Book and media review

Abstract

THE THIRD EDITION OF THIS WELL-RESPECTED TEXTBOOK SUPports theneweditors’ aimtoprovideagreater focusonclimate change, environmental influences, and underlying preconditions, as well as critical perspectives on the political economy ofhealth, includinghealthundercrisisconditions. It compares well with Essentials of Global Health (Sudbury Jones & Bartlett [2008]) in terms of breadth of coverage and with Understanding Global Health (McGraw-Hill [2007]), in terms of detail. Its readability benefits from plenty of tables, boxes, lists of key questions, and learning points, all uniformly pertinent. The early chapters present historical and epidemiologic data on global health with fluidity and a willingness to confidently tackle controversial political themes without overt ideological bias. These chapters were central to previous editions, and their general structure and content will likely be familiar to many readers. Chapter 8, “Health Under Crisis,” deals with the effects of natural disasters such as hurricanes, floods, tsunamis, and earthquakes. Readers learn that Cuba’s civil defense system encourages universal community participation in several storm preparation exercises every year; this preparation has prevented so many deaths that the United Nations has praised the model. Similarly illustrative is the point made that a crucial part of the successful response to the 2005 earthquake in Pakistan involved staffing relief clinics with women doctors and nurses so that injured women could obtain care. Chapter9, “Globalization,Trade,Work, andHealth,”pulls no punches in encouraging communities around the world to champion health interests against neoliberalism, worker exploitation, and unilateral structural adjustment and deregulationdecisionsmadebyunaccountableglobal institutionssuch as the World Trade Organization, World Bank, and the International Monetary Fund. It highlights the health problems in the maquiladora industrial belt along the US-Mexico border asaprimeexampleoftheproblemscreatedby“freetradezones.” The chapter also discusses the civil society victory against the Multilateral Agreement on Investment from the Organisation for Economic Co-operation and Development in the 1990s but fails to mention how many bilateral and regional trade agreementshaveincludedinvestor-statedisputesettlementprocedures that allow foreign corporations to sue domestic governments—for instance,when investmentby thesecorporations has been impeded by necessary public health legislation. It also does not mention the use of nonviolation nullification of benefits provisions in trade agreements to facilitate lobbying of government officials to inhibit public health legislation thatallegedly interfereswithvaguelydefinedexpected benefits without contravening any provision in the deal. Furthermore, it does not mention how bilateral trade agreements havebeenusedtounderminescientificcost-effectiveness–based reimbursement systems for pharmaceuticals. Chapter 10, “Health and the Environment,” begins by notinghowtheWorldHealthOrganization in2006estimatedthat one-fourth of all diseases and deaths were caused by modifiable environmental factors. Details are provided on the effects ofnuclearwaste,pesticides, industrialpollutants, lackofclean water, and toxic metals on degrading food supply and human health.Thechapter includesan introductionto thehealthconsequences of climate change that emphasizes 5 relatively uncontroversialmechanismswherebya2°Cincreaseinatmospheric temperature may stall or reverse human development: (1) reducedagriculturalproductionandfoodsecurity,(2)waterstress and water insecurity, (3) rising sea levels and exposure to climatedisasters, (4)degradationofecosystemsandbiodiversity, and(5)decreasedhumanhealth.Thechapterdiscussestheconcept of “ecological footprint” in terms of the total area of biologicallyproductive landrequired toprovide resources forhuman energy, water, food, material, and service requirements. However, chapter10alsomighthave focusedontheequally importantconceptofdailypercapitapowerconsumption,which for a citizen of a developed nation is about 125 kWh/d ( 250 kWh/d for a citizen of the United States) and currently totals about 450 EJ/y globally. The chapter could have highlighted toagreaterextentthatpotentiallyusablesolarenergyconsumed atapproximately1kW/m (3.9 10 EJ/y)woulddwarf theestimatedglobal2050primaryenergyconsumptionof500to1000 EJ. Thediscussionofalternateenergysourcesdoesnotmention the most promising—using nanotechnology and solar energy tosplitwater intohydrogenfuel,whichwhenburnedproduces clean water (to this end, $122 million was recently allocated to the Joint Center for Artificial Photosynthesis at Caltech). Chapter 11, “Health Economics and the Economics of Health,” cites how in 2006 alone, 2400 cases of health fraud totaling $60 billion were investigated in the United States. It discusses how the concept of global public goods includes knowledge from research, safety, and cost-effectiveness regulation and health systems but requires guaranteed streams of funding from sources such as taxes on international financial transactions and on multinational corporate earnings. Chapter 14, “Doing International Health,” brings the book to a close by discussing what constitutes success in international health. Jeffrey Sachs argues that health is increasing and transforming foreign aid. Other candidates mentioned are increased health services, trained health workers, improved focus on health in trade relations, decreased levels of