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Meredeth - The Politics of Public Health

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In the progressive public health tradition, Meredeth Turshen criticizes conventional approaches to disease and offers an alternative framework based on the concept that health and illness are socially produced throughout the world. Using contemporary and historical accounts of great moments and great debates in public health, Turshen exposes the failure to improve health even when a specific program like smallpox vaccination succeeds. Her analyses incorporate theoretical contributions from Marxism and feminism. The book is divided into four parts. Part I outlines current and alternative approaches to health, theories of disease causation, the policies and practices that follow from these theories, and issues of equity and access to health care. A chapter on womens health in three African countries illustrates these concepts. Part II describes limits to conventional public health, using case histories of plague control, dioxin decontamination, sanitary reform, and smallpox and malaria eradication. In Part III, Turshen presents case histories of preventive medicine, nutrition and agribusiness, mental health, and AIDS in Africa to suggest new approaches based on an alternative model of social production. Part IV looks to the future of public health by examining basic issues in the integration of research, training, and services; it concludes with an agenda for action. Meredeth Turshen is a Professor in the Edward J. Bloustein School of Planning and Public Policy at Rutgers University and author of The Political Ecology of Disease in Tanzania (1984) and Privatizing Health Services in Africa (1999), published by Rutgers University Press.

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title The Politics of Public Health author Turshen Meredeth - photo 1

title:The Politics of Public Health
author:Turshen, Meredeth.
publisher:Rutgers University Press
isbn10 | asin:0813514223
print isbn13:9780813514222
ebook isbn13:9780585034577
language:English
subjectSocial medicine, Public health.
publication date:1989
lcc:RA418.T915 1989eb
ddc:362.1
subject:Social medicine, Public health.
Page iii
The Politics of Public Health
Meredeth Turshen
The Politics of Public Health - image 2
RUTGERS UNIVERSITY PRESS
New Brunswick, New Jersey
Page iv
Copyright 1989 by Meredeth Turshen
All Rights Reserved
Manufactured in the United States of America
Library of Congress Cataloging-in-Publication Data
Turshen, Meredeth
The politics of public health / Meredeth Turshen.
p. cm.
Bibliography: p.
Includes index.
ISBN 0-8135-1421-5 (cloth) ISBN 0-8135-1422-3 (pbk.)
1. Social medicine. 2. Public health. I. Title.
RA418.T915 1989
362.1dcl9 88-36976
CIP
Page v
In loving memory of my mother
Page vii
CONTENTS
Acknowledgments
ix
Introduction
1
Part One. New Principles for Public Health
7
Chapter 1. A New Vocabulary
9
Chapter 2. New Tools for the Study of Ill Health
33
Chapter 3. Public Health Policy
50
Chapter 4. Equity and Access
65
Chapter 5. Women's Health
91
Part Two. The Limits to Conventional Public Health
119
Chapter 6. Containing Disease
121
Chapter 7. Cleansing the Environment
135
Chapter 8. Disease Eradication
150
Part Three. Non-Medical Approaches in Public Health
165
Chapter 9. Preventive Medicine
167
Chapter 10. Nutrition and Agribusiness
182
Chapter 11. Mental Health
198
Chapter 12. AIDS in Africa
219

Page viii
Part Four. Unconventional Wisdom
243
Chapter 13. Issues in Integration
245
Chapter 14. An Agenda for Action
266
Notes
277
Bibliography
285
Index
309

Page ix
ACKNOWLEDGMENTS
I enjoy reading authors's acknowledgments. Even when I skip a foreword or preface, I never miss the acknowledgments because they reveal something about the social relations of the book's production, which give important clues to what I am about to read. Of course, it is even more fun to reach the stage where one writes one's own note of thanks.
As befits one who believes in the economic importance of institutions, I begin by thanking Rutgers University, the Rutgers Research Council, the Department of Urban Studies, and the Graduate Program in Public Health of Rutgers and the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, all of which supported me while I did the research for this book. Special thanks to Bernard Goldstein and Michael Greenberg, director and codirector of the Graduate Program in Public Health, and to the students who listened to my lectures patiently (and impatiently) and challenged my ideas. I also wish to thank the Nuffield Institute for Health Services Studies of the University of Leeds at which I spent a sabbatical semester working on the book. Thanks to Carol Barker, acting director of the Nuffield Institute, and Shubi Ishemo for many stimulating discussions over delicious dinners of Scotch salmon.
My greatest debts are to my editor, Marlie Wasserman, who encouraged me and supported this book from the first tentative outline to the final version, and to my gifted reader, Evan Stark, whose generous comments were consistently positive, intellectually challenging, and most helpful in giving concrete guidance and direction. Dorothy Remy first suggested this work, which pulls together many of my ideas elaborated over twenty years in public health. And I thank Frank Popper for reminding me that revolutionaries don't speak in the passive voice.
Many people helped by sending me references or comments: thanks to Edward Allworth, Tony Astrachan, Rick Brown, Ron Caplan, Pierre Chaulet, Sally Cornwell, Ramana Dhara, Ray
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