Helping the North get healthier

We cannot know when and how unification will arrive. It can come as sudden as the crumbling of the Berlin Wall or it can be incremental. There are many factors that can affect unification apart from our will and efforts.

Regardless of what form unification takes, we must be prepared in all aspects. One area we must attend to is to improve the gap in healthcare and medical services between the two Koreas.

During the six-day Peace Odyssey, a 1,400-kilometer journey along the border region between China and North Korea, I pondered what a medical professional like myself can do to contribute in providing good healthcare for people on both sides of the border.

During the poor days of the 1960s and 1970s, our health, sanitation, and medical standards were disastrously inadequate. These days, we are mostly concerned with illnesses like cancer, cardiovascular diseases, high pressure and diabetes, but in those deficient days, the most-feared sicknesses were infectious diseases like typhoid, dysentery, measles, cholera, and hepatitis.

There is no accurate information, but I assume the state of North Korea’s healthcare, sanitation and medical standards would be similar to ours in the 1960s and 1970s. Healthcare levels reflect economic development. North Korea’s medical standards would be as underdeveloped as its economy. Many experts believe the wretched state of its healthcare could hugely affect the Korean Peninsula after unification.

Take mycobacterium tuberculosis (TB) as an example.

Many people with TB in North Korea do not get adequate treatment for the disease, which requires a course of different antibiotics for a minimum six months to be fully cured. Despite various grants from international aid groups, resources fall short of demand and many have to stop treatment.

This could lead to an increase of people with drug-resistant TB, which could rapidly spread among people in the south after unification. The prevalence of other infectious diseases like malaria and hepatitis is also estimated to be high in North Korea.

This could be a major problem that could develop into a crisis after unification.

We need to offer help alongside international groups to enhance North Korea’s pitiful healthcare system. The endeavors are not just for North Koreans, but to pre-empt crisis that could hit us as interactions increase and unification takes place. We must come up with ways to systematically assist the development of a modern healthcare system and a comprehensive program to improve sanitation. Since we have been through poverty in 1960s and 1970s, it won’t be that hard, and there have already been discussions with North Korean healthcare and medical personnel.

Inter-Korean ties are thawing for the first time in many years, and the two Koreas are discussing separated family reunions and the resumption of tourism programs. Health-related cooperation should be included in the agenda. Endeavors to improve North Korea’s health and medical system are not a choice but a duty as a part of preparation for unification. Medical support should not be considered a cost, but an investment for our common future.

Medical costs alone would be astronomical after unification. The first major cost would be expansion of the national health insurance. North Koreans would demand equal insurance coverage as South Korean citizens. Premiums would naturally spike in order to provide the same coverage for 20 million North Koreans. It is impossible to come up with the sum overnight.

It would be better to even out expenditures starting now. North Koreans must become healthier to reduce insurance spending in post-unification days.

We must prioritize what must be done today and after unification. Policy solutions must be sought. Unification preparations and discussions have been mostly led by political, economic and military experts, as well as scholars, bureaucrats and politicians. But various experts from other areas like health and medical care, transportation, environment, language, history, farming, fisheries, and forestry experts should also be included in the talks and process.

Translation by the Korea JoongAng Daily staff

JoongAng Ilbo, Aug. 28, Page 29

*The author is the head of the Yonsei University Health System.

by Chung Nam-sik