improved overall survival chances but reduced previous differences in mortality between urban and rural areas."
North Korean statistics reveal a substantial increase in the number of hospitals and clinics, hospital beds, physicians, and other health-care personnel since the 1950s. Between 1955 and 1986, the number of hospitals grew from 285 to 2,401; clinics increased from 1,020 to 5,644; hospital beds per 10,000 population from 19.1 to 135.9; physicians per 10,000 population from 1.5 to 27; and nurses and paramedics per 10,000 population from 8.7 to 43.2. There are hospitals at the provincial, county, ri, and dong levels. Hospitals are also attached to factories and mines. Specialized hospitals, including those devoted to treating tuberculosis, hepatitis, and mental illness, are generally found in large cities.
Preventive medicine is the foundation for health policies. According to the Public Health Law enacted on April 5, 1980, "The State regards it as a main duty in its activity to take measures to prevent the people from being afflicted by disease and directs efforts first and foremost to prophylaxis in public health work." Disease prevention is accomplished through "hygiene propaganda work," educating the people on sanitation and healthy lifestyles , and the "section-doctor system." This system, also known as the "doctor responsibility system," assigns a single physician to be responsible for an area containing several hundred individuals. In general, medical examinations are required twice a year, and complete records are kept at local hospitals. According to one source, persons are required to follow the orders of their assigned physician and can not refuse treatment. In the countryside, medical examination teams (kmjindae) composed of personnel from the provincial central hospital make rounds to investigate health conditions; local doctors also make frequent rounds.
North Korean statistics reveal that the major causes of death are similar to those in developed countries; 1986 figures showed that 45.3 percent of reported deaths were caused by circulatory ailments such as heart disease and stroke, 13.9 percent by cancer, 10.4 percent by digestive diseases, and 9.4 percent by respiratory diseases. Infectious diseases and parasitism, major causes of death in earlier decades, were a relatively insignificant cause of death and accounted for only 3.9 percent of reported deaths in 1986. As of 1990, the latest year for which data were available, no cases of acquired immune deficiency syndrome (AIDS) had been reported.
Although shamanistic medicine has been repudiated as superstition, herbal medicine, known as Eastern Medicine (Tonguihak), is still highly esteemed. Practitioners of Eastern Medicine not only give preparations orally, but also practice moxibustion (burning herbs and grasses on the skin) and acupuncture. The high value accorded traditional herbal medicine reflects not only its efficacy but also the chuch'e emphasis on using native products and ingenuity. Moreover, in 1979 Kim Il Sung published an essay entitled "On Developing Traditional Korean Medicine." Central Eastern Medicine Hospital in P'yongyang, the Research Institute of Eastern Medicine in the North Korean Academy of Medical Sciences, and many pharmacies deal in traditional herbal remedies.
Over the centuries, Korean physicians have developed an extensive pharmacopeia of curative herbs. North Korean sources claim that herbal medicines are superior to Western medicines because they have no dangerous side effects. According to a 1991 article in the P'yongyang Times, "[t]he combination of Korean medicine with Western medicine has reached 70 percent in the primary medical treatment," and "[t]he native system is popular among the people for its effectiveness in internal and surgical treatment, obstetrics and gynecology, pediatrics and other sectors of clinical treatment and health and longevity." Natural products with medical properties distributed by pharmacies include extracts of insam (ginseng), deer's placenta, and a "metabolism activator" called tonghae chongsimhwan, a mixture of herbs, and animal and mineral products collected around Kwanmo-san and along the coast of the East Sea.
Physical education is an important part of public health. Children and adults are expected to participate in physical exercises during work breaks or school recesses; they are also encouraged to take part in recreational sports activities such as running, gymnastics, volleyball, ice skating, and traditional Korean games. Group gymnastic exercises are considered an art form as well as a form of discipline and education. Mass gymnastic displays, involving several tens of thousands of uniformed participants, are frequently organized. Some of the largest were held in commemoration of the eightieth birthday of Kim Il Sung and the fiftieth birthday of Kim Jong Il, both celebrated in 1992.
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