Review of Health psychology in global perspective.

Abstract

FRANCES E. ABOUD Health Psychology in Global Perspective Thousand Oaks, CA: Sage Publications, 1998, 343 pages (ISBN 0-7619-0941-9, US$37.95, Softcover) Reviewed by DAVID N. COX Initially, I was unsure of what to expect from this book, and yet in completing it I feel humbled by the perspective it provided me on international and cross-cultural health issues. It is clear that this is a field in which excitement is often derived from small successes and in which disappointments are frequent. The statistics presented are at times overwhelming. The opening paragraph describes a global picture in which each year 585,000 mothers die in childbirth, 2.7 million young adults become HIV positive through unprotected sex, and 7 million children die of preventable diseases. I found myself reading again passages that reminded me of just how unaware and insensitive I am to health concerns in developing countries. Clearly, our media determine much of what is considered important by us in terms of health, ill health and, ultimately, death. It also serves to protect us against the realities of the global situation. For example, while enjoying the benefits of the Canadian health care delivery system, it seems inconceivable that, according to UNICEF estimates, 8,000 children around the world die every day from diarrhea) dehydration. I found myself actually doing the calculation to confirm that, as Aboud states in another part of the book, this results annually in the death of 3 million children under the age of five. One can only imagine the uproar that would occur in this country if the newspapers headlined the death of over 250,000 children in the past month from a largely preventable causes. Aboud makes wonderful use of case studies throughout the book, and in regard to this particular problem she describes a program in Gambia to increase the use of a water-sugar-salt solution that serves to help the sick child absorb water and combat the dehydration. A package to which one adds water is available for 10 cents, or people can be taught how to make a homemade version. Initially, mothers needed to be instructed on how to mix and administer the solution properly, and a system of rewards was set up for those mothers who correctly followed the procedure. At the beginning of the program, none of the mothers knew the mixing procedure, whereas in nine months 70% of them did. At a twoyear follow-up, 74% of the diarrhea cases were being treated with the solution. However, three years later, it was found that only 11% of the cases were being treated and the long-term sustainability of the program in the absence of continuing motivators was in question. My sense of health psychology is the one that developed in North America in the early-1980s out of the field of behavioural medicine and describes the contributions of psychology to the promotion and maintenance of health and the prevention and treatment of disease. For me this has meant a welldefined model, which examines health concerns in an often subtle and well thought out manner. The solutions are frequently obvious and successful. The reading of this book has served to expand my definition of health psychology to include global and cross-cultural concerns. This is a realm where the solutions are often very complex and success is not guaranteed. The organization of the book is logical and easy to follow. The first two chapters provide an introduction to the rest of the text. In the first, the field of international health psychology is described, definitions are provided, and the biopsychosocial framework, which examines health and illness from a biological, psychological, and social perspective, is outlined. Interestingly, the section in this chapter on epidemiology is written by Charles Larson, who is an epidemiologist and a physician. The second chapter focuses on measurement issues in a somewhat unique manner as consideration is given to how both quantitative and qualitative methods can be applied to international health issues. …