근대 동아시아 위생 개념의 확산과 공공의료 담론의 형성(†)

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.