If a Dictatorship, Hermit Regime Such as North Korea Became a Democracy, How Would One Be Able to Predict the Trajectory of Health Inequalities Within the Country?

By: Martina Cugini

Kim Jung-Un and several doctors surrounding a sick patient in a North Korean hospital.

North Korea is an authoritarian state that has been run by the Kim family for decades. The citizens of the North must comply with the strict laws set by the dynastic dictatorship, such as no freedom of speech, no movement in or out of the country, and anything considered anti-socialist behaviour being forbidden. While North Korean laws state that healthcare within the country is free for any citizen, the regime lacks the resources to live up to this claim. Using Chile’s change from dictatorship to a democracy in 1990, a prediction will be made. 

The USSR's collapse in 1991 forced them to cut off North Korea from their economic support line. Soon after, shortages of resources such as fuel and fertilizer were seen in the country. This contributed to large-scale famines and weakened their economy, which meant that public distribution systems that allocated clothes and other necessities to live in had become unreliable. As a result, their public health system, based on parts from the pre-1989 communist bloc, fell due to a dramatic shortage of funds and lack of supplies. Life expectancy has decreased significantly, according to an analysis of data from two censuses in 1993 and 2008, with the greatest impact coming from rising deaths in childhood and later middle age. The prompt of North Korea changing its political system would alter many things within the country (Lee, H., Robinson, C., Kim, J. et al., 2020). To predict the outcome of democracy, the example of Chile’s shift from dictatorship to democracy will be used. General Augusto Pinochet used similar methods of repression as the previous/ current leaders of the DPRK. This included political suppression, infringement upon human rights, and other authoritarian values. In 1990 when Chile eventually became a democracy through the armed forces gaining control of the state. The newly democratic government experienced problems left over from the Pinochet regime, including a deterioration in the public infrastructure and inefficient management in the decentralized organizations. Poor coordination between regional health care services and municipal authorities occurred, conditions and wages deteriorated, and rural areas faced the worst of this. However, things improved greatly in a matter of time. From 1990-2002, tax revenues within Chile doubled and allowed for a social expenditure of 240%. In 2000, expenditure on health care accounted for 7.3% of the gross domestic product, 3.1% of publicly provided care, and 4.2% of private care. In 2004, out-of-pocket expenditures amounted to 27% of total health expenditures.  Poverty was drastically reduced under the democratic governments, declining from 45% in 1985 to 21.7% in 1998 and 13.7 % in 2006. Although the factor of income inequality came about, Chile’s health indicators were good, with low maternal and infant mortality rates (Unger, J. P., De Paepe, P., Cantuarias, G. S., & Herrera, O. A. 2008). 

Chile was never in the exact condition as the DPRK, but similarities posed with the advantages taken by leaders of both governments and government styles. Using Chile’s model of improved health inequalities, once democratic relations were produced within the country, perhaps North Korea would shift in the same way. Limitations posed with this prediction, as not a lot is known about the North Korean regime due to its secrecy, but if a political system change was seen from a major event such as the overthrowing of the Kim dynasty, conditions in the country may improve as they did for the Chilean citizens. 

Works Cited

Image Citation: KCNA. (2020, February 21). Ask a North Korean: What is the healthcare system in the DPRK really like?: NK News. NK News - North Korea News. https://www.nknews.org/2020/02/ask-a-north-korean-what-is-the-healthcare-system-in-the-dprk-really-like/ 

Article Citation: Lee, H., Robinson, C., Kim, J. et al. Health and healthcare in North Korea: a retrospective study among defectors. Confl Health 14, 41 (2020). https://doi.org/10.1186/s13031-020-00284-y

Unger, J. P., De Paepe, P., Cantuarias, G. S., & Herrera, O. A. (2008). Chile's neoliberal health reform: an assessment and a critique. PLoS medicine, 5(4), e79. https://doi.org/10.1371/journal.pmed.0050079