International Journal of Epidemiology 2002;31:877
© International Epidemiological Association 2002
Book Review |
Diseases of Globalization, Socioeconomic Transitions and Health.
McMurray C, Smith R. London: Earthscan, 2001, pp. 200, £45.00 (HB) ISBN: 1-85383-710-5; £16.95 (PB) ISBN: 1-85383-711-3.
The impacts of globalization on human health are diverse and multi-faceted, and empirical evidence that sheds light on these complex linkages is highly welcome. This book seeks to fill part of the existing knowledge gap by presenting the results of research on the health effects of global changes on three ‘societies in transition‘: Mongolia, the Marshall Islands and Uzbekistan. The authors argue that the three case studies illustrate the manner in which political change and economic modernization have impacted on health and well-being, as well as demonstrating broader trends reflected throughout the world.
The first three chapters of the book set out some key issues that form the backdrop of the book—the dual forces of expansion and marginalization, shifting boundaries and changing values, the demographic and health transition, and the epidemiological transition from infectious to non-communicable disease burdens (NCD). It goes on to explore different approaches to development as historical and ideological precedents for current globalization processes. This is followed by an introductory overview of the determinants of health, distinguishing between genetic, external and sociological factors. All three chapters are brief and introductory.
The main challenge of determining cause and effect among these issues, approaches and determinants of health form the bulk of the remainder of the book. And it is here that the book’s failure to set out sufficiently clear definitions and framework for analysis becomes apparent. For example, the book begins with the statement that ‘modernization is leading to changing patterns of health’. This is indeed historically true but a conflation of globalization with modernization is neither helpful nor accurate. Neither is the underdeveloped definition of globalization offered: ‘various processes that undermine local autonomy, such as international flows of capital and investments, and the promotion of Western values and lifestyles through global media transmissions. States and individuals have become interconnected under the general rubric of "globalization"’ (p. 1). While this definition touches on some elements of globalization, as identified by other authors, it fails to be distinct from such terms as liberalization and westernization.1 This simply causes confusion and, importantly, analytical imprecision. Indeed, the essential characteristic of globalization, as forces that circumvent and even ignore territorial space, is not described. Curiously, while most definitions of globalization point to the erosion of national borders and the emergence of new patterns of health that cut across state boundaries, the authors choose to undertake three country case studies. The book title is also slightly misleading as the subject of the book is more narrowly focussed than suggested. The focus is largely on changing trends in NCD although some mention of infectious disease is made. Overall, while changing trends in health and disease are reported for the three countries, these are not convincingly proven as the result of globalization.
Despite analytical fuzziness, there are important messages that arise from the book. First, the task of sorting out the complex linkages between globalization and health will be a tough analytical challenge. Multiple forces and determinants are at play and will require rigorous conceptualization and empirical evidence to demonstrate their relationships. Second, the need to link micro and macro level analysis will be central to this task. The attempt in this book to bring the analysis down to the societal and even individual level is an important contribution. Third, the importance of using qualitative and quantitative data is illustrated. The authors make use, in particular, of focus groups, interviews and other methods to assess how global changes are influencing social and cultural contexts within which healthy lifestyles are achieved or not. Given these contributions, the aim of the book is clearly laudable—to lend greater empirical evidence to the health impacts of globalization.
Reference
1 For a discussion of the distinct definitions of these terms see Scholte JA. Globalization: A Critical Introduction. London: Macmillan, 2000. Bettcher D, Lee K. Glossary on globalisation and public health. J Epidemiol Community Health 2002;56:8–17.
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