Equity, social determinants and public health programmes.
Article Type: Book review
Subject: Books (Book reviews)
Author: Mukhopadhyay, Alok
Pub Date: 05/01/2011
Publication: Name: Indian Journal of Medical Research Publisher: Indian Council of Medical Research Audience: Academic Format: Magazine/Journal Subject: Biological sciences; Health Copyright: COPYRIGHT 2011 Indian Council of Medical Research ISSN: 0971-5916
Issue: Date: May, 2011 Source Volume: 133 Source Issue: 5
Topic: NamedWork: Equity, Social Determinants and Public Health Programmes (Collection)
Persons: Reviewee: Bias, E.; Kurup, A.S.
Accession Number: 258994226
Full Text: Equity, social determinants and public health programmes, E. Bias & A.S. Kurup, editors (World Health Organization, Geneva, Switzerland) 2010. 300 pages. Price: CHF/US $ 40.00; in developing countries: CHF/US $ 28.00. ISBN 978-92-4-156397-0

This book is a significant contribution to the knowledge and practice of health interventions with a social determinants approach towards improving the health equity. It is an outcome of intense research work of WHO-based Knowledge Network on Priority Public Health Conditions Knowledge Network, which was part of the Commission on Social Determinants of Health (CSDH). It was commissioned by the Department of Ethics, Equity, Trade and Human Rights. The book highlights 16 of the major public health programmes of WHO. It is a collection of analyses of the social determinants of health that impact on specific health conditions. In order to achieve health equity the Network adopted a holistic view of the social determinants of health taken by the CSDH. The approach is pragmatic and presents each health concern in a uniform frame, facilitating an ease in reading through the complexities involved while addressing them.

The network precisely aims at addressing the following questions in this publication: (i) What can public health programmes do individually?, (ii) What can public health programmes do collectively?, (iii) What can public health programmes do vis-a-vis other sectors?, and (iv) What must be done differently?

As an effective solution, each chapter addressing a health concern presents a concrete set of evidence based action points as the promising entry points for intervention.

The goal of this book has been to achieve greater equity in various specific global health and development targets. The criteria used in the identification of the public health conditions that merit maximum attention represent a large aggregate burden of disease, display large disparities across and within populations, disproportionately affect certain populations or groups within populations and are emerging or epidemic prone.

The book justifies the purpose of establishing the Priority Public Health Conditions Knowledge Network by presenting a well researched knowledge base for the priority health conditions with an exploration of the possible avenues of action. A five-level framework was chosen--the top level relates to the structure of society, the second to the environment, the third to population groups, and the last two to the individual. This book uses the notion of a public health programme in a wider perspective to include the health condition-related WHO programmes as well as their health counterparts in countries and internationally, whether governmental, non-governmental, private, inter-governmental or international.

One of the prime tasks of public health programmes is to translate knowledge on causes into concrete action. Consideration of interventions and how these are to be implemented, while being sensitive to possible risks and assumptions, has therefore, been key to the work.

The entire process was vast and has been tackled skillfully by establishing 14 programme nodes in order to include 16 of the major public health programmes of WHO. Thirteen of those nodes completed all phases of their work and their outputs have been presented as chapters of this volume.

This book has an interesting design. The first chapter 'Introduction' sets the stage for the ethos behind the book and the approach followed. There are 12 theme based chapters (Chapters 2 to 13) and each chapter is organized according to a common framework that allows a fresh but structured look at many familiar problems. Each chapter starting off with a page of contents having four uniform sub-headings, Summary, Introduction, Analysis, Discussion, Interventions, Implications and Lessons Learnt followed by a list of References and Figures and Tables along with page numbers for each sub-section.

The last chapter takes a step forward by presenting a synthesis of these programme interventions--what are the common lessons and what could be the basis for common action rather than summarizing the finding of each of the individual chapters. The overall purpose of this extensive work comes explicitly in this chapter.

Chapter two focuses on 'Alcohol: Equity and Social Determinants.' Chapter three covers 'Cardiovascular disease: equity and social determinants.' Table 3.26 of this chapter presents intervention strategies based on the social determinants, which will of interest to all practitioners. Chapter 4 looking through the 'Health and nutrition of children: equity and social determinants,' presents the emerging lessons and comes up with a conclusion to reduce the out-of-pocket payments as the principal means of financing of health care in most of Asia and Africa. It equally lays stress on the need of prioritizing the diseases of the poor based on an assessment of the burden of diseases and allocation of resources accordingly.

Chapters 5-9 cover important health concerns, Diabetes, Food Safety, Mental Disorders: Equity and Social Determinants of Neglected Tropical Diseases, and Oral Health: Equity and Social Determinants.

Chapter 10 covers 'Unintended pregnancy and pregnancy outcome: equity and social determinants,' which forms a major health concern. The suggested macro and micro level interventions present a broad horizon of controlling the harm.

Chapter 11 gets into 'Tobacco use: equity and social determinants.' A detailed analysis of the social determinants of tobacco use offers practical guidelines dealing with the options to control the root cause.

Chapter 12 covers 'Tuberculosis: the role of risk factors and social determinants', and will be of equal interest to both clinical and community practitioners. It comes out with the correlation between urbanization and occurrence of TB.

Chapter 13 covers 'Violence and unintentional injury: equity and social determinants.' It assesses that around 90 per cent of global road traffic deaths are in low and middle income countries. The section on 'Interventions' followed by the section on Interrelationship between Injuries and Determinants stresses upon the need to develop policies to tackle injuries at a national level in a complete synchronization with the local determinants.

The text throughout is supported by ample, recent references to scientific papers, relevant textbooks and policy documents. One distinctive advantage of the book is that it shows the complexity of health and incorporates specialists from different disciplines. The focus on determinants of health also demonstrates logically the need for multi-sectoral action and multiple approaches when working to improve health.

As a practitioner and reader, I am in complete appreciation of this compendium bringing across the action points based on an in-depth analysis of social determinants of health. If there are amendments to wish for in a second edition, a more thorough review of social determinants of health and on social differentials in developing countries along with inclusion of the lessons emerging from several developing countries would be welcome. However, as the matter stands, in addition to the book, WHO has commissioned case studies on a number of public health programmes to examine the implementation challenges in addressing social determinants of health in low-and middle-income settings. These will be published soon as a web-based publication.

Although it may be difficult to confirm the statement on the back of the book that it 'provides all you need to know about health', it does present a scientific analysis of priority health conditions from a determinants perspective with an action oriented approach. The editors and the authors need an applaud for their effort. This book is available to all interested readers at http://whqlibdoc.who.int/ publications/2010/9789241563970_eng.pdf

Alok Mukhopadhyay

Voluntary Health Association of India

B-40, Qutab Institutional Area

New Delhi 110 016, India

ceo@vhai.org; vhai@vsnl.com
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