Book Reviews
Health Social Science: A Transdisciplinary and Complexity Perspective
Nick Higginbotham, Glenn Albrecht and Linda Connor
ISBN: 0-195507-87-8 2001 408 pages Oxford University Press
Carol Grbich
School of Medicine, Flinders University, Adelaide, South Australia
One of the greatest problems we face in health is how to transmit information and education to those who suffer the worst levels of health in our community. These people tend to be in the lower socioeconomic groups and also appear quite resistant to taking on the carefully prepared information made available to them by middle class health professionals.
We have known for some time that success rates in health promotion have not been high with these groups but we have tended to put this down to the fact that those in lower socioeconomic situations will always be slower to take up suggestions until these have been adopted as mainstream by the rest of society. But we have never really had the tools or knowledge to understand why this is so. This text is the first in the health field to attempt to probe such problems from new and creative perspectives.
So what is a transdisciplinary approach; how does it work? And where does complexity fit in?
The focus on the transdisciplinary brings together Australian academic authors from environmental sciences, clinical epidemiology and biostatistics, medical anthropology, public health and community medicine. The major focus is clinical epidemiology but the incorporation of other disciplines allows explorations to go beyond this and beyond the range of disciplines involved. What does transdisciplinary mean, for example, in terms of coronary heart disease or the use of pharmaceuticals? In brief it links biological and social, but the additional focus on complexity allows the development of open systems, removing linearity to permit the view that subcultures (named here as ‘respectables' and ‘larrikans') interpret information and education programs differently. These differences can be seen in an interpretation of heart disease in a study in the Hunter Valley coalfields.
The book is divided into three parts. Part 1 justifies the transdisciplinary/complexity orientation, while Part 2 moves on to apply these foci in two case studies covering heart disease and pharmaceuticals before progressing to the operation of transdisciplinary teams and research implications. Part 3 explains in more detail how to conduct research using transdisciplinary methods for epidemiological study designs, qualitative designs, combined methods, qualitative case control and case study designs.
I found the transdisciplinary/complexity approach in the Part 2 case studies very exciting if somewhat in need of updating (epidemiologically speaking), and I would love to have seen many more of these case studies explicated and explored. Part 3, which is really about research methods, fits into the orientation of the book, but Parts 2 and 3 could well have been extended to become texts in their own right. Part 3 is valuable in that it clarifies the variety of approaches that can be used to explore a particular phenomenon and this in itself is useful for budding researchers.
On the downside, this book was published in 2001, and for today's readers many statistics appear very much out of date, being mostly from the 1980s and 1990s. The usefulness then lies not in the epidemiology but in the creative manner in which the case studies have been approached, and the suggestions for what has always been a difficult issue: how to combine different disciplines as well as the application of complex system theory to health problems.
The target audience is students, professionals and practitioners with a social science background such as psychology, sociology and social work, as well as clinical epidemiologists, and those in change management, health policy and project management.
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