治理｢近視王國｣：從學校監管醫療到家庭健康促進

Abstract

台灣的近視盛行率奇高，1990 年代以來號稱｢近視王國｣，激發許多學術調查與政府介入。那麼相應的治理部署究竟何時和如何成形、有什麼結構性轉變、家長又是如何回應這些措施與訊息呢？我分析期刊、調查報告、政府檔案資料，進行多元行動者的深度訪談（28 位），以釐清這些研究問題。本文的研究發現與貢獻如下：（1）近視在1960 年代的問題化，附屬於政府與教育界對｢升學主義｣的一系列論述與介入，近視治理源於教育問題。醫療專家與官員配合同時代的教育改革，聚焦於國中小學生、以過度升學競爭解釋學生大量近視，並靠改善教室空間和特定眼睛體操介入。眼科醫師對該議題的壟斷也隨1980 年的近視政策而強化。（2）自1990 年代起，近視治理在學生近視盛行率逐步攀高的治理危機下，更著重家庭親職的自我照護，我稱之為｢家庭化轉向｣。治理對象逐漸擴及「學齡前｣的幼童以及電視和電腦等視聽娛樂風險、相關論述越來越著重親職的責任、措施由特定眼睛體操轉變為日常活動時間的計算、日益擴大的眼科市場也出現了角膜塑型片等新手段。（3）近視照護的親職顯示：文化健康資本必須包含｢照護勞動時間｣這項要素，近視照護的兩難也彰顯不同親職實作之間的張力。一方面，預防、檢查、處理到度數控制等各環節，都有特定的健康不平等，家長的健康知能、財力與投入照護的勞動時間扮演了關鍵角色。另一方面，家長會以強化眼睛、差別性排除風險因子、選擇性接受部分風險等方式，來協商相互衝突的要求。最後，我也提出政策建議：視力保健應由國小延伸至國中，並分辨不同的家庭型態，且在流行病調查中結合教養風格與醫療商品等面向。

Known as the “kingdom of myopia” due to its high prevalence rate of myopia since the 1990s, such an epidemic in Taiwan leads to a great deal of investigations and interventions. This thesis analyses how and when the dispositif of myopia governance is developed, whether and how it changes historically, and how the Taiwanese parents respond to such an issue in their care practices. Through the examinations of journals, research papers, policy documents and 28 in‐depth interviews, this paper has three major findings. (1) The problematization of myopia during 1960s follows the lead of critique and intervention by the ministry of education against “education fanaticism”, the myopia governance is thus originated from the educational concern. Influenced by contemporary educational reforms, the experts and the officers focus on middle and primary school students and explain their prevalence rate by the over‐competition under education fanaticism. They also strive to improve the spatial environments of school and impose certain forms of eye gymnastics, and strengthen their monopoly of this issue with the help of the creation of the policy of myopia in 1980. (2) Since 1990s, however, under the crisis of the climb of the prevalence rates, the governance of myopia turn to focus on the self‐care of family parents, I call it as “the domestic turn”, in which the objet of governance extends to the pre‐school children and the risks of audio‐video leisure (such as TV and computers), the relevant discourses tend to explore the responsibility of parents, the eys gymnastics are replaced by the calculation of out‐door activities, and Ortho‐K emerges in the growing market of ophthalmology. (3) This case shows that the cultural health capital should include the “care‐labor time”, and the dilemma of myopia care embodies the tension between different parental practices and dispositions. On the one hand, from prevention, examination, treatment and control, all these practices show a form of health inequality caused by the differences of health‐related competences, economic meansand the time available for care ; on the other hand, parents interviewed tend to negotiate the pressure of education fanaticism and the health of the eye by strengthening the eyes of their children, discriminating and excluding some risk factors while selectively accepting some others. Based on these findings, this paper suggests that the policy interventions should extend to the secondary schools, distinguish different forms of family and take into consideration the style of childrearing and the use of medical commodity.