From the Ministry of the Interior to COVID-19: Japan's Healthcare Paradox (Part 2 of 3)

Masahiro Kami, M.D., Ph.D.

President, Medical Governance Research Institute, Tokyo, Japan

The Ministry of the Interior was established in the aftermath of the political upheaval in Meiji 6 (1873) that began with debates over the Korean invasion proposal. This political disturbance saw Saigo Takamori, a key figure of the Meiji Restoration, resign from his official position, which eventually led to the Satsuma Rebellion four years later. Okubo Toshimichi, who had returned from an overseas mission as part of the Iwakura Embassy, became the inaugural leader (Minister of the Interior) of the ministry. He was one of the Three Great Nobles, regarded as one of the main founders of modern Japan alongside Saigo.

It is said that Okubo aimed to strengthen public order through the Ministry of the Interior. This intent is symbolized in roles such as the Deputy Minister, Director of the Police and Security Bureau, and Superintendent General of the Metropolitan Police Department, which were collectively referred to as the "Three Key Positions of the Ministry of the Interior." This historical context has significantly influenced the ethos and decision-making of subsequent governmental bodies, including the modern MHLW, underlining the importance of understanding institutional lineage and values in shaping policies.

Okubo was not only intent on maintaining public order but was also a staunch advocate for local decentralization. His efforts in this direction were spurred by the discontentment among samurai who lost their positions due to the abolition of the feudal domains and establishment of prefectures, leading to rebellions such as the Satsuma Rebellion. In Meiji 11 (1878), Okubo proposed reforms titled "Regarding the Revision of Local Systems." Subsequently, the Ministry of the Interior gained the authority to appoint governors throughout Japan's prefectures.

One factor that seems to have influenced the Ministry's interest in local administration was the presence of fewer members from the Satchō domains, and a higher number of local members from the other domains aligned with the old shogunate and affiliated domains. Essentially, while Satchō figures dominated the central government, others managed local administration.

In subsequent years, the responsibility of overseeing local administration within the Ministry of the Interior fell to the Local Bureau. The position of a prefectural governor was typically held by mid-tier bureaucrats. The 2021 film "Ikiro: Shimada Ei - The Last Okinawa Prefectural Governor During the War" aptly depicts the circumstances of this era.

Traces of these historical personnel systems remain evident even today. Of the 47 prefectural governors, 33 are former bureaucrats, with 25 being graduates of the University of Tokyo. Despite current calls for local autonomy, bureaucratic control persists.

Many governors who come from a bureaucratic background tend to be appointed to prefectures during their tenure as assistant directors and then often rise to the governor's position. Few have experience as Administrative Vice-Ministers or Bureau Directors. It's intriguing that, much like in the pre-war era, these posts are considered "lightweight" roles.

On a tangential note, during my university student days at the University of Tokyo, I was a member of the athletic association's kendo club – specifically, the one that competed against other universities. The University of Tokyo's kendo club was inaugurated in the 20th year of the Meiji era under the moniker "Gekkenkai". Its first master instructor, Sakakibara Kenkichi, was a former samurai under the shogunate and an adept practitioner of the Jikishinkage-ryū school of swordsmanship. After the Meiji Restoration, he found himself in obscurity but was subsequently appointed by the new government.

The prominence of the police in promoting kendo came in the wake of the Satsuma Rebellion in the 10th year of the Meiji era, particularly after the Battle of Tabaruzaka, where the special sword-bearing police squad led by Kawaji Toshiyoshi made notable contributions. It's believed that the Meiji government had an ulterior motive: by encouraging the art of kendo, they hoped to employ samurai who had lost their jobs during the restoration as police officers, preventing further uprisings.

Subsequently, the University of Tokyo's kendo club grew in tandem with the Ministry of the Interior. Starting with Sakakibara, to this day, the chief instructor position of the club is synonymous with being the head instructor at the Tokyo Metropolitan Police Department's kendo training room. After World War II, out of the ten individuals who became presidents of the All Japan Kendo Federation, eight were alumni of the University of Tokyo's kendo club. Many, including its first president, Kimura Atsutaro—who served as Attorney General in the Shidehara cabinet and Justice Minister in the Yoshida cabinet—had ties to the Ministry of the Interior.

Presently, popular career choices for the club's graduates lie within government agencies once affiliated with the old Ministry of the Interior, such as the Ministry of Internal Affairs and Communications, National Police Agency, Ministry of Land, Infrastructure, Transport and Tourism, and Ministry of Health, Labour, and Welfare. Few have ventured into the Ministry of Finance or the Ministry of Foreign Affairs. To my knowledge, none have joined the Ministry of Foreign Affairs. This, I believe, encapsulates the "intrinsic values" of the University of Tokyo's kendo club.

To circle back, as the gubernatorial appointment system solidified, the core of the Ministry of the Interior became its Police and Public Safety Bureau and the Local Administration Bureau. But, how was healthcare treated within this framework (To be continued)?