Pergamon Soc. Sci. Med. Vol. 44, No. 7, pp. 1077-1079, 1997

Published by Elsevier Science Ltd. Printed in Great Britain 0277-9536/97 $17.00 + 0.00

BOOK REVIEWS

The Imperative of Health: Public Health and the Regulated Body, by Deborah Lupton. Sage Publications, Newbury Park, CA, 1995. 181 pp. U.S.$65.00 (cloth), $21.95 (paper).

The aim of this book is to explore the ways that public health and health promotion in Western societies are embedded in historical, socio-cultural and political settings. The author rejects what is defined as the reductive dualisms of traditional critiques of public health and health promotion by analysts rooted in either a laissez-faire model of government or a political economy of health perspective. The former sees interventions into public health matters as apparatuses of an over-authoritarian state, while the latter criticizes public health for an excessive focus on individuals to the exclusion of challenging structural causes of ill-health. The two traditional critiques dichotomize the state as an instrument of oppression, and the people, who must be empowered to combat the oppression. As an alternative to these critiques, the author argues that public health as an instrument of state control, exerts power through a process of producing citizens that regulate themselves according to the values and priorities held by the state. In a process of normalization, experts are used to measure populations and establish norms for comparing individuals. Experts thus mediate between authorities and individuals, playing an essential role in controlling and shaping society by knowledge and rationality rather than compulsion.

Synthesizing traditional critiques of public health could facilitate moving beyond dysfunctional tendencies to separate individual rights and responsibilities from state power and responsibilities. Evidence that public health is embedded in and reflects socio-cultural conditions and historical circumstances instead of operating simply as either a mechanism of state control in the name of health, or as a means of protecting the public health, is useful for illustrating the weaknesses of traditional critiques. However, rather than explicating how socio-cultural processes operate to shape public health and maintain the dichotomous critiques, this book tends to denigrate public health.

Contemporary public health and health promotion are conceptualized and treated in the discussion as no more than

traditional health education. In order to make this narrowed conceptualization of the field fit the idea that public health, operating through the medium of expert knowledge, functions predominantly to limit the freedom of individuals, all activities, developments and references that contradict this thesis are omitted. The author ignores whole bodies of literature on subjects taken up in the book. As an example, in the discussion of theory in health promotion, it is asserted that the field rather than building on the perspectives of different disciplines is based on the paradigm of social psychology. Actually debates about the weaknesses of this paradigm were a central aspect of the emergence of the field of health promotion. The criticisms of the health belief models presented in this book have been made by many in the field of public health discussing the limits of traditional health education. Likewise, the limits of the risk factor model of disease have been analyzed within the field of public health for some time.

Following the critique of public health, a "'discourse" on pleasures, fears and desires developed from a psychoanalytic perspective is presented. Ranging from rather disjointed comments on many subjects to relatively detailed discussions of a few behavioral practices (cigarettes as an "object and conduit of beauty" in the extension of the innermost self), this discussion is presented as an alternative to traditional health promotion discourses. Whether or not most smokers would agree with the characterization of their smoking as an expression of defiance or that their life would lose meaning without cigarettes, it is doubtful that many people would agree with the author's oversimplified characterization of public health institutions as vested interests. It is difficult to view the content of this book as less polarizing than the traditional laissez-faire assessments of public health.

Population Health Studies Ribegade 6 st tt, DK-2100 Copenhagen Denmark

Kathryn Dean

Women's Health--Missing from U.S. Medicine, by Sue V. Rosser. Indiana University Press, Bloomington and Indianapolis, 1994. 213 pp.

Historically, in the medical and health care systems of the United States, women have been the forgotten and marginalized gender in much of the research that has been conducted and the subsequent policies that have been developed. Women's Health--Missing from U.S. Medicine appears at a time when the debate about women's issues has become increasingly heated after the Beijing international meeting on the role of women and Cairo's international conference on population and development. Governments are being forced to address the issues of women's health within a broader context of social and economic development.

Sue V. Rosser's book is a work of breadth and passion, charged with political commitment and gender empower- ment. Even if the author primarily addresses American readers' interests, it is also an important contribution for a non-U.S.A, reader without a background in medicine. The book's unifying theme of focussing on the unique needs of women presents a special challenge for health professionals and students, feminists, policy makers, funders, and for anyone who understands that policies are needed to improve the "health of the nation, which depends on the health of its women".

Women's Health--Missing from U.S. Medicine methodi- cally explores the ethical problems raised by an androcentric bias in clinical research and the extent to which it has distorted science: the choice and definition of problems to be studied, the methodology used to collect and interpret

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