(Bloomberg) — North Korea executes officials and arbitrarily imprisons those seen as enemies of the state. Its citizens struggle to put food on the table.
Yet when it comes to North Koreans kicking their cigarette habit, Kim Jong Un’s government is willing to help.
As countries the world over scramble to combat smoking, even one of the most repressive states on the planet is displaying concern that half its male population lights up.
The impoverished nation has one of the world’s highest lung cancer rates. To examine ways to cut the number of smokers, they’ve turned to one of the world’s leading anti-tobacco campaigners, Judith Mackay, who has counseled kings, presidents and vigilantes in a three-decade war on smoking.
“They’re facing the headaches health officials all over the world are: it’s the same product, same concerns, same consequences,” said Mackay, a senior policy adviser to the World Health Organization. “At this moment in time, North Korea has a unique opportunity to stub out this epidemic.”
Officials in Kim’s government seem more concerned than their boss about the potential damage of tobacco use. In December, weeks after the North Korean dictator vanished for 40 days last year due to health problems attributed to his lifestyle, he was pictured in state media inspecting troops, his trademark cigarette still in hand.
Since coming to power three years ago, Kim has frequently been caught on camera smoking: sitting on a bed during an official hospital visit; alone on a ski lift; alongside a specially placed ashtray at the theater; even at the site of a rocket launch.
While the majority of the country’s 24 million people face chronic food shortages, it emerged from famine in the 1990s with a better child nutrition record on some indicators than India or Indonesia. The hermit kingdom is also working on enforcing bans in smoke-free areas and studying raising prices from as little as 27 U.S. cents a pack now to a deterrent level, Mackay says.
Even so, getting people to quit will be a challenge with the nation’s ingrained smoking culture and Kim’s penchant for 727s, a brand named after “Victory Day,” marking the end of the Korean War in 1953 when the split with South Korea was cemented.
“Cigarettes are more or less omnipresent in Kim’s public appearances,” said Adam Cathcart, a lecturer at the University of Leeds, who studies North Korea-China relations. “He’s very obviously addicted, even when he’s not smoking he’s fidgeting with his cigarette pack through his trench coat.”
Mackay has a track record in one-party states. She considers a 2012 meeting with the Chinese Communist Party’s Central Party School one of the pinnacles of her career, and says policy directives that followed led to a “sea change” in the commitment to tobacco control in the country.
Three decades ago, when she began campaigning against smoking in China, former Chinese leader Deng Xiaoping smoked in public often. Today, none of the seven elite Politburo Standing Committee members are seen holding cigarettes and the State Council is weighing laws to make all public places smoke-free. While it’s too early to gauge the impact of China’s measures, which are not in force yet, the WHO says they could fuel a discernible decline in the smoking rate.
Mackay’s work in North Korea began a decade after she lent a helping hand to some of the country’s soccer heroes in 2002.
She and her husband helped sponsor some parts of a trip taken by stars of the nation’s 1966 World Cup team, when the athletes revisited the town of Middlesbrough, England, where a documentary about them — called ‘The Game of Their Lives’ — had been filmed. The Mackays made the gesture after reading a newspaper report about how the ex-players were short of funds to attend an event commemorating a match where they famously defeated Italy.
When the couple planned a tourist visit to Pyongyang in 2012, health officials granted her a rare official meeting when they found out about her “unique contribution,” she said.
Mackay has returned several times since, meeting ministers of health, finance and education to discuss tobacco-control plans. North Korea has a five-year plan to fight non-communicable diseases such as cancer, diabetes and heart disease, in line with other countries following WHO programs.
Kim, who is believed to be around 30, is sometimes the face of that campaign. Examples of clips regularly broadcast on state media are ones of Kim explaining the health benefits of eating fish or even admiring some new exercise machines, Cathcart said.
“He sort of sounds like Michelle Obama at times,” Cathcart says, referring to the U.S. First Lady’s public health mission. “His concern for the well-being of the North Korean people is supposed to be all-encompassing.”
While accounts of Kim’s love for vodka and Swiss cheese swirled in foreign press when he disappeared from view after Sept. 3 of last year, smoking stands out as the bad health habit he indulges in so publicly. Kim’s father, former leader Kim Jong Il, was also often pictured smoking.
Officials in Pyongyang are still in an early stage of tobacco control and forming legislation, but they’re “intensely interested” in learning what other nations have experienced, Mackay said.
During the 46-year rule of Kim’s grandfather, Kim Il Sung, North Korea’s medical system was extensive, according to Hazel Smith, the director of University of Central Lancashire’s International Institute of Korean Studies. Life expectancy doubled from 31 in the 1950s to almost 70 by 1989, said Smith, who lived in Pyongyang from 1998 to 2001 while working for UN agencies.
When famine ravaged the nation in the mid-1990s, infectious diseases such as malaria and tuberculosis soared, she said. Smoking was sometimes the only available solace, even among children.
“If they couldn’t find food they’d pick up cigarette butts and re-roll whatever tobacco remained with discarded paper,” journalist Barbara Demick wrote in her 2009 book ’Nothing to Envy.’ “Almost all the children smoked to dampen their hunger.”
Since the economy stabilized at the turn of the millennium, North Korea restarted public health campaigns on everything from the importance of washing hands to getting vaccinated.
“Action can happen quickly if North Korea decides to do it,” Mackay said, referring to the country’s all-powerful government. “Not many countries in the world are in that position.”
The male smoking rate was 52.3 percent in 2012, according to the WHO’s country office, with a zero smoking rate among women. Women typically do not smoke in public as it is considered an inappropriate activity for their gender, according to George Washington University PhD student and North Korea scholar Benjamin R. Young.
Many men pick up the habit when they’re serving their mandatory military duty, which can last up to a decade, Simon Cockerell, general manager at Koryo tours, who has been to North Korea more than 140 times since 2002 and organizes tourist visits there.
North Korean men are “among the world’s most prolific smokers,” said Catherine O’Connor, senior analyst at market research firm Canadean. “While it is clear that official policy of North Korea is to reduce per capita levels, the absence of any real policies to reduce tobacco use suggests this is far from the case and indicates that smoking rates within the country will remain high.”
The per capita consumption of tobacco is expected to increase 19 percent to 23.3 billion cigarettes smoked a year by 2022, fueled by low-cost domestic brands and younger people taking up the habit, according to O’Connor.
Cigarette brands have names like Ggulbol (honey bee), Dungdae (lighthouse) and Pungnyon (fruitful year) in the country. Some North Koreans like to smoke foreign brands to show off their status, Cockerell said, such as Mild Sevens, the Japanese cigarettes now known as “Mevius.” Kim smokes the domestic ’727’ brand, he added.
It is hard to estimate the size of the tobacco industry relative to the economy, O’Connor said in an e-mail, as it remains one of the world’s most secretive societies. The country’s economy expanded 1.1 percent in 2013 to about $30 billion, South Korea’s Bank of Korea said in June, putting it on a par with Bolivia.
Smoking is allowed almost everywhere, though not near the statues of the Kims that dot the country, as it would be disrespectful to have cigarette butts around those, according to Koryo’s Cockerell.
Global “no-smoking day” campaigns are announced on the news, though more common are reports of Kim Jong Un’s tours and visits where he’s holding a cigarette in his hand, he said.
The impact of that in the psyche of the smoker’s mind isn’t clear. In a country of 24 million people, “no way are they just listening to one person, that’s a myth,” Smith added.
Mackay says sometimes people express shock when she tells them she’s helping North Korea, citing its record of human rights abuses. The campaigner is undeterred.
“I’ll work in any country which has smokers,” she said. “I say to them: ‘if you feel that the North Korean people are suffering, do you want them to suffer even more?’”
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