Infrastructure-building for Public Health : The World Health Organization and Tuberculosis Control in South Korea, 1945-1963

Abstract

This paper examines WHO's involvement in South Korea within the context of the changing organization of public health infrastructure in Korea during the years spanning from the end of the Japanese occupation, through the periods of American military occupation and the Korean War, and to the early years of the Park Chung Hee regime in the early 1960s, in order to demonstrate how tuberculosis came to be addressed as a public health problem. WHO launched several survey missions and relief efforts before and during the Korean War and subsequently became deeply involved in shaping government policy for public health through a number of technical assistance programs, including a program for tuberculosis control in the early 1960s. This paper argues that the principal concern for WHO was to start rebuilding the public health infrastructure beyond simply abolishing the remnants of colonial practices or showcasing the superiority of American practices vis-a-vis those practiced under a Communist rule. WHO consistently sought to address infrastructural problems by strengthening the government's role by linking the central and regional health units, and this was especially visible in its tuberculosis program, where it attempted to take back the responsibilities and functions previously assumed by voluntary organizations like the Korea National Tuberculosis Administration (KNTA). This interest in public health infrastructure was fueled by WHO's discovery of a cost-effective, drug-based, and community-oriented horizontal approach to tuberculosis control, with a hope that these practices would replace the traditional, costly, disease-specific, and seclusion-oriented vertical approach that relied on sanatoria. These policy imperatives were met with the unanticipated regime change from a civilian to a military government in 1961, which created an environment favorable for the expansion of the public health network. Technology and politics were intricately intertwined in the emergence of a new infrastructure for public health in Korea, as this case of tuberculosis control illustrates.