Experts criticize WHO’s North Korea suicide stats

Data based on risk factors present in other countries doesn’t hold up in the North, scientists say

A study released last month by the World Health Organization placed North Korea’s suicide rate at among the worst in the world, but a number of scientists have slammed its conclusions.

The report, Presenting Suicide: A Global Imperative, estimated that 9,790 North Koreans took their own lives in 2012. This would give the North a higher suicide rate than South Korea, a nation with anotorious problem of people taking their own lives. In fact, among the nations surveyed the report placed the North behind only Guyana in terms of suicide prevalence.

However, given the well-known difficulty of accessing information about the North – especially information with the potential to embarrass the regime – how did the WHO research its suicide rate? What kinds of methodology did the WHO employ, since the North restricts medical professionals from freely moving throughout the country?

GATHERING DATA

‘…the estimates based on what is expected in neighboring countries with totally different political, social, financial and value systems would be less than reliable and the quality of these stats will be highly variable’

“For some countries without available death registration data, the Global Burden of Disease Study has made use of other types of available data on national patterns of causes of death from surveys, verbal autopsy studies and health and mortuary facilities,” Alison Brunier, communications officer for the WHO, told NK News. “In the case of the DPRK, no such data was identified and the statistical estimates for suicide deaths by cause were based on regression models that predicted the levels of suicide based on data from surrounding countries (such as China, Republic of Korea and other Asian countries) adjusted according to levels of statistically predictive factors such as alcohol consumption, population density, average income per capita, average education levels, religion, etc.”

However, Joseph Lee, an epidemiologist at Columbia University, said the WHO’s methodology regarding the North was problematic for three reasons.

“First, even with all the predictors they used, (calculating the) prevalence of suicide (using) the regression model estimate will be very limited as these parameters will not explain a large proportion of variation,” he said. “Second, the estimates based on what is expected in neighboring countries with totally different political, social, financial and value systems would be less than reliable and the quality of these stats will be highly variable.

“Third, these estimates will have even greater uncertainty when the number of people in certain subgroups is small. Since life expectancy is lower in North Korea than elsewhere, I suspect the estimates will be highly unstable in older groups because there would be smaller numbers of people there.”

According to the CIA World Factbook, North Korea’s life expectancy rates are lower than in its neighbors, including an entire decade lower than the South.

Hazel Smith of the University of Central Lancashire called the WHO stats on the North “highly speculative.”

“It’s sometimes okay in science to draw inferences, but to do that with any possibility of saying something valid, the inferences must be based on some demonstrably accurate data and you have to be very, very explicit about why this inferential approach is being used, how it is being used and show how these inferences can end up with reasonably accurate conclusions,” she said. “None of that is evident in the reports I have seen. WHO analytics are normally fairly rigorous so it’s a bit surprising to me to see this level of fuzziness.”

Joe Terwilliger, professor of neuroscience at Columbia University, said that the WHO’s statistics on North Korea had been largely based on the presence of environmental risk factors that contributed to suicide South Korea and China.

“The universality of these statistical relationships is an assumption underlying this model, with the caveat that they might vary ecologically or geographically,” he said.

The problem, he said, is that there are different cultural factors present in the North.

“Such variation, however, is assumed to be continuous and the possibility that they might be a function of the nature of the society is apparently discounted,” Terwilliger said. “China and South Korea are among the most competitive capitalist societies on earth, while the DPRK is among the least competitive and capitalist societies by every conventional measure.”

The WHO declined to provide additional information on its report to NK News.

DEFECTORS’ TAKES

The WHO’s report also does not align with previous research on suicide in North Korea, and defectors organizations in the South are aware of no changes in the suicide rate or factors that would explain a recent upswing.

‘Taking one’s own life is not deemed an option’

A January 2013 report by the Unification Medical Ministry (UMM) at Seoul National University suggests that despite difficult living conditions, North Koreans rarely take their own lives. According to the report, the low suicide rate is due in part to North Korea’s songbun system where members of one’s family can be demoted in social hierarchy, or even sent to North Korea’s infamous prison camps, if he/she opposes the state in any way, such as defecting, badmouthing the Kim family or committing suicide.

After interviewing three North Korean defectors, the research team concluded that, “Taking one’s own life is not deemed an option.”

This situation, by most accounts, remains in effect in the North.

“In case one of the family members (commits) suicide, the rest of family members will get bad social status,” Bada Nam, director of People for Successful COrean REunification (PSCORE) told NK News.

One of the eye-catching features of the WHO report was the assertion that suicide rates for North Korean men (50.7 percent) and women (49.3) were nearly equal – in almost all countries surveyed the male suicide rate was considerably higher. Since the breakdown of the food distribution system in the mid-1990s, more and more North Korean women have reportedly had to assume the role of breadwinner on the black market, thus increasing their status but also their workload and, potentially, their stress levels.

However, a staffer with the Database Center for North Korean Human Rights said that, while women do face their share of challenges in North Korean society, they have heard nothing in recent years indicating an increased incidence of female suicides.

CULTURAL INDICATORS

‘…it is certainly good that we are reminded that such things as suicide exist in North Korea so that we are motivated to dig into other analyses and surveys’

In its propaganda North Korea has used the high suicide rate in South Korea to show its citizens that their neighbors to the South are struggling under the rule of the control United States “lackeys” in the conservative government. For example, a KCNA report from December 17, 2012 stated that, “South Korea is called ‘paradise of suicide’ as it tops the world list of suicide. A man or woman chooses suicide in every 34 minutes.”

Felix Abt was managing director for the PyongSu Joint Venture Company, the first foreign-invested joint venture in the pharmaceutical field in the DPRK, from late 2005 to February 2009. Abt told NK Newsthat while in the North he had enquired about mental illnesses associated with suicide, such as depression or anxiety.

“Although doctors saw patients with such symptoms or with a suicidal behavior the percentage did not seem higher in comparison to estimates I had from other developing countries,” he said.

Abt also said that global studies on communicable diseases were not the same as in phenomena like suicide, which has different implications based on culture. North Korea would not be the only place where such data is difficult to gather, he said; it would also be a challenge in Muslim countries, whose religion forbids suicide, and China where it is stigmatized.

Still, Abt said, “I wonder how the WHO made its judgment in the absence of any reliable statistics.”

Jana Hajzlerova, chair of the Czech-Korean Society in Prague, said that it is useful for those outside the North to consider that the country has social problems, but also cast doubt on the methodology used and warned against drawing conclusions based on it alone.

“While it is certainly good that we are reminded that such things as suicide exist in North Korea so that we are motivated to dig into other analyses and surveys,” she said, “I would find it problematic if these WHO findings were used as a factual background for any import policymaking actions,” she said.