While reviewing the latest UN Overview of Needs and Assistance in DPRK report [pdf]—see our overview posted Monday—we came on an interesting table that contained updates on childhood nutrition status. The update contains 2009 information from the UNICEF led Multiple Indicator Cluster Survey [pdf]. The measure of childhood nutrition status is the percentage of children exhibiting known signs of malnutrition of different sorts: wasting (low weight-to-height), stunting (low height-for-age), and underweight (low weight for age). The two age-related measures (stunting and underweight) can be interpreted as reflecting the effects of chronic malnutrition. Wasting, the low weight-to-height, measure, can be interpreted as signaling immediate, acute malnutrition. This measure tends to be noisier and may fluctuate with seasonal variability in food availability. We reported on past survey data on these indicators in Famine in North Korea.
The 2009 survey reports relevant population percentages in three groups: global, moderate, and severe. Global acute malnutrition is defined as an individual being 2 standard deviations or more below the median. Moderate acute malnutrition is defined as being between 2 and 3 standard deviations. Severe acute malnutrition is defined as being more than 3 standard deviations below the median. In the table below, we report the 2009 stunting and underweight numbers by province and overall in addition to the figures for 1997, 2002, and 2004 from past reports. We also report the change in global acute malnutrition percentages between 2009 and 2004.
The results in 2009 display a modest improvement for both indicators in all but one province. South Pyongan has remained relatively steady since 2004, but it has been among the more “healthy” provinces since 2004. A more interesting, but not unexpected, finding is that the northeastern provinces exhibit much higher rates of malnutrition than the rest of the country. Yanggang, North Hamgyong, and South Hamgyong all exhibit stunting rates near or above 40% and more than 20% underweight. These numbers are far closer to the post-famine numbers from 2002 than the numbers in in and around Pyongyang. In the figure below, we display the long run trend in the country-wide data for stunting and underweight.
The overall trend leaves much to be desired. Overall rates for stunting have declined by less than 7% since the 2002 survey. Overall rates for underweight have fallen by just over 1%. Rather than declining, rates for the country as a whole were only leveling off at the time of the 2009 survey. Much of this can be attributed to the lack of improvement in the northeast; if Kim Jong Un would like to fulfill the promise of becoming a strong and prosperous nation, the northeastern provinces will be a good place to start. But we were reminded that Pyonygyang itself was hardly spared; 22 percent of children in the capital are stunted and 14 percent are underweight.
Unfortunately, things have not gotten better since 2009 and have probably gotten worse. The WFP launched an emergency operation in April 2011 to meet the needs of up to 3.5 million of the most vulnerable children, pregnant and lactating women and the elderly. Despite these efforts, large swaths of the population experienced prolonged food deprivation from May through to September 2011. According to the report, “UNICEF implemented an integrated package of combined WASH (provision of safe water through gravity-fed water supply systems), nutrition, and health interventions in the 25 most food-insecure counties in four Northern provinces, in addition to all baby homes and paediatric hospitals.” They also conducted screenings in these most seriously affected counties and the results were alarming, with 14.6 per cent of adults showing moderate and 2.8 per cent of severe acute malnutrition compared with the MICS 2009 data estimating 4.7 per cent of moderate and 0.5 per cent of severe acute malnutrition. In sum, the problems are both chronic and widespread but also acute in the most severely-affected parts of the country.
This information should all be read with a note of caution. We have argued in the past that some of this data can be dodgy, particularly in the earlier surveys. As we often say, caveat emptor.