From Pre- to Post-Famine: Trends in Underweight among North Korean Children, 1987-2012

IntroductionTo let all people "eat rice with meat soup," as a common propaganda slogan has it, has been an objective of the leadership of the Democratic People's Republic of Korea (DPRK), also known as North Korea.1 Yet contrary to official proclamation, nutritional stress has lingered in North Korea ever since its foundation in 1948, which was brought about by the emerging Cold War (1945-1991). As a manifestation of food calamities, mean final height of North Korean men, taken as a proxy for nutritional and epidemiological stress in early life,2 merely stagnated for all decades of the Cold War.3,4 In stark contrast, contemporary South Korean men are by now the tallest in all of East Asia because of healthy and wealthy living conditions in the southern half of the Korean Peninsula.5Worst of all, by the 1990s, North Korea experienced a great famine.6,7 Massive starvation of North Koreans occurred with the downfall of socialism and the geopolitical disintegration of the Eastern Bloc. Food, fertilizers, and energy could no longer be afforded on the basis of world market prices. Lacking these necessary inputs, North Korea's economy collapsed in the 1990s.8 More important, in the previous Cold War era, the socialist government inefficiently focused on heavy industrialization and symbolic mammoth projects of marginal economic use in addition to overspending up to one-third of its budget on the military.9 This leftNorth Korea without comparative advantages in exports in the post-Cold War era to raise the levels of living and revive its economy.Though macroeconomic shocks and long-term strategic malinvestments are the underlying causes for North Korea's decline after the Cold War, the food crisis of the 1990s itself was triggered by two consecutive floods in 1995 and 1996 that devastated large parts of the country and "evolved into a major famine."10 The floods in turn were a result of the El Nino weather anomaly at that time, although deforestation accelerated the crisis. However, by the early 2000s, North Korean living standards improved thanks to international assistance. In the early 1990s, North Korea joined the United Nations, and after the first floods in 1995, it officially appealed for aid. Ever since then, international food aid has been pouring into the DPRK, with peaks from 1997 to 2005 (Figure 1). Another important factor for North Korea's revitalization in the post-Cold War era was liberalization reforms. These were officially introduced in 2002 ("July First Reforms") and led to a paradigmatic shift, including marketization and decentralization.11,12,13 Table 1 demonstrates that probably 78 percent of North Koreans were participating in the informal economy by the time they were interviewed from 2004 to 2005.This article investigates the trends in underweight of children in North Korea from 1987 to 2012 to explore how the nutritional status of the North Korean people developed in the critical decade of the 1990s and beyond. First and foremost, the starting point of this study is the year 1987, which is a prefamine period when North Korea was still integrated into the Eastern Bloc. The last year of observation is the post-famine year 2012, which is over a decade after the great famine of the 1990s. Hence, this study offers very rare evidence on the long-term development of North Korean biosocial living standards. Previous statistical analysis on North Korean child malnutrition focused on cross-sectional evidence during the peak of famine14,15 or after the famine16,17 as well as on the regional effects of the food crisis.18,19 What is more, this paper compares underweight rates of children in North Korea to that of their peers in South Korea by drawing on recently released statistics based on a nationally representative anthropometric survey carried out from 2003 to 2004. This is another intriguing comparison because both Koreas share the same genetic and cultural ancestry and were also not affected much by migration over the last centuries. …