Welfare for Elites: The Student Health Center at Tokyo Imperial University and the Paradox of Medicare in Japanese Meritocracy

Abstract

How did the Japanese establish a medical welfare system? In answering this question, historians of modern Japan have accentuated the assertive role of state bureaucrats, especially from those of the Home Ministry (naimusho). Historians of Japanese medicine also emphasized the role of the state. William Johnston, in his pioneering work on tuberculosis in Japan, explored the rise of a hygiene administration on this disease as a state enterprise. In the medical history of Japan, scholars highlighted the significance of the wartime period in the birth of this system. The emphasis on the Japanese wartime state is justified. The Japanese government managed to establish a national health insurance in 1935, while the United States government has not been able to establish a medical insurance for every citizen to this day. However, these scholars have not explored how welfare benefits were distributed to members of Japanese society. This article seeks to fill this historiographical gap by looking at the Student Health Center of Tokyo Imperial University (Todai), Japan's first state-established university founded in 1886. This university, I contend, was a critical locus in the birth of medical welfare in Japan. At this university were the most privileged medical facilities and practitioners who could provide medical services, as well as students without stable incomes of their own, thus in need of welfare support. The demand of staff of Todai's Student Association to establish a Student Health Center was accepted and realized in 1926, and Todai students became the beneficiaries of state-managed medical support. The Todai Student Health Center was different from other medicare facilities in that its role was not limited to save students from poverty. Student Health Center practitioners helped students check health for university admission, campus life, and job placement to be white-collar elites. Student Health Center practitioners evaluated students' health when they tried to enter Todai and get jobs and inculcated students in how to manage living as mental-worker "gentlemen," in coping with tuberculosis, venereal diseases, and neurotic breakdown. Also, they produced statistics about the health condition of Todai students, which immediately stimulated further investment in the facilities of Todai authorities for the center. Based on statistical data, Todai authorities developed a hygiene campaign against tuberculosis so that students could take advantage the of state-of-the-art treatments inexpensively. As such, Todai students became among the biggest beneficiaries of this process. In other words, the Student Health Center had a dual significance at Todai: a medicare institution as well as part of privileged campus culture. Todai was a symbolic locus that reveals the uneven diffusion of medical welfare benefits in Japanese society. Through the lens of this facility, this article seeks to explore the paradox of welfare in meritocracy that contributed to the formation of the elite class in modern Japan.