Book Title: Textbook of Global Health, Fourth Edition
Book Authors: Anne-Emanuelle Birn, Yogan Pillay, and Timothy H. Holtz
Publication Information: New York: Oxford University Press, 2017, 674 pp., $85, hardcover
The first mistake a reader unfamiliar with earlier editions of this textbook might make is to assume this is a clinical reference work along the lines of Manson’s or Hunter’s.1,2 It is not. Rather, it is a densely packed treatise on the history, influences, philosophies, and future of global health. It encompasses public health, national health policy, significant players in global health, politics, international trade, and economics, with only allusions to the clinical practice of medicine. This fills an important gap in the training and experience of most clinicians.
The volume begins by explaining why global health matters from a variety of perspectives, closely followed by chapters explaining what international/global health has been historically and how it has been practiced. A valuable critique of the vertical single-issue silo approach common in global health is included on page 70. The historical account presented in chapter 1 is excellent, and along with the introduction should be required reading for anyone embarking on a global health venture. A lucid explanation of international vs global health is offered (no mere semantics here!), with a table (p. 77) highlighting the differences.
The third chapter transitions with a discussion of the authors’ philosophical approach to global health, upon which the text is based: the political economy approach. While the validity of applying this economic interpretation of history3 to health and health care is certainly open to discussion, it speaks highly to the authors’ integrity that they reveal their worldview early in the book. One of the strengths of the political economy model over previous models is its incorporation of the social determinants of health as a major factor in global health. A convenient comparison between this and the biomedical and biopsychosocial models is provided on page 108 (Table 3-2).
After setting the context for the remainder of the book, the authors introduce the major players in global health. An appendix including contact information for the major organizations named would have been a nice addition—perhaps this will be part of the next edition. There was a clear big business, big government, top-down bias in the collation of organizations; smaller, grassroots organizations are barely mentioned. The religious organization section was also disproportionally small compared to the impact missionary hospitals have; anyone with field experience abroad can’t help noticing their ubiquity. In compiling a list of players, one must of course make decisions on whom to include; the authors appear to have selected large-budget players, a legitimate approach consistent with their model. For a more comprehensive list, one may wish to review the somewhat dated American Medical Association’s Practical Guide to Global Health Service.4
A valuable review of statistics is included, clarifying the need to objectively measure meaningful outcomes. This is critical for policymakers, who undoubtedly compose a significant portion of the volume’s readership. The emphasis on evidence-based public health is most welcomed. Chapters on epidemiology—and not just exotic infections—and social determinants of health demonstrate the practical application of these principles.
Influences on health including disasters and war, globalization, the natural environment, health systems, and health economics all receive attention. For clinicians not accustomed to considering the complexity of these factors, these chapters provide critical insight. Naturally, as family physicians accustomed to dealing with patients in the context of their family and community, one would hope that we’ve already given thought to these factors in our global health involvement! A nice summary comparing the neoliberal and the social justice approaches to health economics is found on page 556 (Table 12-9). The table could have been improved by also including a column on a classical liberal approach.
In the chapter “Building Healthy Societies,” the focus is primarily on large vertical health interventions despite acknowledging their limitations. An unfortunate omission is any significant discussion on the need for integrated horizontal activities, ie, primary care, which are recurring themes at venues such as the American Academy of Family Physicians’ annual Global Health Workshop.5 There is only a brief acknowledgment of the importance of local personnel and resources, and that isn’t until the final chapter (p. 603).
A cover-to-cover reading of this book is daunting; the final chapter provides an excellent summary. Readers who are reluctant to bite off the entire volume would do well to start here and then focus additional reading in the earlier chapters addressing the topics they find compelling.
This textbook may not fit in every clinician’s personal library, but it definitely belongs at every institutional program on global health, whether the focus is clinical, policy, or public health.
There are no comments for this article.