The Health of Native Americans: Towards a Biocultural Epidemiology

By T Kue Young
New York: Oxford University Press, 1994; 275 pp;ISBN 0-19-507339-8

This book presents an excellent and extensive review of published literature related to the health of aboriginal people of North America. The information is presented as a case study to support the development of a biocultural approach to epidemiology. It attempts to bring together the fields of anthropology and epidemiology, providing many examples where unique genetic, environmental and cultural issues have an impact on health status and the effectiveness of interventions. Where appropriate, issues are generalized to all aboriginal peoples in North America, but the book clearly outlines differences between the many aboriginal communities in North America.

There are four major sections that discuss specific health issues: demographics and risk factor surveillance, infectious diseases, chronic diseases, and injuries and the social pathologies. Within each area, the extent and magnitude of the problem, the etiology, risk factors and prevention and control strategies are discussed. Mental health is discussed in the context of suicide, homicide, violence and alcohol and substance abuse. However, mental health is not addressed extensively otherwise.

The book is based on published literature and lists an impressive 813 references, most of which relate to studies undertaken in North American aboriginal communities. A strength of the book is its reliance on published evidence and the accomplishment of synthesizing this large body of literature. However, some will find that the book is overly dependent on published research.

The author covers a broad array of information, and within each section there is limited space devoted to detailed analysis of the studies reviewed. For example, the author summarizes numerous articles related to the prevalence of diabetes, but devotes limited space to the details of each study. The book provides an excellent starting point for many specific topics. Some readers will wish to review the original articles to gain a full understanding of issues such as study design in order to be able to compare the studies from different aboriginal communities.

This book is an important resource for epidemiologists, health planners, policy makers and health care workers who work with aboriginal communities. It also presents a compelling case for integration of epidemiology and anthropology in what Young refers to as "biocultural epidemiology."

Charles Mustard
Community Medicine Specialist
Indian and Northern Health Services
Medical Services Branch, Health Canada
Jeanne Mance Building, 11th Floor
Tunney's Pasture, Ottawa, Ontario K1A 0L3

Epidemiology: The Logic of Modern Medicine

By Milos Jenicek Montreal: EPIMED International, 1995; 335 pp; ISBN 0-9698912-0-2;
As Alvan Feinstein says in his foreword, this book is a tour de force in its synthesis of population epidemiology, clinical epidemiology and related fields. A big hardcover book in 8.5" x 11" format, it is handsomely designed, with good figures and with core concepts highlighted against a (rather too dark) grey background.

Because the book is intended to inform working doctors, its 10 chapters follow the sequence of medical tasks rather than that followed by most epidemiologic texts. After two somewhat philosophical chapters on health and health problems, there are chapters on identifying cases of disease, describing cases and diseases, the search for causes, the evaluation of treatment, studies of prognosis, meta-analysis and decision analysis.

The author offers many lists of criteria and ways to approach issues, drawn from various authorities where these have been published and based on his own approach where they have not. These are usually useful, but occasionally somewhat laboured. The book is heavily influenced by the thinking and vocabulary of Feinstein and, in my opinion, does not pay sufficient attention to the contributions of other key thinkers (e.g. Olli Miettinen on case-control studies).

The presentation of basic epidemiologic methods is often somewhat unclear (e.g. the description of types of incidence) and sometimes idiosyncratic (defining an epidemic as the occurrence of cases in excess of the confidence interval of an incidence curve). The English style is frequently awkward, e.g. some chapters have a great excess of commas. There are many typographical and spelling errors, only some of which are noted in the errata sheet provided.

The book is intended for undergraduate medical students and for practising physicians. I find it far too large to serve as a textbook for the former, and I suspect that it will be purchased only by the converted among the latter. On the other hand, I think that this book will be a valuable reference for epidemiologists, who will use it as an entry point to unfamiliar topics and will appreciate its huge numbers of references.

RA Spasoff
Department of Epidemiology and Community Medicine
University of Ottawa, Faculty of Medicine
451 Smyth Road
Ottawa, Ontario K1H 8M5

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