nuclear weapons

How China can help avoid nuclear ‘fire and fury’ in North Korea

The most viable non-military solution to the standoff with North Korea is to get China to apply pressure. But that's not so easy.

US President Donald Trump and North Korean leader Kim Jong-Un are playing a dangerous game of brinkmanship.

North Korea got the world’s attention – and Trump’s – when it successfully launched an intercontinental ballistic missile for the first time on July 4. In response, the United Nations approved new economic sanctions against North Korea which, predictably, inspired a bellicose response from the rogue regime.

Trump threatened that further provocations will be met with “fire and fury and frankly power, the likes of which this world has never seen before.”

In response, North Korea issued a threat of its own – missile strikes on the US territory of Guam.

With tensions escalating, it is important to be realistic about how we can get out of this mess.

In short, any non-military solution will rely on China choosing to apply its massive economic leverage over the North Korean regime. This is a point that Trump clearly recognises. In July, he tweeted that Chinese trade with North Korea “rose 40% in the first quarter,” highlighting China’s reluctance to punish North Korea for its pursuit of nuclear weapons.

While the poor quality of the data hinders a detailed analysis, Trump’s overall sentiment is correct. China has increased its trade with North Korea in recent years and done little to forestall North Korea’s nuclear ambitions besides backing the most recent round of UN sanctions. China’s foremost objective seems to be promoting greater stability from its volatile neighbor.

Yet a quick look at the data, however murky, shows just how much leverage China has, if it wishes to use it.

North Korea’s primary patron

In general, exports from one country to another can be mostly explained by the distance between them and the sizes of their markets, a pattern that holds for China and North Korea.

Geographically, they share a long border, which makes China a natural, though not inevitable, partner for trade. As a case in point, North Korea also shares a long border with South Korea, but these countries have almost no trade between them. In addition, North Korea shares a small border with Russia, with whom it has little, though ever-increasing, trade, as I discuss below.

China’s large market, proximity and – most importantly – willingness to trade with North Korea has led to a situation in which North Korea has become highly dependent on trade with what has become its primary patron. About half of North Korean exports and imports go directly to and from China and most of the rest of its trade is handled indirectly by Chinese middlemen.

North Korea’s dependence on its neighbour has grown hand-in-hand with China’s increasing economic dominance of East Asia, which gained momentum 15 years ago when China joined the World Trade Organisation. Since then, both Chinese gross domestic product as well as its annual trade with North Korea have increased nearly tenfold, to around $11 trillion and $6 billion, respectively.

North Korea imports nearly everything from China, from rubber tires to refined petroleum to pears, with no single category dominating. Meanwhile, coal constitutes about 40% of North Korean exports to China, followed by “non-knit men’s coats.”

Time to use that leverage?

However, recent events – such as the use of front companies by Chinese firms to evade sanctions imposed on North Korea and China’s reluctance to cut off energy supplies to the country – have led to some uncertainty about the extent to which China is willing to use this economic leverage to rein in North Korea’s military ambitions.

On one hand, China claims that coal imports from North Korea have recently been stopped as part of an effort to punish the regime for recent missile tests and the suspected assassination of Kim Jong-nam, the estranged half-brother of North Korean leader Kim Jong Un. If true, this would be an important signal of China’s willingness to support US concerns about the missile program as it would represent a loss of about a third ($930 million) of North Korea’s import revenue.

However, there is evidence that coal shipments in fact never ceased. And, in any case, China may have dramatically increased its imports of iron ore from North Korea to offset the lost coal revenues.

This is consistent with the idea that China carefully considers the resources and revenue that are available to the North Korean regime at any moment and uses trade as a lever to control them. In this way, China walks a fine line between providing too many resources, and thus allowing the regime to prosper, and not enough resources, such that North Korea is in danger of collapsing. Ultimately, trade may be used as a lever to do some light scolding, but China’s overwhelming concern is preventing North Korea’s collapse.

Further evidence that China has tight control over the North Korean economy comes from a recent report from C4ADS. The research group found close, and often common, ownership ties between most of the major Chinese companies who do business with North Korea. This suggests that trade with North Korea is highly centralised and thus easily controlled.

Trucks cross Friendship Bridge from China’s Dandong, Liaoning province, to North Korea’s Sinuiju. Reuters/Thomas Peter
Trucks cross Friendship Bridge from China’s Dandong, Liaoning province, to North Korea’s Sinuiju. Reuters/Thomas Peter

Russia: North Korea’s other ‘friend’

China is not the only country that North Korea trades with, though the others currently pale in comparison. Other top export destinations include India ($97.8 million), Pakistan ($43.1 million) and Burkina Faso ($32.8 million). In terms of imports, India ($108 million), Russia ($78.3 million) and Thailand ($73.8 million) currently sell the most to North Korea.

Russia in particular may soon complicate US efforts to isolate the regime. While still small, Russian trade with North Korea increased 73% over the first two months of 2017 compared with the same period of the previous year.

But whereas China is legitimately worried that an economic crisis in North Korea could lead to a flood of refugees or all-out war, Russia likely sees engagement with North Korea in much simpler terms, namely as an additional way to gain geopolitical advantage relative to the US.

A way out?

Nearly all experts agree that there is no easy way to “solve” the North Korea problem. However, one plausible approach is to encourage South Korea and Japan to begin to develop nuclear weapons programmes of their own and to only discontinue these programmes if China takes meaningful steps to use its trade with North Korea to reign in the regime.

Threatening to introduce new nuclear powers to the world is clearly risky, however stable and peaceful South Korea and Japan currently are. But China is highly averse to having these economic and political rivals acquire nuclear capabilities, as it would threaten China’s ongoing pursuit of regional control. In short, this is a sensitive pressure point that could be used to sway the Chinese leadership.

One way or another, China must become convinced that the costs of propping up the North Korean regime through trade are higher than the costs of an increased probability that the regime will collapse.

Greg Wright, Assistant Professor of Economics, University of California, Merced.

This article first appeared on The Conversation.

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.