A Review of Public Health: What It Is and How It Works, 3rd ed, by Bernard Turnock. Sudbury, MA: Jones and Bartlett Publishers; 2004. 420 pages, paperback only, $59.95 (call 978-443-5000 or see http://www.jbpub.com).

This excellent book is clearly intended for use as a textbook by undergraduate and graduate students. However, it is also an excellent general overview of public health for anyone-professional, academic or layperson-interested in the topic. It is well written, well formatted, and well illustrated, making liberal use of tables, graphs, charts, verbatim quotes from consumers, examples, case studies, and conclusions followed by discussion questions and answers at the end of each chapter. There are 9 chapters in all, followed by a glossary of key terms. The chapters include an overview of what is public health; understanding and measuring what we mean by health; public health and the health care system; law, government, and public health; core functions and public health practice; the infrastructure of public health; public health interventions; public health emergency preparedness and responsiveness; and future challenges for public health in America. Also included throughout the book are valuable Internet and Web-based resources for students to access; for example, Internet-based resources for courses based on this text are available at http://publichealth.jbpub.com/turnock.

Turnock opens in the preface with demonstrating that at the turn of the last century, it was not at all unusual for children to die of any one of a number of serious acute illnesses such as smallpox, tuberculosis, pneumonia, diphtheria, diarrheal diseases, scarlet fever, whooping cough, measles, and polio. The average life expectancy was 47 years. At the turn of the 21st century, Turnock says the average life expectancy is 80 years, and there are at least 22 different conditions for which we have effective immunizations. Childhood deaths have dropped more than 95% from their past levels (ie, this means that 19 of 20 deaths that once occurred in this nation no longer occur). In fact, when we do presentations (especially to parents or to employers), we warn them that little girls born today should be prepared to support themselves through the age of 100-125 and, thus, need a lot of education and training as well as huge life savings toward retirement and future health care/long-term care needs.

Because the story of public health is complex and not easily told, the author hopes to present for the reader a broad overview of the public health system in the United States: what it is, what it does, how it works, and why it should be important to all Americans. It has always seemed to us that public health has suffered from 2 major problems: it is difficult to get the public to understand the tremendous value of prevention and to prove the value of prevention in laymen's terms; and the public throughout history has tended to ignore and underfund the public health system until a catastrophe of some kind has forced them to focus their attention on it. As Turnock points out, most of the huge increases in life expectancy and the quality of life that we are currently experiencing have come about due to effective public health efforts, yet vast sums of money still flow to medical services while public health remains underfunded and underheralded. In a particularly illustrative paragraph, Turnock writes, "In the year 2003, there were nearly 900,000 fewer cases of measles reported than in 1941; 200,000 fewer cases of diphtheria than in 1921; more than 250,000 fewer cases of whooping cough than in 1934; and 21,000 fewer cases of polio than in 1951. The early years of the new century witnessed 50 million fewer smokers than would have been expected, given trends in tobacco use through 1965. More than 2 million Americans were alive that otherwise would have died from heart disease and stroke, and nearly 100,000 Americans were alive as a result of automobile seat belt use. Protection of the United States blood supply had prevented more than 1.5 million hepatitis B and hepatitis C infections and more than 50,000 human immunodeficiency virus (HIV) infections, as well as more than $5 billion in medical costs associated with these 3 diseases. Today, average blood lead levels in children are less than one-third of what they were a quarter century ago."^(p1-2) We don't normally quote the authors we are reviewing and we certainly don't add in long quotes, but it seems to us that Americans should be doing cartwheels in celebration of the successes of public health and the quality of life and reduction of suffering these have brought us.

The author has added lots of valuable charts to the book. One of the most interesting spells out the major eras in public health history in the United States from 1850 through modern times. Another is the selected history of public health activities in Chicago from 1834 through 2003, which really gives us a feel for the scope and the flexibility of public health efforts. It is also fascinating to compare the leading causes of death in 1900 to those in 2000; this brings into sharp focus the fact that we rarely die of acute diseases today, but rather of chronic illnesses and conditions that are mostly brought on by lifestyle choices. At the same time, Turnock points out that there are several unique features of public health (the underlying social justice philosophy; its political nature; its ever-expanding agenda as new issues and problems occur over time; its link with government; its multidisciplinary nature with biologic, physical, quantitative, social, and behavioral sciences; its focus on prevention; and the unique bond and mission that link its advocates (see page 14). Also discussed is one of the most important documents setting forth public health goals for the nation: Healthy People 2010. The charts comparing life expectancy by gender for the nations of the world challenge us to understand why the United States is so far down on the list; one possible explanation, we have always thought, is that we are a very heterogeneous nation (thus, it is difficult to even out health disparities caused by cultural and socioeconomic differences) while many other nations are relatively small and homogeneous. However, the United States continues to spend about 13% of its GDP on health care, yet, on most measures, falls far short of the health care accomplishments of other industrialized nations.

Turnock believes that there will be a gradual evolution of the American health care system (more managed care; better integration of services and financing; more accountability to those who purchase and use the services; more awareness of and responsiveness to the needs of enrolled populations; more effective and efficient use of resources; more innovative and diverse ways to provide health care services; more inclusive definitions of what health is; less focus on treatment and cure and more focus on wellness, prevention, education, and care management; more population-based management; and much more reliance on data outcomes and research evidence). Turnock even challenges readers to think about the interrelationship of managed care and public health issues in the future (see pages 127-128).

In one particularly fascinating section, the author lays out the drop in deaths despite sharp increases in vehicle miles traveled; this has been accomplished through seat belt use, airbags, and child safety and booster seats, although certain high-risk populations such as alcohol- and drug-impaired drivers, young drivers, and pedestrians continue to be at risk. Turnock includes for us the 10 commitments for great community health education programs as well as various coalition-building exercise scenarios. In one particularly important section, the author strongly links the planning and the evaluation processes, saying that one cannot go forward without the other. Equally important is the chapter on bioterrorism and how this has come to the forefront of public health efforts since the attacks of 9/11. These attacks may strengthen the public health infrastructure in many areas such as agriculture, food storage, food transport, and preparation, the transportation system, water and air quality, immunizations, and much more.

This book deals clearly and well with an increasingly complex and multidimensional, multidisciplinary field. The work is clearly a labor of love for the author, who does an excellent job of providing an overview and history of public health and all its moving parts. This is truly a challenging and thought-provoking book, and we recommend it highly.