Two Koreas and public health: ‘First, do no harm’

In Khang’s insightful article regarding public health in North and South Korea, the author suggested that ‘militant’ reaction against North Korea could harm public health efforts.¹ Likewise, ‘militant’ international policies exist that are clearly harmful to public health in North Korea. For example, despite the ongoing public health crisis in North Korea, the country remains under economic sanctions from the USA, Japan and the United Nations.² Epidemiological studies have consistently shown that economic sanctions lead to dramatic increases in morbidity and mortality.^3–5 Economic sanctions are particularly harmful to the most vulnerable segments of the targeted country’s population.⁵ Indeed, economic sanctions have been called a ‘tool of warfare’ because of their devastating impact on health and human rights.⁶ Therefore, the continuation of economic sanctions in North Korea is unacceptable from a public health standpoint.

Another policy, albeit an unofficial one, that has harmed public health in North Korea is the use of humanitarian aid for political leverage. For example, the Bush administration withdrew food aid from North Korea in 2008 citing deficiencies in aid monitoring.⁷ This was done despite significant improvements in the quality of aid monitoring in North Korea through the years and assurance from on-the-ground aid personnel that the vast majority of the food aid was reaching the intended beneficiaries.^7,8 Furthermore, nutritional surveys have shown that food aid has significantly improved children’s nutritional status in North Korea.⁹ Although the official US policy is that humanitarian aid is to be provided based solely on need, the withdrawal of food aid in 2008 to gain political concessions from North Korea is consistent with a longstanding pattern of using aid for political aims by US administrations.⁷ Unfortunately, this unofficial policy continues to harm vulnerable North Koreans today under the Obama administration.¹⁰

Khang asserted that the public health community could contribute to preventing war and improving health in the two Koreas.¹ We should also insist that our governments practice the fundamental medical principle: ‘First, do no harm’.