Volume 23
Number 2
2002

[Table of Contents]

Book Review

Critical Issues In Global Health

Predicting the future with any accuracy is impossible.

For this book, Dr. Koop et al. asked international health experts from the government, private and voluntary sectors to provide their insights on the important issues facing global health in the 21^st century. Building on an assessment of past successes in health, the essayists in this book have offered their perspectives on critical health issues and their insights into what can be done in the future to improve the health of populations around the world.

The book is divided into three sections. The first provides an overview of public health situations in the major regions of the world. Six country-specific analyses focus on the US, China, Russia and India - representing the four largest population groups in the world - as well as on Canada and Mexico because of their inextricable links to the US. These essays hold no surprises for policy analysts or decision makers who are aware of worldwide public and population health issues. For a reader requiring a synthesis of the health situations in other countries, they offer readable status reports without delving into the academic. Worldwide issues range from the problems of infectious diseases (Africa), to poverty (India), to factors within personal control, such as tobacco use and obesity (Russia, US, Canada). On a smaller scale, health inequities exist not only between countries, but also within them: Canada's Aboriginal populations, for example, continue to face them.

The second section, "The Organizational Landscape in Global Health", was, in my view, the most interesting section. It highlighted pressing health issues, regardless of borders, and offered "crystal ball" predictions on the future of public health in the 21^st century. Building on the successes of public health interventions in the 20^th century, such as the development of vaccines for smallpox, polio and measles, the essays in this section focus on the influence of the determinants of health on future health outcomes. The essayists agree on common challenges for health: globalization of trade and economic issues; the advancement of technology, both its positive effects, such as the development of biomedical research, and its negative ones, such as the widening of the gaps between developed and underdeveloped countries; communication as key to health promotion and health education; and the involvement of the government, private and voluntary sectors in health advancement with a focus on community capacity. Many of the essays talked of the importance of meeting these conditions in order to achieve health for all in the 21^st century.

The key trends in the future of health are the continuing worldwide burden of chronic diseases, specifically cardiovascular diseases, partially due to the continued and increased use of tobacco. Aging populations, lower fertility rates, and growth in populations with sub-optimal health such as in India, where already malnourished girls give birth to low-birthrate babies, are demographic shifts that will also place a burden on future health advances.

I found that the essays in this section also offer the most hope for the future. They recognize a more holistic approach to health by acknowledging the importance of the interrelationships between the environment, social sciences, economics, alternative practices, nutrition, education, violence against women, and other factors. The essay on the "Relationship between Oceans and Human Health" intrigued me as a new area of exploration for integrating biomedical research with practical solutions.

The third section, "Organizations, Management, Leadership and Partnership" further discusses the synergies needed between the government, business and non-profit sectors in finding health solutions. These essays outline the important strengths and limitations of each sector and postulate that bringing them together will contribute to improvements in global health status.

The key things I liked about this book: it is not overly statistical and it strikes the right tone between academic and practical solutions, making it easy for anyone with an interest in health to understand. It contains important and insightful messages for university students, policy makers and decision makers. For those looking for a vision of public health, I recommend the opening essay of the book by Dr. Gro Brundtland. A true visionary, she offers hope that health inequities can be eradicated. I hope that there will be a check every 10 years or so to see what progress is being made.

Brenda Paine

Special Advisor
Office of the Assistant Deputy Minister
Public Health Agency of Canada
Health Canada
Tunney's Pasture
AL: 1916A
Ottawa, Ontario
K1A 0K9

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