housing at the same time.

G.B. Wyatt, Department of Community Medicine,

The University of Papua and New Guinea.

W.W. Holland & S. Gilderdale: Epidemiology and h l r h (International Epidemiological Association / Henry Kimpton, London, 1977)

We would expect from the title of this book that it would describe the epidemiological elucidation of the causes of ill health and its translation to health promotion. Indeed, in the introduction, Kenneth Newel1 develops this theme but then tells us we’re wrong. - It’s not about health but health services! We then conclude that the book will develop the view that epidemiology is the basic science behind health services research. Wrong again! After a poor description of epidemiological methods and a good outline of their application to health service problems by Walter Holland we come to a chapter by Basil Hetzel and Tom Selwood on health. Well, it’s about health after all. But wait, don’t jump to conclusions because there are three chapters t o come on health services in Eastern Europe (by Jan Kostrewski), India (by Rameshwar Sharma) and Iran (by M.A. Faghih and F. Amini) with a chapter on “Cost and Quality” by Andrew Creese sitting in the middle.

The chapter by Creese is in fact excellent and touches on epidemiology, economics, health services and health. An economist costs the inputs, an epidemiologist measures the outputs, alternative policies are ranked according to their costlbenefit ratios and a health planner/administrator behaves rationally as a result.

Beautiful, but it’s too good to be true. Mowbray in The Management Process warns - “. . . many research studies do not have the impact on health care that might be expected given the implications and relevance of their results.” To a greater or lesser degree this problem and its generation by those who insist that “comprehensive rationality is preferable to ‘muddling through’ as a strategy of decision” is the subject of the preceding and subsequent chapters by John Wyn Owen and Donald Anderson. Surprisingly, at the end of all this, Lester Breslow gathers the scattered themes into a lucid summary of the contributions and role of epidemiology in the planning of health services.

If the preceding paragraphs have appeared disjointed it’s because they’re about a

COMMUNITY HEALTH STUDIES

disjointed book. Disjointedness is a characteristic of a number of books prepared b y the International Epidemiological Association (IEA). At least two possible reasons for this can be advanced: 1. The IEA tries to achieve geographical

“democracy” in authorship - a laudable objective for an international association.

2. The panel of authors often bears a similarity to the IEA Council, consequently the same names (and often the same ideas) appear repeatedly under different book titles. This approach is undoubtedly dictated by the financial savings possible by combining meetings of Council with meetings of the contributors to a book. A result of these quite understandable

policies is that the authors are not necessarily expert in the subject under consideration and may not wish or be able to devote the time necessary to preparation of a chapter which contributes directly and uniquely to the theme of the book. Thus Epidemiology and Health is “good in parts”. It should not be read as a book but there are some thought-provoking chapters for those who are concerned about the rational development of policies for health and health services.

Bruce Armstrong, Public Health Department,

Perth, Western Australia.

E.A. Cleland, R.J. Stimson and A.J. Goldsworthy: Suburbon Health Cbre Behaviour in Adehide (Centre for Applied Social & Survey Research. Monograph Series No. 2, Flinders University, Adelaide, 1977)

After a rather lengthy introduction, encompassing discussion of the fragmented health service system, the aims and objectives of the Community Health Program in Australia, evaluation models and strategies and some theories about the structure of health services and their spatial distribution, the authors finally get down to the “nitty gritty” of the study undertaken.

In the first sections of the book the authors go to great lengths to discuss the difficulties involved in establishing definitions of “demand”, “need” and “health” and criteria for measuring “health”, as well as the problems associated with the development of a methodology for evaluating the impact of new types of health services in the real world. It is unfortunate that, after considerable effort in

42 VOLUME 11, NUMBER 1,1978