Evaluation of Public Health Postwar Reconstruction Policy in Postwar Okinawa based on GHQ/USCAR Document Database-Focused on the Nutrition/Food Policy-

【导言】日本公共卫生政策评估的问题包括以下几点：1)单纯核实过去的公共卫生政策决定是不够的。2)目前没有有效的评价流程。3)政策决定对公共卫生有重大影响。为了解决上述问题，本研究从战后冲绳重建政策的角度，从盟军总司令部/最高司令部（GHQ/SCAP）和美国琉球群岛民政管理局（USCAR）的角度，将一个综合的冲绳文件数据库整合在一起，并审查了在现代背景下使用它的可能性。GHQ冲绳数据库的意义和应用可以从以下几个方面来考虑。1)有能力识别和分析随着时间的推移政策决策的变化，2)数值数据支持分析的有效性，3)有能力比较和对比美国在冲绳和m…日本内陆的政策决定，4)经验教训可以应用于伊拉克，阿富汗和非洲地区的战后重建工作。我们的研究目的集中在战后美国冲绳营养政策的决策过程，必须建立一个全面的数据库，以便对公共卫生决策实践进行系统的评估和分析。[目的]GHQ/SCAP/PHW冲绳相关档案中有关营养/食品领域政策决定的文件在审查以下问题时很有用。(1)是否有可能根据主食（红薯- b>（面粉）- b>大米）的转变所伴随的食物消费结构和能量摄入的变化来确定文件和政策决策与营养转型之间的关系？能否从政策的各个方面揭示主食转型的背景？(2)与(1)相关，是否有可能确定能源需求、学校午餐和营养调查等政策决策过程的各个方面？(3)是否有可能将政策决策的影响与健康测量和作为营养摄入结果的身体测量（身高、体重、BMI等）之间的关系联系起来？(4)是否可以用食物供应、分配和摄入的数字数据来解释上述(3)项的关系？(5)是否可以考虑在政策制定过程中利用剩余的许多类型的文件，如统计参考文献、研究报告和笔记？(6)是否可以从不同文化接触的角度来考虑不同饮食文化地区的方法（如食物支持）？(7)在为以水稻为主要文化的东亚和东南亚国家在粮食支持和营养领域提供国际支持的理想模式作出决策时，是否有可能将其作为基本参考？提出上述问题是为了通过营养/食品领域的方法揭示政策决定的过程。本报告概述了PHW的营养/食品相关文件。[方法]利用冲绳版GHQ/SCAP/PHW文件光盘数据库，从营养/食品相关类目的标题和相关人员列表中搜索相关文件，然后在其他类目中选择有营养人员或相关项目的文件。对所选文件进行了基本总结，并将重要文件由英文翻译成日文。【结果与讨论】共选取62份文献。档案分为7个小类别，包括“营养/食物统计”、“营养/食物研究（包括人体测量数据）”、“能量/营养需求”、“食物分配/支援”、“学校午餐”、“营养师教育”及“其他”。不计“其他”，“食物分配/支援（27%）”、“营养研究（21%）”及“学校午餐（13%）”共占61%。关于各类别时间序列过渡的大纲，假设1945年考虑“营养研究”并进行“（紧急）食物支援”，1947年初步计算“能量/营养需求”，1949年进行“营养调查”，其格式与1945年在东京进行的调查几乎相同，然后同时实施“学校午餐”和“（计划）食物支援”。1.最终确定能量摄入的决策顺序流程为：（统计参考分析）->（调查设计定义）->（调查实施）->（调查分析）->（基于调查确定能量摄入）。2.冲绳的营养政策直到1949年才真正实施。3.PHW的食物分配政策的理由是根据调查结果，每个营养类型（年龄/班级）所需的能量。4.根据1949年对约500名居民进行的称重法营养调查的结果，在较短的时间内（约2个月）确定了粮食分配计划。5. 从PHW文件的注释来看，统计专家制定的计划显然得到了实施。6.虽然在PHW档案中几乎不明显，但冲绳方面的保健/医疗工作者以及从大陆派遣的专家的贡献是不容忽视的。C.F.Sams （GHQ/PHW主任）在1947年的报告中宣布了冲绳公共卫生方案中最重要的项目。在报告中，萨姆斯将“营养”列为第二优先事项，并警告说，有必要制定一个总体计划，提供足够的膳食，并进行营养研究，以收集基本数据（备忘录）。Sams cf . 1947年6月19日)。未来有必要根据目标设定的顺序和影响的实际情况，以及各组织和个人的想法，从数量和质量两个方面对数据收集->实施->结果->评价的各个过程进行分析，以披露PHW对营养/食品政策的规划过程。[结论]1)冲绳可以作为一个案例研究，以协助当前和未来的战后重建工作。2)公共政策可以根据冲绳模式的优缺点进行调整。3)可以为战后国家的公共卫生政策制定一个综合模型。少

[Introduction]Problems of policy assessment in the public health of Japan include the following points : 1)Simply verifying past public health policy decisions is insufficient. 2)Currently there is no effective evaluation process. 3)Policy decisions have a significant impact on public health. In an attempt to address the above concerns, this research put together an integrated Okinawan document database from General Head Quarter/Supreme Command Allied Power(GHQ/SCAP) and United States Civil Administration of the Ryukyu Islands(USCAR) from the viewpoint of the reconstruction policy in postwar Okinawa and examined the potential to use it in modern contexts. The significance and applications of the GHQ Okinawa database can be thought about in the following ways. : 1)There is ability to identify and analyze changes in policy decision making over time, 2)The numerical data support the validity of the analysis, 3)There is ability to compare and contrast U.S. policy decisions in Okinawa and m … More ainland Japan, 4)Lessons can be applied to postwar rehabilitation efforts in Iraq, Afghanistan, and regions of Africa. Our research purpose was focused on the decision process of the policy making of the nutrition policy in postwar Okinawa by the US, a comprehensive database must be created to enable systematic evaluation and analysis of public health decision making practices.[Purpose]Documents related to policy decisions in the nutrition/food area in the Okinawa-related files of GHQ/SCAP/PHW are useful when reviewing the following questions. (1)Is it possible to determine the relationships between documents and policy decisions with the nutrition transition based on the changes in food consumption structure and energy intake accompanied by the transitions in staple foods (sweet potato -> (flour) -> rice)? And is it possible to disclose the background to the transitions in staple foods in various aspects of the policy? (2)Related to (1), is it possible to determine the aspects of the processes of policy decisions such as energy requirement, school lunches and nutrition surveys? (3)Is it possible to relate the effects of policy decisions to the relationships between health measurements and physical measurements (height, weight, BMI, etc.) as outcomes of nutrition intake? (4)Is it possible to interpret these relations (in (3)above) using the numerical data on food supply, distribution and intake? (5)Is it possible to consider the policy making process taking advantage of the many types of files remaining, such as statistical references, research reports and notes? (6)Is it possible to consider the approaches to regions with different food cultures (such as food support) from the perspective of contact between different cultures? (7) Is it possible to use it as a basic reference when making decisions for an ideal model of international support in the area of food support and nutrition to countries in East Asia and South East Asia having mainly a rice culture? The above issues have been raised to disclose the process of policy decisions through an approach from the nutrition/food area. This report outlines the nutrition/food-related files of PHW.[Method]Using the CD-ROM database of the Okinawa version of the GHQ/SCAP/PHW files, a search was conducted for relevant files from the lists of titles and people concerned in the nutrition/food-related category, and then files were selected in the other categories in which nutrition personnel or relevant items were found. The selected files were basically summarized, and the important files translated from English into Japanese.[Results and Discussion]Sixty-two files were selected. The files were organized into 7 sub-categories consisting of "Nutrition/Food Statistics", "Nutrition/Food Research (including anthropometric data)", "Energy/Nutrition Requirement", "Food Distribution/Support", "School Lunch", "Nutritionist Education" and "Others". Excluding "Others" the total of "Food Distribution/Support(27%)", "Nutrition Research (21%)" and "School Lunch(13%)" accounted for 61 %. Regarding the outline of the time serial transition per category, it has been assumed that "Nutrition Research" was considered and "(Emergency) Food Support" was conducted in 1945, the "Energy/Nutrition Requirement" was tentatively calculated in 1947, the "Nutrition Survey" was conducted in 1949 in almost the same format as the one conducted in Tokyo in 1945 and then, "School Lunch" and "(Planned) Food Support" were simultaneously implemented. 1.The flow of the decision order to finalize the energy intake is : (Analysis of Statistical Reference) -> (Definition of Survey Design) -> (Implementation of Survey) -> (Analysis of Survey) -> (Finalization of Energy Intake Based on Survey). 2.The nutrition policy in Okinawa wasn't really implemented until 1949. 3.PHW's reason for the food distribution policy was the required energy as per nutrition type (age/class) based on the survey result. 4.Based on the result of the nutrition survey through the Weighing Method conducted on approximately 500 residents in 1949, the food distribution plan was finalized in a relatively short period of time (about 2 months). 5. From the notes in the PHW files, it is assumed that plans made by specialists in statistics were apparently implemented. 6.Although it is barely apparent in the PHW files, the contribution of the health/medical workers on the Okinawa side, as well as that of the specialists sent from the mainland, cannot be ignored. C.F.Sams (Director of GHQ/PHW) announced the most important items of the public health program in Okinawa in the report in 1947. In the report, Sams gave the second priority to "nutrition" and warned that it was necessary to make a general plan to provide adequate meals, and to conduct nutrition research for collecting basic data (Memorandum for the record. Sams CF.19 June 1947). In the future, it will be necessary to analyze each process of data collection -> implementation -> result -> evaluation in the aspects of quantity and quality based on the actual situation of the order and influence of target-setting and ideas of each organization and individual to disclose the planning process of the nutrition/food policy by PHW.[Conclusions]1)Okinawa can be used as a case study to assist in current and future post-war reconstruction efforts. 2)Public policy can be adjusted according to strengths and weaknesses of the Okinawa model. 3)A comprehensive model can be developed for public health policy in post war countries. Less