UN Health and Labor Organizations Rank North Korea Worst on Work-Related Disease and Injury

The World Health Organization (WHO) and the International Labour Organization (ILO), two highly regarded agencies in the UN system which take the lead on international health and labor issues, have joined forces to deal with workplace disease and injury “to ensure healthy lives and promote well-being” in the workplace. In 2016, the two organizations produced the first in a series of periodic reports on labor and health issues.

This first Global Monitoring Report was released in late September 2021, entitled WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury, 2000–2016: Global Monitoring Report. The 80-page report is a testament to the caliber and quality of work done jointly by the two organizations. The report has data and informed discussion of the methodological issues of measuring and analyzing work-related disease and injury, and it also includes detailed statistics on all individual UN member countries on the basis of their analysis. 

The WHO/ILO Joint Report

The report estimates that 1.88 million deaths and 89.72 million “disability-adjusted life years” (DALYs) were attributable to work-related disease and injury in the year 2016. The DALY measure is the estimate of the amount of time workers suffer over their lifetime as a result of work-related injury and disease-producing disability and loss of quality of life. The complex methodology and data sources are discussed in detail in the report (pages 3–45).

The purpose of this commentary is not to discuss or critique the methodology of this complicated and careful work, but to look at what the data suggest regarding North Korea in comparison with other UN member nations. The international group of highly trained analysts who produced this report made an honest and methodologically sound effort to draw conclusions about the costs and burden of unsafe and unhealthy working conditions internationally. Furthermore, they made a serious effort to examine and quantify differences between countries.

The report focuses on three specific points of time and makes calculations for each of these periods—the years 2000, 2010, and 2016. This is helpful because it provides an opportunity to consider the direction of change in workplace health and safety over time. Furthermore, the study looks at death and disease rates, in most cases in terms of disease or injury “per 100,000 workers.” This makes it possible to look comparatively at data on China (with a total population of over 1.4 billion) at one extreme and the Marshall Islands (with a total population of 58,000) at the other. The use of rates gives the ability to make cross-country comparisons. Clearly, however, there are many factors other than total population that are at play in this analysis.

In an effort to take into consideration differences between countries with a large young population, the death rates and the DALYs are also given for both the total population and the working-age population. The working-age population standard is set as age 15 and above. This makes comparisons for countries with a large growing young population more accurate and appropriate.

Work-Related Death Estimates for North Korea

In terms of work-related deaths, the WHO/ILO study calculates that North Korea had a rate of 56.2 deaths per 100,000 workers in 2000, 78.1 in 2010, and 79.5 in 2016. In addition to northeast Asian countries, death rates for the United States, the United Kingdom, and the Netherlands are included for comparison with advanced industrial countries, all of which help to place the data for North Korea in context.

Only two countries had death rates that were higher than North Korea in 2000. Nepal showed a death rate of 65.0 per 100,000 in 2000. In subsequent years, however, Nepal reduced its rate to 55.2 in 2010 and 52.7 in 2016. The other country with a rate higher than North Korea in 2000 was Sierra Leone, which had a death rate of 61.0 per 100,000 in 2000. However, the rate for Sierra Leone declined even more dramatically than Nepal’s for subsequent periods—44.6 in 2010 and 40.0 in 2016.

In sharp contrast to Nepal and Sierra Leone as well as most other countries around the world, North Korea’s death rate did not decline in the following time periods but climbed to 78.1 in 2010 and even higher to 79.5 in 2016. North Korea’s death rates for the two most recent time periods are significantly higher than any other country.

The Impact of Long Working Hours

Another category of death calculations that was examined and compared in the WHO/ILO study was deaths “as a result of stroke attributable to exposure to long working hours.” By “long working hours,” the report is referring to working more than 55 hours per week. The study concluded that long work hours in the study were primarily responsible for over 745,194 deaths worldwide in 2016. That was an increase from 671,029 deaths in 2010 and from 589,838 in 2000. (For the trends and the methodology of this particular element of the WHO/ILO study, see this summary.) The trends relating to North Korea are very similar to the broader data on work-related deaths. 

With regard to the deadly impact of longer working hours, North Korea was again among the worst. The only country in 2000 with a higher number of stroke-related deaths due to long working hours was Sierra Leone, whose deaths per 100,000 were calculated at 18.7 in 2000. Again, however, Sierra Leone improved its record, with that number dropping to 13.8 in 2010 and further to 11.8 in 2016. In North Korea, on the other hand, stroke-related deaths from long working hours increased from 17.5 to 28.1 between 2000 and 2016. North Korea was one of the very few countries in the world that saw deaths in this category increase, moving from the second highest to decisively the highest rate in 2016—the opposite direction of the change for all other countries.

Workplace Disease and Injury Growing Worse in North Korea

The most striking feature of the data for North Korea in both the overall number of work-related deaths and in the number who suffered death from stroke as a result of overwork is that the number went from one of the worst in the world to decisively the worst of all UN member states. In almost every other country in the world over the period of this study, the death rate from workplace disease and injury declined.

The comparison of the UN numbers for North Korea and South Korea is also particularly stark. North Korea’s total workplace deaths per 100,000 went from 56.2 in 2000 to 79.5 in 2016. That is in stunning contrast with South Korea. In 2000, North Korea had less than twice the number of deaths per 100,000 as South Korea, but by 2016, North Korea had a death rate that was four times the rate of South Korea—79.5 deaths per 100,000 in North Korea compared with 20.6 in South Korea.

The same pattern of numbers for the two Koreas was even more dramatic with regard to deaths from stroke attributed to working long hours. Deaths from overwork in North Korea increased by over 60 percent from 2000 to 2016. South Korea’s deaths over that same period dropped from 8.9 to 3.9—a reduction of well over half. In 2000, North Korea’s rate was twice that of South Korea; in 2016, it had increased to seven times that of South Korea.

The WHO/ILO report is an effort to look at the work-related burden of disease and injury in a global context, but it also provides a revealing tool for examining the health and safety standards applied in individual countries. It makes a very strong case that North Korea is failing to provide for the welfare and well-being of its citizens. The data also show that North Korea has the worst record in comparison with the neighboring countries in northeast Asia.