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Book Review
Understanding health: A determinants approach
Helen Keleher and Berni Murphy (eds)
ISBN: 0-1955166-1-3 2004 361 pages Oxford University Press, Melbourne
Bo Burström
Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, Stockholm, Sweden
Understanding health: A determinants approach sets out to provide a comprehensive introduction to the determinants of health to undergraduate students in different health and health-related disciplines. It is written so as to be accessible to newcomers in the field. One distinctive advantage of the book is that it shows the complexity of health and incorporates specialists from different disciplines. The focus on determinants of health also demonstrates logically the need for multisectoral action and multiple approaches when working to improve health.
The editors have included chapters on social, environmental and biological determinants of health, on population health and health in specific groups and health promotion approaches to areas like illicit drugs, alcohol, tobacco and physical activity. Social exclusion is discussed both as a concept and in relation to specific groups who might be more vulnerable to exclusion. The different approaches and principles of health promotion and disease prevention are also presented extensively and there are several good examples of how the theoretical concepts in health promotion may be applied in practice. There are also examples of actions at different levels of implementation. For instance, in the chapter on health promotion in action, the concepts of the five action areas of the Ottawa Charter for Health Promotion are shown in a table illustrating how they might apply to different health promotion activities in practice in a very concrete manner (p.175).
The text is backed by ample, recent references to scientific papers, relevant text books and policy documents, and the book compares well with other European books in the same field. Undergraduate students who master the contents of this book will surely have a good basis for understanding different determinants of health and health promotion approaches.
The emphasis of the book is on health promotion and disease prevention, but many important perspectives on health equity, social and economic determinants of health, physical and psycho-social factors concerning workplace health are also addressed. It seems particularly important to provide these broad perspectives early to undergraduate students and newcomers to public health, to provide a structure in which their further knowledge can be placed. It may be challenging to be a new student to the area of understanding health and health promotion from a determinants approach, but the book does a good job at introducing the issues. The book also addresses more recent topics that are not always dealt with in other books in the same field, such as migrant health, health issues among homosexual groups, social exclusion, healthy ageing. These are all issues which are likely to become more important in the future, and which may require new and innovative health promotion approaches. The chapter on disability is also important, since it demonstrates the interactive nature between the individual and his/her environment, also in the social and economic consequences of disease. The degree to which a functional impairment results in a handicap very much depends on the degree to which the environment hinders or facilitates the person's participation. Many of the case studies, examples and data provided come from Australia, although there are also examples from other countries and regions. Each chapter ends with a summary of the key points and concepts which have been addressed, and suggests discussion topics for further reflection based on the knowledge gained. The chapters also provide useful web site addresses with further information for interested students.
The editors are co-authors of several of the chapters, with additional contributions from a number of authors, most of whom are based in Australia, including John Catford (editor of the journal Health Promotion International) who contributes in two chapters. There are also chapters by authors from other countries, such as Damien Ridge (at Oxford University) who discusses social determinants of mental health for young same-sex attracted men. Bernie Marshall's chapter on health promotion in action provides good examples from Australia of various health promotion strategies and initiatives.
If there are amendments to wish for in a second edition, I would welcome a more thorough review of social determinants of health and on social differentials in health, as these are fundamental underlying factors both for the production of ill health and disease and for the distribution of health in populations. Some of the chapters at the end of the book might have a more logical place in the first part of the book (e.g. grouping the chapters on social exclusion and workplace health with those on social determinants).
A book with such an all-encompassing approach directed to such a wide audience naturally runs the risk of becoming shallow. Although it may be difficult to confirm the statement on the back of the book that it 'provides all you need to know about health', it does supply many interesting insights which are presented in understandable language to a wide audience. The book is a very good, up to date introduction to understanding health from a determinants perspective for students of public health and health promotion.
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