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现代东亚卫生观念的传播与公共卫生话语的构建。

The Spread of Hygiene Concepts and the Making of Public Health Discourse in Modern East Asia.

机构信息

Department of Medical Humanities & Institute for Women's History of Medicine, Korea University College of Medicine.

出版信息

Uisahak. 2022 Dec;31(3):613-646. doi: 10.13081/kjmh.2022.31.613.

Abstract

If public health can be defined as "all activities to ensure universal medical use of the people and protect and promote health," it can be said that public health emerged in the process of developing the concept of hygiene in East Asia. While traditional hygiene emphasized individual curing and longevity, modern hygiene was the state in charge of individual body and discipline. East Asian countries had to practice modern tasks in the field of hygiene and medical care in line with the construction of modern countries, and it was considered legitimate for modern countries to intervene in individual bodies. As the demand for modern national construction became stronger, interest in public health rather than personal hygiene increased. In East Asia, a new interpretation of the concept of hygiene began in Japan. Sensai Nagayo(1838-1902) newly defined the concept of 'sanitation' to justify the physical intervention of the modern state in Meiji period. The concept of 'public health' began to be used in earnest in 1890, when Ogai Mori(1862-1922) translated Western-style health protection measures for the public as public health. Since then, public health has evolved into a universal social discourse in Japan. Japan's public health expanded to colonial Joseon, Taiwan, and China. Japan's victory in the Sino-Japanese War led East Asian countries to believe that hygiene was the root of the Japanese nation's power. In the early 20th century, the government of the Republic of China began to imitate the case of Japan while promoting modern education reform and institutional reform. Japanese-style 'public health' was transplanted into various hygiene laws and sanitary equipment. In Korea, modern hygiene was introduced and spread from the end of the 19th century to the first half of the 20th century, and the concept of 'public health' in Japan was mainly spreading. Public health in Japan was vaguely defined as an activity to protect and promote the health of the people, but in practice, it was focused on improving quarantine and environmental infrastructure. In response, the concept of American-style public health, which values prevention and treatment at the same time, has already begun to emerge under the Japanese colonial rule. In East Asia in the 1920s and 1930s, Japanese-style public health and American-style public health discourse competed, and measures to solve medical inequality were discussed in earnest. Interestingly, in common in East Asian countries, Actual Medical Expenses Campaigns to improve medical access at low cost and social medicine to universally provide prevention and treatment to the people have drawn attention. This was also a phenomenon caused by intensifying medical inequality as rapid urbanization and industrialization progressed in East Asian countries in the first half of the 20th century. Although it was impossible to resolve social contradictions or move toward fundamental reform of the national medical system due to the nature of the private movement, the actual medical movement further imprinted the need for public health care in the country and society. Social medicine studied the effects and relationships of the social environment on diseases and health, and studied ways to promote public health by using preventive medicine and therapeutic medicine. If social medicine was supported by state power, it was possible to go forward with practice such as State Medicine like China, otherwise it would only be a civilian movement such as the People's Health Movement, as in colonial Korea. Liberation and the Korean War were a dramatic turning point in American-style health that led to Japanese-style hygiene. Immediately after Liberation, there was a discussion between the left and right camps over medical nationalization to enhance the publicity of medical care. The medical community was sympathetic to the nationalization of medical care, but due to the lack of medical personnel and financial resources, specific alternatives could not be proposed. As American-style health studies gradually expanded their influence after the Korean War, American-style public health, which emphasized prevention and treatment activities, became established, and efforts were made to establish a health center system.

摘要

如果公共卫生可以被定义为“确保全民普遍使用医学和保护与促进健康的所有活动”,那么可以说公共卫生是在东亚卫生概念发展过程中出现的。虽然传统卫生强调个体治疗和长寿,但现代卫生是国家负责个体身体和纪律的卫生。东亚国家必须根据现代国家的建设在卫生和医疗领域开展现代任务,现代国家干预个体身体被认为是合法的。随着对现代国家建设的需求变得更加强烈,人们对公共卫生而非个人卫生的兴趣增加。在东亚,卫生概念的新解释始于日本。长谷川清(1838-1902 年)重新定义了“卫生”的概念,为明治时期现代国家对个人身体的物理干预提供了正当理由。“公共卫生”的概念于 1890 年开始认真使用,当时大森贝吉(1862-1922 年)将西方公共卫生保护措施翻译为公共卫生。从那时起,公共卫生在日本演变成了一种普遍的社会话语。日本的公共卫生扩展到了殖民时期的朝鲜、台湾和中国。日本在中日战争中的胜利使东亚国家相信卫生是日本民族力量的根源。20 世纪初,中华民国政府在推行现代教育改革和制度改革的同时,开始效仿日本的案例。日本式“公共卫生”被移植到各种卫生法和卫生设备中。在韩国,现代卫生从 19 世纪末到 20 世纪上半叶开始传入和传播,日本的“公共卫生”概念主要在传播。日本的公共卫生被模糊地定义为保护和促进人民健康的活动,但在实践中,它侧重于改善检疫和环境基础设施。对此,同时重视预防和治疗的美国式公共卫生概念已经在日本的殖民统治下开始出现。20 世纪 20 年代和 30 年代的东亚,日本式公共卫生和美式公共卫生话语相互竞争,认真讨论了解决医疗不平等的措施。有趣的是,在东亚国家,以低成本改善医疗可及性的实际医疗运动和为人民提供普遍预防和治疗的社会医学引起了关注。这也是 20 世纪上半叶东亚国家快速城市化和工业化进程中医疗不平等加剧所导致的现象。尽管由于私人运动的性质,不可能解决社会矛盾或推动国家医疗体系的根本改革,但实际的医疗运动进一步在国家和社会中铭刻了对公共医疗保健的需求。社会医学研究社会环境对疾病和健康的影响和关系,并研究如何利用预防医学和治疗医学来促进公共卫生。如果社会医学得到国家权力的支持,就有可能进行像中国那样的国家医学实践,否则,就像在朝鲜的殖民地那样,只能进行平民运动,如人民健康运动。解放和朝鲜战争是美国式健康导致日本式卫生的戏剧性转折点。解放后不久,左派和右派之间就医疗国有化进行了讨论,以增强医疗保健的宣传。医学界对医疗国有化表示同情,但由于缺乏医务人员和资金,无法提出具体的替代方案。随着朝鲜战争后美国式健康研究的影响力逐渐扩大,强调预防和治疗活动的美国式公共卫生得到确立,并努力建立一个健康中心系统。

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