Cooperative Work and Public Health Nursing in Rural Wartime Japan
The American Association for the History of Nursing is so pleased to partner with Nursing Clio for this special series, which showcases some of the innovative and diverse work being done by historians of nursing across the world. The AAHN holds its annual meeting this week in Rochester, New York, and these essays are windows into the kind of questions and issues being explored at that meeting, by historians who use nurses as a lens through which to understand the intersection between gender, work, and health. Nursing history did not start with Florence Nightingale, nor is it at an end. As nurses continue to make up the largest health care workforce, practicing their art and science in a variety of settings, communities and political contexts, it is more important than ever that we look to where we have been to learn the lessons we need for the future of increasingly complex healthcare systems. Whenever I talk to students or fellow scholars about the significance of nursing history, especially at the moment, I emphasize the significant social role that nurses have played. Nurses have had to negotiate sexism and racism within society, and within their profession. They have been continually challenged by hierarchies of medicine, power, and authority as they attempted to provide care, as historian Susan Reverby has argued, in a society that does not value caring. And they have not always been angels of selfless good. Yet nursing continues to be the most trusted of all the professions, and that trust is something that has been, and continues to be, earned. These essays from the history of nursing demonstrate the complex ways in which nurses have striven to provide careful, compassionate, patient-centered care, and how they have always been agents of social change.
Dr Kylie M Smith
Andrew W Mellon Faculty Fellow for Nursing & the Humanities
Emory University, Atlanta Georgia.
Director and Chair of Communications
American Association for the History of Nursing
The emergence of rural social work in Japan during World War II influenced the development of public health nursing. This short essay introduces activities from the program of practical training in the public health nursing schools and the experiences of certified public health nurses. During World War Two, Japanese public health services were broadly focused on healthcare in public health centers, cooperatives, and municipal offices; home visits for infant development; prevention of the spread of infection; assistance with medical examination; and health counseling. The activities show the public health nurses’ contribution in connecting residents to these programs. As a result, the public health nursing system was extended over two areas: first, public health, and second, social welfare.
This essay is based on the results of interviews that took place between 2010 and 2013 with seven female retired public health nurses, now mostly aged around 90 years old. They were the first graduates from Matsue Public Health Nursing School and Hamada Public Health Nursing School, both in Shimane Prefecture in Western Japan. The two schools were established in October 1940 as the first authorized two-year courses in Japan. The training program of these schools consisted of half lectures and half practical training. In interviews, everybody spoke of their education highly. The women graduated in September 1942, and went on to work as nurses in cooperatives and health centers and village offices, or as school nurses.
The work of farmers was particularly heavy, yet people did not have much time for cooking and the nutritional quality of meals was generally poor. Farmers also played an important role in wartime, especially in human resources. Food production output increased, preventing poverty and providing food for the growing population. They made good use of local resources, local residents, professions, such as doctors and nutritionists, and used community centers, and so on. With many young and adult men absent during the war, the importance of the work of women and older men increased. The aim of the government was to ensure farmers had sufficient rest and nutrition to increase overall productivity in agricultural enterprises. New social welfare programs emerged as a solution to this situation, including the establishment of public health nursing.
There was a cooperative system for farming and agricultural work, or kyoudou Suiji in Japanese, and child daycare centers or Nouhanki Takujisho in Japanese. Nurses played an important role in these programs. These programs helped ease the problem of nutrition in rural areas. In rural areas during wartime, people were generally not well fed. Daily meals were not well balanced, often composed mainly of basic staples, and the intake of protein was particularly insufficient.
Community cooking lowered the individual burden and promoted more effective farming. Interviewee A stated: “In the rural areas back then, government promoted community cooking and child daycare centers during planting and harvesting seasons in June and November so that women could be used for hard labor. I worked in community cooking and child daycare centers each week. I thought that I wanted to do something to help the physical burden of the other women. Community cooking during planting and harvesting seasons was helpful for them.” Most of the women in the picture of providers of community cooking were students and teachers at Matsue Public Health Nursing School.
These programs also helped provide a variety of healthful food for the rural population. Interviewee A stated: “Food was scarce during the war. In the case of community cooking, people got additional cooking oils and sugars.” A traditional menu was prepared that was different from place to place in each respective area. A menu was proposed by a prefectural nutrition official and home economics teachers at elementary schools. To increase the intake of animal protein, the breeding of goats at every home and carp farming in rice fields was recommended.2 In another photo, students shred cutting cabbages. Interviewee B stated: “A Japanese food called ‘Tekkamiso’–fried soybean and burdock, carrot with sugar and miso–tasted very good.”
In the 1941 harvesting season, community cooking programs and child daycare centers were operating in almost all prefectures. Community cooking was carried out in 3,726 areas. The number of households participating was 70,246, with 24,193,731 total individual participants. Child daycare centers operated in 2,046 areas, with 43,200 households and 1,752,971 participants.3 These projects had financial backing from the Prefectural governments throughout Japan, which purchased food in bulk.
Interviewee B stated: “We–as public health nurses–couldn’t stay in one place in the village since community cooking and daycare was happening in different places. We worked with a nutritionist to maintain sanitary conditions. For example, we made sure that cooked food was not preserved for too long, and that everyone washed their hands before each meal.”
At child daycare centers in rural areas during wartime, older brothers and sisters were freed from looking after younger brothers and sisters so they could go to school.4 Protection of babies, infants, and pregnant mothers was just one part of the national policy in those days.5 Interviewee B stated: “I remember in the children’s daycare services, I made sure that children did not go to dangerous places such as the river, and I treated any injuries or skin diseases.”
From the point of view of social work, performing these tasks involving community cooking and child daycare centers were important for the promotion of health. To improve organizational productivity, the health point of view was needed in cooperative work and the call for, and public recognition of, public health nurses increased. In Japan in those days, there was no clear separation between social work and public health in rural areas, as there were insufficient facilities for health. Public health nursing was concerned with the improvement of conditions of diet and lifestyle. Public health nurses’ concern with the locals revolved around the idea that a healthy lifestyle depended on daily choices and practices. This led to the improvement of the condition of the rural population’s health.
- Sangyou Kumiai Chuo-kai, Nouhanki niokeru eiyoushoku kyoudousuiji oyobi kyoudoutakujisho no hirakikata. (Tokyo: Sangyou Kumiai Chuo-kai, 1941): 211. Return to text.
- Watanabe Yoshio, “The Mission of the Public Health Center and the Future (Hokenjo no shimei to sono shourai) Kouseijigyoukenkyu 31, no. 7 (1943): 4-5. Return to text.
- Sangyou Kumiai Chuo-kai, The Co-operative Year-book 1942 (Sangyou kumiai nenkan 1942) (Tokyo: Sangyou Kumiai Chuo-kai, 1942): 248. Return to text.
- Matsuda Sumiko, “A Study of Seasonal Nursery in Yamagata (Yamagata kennai no nouhantakujisho nitsuite)” Bulletin of Yonezawa Women’s Junior College, 40 (2005): 48. Return to text.
- Nishigaki Mihoko. “How Agrarian Social Work Grasps the Meanings and Problems of Child Protection and Child Social Work in Rural Communities [Nousonshakaijigyouron ga toraeru nouson niokeru jidouhogo・jidoushakaijigyou no igi to kadai]” The Bukkyo University Graduate School review compiled by the Graduate School of Social Welfare, 37 (2009): 99. Return to text.
- Sangyou Kumiai Chuo-kai, Shitei chouson niokeru nouhanki eiyoushokukyoudousuiji narabini kyoudoutakujisho jireichousa (Tokyo: Sangyou Kumiai Chuo-kai, 1942): 14-15. Return to text.
Yuko Kawakami is a lecturer of Gerontological studies at Kameda College of Health Sciences in Chiba, Japan. She received her Ph.D. in Human Developmental Sciences from Ochanomizu University in 2011. Her subsequent research, published in Japanese, has focused on public health nursing and administration during the Second World War period in Japan, including "Formation and Evolution of the Public Health Nursing in Prewar and Wartime Japan" (2013).