美援對台灣的衛生計畫與醫療體制之形塑

1950至1960年代冷戰格局下的中華民國政府，既缺乏統籌全局的中央衛生單位，也沒有全面的「衛生政策」。美援在這段期間內不但是台灣軍事安定與經濟發展的重要支柱，其所挹注的資金、技術與設備對台灣社會的重整與轉型亦貢獻良多。美援相關單位所提出改善醫療衛生環境的對策，其重點與特色為何？這些對策與作為對當時台灣社會的「重建」或「復舊」發揮了什麼功能？與日治時期所重視的衛生治國策略有什麼異同？美式醫療衛生理念與架構又對台灣社會產生哪些影響？有別於以往研究從個案或專題出發、由下往上看的視野，本文從美援會的檔案出發，正本溯源地追究美援在戰後台灣衛生策略的擬定、推動與執行過程中所扮演的角色，1950與1960年代衛生計畫的形塑與轉向，是此期醫療衛生體制改造與組織建置的關鍵所在。從衛生計畫優先次序的爭議，及從計畫擬定到機構建置轉型的過程，本文進一步追究衛生組織與政策在國家建構過程中之關係與意義；著眼於醫療體制之改善和環境衛生之推動，本文最終探討美式公共衛生理念對台灣醫療衛生的變革。

關鍵字

國際合作總署；世界衛生組織；美援會；農復會；台灣省衛生處；台大醫學院；國防醫學院；環境衛生

並列摘要

Departing from the conventional research on U.S. aid to Taiwan, which focuses on its relationship to Taiwan's economic growth, this study explores the influence and continuity of U.S. aid from the perspective of the medical system and public health. Since the Taiwan government had provided for neither a national health policy nor a central health organization in the Cold War period of the 1950s and l960s, American guidance and recommendations played a vital role in shaping the long-term health planning of Taiwan. The Ten Year Health Plan of the 1960s, proposed by the Provincial Department of Health and suggested by the representative of the World Health Organization, had been shaped by the U.S. Aid Health Program of 1950s. What were the priorities and characteristics of these programs? How did American ideas on public health reintegrate the social order of Taiwan? Why did the new priorities differ from the powerful health policy of the previous Japanese rule, which emphasized tropical disease control? Based on the archives of the Council for United States Aid (CUSA), this study examines the arguments between Taiwanese health officers and American advisors and their differences concerning health planning in the 1950s and 1960s. Focusing on hospital reconstruction, medical education, and environmental sanitation, it traces how American ideas on public health changed medical practice in Taiwan.