The next phase in global health

Those of us trained as "curative" practitioners should pause to take note of this book, which gives an account of many awesome phenomena. These include: the terrible inequalities and worsening health figures in many countries; the importance of non-medical factors (such as schooling for girls) in achieving better health outcomes; a disgraceful rise in tobacco marketing and in the incidence of tobacco-related disease in developing countries; unipolar depression as the greatest cause of chronic disability in developed countries; the destruction of our fragile biosphere; health outcomes in Canada consistently outperforming those in the United States; and the political nature of many of our problems.

Many of us practise some preventive medicine, such as vaccination and providing lifestyle advice — but as adjunctive activities. This is a book for those interested in the next steps in public health. It is not, nor does it pretend to be, a first book. It does not study the rudiments of public health. It points to new and different world problems. It identifies important influences in our previous "golden" century of progress and other influences that will be important this century.

However, the text lacks a discussion of the possible consequences for local and international economies of acting on some of the strategies advocated by public health practitioners. Thus, if universal immunisation was achieved, avoidable child mortality would drop and nations would then have to provide more schools, more teachers, more roads, more hospitals, more clean water, more food, more social services and so on. None of these downstream consequences is developed adequately.

Peter E Baume AOHonorary Research AssistantSocial Policy Research Centre University of New South Wales Chancellor, Australian National University