Cancer in East Asia, Health in Taiwan

A petting zoo near my house has an ostrich. Must be tough on the kids.

Pfizer has a very interesting report on Cancer in Asia which a friend of mine flipped me.

This report presents cancer statistics for fifteen South Asian and Southeast Asian countries: Japan, Taiwan, Singapore, South Korea, Malaysia, Thailand, China, Philippines, Sri Lanka, Vietnam, Indonesia, Mongolia, India, Laos, and Cambodia. For purposes of comparison, statistics are also presented for the United States.

Among its findings:

• Among the 15 Asian countries the highest incidence rates (age-standardized) for total cancer (all sites) in males are in Taiwan, Korea, and Japan; female total cancer incidence rates are highest in Taiwan, Singapore, and Philippines.
• Lung cancer is the most common or second-most common cancer among males in all Asian countries but for India, Japan, Mongolia, and Taiwan.
• Stomach cancer is the highest incident-rate cancer among both males and females in Korea; it is the most common among females in China, and the most common among males in Japan.
• Among females, breast cancer is the highest incident cancer in 7 countries— Indonesia, Japan, Malaysia, Philippines, Singapore, Sri Lanka, and Taiwan.
• 41% of all new cancers diagnosed in males, and 37% of cancers diagnosed in females are in the fifteen Asian countries—about 3 times as many cases as that in the United States.

The data are taken from a 2005 report for Taiwan, and are probably out of date.

A couple of friends of mine have also raised the problem of arsenic and other toxins in the air Taiwan. Groundwater arsenic is a well-recognized problem and there are numerous studies of it, including of the famous blackfoot disease in southern Taiwan. Groundwater arsenic is not caused by the IT industry and thus is safe to investigate. But there seems to be little on arsenic and other airborne toxin exposure from power plants and factories. It's long been recognized that the dominance of the IT industry (and here and here) means that the government has looked the other way when those industries pollute downwind and downstream. This is true of all industries. Paul Jobin's piece entitled Hazards and Protests in the "Green Silicon Island" in 2010 notes:

Between 1988 and 1991, along with their opposition to the construction of the fourth nuclear plant, environmental activists and intellectuals joined in solidarity with the Dawu aboriginal people to protest the storage of nuclear wastes in Lanyu (Orchid Island). (16) Around the same time, the magazine Renjian reported on the sudden deaths of temporary workers employed in the maintenance of the existing three nuclear plants.(17) Ten years later, the situation has not improved: despite Taipower’s denial, most workers, though exposed to high levels of radiation, did not have the appropriate regular health checks. (18) An epidemiological survey found that the population living between the two nuclear plants near Jinshan, 20 kilometres north of Taipei, had elevated blood cell counts that could induce hazardous consequences for health. (19) Another survey near the research reactor of the Institute of Nuclear Energy Research based in Taoyuan, south of Taipei, revealed abnormal levels of Cesium 137, a highly radioactive isotope. (20) Around 1992, the fear of nuclear power became even more palpable for the urban middle-class with the scandal of 200 buildings containing steel bars contaminated by cobalt 60, which put at risk more than 10,000 citizens and students.(21)

After a review of the early protests against poisonous factories in Lukang and in Linyuan, against which the government deployed the full martial law apparatus, including death sentences for the protesters (suspended), he observes that the famous RCA factory ushered in the chemical and technology industries that are poisoning Taiwan today, and observes:

But RCA and the launch of the electronics industry in Taiwan share another legacy, as RCA’s Taoyuan plant is the likely cause of at least 1,200 known cases of cancers among its former workers, mostly women, as well as permanent pollution in the vicinity of the plants. (37) The RCA plants were shut down in 1991, but other cases remain hidden, as all electronics plants continue to use massive quantities of chemical products. (38) Many of those products have known toxicity for humans, and many are carcinogens. Given the complexity of carcinogenesis, especially when many different forms are at stake, and due to the long latency between exposure to the products and the appearance of cancer, there is reason to focus now on conditions at other electronics companies and science parks, and not to wait for the next RCA-type issue to emerge. But the task is daunting, mainly because of the direct economic benefit of the electronics industry to the nearby cities of Hsinchu, Chupei, Taichung, Tainan, and Kaohsiung, and because of its strategic importance to the Taiwanese economy. The epidemiologist Chen Pau-chung, who has conducted one of the few retrospective cohort studies on semiconductor fabrication at the Hsinchu Science-based industrial Park (HSP), found that female workers who were exposed to chlorinated organic solvents during pregnancy might show increased risk of cancer among their children—especially leukaemia—while the offspring of male workers might have an increased risk of infant mortality and congenital cardiac malformation. (39) So far there has been no equivalent survey concerning the population living near the science parks.

You live near a science park? Only the gods know what you're breathing... few people have the courage of Chan Chang-chuan, who was involved in the epidemiological survey work for the Linyuan naptha cracker, and then went on to look at the Mailiao complex in 2009. His results have been attacked by the company and by other scientists and politicians. Two years ago Tsuang Ben-jei of NCHU was sued by the Formosa Plastics Group for a study opposing the construction of the new naptha cracker in Changhua, which thankfully was not built. It's not a surprise there's so little work out there.

There is one long-term study out there, which Chan participated in. It is open access: "Our findings suggested that life expectancy lengthening was slowed and income growth was stalled for residents living in the industrial communities."
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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!

About Gout

Fields of chili peppers near Jhuolan.

If you've lived in Taiwan for any length of time, you've encountered gout. I know several foreigners who struggle with it. Apparently Taiwan is number one in the world as new research observes gout has strong inherited aspect:

The oldest recorded disease in medical history, gout, has long thought been thought to be a result of an overindulgent lifestyle; excessive drinking and meat consumption leads to deposits of uric acid in the joints, causing debilitating pain. But new research done in Taiwan, where gout is most prevalent in the world, adds to the body of evidence that while gout may be a self-inflicted "rich man's disease," it is also very hereditary.

Previous research indicates that nearly 4 percent of the 23 million people in Taiwan have gout. For the latest study, The University of Nottingham examined data from 4.2 million families and found compelling evidence that the disease clusters in families, with an increased risk of gout in individuals who have immediate or secondary family members that also suffer from gout.

Not only does gout afflict more people here, they get it at younger ages. FocusTaiwan summarized:

Chen Shih-yang, director of Country Hospital's gout treatment center, told a medical conference that the age at which people are contracting gout in Taiwan has fallen markedly over the past 30 years.

Based on 40,000 data entries on gout patients he has accumulated since 1981, Chen said gout occurred mainly among men in their 50s and 60s in the 1980s but grew increasingly prevalent among men in their 30s in the 1990s and among men in their 20s in recent years.

Today, Chen said, 20-somethings account for 20 percent of Taiwan's gout population, an unheard of percentage two decades ago.

Before I started biking my doctor warned me that I was at risk for gout; fear of it was one of the factors that put me on a bike (my numbers have since normalized). Gout also runs rampant among local aborigines and indeed, this study and this one have identified gout-related genetic traits. This study opens:

That there is a high prevalence of gout disease among adult Taiwan aborigines is well known, with incidences ranging from 15 to 44% documented for Atayal men aged over 40 years, followed by Bununs (28.1%) and Paiwans and Tsou tribes (> 5%)1,2. In addition to high prevalence of the disease itself among aboriginal tribes, hyperuricemia is also known to be an asymptomatic feature among the adults2 and children3, but not all the subtribes of Taiwan aborigines suffer from gout. According to Bellwood4, the ancestral homeland of Austronesians was the agricultural heartland of Southeast Asia, from where they first radiated to Formosa (Taiwan; 4000 BC), then western Polynesia (1200 BC), central Polynesia (200 BC), and New Zealand (800 AD). Studies have shown male Micronesians to have prevalence of hyperuricemia ranging from 21 to 64%5-7, and in male Polynesians the figure ranges from 24.3 to 49%8,9. This is higher than in male Caucasians (6 to 23%)10-12, suggesting a direct association with gout.

Gout is also a risk factor in other diseases, such as chronic kidney disease. Among Asian doctors you often hear that soy foods cause gout, but the good news is that this review of studies on the soy-gout connection finds that there is none. So enjoy your tofu, and get on a bike!
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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!

Rabies is back

A fly friends a slug.

The KMT news organ reports important news.

Rabies has reappeared in Taiwan for the first time in five decades. The Council of Agriculture (COA) yesterday morning convened a meeting of experts and confirmed three cases of rabies-induced deaths in wild ferret-badgers (Melogale Moschata Subaurantiaca). One of the three dead ferret-badgers was found in Yulin County’s Gukeng Rural Township (古坑鄉), and the other two in Nantou County’s Yuchih (魚池鄉) and Chitou ( 溪頭 ) Rural Townships. The COA would inform the World Organization for Animal Health of the confirmed rabies infections. Taiwan will now be listed as a rabies-infected area after five decades on the rabies-free list.

We have to be rabies-free for two years before we go back on the rabies-free list. One of the best things about Taiwan is that the stray animals are safe from that disease. I am seriously phobic about rabies: maybe someday I will tell the story of How I got Rabies in Kenya.
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Let the Panic Begin!

Wood chips, drying in Hengchun.

New cases suspected.... it's spreading!!!!!

Test results have cleared three suspected cases of H7N9 avian influenza infection, as 10 new suspected cases were reported, the Central Epidemic Disease Surveillance Command Center said yesterday.

Virus uncovered in poultry markets in Shanghai. Meanwhile, in Taiwan....

Six suspected cases of H7N9 virus found in Taiwan, but four cleared.....

CDC Deputy Director-General Chou Chih-hau (周志浩) said on Thursday that six people reported fever symptoms after arriving in Taiwan from China recently. Two of them were infected with the H1N1 influenza, two people had bacterial infections, while diagnoses for two people was yet be confirmed.

Changhua County to reinforce blood tests for poultry.

Taiwan's travel industry is taking its time to size up the bird flu threat.

Taiwan's travel industry is apprehensive about the uncertainty and public anxiety being caused by the H7N9 bird-flu virus and has shown a rare reluctance to gauge the potential impact of the outbreak of the disease in China. Usually quick to openly assess the effect of global incidents on the travel market -- including during the latest tensions on the Korean Peninsula and the 2011 earthquake in Japan -- industry insiders said they would need time to digest the situation in China.

DOH says vaccines can be produced in as little as two months:

The task force convened its first meeting yesterday. Lin said that two Taiwan experts currently in Shanghai were expected to obtain the H7N9 virus strain from the Mainland, which would be used to produce the rapid screening reagent. Lin also noted that a cross-Strait agreement on disease control cooperation had been signed in 2010, but this was not the only channel for the DOH to obtain the virus strain. He said that Taiwan had obtained virus strains from the World Health Organization (WHO) when an outbreak of SARS (Severe Acute Respiratory Syndrome) occurred in Asia in 2002-3.

The DOH also said it would develop its own vaccine rather than work with Beijing. CDC staff on way to China to gather information, samples. In Taichung monitoring measures are being stepped up to handle the outbreak. Nantou has prepared 44 isolation rooms for patients if H7N9 appears in Taiwan. Health officials have been calling on hot pot restaurants telling them not to serve raw eggs.

Some reality from a commentary in the TT:

There have been no reports of birds infected with this virus strain in Taiwan, nor of any human-to-human transmission. We cannot keep people from the areas in which the outbreak has occurred from coming to Taiwan, but if they do, they will not cause an outbreak here.

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Daily Links:

• Next Media Animators --- vote for them to win a Webby!
• Here's a question from the Atlantic: why doesn't anyone in Taiwan read anymore?
• Orchid Island Nuke Waste Dump, nice piece on it and the local people
• China vs US: the state of the competition
• Tie Non visits Quemoy/Kinmen with zillions of pics.
• Water supplies sufficient to end of June.
• Taiwan to discuss relaxing citizenship rules for China spouses.
• Taiwan grapples with nuclear, renewables

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!

Nursing a Grievance

This is a video of 500 nurses holding a meeting to complain about conditions at Taipei's Rungzung Hospital, a situation replicated all over Taiwan. The hospital was successful in keeping the media out of the meeting so this video comes from the cellphone of a participant.

According to the video, the hospital is short 171 nurses, and thus each of its nurses care for too many patients. Rungzung is famous; it has a 95% occupancy rate. The nursing shortage is paradoxical -- there are more nursing students then places for them, but then they leave the profession at greater rates than they enter when they realize how awful it is. At some hospitals the nurses clock out at the end of the shift as required by law but then work unpaid and unrecorded overtime, exploitative, illegal, and dangerous.

This is not a health industry problem but is par for the course in all sorts of production situations in Taiwan, especially where there is a moral or public service element involved (the police also have brutal schedules) but in general workers in offices and factories who work overtime without pay don't kill people when they make inevitable errors. These problems are only the tip of the iceberg, I hope to do some interviews of nurses before the summer and expand the list of issues. What I've already heard will make your hair turn white.

The first nurse to rise complains that they make $30,000 month as a nurse; on her recent trip to a Taichung night market she encountered a student worker making $33,000 a month selling fried octopus meatballs in the night market. "Shouldn't I go sell octopus balls in the night market?" she says, to everyone's laughter and resounding "yes!" Then she goes on: "those of you who have been here three years, four years, have you been promoted?" "No!" The next woman who stands up complains that the money the hospital has been spending on purchasing flowers to beautify the place should be going to paying the nurses.

Because it is doctors who generate income for the hospital by taking on patients, hospitals seek to maximize doctors and minimize nurses, who represent a cost to the institution, which are often privately owned and like so many large corporations in Taiwan, farming Taiwan's subsidy regime. At the bottom of the institutional pecking order, often from working class families, nurses are the target of the System's attempt to reduce costs by exploiting labor. The job is so awful that even nursing positions that pay as much as college professor positions go unfilled.....

Clearly reforming the NHI is going to involve much more than simply adjusting the billing and payment regimes. The whole approach to the use of labor is going to have to be rethought.
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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums! Delenda est, baby.

A Nurse Speaks

Had a conversation on Facebook with an old student who is now a nurse.... not her real name, of course:

PAULA:

i think NHI is not used properly...

think about it, even drug abusers are sent into the hospital and the government pays for their treatment or people drink and drive and kill people in an car accident and the government pays for all their medical treatment

another thing is that,more and more Taiwanese people took this for granted they pay little when they go to the hospital and they see doctors and nurses with no respect because its cheap

NHI pay too little for medical staffs especially nurses so hospital wouldnt hire more nurses, they would rather pay more to doctors ( cuz NHI pay doctors by how many clients they treat)

too many things, this pyramid is going down

and one thing is that, families dont appreciate what doctors and nurses do they are getting more picky and complain about medical treatment

again, because it is too cheap what they are paying

NHI cover mostly 80-90%

i was upset by the news that a neurosurgeon has been sued by a patient who was paralyzed after brain surgery but he was nearly dead in a car accident

the doctor was sentenced to pay 30 million to the family

but, some other guy drinks and drives and causes people to die in a car accident

how much does he have to pay? like 2 or 3 million ridiculous

i work in the ICU sometimes i can really feel tense communication with the patient's family

its like they all assume that we are gonna harm them or something because they ve been watching bad things like this on TV before

media!

even after the patient is cured and goes home many times we hear doctors talk about "NHI refuse to pay them money (those medication and examination has been given and done on patients)

so the doctors have lots of paper work to do to write down the reason one by one why they chose to give that order because the NHI officer assumes that doctor wanted to make more money so they prescribe expensive medications

you see, this is the problem: there is only one pie for everyone to share

so hospital wouldnt give move money to the staff and it is too cheap

people dont cherish it

and they are not friendly to medical staff

so there are many news stories about doctors rather choosing to become plastic surgeons

no one wants to risk their life to be a heart surgeon or neuro surgeon

cuz they dont wanna ending up getting their ass in the jail or bringing themselves to the court and eventually having to pay lotttsssss of money to the patients

doctor and nurses are not God

well, from my experience, i just dont like some people who come into the ICU and notify me that their family or friends are someone famous or big

i just dont care

i got only two hands

thats stupid

im not saying everyone is like that

there are some family are really nice

but im concerned this is dragging everybody down

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums! Delenda est, baby.

Taiwan's Awesome Health Care System

My wife just finished a round of surgery. The problem was serious, but it appears to be taken care of.

We are grateful beyond words for Taiwan's incredible health care system. Here in Taiwan the cost of this complex care for my wife appears unlikely to exceed several hundred US dollars for surgery, pre-surgery tests, and ten days of post-surgical care. A third of that charge is a $6000 NT charge for the morphine drip (I got the expensive version) which the patient must pay for. Heaven knows what would have happened had we faced this problem in the crapshoot that Americans call a health insurance system.

I can't say enough good things about everyone involved -- the nurses were great, the doc totally professional and talented -- and caring, he works 14 hour days yet still spends the time to talk with each patient. We did spend months prior with misdiagnoses, but that occurs in all systems. I don't really think it is a doctor issue so much as a specialist issue; misdiagnoses are common in all professions. The difference is that when a car mechanic or a computer repairman misdiagnoses your car or computer, it doesn't scream at you in pain or wake up in the middle of the night bleeding all over the sheets.

An interesting wrinkle we discovered is that when you have a serious illness the government gives you a special health insurance card, the Serious illness Card, which means that you get lower health fees forever after. Shouldn't we have to pay slightly more, to help amortize system costs? No wonder the system is suffering funding problems.

In Taiwan patients' families must stay with them in the hospital to help out with the care. This saves the NHI a bundle of money on patient care, since fewer nurses, assistants, and volunteers are required as a result. A whole system has evolved for this. In the hospital we stayed at the chairs in each ward folded out to become beds for family members, and the nurses are used to cooperating. If the patient has no family available, there are people who hang out around the hospital and hire themselves out as patient caregivers. So my kids and I took turns sleeping at the hospital to care for my wife.

I was here in Taiwan before this system was implemented. After using it for more than a decade, all I can say is that single payer is the only rational choice.
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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!

Principled Resignation

I always enjoy reading comments from China on Taiwan's democracy, such as this excerpt from a speech from a PRC scholar on rule of law in Taiwan. Such principles were on display this week as two cabinet officials tendered their resignations over issues of principle.

First, justice minister Wang resigned over the death penalty....

Justice Minister Wang Ching-feng published an article on March 9 entitled “Rationality and Forgiveness,” articulating her view that the death penalty should be abolished and stating that she would not sign the execution order for any convict on death row during her term in office. Minister Wang’s article induced an angry backlash among the public. Wang wrote that she would insist on doing the right thing even if her opposition to the death penalty meant that she would have to step down.

However, Presidential Office spokesman Lo Chih-chiang yesterday, in a press conference, stated that ours was a government of law, therefore, everything must be done according to the law. The executions of death row inmates must be carried out unless there was a legally sufficient reason for the execution to be stayed, Lo said, adding that otherwise, the Justice Ministry must carry out its duty in accordance with the law.

The local focus was on how the President simply threw Wang to the wolves, refusing to support her. Focus Taiwan translated a China Times editorial that sketched her career as an activist. The editorial observes that the Chen Administration stalled executions because it feared international repercussions. It also hints at a problem within the Administration: when it vetted its appointees for the justice post, didn't anyone ask about this key issue? D'oh.

The Wang resignation also highlights another problem endemic with Ma: the appointment of individuals to high position who come from academic backgrounds and have little political experience. This pan-Blue papers have roundly condemned Ma for this.

The death penalty is highly popular in Taiwan, with widespread public support. It make a cheap target for moralizing. But when it comes to the hard stuff.... it is a shame that Wang's high morals didn't extend to the numerous problems with the Chen Shui-bian detention and trial. Taiwan News gives another take and observes that under the law -- despite claims to the contrary by KMT officials and KMT papers -- she is not required to sign execution orders:

Unfortunately, Taiwan society remains dominated by the hoary and barbarian precept of vengeance and understandable but dangerously vindictive feelings of survivors of murder victims, which ultra-conservative KMT lawmakers are utilizing to stir a reactionary populist storm in order to turn the clock back on Taiwan's human rights progress.

The fuse was lit by Control Yuan Commissioner Chao Chang-ping and other colleagues who declared "orders for the death penalty should be approved by the justice minister and implemented within three days" and threatened to "investigate" Wang for "illegally" delaying executions.

Indeed, Article 127 of the Criminal Code mandates that public officials who do not implement legal punishments are liable for a sentence of up to five years, but this rule applies mainly to prosecutors or jail wardens and not to the justice minister who is not an "public official tasked with implementing punishment" but the chief of the highest administrative judicial agency.

Indeed, there is no article in the Criminal Code that explicitly requires the justice minister to sign such orders and it is evident that the justice minister is granted the "under the law" the discretionary power to sign or not to sign such orders.

Therefore, neither Wang or any other previous justice ministers who refused to sign death sentence orders have transgressed the law and indeed have honored the Constitution through their respect for all human life.

There were even gloating KMT legislators who said that all 44 of the prisoners currently on death row should be executed. Disgusting. The sad part, as many noted, is that with Wang calling attention to the death penalty, which has 70%+ support on the island, it is likely that executions, which had been stayed for the last five years, will resume.

Also resigning this week was the Health Minister Yaung Chih-liang, who bluntly told the Premier that his requirements to confine health fee increases to the upper income brackets wouldn't work. The Premier had wanted 75% of the population to experience no fee increases, but the math doesn't work. Yuang instead had called for 41% of the population to experience slight increases. His resignation has not been accepted.

Take note of the explosive political issue that underlies this, one that shapes so many issues in Taiwan, but often flies under the radar: local government debt. A number of local governments, including Taipei, have not paid their debts to the NHI. It is not just fees that have to rise, but enforcement of payments on local governments as well.

It is obvious to every sentient mind on the island that health fees must go up if the wonderful NHI system is to survive. It would be great if the legislature would sit down and pass a set of fee increases with bipartisan support. I think the government and both parties would be pleasantly surprised to find how quickly the public would adapt.
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Daily Links:

• Short film on Taiwan's critically endangered dolphins.
• A story about fox spirits in Taiwan from RTI.
• Taiwan rejects ban on tuna fishing but will accept a quota. As if anyone would pay attention to it. Do these people want to have tuna left for their children to eat? Apparently not.
  
• Ma says Chinese students to enter Taiwan universities. Some are already here, I have one in one of my classes, from Macau.
  
• Taiwan approves plans to permit Chinese banks to invest.

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[Taiwan] Don't miss the comments below! And check out my blog and its sidebars for events, links to previous posts and picture posts, and scores of links to other Taiwan blogs and forums!

Paper on Parade: Japanese Colonialism and Stature in Taiwan

Last year China Quarterly published a very interesting paper on the standard of living of Taiwanese under Japanese colonialism entitled Was Japanese Colonialism Good for the Welfare of Taiwanese? Stature and Standard of Living by Stephen L. Morgan and Shiyung Liu. The China history blog Frog in a Well mentioned it, so I thought I'd go have a look at it.

The authors begin by noting that there is still some disagreement on the overall effect of Japanese rule on the economic welfare of the Taiwanese themselves. While there is little debate that key indicators rose, and productivity and economic output rose, there is still some disagreement on the effect of the growth on the welfare of the Taiwanese themselves, with a few scholars arguing that Japan's extractive policies took most of the gains, and Taiwanese capitalism was stunted. The problem, scholars realize, is that adequate data of income under the Japanese are lacking.

Enter height.

According to Morgan and Liu, studies of human growth have shown that average population height is "primarily attributable to the environment" in which it lives. All other things being equal, taller populations live better. Height itself is a function of net nutrition over time. A well-fed population will enjoy good growth, and even temporary impairment of nutrition can be made up, but long-term lower nutrition will result in permanent falls in height. The authors observe later in the paper that height cycles similar to the business cycle have been detected. I guess I have Nixon to thank for me not being able to play starting forward for the Pistons....

While height and income are correlated, the relationship is not linear. Incremental rises in height decrease as income rises, and in some cases may even diverge. Moreover, height is more closely related to income distribution, they observe. Not only is the gain affected by public health and other factors, but shifts in consumer preferences may also influence it.
Using several different databases, the authors then explore the changes in the average heights of males during the period of Japanese colonialism in Taiwan. There appear to be some correlations with region (central Taiwan people were taller), occupation (professional and skilled were taller), and education (better-educated were taller). After analysis of the data, the authors found that height rises rapidly through the 1910s and 1920s, and then levels off during the 1930s. In fact, that decade is the only period from the 1880s through the 1970s in which growth in height was not regular, according to the authors. The authors conclude:

"The statistical evidence for the flat trajectory of in height during the 1930s-40s is striking confirmation of the adverse impact on the Taiwanese of the shift in colonial policy in the early 1930s, as Japan increasingly militarized and reoriented development in its colonies to support projection of imperial power."

These gains were driven by improved public health, economic growth, and economic policy. In Taiwan Japan reduced infant mortality, and eliminated tropical diseases. In a footnote there is an impressive quote from George Mackay, the 19th century missionary, on how malaria laid low large fractions of the population, preventing it from doing meaningful work. At the same time incomes nearly doubled in the 1920s, and the income distribution improved, changes confirmed by both the height data and economic data. In the 1930s economic policy changed and the minor industrialization Taiwan was undergoing may have led to drops in the health of the population, as rural laborers shifted to factory employment, even though most people stayed on the farms where subsidies to rice drove rising incomes. Consumer preferences may have changed, promoting purchases of goods that detracted from health. The economic and historical data are not clear, however.

Overall, their conclusion is that whatever you may say about colonialism, there is no denying that it produced gains in the height, health, and lifespan of the Taiwanese. Japanese colonialism in Taiwan was about more than just laying the foundation for the miracle growth during the KMT period; it was about major improvements in living standards for most Taiwanese.

[Taiwan]