“All developed countries have substantially hidden illnesses, but its scale depends on the excellence of each country’s medical system, creating the component of the term ‘morbidity iceberg.'”

Professor Christopher Davis from the University of Oxford made the remark in his presentation “Morbidity icebergs in the USSR and Russian Federation: Lessons for South and North Korea,” at Severance Hospital Avison Biomedical Research Center_{세브란스병원 에비슨의생명연구센터} in Seoul Tuesday.

Morbidity iceberg is a metaphor emphasizing the number of known cases of a disease is outweighed by that of what remains unknown, much as the unseen part of an iceberg is much larger than the portion visible above the water.

“Illness at the center of ‘health production,’ which envisions health as a capital stock or education or human capital, such as life expectancy generated by family and individual behaviors, poses challenges to the medical system, and illness patterns influence mortality outcomes,” Davis said. “Most analysis of illnesses is based on reports, but all countries have a lot of unreported diseases.”

He noted that the Union of Soviet Socialist Republics (USSR) and Russia had conducted large-scale studies of morbidity icebergs, which is relevant to South Korea, a developed country like the U.K., and North Korea, similar to the USSR in the 1960s.

Davis then compared the demography, economy, and health sectors between South and North Korea. “The population of South Korea is 49 million, and North Korea is 24.8 million. Infant mortality in South Korea is 3.9 versus 24.5 for North Korea. Life expectancy in South Korea is 79.8 years while that in North Korea is 69.8.”

“What’s interesting is that South Korea has 2.0 doctors per 1000, and North Korea has 3.3. Because North Korea’s healthcare is relatively fragile, they try to make up for it by securing more doctors, similar to socialist countries such as Russia.”

Stressing that household health production is influenced by factors such as demography, consumption and the environment, Davis said that Russian leaders did not pay enough attention to the healthcare sector during the country’s industrial revolution, leading to the consequences of the bad quality of life such as air pollution, affecting citizens.

The determinants of hidden diseases can be the patient’s ignorance of symptoms, gender differences in reporting illness (Russian men were more reluctant than women), inadequate quality care, and high travel costs. Failure to notify the disease is also associated with low education, low income, and rural residence.

“Russian citizens are entitled to free universal health care, but patients had informal fees, such as paying costly imported medicine,” Davis said. “With their lowly income, Russians are often reluctant to receive treatment, which is very similar to what North Koreans are facing right now.”

The measurement of hidden illnesses was based on surveys of the population by medical specialists in sample areas, interviews, and examination of patients.

Hidden illness in developed countries, such as the U.K. and South Korea, results from late diagnosis due to inadequate reporting by poorer classes. Addressing this problem could save thousands of lives, Davis added.

The Oxford professor expressed his confidence in the peaceful unification of the two Koreas. “North Korea can have a gradual reform of economy starting with their agriculture sector, and maintain a variant of the existing political system, or move toward the market economy and democratic political system before seeking gradual integration South Korea,” he said.