The People's Health

The first volume of this enterprise deals with developments in Australian public health up to the middle of the last century. Arranged chronologically, successive chapters reflect the broad changes in public health ideology and practice that have also been identified in other industrialized economies. An introduction to the global history of public health up to the mid-nineteenth century is followed by a chapter charting the health and disease profile of a newly colonized land. Subsequent chapters provide richly detailed accounts of environmental sanitary reform from the middle of the nineteenth century; preventive measures primarily aimed at mothers and young children around the turn of the twentieth century; and twentieth-century arguments for a health system that integrated preventive and curative services, was funded by taxation, and emphasized equity of access. Volume 2 also assumes a broadly chronological approach, tracing the emerging significance of chronic diseases such as heart disease and cancer; evaluating on the one hand specific initiatives such as the Community Health Program and, on the other, the expansive idealism of the late twentieth-century version of the New Public Health; and considering the themes that associate public health so closely with social justice. Extensive treatment is given in this latter section to aboriginal and immigrant health. These volumes, therefore, represent an exhaustive and up-to-date history that will in all probability appeal to both historians and public health practitioners.

It is impossible here to consider the wide range of issues raised by an account spanning more than two centuries. Milton Lewis is on surest ground when discussing institutional and policy developments closer to the present, providing detailed descriptions of the arguments and political debates in Australia surrounding national health insurance and the failure to establish some form of national health service up to the middle of the twentieth century. In addition to an underlining of key ideological underpinnings such as national efficiency and race degeneration, one consistent element in the narrative of volume 1 in particular is the way in which the individualistic, therapeutic model of biomedicine has dominated the direction of public health and health-service provision in Australia. The central observation of volume 2 is that, for some time now, public health has been approaching a crossroads. The choice presented by Lewis is that public health can either continue to follow a route essentially dominated by the science of epidemiology, concentrating on risk factors, prevention, and control; or, it can take a broader pathway, addressing a gamut of issues at the intersection of health with social justice, equity, the environment, and human rights.

Lewis himself seems to be in little doubt that public health should follow the latter path. Indeed, in the final pages of volume 2, in the chapter "Civilizing Global Capitalism in the Interests of Health Advancement," he considers the ways in which public health can become a force for "global public good" (2: 324). He argues that the sanitary reform movement in nineteenth-century Britain, characterized as ameliorating the worst social evils of a capitalist system gone awry, points the way for public health's "civilizing" potential. Lewis is uncomplicatedly optimistic about the ability of the institution of public health to act as an advocate for social and environmental reform, facilitating multiagency action.

To my mind, this last section captures all that is good and not so good about this book. On the negative side, there is little or no engagement with the sociological critiques of the New Public Health that have emerged since the mid-1990s, many of which emanate from the Australian academe itself. This is a feature of the book generally, in that the listing...