Social Inequality and Public Health . Bristol : The Policy Press , 2009 £19.99 xii + 243 pp . ISBN 978-1-84742-320-7 ( pbk )( ed .)
This collection, edited by Salvatore Babones, presents an overview of a wide variety of issues in health inequalities, both national and international. The book ‘…emerged out of conversations held at the 2006 Pitt International Conference on Inequality, Health and Society’ (p.vii). However, the editor stresses that this is not simply a collection of conference papers, and that most chapters have been written specifically for the book. Whilst not a detraction, the book’s origins perhaps explain the slightly eclectic mix of methodological/theoretical and empirically-based chapters. The book deliberately sets out not to include too much in the way of complex analysis and statistics, and is therefore suitable for a wide audience with interests in inequality, public health and social epidemiology.
The chapters include some extremely well-known examples of health inequalities research, such as Eric Brunner’s overview of findings from the Whitehall II Study on work-related psychosocial factors, and a review from Richard Wilkinson on the population impacts of unequal societies. Also included is a broad selection of pertinent topics, such as a useful review of the role of time preference/time perspective on health behaviour; how we perceive our future prospects seems highly significant in determining our current behaviours. Other examples include a discussion of the role of non-governmental organisations in health reform in Chile and Uruguay, and an analysis of increasing health inequalities in post-communist Central and Eastern Europe. The discourse is certainly not restricted to an epidemiology/health services point of view. For example, one chapter focuses on the role of urban planning and sustainable communities, while in another Siddharth Chandra, an economist, presents a theoretical model relating inequality, individual identity and violence. These chapters come together to produce a fascinating collection of issues in modern public health research, policy and practice. As Babones suggests in the introduction, the ‘new’ public health of the last couple of decades, and the subjects addressed in the book, represent a welcome return to a focus on wider socio-economic and political impacts on health and inequality, relative to the individualism predominant for much of the 20th century.
The book is interestingly structured, with four sections on different ‘pathways’ to inequality: individual behaviours; group (dis)advantage; psychosocial factors; and ‘healthy and unhealthy societies’. The stated intention is that these pathways become more contentious and contested as the book develops, and this neatly leads the reader through to three concluding chapters under the heading ‘Public understanding of the new public health’. These last three chapters are broad in scope, and certainly go a long way beyond simply understanding inequalities in health through social epidemiology. The first argues for increased public health advocacy, particularly the education of individuals about inequality and what affects the health of populations (as distinct from education of the public about individual health and behaviours). The second takes a global perspective on health inequalities, and discusses the Millennium Development Goals in comparison with developments in the international human rights arena. Finally, Babones concludes the book, drawing together brief summary comments on the rather disparate chapters, and adding weight to the argument for educating the public about inequality and public health as part of a democratic push for solutions.
This is not a comprehensive guide to social inequalities in public health (a very much larger volume would be required to fulfil that purpose), but the book does present a very accessible round-up of a selection of issues, some general, some specific, some relevant to particular parts of the world, others of global significance. The variety of topics covered is a positive aspect, and this reviewer certainly found a number of novel and stimulating issues and arguments to digest. Each chapter of the book stands alone quite effectively, meaning that reading from cover to cover in sequence is by no means essential. However, the evolution of the book’s sections, from influences on individual health behaviours to more ‘wide-scale’ and arguable determinants of health inequalities does work well. Some of the book consists of relatively mild-mannered reviews of methodological and empirical issues. The take-home message, however, is more provocative: existing and growing internal and international social inequalities are morally unacceptable, bad for us all, and we are challenged to be proactive in addressing them.