BACKACHE AND WORK INCAPACITY IN JAPAN

No one is spared a regional backache. Some episodes will compromise function to the extent of work incapacity. Throughout the industralized world, workers' compensation insurance programs provide recourse for the segment of people whose incapacitating backache is held to have arisen out of and in the course of employment. Most programs have evolved from the Prussian paradigm introduced a century ago. That evolution represents country specific, de facto experiments in health policy. In the case of Japan, the Prussian paradigm was imposed on a very distinctive tradition at the end of World War II. Therein lies one of the more dramatic experiments of health policy. This essay attempts to document the process that resulted. To gain such insight, relevant physicians and bureaucrats in Japan were interviewed and government documents reviewed. This information was supplemented by nonsystematic culling of relevant reflections of scholars also pursuing the heuristic method but with different, usually nonclinical, tempering. It is clear that Japan has evolved an approach to the worker with an incapacitating backache that favors options other than recourse in workers' compensation for redress.