Book Review

Maxcy-Rosenau-Last Public Health and Preventive Medicine

N Engl J Med 1993; 328:893-894March 25, 1993

Article

Maxcy-Rosenau-Last Public Health and Preventive Medicine
Thirteenth edition. Edited by John M. Last and Robert B. Wallace, with six others. 1257 pp., illustrated. Norwalk, Conn., Appleton and Lange, 1992. $120. ISBN: 0-8385-6188-8

This edition of the classic textbook begun by Milton J. Rosenau in 1913 consists of 75 informative, self-contained chapters in diverse areas of public health and preventive medicine. Each chapter has been prepared by contributors (165 in all) who are deeply involved in research, practice, or both, in the area described. As such, and at the very least, the book provides an accurate and comprehensive picture of public health and preventive medicine as we near the beginning of the 21st century.

Dr. John Last, professor of epidemiology at the University of Ottawa, is the editor of this and the two previous editions of this book. During his tenure as editor, Last has increased the diversity of the contributors as well as the range of topics and has written or contributed to several chapters that define a context for other material. In this edition, Last is assisted by Dr. Robert Wallace as coeditor and by six associates who serve as editors for individual sections.

A major theme running throughout this book is the spectacular successes over the past 200 years in the areas of preventive medicine and public health. Improvements in sanitation and personal hygiene, the development of vaccines and antibiotics, and vast changes in lifestyle factors affecting health are all documented here. Also documented are the resulting massive and historic changes in health, including the precipitous reduction in infant mortality around the world, the worldwide eradication of smallpox, the control of poliomyelitis and many other communicable diseases, and more recently, the reduction in the rates of stroke and heart disease in most developed countries.

A particular strength of this book is that it presents a compelling picture of the emerging challenges in public health and preventive medicine. Ironically, many of these challenges can be traced directly to previous and current successes. In industrialized countries, reduced mortality rates along with reduced fertility rates have shifted the age distribution toward an increase in the elderly population, with a concomitant need for increased medical services and long-term support. Falling mortality rates have contributed directly to the exponential increase in the world's population over the past 200 years, resulting in urban crowding, political instability, and a strained ecosystem. As discussed in several chapters contributed by Last and others, this population increase has consequences beyond the individual level, including consumption of nonrenewable resources, problems in the disposal of waste, and even possible effects on the global climate.

These themes -- past and current success and emerging challenges -- are woven throughout the 75 chapters, which are organized into 6 major sections. The first section, “Public Health Methods,” contains excellent chapters on epidemiology (“the basic science of public health”) and on the relation of population dynamics to public health.

The second section, “Communicable Diseases,” contains a chapter describing diseases controlled primarily by vaccination, including measles, mumps, and poliomyelitis. Other chapters in this section are organized primarily according to the mode of transmission -- for example, sexually transmitted diseases, diseases spread by food and water, and diseases spread primarily by arthropod vectors. Together, the chapters in this section document the history and current state of progress in the classical areas of public health. Included in the chapter on sexually transmitted diseases is a discussion of the acquired immunodeficiency syndrome. The material is accurate and informative, although the number of pages allocated to this disease seems inadequate considering the devastating worldwide impact it is projected to have for the foreseeable future.

The third section, “Environmental Health,” includes chapters organized according to type of exposure (for example, asbestos, noise, pesticides, and radiation), as well as chapters organized according to professional activity (toxicology, ergonomics, and industrial hygiene). A chapter subdivided in sections to consider special working groups (such as workers with disabilities, migrant and seasonal workers, and women) has been expanded from the previous edition, but each of these groups could easily become the subject of an entire chapter. A chapter on housing and health and another on global environment, health, and health services describe broad social and political dimensions of the environment in relation to health.

The fourth section, “Behavioral Factors Affecting Health,” includes chapters on social and behavioral processes that underlie patterns of health and disease. There are separate chapters on behaviors that constitute health risks, including cigarette smoking, alcohol consumption, and drug abuse, as well as chapters on health education and behavior-change methods. The issue of individual change versus institutional or social change is considered throughout these chapters.

The fifth section, “Noncommunicable and Chronic Disabling Conditions,” includes lengthy chapters on conditions that have long been considered in the realm of medicine and public health -- for example, cancer, heart disease, hypertension, and diabetes. This edition also includes an entire chapter on violence as a public health problem. This chapter includes brief but excellent discussions of rape and sexual assault, spouse abuse, and child abuse -- areas that have only recently begun to receive attention as major public health problems.

The sixth and last section, “Health Care Planning, Organization, and Evaluation,” includes chapters related specifically to the organized delivery of health care and prevention services. Chapters on international health and on ethics in public health provide a context in which to interpret other material in this book.

Overall, the book illustrates the tremendous resources of knowledge in the areas of preventive medicine and public health. At an informational and technical level, we already know how to reduce injury and death from traffic accidents, how to control most communicable diseases, how to reduce premature morbidity and mortality from chronic diseases such as cancer and heart disease, and probably most important, how to control population growth. Given this technical capacity, the health of the public (measured in terms of absence of disease and quality of life) may now increasingly be determined through public debate about broad social and political priorities. By describing the basic technical concepts and capabilities in public health and preventive medicine, and by simultaneously discussing social, ethical, and philosophical concerns, this book provides an invaluable context and source of information for this public debate.

The book is not without some flaws. The allocation of space to different areas is a difficult problem in any review of this magnitude, but the issue becomes more relevant when, in the case of preventive medicine and public health, the amount and scope of information are rapidly increasing. Perhaps more important, the contributors to the book are largely from North America, and thus, despite several excellent chapters written with an explicit focus on international issues, the book is overly limited in geographic perspective. Overall, however, the book continues the tradition of this series and is an invaluable source of information for professionals and students working in public health and preventive medicine, as well as others interested in this area.

David R. Ragland, Ph.D., M.P.H.
University of California School of Public Health, Berkeley, CA 94720