International Journal of Epidemiology 2002;31:705-706
© International Epidemiological Association 2002
Book Review |
Ecosystem Change and Public Health. A Global Perspective.
Joan L Aron, Jonathan A Patz (eds). Baltimore, MD: Johns Hopkins University Press, 2001, pp. 526, $85.00 (HB). ISBN: 0-8018-6581-6; $38.00 (PB). ISBN: 0-8018-6582-4.
Musing on the way time passes more quickly now than it used to, John Mortimer quotes an acquaintance who said that after 80 one seemed to be eating breakfast every five minutes. Public health textbooks do not come round quite as quickly as that, but it does seem that there is more to choose from than previously. Whether or not that perception is true, ‘Ecosystem change and public health’ stands out from the pack for two reasons.
First, I know of no other public health text that gives central place to ecological considerations. Public Health and Human Ecology, published in the late 1980s by John Last, was essentially a compact version of Maxcy-Rosenau, and kept the traditional structure and emphasis on human diseases. Tony McMichael and others have written on the links between ecosystems and human health, but their work has been in the form of polemic rather than text. The purpose of Aron and Patz's book is two-fold: to advance the argument that the foundation of human health is ecological, and to provide at the same time an instrument for curriculum reform.
The other distinguishing feature of the book is that it engages directly with the question of what textbooks are for. The question is a timely one. For that fraction of the world's population with a computer and an internet connection, information has never been so accessible. Type in ‘how fast is the speed of light?’ and Google gives you a million answers in less than half a second. Look up current knowledge on anything from Pap smears to anthrax and thousands of entries await a tap of the button. Paper-based texts cannot compete with that volume of data and ease of access. So if they do not serve as an enduring repository of knowledge, what purpose do textbooks have?
The answer, according to Ecosystem Change and Public Health, is that textbooks should serve to prompt, challenge, guide and illustrate. On the whole, I think this book meets these objectives. There is a good introduction, explaining the different ways in which the book can be used and reflecting on textbooks and information literacy in the internet age. An appendix provides an annotated listing of relevant, reviewed websites.
The book is arranged in three parts. These include approaches to studying global change and its effects on human health, descriptions of major changes that are currently occurring, and case studies. The net is cast wide. For instance, chapters in the first section include epidemiology in 40 pages, geographical information systems, integrated assessment and (oddly placed) a short account of the policy/science interface. The authors are senior people in the field, mostly American, and mostly from Johns Hopkins. However, as befits a book on global change, the perspective is international, and examples are given from many parts of the world.
For me the attractions of this book include the variety of the material included, the serious attention paid to combining methods and applications (the chapter on integrated assessment is an excellent introduction to the topic), and the emphasis on learning through case studies. The epidemiology chapter, for example, includes a very interesting and instructive account of the sequential application of epidemiological methods (survey to intervention study) to control of filiariasis in the Nile delta. There is a downside of course to the width: none of the chapters explore their topics in depth, and certainly the epidemiology chapter would not, on its own, provide a graduate student with an adequate introduction to the topic. However, the book does provide a bridge between traditional public health disciplines and new concerns, and as a model of the new generation of texts it is well worth reading.
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