Pergamon Healrh & Plocr, Vol. 1. No. I. pp. 6%7.5, 1995

Elscvier Science Ltd

Printed in Great Britain

1353-X292/95 $9.50 + O.tX)

Book reviews

Locating Health: Sociological and Historical Explorations S. Platt, H. Thomas, S. Scott and G. Williams (eds) Avebury Aldershot (IYY3) 235 pp

This volume is part of the British Sociological Association’s Explora- tions in Sociology Series and consists of revised versions of I1 papers that were originally presented at the asso- ciation’s 1991 conference on Health and Society. The editors’ most ob- vious concern is to broaden the de- bate on health inequalities by show- ing that variations in health are pat- terned according to a number of different social locations besides the positions of class and economic activity which have traditionally dominated the discussion. There is a

feeling, however, that the editors have an additional concern-the sta- tus of health-related research within sociology. Whilst the social distribu- tion of health was once of consider- able importance in sociology, the subject now occupies only a marginal position within the discipline. To try

and improve this situation, not only does the book emphasize the import- ance of sociology for health, but it also attempts to emphasize the im- portance of health for sociology and a number of the papers focus as much on what health tells us about society as what society can tell us about health.

Whilst the main title of the volume has a distinctly spatial connotation, the sub-title indicates that the main emphasis of the collection is on locating health in terms of its social and historical positions rather than anything more explicitly geographi- cal. Its undoubted strength is that the papers do place the discussion on health inequalities within a much broader and more holistic framework than usual. This framework consists of a re-conceptualization of the tra-

ditional position of social class

together with the recognition of the importance of other social locations. such as age and gender, which are obviously not new concerns in sociol- ogy but which have tended to be ignored in relation to health ine- qualities. In addition, ‘newly emer-

gent locations’ such as consumption and lifestyle are incorporated and there is also a realization that peo- ple’s lives are constructed around a number of different locations simul- taneously. Consequently, the collec- tion does constitute a diverse and complex representation of the societ- al nature of health. It should be noted, however, that whilst many locations are considered the majority of attention (five out of the eleven papers) focuses on differences re- lated to gender and none of the papers are concerned with the pat- terning of health according to race. Besides this detailed sociological emphasis, the collection also prom- otes the importance of a historical perspective and four of the papers illustrate how the societal nature of health is always formed within par- ticular historical contexts.

Geography, however, is not com- pletely ignored. ‘Place’ is recognized as one of the ‘newly emergent loca- tions’ and papers by Peter Phillimore and Rory Williams emphasize that social and historical processes re- lated to health are geographically sensitive and do not necessarily work out the same way in all places. Philli- more’s paper outlines the large dif- ferences in mortality between

working-class areas in Sunderland and Middlesborough and explores some of the ways in which these two locales, whilst appearing similar, may in fact be quite distinctive. Wil- liams’ work considers a number of place-specific factors that led to Clydeside having a very different historical and contemporary health

experience from the rest of Britain. As well as these explicitly geo-

graphical chapters, the paper by Richard Wilkinson also suggests the importance of place, as his work on life expectancy emphasizes that what matters in the developed world is not

our position on absolute standards but our position in relation to those around us. Whilst this work is con- ducted on a national scale it must have implications in terms of the importance of propinquity at other scales of analysis.

By bringing into focus a number of neglected locations (particularly gen- der) the book does succeed in revita- lizing the debate on health inequali- ties. Some of its claims, however, are certainly overstated. It is declared that morbidity will be the focus. yet four of the papers are concerned with the analysis of longevity and mortality ratios. It is also suggested that the theoretical and conceptual bases of the subject are re-worked. While this is true, it is only practised in a traditional empirical model- building fashion and, with one par- tial exception (the final chapter by David Smith and Malcolm Nicolson on the twentieth-century discourse about the diet of the working class).

the papers do not reflect the recent substantial theoretical developments within social and cultural theory. Like most of the work on health inequalities, this volume is based around the development of concepts through empirical testing and there is little sense of a more fundamental theoretical reflexivity.

Finally. it is proclaimed that new methodological approaches in the examination of data are developed. The overwhelming majority of the papers, however, use simple descrip- tive statistics to summarize routine data sources.

In summary, this book is both interesting and valuable. However,

Book reviews

it is only partially successful and given also the inclusion of some obscure and highly specialized topics (for example, occupational health in the UK gas industry and health issues in male early retirement) and the exclusion of other more signifi- cant ones (for example, there is no mention of mental health) it should perhaps be regarded more as a useful reference for those who are resear- ching particular dimensions of in- equality rather than as a comprehen- sive and substantial key text.

Craig Duncan University of Portsmouth

The Determinants of Population Health: A Critical Assessment (West- ern Geographical Series 229) Michael V. Hayes, Leslie T. Foster and Harold D. Foster (eds) University of Victoria Department of Geography Victoria (1994) 228 pp $20.00 Canadian (paper) plus ship- ping ($25.00 total available from De- partment of Geography, University of Victoria, attn: Dr H. D. Foster)

In 1993, a symposium was held at Simon Fraser University’s Harbour Centre campus to ‘stimulate discus- sion . . . about the population health approach to understanding the “de- terminants of health” ‘. The sympo- sium focused on a document pro- duced by the Canadian Institute for Advanced Research (CIAR) entitled The Determinants of Health. Selected participants were invited to respond to the CIAR document. This edited volume is the permanent record of their comments.

The editors have done an excellent job of organizing the chapters in a logical format. Chapter 1 lays out the background for the symposium. The CIAR document is presented by J. Fraser Mustard and John Frank in Chapter 2. The remaining chapters are grouped by concepts of society underlying the CIAR document (Chapters 3-5), the rules of evidence (Chapters 6 and 7), and social policy implications (Chapters S-11). For in- terest, the editors interspersed five historical black and white photos from the British Columbia Archives

and Records Service throughout the volume. These provide wonderful places to pause and ponder how Western societies have changed in their practice of public health over time.

Typical of edited volumes, the chapters span a wide variety of view- points and writing styles. For exam- ple, Nicholas Blomley provides a polemic in Health, Society and Geography, arguing that the CIAR document is morally charged and lacks both a social model and geog- raphic sensibility. This is the stuff that stimulates discussions among graduate students, but it is unlikely to interest those outside of academia. In contrast, McCarron, Tenenbein, and Hindley provide a comprehensive discussion of ‘home’ in Communication, Belonging and Health. This is a topic anyone can relate tea comfortable way of looking at determinants of health. Completing the section on concepts of society, Harold Foster tackles Health and the Physical Environ- ment, pointing out the direct and indirect effects of air and water pollution, hthospheric alteration, and biosphere decline on human health.

The two rules of evidence chapters include Evidence, Determinants of Health and Population Epidemiolo- gy by Michael Hayes and An In- tegration of Quantitative and Qual- itative Approaches in Health-related Research by Susan Elliott and Jamie Baxter. Hayes notes that the CIAR document identifies shortcomings in data gathering, but fails to address the fundamental questions of who or what gets counted, why, how and by whom. Indeed, health research is dominated by data gathering and analysis in order to determine risk. Rarely does it question ideology, epistemology, or philosophy of method. Given the empirical nature of most health research, Hayes feels the CIAR document’s call for in- tegration of qualitative and quantita- tive social sciences to understand health is misguided. Elliott and Bax- ter counter Hayes by laying out a combined qualitative and quantita- tive health and well-being research project carried out within the posi-

tivist paradigm. They note that both qualitative and quantitative methods are useful tools which can enhance our understanding of the determi- nants of population health.

Paul Pallan and Leslie Foster lead the policy section with Integrating Health Determinants into Policy. The authors call for developing inte- grated health and social policies based on good information, educa- tion, support and commitment, structures and incentives, and a plan of action. Richard Hudson takes on the culture of medicine in Can Health Care Become a Determinant of Health? Morris Barer comments on Hudson’s paper in Slouching To- ward the U.S.? John Millar further expounds on the policy theme in A Consensus on the Causal Role of Social Factors in Population Health. Finally, Christine Gordon comments on the CIAR document with Health Policy and the Development of Hu- man Potential. All the policy authors conclude that there is a strong asso- ciation between socio-economic fac- tors and health, that there is a genuine need for social programs to address poverty, and that without such programs, population health is unlikely to improve.

This volume will especially in- terest Canadians, those who wish to maintain a complete library on the new public health, and those in- volved in health policy. The hberal- minded, the bureaucrat, and the academic will find it an easy read. The hard-core empiricist-the health economist or epidemiologist-will probably not find the message con- vincing.

Dona Schneider Rutgers University

Health and Development David R. Phillips and Yola Verhas- selt (eds) Routledge London (1994) xvi + 331 pp $24.00 paperback

The 20 chapters of the book are grouped into three parts: (i) Health and Development Perspectives, (ii) Development and the Health of Places and Groups, and (iii) Region-

70