Reinventing Public Health: Policies and Practices for a Healthy Nation, edited by Lu Ann Aday, John Wiley & Sons, San Francisco, California, 2006, 400 pp, $55, ISBN 0-7879-7561-3.
Lu Ann Aday and colleagues introduce a new framework of public health assessment. In a very well-written seven chapters, the authors draw a clear picture of the analytical framework addressing fundamental social, economic, and ecological determinants of population health.
This book is the outcome of the Rural Economic and Community Health (REACH) partnership between the University of Texas School of Public Health, the Texas Tech University Health Sciences Center, and the Texas Department of Health, and other local and state health departments. REACH is also the origin of multidisciplinary contributors for this book including the editor Lu Ann Aday. Dr Aday is the Lorne Bain distinguished Professor in Public Health and Medicine at the University of Texas School of Public Health.
Readers should start reading this book on page 53 where the authors summarize the current US health policy, which gives eye-opening information to public health professionals: "The United States is the only country in the Organization for Economic Co-operation and Development (OECD) that does not have a national health care system[horizontal ellipsis]. [D]espite the United States spending far more than any other country in the OECD, its people's life expectancy ranked 21st among the member OECD countries and 24th in infant mortality in 2001." This information clearly highlights the importance of Aday's work, which proposes a new approach to public health assessment and intervention.
In the first chapter, the authors state the central thesis of this book: "to effectively improve population health and reduce health disparities, policymaking in a variety of policy domains must take into account the fundamental social, economic, and ecological determinants of health." Throughout the book, they acknowledge that this population health-focused policy vision has not been implemented in the United States, and it does not seem likely in the near future. The second chapter focuses on fundamental determinants of health, and proposes a modification in Evans and Stoddart's model on the determinants of population health. The authors connected individual health and behavior with social and physical environment, and included the idea of well-being and prosperity into the concept of population health. In the analysis of Evans and Stoddart's original model, the authors highlighted the fact that increasing investment in healthcare is not an efficient way of improving population health. This controversy was also stated in the foreword of the book by giving two exceptional examples of Costa Rica and the state of Kerala in India. One may add another country, Cuba, which accomplished an extraordinary success in public health without large financial resources. After focusing on sustainable development, human development, economic development, and community development in chapters 3 to 6, Aday's book concludes in chapter 7 by answering the question "how?" They present blueprints for the intersectoral local public health agency, population health-centered public health practice, and even a public health university. They mention "in order to achieve the success of an intersectoral public health system, public health training and practice require major transformation[horizontal ellipsis]. Public health practitioners need to be trained in promoting deliberative democracy, developing local leadership, respecting community interests and values, and motivating political action in order to facilitate positive changes in communities." This easy to read book will be a valuable reference for all levels of public health professionals, students, and academicians who look for a new perspective of public health.
Omur Cinar Elci, MD, PhD
Division of Community Health and Preventive Medicine, Brody School of Medicine at East, Carolina University, Lakeside Annex #3, Greenville, NC 27834. E-mail: [email protected]