Health Work with the Poor: A Practical Guide (review)

This 239-page guide, written for students in the health care sciences as well as many clinicians who provide direct care to the poor, contains eight chapters and a highly useful appendix detailing additional resources on health care and poverty. Christie Kiefer, a cultural anthropologist by training as well as a committed health care advocate for the underserved, examines the root causes of ill health among the poor from the unique perspective shaped by his academic background and community activism.

At the outset, Kiefer posits the claim that health care workers have both the opportunity and the obligation to address the underlying causes of poor health and health care among the medically underserved. He develops this point in greater detail by dividing his text into three main parts consisting of two to three chapters each. In Part 1, Kiefer examines the relationship between the health care worker and the low-income client. Combining a theoretical analysis of what it means to be poorwith practical approaches to effective provider-client interactions, he simultaneously guides and challenges clinicians to cultivate a broader understanding of the social/community context within which they provide care. Part 2 is devoted to a rather thorough political and economic analysis of poverty in America. Assuming the perspective of a social analyst, Kiefer succinctly explores the historical and political roots of poverty in the United States. Part 3 moves beyond theory and outlines a praxis of activism. Kiefer provides a concise, yet informative, history of the community health center movement in this country and later speaks directly to the role a health care worker can assume in facilitating community involvement through effective community organizing.

This book succeeds admirably at achieving its stated ends. Kiefer's writing style is clear, engaging, and highly readable. Although he takes a solid academic approach to his political and economic analyses of poverty and health care, he has successfully managed to avoid a detached, overly intellectualized treatment of the subject. He achieves this by deftly mixing anecdote with theory, supporting his more abstract points with brief clinical vignettes. Assuming the role of a good teacher, he develops his theoretical points in a number of different ways, but always with the attempt to put a human face on the issues he so fervently wants to bring to the attention of those involved in health care for the underserved. Throughout his social analysis of poverty and the health care system in the United States, he manages to remind the reader that what is absolutely central to the discussion is the personwho is enduring the effects of poverty and inequitable access to quality medical care.

The book is best suited for a class, seminar, or group discussion. A clinician at a public health unit who is expecting a practical, clinically oriented manual describing a how-to approach to working with low-income clients, in contrast, will likely be a bit disappointed. The book lends itself to group discussion where analyses on poverty and health care can be debated, myths explored, stereotypes challenged, and strategies of community action developed. Kiefer's suggested questions for initiating a dialogue, which conclude each chapter, and his brief appendix on teaching guidelines, help to make this a stimulating discussion book for those health care students and providers committed to working with the poor.