From Colonial Medicine to International Health in East Asia

Michael Shiyung Liu Institute of Taiwan, Academia Sinica
Abstract: This essay examines in depth the history of colonial medicine in East Asia and its transition to an international health initiative. Pre–World War II activities by the League of Nations Health Organization helped bypass Westphalian principles in East Asia and established an Eastern Bureau in Singapore along with an Advisory Council from the colonial states. The Far Eastern Association of Tropical Medicine, established in 1908, cooperated with the League of Nations Health Organization and created a new framework to integrate colonial governments and national sovereignty around public health concerns. The Rockefeller Foundation’s hookworm eradication program became a focal point for many other East Asian medical programs and helped to link East and West health concerns prior to World War II. Finally, the influence of the Cold War in East Asia and the decline of aid from the Rockefeller Foundation and other nonprofit organizations incited a tremendous amount of aid to the region, based on the economic and political self-interest of the United States. With respect to the history of the changing international health system in East Asia, a contrast between the formal colonialism of the pre–World War II era and a new, invisible form of colonialism in the postwar era can be seen. However, postcolonial discourses may offer enlightening ways to interpret this transformative period in which American criteria of health came to dominate international health in East Asia.

East Asia is an important example in revealing the controversy regarding the transition from the mechanism of colonial medicine to international health, even global health. The idea of a transnational project of public health did not originate in the post–World War II period with the World Health Organization (WHO). As early as the 1930s, years before the establishment of WHO in 1948, the mission to promote international health and instantly report epidemic cases in East Asia had been long developed. However, most contemporary researchers merely paid attention to the development of international health diplomacy and organizations in the Western Hemisphere. Despite the term globalization having only been introduced recently into analyses of world affairs, most definitions of global health actually are rooted in the history of international cooperation of quarantine and public health in the West. The history of international health is, in fact, a process of increasing interconnectedness between societies and growing awareness that events in one part of the world have health effects on Western peoples and countries far away.

The history of international health is, in fact, a process of increasing interconnectedness between societies and growing awareness that events in one part of the world have health effects on Western peoples and countries far away.

The public health risks that acquired international attention, especially in the East, including East Asia, were significantly associated with the colonizer’s health or colonial competition in the past. National sovereignty was not a major issue in East Asia prior to the 1960s. The trend of international cooperation in public health and quarantining in pre–World War II East Asia laid a foundation for modern international health to try out Western ideas in East Asia, a very different circumstance sociopolitically. Also, international health, due to a global fear of diseases compared to colonial medicine in pre-World War II East Asia, brought about a new framework for the United States to harvest former efforts and keep the "old wine in a new bottle,” the WHO Regional Office for the Western Pacific (WPRO). The concept of international health in early Cold War East Asia, compared to colonial medicine in the region prior to the Second World War, brought about a new outlook while the image of colonialism was still being preserved.

Colonial Medicine in East Asia before 1945

During the 1920s and 1930s, the policy practice of colonial medicine gradually shifted from "enclavist" approaches (serving colonial regimes and armies) to "public health" approaches (emphasizing prevention and treatment of contagions facing all societies)1 in East Asia. However, the inequalities that remained between colonial societies and sovereign states, such as Japan and China, brought obstacles to information exchange and health promotion. The competition between colonial powers and sovereign states also added to the tensions and interconnections between colonial medicine and the practice of international health, which played an essential role in shaping the governance of the colonies and sovereign states in the region. While focusing on the cases of Japan, China, and the United States in the Philippines, the following argument reveals that public health in these societies was a trans-East Asian enterprise in the 1930s. The grand ambitions of three major players in the region to promote international health in East Asia were not integrated at the beginning and each carried different missions. However, common ground did exist in East Asia for mutual infusion in the 1930s.

League of Nations Health Organization (LNHO)

The League of Nations Health Organization (LNHO) was intended to be a global organization. The Westphalian principle,2 however, not only weakened its capability but also brought about obstacles to East Asia, a region that had only two sovereign states—China and Japan. To avoid epidemics spreading from the East to the West, proposals had been made by the LNHO to improve the epidemic control systems in the Far East, and particularly to institute an epidemic intelligence system in that area. The Eastern Bureau of the LNHO was settled in Singapore in 1925. An Advisory Council from the countries in the area was created for the Bureau and was financed partly by the Health Organization’s funds, partly by a grant from the Rockefeller Foundation, and partly by voluntary contributions from the countries in the area. In 1927, an agreement was approved between the Paris Office and the LNHO whereby the Bureau became a Regional Bureau of the Paris Office (Goodman 1952, 128–129). The Bureau was unique in LNHO’s infrastructure and acted like a subcenter of the LNHO in East Asia.

The concept of international health in early Cold War East Asia, compared to colonial medicine in the region prior to the Second World War, brought about a new outlook while the image of colonialism was still being preserved.

The Bureau in Singapore first led the Japanese member of the Health Committee to renew the proposals (ibid., 128). Japan continued to finance the Bureau until 1939, six years after that country had decided to withdraw from the League’s political agencies (ibid., 19). The Japanese occupation of Singapore compelled the Bureau to close in January 1942, but it was reopened by the Southeast Asia Command after the war and was transferred into the Interim Commission of WHO in 1947 (World Health Organization 1958, 69).

In 1937, under the guidance of the Advisory Council, the Bureau further concerned itself with other matters of disease prevention in the area and became a general hub for medical and health information, including research. It carried out preliminary and follow-up work for the Conference of Far Eastern Countries on Rural Hygiene at Bandoeng in 1937 (Brown and Fee 2008), including the coordination of public health surveys in rural areas and research on nutrition in seven national nutrition research institutes.

Rural hygiene was the main mission that the LNHO had already been conducting in China. In 1929, the LNHO helped to reorganize the Chinese quarantine service and had also helped to establish the public health service under a plan for technical collaboration. By 1937, some 500 public health institutions had been set up until Japanese aggression against China disrupted these efforts in 1937 (Goodman 1952, 126). All the missions to China were authorized by Ludwik Rajchman, the medical director of the LNHO from late 1921. With support from the Rockefeller Foundation, he strove to achieve an international "esprit de corps" among public health professionals of various nations by arranging extensive study trips ("interchanges") to exemplary public health projects and training sites (Brown and Fee 2014). Rajchman was particularly concerned with the Far East and in 1925 pushed for the creation of an "Eastern Bureau" in Singapore as an epidemiological transmission station (Manderson 1995). By 1928, China’s Ministry of Health formed an international advisory council of three, with Rajchman as an invited member (Borowy 2009). Rajchman himself was deeply involved with the "China Program," and in 1933 his passion for China was so intense that he agreed to go on leave as director of the LNHO so that he could serve as a "technical agent" to coordinate all League of Nations assistance to China while being paid by the Chinese government (Brown and Fee 2014, 1639). However, Japanese protests over the League’s assistance to China forced Rajchman back to his position as head of the LNHO.

The Far Eastern Association of Tropical Medicine (FEATM)

Colonies were common in East Asia in the pre-World War II period. These areas obviously wanted to bypass the Westphalian system for maintaining international cooperation regarding health promotion. The establishment of the Far Eastern Association of Tropical Medicine (FEATM) at Manila in 1908 could have been an answer.

Victor Heiser, the director of public health of the Philippine General-Governor Government between 1905 and 1915, proposed the idea of organizing a nongovernmental agency to promote the exchange of epidemic information, preventive designs, and essential medical knowledge in the Far East (Hoops and Scharff 1924). According to the objectives of the Association, FEATM meant to serve as a scientific platform for medical professionals in the region, especially for those from each colony.

In the period when FEATM was in existence (1908–1938), nine meetings were held. Most of the locations were in colonies, with two exceptions: Japan in 1925 and China in 1934. The 1923 FEATM Singapore meeting marked the cooperation between FEATM and LNHO. The coordination between these two essential organizations began with Norman F. White’s trip to East Asia in 1922–1923 (White 1922). His report showed that quarantine procedures in that area were still being conducted along old individualistic lines and that the international system for epidemic intelligence was rudimentary (White 1923). Singapore is a nodal point in the trade routes of East Asia to the world. White recommended the establishment of a central epidemic intelligence bureau in Singapore. Moreover, White’s report also encouraged conversion of the LNHO’s global quest to FEATM’s regional governance agenda.

White’s original mission from the LNHO regarding the Far East was the investigation of the main ports of the region. However, soon after his arrival, White discovered the importance of interactions in regard to epidemic prevention among Asian colonies. In his report, White encouraged the establishment of a regional epidemiological intelligence center, later the Bureau in Singapore, for the exchange of epidemic information and for standardization of quarantine procedures. Realizing the potential of FEATM in avoiding the obstacle of the Westphalian principle in this region, he also promoted the use of its secretariat as an advisory body for the proposed regional center (White 1924a). In 1924, the LNHO passed an amendment to establish cooperation with FEATM’s inter-imperial/colonial practices, including the Bureau in Singapore, aligning its advisory body and operations with FEATM’s (White 1924b). With White’s report and Rajchman’s support, the activities of the LNHO and FEATM merged in 1925.

While LNHO maintained its conventional role of working with the two sovereign states in the region, FEATM consolidated medical professionals and quarantine officials in the colonies. In 1925, in the Proceedings of the Tokyo meeting, its preface stated that FEATM encouraged medical professionals to be concerned about the international welfare of all human beings while positively attending to and collaborating with the empires regarding medical progress (The Far Eastern Association of Tropical Medicine 1926, x). The word international, judging from the operational pattern of FEATM, was obviously non-Westphalian in scope. In FEATM, medical experts from colonial governments and representatives from the Imperial countries could discuss the issues as equals (Hoops and Scharff 1924). More importantly, a new framework was established, beyond the Westphalian principles, to integrate colonial governments and national sovereignty in East Asia.

Rockefeller Foundation

The Rockefeller Foundation was established in 1913 and aimed to "promote the well-being of mankind throughout the world" (The Rockefeller Foundation Annual Report 1913–14). Before its establishment, the Rockefeller family already had launched a program in 1909 that met that claim—the Sanitary Commission for the Eradication of Hookworm. Anti-hookworm efforts later expanded to other parts of the world. Virtually all of the International Health Board (IHB, later renamed the International Health Division, IHD) staff began their careers at the Rockefeller Foundation in hookworm projects—John Grant in Puerto Rico and Santo Domingo, Lewis Hackett in Central America and Brazil, Victor Heiser in Ceylon, India, and Australia, and Wilbur Sawyer in Australia ("The Work of the Rockefeller Foundation" 1921). Among these, John Grant in China and Victor Heiser in the Philippines eventually became key persons to promote the Rockefeller Foundation’s medical philanthropism in East Asia. As Victor Heiser’s FEATM played an essential role in the Rockefeller Foundation’s contribution to health in East Asia, John Grant was devoted to modernizing public health in the region and introduced Ludwik Rajchman to China.

The Rockefeller Foundation was established in 1913 and aimed to "promote the well-being of mankind throughout the world" …China was the major target for the Foundation’s medical philanthropism and promotion of international health.

China was the major target for the Foundation’s medical philanthropism and promotion of international health. One month after the Foundation was established, the China Medical Board (CMB) was immediately placed under the International Health Board to oversee programs in China and soon became the center to finance various health projects in East Asia (Reinsch to Buttrick December 1, 1915; Heald and Kaplan 1977, 6).

Besides John Grant’s essential role in the CMB and his generous contribution in modernizing Chinese public health,3 Heiser was equally essential while he was the director of health in the Philippines (1905–1914) in promoting and transforming FEATM to a platform for exchanging colonial medical information in East Asia. Moreover, Heiser later became the director for the East of the Foundation’s International Health Board in 1915 and was able to exert more impact via the Foundation’s financial support and FEATM’s technical assistance to various health projects in the region. By using FEATM as a platform for regional medical professionals, he promoted sanitary projects in the Philippines and surrounding counties and colonies through the Foundation’s donations of money and people (Yaeger to Heiser July 3, 1929). Heiser had "formed the opinion that better health progress might be made by enlisting the services of women (trained under American standards), than to depend upon the current type of sanitary infrastructure and health officer of the past." He believed that if public health were left under the control of local governments, the American project would surely have collapsed. He stated that "no group in [the] Far East… does effective work as we planned and reach[es] our expectation. . . . " (Heiser to Munson August 21, 1923). Heiser was convinced that public health work in East Asia required the contributions of American ideas, promotion, and monetary donations.

Like FEATM, the LNHO required support from the Rockefeller Foundation, not only for their work in East Asia, but for their work in the West from the very outset. Meanwhile, epidemics were potential threats to Europe and to the Americas. The United States obviously could not overlook these dangers and had to prevent potential crises. Therefore the Advisory Council of the Bureau in Singapore was cofinanced by the LNHO and the Rockefeller Foundation, with additional local contributions from the area (League of Nations 1938). By the outbreak of World War II, the Foundation was already supporting LNHO’s work to East Asia. And by doing so, American ideas regarding international health were introduced to the region through individual Foundation internal health projects.

The [Rockefeller] Foundation’s project to improve rural health was ambitious and designed to demonstrate American ideas of a modern public health infrastructure.

To coordinate with the IHD, which Heiser headed, LNHO eventually adopted the Foundation’s models "dissolved [to LNHO’s Far Eastern projects] during implementation [of American funding]" (Gillespie 1995). By 1930, for example, Selskar Gunn4 urged the Foundation to engage in the "full needs of the community rather than an isolated need such as public health" (Gunn [October 28–30, 1930] 1984), per a request to support Rajchman’s rural health project. At the time, besides goals such as "rural uplift"or "rural welfare"circulating among FEATM members, the Rockefeller Foundation’s multidisciplinary China Program (1935) departed from its preset goals. Medical aid agencies backed by the Foundation in New York remained content with backing efforts that were "60% efficient rather than Western ones that were 100%" (Grant [1922] 1980, 141). Attention was drawn to fragile experiments of the sort designed by the Mass Education Movement at its demonstration center in Tinghsien (Ding-xian), Hopei (Hebei) Province. An instant hit, as Gunn noted, this "village self-government organization sparked unequaled enthusiasm, for talented Chinese students and foreign experts" (Gunn 1931, 85; Thomson 1969, 128). The Foundation’s project to improve rural health was ambitious and designed to demonstrate American ideas of a modern public health infrastructure.

Generally speaking, in pre–World War II East Asia, LNHO, FETM, and IHD simultaneously played roles in promoting "international" health there. As the LNHO brought the international framework to link East and West health needs, FETM created an unofficial network to bypass the limitations of the Westphalian system, while the Foundation poured funding and medical ideas into the region.

The Dawn of International Health during the Cold War in East Asia

World War II almost destroyed the framework established by the three above organizations. Only American support was able to survive during the wartime period (Liu 2014). In the second half of 1940s, the Western powers emerged from the World War II with a renewed determination to retain most, if not all, of their colonial possessions. The proposal to establish a new organization of international health, later the World Health Organization, by China and Brazil in 1947 did not come out of thin air. The works of LNHO, FEATM, and the Rockefeller Foundation during the pre-World War I years had left some legacies. The influence of colonial medicine, however, would not fade away without a fight.

The United Kingdom, a major colonial power in pre-World War II East Asia, first warned that "it is impossible to expect the countries well developed technically to be overruled by the vote of nations less developed from a public health and medical point of view." It strongly opposed direct colonial representation to establish the WHO. In addition, American attitudes toward the WHO were indecisive, as they were in the 1930s regarding the establishment of the LNHO. The challenge came from the United States and other primarily noncolonial supporters of a postwar liberalization of trade. According to the new approach to international public health associated with the American architects of WHO, international quarantine, with its restriction on movement of people and commerce, had to be supplanted by vertically driven disease eradication programs that only minimally constrained by respect for national boundaries or sovereignty (Gillespie 2008, 127). Similar principles had frequently been mentioned in various FEATM meetings and in regard to Foundation programs in East Asia. Political reality soon tempered the lofty ideal of building the WHO, which struggled to adapt their policies to fit the agendas of suspicious recipient nations and the new models of political and economic development that gave little regard to the claims of public health (Amrith 2004). This ambiguous and uneven climate could have implications for our understanding of the formation of international health in the foundation years of the WHO. The colonial powers, like the UK, initially saw multilateral agencies as part of a broader threat to their sovereignty. At the same time, through the United Nations, they faced new scrutiny of their fulfilment of their promises to broaden social development in their colonial possessions, development that no one could afford to finance by themselves (Solomon, Murard, and Zylberman 2008, 125). In the case of the UK, the biggest colonial power in the Far East, the Colonial Development Act of 1940 brought with it a rhetoric of "junior partnership"and "welfare imperialism" (Cooper 2010, 204–05; Hayinden and Meredith 1993, 206–35). Moreover, the Colonial Development and Welfare Act of 1940 had pledged the UK to a vast increase in health and welfare expenditures; by the end of the war, these costs were eating up almost one-fifth of colonial budgets, an expense that the declining Britain Empire could not afford. The Foreign Office thus warned that if the UK failed to get United Nations Relief and Rehabilitation Administration (UNRRA) funds for Burma and Hong Kong, whereas China was lavishly funded, the colonial power would forfeit its moral claim to continued authority (Gillespie 2008, 127). The former strongest colonial power had obviously lost its control to a new diplomatic and economic infrastructure under America’s influence. Compared to the rapid recovery of the framework of international health in the Western hemisphere post–World War II, however, the civil war in China and other military conflicts slowed down the expansion of WHO’s work in the West Pacific.

Compared to the rapid recovery of the framework of international health in the Western hemisphere post–World War II, however, the civil war in China and other military conflicts slowed down the expansion of WHO’s work in the West Pacific.

Furthermore, American concerns regarding free trade and military security created major differences in the U.S. approach to promoting international health between the pre– and post–World War II eras. These concerns were caused by economic benefits to the United States in rebuilding the international order in the post–World War II era. As early as 1946, James A. Crabtree, Deputy Surgeon General of the U.S. Public Health Service, had promoted the idea of building a new organization for international public health (Williams 1951, 487), a mission that had been carried out by the LNHO before the war and that had goals similar to those proposed by many American civilian organizations such as Johns Hopkins University, the Rockefeller Foundation, and the American Medical Association. To resume the achievements of American medicine in pre–World War II East Asia, the reconstruction of international health campaigns, first in China and later in other East Asian areas, was necessary.

To continue the medical philanthropism that had existed prior to World War II, U.S. civilian organizations, including Johns Hopkins University, the Rockefeller Foundation, and the American Medicine Association, provided charitable resources in taking steps toward the early formation of a new international organization (World Health Organization 1958, 38–40). The involvement of American civilian medical resources toward public health reconstruction in East Asia was initially benevolent. The situation in East Asia quickly deteriorated, however, and communist alliances seemed irresistible between 1945 and 1950. The United States was losing its confidence in Nationalist China, making former enemy Japan important in rebuilding U.S. influence in East Asia. The year 1951 was a turning point in creating an international health framework in East Asia. For example, 1951 saw the outbreak of war on the Korean peninsula, the withdrawal of General Headquarters from Tokyo, and, most importantly, the establishment of the WHO Regional Office for the Western Pacific (WPRO) in Manila, the Philippines. In 1948, China had proposed hosting the WPRO to the First World Health Assembly but had been rejected. The proposal in 1950 to place the WPRO in Manila was made by the temporary office in Hong Kong, headed by I. C. Fang, and approved by the Third World Health Assembly. The World Health Organization Executive Board formalized the selection process on June 1, 1951 when the Philippine government and the WHO signed a Host Agreement for the establishment of the Regional Office in Manila. On August 15, 1951, the Regional Office was transferred from Hong Kong to Manila and was initially housed at the Bureau of Quarantine, Port Area, Intramuros,5 the same location where Victor Heiser had built the first port quarantine station in the Philippines ("Philippine Islands" 1912). The process of locating the WPRO coincidentally highlighted the interwar connection between the LNHO, FEATM, and the Rockefeller Foundation.

The Korean War pushed the United States to alliances with former enemy Japan and old friend Taiwan. The Mutual Security Act (MSA) was the legal foundation of American aid to East Asia in 1951 and the Mutual Security Agency made grants to numerous East Asian countries. To carry out the mission of the Act, agencies like the Mutual Security Agency were created under the principle that strengthening America’s allies through military assistance and economic recovery would be beneficial to America’s long-term security (Morgner 1967). However, the continuity from pre–World War II to postwar contexts should not be exaggerated. Due to the tension in East Asia, the expansion of state-governed international institutions alongside America’s emergence as a global superpower transformed state foundation relationships in profound ways (Anheir and Hammack 2010, 222). This shift was evident following the creation in 1948 of the WHO, in 1950 of the National Science Foundation, and in 1951 of the National Institutes of Health. All three organizations were chartered to take on roles in research, field building, and infrastructural development in which the Rockefeller Foundation had earlier been a prominent player. In 1951, only three years after the creation of the WHO, the Foundation shut down its prestigious IHD.6 The major source of private charity in medical aid to East Asia in the 1920s and 1930s totally transferred their power to the state from the 1950s onward. Over time, and increasingly in the period after World War II, as U.S. foreign policy and international development expanded, states came to impinge even more profoundly on the international work of U.S. foundations, including those working in international health (Hess 2005). This shift of authority and influence away from private foundations was reinforced by developments outside the United States: decolonization, the growing authority of "new states" in East Asia previously under European control (Anheier and Hammack 2010, 215), and the increasing prominence of state-led international institutions. Under the new framework of WHO in the 1950s, the Foundation’s role in supporting global malaria eradication was part of America’s exercises in international health diplomacy. WHO during the 1950s was mainly subsidized by the United States; the major international health programs were thus designed and implemented for the politics of anticommunism.

Reviewing the history of the changing international health system in East Asia identifies a gap between the end of formal colonialism (1945) and an invisible form of colonialism.

It is worth noting that, unlike the transformation of the Foundation’s policy in its implementation of the China Program in the 1930s, the economy was the vital factor for the United States to support its allies in Cold War East Asia. United States Representative John M. Vorys once asserted that military aid to "nations who will fight on our side" is "sound economy" ("Mutual Security Act of 1951" 1952). Richard Betts points out that, despite the U.S. choice to aid East Asia, the aid could not be lumped under the dichotomy of two dominant outlooks: realism and liberalism. Both were meant to transform allies in East Asia to meet American values and to integrate into the U.S. Cold War security network. Within the liberal school, one main variant emphasized the American economy and values such as free markets and trade, the division of labor according to comparative advantages, and maximization of material gain (Betts Winter, 1993–1994). Under the shadow of invasions by communists, in addition to American benefits, East Asian states sought to enhance their economic positions in preparation for war, and mercantilism actually went hand in hand with that goal (Stubbs 1999).

To secure military logistics to Korea, in 1951 the U.S. Foreign Operations Administration (FOA) reviewed medical and public health conditions in the region.7 The report later served as the basis for the U.S. AID Health Program to East Asia, aimed at maintaining economic stability and military power among East Asian allies (Yang 2008). It also is worth noting that during the early Cold War period, WHO’s work in the region was commonly covered by the Program of Technical Assistance for Economic Development. The program again showed American concern for its economy behind its promotion of international health. The DDT-spraying program is a good case to show the real agenda of the Program of Technical Assistance for Economic Development when the WHO and WPRO were greatly under American influence.8 How did these developments affect international health in East Asia? During his trip to Asia in 1953, political observer James Reston reported: "America’s contribution to the safety and sanity of Asia, however, goes well beyond the products of her factories. . . . In Korea, Japan and Formosa (Taiwan), dependence on America is so great as to be almost pathetic. I had long talks with Syngman Rhee, Premier Yoshida of Japan and Chiang Kai-shek. Each in his own way had criticisms to make of American policy and all were asking more" (Reston 1953). Reston’s description expresses the general U.S. domestic feeling about American medical aid to East Asia.

Concluding Remarks

The problem we face now is how to understand the global configuration of power and international health framework that was created during the Cold War in East Asia which was both similar to and different from the historical Imperial-colonial paradigm.

Reviewing the history of the changing international health system in East Asia identifies a gap between the end of formal colonialism (1945) and an invisible form of colonialism. The problem we face now is how to understand the global configuration of power and international health framework that was created during the Cold War in East Asia which was both similar to and different from the historical Imperial-colonial paradigm. In 2007, Ann Laura Stoler, Carole McGranahan, and Peter Perdue (Stoler et al. 2007, 1–42) asked "how could one study European and non-European forms of empire in the same analytical frame?" In a similar vein, their question calls for a more nuanced understanding of colonialism without colonies, adding another dimension in thinking about imperialism and colonialism. In addition, in treating Taiwan as a not yet decolonized/deimperialized state, the concept of "sub-imperialism" as articulated by Kuan-Hsing Chen and others defines sub-imperialism as a new form of imperialism under the American economic superpower and states that "stratified construction of global capitalism is neocolonial imperialism" (Chen and Wang 2000). The features of old colonization are succeeded by subimperialism or neocolonial imperialism via political and economic dominance. This preliminary study attempts to provoke discussion about the nature of international health initiatives in 1950s East Asia, what constitutes an international relationship in global health, and whether we can consider transnational medical projects in the post-World War II period as an American version of colonial medicine. While not explicitly colonial, the relationship between the United States and East Asian countries during the Cold War was nonetheless more nuanced than their official status as allies would suggest. Prasenjit Duara contends that empire without colonialism is the "new imperialism" of the twentieth century. He states "the new imperialists espoused anticolonial ideologies and emphasized cultural or ideological similarities; they made considerable economic investments, even while exploiting these regions, and attended to the modernization of institutions and identities" (Duara 2006). In the same vein, the transformation of medical paradigms in the 1950s could imply a new form of American "colonial medicine" in Cold War East Asia. During the past decades, new discourses of decolonialism or postcolonialism arose. These arguments have demonstrated a definite effort to turn away from the old school of colonialism and focus more on social and cultural questions. The latest theory may bring us a ray of light to interpret vital issues during the transformation from Japanese colonial medicine to American criteria of international health in postwar East Asia.


  1. I have borrowed this concept of transformation from Peckham and Pomfret (2013).
  2. The Westphalian system before the 1950s asserted that states ought to be the primary institutional agents in an interstate system of relations. As European influence spread across the globe, the Westphalian principle, especially the concept of sovereign states, became central in bringing about respect for one another’s territorial integrity of colonies (Osiander 2001).
  3. For a brief description of John Grant’s work in China, see to Bu and Fee (2008).
  4. Selskar Gunn was Vice President of the Rockefeller Foundation and promoter of the rural reconstruction project in northern China between 1935 and 1937. For his career, refer to Litsios (2005).
  5. WPRO Web site:; accessed Dec 28, 2016.
  6. After World War II, Dwight Macdonald wrote, the government increased its research budget from $90 million to $2.1 billion. "Some $150,000,000 of the total goes to universities for government-sponsored projects; trivial though this sum is in comparison to what the government is spending directly, it is more than all the foundations combined contribute to university research. The Department of Commerce now undertakes the national-debt surveys that were initiated by Edward A. Filene’s Twentieth Century Fund as well as much of the statistical work on national income that was originally done by the Rockefeller-financed National Bureau of Economic Research; the General Education Board’s farm and home programs have long since become part of the Department of Agriculture’s extension services; and the Point Four program dispatches American experts and techniques to backward countries on a scale that no foundation can begin to match" (Macdonald 1956, 48).
  7. "Zhinaizhengbu Taiwan shengzhengfuhangao (Draft letter from CUSA to the Ministry of Internal Affairs and Taiwan Provincial Government)." September 16, 1954, CIECD36-11-003-001, Institute of Modern History of Academia Sinica.
  8. For the case of Taiwan, refer to "Annexes to the Plan of Operations for Malaria Eradication in China (Taiwan)," Document 2025, 69, Taiwan Provincial Malaria Research Institute (TAMRI).


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