• Open Access

Public Health: What It Is and How It Works


By Bernard J. Turnock . Published by Jones and Bartlett Publishers , Massachusetts , 2008 , Paperback 522 pages plus index . ISBN 9780763754440 . RRP $93.95

Reviewed by Mark J. Ferson

Public Health Unit, South Eastern Sydney Illawarra Health, New South Wales

This is the fourth edition of a book first published in 1997, perhaps confirming the rapid expansion of fields and topics that fall within the broad definition of public health. The author has had a distinguished career in public health practice and administration, and more recently as a teacher: his current post is as the Director of the Center for Public Health Practice in the School of Public Health, University of Illinois in Chicago.

Although clearly written as a comprehensive textbook of public health, it can also be viewed as a form of advocacy for public health as a historical, yet complex and continually evolving endeavour. In his preface, the author reflects on how poorly public health workers really understand the field in which they are working and expresses the hope that those who read this book will gain a realisation of the breadth and hence importance of the collaborative effort we refer to as public health.

The text is divided into nine chapters, of which the first four discuss the basis of public health — what it is; how it can be measured and otherwise defined by reference to the health status and problems of populations; the relationship of clinical and preventative health services to public health; and the legal and governmental basis for public health services in the US. The final chapter describes future public health challenges in the American context, which nonetheless provide food for thought for public health practitioners working in any developed nation.

The intervening four chapters go into greater detail by essentially turning theory into practice. Chapters 5 and 6 describe historical and current public health practices in the US, and concentrate on organisational arrangements and on the human, informational and financial inputs required to deliver services. Chapter 7, entitled ‘Public health interventions’ uses multiple examples to outline processes by which interventions might be designed around need and evidence of what works, together with a structure for management and evaluation. Chapter 8 entitled ‘Public health emergency preparedness and response’ not surprisingly gives special attention to bioterrorism and homeland security, but does have relevance for the situation here. This is not solely because of the pandemic threat of novel influenza H1N1 infection at the time of writing, but because the principles of public health emergency management are now well-accepted internationally and processes and exercises described in this chapter are valuable aids to learning.

Despite the largely American content and orientation of the book, it does provide a comprehensive course in public health. Chapters provide a good mix of theory and practice, while the author utilises specific examples to illustrate each chapter and make each lesson more concrete. These examples or ‘spotlights’ summarise a particular problem and intervention or institution. My interest in both public health history and infectious diseases epidemiology was satisfied by reference to spotlights on, for example, the establishment of the CDC, control of infectious diseases and HIV screening. The author strikes a sensible balance, and other spotlight topics cover tobacco control, cardiovascular disease and injury prevention, among others. The book also has a useful glossary and a good index. An innovative feature is the associated website http://publichealth.jbpub.com/turnock/4e/, which provides a variety of free student resources, including key public health websites and on-line access to video and slide presentations and reprints of milestone reports (e.g. Chadwick, Snow on cholera, Koch on tuberculosis). The book and website both provide discussion questions for each chapter, while the website provides resources for teachers, access to which requires application to the publishers.

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