by Gavin Mooney . Published by Zed Books , London UK , 2012 . ISBN 9781780320595 ; 224 pages .

Reviewed by Sharleen O'Reilly

School of Exercise and Nutrition Science, Deakin University, Victoria.

Healthcare systems worldwide are in crisis with rising rates of ill health and a growing gap between the poor and wealthy. Neoliberalism has influenced the development of modern healthcare systems and had a negative effect on the overall health of populations as a result of its focus on benefitting individuals rather than communities. In this environment, public health spending is cut back to the detriment of those who need it most, whilst private healthcare is supported to provide quality healthcare only to those who can afford it. Budgetary cuts generally come at the expense of the primary determinants of health because political gains are focused on the short term and propping up the healthcare system is a quick “Bandaid solution” to an open, gushing wound.

Enter Gavin Mooney, who held honorary Professorial positions at Universities of Sydney, New South Wales, Cape Town, Southern Denmark and Aarhus. Mooney was well placed to provide commentary on the phenomenon of neoliberalism and potential solutions to improve the problem with over 40 years’ experience in health economics around the world. Sadly, he passed away in December and the public health community will miss his voice as a strong advocate of community engagement and citizen juries underpinning healthcare decision-making to reduce inequalities in health.

His book uses a case study approach and is broadly divided into three sections: what neoliberalism is and why it ‘kills’; the negative impact of neoliberalism on healthcare delivery; potential solutions that have generated population health gains in different countries. His writing style was clear and persuasive, using a tone that coaxes the reader along on his journey. The author was obviously passionate about neoliberalism being the root cause of healthcare system failure and advocated strongly for the ideal of communitarianism being the treatment that should be prescribed.

Mooney was critical of the pharmaceutical industry, medical profession unions, World banking institutions and political decision makers’ roles in worsening the health of the World's poor. He challenged neoliberal assumptions directly and had a ‘no-holds-barred’ approach – his assessments will generate debate amongst the medical profession, health economists and public health practitioners in some instances. The text presents its salient points in an easy to read manner, supporting reader engagement.

His analysis of neoliberalism, and possible solutions, bear serious consideration. The mounting pressures on underfunded healthcare systems, deteriorating population health and burgeoning impact of global warming on the marginalised poor are problems that continue to worsen in the current political climate. One only needs look at the recent budgetary cuts in Queensland – decimating their much-envied public health nutritionist, indigenous nutrition promotion and health promotion workforce – to see that tackling the primary determinants of health and closing the gap between indigenous and non-indigenous peoples are political ‘optional extras’. This book will serve as a useful and thought-provoking text for anyone interesting in thinking about how healthcare and health policy might be shaped to reduce health inequalities. It will have a broad level of appeal within public health and takes a much-needed global approach to the issues and solutions put forward.