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The changing face of disease: implications for society
  1. Shona Wynd

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    Nick Mascie-Taylor, Jean Peters, Stephen T McGarvey, eds. Florida: Boca Raton, 2004, $89.95, pp 208. ISBN 0-415-32280-4

    The Changing Face of Disease is a collection of papers originally presented at the 43rd Society for the Study of Human Biology symposium. While underpinned by a human biology view of the world, the collection makes strides towards presenting arguments from a public health oriented, global burden of disease perspective. It is well targeted to human biologists who have an interest in the socioeconomic and political factors influencing their work.

    The book has 23 contributors, 12 chapters, and is divided into two main parts: Historical aspects and Current challenges. It contains a list of the 20 figures, and another of the 15 tables. Nick Mascie-Taylor, Jean Peters, and Stephen T McGarvey have edited the book with a clear direction in mind. The introduction provides a backdrop to the evolution of the book, as well as a concise summary of the chapters. Locating the book within the human ecology perspective, the introduction grounds the chapters in the intent to provide a wide focused and nuanced understanding of the complexity of factors affecting human disease. For those unfamiliar with the perspective, the introduction provides a user friendly entrée. References are found at the end of each chapter. A thorough index completes the book.

    The first three chapters, “Emerging disease in the third epidemiological transition”, “Life history perspectives on human disease”, and “The evolution, transmission and geographic spread of infectious diseases in human populations: questions and models” make up the Historical Aspects section. Issues of social and economic inequity and emerging disease are effectively interwoven from the outset. In the first chapter, Amargelos takes the reader from the first epidemiological transition through to the current complex state of affairs. Overall, the section provides a very useful introduction to ways in which long term views of disease, disease patterns, and human behaviours can illuminate our understanding of particular diseases or health patterns.

    The second section, Current Challenges, contains a more diverse selection of topics. The chapters, vary from broad views of changes in public health, as in Peter’s “The public’s health: the changing role of public health”, to the more specific disease oriented topics, as in Wareham’s “Unraveling gene-environment interactions in type 2 diabetes”. The contributions are international in nature, with topics ranging from health care in American Indians, to malaria in pregnant women in the Gambia, and HIV/AIDS in Central and Eastern European countries. What binds the selection elegantly together is the focus on embedding the research in the broader view of human influences—whether it is in the form of population movement, trends in political, or sociocultural beliefs, or, as in “Urban pollution, disease and the health of children”, the combined impact of collective human behaviour, choices, and the modern world. Most insightful, perhaps, is the piece by McGarvey et al that focuses on interdisciplinary research on Schistosoma japonicum and benefits from the insights of the diverse fields of biological anthropology, paediatrics, human epidemiology, health economics, immunology, human pathology, veterinary medicine, veterinary epidemiology, and internal medicine. The authors round off the chapter with the following challenge to themselves and the research community: “It is a truism in human population biology and health research that interdisciplinary perspectives will yield findings and insights greater than available within the individual disciplines. This truism is repeated here both as an admonition and a promise.”

    Perhaps the only jarring note is found in the final chapter, “Human behaviour and the changing pattern of disease”. In attempting to offer up a contemplative review, the author instead presents a curiously Victorian perspective on the impact of modernity on microbiology. His use of terminology such as “unfettered sex” and “promiscuity”, and reference to “the vogue for sexual freedom” undermine any belief in a balanced presentation of the variables affecting sexually transmitted diseases. While it seems he is attempting to make the point that the public should be more informed of the microbiological implications of the changes that have resulted from evolving human behaviours and trends, he unfortunately comes across as dated, judgmental and, ultimately, antimodernist.

    The final chapter aside, the book is an effective introduction to the intricate linkages between human biological sciences and the wider socioeconomic and political influences. The broad range of topics presents the reader with a number of different perspectives on disease patterns, and ultimately serves as an invitation to delve further into the relation between human behaviours and their own area of specialty.