A violation of the right to health and a call to action
On 12 June 2009, the United Nations Security Council approved its strictest economic sanctions to date against North Korea in response to a series of provocative acts, including the detonation of a nuclear device.1 The United States is also considering expanding sanctions and has appointed a high level task force to coordinate military, political, and financial strategies against North Korea. However, economic sanctions are being considered with virtually no public discussion of their potential effects on the North Korean people. Notably, even the health community has been silent.
In contrast, during the lead up to the Iraq war, health professionals contributed invaluable insights to public discourse regarding the effects of economic sanctions on health.2 3 Prominent health associations published position papers and issued statements opposing their use.2 4 In fact, economic sanctions have been shown to violate the fundamental right to health.2 5 Furthermore, they do not achieve political change—60 years of US sanctions against North Korea have failed to do so. The health community urgently needs to take the lead in opposing the use of economic sanctions against North Korea on the basis of principles of health and human rights.
Economic sanctions create social disruption and material deprivation, including dramatic declines in resources that are essential for health, such as drugs, vaccines, food, water, and energy.2 5 For example, during 10 years of UN imposed economic sanctions on Iraq in the 1990s, mortality among Iraqi children under 5 years old more than doubled (from 56 to 131 per 1000 live births).3 In Cuba, with the loss of Soviet Union trading partners in the early 1990s, population level measures of health declined and then worsened with the tightening of economic sanctions by the US. Shortages in drugs resulted in a 48% increase in mortality from tuberculosis and a 77% increase in mortality from pneumonia and influenza.6
Similarly, North Korea’s economy plummeted under the combined effects of economic sanctions and the fall of the Soviet Union. Its economic and public health systems further buckled with successive years of floods and droughts, leading to widespread malnutrition and up to one million excess deaths in the 1990s.7 Although many of the US trade sanctions against North Korea were lifted during the 1990s, the sanctions that are currently in place continue to handicap North Korea’s attempt to recover from the ongoing public health crisis. Despite their stated intent of targeting illegitimate activity, recently enacted financial sanctions and sanctions on “dual use” items have been implicated in restricting legitimate trade.8 9 10 Dual use refers to technology that may be used for civilian or military purposes. In North Korea, sanctions on such goods have restricted the import of items needed to build a modern economy, such as personal computers.9 Ultimately, North Korean civilians are harmed.
Economic sanctions violate principles established by the Universal Declaration of Human Rights and the Convention on the Rights of the Child that assert the right to “a standard of living adequate for health and well-being.” Furthermore, human rights obligations extend beyond national borders to third parties and international bodies. The UN Committee on Economic, Social and Cultural Rights asserts that “the inhabitants of a given country do not forfeit their basic economic, social and cultural rights by virtue of any determination that their leaders have violated norms relating to international peace and security.”11
Economic sanctions rarely achieve their stated objectives, with perhaps 5% having any success in changing national policies.4 Little evidence is available that economic sanctions against North Korea have had any impact on political change, prevention of nuclear proliferation, or improvement of human rights. In fact, economic sanctions and political threats are likely to have emboldened hardliners within North Korea to militarise even further.10
If military action is unacceptable because of the potential for millions of casualties, and human rights implications prohibit the use of economic sanctions, what should be done? Diplomacy is the answer. Direct negotiations by the US in the 1990s resulted in a nine year freeze of North Korea’s plutonium enrichment programme. In 2007, after direct negotiations with the Bush administration, North Korea began dismantling its Yongbyon nuclear processing plant.12 Despite these gains and the work of the six-party negotiators, full scale diplomacy has yet to be engaged. Such engagement might extend beyond nuclear programmes to health and science. With this “health diplomacy” perspective, the US could usher North Korea into the international community by promoting educational, scientific, cultural, health, and economic exchanges. Ending isolationist policies would be a powerful incentive for disarmament and could potentially empower proengagement elements in North Korea.10 Given the Obama administration’s widely publicised willingness to engage diplomatically with adversaries, such expanded possibilities are now more timely than ever.
In light of the grave implications for the health of the North Korean people, the health community must oppose the use of economic sanctions. Through purposeful health diplomacy, US and other health professionals should use their expertise and commitment to human rights to contribute to meaningful engagement. With regard to health, humanity has more in common across political divides than differences, even in North Korea; it is time to work with those commonalities in the pursuit of peace.
Sanghyuk S. Shin is a Fellow with the Korea Policy Institute. Ricky Y. Choi, M.D., M.P.H., is a clinical instructor in the Department of Pediatrics at the University of California, San Francisco. Thomas E. Novotny, M.D., M.P.H., is Professor and co-director of the Joint Degree Program (PhD) in Global Health.
Competing interests: None declared.
Provenance and peer review: Not commissioned; externally peer reviewed.
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