Ewha Med J.  2022 Oct;45(4):e14. 10.12771/emj.2022.e14.

Comparative Analysis of Health Patterns and Gaps due to Environmental Influences in South Korea and North Korea, 2000–2017

  • 1Institute for Development and Human Security, Ewha Womans University, Seoul, Korea
  • 2Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
  • 3Graduate School of International Studies, Ewha Womans University, Seoul, Korea
  • 4Department of Pediatrics, College of Medicine, Ewha Womans University, Seoul, Korea
  • 5Department of Public Administration, Ewha Womans University, Seoul, Korea
  • 6Department of North Korean Studies, Ewha Womans University, Seoul, Korea
  • 7Department of Thoracic and Cardiovascular Surgery, College of Medicine, Ewha Womans University, Seoul, Korea
  • 8Department of Nutrition Science and Food Management, Ewha Womans University, Seoul, Korea
  • 9Graduate Program in System Health Science and Engineering, College of Medicine, Ewha Womans University, Seoul, Korea
  • 10Graduate School of Pharmaceutical Sciences, College of Pharmacy, Ewha Womans University, Seoul, Korea
  • 11Department of Sociology, Ewha Womans University, Seoul, Korea
  • 12Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, Seoul, Korea
  • 13Department of Women’s Studies, Ewha Womans University, Seoul, Korea
  • 14College of Nursing, Ewha Womans University, Seoul, Korea
  • 15Institute of Ewha-SCL for Environmental Health (IESEH), College of Medicine, Ewha Womans University, Seoul, Korea


To conduct a comparative study of children’s health in South Korea versus North Korea focusing on air pollution.
We used annual mortality rate, prevalence, and environmental indicators data from the World Bank and World Health Organizations (WHO). Trend analysis of the two Koreas was conducted to evaluate changes in health status over time. Spearman’s correlation analysis was used to find out the correlation between environmental indicators and children’s health status.
We found a distinct gap in children’s health status between the two Koreas. While North Korea reported a higher death rate of children than South Korea, both showed a decreasing trend with the gap narrowing from 2000 to 2017. The prevalence of overweight and obesity increased and that of thinness decreased in both Koreas. Except PM2.5 exposure, South Korea reported higher figures in most indicators of air pollutant emissions (South Korea, mean (SD)=28.3 (2.0); North Korea, mean (SD)=36.5 (2.8), P-value=0.002).
This study empirically discovered the gaps and patterns of children’s health between South Korea and North Korea. North Korean children experienced more severe health outcomes than children in South Korea. These findings imply that epigenetic modification caused by environmental stressors affect children’s health in the two Koreas despite similar genetic characteristics. Considering the gaps in children’s health between the two Koreas, more attention and resources need to be directed towards North Korea because the necessary commodities and services to improve children’s health are lacking in North Korea.


Child health; Environmental health; Environmental exposure; Environmental pollution; Environment and public health


  • Fig. 1. Trends in children’s health (mortality) in South Korea and North Korea. The red line stands for children’s health status (mortality, per 1,000 live births) in North Korea and the blue line for South Korea.

  • Fig. 2. Trends in children’s health (prevalence) in South Korea and North Korea. The red line stands for children’s health status (prevalence, %) in North Korea and the blue line for South Korea.

  • Fig. 3. Correlation between air pollution exposure and children’s health in South Korea and North Korea.



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