Edited byand . Published by Sage Publications . Hardback , 328 pages . RRP $139.00 ISBN: 9781 4129 4879 1
Reviewed by Rosemary Aldrich
Hunter New England Health, New South Wales
If there is a need to be introduced to, reacquainted with or taught public health concepts as they relate to the UK, then Key Concepts in Public Health may well be a handy resource. However, because it relies so heavily to illustrate its ideas on UK histories, stories, structures, legal frameworks, champions, approaches and policy directions, it is less valuable for readers outside the UK. Its focus is entirely understandable – the authors wished to make public concepts alive with real case studies and illustrate responses to real public policy imperatives – but it is a bit of a shame because it is a very readable text.
The book has 50 chapters divided into three parts: theoretical concepts, practical concepts, and populations and public health practice. Each chapter is about five or six pages, into which is packed sections on definition, key points, discussion, a case study, a conclusion, and further reading; a format that makes it possible to get a very quick overview of the content presented. As with most general texts, the authors have tried to write an introduction useful to the majority of readers most of the time, and have crammed a lot in. Two areas of interest to me – health impact assessment and health governance, including how equity and policy considerations figure in both – receive some attention. The chapter on health impact assessment discusses the need to incorporate equity considerations into any program, planning or policy process (although the chapter on health planning does not). While governance is mentioned on only three occasions, there is strong sense throughout the book that leadership, structures for partnerships and shared responsibility for decision-making based on strong principles are necessary for gains in public health. In addition professional ethics and applied ethics are discussed, including concerning two key issues in public health – finding the correct balance between autonomy and paternalism, and recognition that “greatest good for the greatest number” may mean that the marginalised are left further disadvantaged.
The authors are sourced from a wide range of disciplines, reflecting the multi-disciplinary backgrounds of public health practitioners. There seems little evidence of the idea perhaps sometimes subtly promoted in Australia that ‘traditional’ public health is associated with those elements of practice undertaken by food or environmental inspectors and medical officers compelled by their training to view the health of the population through a determinants-of-disease lens, and that new or modern public health is the domain of others working with a determinants-of-health paradigm in which health protection and shaping health services and structures are relegated as an aside to the practice of real public health. Instead there are a number of simple explanations of how social, system, service and individual factors, differentially distributed, interact to deliver health outcomes in individuals and populations, communicating that there is both a need and room for a wide range of health professionals to work in public health.
The text does explore sensitive ground. There is a critique of the limitations of the initial theoretical underpinnings of the new public health, arguing that health promoters, in seeking to empower individuals to make healthy choices, transferred to individuals the blame for their health failure and inadvertently contributed to widening disparities in health status. This perspective is itself contentious, but does introduce the idea to the reader that it is healthy to think through the values and beliefs that motivate public health policy thinking and action, and their unintended consequences.
Minor criticisms include that chapters seem not always to be set out in logical order or cluster, so that sections appear rather hurriedly put together and without a coherent approach. This point is reflected at the end of chapter 3 – Determinants of Health – where the authors suggest that the reader “cross-reference” with “Chapters 5, 21, 22 24 and 34”. Other irritations include almost no mention of WHO's Commission on Social Determinants of Health, some inconsistencies between chapters written by different authors, simplistic or careless generalisations such as “people in lower socio-economic groups have unhealthy diets because.”, that the key points in some chapters are just the dot point headings addressed in the Discussion, and that some case studies tell a story while others set a task for the reader. Finally, a strength of the book is also a limitation: the chapters really are very brief, and the list of further reading at the end of each chapter is often very thin.
Notwithstanding these elements, the text is a fairly simple and a useful handbook for readers who wish to become familiar anew or again with public health concepts. I expect an Australian equivalent to this text would prove very popular.