Is North Korea Poor? A Public Health Perspective

North Korea’s economic isolation and political policies have long fueled questions about living conditions. While its government tightly controls information, reports from defectors, satellite imagery, and international organizations indicate significant public health challenges linked to poverty.

Assessing North Korea’s public health requires examining food availability, disease prevalence, healthcare access, environmental conditions, and maternal and child well-being.

Food Insecurity And Malnutrition

North Korea’s food supply has been unstable for decades due to environmental challenges, inefficient agriculture, and political decisions. The country’s reliance on collective farming and state-controlled distribution has led to chronic shortages, exacerbated by extreme weather events like droughts and floods. According to the Food and Agriculture Organization (FAO), North Korea consistently fails to produce enough staple crops like rice and maize, often falling short by over a million metric tons annually. This shortfall forces reliance on government rations, informal markets, and foraging.

The Public Distribution System (PDS), meant to provide state-allocated food, has been unreliable, with daily allotments dropping well below the World Health Organization’s (WHO) recommended minimum caloric intake. A 2022 World Food Programme (WFP) report estimated that nearly 40% of North Koreans are undernourished, with many consuming fewer than 1,800 calories per day—below the 2,100-calorie threshold for basic health. Chronic undernutrition has led to widespread stunting in children, with UNICEF reporting that 18% of North Korean children under five suffer from stunted growth, which can have lifelong cognitive and physical consequences.

Micronutrient deficiencies further worsen health outcomes, especially for pregnant women and young children. A 2019 study in The Lancet found that iron-deficiency anemia affects nearly one-third of North Korean women of reproductive age, increasing the risk of complications during pregnancy. Vitamin A deficiency, linked to night blindness and weakened immune function, is also prevalent due to limited access to diverse foods.

Infectious Disease Trends

Inadequate medical infrastructure, limited vaccines, and poor sanitation contribute to the persistence of infectious diseases. Tuberculosis (TB) remains one of the most severe health threats, with North Korea ranking among the highest-burden countries globally. A 2023 WHO report estimated that nearly 130,000 North Koreans suffer from active TB, with multidrug-resistant tuberculosis (MDR-TB) posing a growing challenge. Limited diagnostic capacity and inconsistent drug supplies hinder effective treatment, worsening drug resistance.

Malaria has also resurged, particularly in southern provinces near the demilitarized zone. Though nearly eradicated in the early 2000s through vector control efforts, lapses in funding and sanctions restricting medical aid have led to a resurgence. The Global Fund, which previously supported anti-malaria programs, suspended funding in 2018 over transparency concerns, leaving the country with dwindling resources for mosquito control and treatment. As a result, Plasmodium vivax malaria cases have re-emerged, with seasonal outbreaks reported.

Vaccine-preventable diseases remain a challenge, with measles and whooping cough outbreaks highlighting immunization gaps. While North Korea has participated in global vaccination initiatives through organizations like Gavi, logistical difficulties and inconsistent cold chain management have led to coverage gaps. The COVID-19 pandemic exposed further vulnerabilities, with the country initially refusing vaccine shipments before later accepting aid from China. Due to limited testing and reporting, the true extent of the SARS-CoV-2 outbreak remains uncertain, though satellite analysis and defectors’ reports suggest a significant impact.

Healthcare Accessibility

North Korea’s state-run healthcare system, in theory, provides free medical services to all citizens, but in practice, access is severely limited by shortages of supplies, outdated facilities, and uneven resource distribution. Hospitals in Pyongyang, where the political elite reside, tend to be better equipped than those in rural areas, where even basic medications like antibiotics or pain relievers are often unavailable. Reports indicate that patients frequently procure their own medical supplies from informal markets or offer bribes for treatment, undermining the principle of universal healthcare.

Medical personnel struggle due to outdated training and limited exposure to international advancements. Since North Korea remains isolated from global health networks, doctors often rely on Soviet-era medical practices. In rural hospitals, surgeries may be performed without anesthesia due to supply shortages. Many healthcare facilities also lack functional imaging equipment like X-ray machines or CT scanners, making early disease detection difficult and leading to delayed or inaccurate diagnoses.

Pharmaceutical availability is another major issue, as international sanctions restrict North Korea’s ability to import essential drugs. While humanitarian exemptions exist, bureaucratic hurdles and government reluctance to allow external monitoring have made medical aid deliveries inconsistent. As a result, counterfeit or expired medications circulate widely, posing risks of ineffective treatment or harmful side effects. Herbal remedies and traditional medicine are often used as substitutes, though their efficacy varies and lacks scientific validation.

Environmental Factors In Public Health

North Korea’s environmental conditions significantly impact public health, particularly air and water quality, industrial pollution, and deforestation. Heavy reliance on coal has led to widespread air pollution, with particulate matter levels in urban areas frequently exceeding WHO safety thresholds. This has contributed to rising respiratory ailments, particularly among children and the elderly. Satellite imagery reveals extensive coal mining and poorly regulated industrial emissions, worsening conditions in densely populated regions.

Deforestation, driven by agricultural expansion and fuel shortages, has intensified environmental degradation. As forests are cleared, soil erosion and desertification have worsened, reducing arable land and increasing the frequency of dust storms that carry harmful particulates. These environmental shifts have also contaminated water sources, as eroded soil and industrial runoff seep into rivers and reservoirs. Clean drinking water remains inconsistent, particularly in rural areas lacking filtration and sanitation infrastructure. Waterborne illnesses, including diarrhea and parasitic infections, remain persistent concerns due to inadequate waste management and unreliable purification systems.

Maternal And Child Health Patterns

Limited prenatal care, high maternal mortality rates, and inadequate neonatal services shape maternal and child health in North Korea. Expectant mothers often struggle to receive consistent medical attention due to shortages of trained healthcare professionals and essential supplies like prenatal vitamins and sterile birthing equipment. Many give birth without proper medical supervision, increasing the risk of complications such as obstructed labor or postpartum hemorrhage. The maternal mortality rate, estimated at 89 deaths per 100,000 live births by UNICEF, remains significantly higher than in neighboring countries, highlighting the challenges in accessing timely obstetric care.

Neonatal and infant health outcomes are similarly affected by malnutrition, poor sanitation, and insufficient medical interventions. Low birth weights are common due to maternal undernutrition, leaving newborns more vulnerable to infections and developmental delays. Immunization programs, while present, are inconsistent in rural regions, leading to gaps in coverage for diseases like tetanus and hepatitis B. Breastfeeding is widely practiced, but many mothers struggle to meet nutritional needs, affecting milk quality and infant growth. Without adequate postnatal care, preventable conditions like respiratory infections and diarrheal diseases contribute to high infant mortality rates, reflecting broader systemic deficiencies in maternal and child health support.