Pergamon

Soc. Sci. Med. Vol. 45, No. 8, pp. 1311-1314, 1997 1997 Elsevier Science Ltd. All rights reserved Printed in Great Britain 0277-9536/97 $17.00 + 0.00

BOOK REVIEWS
Health and Societies: Changing Perspectives, by Sarah Curtis and Ann Taket. Arnold, London, 1996. 358 pp., U.S. $27.95 (paper).

This book examines changes in perspectives that have occurred in the study of health, health services and health policy. It identifies some of the cultural, socioeconomic and political factors that have led to these changes. According to the authors, there is no single body of theory which is adequate to represent or explain the complexity of factors relevant to health. Diversity of approaches and the importance of context are therefore critical in furthering our understanding of health. The book thus looks at health from an interdisciplinary perspective. Curtis and Taket provide evidence illustrating how the concepts of health and illness are to a large extent socially constructable. They argue that inequities in the provision of health care are a reflection of the unequal distribution of social and political power within societies. The book comprises 10 chapters. Chapter 1, "Changing perspective on health and societies: the example of medical geography," is an overview. It examines how the subjecl: has evolved from one dominated and informed by naturalist theories of disease and health to current humanistic, cultural and socio-ecological approaches. The authors use the development of strands of research in medical geography to illustrate the interdisciplinary nature, changing perspectives, and methodologies that have modeled our understanding of health. The second chapter, "Changing perspectives on the social construction of health, disease and illness," discusses contrasting views on the nature of health, illness and disease. The authors identify two main currents in the debat,,- on social construction of health and illness: the biomedical and socio-ecological models. Lay and professional views of health are contrasted. Examples of hysteria, homosexuality, and AIDS are used in the third chapter ("Contesting concepts of health") to illustrate how different concepts of health and ill health are not independent of social context. Examples are provided to demonstrate how gender, sexuality and race have played an important role in the construction of health. The fourth chapter, "Social and spatial inequalities in health," examines variations in health from the vantage point of medical geography. In that chapter, Curtis and Taket argue that much of the global and local inequality in health reflects the unequal distribution of political, social and economic resources in society. The next several chapters address a variety of social and policy issues. The fifth chapter, "Reforms in national health systems: changing strategies for equity and efficiency," focuses on health services within the framework of national

health systems. Health care systems in the U.S.A., Britain and Russia are compared. The sixth chapter deals with local dimensions of the delivery of health services. The suggestion is that the concept of territorial justice should be used to examine the allocation of health resources in relation to needs. Chapter 7 includes a discussion of the impact of public health models aimed at transcending the limitations of conventional health services. The case of Healthy Cities is cited as one way that local communities are acting to achieve health gains. Chapters 8, 9, and 10 include discussions of important policy issues. The formulation and implementation of health policy at both international and national levels is analysed in Chapter 8. In that chapter, the authors also explore the debate on the role of deeentralisation and lay participation in health policy. The ninth chapter details the role of international organisations concerned with health policy and health services. The origins of the World Health Organisation are discussed along with its structure and functions. The "Health for all by 2000" strategy is examined in detail in that chapter. The World Bank and its strategy, "Investing in health," is also used as an illustration of the important interplay between economic development and health. The tenth and final chapter, "Towards 2000: issues for a research agenda," briefly discusses some issues on which future research should focus. These include pluralism in approaches to disease, illness and health, globalism and interdependence of the determinants of health, the structure of health services, and power relationships through which health and the provision of health services are mediated in societies. The references in this book are fairly comprehensive, and much of the literature cited is up-to-date. The diversity of issues tackled tends sometimes to result in cursory treatment of some topics, e.g., methodological difficulties in the quantification of health. Nevertheless, Curtis and Taket have made a significant contribution towards a critical discourse on health. I especially found their arguments linking the dominance of Western medicine to capitalism, colonisation, and imperialism very interesting. The book also affords another perspective from which the dominance of biomedicine may be contested. Health and Societies is a good reference for all involved in research aimed at achieving greater public and lay participation in health policies.
Jairo O. Arrow Department of Statistics and Operations Research University of the North 262 Marshall Street Pietersburg South Africa

Urban--Rural Variations in Health and Health Services Utilization: An Annotated Bibliography, by Paulten Zijthoff, Robert Verheij and Dinny de Bakker. Utrecht-Nivel Netherland Institute of Primary Health Care. Nivel bibliography No. 50. 1994. 157pp.

This work is No. 50 in the series, it continues a tradition of the Netherlands Institute of Primary Health Care (NIVEL).

The volume is a very important reference for health care providers and planners as it provides the distillation of years of research work and experience. In the "Guide to the Bibliography," the authors state that urban status has important impact to health service utilization. This is specially true in today's world where urban-rural variations are highly relevant public policy issues, and inequalities in accessibility of health services are completely unacceptable.

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