Book reviewed this issue are:
Public Health for the 21st Century – New Perspectives on Policy, Participation and Practice
Judy Orme, Jane Powell, Pat Taylor, Melanie Grey 2007. Open University Press/McGraw-Hill Education.
ISBN 10-0 336 33307 2 (paperback) £24.99
According to its introduction ‘Public health for the 21st Century – New perspectives on Policy, Participation and Practice’ aims to inspire the development of future public health practice. It seeks to do this by exploring the meaning of public health within in the 21st century context and examining the current debates and policy changes that shape it. The multi-authored book is divided into four parts, being Policy for the 21st Century,
Participation and Partnerships, Major contemporary themes in public health and Evaluation evidence and guidance, each part containing stand-alone chapters, allowing the reader to access specific issues as well as to take a broad overview. Each part is prefaced by an editor’s overview setting it in context, and the authors of each chapter usefully summarise their views which in a forward-looking volume such as this is of considerable assistance to the reader.
There are two challenges for the authors of a public health text. The first is that consideration of emerging policy is likely to be out of date very shortly after publication – this second edition follows closely on the first, published in 2003. The second is that the potential span of readership is very wide, encompassing those in mainstream public health to lay readership, all of whom will be looking for different things. This edition manages to address the two challenges well.
It starts in Part 1 by mapping public health, tracing its history and establishing the roles of the main players. It considers how changes in policy have changed delivery mechanisms and have broadened the range of players and critically evaluates the role of public bodies in delivering health improvement.
Part 2 considers capacity and capability of the traditional public health workforce and asks whether it is fit for purpose. It further considers in some depth the newly emerging role of lay people and communities in delivering multidisciplinary public health, and devotes a chapter to community development and networking for health and the informal networks that have sprung up to tackle delivery of local public health issues, and concludes, perhaps predictably, that partnerships and wide participation in both policy design and delivery are the way forward.
In its third part the book looks at national and global themes in public health – tackling health inequalities, neighbourhood renewal and regeneration, sustainable futures in cities and issues around globalisation and health. These are very broad canvases, each of which would probably merit a volume in its own right, but they are tackled well, with the authors not being afraid to raise the big questions even when answers may not be readily forthcoming.
Part 4 considers the evaluation of evidence and evidence-based practice. With health economics being a major driver and resources being finite and increasingly limited, this part of the book is very important, raising as it does issues such as the ethics of public health delivery and the trade offs between efficiency of intervention and equity of delivery. It uses recent UK examples to underline the points made, such as the ban on smoking in public places citing on the one hand the health case and on the other the perceived creep of state control into personal health choices.
Equally uncomfortably for some, the Wanless and Beecham reviews applied hard economic ideas to fuzzy public health concepts and are increasingly seen as the way to cost the effectiveness of justify interventions, which will be a challenge for policy developers and delivers alike in the 21st century. The authors draw no easy or glib conclusions, which, while uncomfortable for the reader, underlines the additional challenge that is on us now and will continue for the foreseeable future. Public Health for the 21st Century is a comprehensive consideration of the emerging challenges for public health policy makers. Its structure makes it accessible to those wishing to dip into specific areas as well as being both coherent and comprehensible to those who may wish to read the whole volume. It is a valuable addition to any public health library.
Review by Julie Barrat Director, CIEH Wales.
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Synthesising Qualitative and Quantitative Health Evidence: A guide to methods
Catherine Pope, Nicholas Mays, Jennie Popay 2007.
Open University Press/McGraw-Hill Education.
ISBN 13: 978 0 335 21956 (paperback). £21.99
If you have a professional interest in pulling together health evidence to inform practice, then “Synthesizing Qualitative and Quantitative Health Evidence”, published by Open University Press, is for you. There is an underlying paradox that the increasing information mountain of research outputs in various forms makes policy and practice development more difficult than ever. This book goes a considerable way to address this paradox. In three parts, this paperback edition covers the evidence review process, the methods used for synthesis and the output from this process of making ‘whole pictures’ from multiple research ‘snap-shots’ to inform policy and practice.
The processes of evidence review, described in Part One, clearly acknowledge the different types of review, linked quite closely to and exploiting the wide range of types of primary research. The recent developments from basic literature review, through systematic approaches and decision-support methods, are covered with many helpful examples to illustrate how these may be applied.
Part Two looks at synthesis in three parts: first, mainly quantitative (though statistical methods are not covered) including content analysis and Bayesian approaches are described. Second, the authors cover relatively recent types of synthesis of evidence using mainly qualitative text-based methods having an emphasis on interpretation but again making good use of primary research methods like grounded theory and ethnography, treating published research studies as primary data sources.
Third, other more eclectic methods which by definition do not fit the mould , a.k.a. ‘mixed methods’. Thematic analysis is described as a lower order type of content analysis; while realist and narrative synthesis … are intriguing methods which answer questions such as “What works, for whom, in what circumstances?” In all cases, ample use of exemplar synthesis helps the reader to grasp these fairly complex approaches to secondary analysis of health research. Part Three considers the “so-what?” question: what is the point of synthesis and what can be done with it? Chapters are included to guide researchers on early engagement with end-users to help plan presentation and dissemination of synthesis rationale, methodology and findings. In addition to summary tables, interesting examples of a mind-map, flowchart, graphs and diagrams are included. Software specifically devised to support synthesis is briefly described. Final chapters reemphasise the importance of synthesis in evidencebased health policy-making and re-visit the importance of matching method to purpose (with a helpful table for so matching). The book rightly ends with a neat set of 13 questions to be used in quality assessment of synthesis. This makes me think I need to apply more rigour to book reviews as well: but that is another story.
Review by George Kernohan Professor of Health Research, University of Ulster
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Traditional Herbal Medicines – a guide to their safer use
Lakshman Karalliedde and Indika Gawarammana, with Debbie Shaw. 2007
Hammersmith Press, 376pp.
ISBN978-1-905140-04-6 (paperback) £18.99
The world market for herbal medicines is estimated at about US$70 billion per annum and growing. In the UK, the market is about £275 million and about half of the population will use a herbal product in their lifetime in addition to, or as an alternative to, allopathic (Western) medicines. In the developing world, traditional medicine may be all that is available to most of the population.
In the West, traditional herbal medicinal products are perceived as a ‘natural’ alternative. They are also more accessible, and may be cheaper. Their use could also reflect discontent with allopathic medicine. Unfortunately, ‘natural’ does not necessarily mean ‘safe’. Many herbals are extremely potent and may produce adverse reactions. Some may interact with allopathic medicines and others may cause complications in surgery.
There have been problems with mis-identified herbs, quality control and contaminants and, often, there is little or no advice about dosage – and, as they say, the difference between a medicine and a poison is the dose. Regulation of herbal medicinal products is generally weak, compared with prescription and over-the-counter medicines, and cannot be relied upon to protect public health, though the USA and UK are currently strengthening their regulatory systems. Consumers might seek advice from their doctor or pharmacist, but the benefits and dangers of traditional herbal medicines are not included in pharmacy and medicine curricula. There has been a long-standing need for an easy-to-use, comprehensive reference text for both the public and for health professionals. Karalliedde and Gawarammana were ideally placed to author such a work.
Their upbringing in Sri Lanka seems to have given them a natural respect for herbal remedies that was later tempered by their training as allopathic medical practitioners and distinguished careers as toxicologists. Editorial advisor Debbie Shaw leads work on herbals at the Chinese Medicine Advisory Service at the Medical Toxicology Unit at Guy’s Hospital. About half of the book is an A-Z of commonly used herbs. It sets out their uses, probable modes of action, adverse effects and precautions. Other chapters address: common medical disorders – setting out both allopathic and traditional treatments; potentially harmful constituents; precautions in special circumstances such as pregnancy, breastfeeding, infancy, old age, diabetes and surgery, and drug-herb and herb-herb interactions. There is a very useful glossary.
The book is clearly structured and well indexed for ready reference, and much of the content is set out in tables. In less than a minute I was able to look up Echinacea. This is one of the most commonly taken herbal medicines, and its use is often promoted in popular magazines and newspapers. I found that while it has many benefits, it should not be used except under medical supervision by persons suffering from immune system dysfunction, autoimmune conditions, multiple sclerosis, HIV, tuberculosis and diabetes mellitus, and it has been associated with liver disease and life-threatening allergic reactions. I wondered how many GPs and pharmacists, let alone users of that product, were aware of this.
While I would have preferred more of the content to be academically referenced, the book sits comfortably at an acceptable level for both popular and professional use. For the protection of the public, it should be on the shelf of every GP, herbal practitioner, pharmacist, toxicologist, anaesthetist and public health department.
Review by Norman Parkinson Senior Lecturer in Public Health King’s College London, School of Medicine
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