- Public Health for an Aging Society ed. by T. R. Prohaska, L. A. Anderson, and R. H. Binstock
By 2031, Statistics Canada (2005) has estimated that there will be nine million adults over the age of 65 in this country. The goal of public health as it relates to the aged population is to provide and maintain the health of those people and to promote and sustain functional independence. This new book by Prohaska and colleagues addresses those tasks. A caveat: Throughout this book, the authors have relied largely on U.S.-based data. Although Canadian readers might appreciate data specific to our different cultural and demographic composition, many critical issues facing public health programs are universal and global. Such issues include problems of chronic and infectious disease and health care disparities, and the development of health and wellness promotion and disease prevention initiatives.
The four papers in Part I, "Fundamentals", introduce core public health functions as well as two relevant conceptual models: the population perspective and the social/ecological approach. A particular strength of Part I is its excellent descriptive material on population aging from a global perspective, which highlights the challenges facing all public health providers everywhere. The paper on new metrics to guide public-health decision making can be commended for identifying key priorities for developing age-friendly cities and communities. Unfortunately, discussions about training and organizational issues in health and long-term care have little applicability to the Canadian situation. Additionally, the last paper in Part I addresses the quality of life for older populations, and its strengths include its discussion not only of general concepts (such as successful aging, and a broad definition of health), but also of measures and reporting mechanisms specific to assessing the U.S. public health system and related challenges faced in interpreting and applying data about quality of life. The paper relies on the aforementioned social/ ecological model of aging, a model which overlaps with other key gerontological theories (such as the determinants of health) and is further referenced elsewhere in the book (e.g., a paper on the epidemiology of aging).
Part II, "Social and Behavioral Factors", concentrates on social and behavioral determinants of public health. The first of three papers addresses social determinants, including a good presentation and discussion on health equity and public health programs. Of course, the U.S.-based examples are most relevant to that country's unique health service arrangements, health insurance programs, and distribution of health services. Aspects with broader application include a description of a 2008 World Health Organization report and its specific action principles. The take-away message of this paper is that no single public health agency or policy alone will be able to address health inequalities driven by class, race, and gender.
A strength of the second paper on disability and decreased functional status is its description of risk factors, rooted in specific conceptual models (e.g., the four-stage linear progression model, person-environmental fit). There is also good material on stages of the disability process, and measurement and data-related concerns. The identification of public health challenges and goals in relation to disability may be extrapolated for application and consideration in more-general contexts. This is followed up in the subsequent paper by an overview of primary, secondary, and tertiary prevention strategies.
The final paper, on behavioral risk, highlights issues related to physical inactivity, poor diet, body weight, tobacco use, and alcohol consumption. Tables (e.g., those summarizing the National Cancer Institute's research on behavioral change and theoretical frameworks) are universally applicable. Similarly, the sections on design, testing, and efficacy in public health programs are also widely applicable. This information blends nicely with much of the health promotion material currently being used in Canadian gerontology education and adds 12 new objectives, including three focusing on developmental risk (i.e., derived from the U.S. Healthy People 2010 report).
Part III, "Societal Applications", includes four papers. The first, dealing with dissemination and implementation, raises many issues for teachers and...