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Book Review
Social and Behavioral Foundations of Public Health
Coreil J, Bryant C, Henderson J, with contributions from Forthofer M and Quinn G.
ISBN: 0-7619174-4-6 2001 376 pages Sage Publications, Thousand Oaks
Helen Keleher
School of Health and Social Development, Deakin University, Burwood, VIC
This book is based on a multidisciplinary approach to public health that is developed by drawing on perspectives from a number of social and behavioural sciences and integrating them with epidemiological public health knowledge. The authors structure their analysis of public health in relation to three conceptual frameworks: the 'Social Ecology of Health Model', the 'Health Impact Model', and the 'Causality Continuum'. These are applied at various points in the book to highlight central themes of the book - the analysis of public health problems within multilayered systems perspectives, socio-cultural contexts of health and illness, and the complex, multifactorial genesis of health problems. Very early in the book, the authors distinguish their socio-ecological, socio-cultural and systemic analysis from that of risk-factor approaches to public health. Nonetheless, there is considerable discussion of socio-behavioural approaches to health problems which are more aligned with risk-factor approaches than socio-cultural or socio-ecological approaches to understanding health.
The book is organised into four parts. Part I consists of an Introduction and an Overview that provide historical perspectives and a rationale for the study of health and behavioural factors in relation to health and public health. Part I also includes a chapter that introduces social epidemiology. Part II, 'Conceptual Foundations', is organised into three chapters that address health and illness behaviours, the social environment and health, and social differentiation, cultural diversity and community health. Part III examines socio-cultural responses to illness, and here some concepts and interventions from health promotion are covered, with one chapter devoted to community interventions and another to social marketing. Part IV provides a chapter on each of four 'Special Topics': 'Health Behaviour in Developing Countries', 'Food and Society', 'Public Mental Health', and 'Public Health and Ageing'.
The book is written more for graduate level students than undergraduates as the language is moderately technical, although upper-level undergraduates may find it helpful. As an Australasian reference book its usefulness is limited by its USA focus. Nonetheless, the conceptual foundations that link understandings of social and behavioural health to public health have applicability across countries and systems. For example, while the book challenges public health systems in the USA about their inadequate responses to key social conditions that contribute to poor health, an Australian readership is likely to find strong parallels.
Overall, I found the book deficient and uninspiring because it lacked a clear and integrating standpoint in relation to public health values or justice in health. And though the authors do acknowledge the concerns of vulnerable populations in public health, they do not explain the social foundations of such concerns. Further, while health promotion is discussed in terms of community-based approaches - such as the 'Planned Approach To Community Health' (PATCH) model and social marketing interventions - it is not discussed within a socio-political context as it is in the Ottawa and Jakarta Charters for Health Promotion, for example. I would have liked to see an expanded discussion of the determinants of health and health promotion interventions. This could have been provided in relation to the chapter on social epidemiology that examines and explains proximal, intermediate and distal factors that determine health. Evidently, the authors did not see such a connection.
The strengths of this book are its conceptual frameworks. They successfully integrate social science and public health ideas to guide research into the determinants of health. There is, however, limited guidance to interventions that seek to influence or change socio-cultural, political or economic determinants of health which are fundamental in understanding and practising public health.
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