Petersen, A. and Wilkinson, I. (eds) Health, Risk and Vulnerability 2008 . Abingdon : Routledge . X+ 165pp £21.99 ISBN 978 0 415 38308 0 (pbk)

The welfare state is the main mechanism through which we collectively act to protect the vulnerable. But sometimes this laudable goal is distorted by the process of delivering services. The theme of this book is based around the notion that individual vulnerabilities are constructed by and through the techniques of categorisation and classification employed by bureaucracies and institutions. In this sense the book offers new insights on the relationship between risk and vulnerability. In the introductory chapter the editors take us on a brisk tour of the risk literature. They make a number of bold statements in relation to risk and vulnerability, seeing the turn to debates on vulnerability as a reflection of an ever-broadening conception of health. They then set themselves and their co-contributors a challenge to ‘draw attention to the often unacknowledged socio-cultural and political significance of risk in the field of health and health care’, their aim being to advance understanding of the conjunction of health risk and vulnerability. Although the editors’ opening chapter is marred somewhat by a lack of clarity when discussing the concept of vulnerability (with a consequent knock-on effect on the discussion of the relationship between risk and vulnerability) I was in general in accordance with their basic premise and looked forward to reading the chapters that followed.

In Chapter 2 John-Arbe Skolbekken gives a by now standard account of medicalization risk and somaticization arguing that we are witnessing increasing medicalization of life through the pathologisation of normality. It seems that that risk factor epidemiology has side effects that construct individuals as vulnerable. There are important points to be found here but the material at times seemed overblown leaving the reader at the end with a rather weak metaphor for the pharmaceutical industry as a ‘spider’ weaving a web of interactions that medicalization is based upon. In Chapter 3, Joanne Warner looks at risk and vulnerability in mental health care and argues that the construction of mental health users as ‘risky’ is accompanied by the construction of the community as vulnerable. Here we have a clearer and more nuanced concept of vulnerability rooted in empirical work. With the construction of people as risky objects, social work may be increasingly caught between mediator and constructor of object while psychiatry is simultaneously creating a subject and advocating for the subject. In Chapter 4, Joos Van Loon discusses the sub-politics of teenage sexual risk behaviour and suggests the British Teenage Pregnancy Strategy (BTPS) is an exemplar of a form of governmentality that renders young people vulnerable. I found that the mixing of what appeared to be a limited quantitative analysis with discourse analysis was not entirely convincing and the chapter appeared to push the concepts of panopticism and the sexualisation of society to their limits.

In Chapter 5, Andy Alaszewski and Kirstie Coxon consider systems aimed at preventing clinical errors in the NHS. Reporting on an exploratory study of a joint NHS and Social Care Trust they highlight the possible harmful effects of well meaning initiatives in the context of hierarchical bureaucracies. These include disagreements over what constitutes an adverse event, disagreements over the purposes of the reporting system and suspicion/scepticism about a ‘no blame’ culture. They provide a lucid and interesting account of how compliance with reporting is related to levels of trust and professional hierarchies.

In Chapter 6, Jacquelin Davies and colleagues present a very interesting account of risk management in forensic mental health services using ‘ecological validity’ as a prism. Ecological validity refers to the problems associated with psychological experiments where the environment in which those experiments are undertaken may influence the outcome and lead us to question the generalisability of the findings. The authors suggest that we should consider the possibility of similar problems occurring in relation to risk assessments of mental health patients’ behaviour where those assessments are conducted in mental health units but are deemed to be applicable to life in the community.

In Chapter 7, Dawn Jones discusses women's perceptions of antenatal testing, drawing on an analysis of internet forums. There is a well informed discussion of the pros and cons of covert research in the context of the internet but Jones also presents an analysis that suggests that even within ‘reflexive modernity’ the women in her study still sought security and reassurance through recourse to science. In Chapter 8, Anthony Price examines sexual identities in cyber chat rooms. The chapter raises some interesting points in relation to how users of cyber sex media may be pathologised while also placing themselves at risk; but it suffers somewhat from the presence of seemingly loosely connected sections.

Finally, Pru Hobson-West discusses the risk discourse of a vaccine critical group in the UK and in doing so presents a thought provoking classification of how groups challenge and reframe dominant scientific discourses by stressing unknowns, questioning individual and community risk, highlighting how risk is manipulated, challenging the benefits of vaccination and focusing on vaccine-related conditions/side-effects. Such a classification may also be a useful framework for studying other groups, for example environmental campaigners, anti-wind farm groups, GM crop protestors.

Overall, I thought the book was based on an interesting linkage between the concepts of risk and vulnerability. The chapters presented some findings that indicated to me there is much here for sociologists to reflect upon and pursue in future research. The book will be of interest to those working in the field of risk and will be a useful resource for postgraduate courses. While I have reservations about some of the material contained in individual chapters I think the book was redeemed where authors addressed risk and vulnerability in ways that presented new and stimulating ideas.