• Open Access

Public Health for an Aging Society


Edited by Thomas R. Prohaska, Lynda A. Anderson and Robert H. Binstock . Published by the John Hopkins University Press, Baltimore 2012 . ISBN 9781421404356 . 456pp

Reviewed by Rhonda Nay, Australian Institute for Primary Care and Ageing, La Trobe University, Victoria

The editors of this book are well read in public health and ageing – in particular, Robert Binstock (1935–2011), who made a significant contribution over a long career and is well respected in the ageing field. This book builds on previous editions to acknowledge progress that has been made and anticipate new challenges that ageing presents to public health policy and practice. The purpose is to promote discussion across research, practice and policy. The book provides definitions of public health and points to the complementary nature of differing approaches, and the need to consider public health from varying perspectives to enrich understanding and improve policy and practice. Critical issues for public health, such as the re-emergence of infectious diseases alongside the chronic ill health epidemic, are identified. Not surprisingly inequality/disparity remain the major risk factors to be addressed.

The role public health can play is illustrated with life span examples such as cardiovascular disease being reduced by exercise, diet and not smoking. Importantly, however, the authors argue that public health measures influence life quality even into very old age. Branch et al. in Chapter 6 support primary, secondary and tertiary public health approaches. The latter is most relevant to address chronic conditions and associated disabilities. A major gap awaiting public health initiatives is that of disability related to arthritis.

While the book is very focussed on the United States, the challenges of how to finance health care and meet the workforce demands are relevant to the rest of the world. In particular, the ageing of the workforce and the role that assistive technologies can play in supporting self-care, and reducing hospital presentations and costs, will be of interest to policy makers and industry. Furner and Anderson in Chapter 4 provide a useful table of commonly used health-related quality of life measures. They also illuminate the need for better linked and accessible population data.

The broader public health initiatives noted by Wallace (p.113) at least should be questioned as we move forward and seemingly become more and more regulated: where is the balance between the right to take risks and health care costs?

Prohaska et al. discuss implementation and knowledge translation approaches in Chapter 8. They move from primary research through systematic reviews across dissemination, translation and sustainability. I would recommend that this chapter in particular, is essential reading for government, industry and practitioners.

Support for caregivers including structural changes are addressed in Chapter 9 and the essential ingredients of social engagement to healthy ageing in Chapter 10. I would have liked some recognition of the difference between aloneness and loneliness – engagement and participation can have many guises and must be individualised. Engaging with memories may be more important for some, especially in very old age when family and friends have all gone and/or dementia is constraining the life experience. Indeed, given the dementia epidemic I was surprised it did not rate a chapter.

Frieden's ‘health impact pyramid’ is presented and promoted in Chapter 11. This model changes the context to make healthy decisions easy. The chapter on technology is especially relevant in an environment of increasing demand and reduced workforce. Adoption by general practitioners (GPs) will, of course, require good business incentives.

In relation to the workforce I was interested to see the emphasis was on the usual suspects (GPs and nurses) but that some of the allied health practitioners I would see as at the forefront of primary health were not highlighted. While social workers get space, little is said about the role physiotherapists and occupational therapists play. Perhaps my experience is too limited but I think social workers are more likely to say “you need placement”!

Disaster preparedness is a new and contemporary topic. The deaths of older people in fires, floods and heat waves are all too familiar and too often avoidable with good disaster plans.

Overall, I found the book very readable, with a wealth of important public health discussion and information. I would like to recommend it for all pre-entry health practice and policy courses. However, I know crowded curricula will reduce the likelihood of this occurring. At the very least it should be a reference text. My only major criticisms are the lack of attention to dementia, and that it is very US-centric. Situating the ideas more globally (and not just in the last chapter) would have made a great book even better!

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