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Book Reviews
Population Health: Concepts and Methods
This beautifully crafted textbook fills a long-empty niche in public health training. It provides between one set of covers a comprehensive introduction to all the quantitative methods for the assessment of population health status that the average health professional needs to know. Perhaps there's even enough for the non- epidemiologist Master's level student in programs designed to train health administrators, health promoters or occupational/environmental health specialists. Full-fledged epidemiologists may also find it useful in teaching basic concepts-especially to undergraduates or non-specialist graduate students. However, they would generally find the depth of methodological matters covered to be inadequate for training graduate students aiming for a career in epidemiologic research. The best thing about the book is its clear, simple explanation of almost every basic idea in epidemiology, and quite a few in demography and health economics as well as several other core public health sciences. The author has included (unusually but very helpfully in this era of multidisciplinary work) brief sections on complementary social science and qualitative approaches to public health, including the area in which he has graduate training-cultural anthropology (although he is better known as an epidemiologist). The whole effect is very refreshing and holistic-this is a book that can really be used to give a broad, if introductory, picture of how we know what we do about the health of populations. Another great strength of the book is the rich, up-to-date examples of all the main ideas presented, making use of text boxes and many fine figures and tables that please the eye. Furthermore, there are well thought-out exercises for each chapter, complete with model answers at the back of the volume. Not since Mausner and Kramer's book1 of 14 years ago has there been such a useful introductory text in this field. And the examples are not only current but also frequently Canadian-a great credit to the publishers, who are clearly aware that copies must be sold in the USA to recoup their investment! One word of warning-those expecting the title to imply that the entire book is a treatment of the ideas that have come to be associated with the term population health in Canada in the last decade will be disappointed. The author has covered these ideas, with appropriate citations of key works such as Why Are Some People Healthy and Others Not?2 But these sections only stretch to a few paragraphs here and there. Essentially the author uses the term population health to mean "the health of populations." However, this is not a failing: the book sets out to acquaint the student with a broad and comprehensive view of all the factors that influence the health of societies, as well as the basic methods for assessing it. In this, the author succeeds admirably. The big question is whether undergraduates in the health sciences would be given the timetable space to cover this essential material in most universities ... I doubt that most medical schools would do so. Yet a strong case can be made that all the ideas and techniques covered in this book are the bare minimum required for the intelligent practice of a clinical discipline in the early 2000s. Indeed, one cannot even read a general medical journal, let alone critically appraise research reports, without a mastery of the ideas in this book. Perhaps the very fact that these ideas have been so skilfully and attractively brought together by Kue Young in this volume will provoke a long overdue reappraisal of what core training of health professionals in public/community health should be. If so, then the author will have done us all a great service.
References 1. Mausner JS, Kramer S. Epidemiology. 2nd ed. Philadelphia: Saunders, 1985. 2. Evans RG, Barer ML, Marmor TR. Why are some people healthy and others not? Determinants of health of populations. New York: Aldine de Gruyter, 1994.
and
The fourth edition of the best known Canadian textbook of public health states that it has two purposes. The first one is to help readers learn about their role as health care professionals, administrators or policy makers within the health care system. Second, it is intended for anyone interested in participating in the ongoing debate on health care issues by providing the fundamentals of health and health care of Canadians. A glance through the table of contents shows that the book is meant to be comprehensive. For instance, it ranges from epidemiologic methods to the regulation of health professionals, from environmental health to the evolution of national health insurance. In particular, it attempts to give both methods and content: to describe the structure and function of subsystems within the health care system and, at the same time, give content information on the health problems that the subsystem faces. Not only is occupational health in Canada described as a system, but major workplace health hazards (of which there are a bewildering number) are then discussed in some detail. This pattern is repeated in several other sections. Compiling a book like this is a difficult task. The range of potential salient facts and observations is huge, and the information is changing rapidly enough in some areas to be outdated by the time publication occurs. Yet, with the comparatively small Canadian audience, it is important for the book to be as broad as possible. This means that the author must become a master of areas that are rarely considered together and where a detailed understanding of current issues in one area does not necessarily give insight into the others. Because the intended audience is made up of a wide range of different interests within the health care system, the author cannot easily sacrifice depth for breadth. On the other hand, when a book is in its fourth edition, the author may well have learned how to refine each section, paring it down to its essentials without loss of important detail. How well has this task been achieved in Public Health and Preventive Medicine in Canada? To answer this question, I took three stabs at accessing the book from the index backwards. My first try was not promising. The index heading "socioeconomic links to health" led me back to a discussion on the health effects of child poverty, called "psychosocial environment." The labels "psychosocial" and "socioeconomic" were used interchangeably here, with no discussion of the distinctions that are usually made between them or their complex interplay. On my second try, however, I hit pay dirt. Under "regional health boards - functions in Canadian provinces," I found a wonderful four-page summary table of the structure and function of boards by province. Although the information will change over time, it is an excellent entry point to the subject of similarities and differences in the decentralization of health care by jurisdiction in Canada and a very efficient vehicle for doing so. Finally, under "periodic health examinations," there was a four-page section that went to the heart of Canadian thinking in this area. In general, when the book is accessed in this way, the "hit rate" for getting the most pertinent information in the most efficient way is very high. When one table on a subject is given, it is a useful one and often the most relevant one. This was especially true in the areas of funding of health care and health care organization. My conclusion is that this is a book that has benefited from its author's accumulated experience over four editions. It is a refined and helpful resource. Perhaps the most difficult question to answer, though, is "helpful to whom?" Although the book is meant for a Canadian market of health professionals and general Canadian audiences, I think that it ought to be considered for international audiences as well. First, it could serve as a basic text in American schools of public health and health administration, where Canadian approaches are widely admired but often not understood in any detail. Second, it ought to be promoted among the 24 Canadian studies programs in other parts of the world, as a case study of how we organize our largest and most sophisticated public endeavour. Finally, it would be an excellent introductory reference for all the international visitors who come through on work-study tours. In this context, the most awkward problem with Public Health and Preventive Medicine in Canada may be found in its handling of the difference between how systems are officially said to work in Canada and how they work in practice. For instance, the section on occupational health describes a system with a great many more options and access points than the one that workers face on a day-to-day basis. The section on the evolution of health care in Canada does not adequately convey the degree to which political struggles between the federal and provincial governments actually steer the realities of the health care system. The danger here is in exacerbating something I would call the "Lalonde syndrome," which is the strongly held belief in other parts of the world that Canada's achievements in producing health are as great as the conceptual frameworks we create are imaginative. Yet, with this caveat in mind, Public Health and Preventive Medicine in Canada does provide an accurate portrait of a system about which we ought to be proud.
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Last Updated: 2002-10-20 |  |
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