North Korea has a life expectancy of 74 years . While North Korea is classified as a low-income country, the structure of North Korea's causes of death (2013) is unlike that of other low-income countries. Rather, causes of death are closer to the worldwide averages, with non-communicable diseases – such as cardiovascular disease – accounting for two-thirds of the total deaths.
Historically North Korea claimed to provide universal health care with a national medical service and health insurance system for free. However by 2025, the phrase "Universal Free Healthcare System" had fallen out of usage with the "District Doctor System" and "Preventive Medicine" being emphasised, and hospitals had begun officially listing fees at reception openly.
Overview In 1946, free, but not universal, healthcare was mandated by North Korea's Social Insurance Law. Beginning in the 1950s, North Korea put great emphasis on healthcare. In 1952 basic universal healthcare was started, and between 1955 and 1986, the number of hospitals grew from 285 to 2,401, and the number of clinics from 1,020 to 5,644.
Most hospitals that exist today in the DPRK were built in the 1960s and 1970s. During the rule of Kim Il Sung, effective mandatory health checkups and immunization programs were initiated. The country could support a large corps of doctors due to their low salaries. The number of doctors remains high, though there is a shortage of nurses, meaning that doctors often have to perform routine procedures. The medical infrastructure is fairly effective in preventive medicine, but less so in terms of treating the more demanding conditions. Since 1979, more emphasis has been put on traditional Korean medicine, based on treatment with herbs and acupuncture. A national telemedicine network was launched in 2010 that connects in Pyongyang with 10 provincial medical facilities.
North Korea's healthcare system suffered a steep decline since the 1990s because of natural disasters, economic problems, and food and energy shortages. In 2001, North Korea spent 3% of its gross domestic product (GDP) on health care, but during that same year, many hospitals and clinics in North Korea lacked essential medications, equipment, and running water due to the international sanctions against North Korea. Electricity shortages remain the biggest problem. Even when sophisticated equipment is available, it is useless without electricity. Some facilities have generators available to meet demand during power outages. Lack of fuel due to sanctions also affects patient transportation and delivery of medical supplies to the countryside.
In his 2013 book The Real North Korea, Andrei Lankov wrote that North Korea's achievements in terms of life expectancy were remarkable for a country so poor, though he did note that most hospitals used outdated equipment and access to drugs was limited. He claimed that North Korea's achievements in healthcare may in large part be due to its nature as a police state enabling a high level of preventive medicine, writing that during the rule of Kim Il-sung the entire population was subjected to regular health checks, which were obligatory for every citizen to attend. Although simple, these checks could detect medical problems in their early stages. In addition, low doctors' salaries enabled the state to field a large number of doctors. However, according to Lankov, the healthcare system was good for "fractured bones of tractor drivers or pneumonia among infantry soldiers" but less equipped to deal with more complicated conditions, with sophisticated surgery available only in hospitals used by the elite and everyone else "left to their sorry fate if they were unlucky to catch something serious."Lankov, Andrei: The Real North Korea: Life and Politics in the Failed Stalinist Utopia, p. 63-65.
The country's healthcare system has seen improvements since the 2000's, with a steady rise to healthcare access, particularly to women and children, being reported by the World Health Organization (WHO) in 2016.
In 2020 the construction of a new central Pyongyang hospital started, the Pyongyang General Hospital, in front of the Monument to Party Founding. This is part of a programme of healthcare system improvement. Using the experience of building Pyongyang General Hospital, the construction of three pilot local hospitals was announced: Kangdong County Hospital , Kusong City Hospital and Ryonggang County Hospital. 2025 was designated "First Year of the Health Revolution" with a campaign to construct modern hospitals nationwide.
In 2022, state-run "Standard Pharmacies" began to be established, and were available in all cities and counties by 2024. These pharmacies charge patients for medicines.
In 2025, the Ministry of Health launched a smartphone app providing a drug and medical product ordering and delivery service, a common medical problems query and answer system, and a facility for online consultations with medical practitioners. The drug database is for over 3,000 pharmaceuticals, traditional medicines and medical goods, including information on associated medical conditions, and can be consulted when offline.
Health status
In 2010, Amnesty International and the World Health Organization made wildly varying claims on the state of the North Korean healthcare system. Amnesty International, citing interviews with 40 North Korean defectors and foreign healthcare workers, explained the North Korean healthcare system as one with "barely functioning hospitals." It described hospitals that operate without heating or electricity and shortages of medicines and medical equipment. It also challenged the claims that healthcare was free, claiming that according to interviews with defectors healthcare, had not been free since the 1990s. The World Health Organization (WHO) criticized the Amnesty International report as outdated and factually inaccurate, describing the healthcare system as "the envy of the developing world" while acknowledging that "challenges remained, including poor infrastructure, a lack of equipment, malnutrition and a shortage of medicines." The World Health Organization claimed that the report was based on a small sample of people who had left North Korea, some as far back as 2001, and did not reflect present conditions, particularly after recent improvements in the system due to a program funded by South Korea and aided by the WHO. Commenting on the reports, a BBC reporter said that UN agencies with aid projects in North Korea are typically reluctant to openly criticize the country for fear of jeopardizing their work there. Special health care is available mainly in cities, where pharmacies are also common. Essential medicines are also well available. There are hospitals attached to factories and mines.
In a 2020 article, a North Korean defector who left the country in 2018 claimed that the healthcare system in North Korea caters to the upper classes, who get free care in the country's best medical facilities, while everyone else must pay for care in substandard hospitals. According to him, healthcare coverage was better during the reign of Kim Il Sung, with free hospital treatment available in the 1970s and 1980s, but patients must now pay doctors for their services and must also pay for the medicine and medical equipment used to treat them due to shortages, writing that "average North Koreans see their lives as left to fate. They no longer expect anything from the government in terms of health care." He described hospitals lacking electricity and heating, doctors conducting surgeries by battery-powered flashlights, and wealthier patients paying for firewood or using self-made heaters by burning wood inside steel plates or a drum to heat their rooms. He claimed that it was not unusual for patients to endure surgery without anesthetic to save money. Describing a personal case where he and his wife needed surgery, he claimed that they had to buy "everything from cotton and dressing to anesthetic (novocaine) and antibiotics (penicillin)", pay the surgeon, and treat the rest of the staff to a meal at a privately-run restaurant. He wrote that "How much money a patient has determines whether they live or die." Commenting on accessibility, he claimed that "only the top 1 percent actually enjoys free healthcare. Maybe 20% can afford to pay a doctor. The rest wouldn't even dare to think of going to visit a doctor."
A study based on interviews with respondent-driven sampled defectors living in South Korea found that 65.4% of respondents paid out-of-pocket for medicines, 82% had paid for medical supplies and 75.9% paid for other items such as "meals or heating when in health facilities."
A 2013 study stated that the largest obstacle to understanding the accurate health status of North Korea is the lack of validity and reliability of its health data.
Life expectancy North Korea has a life expectancy of 73.98 years (). The 2009 gender breakdown was 72.8 years of life expectancy for females and 64.9 for males.
PeriodLife expectancy at PeriodLife expectancy inYearsPeriodLife expectancy inYears1950–195537.61985–199068.62020–202573.451955–196049.91990–199570.02025–202673.921960–196551.61995–200063.51965–197057.22000–200568.11970–197561.72005–201068.41975–198065.02010–201570.81980–198567.12015–202072.96 Source: UN World Population Prospects
Malnutrition
During the 1990s, North Korea was ravaged by famine, causing the death of between 500,000 and 3,000,000 people. Food shortages were persistent, with factors such as bad weather; lack of fertiliser; and a drop in international donation, particularly caused by the Dissolution of the Soviet Union, meaning that North Koreans often did not have enough to eat. A study of North Koreans in 2008 found that three-quarters of respondents had reduced their food intake. Extreme poverty is also a factor in the hunger faced by North Korean people, with 27% of the population living at or below the absolute poverty line of less than US$1 a day.
These food shortages cause a number of malnutrition diseases. A 2009 UNICEF report found that North Korea was "one of 18 countries with the highest prevalence of stunting (moderate and severe) among children under 5 years old". A survey in 2017 found that less than 20% of North Korean children were stunted, a decrease from 32% in 2009. While the DPRK has recovered from the precarious situation in the late 20th century, the country still faces challenges in remediating food insecurity. Under the tenure of Kim Jong Un, several institutional and economic reforms have been made to address food security as well as agricultural productivity.
Sanitation A survey conducted in 2017 found that most people had access to a toilet, but that 93% of sanitation facilities were not connected to a sewage system. Rather, the human waste was used as fertilizer on fields, creating the potential health risk of spreading intestinal worms. The survey also found that a quarter of people ingested contaminated drinking water.
Ophthalmology