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Global public health: a new era
  1. Douglas W Bettcher

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    Edited by R Beaglehole. Oxford University Press, 2003, pp 284, £29.50 (paperback). ISBN 0-19-851529-4

    Plotting a roadmap for public health from the global to the national/local levels, and proposing strategies for strengthening public health in the 21st century is no small task. Indeed, this book sets out to address these rather daunting objectives. Such an ambitious and complex project is a potential minefield, in that the final product can turn out to be an incoherent and disconnected jumble. However, I am pleased to report that this book avoids such pitfalls. The different chapters, covering a representative range of expert views from developing and developed countries from all regions of the world, form a seamless analysis that is a pleasure to read. In fact, I was so totally engrossed with the subject matter of this book, that I carried it everywhere with me so that I could dive in to it whenever I had some spare time.

    The first two chapters chart the global context and scope of public health and provide an overview of current global health status. The core of the book is comprised of nine chapters providing a summary for different countries and regions of the world of the trends in health status and the principal health determinants, as well as the policy implications and public health challenges for the various populations examined in these chapters. Three further chapters in the final segments of the book cover contemporary health challenge and opportunities: bioterrorism, ethical issues in global public health, and how to make public health a more people centred enterprise.

    In the final chapter, public health veterans, Robert Beaglehole and Ruth Bonita, have drafted a unique and insightful chapter that ties together nicely the various strands of this book. Despite the daunting public health context of the 21st century, weaknesses in public health infrastructures and the workforces, the double burden of communicable and non-communicable diseases, and the threats posed by globalisation the authors of this summary chapter are optimistic that a renaissance of public health may be just around the corner. However, for this to transpire the intrinsic multi-sectorality of public health must become a social and political reality: the ultimate goal of public health practitioners must be to ensure that public health is integrated into all health, economic, and social policies and programmes. For instance, the links between trade liberalisation and public health and poverty, particularly in developing countries, demonstrate that public health practitioners cannot ignore the activities and policies of other sectors. The fact that health has now crept its way up towards the top of the development agenda, and that new global funds for health have evolved in recent years bears testament to a “reasonably optimistic future” for public health improvement.

    I am convinced that in time we will look back on this book as a public health classic. It brings together an armada of intellectual heavyweights in contemporary public health, and also manages to map out a way forward amid the unpredictable and tangled realities of public health in the early 21st century. The book presents a concise, logical, and practical template for navigating the potentially troubled waters that lie ahead of us in the world of contemporary public health.

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