Evaluation of Public Health Evaluation of Public Health Postwar Rehabilitation PolicyPostwar Rehabilitation Policy

A lesson from the United States experience in postwar Okinawa

Hidemi Todoriki, Ph.D.Hidemi Todoriki, Ph.D.

Faculty of Medicine, University of the RyukyusFaculty of Medicine, University of the Ryukyus

Okinawa, JapanOkinawa, Japan

Learning from OkinawaLearning from Okinawa Learning from the United States

experience in Okinawa can help to promote the success of current efforts in Iraq

By Alexander Cooley and Kimberly Zisk Marten at Barnard College, Columbia University. The New York Times July 30, 2003.

Policy decisions have a significant impact on public health

Life expectancy in Okinawa is the longest in the world

Simply verifying past public health policy decisions is insufficient

Currently there is no effective evaluation process

BackgroundBackground

Implications & ObjectiveImplications & Objective

“A comprehensive database must be created to enable systematic evaluation and analysis of public health decision making practices”

7,320 documents 1,917 cases

GHQ/SCAP/PHWGHQ/SCAP/PHWOkinawa DatabaseOkinawa Database

Example of MethodologyExample of Methodology

Data on Okinawan people infected with malData on Okinawan people infected with malariaaria

GHQ/Okinawa DatabaseGHQ/Okinawa Database

Findings Findings in Okinawain Okinawa

Creation of new Creation of new healthcare policies healthcare policies in U.S.in U.S.

Ability to identify and analyze changes in policy decision making over time

Numerical data support validity of analysis

Ability to compare and contrast U.S. policy decisions in Okinawa and mainland Japan

Lessons can be applied to postwar rehabilitation efforts in Iraq, Afghanistan, and regions of Africa

Significance and Applications of Significance and Applications of GHQ Okinawa DatabaseGHQ Okinawa Database

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1946

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1953

Environmental Hygiene

Nourishment

Measure against infections

Social welfare

Veterinary science

Medical affairs

Medical materials

Year

Annual Transition in Annual Transition in Amount of DocumentationAmount of Documentation

Policy AssessmentPolicy Assessment

Transition of policy development Policy assessment of malaria

measures Political decisions regarding dietary

energy allowances for inhabitants of post-war countries

Weight of schoolchildren in post-war countries and analysis of nutritional transition as a result of food supply policy

Analysis of extent to which fundamental policy of 50 years ago applies today

Identification and evaluation of best common practices in past and present

Comparison with other public health programs today (e.g. MSF: Medecins Sans Frontieres ,Doctors Without Borders)

Does the U.S. previous postwar Does the U.S. previous postwar rehabilitation policy apply today?rehabilitation policy apply today?

Applications of Okinawa Model

Okinawa can be used as a case study to assist in current and future post-war rehabilitation efforts

Public policy can be adjusted according to strengths and weaknesses of the Okinawa model

Educational tools can be developed based on the Okinawa study

A comprehensive model can be developed for public health policy in post war countries

Broad Objective: Adjustment of United States Public

Health Policy

Current Undertakings: Evaluation of health care policy for

Hansen's disease Policy assessment of food nourishment

measures Political decisions regarding dietary energy

allowances for inhabitants of post-war countries Weight of schoolchildren in post-war countries and

analysis of nutritional transition as a result of food supply policy

Future Aims

Military Public Health Military Policy Decision Making (Public

Health) Personal history of Army surgeon in GHQ Personal affairs of Army surgeon in GHQ Future applications to North Korea (rice

staple as a common link with Okinawa, Japan)

Additional Areas to Investigate