BOOK REV I EWS-SOU T H ASIA facilities brought down the .nfant and general morcalicy races drastically. Overall, how- ever, the health-care delivery system emerges as the principal facror underlying the improvement in Kerala's health status. The emerging morbidity pi. ture of Kerala is characcetizcd by the coexistence of diseases of poverty with diseases cf affluence. The state's expenditure on health in both government and private seccors is very high, but with an increasing trend in morbidity, it will have co be higher in the years to come. The authors complain that though the genesis of the dominant disease entitic$ lies in poverty, their continued prevalence is due ll> a partial perceptio:i of the problem and ad hoc remedies adopted. Whereas health should form an integral component of overall socioeconomic development, the health policies and programs here are frag- mented in approach and disease-oriented and .:urative in content (p. 103). l'he authors suggest an interseccoral action program that would tap unutilized or underutilized resources in che nonmedical sectors. The emphasis is on prevention rather than cure:. Kerala has already achieved targets set by the national government for the year 2000, but undernut:ition and serious morbidity persist . A reduccion in the prevalence of undernutrition and morbidity should therefore be the goals of the future. For tackling undernutrition, the suggested remedies are growing pulses, vegetables, fruits, eggs, milk, and fish-all of which could be produced with marginal increase in cost. O ther proposals are low-cost housing, revival of traditional sources of water like wells and ponds instead of piped water, cheaper, more convenient waste disposal, and health education for which there is already a strong infrastrucrure. T he healt h seccor should also intervene to control all pollution t hat has any bearing on health. The authors' major recommendation for implementing these programs is com- munity participation and involvement of the pcopl~ in decision making and cost shar- ing. They argue that once the people begin to have a voice in the selection of programs they shoulci be willing co come forward and voluntarily contribute labor, materials, and money. On the whole the authors have succeerted in the· difficult task of assembling a large amount of information on Kerala's health status and drawing inferences that are gen- erally ignored by other writers on health themes. T heir emphasis on non-l1ealth factors, on prevention, and on a micro-level community-based approach to implementing their suggestions may look a little unorthodox in a state that is moving forward rapidly with curative, government-led programs. The recent affluence and changed life-styles brought about in Kerala by the Persian Gulf boom have not only made such services indispensable but have also found agencies that are only coo anxious co provide them . It will be difficult for the state to reverse its present policy. However, the proposed decentralization of authority envisaged at panchayat and municipal levels is bound to put more responsibility on the community, and this would give the needed momentum to the strategy recommended by the authors. On ·the whole this book deserves to be commended for its usefulness to the expert and professional as well as co the general reader. P. K. B. NAYAR University of Kera/a Hyderabad and Brili1h Paramotm/cy, 1858-1883. By BHARAT! RAY. xviii, 232 pp. $19.95. Delhi: Oxford University Press, 1988. Bharati Ray's book focuses on British paramountcy, the development of imperial policy toward India's princely states, and its implementation in Hyderabad state in