［中文摘要］

台灣原住民在諸多健康指標上相較於台灣全體民眾的健康情形來得差，不僅是平均餘命較低且疾病死亡率也較高，尤其在結核病問題更是明顯，原住民比起非原住民有較高的結核病發生率以及死亡率，而且，結核病死亡率的差距過去三十多年中有逐漸加大的趨勢。國內針對原住民結核病的研究缺乏歷史視角的分析，然而，我們若要深刻分析、理解原住民日益惡化的健康處境，必須從歷史的方向做政治經濟學的分析，方能夠在歷史脈絡中理解並對於原住民結核病問題的形成有更進一步的詮釋與分析。



因此本研究在宏觀的層次收集相關的量性與質性的歷史資料，分析台灣原住民社會經濟地位的歷史變遷及原住民結核病問題形成的歷史變化，同時檢視公衛體系對於原住民結核病的防治情形。在微觀的層次，筆者以太魯閣族為主要族群的秀林鄉作為田野調查的場域，以深度訪談及參與觀察進行資料蒐集，深入田野理解原住民部落及原住民個人的得病歷程。



本研究發現，原住民受到台灣政治經濟變化的影響，導致許多原住民為求生存而被迫遷移，但原住民相對於主流教育是屬於低教育者，進而影響原住民的職業性質多屬於低階層的職業，因此其收入就比較低，遷移後的工作環境並不好，以致造成住屋擁擠、營養不足、低免疫力及較差的健康情形，因而罹患結核病。多數曾遷移或未遷移的結核病患者，得病後居住在原鄉部落，但原鄉部落的低社經地位，對於結核病知識了解不夠充份，導致結核病在部落的傳染，而公共衛生體系在這當中並無法發揮真正的作用，大多是醫療的介入措施較多，所以結核病在原住民部落成為一個惡性循環無法消失的疾病，原住民結核病的問題因此在歷史過程中形成。



中文關鍵詞：原住民、歷史分析、政治經濟學分析、結核病問題、結核病死亡率、結核病發生率



［英文摘要］

Many health indicators of the Taiwanese aboriginal population shows much worse health status than general population, as exemplified by their relatively low life expectancy, higher mortality rates, and higher incidence and prevalence of tuberculosis. The disparities in TB mortality rates between the Taiwanese aboriginal population and the general population have been increasing gradually in the past 30 years. In the literature, there is very limited historical perspective on the analysis of the problem of this disparity. However, if we are to do an in-depth analysis to understand the deteriorating health situation of aborigines, we must conduct a historical political economic analysis so that the aboriginal tuberculosis problem can be understood in its historical context and subsequently, a new interpretation of the tuberculosis problem in the aboriginal population can be developed.

In this study, at the macro level, we collect quantitative and qualitative historical data and analyze the historical changes that have occurred on the political economic and socio-economic dimensions of the aboriginal people. We also analyze the making of the aboriginal people’s tuberculosis problem while examining the prevention and control of tuberculosis among aboriginal people. At the micro level, we use Sioulin Township as our field site, which has Taruku tribe as the main ethnic group. We conduct in-depth interviews and engage in participant observation. We use these field data to obtain an in-depth understanding of aboriginal communities and about the tuberculosis effects at the individual level.

We found that aborigines have been seriously affected by Taiwan’s political and economic changes, resulting in many aborigines being forced to migrate in order to find jobs and to survive. Relative to the general population, their education level is low, leading to their disproportionate representation in low-level occupational careers, and low incomes. They often live in overcrowded housing and suffer from malnutrition, low immunity and poor health status, further compounding the aboriginal problem of tuberculosis. Many aboriginal tuberculosis patients returned to their homeland for the treatment of their diseases. The low socio-economic status and the lack of knowledge about tuberculosis led to the spread of tuberculosis among tribe members. The public health system, constituting mostly medical interventions, is insufficiently equipped to have any significant impact on the prevention and control of tuberculosis among aboriginal people. Consequently, in this vicious circle, tuberculosis in tribal community became a persistent disease, resulting in the making of the problem of tuberculosis among aboriginal people during the historical processes.



KeywordS：aborigines、historical analysis、political economic analysis、tuberculosis problem、tuberculosis mortality、tuberculosis incidence