Leadership Succession Recent Developments

On July 13, 2009, YTN television, a South Korean television station, reported that, based on information obtained by South Korean and Chinese Intelligence officials, Kim Jong Il had pancreatic cancer.

Kim Jong Il was publicly groomed for power over several decades by his father, Kim Il Sung, the country's first leader. Despite advancing years and questionable health, the younger Kim has never publicly named a successor.

Video cameras captured his image in his first public appearance in months, as he presided over the opening of a new parliamentary session Thursday. The 67-year-old leader is widely believed to have suffered a stroke in the middle of last year. He appeared to be limping slightly in his left leg, which some have suggested might be paralyzed. He seemed to be able to move both arms freely and clapped stretching both arms up in the air. Mr. Kim's drawn and feeble image on camera was a notable departure from his pudgy appearance in previous years. Some observers suggested the wrinkles on his face looked deep for his age, perhaps as a result of a significant weight loss experienced in a short period of time. This may be the result of a special diet that he followed in his recovery from a cerebrovascular ailment in 2008. His left arm, reportedly paralyzed in 2008, appeared stiff and his left hand looked swollen. When applauding, he moved his right hand toward his left hand, which raised to chest level, remained still.

Paralysis is one of the most common disabilities resulting from stroke. The paralysis is usually on the side of the body opposite the side of the brain damaged by stroke, and may affect the face, an arm, a leg, or the entire side of the body. Some stroke patients have problems with swallowing, called dysphagia, due to damage to the part of the brain that controls the muscles for swallowing. Even though rehabilitation does not "cure" stroke in that it does not reverse brain damage, rehabilitation can substantially help people achieve the best possible long-term outcome. Rehabilitation helps stroke survivors relearn skills that are lost when part of the brain is damaged.

Data on the prevalence and indicators of weight loss in population-based groups of stroke survivors are scarce. Prospective, short-term studies in patients admitted for acute stroke have shown an increased risk of infections, bedsores, impaired functional outcome, slower rate of recovery, poorer rehabilitation potential and higher mortality in patients with a poor nutritional status. The incidence of dysphagia in patients with acute stroke ranges from 30 to 45%. Dysphagia increases the risk of developing poor nutritional status, and new cases of malnutrition develop during the hospital stay, even during the first week. Nutritional therapy includes enriched meals, sip-feedings or enteral feedings.

People with diabetes have a higher risk of stroke, but they can also work to reduce their risk. These include weight loss and regular physical activity. Healthy weight status in adults is usually assessed by using weight and height to compute a number called the "body mass index" (BMI). BMI is used because it relates to the amount of body fat for most people. An adult who has a BMI of 30 or higher is considered obese. Overweight is a BMI between 25 and 29.9. Normal weight is a BMI of 18 to 24.9. Proper diet and regular physical activity can help to maintain a healthy weight.

On 23 January 2009 Kim Jong-il met a senior Chinese official in Pyongyang in his first reported meeting with a foreign dignitary since a suspected stroke in August. General Secretary Kim Jong Il Friday met the visiting delegation of the International Liaison Department of the Central Committee of the Communist Party of China led by its Head Wang Jiarui. Present there were Kang Sok Ju, first vice-minister of Foreign Affairs, and Chinese Ambassador to the DPRK Liu Xiaoming. Wang had met Kim several times since the early 2000s. Wang is an authority on North Korea who has met with Kim whenever there has been a "major issue," including April 2004, when Kim visited China, and February 2005, when North Korea declared that it possessed nuclear capabilities. The moment was closely documented by state news photographers from both North Korea and China. The pictures included not just the ones taken by the North Korean state media, but also some by Chinese media. No video, however, was released either by North Korea or China. A close examination of the photos showed that Kim appeared to have lost weight, with his face worn and his left hand swollen. His well-known potbelly seemed to have diminished.

By 2010 it appeared that Kim Jong-il had become increasingly indecisive since his stroke and other health problems. A recent decision to recall students, scholars, and scientists working or studying in China was a result of a single student's defection in Beijing. Business and trade groups with interests in Northeast China pressured Kim Jong-il to reverse the decision, which he apparently did. Companies in Northeast China developed "positions needing to be filled" to enable those who left the country to get new visas. Not only did Kim Jong-il decide to reverse policies on his own, but officials also charted their own course as different factions competed for Kim's attention, making it difficult for Kim to set a firm, clear direction.