水庫興建與疾病糾結（Syndemics）：以新竹縣尖石鄉玉峰村泰雅族為例

A Dam Construction and Syndemics: A Case Study from the Atayal in Yu-Feng, Jianshi Township, Hsinchu County

1950年代石門水庫的興建不僅改變上游集水區的地形與地貌，也改變居住於這個地區泰雅族人的社會生態系統，但過去60年來少有研究探討社會生態系統變化對居住於石門水庫上游集水區馬里光溪流域泰雅族人健康福祉的衝擊，本研究的目的在於：（1）透過民族誌的研究方法，調查目前居住在新竹縣尖石鄉玉峰村之泰雅族人常見的健康問題；（2）調查該區的在地醫療照讓系統（local health care system）的組成與泰雅族人的求醫行為；（3）分析水庫興建所造成的社會生態系統變化對馬里光溪流域泰雅族人健康福祉的影響。研究結果發現，雖然石門水庫的興建並沒有在上游集水區引發以水生動物為傳播媒介之water-based disease （如血吸蟲病、龍線蟲病、肺吸蟲病）的流行，但卻對玉峰村泰雅族人所處的社會生態系統造成巨大的衝擊，人地關係的改變，增加玉峰村泰雅族人對感冒、肌肉骨路疾病、心血管疾病及糖尿病的生態感病性，加上政府水庫集水區管理政策形成的結構性暴力及醫療資源的分佈在可近性、可利用性、可接受性及品質上皆出現若干缺陷，增加泰雅族人對上述四種疾病的罹患率及疾病管理的困難度，由於這些疾病的群眾涉及複雜的生物、非生物及文化性因子，故應被視為生態疾病糾結的現象，而不應類歸於發生在石門水庫上游集水區的風土病。為解決石門水庫集水區泰雅族人疾病糾結的現象，政府應導入社會醫學的概念及行動計畫，由建置符合文化安全的醫療照護系統及改善人類群體生活條件二方面著手，藉由提升玉峰村泰雅族人的健康權與停止及修正不當的政治、經濟及制度設計及對待，消除水庫興建對玉峰村泰雅族人所造成的社會受苦現象。 The construction of Shih-Men Dam has changed the landscapes of the reservoir and the socio-ecological system (SES) of the Atayal community located in the Mariqwan Basin (the upstream of Shih-Men reservoir) where is in Yu-Feng, Jianshi Township, Hsinchu County since 1950s. However, the impacts of building the Shih-Men Dam have not been completely studied in the reservoir area over the past 60 years. The purposes of this study are to: (1) explore the common health problems of the Atayal in the Mariqwan Basin by employing ethnographic methods; (2) investigate the constituents of the local health care system and health-seeking behaviors of the Atayal; (3) analyze how the changes of SES caused by the dam construction influence the wellbeing of the Atayal in the Mariqwan Basin. Although research results do not find water-based diseases, such as Schistosomiasis, Dracunculiasis and Lung flukes, in this area, the ecological susceptibilities of upper respiratory tract infection (URTI), musculoskeletal disorders, heart disease, and diabetes increase due to the changes of interactions between the Atayal and landscapes in Yu-Feng. Notably, the construction of the Shih-Men Dam has a great impact on the changes of SES as well as the interactions between the Atayal and landscapes. The morbidities of URTI, musculoskeletal disorders, heart disease, and diabetes also significantly increase because of the structural violence caused by the dam construction resulting in the increases of social risks. Also, the insufficient accessibility, availability, acceptability, and quality of the medical care contribute to inadequate disease managements. Consequently, the aggregations of URTI, musculoskeletal disorders, heart disease, and diabetes among the Atayal in Yu-Feng represent eco-syndemics instead of endemics since the pathogenesis of the disease involves complicated interactions among biotic, abiotic, and cultural factors. To solve these eco-syndemics, the government should create an action plan by adopting the concepts of social medicine. Efforts should be given to the protection of the right to health and stopping political, economic, and institutional discrimination by creating an efficient medical care system with the consideration of cultural safety, and improving the life conditions of the Alayal. Through these efforts, the social sufferings of the Atayal caused by the construction of Shih-Men Dam will be able to be relieved.

The construction of Shih-Men Dam has changed the landscapes of the reservoir and the socio-ecological system (SES) of the Atayal community located in the Mariqwan Basin (the upstream of Shih-Men reservoir) where is in Yu-Feng, Jianshi Township, Hsinchu County since 1950s. However, the impacts of building the Shih-Men Dam have not been completely studied in the reservoir area over the past 60 years. The purposes of this study are to: (1) explore the common health problems of the Atayal in the Mariqwan Basin by employing ethnographic methods; (2) investigate the constituents of the local health care system and health-seeking behaviors of the Atayal; (3) analyze how the changes of SES caused by the dam construction influence the wellbeing of the Atayal in the Mariqwan Basin. Although research results do not find water-based diseases, such as Schistosomiasis, Dracunculiasis and Lung flukes, in this area, the ecological susceptibilities of upper respiratory tract infection (URTI), musculoskeletal disorders, heart disease, and diabetes increase due to the changes of interactions between the Atayal and landscapes in Yu-Feng. Notably, the construction of the Shih-Men Dam has a great impact on the changes of SES as well as the interactions between the Atayal and landscapes. The morbidities of URTI, musculoskeletal disorders, heart disease, and diabetes also significantly increase because of the structural violence caused by the dam construction resulting in the increases of social risks. Also, the insufficient accessibility, availability, acceptability, and quality of the medical care contribute to inadequate disease managements. Consequently, the aggregations of URTI, musculoskeletal disorders, heart disease, and diabetes among the Atayal in Yu-Feng represent eco-syndemics instead of endemics since the pathogenesis of the disease involves complicated interactions among biotic, abiotic, and cultural factors. To solve these eco-syndemics, the government should create an action plan by adopting the concepts of social medicine. Efforts should be given to the protection of the right to health and stopping political, economic, and institutional discrimination by creating an efficient medical care system with the consideration of cultural safety, and improving the life conditions of the Alayal. Through these efforts, the social sufferings of the Atayal caused by the construction of Shih-Men Dam will be able to be relieved.