Abstract
This book examines the comparative development of public health measures to lower infant mortality rates and to limit the spread of tuberculosis in the late nineteenth and early twentieth centuries. As the study turns its attention to the late twentieth and early twenty-first centuries, public policies aimed at regulating cigarette smoking and at stemming the transmission of HIV/AIDS become the objects of concern. It would be difficult to explore every dimension of the larger campaigns to address these public health risks, and as such, the author draws more attention to some aspects of these movements than to others. In the case of infant mortality, the primary concern is accounting for variations in the introduction of government mandates to pasteurize milk, with some added discussion of experimentation with well-baby clinics and other educational initiatives tailored to working-class mothers. Controversies over the passage of laws obliging doctors to notify public health officials of tuberculosis cases is the common thread in the book’s survey of policies to combat TB in these four countries, with some attention to public and private charities’ various efforts to establish sanatoria and dispensaries. The advent of restrictions on cigarette advertising and merchandising and associated bans on smoking in public places are the focal points of the study’s overview of anti-smoking measures. In terms of HIV/AIDS, the analysis turns to the success or failure of efforts to implement needle exchange programs for intravenous drug users.
The arguments unfold in three parts: introductory, empirical, and interpretive. The first two chapters shed some light on the advances in biological, medical, and hygienic sciences that triggered public health controversies in each of these societies, and present a rudimentary analytical framework for understanding the divergent political responses to them. The latter draws our attention to familiar issues of state capacity and autonomy, the relative weight and bearing of private interest groups, the health professions, and private charitable agencies in shaping policy agendas, the political conventions that bind together state and civil society, and the overarching role of political culture in mediating the reception of expert findings and recommendations. The greater part of the book takes the form of four discrete, topical chapters on the historical development of the public health measures detailed above with a view to comparing and contrasting policy responses across the four countries. These installments recap and synthesize a range of secondary sources written about public health movements within individual countries, sources that typically vary in terms of their focus and emphasis. As such, sustained, consistent, and precise comparisons across all countries often prove somewhat elusive. The concluding chapters provide a retrospective of these historical summaries by revisiting at length the influence of critical variables in policy formation. In short, the author finds policy-making in each country to be highly idiosyncratic. Public health action depends on “some combination of three ingredients: perceived peril to the nation or to the accepted social order, state interest and capacity, and advocacy group pressure. The relative importance of each ingredient depended on the issue at hand and was variable cross-nationally and across time” (pp.248–49). The unique configuration of ideas, institutions, and interersts in each country engenders differing routes to action as well as to inaction.
This is a highly informative and insightful study. The reader need not be versed in the field of public health to grasp the presentation. The introductions to each empirical chapter on specific public health issues provide most of the background knowledge that a novice requires to follow intelligently the ensuing discussion. The author has written a highly readable account that is accessible to those with a general interest in political sociology, policy history, or comparative-historical analysis, and who also are interested in extending their knowledge of comparative policy-making into unfamiliar terrain. The book would recommend itself to students of health policy and to medical sociologists who have a primary interest in the acute care and personal health services who would like to augment their comprehension of public health issues. Students of social problems might also benefit from this study if they are inclined to explore cross-national variations in the social construction of public issues, and as such, move beyond the more limited focus on American settings that often prevails in the social problems literature. Moreover, the book seeks to close the circle between public agitation and policy outcomes, another commonly overlooked aspect of social problems texts.
The book has evident shortcomings. The most apparent is the lack of precision in conceptualizing and classifying the policy achievements in these four countries. The standards for arbitrating between success and failure in terms of legislative responses on the one hand, and between vigorous or lax prosecution of public health measures on the other, are not always as clear and obvious as one would hope. Nor are we uniformly apprised of the relative effectiveness of differing policy responses to public health issues in each case. A more crisp, robust appraisal of the practical relevance of these divergent styles of policy formation would better underscore the importance of these topics. For comparativists who place some weight on developing a sound rationale for case selection, a more thoughtful and convincing argument could have been made for the policy issues chosen for study.
The organization of the volume either betrays poor editorial guidance or a refusal to entertain sound advice. The book reads like a point-last essay. The author’s principal conclusions should have been better articulated in the beginning of the book and more effectively foreshadowed the evidence to follow. Not all readers will patiently read to the end of a lengthy book to discover the author’s main points. These are subtractions from an otherwise laudable study, ones that could have been avoided with a careful revision.