This study discusses the health care system in the Kamigoto District, Nagasaki Prefecture, which is an isolated island and is treated as a disadvantaged area. The study considers the behavior of each health-related actor inside and outside of the region according to the way in which the actor seeks rationality and equitability.

Through health care policy for the isolated islands, the minimum necessary health care services have been maintained with the support of the mainland. The health care policy for the isolated islands in Nagasaki includes the operation of medical institutions, retention of doctors, plans for transportation by helicopter, and the introduction of a medical information system. Nagasaki Prefecture has strengthened health care services in the isolated islands with the help of the universities and local governments. The Nagasaki Hospital Agency, which was established in Nagasaki Prefecture, was intended to operate hospitals together with the cities and towns in Shimabara, Goto, and Tsushima Districts in April 2009. The agency adopts a special district authority that fully applies the Local Public Enterprise Act, and it operates two prefectural hospitals and nine group hospitals. Three hospitals located in Shin-Kamigoto Town were put into operation by the newly created Nagasaki Hospital Agency.

The implementation of the health care restructuring plan of Shin-Kamigoto Town proceeded as planned. Each health-related facility in the town clarified its function, and all facilities were closely coordinated with each other, with a view to maintain the current service level and improve management. Inpatient medical care was centralized at Kamigoto Hospital as a local base. In addition, the beds at Arikawa Hospital (currently Arikawa Medical Center), Shin-Uonome Clinic, Wakamatsu Clinic, and Narao Hospital (currently Narao Medical Center) were eliminated. As a result, the total number of beds in the Kamigoto District was reduced by almost half, i. e., from 334 to 186. However, the mainland provides supplementary support because no medical institution has the capacity to supply tertiary and psychiatric inpatient medical care in Shin-Kamigoto Town. A prerequisite for the smooth implementation of the plan is cooperation among Shin-Kamigoto Town, the Nagasaki Hospital Agency, medical institutions on the mainland, and Kamigoto Hospital in maintaining health care services on the isolated island.

As described above, the large scale response maintained the health care system on the isolated island by the actors whose jurisdictional area covers all parts of Nagasaki Prefecture encompassing the secondary medical areas outside of Kamigoto District. The phenomenon that multiple actors mobilized health care resources to address the scarcity of such resources is specific to a disadvantaged area. Hence, the process of restructuring health care in the Kamigoto District was accompanied by a review of governance, in which the disadvantageous geographical conditions were overcome not through local governance such as the municipality or a secondary medical area, but by expanding the scale to the level of Nagasaki Prefecture.

Between the 1990s and 2000s, Anglophone researchers engaged in active discussions concerning policy relevance, the so-called ‘policy (re)turn’ debate. This debate occurred almost exclusively among academics, or what might be termed ‘pure’ geographers, and lacked participation from applied geographers and practitioners. This paper seeks to clarify the nature of these debates in the field of applied geography. Furthermore, this work examines relationships between applied geographers, so-called geographic practitioners, and “pure” geographers as well as academic establishments in the Anglophone world, especially in the United States, since the 1970s.

First, this paper traces developmental processes within the field of applied geography since the early 1970s. In contrast to the pattern in Europe, within American academia applied geography lost vigor because of the strong theoretical focus that gained popularity in the discipline. This shift might be termed the rise of the ‘new geography’ within American academia. Additionally, another factor was a growing demand for positions at the level of university teaching staff owing to postwar economic prosperity and the entrance of baby boomers to university.

There was, however, a resurgence of applied geography shortly after this initial decline of practical studies in favor of theoretical research. Following the relevance debate and the decrease of student enrollment within the field, applied geography began to once again gain popularity in the 1970s. These changes in the discipline were mainly brought about by state universities. These institutions were highly dependent on state subsidies and were therefore also governed by state policy. The geographical academies also pushed for the development of the field of applied geography. The Applied Geography Specialty Group (AGSG) and the James R. Anderson Medal of the Association of American Geographers (AAG) were established for distinguished applied geographers. Academic journals such as Applied Geography were also launched in the early 1980s.

Since the 1990s, there has been a rise in geographical information technologies such as geographic information systems (GISs) and remote sensing. Owing to the popularization of the field through technological developments, an interest in geography was developed outside of the academic discipline. Following this development in the discipline, the National Research Council (NRC) published two documents, Rediscovering geography (NRC, 1997) and Understanding the changing planet (NRC, 2011). These reports emphasized the relevance and applied aspects of geography.

However, academic studies in applied geography did not flourish in comparison with institutionalized progress within the field. Academic journals and sections of journals allotted to applied geography stagnated or were discontinued. Results taken from a citation analysis of journals such as Applied Geography and other key human geography journals demonstrate a lack of interaction between ‘pure’ geographers and applied geographers.

This paper further discusses relationships between ‘pure’ geographers and academic establishments within the discipline of geography. ‘Pure’ geographers tended to criticize applied geographers for their lack of theoretical and philosophical grounding. They further critiqued applied geographers as free riders of geographical methodologies who made little contribution to their evolution. ‘Critical turn’ movements in geography led ‘pure’ geographers to exclusively concentrate their interests even further on thoughts and concepts in methodology with a philosophical background. Owing to these debates, these scholars asked applied geographers to reconsider the foundations of their research area and the relevant questions.

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