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Heymann, J., Hertzman, C., Barer, M.L. and Evans, R.G. (eds) Healthier Societies. From Analysis to Action , 2006 . Oxford : Oxford University Press 417pp . £32.99 ISBN 0-19-517920-X (hbk)

This book derives from the Population Health Program launched in 1987 at the University of British Columbia, Canada. Initially, the Program focused on population health, and especially on how systematic differences in living circumstances embeded themselves in human biology. Of more recent years, it has turned also to inequalities at the level of the individual lifecourse, the neighbourhood and the community, always with an emphasis on policy at all levels. This volume is a synthesis of work by a multidisciplinary and international group, and demonstrates how wide-ranging and authoritative the Program has become.

The first part of the book addresses fundamental questions about the extent to which health is determined by biological and by social factors, and how the two interact. The first chapter, by John Frank and colleagues, provides an expert discussion of the role the social environment plays in determining the effect of genetic predisposition. The second, by Clyde Herzman and Frank, offers a clear description of the latest thinking about the ways in which social and cultural environments affect the development of the brain and other systems, and how this in turn influences such things as the immune system, hormonal responses, and defence systems in general. These chapters are particularly valuable in making the connections between social and biological sciences.

In an interesting chapter, Margaret Lock and colleagues then consider ‘local biologies’: and the ‘politics of suffering’: the way in which subjective experiences are influenced by cultural, medical and political influences in time and space. An authoritative account of the lifecourse approach to health and development by Clyde Hertzman and Christine Power follows. The section concludes with a chapter which gives due attention to medical care systems, while emphasising that improvements in healthcare alone are not enough to reduce inequalities.

Part II turns to more specific topics, showing how these relationships work out in different areas of life: a historical review of nutrition and population health, a well-balanced discussion of the relative effects of safer work conditions and increasingly unstable work environments, a more detailed look at the social environmental factors which distinguish geographical areas, and a chapter on income inequality and health at the population level. This last, by Nancy Ross and colleagues who include George Kaplan, James Dunn and John Lynch, is of particular interest, discussing current debates on, for instance, the difference between the US and UK, where income inequality is an important determinant of health, and Canada and Sweden, where it is less so, perhaps because of better safety nets.

Part III of the book then focuses on action: what would be involved in translating research findings into practical policy? Joachim Vogel and Tores Theorell look at a range of social welfare and labour policy models in Europe, analysing how the choices that different countries have made directly affect health. This is followed by a chapter on how the impact of economic policies on health can be measured, developing a new measure of economic wellbeing for the purpose (Lars Osberg and Andrew Sharpe). Then there are case-history chapters: a public policy experiment in Prince Edward Island, Canada, and child health policies in Canada, the US, and Norway. In a concluding chapter Alison Earle and colleagues provide a comprehensive framework for understanding the process of translating research into action, with a wealth of historical examples in different nations.

It will be obvious that this is a comprehensive and scholarly volume, to which a wide range of distinguished international authors have contributed. I began it with a slight doubt as to whether we really needed yet another book on inequalities to add to the shelves full of the subject, but found it difficult to put down. Two features which distinguish it from many other books in the field are the clear exposition of the latest thought on the interaction of biological and social factors, and the emphasis on policy and action. Something which particularly strikes a British reader is the relative absence of ‘social class’: is it possible that in this country the sociology of health inequalities has become bogged down, in the decades since the Black Report, in an obsession with the intricacies and categorisation of RGSC? There are, of course, historical reasons for this, but the range of personal and population variables which ‘social class’ stands for are dealt with here in a more straightforward and convincing way. This is an important book for policy-makers as well as researchers, and it is certainly the book I would use for teaching. I learned a great deal from it myself.