In Sickness and In Health: Disease and Disability in Contemporary America by Thomas Richard K.: (review)

Richard K. Thomas's work is meant to be a comprehensive, clear, educational handbook on disease and disability defined in the widest sense: acute disease, chronic disease, and mental illness; and physical, sensory, cognitive, and psychological disability. The first chapter, which primarily discusses the importance of studying morbidity, is followed by eight chapters that examine how disease and disability are defined in the different disciplines that study them (Chapter 2); the nature of available data (Chapter 3); measurement problems (Chapter 4); the construction of disease and disability indicators from survey data and public statistics (Chapter 5); structural factors (particularly biological and environmental) and local and individual socioeconomic characteristics associated with variations in disease and disability within the general population (Chapters 6 and 7); disease and disability levels and recent trends in the United States (Chapter 8); and a presentation of available sources (Chapter 9).

The last two chapters are the only ones that focus exclusively on the United States. The rest of the book discusses theoretical and scientific empirical studies on various populations drawn from the scientific literature and generalizable to other countries. The book contains few references to developing countries and, as can be deduced from the subtitle, is not addressed to readers interested in their specific problems. It is mostly for debuting researchers, students, and (to a lesser degree) the public at large. It will be of less interest to demographers, particularly specialists of mortality, since many of the issues discussed in connection with disease and disability–problems of identification, definition, and measurement, and the main independent factors that may account for trends and variations within the population at large–are identical to those of mortality generally and causes of death particularly. But the author is convincing on the value of studies bearing specifically on morbidity.

The chapters are designed to be consulted independently of each other, but it is also useful to read the book from start to finish. Its end-of-chapter bibliographies (including website links), followed by a list of additional references and resources, will be appreciated by readers in search of precise information, as will the substantial glossary and precise descriptions of data sources (though only for the United States–unfortunately for those of us interested in other populations). The book is also useful for anyone wishing to get up to date quickly on knowledge about disease and disability, namely in connection with particular disciplines (public health, epidemiology, demography, etc.) and on factors explaining levels, trends, and differentials of the indicators discussed.

The first of the book's two main weaknesses is that it does not mention conflictual debates in the field of health; for example, on the respective roles of medical advances and social factors in long-term morbidity trends, or the difficulty of accounting for reverse causality in relations between disease and disability, on the one hand, and individual characteristics such as income or marital status, on the other. The second is its oversimplified presentation of theories in the field, particularly the epidemiological transition theory, given that several renowned studies have severely criticized the initial version of it. The role of public policy and health system structure, particularly relevant in the current American context, are hardly mentioned. Moreover, there is no concluding chapter, which might have served to point up holes in research on morbidity and disability and to suggest how studies of these subjects might be renewed theoretically and practically. The author makes no mention of the increasing availability of big health data on the Internet, a spectacularly growing field of research that may enable us to renew approaches and measurement methods, not to mention assist us in redefining the scientific questions raised by health. So a useful book, but an incomplete one.