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141 Introduction 1. ­Under the current system, all Japa­nese citizens receive medical insurance through one of several sources, depending on their employment situation. The most basic medical insurance covers 70 ­ percent of medical and phar­ ma­ ceu­ ti­ cal costs, leaving a patient burden of 30 ­percent. The patient burden for ­those who receive health insurance from large corporate entities is often lower, around 20 ­percent. Meanwhile, health care costs are controlled by a point system set by the government; each visit, procedure, product, and prescription medicine is assigned a point value. 2. ­ There are many ways to mea­ sure the relative efficiency of a health care system, but the most basic is to simply compare percentage of gross domestic product (GDP) spent on health care to mea­ sures of population health. Japan spends approximately 8 ­percent of its GDP on health care and enjoys some of the best scores for population health in the world (OECD 2006). According to OECD data, the United States spends twice as much as Japan on health care as a percentage of its GDP, but its infant mortality rate remains twice that of Japan. More dramatic social stratification, stratified health care access, and lifestyle ­factors in the United States prob­ably contribute to this difference. Nonetheless, the ­ wholesale creation of an inexpensive, accessible, top-­ notch health care system may be one of the most impressive and enduring successes of postwar Japan. 3. For an En­glish language report, see “Japan, Seeking Trim Waists, Mea­sures Millions ,” New York Times, June 13, 2008, http:​/­​/­www​.­nytimes​.­com​/­2008​/­06​/­13​/­world​/­asia​ /­13fat​.­html. 4. See article above. 5. The 2012 Nobel Prize was awarded jointly to John Gurdon and Shinya Yamanaka. 6. To protect respondents’ privacy, the name of the town has been changed. Chapter One 1. Some of the most horrific crimes against humanity sponsored by the war­time government involved pseudomedical ­ human experimentation. The infamous Unit 731 and associated units infected, assaulted, and vivisected thousands of men, ­ women, and ­ children to observe the progression of a variety of infectious diseases and traumatic injuries, including bubonic plague, smallpox, cholera, loss of limb, starvation, severe burns, and lethal exposure to radiation through x-­ rays. This large-­ scale lethal­ human experimentation was supposed to provide an empirical basis for Japan’s biological warfare program, estimates for the lethality of weapons such as grenades at vari­ous ranges, and a better understanding of ­battle injuries. The ubiquity of grotesque Notes 142 Notes to Chapter Two for the sake of grotesque, such as experiments where limbs ­were amputated and reattached to other parts or sides of the body, betrays the orgy of vio­ lence against colonial bodies (mostly Chinese) that drove the enterprise. 2. Japan’s recent per capita phar­ma­ceu­ti­cal expenditure is above the OECD average, but significantly lower than the United States (OECD 2011). This is largely ­because Japan has been much more successful than the United States at reducing expenditures through price controls. 3. Comparative data on health consultations in OECD countries is available at http:​/­​/­​ stats​.­oecd​.­org​/­. 4. Japanese primetime tele­ vi­ sion, famous for its wacky quiz shows, has even featured some medical quiz shows. In a recent iteration, medical interns from famous medical schools compete Jeopardy-­style to identify a mystery disease based on a short vignette.Theiranswersareevaluatedbyaprofessorandse­niorphysiciananddiscussed by the requisite panel of minor tele­vi­sion celebrities. 5. In Kleinman’s original formulation, explanatory models are highly personal stories about how and why illness affects a par­tic­u­lar person. I use the term “explanatory model” more broadly than many researchers do, ­because I assume that all ­people have explanatory models for illnesses with which they have any familiarity, even ­those with which they do not have personal or professional experience. Explanatory models are stories about why type 2 diabetes affects a par­tic­u­lar person, but the explanatory model itself can be articulated by anyone—­ friends, ­ family, health care providers, acquaintances , and even total strangers can have explanatory models about illness that are not their own. Chapter Two 1. In one impor­tant exception, Rock (2003) examines the construction of type 2 diabetes as a major public health prob­ lem in Canadian public policy. Rock (2005) analyzesthepre ­sen­ta­tionoftype2diabetesintwoCanadiannewspapersandtwoAmerican magazines, and is used throughout this discussion. 2. This possibility is raised in a recent and already influential popu­lar book, Diabetes Rising: How a Rare Disease Became a Modern Pandemic...


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