Über die Autorin bzw. den Autor

Carl Mosk is Professor of Economics at the University of Victoria.

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Making Health Work: Human Growth in Modern Japan

University of California Press

"There were giants in the earth in those days," says Genesis, drawing a powerful analogy between secular diminution in physique and degradation in moral fiber.1 Linking dramatic change in quality to decisive changes in physique as it does, the quotation is an apt starting point for this work. My two key thesesthat improvements in net nutritional intake mainly attributable to a diminution in the demands placed upon it caused by a shift out of labor-intensive work and a decline in the frequency and duration of infection due to more effective medical and public health intervention led to the improvement in population quality interpreted in terms of enhanced capability and work capacity; and that in addition to supply factors like technology, demand factors working both through the market and through entitlements were crucial to this secular trendare theses about a striking secular change that has rendered Japan's young adult population potentially more productive on a per capita basis and physically taller and heavier than its forbears. Exaggerating somewhat for the sake of emphasis we can say that in quality terms, Japan's population today, in comparison to her population in the past, consists of giants.

Just as the quote from Genesis argues by way of analogy and metaphor, so does the account offered here. But while analogy is important in this work, so is the marshaling and interpretation of historical evidence. In this study I scrutinize a considerable body of evidence, in an eclectic manner. My account is eclectic because it combines both

qualitative and quantitative data and because insofar as it has a quantitative focus it draws on a wide variety of techniques to process and present that datafor instance, regression analysis conventionally employed by economists and cross-classification of data favored by sociologists and anthropologistsin weaving an account that I hope will be comprehensible to historians as well as specialists in various social sciences. That I have adopted an eclectic approach reflects not only my own predilections in analytical matters (in particular, my belief that it is through an interaction of inductive and deductive techniques that progress is secured) but also my desire to communicate my findings to scholars in a wide range of disciplines. I believe this is important because the secular improvement in population quality in Japan was a broad social process going beyond the mere operation of markets as they evolve in response to changes in technology. Institutions at the local and national levels governing the distribution of entitlements over foodstuffs and health-enhancing public health and medical services and the demand for these institutions as voiced through political and social protest play a very important role in my account.

Of the analogies and metaphors central to this volume, the most important are those involving the definition and measurement of population quality and nutritional intake net of the demands placed on it. The remainder of this chapter briefly discusses these key metaphors and some of the thorniest conceptual issues surrounding them and clears the way for more detailed treatment in terms of the historical data for Japan that I analyze in the remainder of this book. I begin with the concept of population quality.

Population Quality and the Standard of Living

By the average quality of a population, I mean the average potential capability and potential work capacity of its members. Capability and work capacity are to be understood in both physical and mental terms. Whether a population of a given average capacity or capability chooses to exercise and develop the potential it has depends on the attitudes toward and the incentives that individuals face concerning the development of these capabilities. From a theoretical viewpoint my concept of average population quality is quite close to the notion put forward by A. Sen et al. (1987) concerning the proper definition of the standard of living. The similarity of my view is briefly discussed in the remainder of

this section. From a practical empirical viewpoint, I choose to use anthropometric measures concerning height, weight, and chest girth for children and young adults at various key ages. That these measures serve as useful proxies for potential capabilities and work capacity is a matter that, to the best of my knowledge, is not discussed by Sen. Discussion of the usefulness of employing these measures as proxies is taken up below.2

Why should we focus on population quality as defined in terms of capabilities and work capacity? There are two lines of reasoning that lead us to this conclusion. The first is the potential feedback of labor productivity on future productivity. That there is a relationship between the productivity of the past and the productivity of the present arises from a variety of potential linkages. For instance, short-run linkages run through the level of nutritional intake or a sense of well-being to work capacity or the eagerness to work in the present period or in the immediate future. Or again this process may take place over several generations. The better fed and the healthier women are in any given period, the more likely they are to give birth to offspring with adequate birth weights and the more nutritious their breast milk is if they elect to breast feed their infants. That feedback appears to have been empirically important in the Japanese case is crucial to the argument I develop in Part II of this book concerning the motivation for and role of population quality-enhancing behavior on the part of households and non-household organizations like enterprises and governments.

The second reason to start with a definition centered on capabilities and work capacity is because it leads to a linkage between the measurement of population quality proposed in this volume and the measurement of the standard of living as proposed by Sen (1987). In my opinion Sen's definition has much to offer when it is contrasted with the more conventional definitions used by economists. For instance, Sen (1987:7 ff.) forcibly argues that the standard subjectivist utilitarian view runs into the objection not only that utility in and of itself cannot be directly measured but that definitions employing it fall short of what most people believe on logical grounds is the standard of living. Thus if we interpret utility in terms of pleasure and happiness, we must address the question of whether persons who are very poor and exploited in material terms may not, by dint of being socially conditioned into lacking ambition and material aspirations, find happiness in their poverty equal to or greater than that experienced by a wealthy individual who commands many more resources in consumption. Again if we think of

utility as defined in terms of the satisfaction of desire, we encounter the same objection raised immediately above that the downtrodden may find their desires so stifled through progressive disappointments that they abandon these desires one by one, retaining only a few modest ones that they are sure of fulfilling. Despite the fact that such...