Edited by SanseeJirojwong, PraneeLiamputtong . Published by Oxford University Press , Melbourne , 2008 . Paperback 344 pages plus index ISBN 9780195560558 . RRP $69.95
Reviewed by Gwyn Jolley
South Australian Community Health Research Unit, Flinders University
This book is intended for undergraduate students of community and population health and health promotion disciplines. The book is divided into five sections: Theory and Concepts, Needs Assessment, Planning, Implementation and Evaluation. Each chapter begins with learning objectives and a list of key terms that are defined in side panels to the text throughout the chapter. A brief conclusion, critical thinking exercises, and a list of further reading and web-based resources conclude each chapter.
For a text aimed at undergraduates, I am not sure if was wise to begin with theory and concepts. This section is fairly dry and hard-going and while a text book is probably not intended to be read from cover to cover, a more lively introduction would help to set the scene for students new to the ideas of population health. That said, this section comprehensively covers the evolution and development of population health, primary health care and health promotion. More could have been said about Aboriginal health early on, for instance ABS data about life expectancy and self-assessed health status is presented without any reference to the gap in life expectancy between Indigenous and non-Indigenous populations. There is no mention of the WHO Healthy Cities initiative in the text although it is a topic in the reading list. The statement ‘The concept of PHC has been widely adopted in many developing countries …’ seems rather misleading if one is concerned with comprehensive PHC rather than selective or medical primary care. The explanation of ‘creating supportive environments’ seems narrowly focused on physical environments without mention of social, political and economic environments supportive of health.
The needs assessment section I found a little paternalistic in that the more recent terminology of strengths-based assessment is not referred to or described. In essence it is suggested that health professionals identify health problems and gaps and then prioritise problems and make decisions about which health needs should be developed. Program planners then use this information in designing health education and health promotion programs. There is little opportunity for community input and discussion of power differences between community and health professionals is very limited. The remainder of this chapter describes data collection methods which are applicable to many areas of enquiry not just needs assessment. Chapter 4 looks at the importance of cultural, emotional and spiritual understandings of health when considering Indigenous health and presents a useful summary of this complex area. There is a brief overview of some contemporary and emerging issues for population health — increased travel and mobility, re-emergence of infectious disease, societal changes and environmental factors. I found the final chapter on needs assessment of health professionals and stakeholders unclear in its structure and it seems to be bringing tougher too many disparate ideas. However, the conclusion provides a useful summary.
Moving into the planning section the content is clearer and likely to be of assistance to students planning a health promotion program. There is a suggestion that qualitative studies are more prone to bias and need skill and experience but no similar critique of quantitative studies. The check list seems somewhat arbitrary, for example it assumes a survey will be used to collect data; sampling, ethics and cultural appropriateness are not included. The chapter on human resources is oddly titled as it contains sections on use of key informants and community stakeholders. The issue of community participation in programs would be better served with a chapter of its own.
The section on implementation is strong with a good introduction, a thorough exploration of power differences with a focus on Indigenous health and some discussion of implementing services for culturally and linguistically diverse communities.
The evaluation section provides a clear but somewhat limited introduction to the purposes and types of evaluation. Realist evaluation is not included and program logic gets only a brief mention. I did not think all the learning objectives were met in this section — for example, students would not be in a position to develop outcome indicators after reading this book and data collection methods are not covered. There is a suggestion that quantitative experimental methods are the ideal and the qualitative methods are only suitable for formative evaluation. This ignores both the real world context of health promotion evaluation and the growing acknowledgment of the need for a constructivist approach to assessing community-based initiatives.
The strengths of this book lie in its breadth of coverage from theory, needs assessment, planning, implementation and evaluation. The structure of chapters supports its use as a text book, including definitions, further readings and resources, learning objectives and questions. The boxed case studies scattered throughout are useful aids to understanding. The editors (who are also the authors of a number of the early chapters) have many years experience teaching and conducting research in Australian universities and overseas.
The main weakness for me was the rather patchy treatment of the social determinants of health and the broader environmental focus. While some chapters achieved this, others reflected a more traditional view of health promotion as health education and behaviour modification programs.
Although this book would not be suitable to use as a stand-alone text, it would make a useful contribution to undergraduate studies for health professionals and should provide many opportunities for debate and discussion.