Nearly a year has passed since North Korean leader Kim Jong Un personally announced the first year of a revolution in public health on Feb. 6, 2025.
The authorities have touted this as proof of the regime’s superiority, claiming the state takes full responsibility for citizens’ lives.
But what has happened over the past year appears less a qualitative advancement in medical care than a concerted attempt to bring the medical sector back under state oversight.
The public health revolution began not with building more hospitals or hiring more medical staff, but with a large-scale survey. In late 2024, the health ministry ordered public health bureaus in each provincial people’s committee to simultaneously survey all medical institutions, focusing on staff numbers, equipment tallies, and medication inventories.
The problem: this survey happened abruptly, without any baseline data, rather than as part of ongoing practice.
The survey found that some hospitals didn’t even know their own staff and equipment numbers, and that some basic medical devices had been privately sourced by doctors rather than supplied by the state. That illustrates the public health revolution was envisioned less as system improvement than as a political measure to assess and manage the gap between propaganda and reality.
Behind the “success story” at Kangdong County Hospital
When construction on Kangdong County Hospital in Pyongyang finished on Nov. 19, the regime hailed it as the public health revolution’s first achievement. Kim Jong Un personally attended the ribbon-cutting ceremony at what’s regarded as the first modern hospital outside the capital.
Kangdong County Hospital reportedly focuses on outpatient treatment, with relatively stable power, water, and heating. Locals have been pleased that consultations and medications there cost less than at neighboring hospitals.
But that stability comes from concentrated support, not systemic capabilities. Most medical equipment is foreign-made, transferred from Pyongyang hospitals, and MRI scanners and other top-tier equipment haven’t been installed yet.
For pharmaceuticals, Kangdong County Hospital joined a privileged list of facilities directly supplied by the health ministry. Some lead doctors are also on loan from Pyongyang, and it’s unclear how long they’ll remain.
Notably, Kangdong County hosts a high concentration of facilities connected with the Second Economic Committee, which oversees North Korea’s arms industry—helping explain why this hospital was built here.
In short, Kangdong County Hospital is less a model for improving regional medical care than a pilot facility for maintaining stability in areas supporting regime-critical industries.
How long this hospital can maintain current operations will be the yardstick for the public health revolution’s actual success.
Improved hospitals aren’t the change North Koreans have perceived while the government has been tightening oversight and control. Even after the public health revolution was declared, illegal medical services reportedly remain routine not only in the provinces but also in Pyongyang itself.
Hospitals lack the most basic drugs, and patients seeking treatment are often told to bring their own medication. So it’s no surprise North Koreans visit their “neighborhood doctor” or even a private acupuncturist for ailments.
This process has further stratified access to medical care. Only affluent people with the right connections can visit renowned physicians. Everyone else must live with their illness unless it’s literally killing them. That shows North Korea’s hyped “free medical care” exists only in regime propaganda.
Transition from free medical care to state-led health care industry
The free medical care system often promoted by the regime hasn’t been officially shuttered. But in reality, medications, consultations, and treatments are rapidly moving to a paid model. That suggests the state isn’t working to restore free medical care, but rather to organize medical services into an industry under its exclusive control.
These changes structurally resemble the shift toward reasserting control over food distribution through state-run grain shops (introduced in 2021), after the old rationing system collapsed.
By establishing median prices between government standards and market rates, the regime brought public currency circulation back under its control—experience it’s now applying to medical care. As part of that strategy, medication and consultation prices at model pharmacies and hospitals are set slightly lower than gray market rates.
But this approach has numerous shortcomings. Model pharmacies may look modern, but they only carry limited medications designated by the Central Committee, and products beyond essentials are reportedly often more expensive than on the market.
That’s a side effect of trying to restore state control over drug and medical service distribution, which had been delegated to marketplaces, rather than actually improving people’s health.
As mentioned earlier, collapsed trust remains a serious issue. Since summer 2025, the idea that sick people must depend on unofficial marketplaces rather than state free medical care has become widespread.
Russian and Chinese-made antibiotics and saline solutions are sold at marketplaces, and North Koreans often buy supposedly fast-acting medicines without even knowing their ingredients because labels are in foreign languages. Such behavior speaks to entrenched distrust of North Korean medicines and collapsed faith in the state medical system.
What global observers can learn from the first year
While North Korea’s public health revolution over the past year suggests officials are serious about addressing systemic issues, implementation has focused more on tightening government control and shifting costs to individuals than on actually improving medical service quality. If medical services shift to a paid model and state monopoly is heavily emphasized amid equipment, drug, and worker shortages, medical inequality will likely worsen.
The key question isn’t how many hospitals exist (20 more are supposed to be built in 2026) but whether the system is sustainable—in other words, qualitative concerns, not quantitative ones.
Furthermore, while North Korea’s public health revolution has the trappings of humanitarian reform, we must not disregard that it also supports the regime’s strategy of tightening public control and reinforcing its financial base.
The first year’s results are clear: the regime is evidently aware of public health’s importance but isn’t yet ready to take responsibility for the people’s well-being.
January 09, 2026 at 05:02AM
by DailyNK(North Korean Media)