Note: this was originally going to be a single article detailing healthcare in North Korea, with the first half being on the health of Kim Jong-un and the second half focusing on the general state of healthcare and medicine in the country. However, due to length, I have decided to split the article into two separate ones, divided among the same two topics: health of the man and health of the nation. "Health of the Nation" will be published in the upcoming days.
Introduction
The health of a nation’s leader and the
health of the population are two factors that can have an outsized role in
determining the course of history, yet it is often overlooked. Immediate,
visible existential threats like invading armies or economic collapse occupy
far more of a government’s attention, while invisible germs or quietly ticking
clogged arteries remain out of sight and all too often out of mind.
However, history is
filled with the turning tides of war, the rise and fall of empires, and
revolutions that are either partially or largely based on matters of health.
U.S president
Woodrow Wilson suffered a stroke in 1919 that severely hampered his ability to promote the League of Nations
Treaty within the United States, leading to its ultimate failure in the Senate.
Without the support of the United States, the weakened League’s ability to
enforce its own resolutions and maintain future peace enabled the Italian
invasion of Ethiopia, Japan’s invasion of Chinese territories, and eventually
lead to the Second World War as Germany began to systematically violate
treaties and ignore post-WWI obligations.
Adolf Hitler’s continual
drug use after 1941 fueled his innate sense of infallibility and compounded his
manic episodes. Coupled with his lack of military knowledge, his addled brain brought
about some of the greatest military disasters in history.
While the leaders of North Korea are painted
in semi-divine terms by state propaganda, they are, in fact, just men. Kim
Il-sung died of heart failure. Kim Jong-il suffered a major stroke and then
died of a heart attack three years later.
And even though Kim Jong-un came into power at a young age, his health then as now has been the subject of much discussion and concern. The illness of any leader can cause instability within a country, and as Kim currently lacks any adult heirs, an unpredictable succession could have major consequences both domestically and internationally.
Surgeries, long periods of disappearance, and even rumors of his death have dogged his first ten years in power.
As such, while Kim
Jong-un can boast some legitimate accomplishments in other areas, the history
of his first decade with regard to his own health can only be given a middling
score.
Health of the Man
Nearly everyone can
find some genetic history of illness in their family. Heart disease, cancer,
dementia, these things are common to have in your family. But most people
manage to live long, healthy lives regardless and one’s lifestyle plays a huge
role in this.
For Kim Jong-un, heart disease runs in his family. It’s also
likely that other conditions like high cholesterol and atherosclerosis affected
both his father and grandfather, but we have little direct evidence of this.
As a teenager, Kim’s lifestyle would have placed him on a
better health footing than genetics may have suggested. He was athletically inclined, loved playing basketball
(even had an aggressive streak), and he enjoyed spending time at the family’s
seaside villa at Wonsan which offers multiple types of recreation.
But as he got older, he began to put on weight and when he came
to power at the age of 27, he may have weighed as much as 90 kg (198 lbs) while
being 5’ 7” tall. This would have given him a body-mass index (BMI) of 31, making him
clinically obese.
Both his predecessors also put on weight as the years wore
on, fueled by extremely rich foods and copious amounts of alcohol.
Kim Jong-il once remarked that he didn’t trust people who
wouldn’t get drunk during parties. And he was known to be Hennessy’s largest
non-corporate customer, importing $700,000 worth of Paradis cognac in one year
alone to keep himself and his friends suitably lubricated.
This raises the specter of alcoholism within the family as
well which would compound any predisposition to other illnesses. I don’t mention
alcoholism just because Kim Jong-il enjoyed parties, but because his sister
(Kim Jong-un’s aunt), Kim Kyong-hui, has struggled
with the disease for many years and because alcoholism is known to be common
among North Korea’s elite.
There is little to suggest that Kim Jong-un does not enjoy
an equally spiritous lifestyle.
Pointing to this is the theory that Kim suffered from gout
in the early years of his reign. After being out of the public eye for forty
days, Kim Jong-un appeared in public again on Oct. 13, 2014 but needed a walking
stick to help him get around.
South Korean intelligence said that he had undergone a
procedure on his foot; however, that belies what could have been a more
complicated truth.
Media commentators and North Korea watchers speculated that
he was more likely suffering from gout, a condition where uric acid builds up
in the joints and causes a wide range of painful symptoms. Major contributing
causes to gout include having a diet high in fats and sugars, drinking, and
smoking.
Gout can also cause tophi, hardened deposits of uric
acid on the joints. One place they tend to develop on is the Achilles tendon.
Kim continued
to use the cane for three weeks.
Of course, none of this is conclusive that he had gout and
it’s never a good idea to do armchair diagnoses, but it is one reasonable
possibility to explain why someone with his history and lifestyle would also
need a cane for weeks.
What is known without doubt is his family history of heart
disease and stroke, and that he is obese, eats an unhealthy diet, smokes, and
has a history of minor surgery.
Kim’s smoking is
both a family trait and a national pastime. Some 46.1% of North Korean
men smoke cigarettes daily, compared to 15.3%
in the U.S.
Kim has tried to stop smoking at least twice, in 2016 and in
2020. Each of those years was also times when the regime promoted anti-smoking
campaigns. In 2020, Kim actually banned smoking in public places.
The issue of Kim’s smoking even came up during a March 2018
meeting with South Korea National Security Advisor Chung Eui-yong, as Kim’s
wife, Ri Sol-ju, said she had been wanting
him to stop smoking for years. Unfortunately, smoking can be a very hard
habit to break and he is still seen with a lit cigarette in many of the
official photographs released by state media.
By 2015, his weight
had further ballooned, possibly
to as high as 130 kg (286 lbs), giving a BMI of nearly 45. This level of weight
gain, if the estimates are accurate, would drastically increase his risks for
developing diabetes, liver steatosis (fatty liver) – made even worse by
drinking alcohol – and would require his heart to work harder, almost certainly
leading to heart disease at a younger age.
Making understanding his health situation more difficult is
that speculations on the health of the Kim family, replete with lurid tales
about their lifestyles, have long been fodder for tabloid writers and
intelligence agencies alike. Western reporters often lack translators (or perhaps
just the discipline) to correctly divine whether or not a story is coming from
a satirical online discussion board or is legitimate breaking news, and foreign
intelligence agencies lack the resources required (both human and electronic)
to get close to the leadership to validate or refute every rumor that pops up.
South Korean media, in particular, have an unfortunate
reputation for getting things wrong when it comes to North Korea or for taking
a mere suggestion from an “unnamed intelligence officer” and running with it as
though it were the gospel truth.
There have been numerous examples where stories of one or
another North Korean official is reported to have been executed
– with no substantial evidence, and then the story gets copied and repeated in
otherwise legitimate media around the world only to have said official show up days
or months later.
And things haven’t been any better regarding reporting on Kim
Jong-un. In 2016 a baseless
rumor about his death was picked up and reported as fact. Such shocking news
caused defense stocks to temporarily rise and the South Korean won to fall.
The fake story even claimed that the Korean Central News
Agency had announced the news. All anyone had to do was to check the KCNA
website. Absolutely no such official story existed. And yet, by the next day,
115 articles had been written on the topic and it began to make the rounds
internationally.
Needless to say, Kim wasn’t dead. But this highlights the
dangers of not checking sources first and exchanging one’s journalistic
standards to post sensational and clickbait-y stories.
Unfortunately, such lessons never get learned.
In 2020, Kim
Jong-un was not seen visiting the Kumsusan Memorial Palace (Kim Il-sung’s and
Kim Jong-il’s mausoleum) for the April 15 Day of the Sun ceremony, the
country’s most important holiday. It was the first
time he missed taking part in the ceremony since coming to power.
Missing such an important event sparked many questions. Soon
after, DailyNK
reported, based on an unnamed source inside North Korea, that Kim Jong-un had
undergone a heart procedure at the exclusive Hyangsan Hospital on April 12 and
was recuperating. It gave few other details but was clear in that Kim was
stable and resting at one of his villas.
It wasn’t long after this that other reports started
claiming he was in critical condition, brain dead, in a coma, and even dead.
Many of these false reports claimed to be citing DailyNK, even though
nothing in the DailyNK article could be construed to mean he was near
death.
This absolute journalistic negligence didn’t even stop when 38
North reported,
with clear satellite images to back it up, that Kim Jong-un’s armored train had
been sitting at Wonsan Palace since April 21 and reports
by others that leisure boats from the palace had been moved around the bay. The
combination of evidence made it almost certain that Kim Jong-un was not
only alive but had moved from Pyongyang to spend the rest of his recovery time
at his favorite residence.
The rumor mill didn’t finally stop until both U.S. and South
Korean officials came out and said they agreed with the assessment that he
underwent a medical procedure and that he was alive and there were no
indications of anything more serious.
Kim finally reappeared
in public on May 1 during the official opening of the Sunchon Phosphatic
Fertilizer Factory. There was continued speculation
about his recovery, but as Jefferey Lewis remarked on Twitter, “Well, I
wouldn't say Kim looks healthy, but he definitely doesn't look dead.”
All three Kim’s have disappeared
from view on multiple occasions, but those periods don’t always concern ill
health. The birth of a new child, taking vacations, or simply needing time to
reflect on new policies can drag even the most spotlight-loving dictator away from
making daily appearances.
However, there has been one other recent absence that did
restart discussions about his health.
After missing for a
few weeks, Kim Jong-un oversaw a parade celebrating the country’s 73rd
founding anniversary on Sept. 9, 2021. The nighttime parade offered a lot for
observers to discuss (like the inclusion of civilian emergency personnel) but
it was Kim Jong-un’s physical appearance that also caught attention.
He had lost a noticeable amount of weight and had an overall
better look and energy level than in the past. Further appearances
substantiated the initial assessment that he had, indeed, lost significant weight.
It was first reported
that he may have lost between 10 and 20 kg (22-44 lbs.). More recent images of
him at the end of 2021 places the weight loss at the higher end of that
estimate and also show that he is managing to keep the weight off for now.
Although he would still be considered obese for his height (his thinner weight is
still between 117 and 120 kg (258-264 lbs.)), it is a good start.
His mobility and breathing have visibly improved as a
result as well.
The weight loss doesn’t only have a positive impact on his
health, which seemed to be deteriorating
over time. Particularly after the DPRK-US summit process collapsed and as North
Korea faces tremendous economic problems due to COVID-19, Kim must be seen as a
vigorous leader. His “on the spot guidance” tours, pioneered by Kim Il-sung,
are an integral part of his rule, and the only way to keep such an active
touring schedule is to maintain a certain level of health.
Additionally, gossip within North Korea by average people
about his weight had increased over the course of his first decade. Even though
such talk against the “highest dignity” is illegal, gossip, jokes, and
criticisms about him routinely spread. In a country of chronically
undernourished people and after he raised the specter of additional “belt
tightening”, being caricatured as the plump Supreme Leader poses a threat.
These concerns over the people’s opinion of Kim have not just shown up in secret government meetings. State media has publicly addressed his weight
loss, implying that Kim was eating less to help the country, harkening back to
the days of the famine when Kim Jong-il was reputed to only eat a single bowl
of rice a day. So, his thinner look pays both political and health dividends
for the leader.
The leaders of
North Korea are no different than any other person in their desire to live as
long as possible, but they do have far greater resources to apply to
accomplishing that. To reach for that goal, a secretive research organization
was established
during the rule of Kim Il-sung, the Longevity Research Institute, to help keep
him happy, healthy and living as long as possible through the use of herbal and
folk medicine mixed in with modern medical science (along with practices of questionable
ethics and effectiveness).
The Institute continued its activities throughout the life
of Kim Jong-il, with 130 doctors and scientists eventually being involved.
While there has only been indirect evidence that the Institute is involved in
Kim Jong-un’s life, it is likely they’re working hard to keep the third
generation of Kim going.
With all of the real (and imagined) health problems Kim Jong-un
has faced, governments and pundits around the world have been contemplating his
eventual death. What would the aftermath of his sudden death mean? Can there be
yet another dynastic succession? What about who controls the nuclear weapons?
Who could maintain internal stability?
These and other questions were all raised during his 2020
absence and literally thousands of articles and reports were written to try to answer them.
I myself wrote three. One for AccessDPRK,
one as part of a digital symposium by The
National Interest, and one discussing the future of the Kim family cult
after his death for Asia
Times.
The opacity of North Korea’s governing system and a lack of
knowledge about any official succession or continuity of government plans
renders discussions about Kim Jong-un’s incapacitation or death little more
than speculation, but his health must be considered to be part of North Korea’s
national security planning. And until his children reach adulthood, there will
be an extra layer of doubt and concern over his health and what might happen in
the future.
Conclusions
With no clear heir, the status of Kim Jong-un’s health does
become more pressing. Although Kim does not engender the same devotion and
loyalty as Kim Il-sung, and although it is unlikely that he has the same level
of absolute control over the state as previous generations of Kim have held,
Kim Jong-un is still the center spoke for a nuclear-armed nation.
With the family medical history such as it is, his recent
weight loss could be the first concrete sign that his health has been
precarious, and that he is now taking steps to ensure his survival and the
continuance of the regime.
There are also hints that Kim has begun to make subtle
reforms to the country’s laws and to the rules of the Workers’ Party that
would theoretically enable someone other than him or a direct heir to one day
rule the country. These changes may only be temporary steps to shore up the
regime in the event of his demise, changes that could be reversed once an
official successor is named, but they are nonetheless incredibly important and
exhibit a level of foresightedness in the face of his medical history.
To directly address Kim Jong-un’s health, his surgeries
point to a relatively young man that may be facing some serious medical issues.
His weight loss is a concrete step toward warding off everything from heart
disease to diabetes, but he will need to go further still. He must eventually
stop smoking and his diet is going to have to change substantially if he wishes
to live – healthily – into his 80s.
Another move would be to lower his stress levels. Genuinely
placing focus on the people’s health and wellbeing and working to finally solve
longstanding issues like food shortages would benefit Kim and the 25 million
others living in North Korea. Of course, if history is any guide, this is
unlikely.
~ ~ ~ ~
I have scheduled this
project to run through to the end of the year, with a new article coming
out roughly every 10 days or so. If you would like to support the project and
help me with research costs, please consider supporting AccessDPRK on Patreon. Those
supporters donating $15 or more each month will be entitled to a final PDF
version of all the articles together that will also have additional information
included once the series is finished. They will also receive a Google Earth map
related to the events in the series, and can get access to the underlying data
behind the supplemental reports.
Supporters at other levels will be sent each new article a
day before it’s published and will also receive a mention as seen below.
I would like to thank my current Patreon supporters: Amanda O.,
GreatPoppo, Joel Parish, John Pike, Kbechs87, and Russ Johnson.
--Jacob Bogle, 1/15/2022
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