The Everyday Lives of Nursing Assistants as Health Workers in the 1970s and 1980s — The De/Hierarchization of Public Health Nursing —

Since the 1960s, the role of nursing assistants as public health workers has been institutionalized as a policy aimed at minimizing the burden of hiring nursing staff while maximizing workforce utilization with minimal investment. Initially, their duties were deemed suitable for ‘non-medical’ individuals, who were believed not to require significant healthcare expertise. However, nursing assistants in public health roles often found themselves in positions demanding extensive public health knowledge and skills, occasionally substituting for the professionalism of nurses. The introduction of a ‘ladder’ to regular employment for these workers in the early 1980s was a governmental measure intended to stabilize health policy while minimizing the financial burden of health investments, similar to the creation of nursing assistant roles in the mid-1960s.This measure, however, was not merely a government initiative but a result of the proactive and voluntary efforts of nursing assistants who sought change despite their precarious status and discrimination. Their sense of pride derived from their contributions to public health achievements and the opportunities for personal and professional growth that these roles provided.Public health workers on the frontline of community health managed public health ‘targets’ and ‘goals’ while navigating the challenges of their temporary employment status and managing personal risks. Although their work was highly visible and brought both risks and rewards, their capabilities and contributions were often undervalued or overlooked, influenced by their non-medical status and temporary employment. The ambiguity between non-medical and medical roles underscores persistent inconsistencies in the legal system over the past 50 years and continues to exacerbate conflicts.In this context, the history of nursing assistants―operating as non-medical personnel yet performing medical tasks―reflects a broader narrative of public health policy and labor history. It highlights ongoing efforts to hierarchize professional expertise and labor value, while simultaneously requiring the dismantling of such hierarchies for reasons of efficiency and cost.