Description

This book parallels the current debate in the UK on inequity. It is an Australian book and has been written by people who live and work there. It highlights issues of importance to those attempting to define and tackle health inequalities in that continent but many of the issues are the same for those attempting this agenda anywhere else in the world.

The presentation of the facts of the New South Wales Health Survey does not provide the most absorbing start. The authors have started the book with this section to frame the following chapters which are a collection of perspectives on why differences between various population groups occur and what can be done about them. These differences are highlighted in the findings of the NSW Health Survey.

The book has some useful definitions of equity, inequity and inequalities and highlights their complex multifactorial causalities. The different contributors present a mosaic of complementary views, which gives an interesting and inclusive approach. Throughout the book the lack of evidence of effectiveness of interventions and the need for further research is highlighted time and time again around issues such as why behaviours have strong socio-economic gradients. The authors challenge researchers to change focus from risk factors to study interactions between risk factors and to understand the context in which risk factors for disease work and how that leads to ill health and prevents recovery.

Contemporary points about health, health promotion and health care are made. The issues of relentless technological advances in search of biological perfection and ever-growing longevity and how this runs the serious risk of imploding, counterbalanced by the view that health services should be addressing essential and basic medical and health values are raised.

Effects of racism, employment, low income and nutrition on Aboriginal peoples lives and health are looked at from both a historical and a current perspective. The need to go to people rather than expecting them to come to health services is expounded. Fear of white doctors and white institutions calls for partnership with Aboriginal people and those responsible for housing, education and employment.

An interesting comparison of treatments for coronary events and treatments for cerebral vascular accidents is made to show the glamour of work on preventing and treating heart attacks and the much less glamorous and dogged approach to prevention and treatment of strokes. Similar examples are made with the fields of mental illness, drugs and alcohol problems.

The forces of prejudice and stigma which permeate the Australian culture are shown to add a further layer of handicap and further disadvantage citizens already handicapped when for example attitudes of prejudice are institutionalised in law and practice e.g. refugees versus asylum seekers. The authors state that marginalised people contribute beyond their number to the work of the health system and that their children too are marked by unequal life chances.

The book raises many questions and provides some suggestions for future action: –

Importance of understanding and respecting the perspectives of disadvantaged people as a basis for working with them successfully.

Achieving recognition of the importance of poverty as the single most important determinant of health.

The need to further establish the patterns and causes of health inequities.

The impact of pressure made by government and business at all levels on reducing and accelerating inequities.

The role of the health sector in taking action independently and in collaboration with others to address these issues.

Reshaping our thinking on social and economic progress through regular reporting on an index of human and social capital.

Mandatory requirements to report on the health and health equity impact of government policies and major private sector developments.

Developing a coalition/s for action to address health inequities.

Defining more clearly the role of the health system in addressing health inequity though its services and programs and develop a set of equity indicators to track action throughout the health system.

Nigel Crisp the new NHS Chief Executive and Permanent Secretary has stated that Inequalities need to be tackled in mainstream policies and services. Ensuring we address the needs of the most vulnerable individuals and groups is key to our shared challenge of narrowing the health gap. If this statement is taken to heart then this book has relevance to many sectors of the health service involved in both policy development and service delivery not just public health. Colleagues in local authorities and the voluntary sector will also find much of use here.

A book of its time and one that if acted on has the potential to narrow the health divide.