The real story on North Korea and its healthcare

By Stephen Gowans

The United States has announced that it is adding a new tranche to the Himalaya of sanctions it has built up since 1950 against North Korea, sanctions I outlined in my last article Amnesty International botches blame for North Korea’s crumbling healthcare. Calling the new sanctions “measures” – perhaps to escape the disfavor the word has fallen into after sanctions wiped out the lives of half of million Iraqi children in the 1990s — US secretary of state Hillary Clinton purred reassuringly that the new “measures are not directed at the people of North Korea.” [1] She didn’t predict, however, whether they would add to the misery the previous umpteenth round of sanctions has already visited upon the lives of North Koreans, even if she says they aren’t directed at them, but we can be pretty sure they will.

At the same time preparations were underway to launch Operation Invincible Spirit, a four day joint US-South Korea military exercise to take place in the Sea of Japan, involving 8,000 troops, 200 warplanes and an armada of warships led by the aircraft carrier USS George Washington. The point of the exercise, according to the US commander in the Pacific, Robert Willard, is to “send a strong signal to Pyongyang and Kim Jong-il regarding the provocation that Cheonan represented” [2](the Cheonan being the South Korean warship that sunk in disputed waters in May.) Inasmuch as the Cheonan’s sinking appears to be a replay of the Gulf of Tonkin incident [3] – the alleged attack on a US Navy destroyer by North Vietnamese patrol boats used by US president Lyndon Johnson as a pretext to step up war on Vietnam – the military exercises represent the second stage of what looks like a plan to increase pressure on Pyongyang, with a view to producing what US policy has been trying to produce north of the 38th parallel for the last 60 years: the collapse of the anti-imperialist governments led by Kim Il-sung and now Kim Jong-il. The first part of the plan was to blame North Korea for the Cheonan’s sinking. The second part is to launch military exercises using the pretext of the first.

China calls the exercises, scheduled to begin this Sunday, provocative. And University of Chicago historian Bruce Cumings points out that the North Koreans become agitated whenever the United States and South Korea carry out joint military exercises, because they “see them as a prelude to a possible attack.” [4] Indeed, since it is impossible to distinguish troops, warships and warplanes massing on one’s borders for the purposes of conducting war games from troops, warships and warplanes massing on one’s borders for the purposes of an invasion, it is hardly surprising that the North Koreans are agitated. And that’s the point: keep the DPRK on a continual war-footing, so that it diverts its sanctions-starved economy into military preparedness and away from productive investments and provision of healthcare, education, housing and so on. Joint US-South Korea military exercises aren’t just a sometimes thing. They happen every year, and Operation Invincible Spirit adds another provocation to the annual cycle.

Forcing its ideological opponents to spend heavily on defense — when they always start off poorer and weaker than the United States and can therefore ill-afford to do so if they’re ever going to progress — is a tactic Washington has been using for decades to contain, cripple and ultimately defeat countries that offer a humane and progressive alternative to integration into a worldwide capitalist system of imperial relations.

On top of the advantages of this tactic abroad, at home the defense spending needed to threaten target countries transfers wealth upwards, from working Americans through their taxes to the investors and businesspeople in the armaments industry who benefit in two ways: first, from the profits they reap from arms contracts and second from interest on the bonds they buy to finance US defense spending. The tab is picked up by US taxpayers with their labor and, if a war is waged against their country, by foreigners with their lives, or with crippled standards of living, if their governments are forced to skimp on civilian spending to build a credible defensive force to deter the threat of US military intervention. As the dues-payers for the US warfare economy along with its foreign victims, US citizens have more in common with the citizens of official enemy countries than they think. Who’s the real enemy?

The tactic of spending ideological opponents into bankruptcy has two dimensions: a physical one, of suffocating an alternative economy until it either breaks down or is left staggering under the weight of economic warfare and the costs of preparing to repel the unrelenting ominous threat of military intervention, and an ideological one, of attributing the break-down to the inherent characteristics of the alternative system itself. In this way a warning is sent on two levels: a surface one aimed at ordinary people, which says, while this alternative may seem like a good idea, it doesn’t work and only leads to disaster. To work, this necessitates the cover up of the real causes of the break down.

At the demilitarized zone separating the two Koreas yesterday, both Clinton and US secretary of war [5] Robert Gates, played up the message that North Korea’s dire straits are endogenous, and not the product of a systematic campaign of breaking the country’s back. Gates said: “It is stunning to see how little has changed up there (in the North) and yet how much South Korea continues to grow and prosper. The North by contrast, stagnates in isolation and deprivation.” [6] Clinton said much the same. Of course, neither mentioned that sanctions, and the continual harassment of North Korea by US forces, might have something to do with North Korea’s isolation and stagnation. On a deeper level, a warning is sent to would-be leaders of oppressed classes and peoples: try to break free from the US imperial orbit, and this will happen to you, too.

Forty years ago, Felix Greene outlined how Washington had used this tactic against China and Cuba, but his description also fits North Korea today.

“The United States imposed a 100 percent embargo on trade with these countries; she employs great pressure to prevent her allies from trading with them; she arms and finances their enemies; she harasses their shipping; she threatens them with atomic missiles which she announces are pre-targeted and pre-programmed to destroy their major cities; her spy ships prowl just beyond these countries’ legal territorial waters; her reconnaissance planes fly constantly over their territory. And having done all in their power to disrupt these countries’ efforts to rebuild their societies by means of blockades to prevent essential goods from reaching them, any temporary difficulties and setbacks these countries may encounter are magnified and exaggerated and presented as proof that a socialist revolutionary government is ‘unworkable’.” [7]

Author William Blum, who writes an Anti-Empire Report monthly, elaborates on Greene’s point:

“…every socialist experiment of any significance in the twentieth century — without exception — was either overthrown, invaded, corrupted, perverted, subverted, destabilized, or otherwise had life made impossible for it, by the United States and its allies. Not one socialist government or movement — from the Russian Revolution to the Sandinistas in Nicaragua, from Communist China to the FMLN in El Salvador — not one was permitted to rise or fall solely on its own merits; not one was left secure enough to drop its guard against the all-powerful enemy abroad and freely and fully relax control at home. It’s as if the Wright brothers’ first experiments with flying machines all failed because the automobile interests sabotaged each test flight. And then the good and god-fearing folk of the world looked upon these catastrophes, nodded their heads wisely, and intoned solemnly: Humankind shall never fly.” [8]

Disputed Territory

Cumings offered insight into the context surrounding the Cheonan affair in a May 27, Democracy Now interview. The incident, Cummings observed:

“happened very close to the North Korean border, we’ve had incidents like this, somewhat different ones, but with large loss of life, going back more than ten years. In 1999, a North Korean ship went down with thirty sailors lost and maybe seventy wounded. That’s a larger total of casualties than this one. And last November, a North Korean ship went down in flames. We don’t know how many people died in that. This is a no man’s land, or waters, off the west coast of Korea that both North and South claim. And the Cheonan ship was sailing in those waters…” [9]

The hypocrisy need not be pointed out. When North Korean ships are sunk, there’s no provocation, except to North Koreans, who, in the view of Western governments and the propaganda apparatus of private-sector mass media, don’t matter (in the same way Israeli soldier Gilad Shalit, who was kidnapped by Hamas, matters to Western governments and Western mass media while the countless Palestinians who have been kidnapped by Israeli soldiers in the West Bank and Gaza and have since disappeared into the bowels of Israeli prisons are invisible.) But when a South Korean ship is sunk in the same disputed waters, North Korea is immediately blamed (by the politicians of South Korea’s ruling Grand National Party, though not by the South Korean military, which for weeks, said it had no evidence of North Korean involvement.) And the sinking is used to justify more sanctions and more military exercises to ratchet up the pressure.

Cumings went on to explain that the waters in which the South Korean warship went down in May “is a no man’s land, where the US and South Korea demarcated a so-called Northern limit line unilaterally. The North has never accepted it. The North says that this area is under the joint jurisdiction of the North and South Korean militaries. So you have an incident waiting to happen.” [10] Into this cauldron of roiling waters waiting for an incident to happen will soon be tossed Operation Invincible Spirit.

The World Health Organization Weighs In

While the Western media lighted on Amnesty International’s portrayal of North Korea’s healthcare system as a horror show with the eagerness of flies on road-kill, the World Health Organization had a more sober assessment of the rights organization’s Cold War-era hatchet job. WHO spokesman Paul Garwood faulted the report for being “mainly anecdotal, with stories dating back to 2001, and not up to the UN agency’s scientific approach to evaluating healthcare.” [11]

“All the facts are from people who aren’t in the country,” Garwood said. “There’s no science in the research.” [12]

In contrast, WHO chief Margaret Chan visited North Korea in April and returned with an assessment that makes Amnesty’s report look like it was written to cater to US foreign policy propaganda requirements.

Chan noted that:

“The health system requires further strengthening in order to sustain the government policy of universal coverage and, of course, to improve the quality of services. More investments are required to upgrade infrastructure and equipment and to ensure adequate supplies of medicines and other commodities, and to address the correct skill mix of the health workforce.” [13]

All of this is consistent, in a way, with what Amnesty says. Of course, the ability of the government to invest in infrastructure, upgrade equipment, and secure adequate supplies of medicines, is severely hampered by the US-led campaign of economic warfare and by Pyongyang’s need to raid its civilian budget to secure it borders against incessant US military harassment. Lifting sanctions and removing the military sword of Damocles that dangles menacingly above North Koreans’ collective heads (I wonder whether the US nuclear missiles targeted on Pyongyang are, as Clinton claims with sanctions, not directed at the North Korean people) would go far to improving the provision of healthcare in North Korea. Which is one big reason it will never happen. The point of sanctions and unremitting military threat is to destroy what the US government calls North Korea’s Marxist-Leninist system (inaccurately) and its non-market economy, not to make life better, healthier and happier for North Koreans.

Despite these challenges, DPR Korea appears to have secured what Chan describes as “advantages over other developing countries,” including:

o No shortage of doctors and nurses.
o No brain drain of healthcare professionals (a particularly acute problem in Africa.)
o An elaborate health infrastructure and a developed network of primary health care physicians. [14]

Chan also noted that “the government has done a good job in areas such as immunization coverage, effective implementation of maternal, newborn and child interventions, in providing effective tuberculosis treatment and in successfully reducing malaria cases.” [15]

Perhaps, the real story about North Korean healthcare isn’t the challenges it faces, or the systematic efforts of the United States to make it collapse, but the fact that it hasn’t collapsed despite these challenges, and has managed to earn the praise of the WHO as the envy [16] of many developing nations.

1. Justin McCurry, “US announces fresh North Korea sanctions”, The Guardian (UK), July 21, 2010.
2. Ibid.
3. Stephen Gowans, “The sinking of the Cheonan”, PSLweb.org, May 27, 2010. http://www.pslweb.org/site/News2?page=NewsArticle&id=14044&news_iv_ctrl=2801
4. “Historian Bruce Cumings: US Stance on Korea Ignores Tensions Rooted in 65-Year-Old Conflict; North Korea Sinking Could Be Response to November ’09 South Korea Attack”, Democracy Now, May 27, 2010. http://www.democracynow.org/2010/5/27/nk
5. The US military is all about offense not defense, unless defense refers to the defense of capital accumulation within a system of imperial relations. Calling Gates the secretary of defense stupidly reinforces this deception. No one, but the Japanese and its Axis allies, would have called Japan of the 1930s and 1940s the liberator of Asia from Western imperialism, even though Japan bestowed the self-serving and misleading title upon itself. Why, then, should we refer to Gates by the equally self-serving and misleading title of secretary of defense?
6. McCurry
7. Felix Greene, The Enemy: What Every American Should Know about Imperialism, Vintage, New York, 1970, p. 292.
8. William Blum, “The Anti-Empire Report,” September 2, 2009. http://killinghope.org/bblum6/aer73.html
9. Cumings: Democracy Now
10. Ibid.
11. Bradley S. Klapper, “WHO criticizes Amnesty report into NKorea health”, The Associated Press, July 16, 2010.
12. Ibid.
13. Lisa Schlein, “WHO chief notes N. Korean achievements in public health care”, Voice of America News, April 30, 2010.
14. Ibid.
15. Ibid.
16. Klapper