Hidemi Todoriki, Ph.D. Faculty of Medicine, University of the Ryukyus Okinawa, Japan

1. Evaluation of Public Health Postwar Rehabilitation PolicyA lesson from the United States experience in postwar Okinawa Hidemi Todoriki, Ph.D. Faculty of Medicine, University of the Ryukyus Okinawa, Japan

2. Learning 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.

3. Background • 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

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

5. GHQ/SCAP/PHWOkinawa Database • 7,320 documents • 1,917 cases

6. Data on Okinawan people infected with malaria GHQ/Okinawa Database Findings in Okinawa Creation of new healthcare policies in U.S. Example of Methodology

7. Significance and Applications of GHQ Okinawa Database • 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

8. 1945 1946 1947 1948 1949 1950 1951 1952 1953 Annual Transition in Amount of Documentation Environmental Hygiene Measure against infections Nourishment Social welfare Veterinary science Medical affairs Medical materials Year

9. Policy 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

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

11. 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

12. Future Aims 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

13. Additional Areas to Investigate • 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)