It seems that Kim Jong-il’s health, perhaps North Korea’s most closely guarded secret, is on everyone’s minds these days. Rumors of Kim’s ailments are growing in their level of seriousness, from the stroke that he evidently suffered in August 2008, to diabetes, heart disease, heart failure, and most recently, pancreatic cancer along with reports that he has chronic renal failure which has placed the 67-year old on dialysis. While it is difficult to prove which, if any, of these may be accurate, one thing is certain: the issue of leadership succession is now a significant concern both inside and outside North Korea.

North Korea has never acknowledged Kim’s stroke and questions to North Korean officials about his health are routinely rejected. His health is not discussed inside the country, but a team of doctors from France acknowledged last year they were called in by North Korea to treat Kim after his stroke. Since the beginning of the year, the Dear leader has kept up a busy schedule of visits around the country touring factories, farms and military bases in what is seen as a desperate attempt to convey a sense of normalcy. Recent photographs and television images of him show him limping and frail. It is Mr. Kim’s loss of weight, in particular, that has elevated speculation about the severity and nature of what is wrong. In his latest public appearance on July 8 at a memorial for his father, Mr. Kim looked thinner and appeared to have less hair than before. His mouth also looked lopsided and there were other indications of paralysis on the left side of his body.

To outsiders, impending change in North Korea has been most visible in an accelerated pace of weapons tests, including a long-range missile fired on April 5 and a nuclear device exploded on May 25. North Korea has also reduced diplomatic contacts and activities, launched a massive propaganda campaign to rally citizens to the government's side and clamped down on public markets and other economic activities that threaten citizens' reliance on and devotion to the state. On July 15, U.S. Assistant Secretary of Defense for Global Strategic Affairs, Michael Nacht stated that Kim is sick, and his youngest son and heir apparent may be in an unstable position to take the helm. Therefore, he said that the U.S. Defense Department is developing a scenario in preparation for a future North Korea without Kim Jong-il.