MISDIAGNOSIS AND MISREPRESENTATIONS

ABSTRACT

The “right-to-health” framework asserts that everyone has the right to the “highest attainable standard of health.” In this article, the authors explore how the right-to-health framework can aid our understanding of the state of health in North Korea today. In recent reports, human rights organizations have accused the North Korean state of violating its people's right to health. Critical examination of these reports, however, reveals a myopic focus on the North Korean state and a limited consideration of the relevant political and historical context in which the right to health ofNorth Koreans may be violated. Furthermore, by selectively applying the right-to-health framework to the public health situation in North Korea, while ignoring other low-income countries with similar health problems, the human rights reports politicize humanitarian conditions and use public health problems to justify hostile policies toward North Korea. To help improve health and welfare in North Korea, the right-to-health framework should be applied with greater consideration of the geopolitical context and take actors other than the North Korean government into consideration. Analyses based on the right-to-health framework should also incorporate studies done by the broader movement for peace and justice in the Korean peninsula and be developed in consultation with peace and justice organizations.

Notes

1 Amnesty International 2010, 5.

2 See Rosette 2010 and Partridge 2010.

3 Lynn 2010.

4 Human RightsWatch 2006; HRNK (Committee for Human Rights in North Korea) 2006; HRNK 2008. DLA Piper is a major global law and lobbying firm that was commissioned to coauthor these reports with the Committee for Human Rights in North Korea as a pro bono project. As the HRNK was the principal author of the DLA Piper and HRNK reports, we will cite these references as HRNK (2006 and 2008) hereafter.

5 In this article, we use the terms “low-income” and “high-income,” which are commonly used to categorize countries in global health and development literature, instead of terms such as “developing” and “developed.” This convention utilizes the World Bank's classification of countries based on their gross national income per capita. See data.worldbank.org/about/ country-classifications.

6 See Shin et al. 2009.

7 For a brief background on the right-to-health principles, see http://www.who.int/hhr/activities/Right_to_Health_factsheet31.pdf (accessed 31 March 2012).

8 Ibid.

9 Yamin 2008.

10 Kenneth Roth, the executive director for HRW, explained his concern regarding HRWincorporating economic, cultural, and social rights in Roth 2004.

11 For example, HRW first began incorporating economic, social, and cultural rights in their human rights analyses with the publication of a 2001 report that highlighted violations of the rights to health, education, and cultural development among HIV–affected children in Kenya. AI followed suit by calling for the protection of the right to health and other economic, social, and cultural rights for HIV–infected persons on World AIDS Day, December 2002. Since then, both organizations have increasingly incorporated economic, social, and cultural rights into their human rights analyses. See www.amnesty.org.uk/news_details.asp?NewsID=14224 (accessed 28 June 2013), HRW 2001, Nelson and Dorsey 2003, and Yamin 2008.

12 Jochnick 1999.

13 Ibid.

14 Specifically, Trade-Related Aspects of Intellectual Property Rights (TRIPS) of the World Trade Organization (WTO) bindsWTO members to institute national policies to protect patents. See Shaffer et al. 2005.

15 See Nunn et al. 2009, Annas 2003, and Shaffer et al. 2005.

16 McGill 2012.

17 WHO 2009, 21.

18 Ibid., 23.

19 WHO 2011, 116.

20 Ibid., 118

21 Ibid., 120–22.

22 In 1978, WHO convened a historic meeting at which attendees released the “Declaration of Alma-Ata,” which outlined the primary health care (PHC) approach for achieving “health for all” by 2000. Based on the PHC model, accessible health services are provided at the levels of the household, community, and local clinic. In low-income countries, village health posts often serve as first-line facilities. Community health workers are recruited from the community and trained to provide a wide range of health services. The PHC model emphasizes patient- centered preventive and curative care and ongoing patient-provider relationship. Many aspects of North Korea's health system resemble the PHC approach. However, a key component of the PHC approach that is missing from North Korea's health system is the strong emphasis placed on community involvement and mobilization. Under the PHC model, community advisory boards are established at the village and district levels to provide guidance and oversight of health program administration. See People's Health Movement 2011, 45–60.

23 Country-level statistics on health infrastructure–related indicators can be found inWHO2011, 115–25. For a general discussion of the challenges to health programs posed by weak health systems in low- and middle-income countries, seeWHOMaximizing Positive Synergies Collaborative Group 2009.

24 See Unicef 2003, 27; Ahmed 2001; and Centers for Disease Control and Prevention 1997.

25 Amnesty International 2010, 20.

26 Lee and Choi 2009, 9.

27 In 1989, U.S. economic sanctions were eased to allow the exportation of “commercially supplied goods for basic human needs” to North Korea. Ibid.

28 Ali and Shah 2000, Garfield and Santana 1997.

29 Woo-Cumings 2002, 11.

30 EU et al.1998, 7.

31 Unicef 2003, 27.

32 WHO 2009, 13.

33 Ibid., 23.

34 The North Korean health system utilizes both Western and traditional Korean (called Koryo medicine in North Korea) forms of medicine to treat patients. See Owens-Davies 2000.

35 See WHO 2009, 12; Owens-Davies 2000; and Watts 2003.

36 WHO 2009, 23.

37 Smith 2002.

38 See Lee 2010 for an excellent discussion of the various factors that may have contributed to strained relations between North Korea and the international aid agencies during the early stages of the famine in the 1990s.

39 Five U.S.–based NGOs were involved in this collaboration:World Vision, Mercy Corps, Samaritan's Purse, Global Resource Services, and Christian Friends of Korea. See Lee 2010.

40 Ibid.

41 Ibid.

42 Ibid.

43 The GAVI Alliance, formerly named Global Alliance for Vaccines and Immunization, is a global health initiative dedicated to expanding vaccine coverage.

44 WHO 2009, 18.

45 Human Rights Watch 2006, 4, and Amnesty International 2010, 1.

46 HRNK 2006, i. The authors published a follow-up report in 2008 with additional recommendations. See HRNK 2008.

47 Amnesty International 2010, 2.

48 Ibid.

49 HRNK 2008, 5 (emphasis added).

50 Smith 2000.

51 For example, Smith notes that international aid workers were surprised to discover that their North Korean counterparts truly cared about the welfare of the North Korean people (Smith 2000).

52 FAO/WFP 2011, 31.

53 Schwekendiek 2008. The WFP's 2002 report is the only WFP report that addresses the effects of WFP food aid.

54 Ibid.

55 AI 2010, 7.

56 HRNK 2008, 6.

57 Congressional Research Service 2009, 14.

58 Ibid.

59 Smith 2002.

60 Ibid.

61 Congressional Research Service 2005, 18.

62 Ibid.

63 Abramowitz 2012.

64 BBC News 2005.

65 WHO 2009, 25.

66 In general, international aid is designed to meet the foreign and domestic policy agendas of donor countries, regardless of the priorities of recipient countries. See People's Health Movement 2008, 308.

67 Amnesty International 2010, 18.

68 HRNK 2008, 3.

69 A study by Chuling Lu et al. found that countries that receive international assistance for health are more likely to reduce national spending on the health sector. See Lu et al. 2010.

70 North Korea is also technically still in a state of war with the United States, since no peace treaty has been signed to end the Korean War. The ongoing hostility has fueled militarization on all sides, including the United States, South Korea, and North Korea.

71 Human Rights Watch 2006, 1.

72 Ibid., 4.

73 Ibid., 20.

74 Ibid., 8.

75 HRNK 2008, 5.

76 HRNK 2006, 25.

77 HRNK 2008, 6. The report cites an article published in the International Herald Tribune, 27 September 2007, available at www.hrw.org/news/2007/09/26/give-north-koreans-food (accessed 1 September 2012).

78 Hong 2011.

79 Smith 2002.

80 HRNK 2006, 25.

81 Jochnick 1999.

82 Human Rights Watch 2006, 7.

83 Gelb 2008.

84 HRNK 2008, 25.

85 Amnesty International 2010, 37.

86 HRNK 2008, 25.

87 Ibid.

88 Interestingly, DLA Piper, the lobbying firm that coauthored (with the HRNK) the 2006 and 2008 reports on North Korean human rights, represents the Zenawi regime and Ethiopia in Washington D.C. In fact, DLA Piper has argued that “[t]he terms ‘political prisoners’ and ‘prisoners of conscience’ are defined and mischaracterize the situation in Ethiopia,” and “should be removed from a bill that condemned the Ethiopian regime for detaining opposition activists.” See Kurlantzick 2010.

89 HRNK 2008, 8.

90 See Rosette 2010 and Partridge 2010.

91 See Congressman Royce's website: royce.house.gov/news/documentsingle.aspx?Document ID = 246940 (accessed 1 September 2012).

92 HRNK 2006, 94.

93 See www.amnesty.org/en/news-and-updates/report/north-koreas-crumbling-health-system-dire-needaid-2010-07-14 (accessed 1 September 2012).

94 Kim 2010.

95 Odinkalu 1999.

96 Moodie et al. 2000.

97 Perry et al. 2011.

98 Reprinted in “Social Medicine Portal,” www.socialmedicine.org/2012/02/25/uncategorized/two-possible-styles-of-dealing-with-the-issue-of-the-right-to-health/ (accessed on 31 March 2012).

99 Ibid.