Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees

Featured Journal Content

American Journal of Preventive Medicine
August 2018 Volume 55, Issue 2, p133-280, e19-e52
http://www.ajpmonline.org/current
Global Health Promotion and Prevention
Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees
Jiho Cha, Pamela J. Surkan, Jaeshin Kim, Isabel A. Yoon, Courtland Robinson, Barbara Lopes Cardozo, Hayoung Lee
p271–279
Published online: June 19, 2018
Introduction
The gravity, scale, and nature of human rights violations are severe in North Korea. Little is known about the mental health consequences of the lifelong exposures to these violations.
Methods
In 2014–2015, a retrospective study was conducted among 383 North Korean refugees in South Korea using respondent-driven sampling to access this hidden population. This study collected information on the full range of political and economic rights violations and measured post-traumatic stress disorder, anxiety and depression symptoms, and social functioning by standard instruments. Multivariate regression analysis was performed with the adjustment of political, economic, and demographic variables in 2016–2017.
Results
The results indicate elevated symptoms of anxiety (60.1%, 95% CI=54.3%, 65.7%), depression (56.3%, 95% CI=50.8%, 61.9%), and post-traumatic stress disorder (22.8%, 95% CI=18.6%, 27.4%), which are significantly associated with exposures to political rights violations (ten to 19 items versus non-exposure: anxiety AOR=16.78, p<0.001, depression AOR=12.52, p<0.001, post-traumatic stress disorder AOR=16.71, p<0.05), and economic rights violations (seven to 13 items versus non-exposure: anxiety AOR=5.68, p<0.001, depression AOR=4.23, p<0.01, post-traumatic stress disorder AOR=5.85, p<0.05). The mean score of social functioning was also lower in those who were exposed to political (adjusted difference=–13.29, p<0.001) and economic rights violations (adjusted difference= –11.20, p<0.001).
Conclusions
This study highlights mental health consequences of lifelong human rights violations in North Korea. Beyond the conventional approach, it suggests the need for a collaborative preventive response from global health and human rights activists to address human rights in regard to mental health determinants of the 20 million people in North Korea.