key: cord-0033677-pqy8bikp
authors: Hayes, Adrian C.; Jupp, James; Tsuya, Noriko O.; Brandon, Peter
title: Book reviews
date: 2003
journal: J Popul Res (Canberra)
DOI: 10.1007/bf03031854
sha: 3227e6bf217edca4cb5e2a5cef41d59603f41704
doc_id: 33677
cord_uid: pqy8bikp

nan

The common picture of the health of populations around the world today is confusing. On the one hand, death rates in most developing countries have declined dramatically over the past 50 years and people live longer; on the other hand, infectious diseases once thought to have been conquered are making a comeback and HIV/AIDS could become the worst epidemic in history. In this book McMichael argues that the way to make sense of this paradox is to use a broad human ecological perspective on population health. He gives a masterful and engaging account of the 'long history of the changing patterns of human ecology and disease' from the Pleistocene to the dawn of the twenty-first century. Patterns of health and disease are examined as the product of ever-changing interactions between human biology and the social and physical environments. New patterns of disease emerging today may reflect the fact that humans are stressing ecological life support systems beyond the limits of their tolerance. In the space of this review I can only mention a few of the many topics McMichael skilfully weaves into the story.

Biology establishes some fundamental parameters for population health. McMichael's first three chapters discuss relevant aspects of human evolution. Human and chimpanzee genuses diverged in Africa 5-6 million years ago as the cooling of the Pliocene produced an ecological niche 'for an ape able to survive mostly out of the forest' (p. 39). Then the enhanced cooling of the Pleistocene (beginning about 2 million years ago) led to rapid speciation of the Homo genus. It is now generally agreed that a succession of Homo species migrated out of Africa, with extensive periods of co-existence among different Homo species. Homo sapiens and Homo neanderthalis, for instance, shared much of western Eurasia for thousands of years before the latter species became extinct around 30,000 years ago. Since then Homo sapiens has been the sole survivor of the Homo genus -and, as McMichael poignantly points out, if the current anthropogenic decline of species continues, it could become the sole representative of the whole great ape family.

Many distinctive characteristics of human biology were established as adaptations to environmental conditions of the Pleistocene. As conditions changed, some of those adaptive responses became no longer so 'adaptive', and the resulting imbalances between biology and environment can manifest themselves as a tendency to disease. One example discussed by McMichael is adaptations in insulin metabolism. Insulin is an 'ancient vertebrate hormone' (p. 66) that plays a vital role in the way the human body processes ingested carbohydrates and fats and converts them into energy for cell metabolism. The australopithecines (our pre-Homo ancestors, including the celebrated 'Lucy') appear to have been mostly vegetarian. As the tropical vegetation thinned during the global cooling of the Pliocene, however, 'the survival benefit gained from supplementary high-quality meat protein would have increased ' (p. 43) . Certainly the hominines (species of the Homo genus) emerging during 'the even cooler Pleistocene … took to meat-scavenging and hunting … the product of an evolutionary branch that invested in cognition rather than mastication ' (pp. 46-47) . We would expect natural selection to have a corresponding effect on the way the body uses insulin. McMichael, drawing on the work of J.V. Neel and others, hypothesizes that 'meat-dependent hunter-gatherers may have reached the end of the Pleistocene, around 15,000 years ago, with a reduced insulin sensitivity by comparison with their australopithecine ancestors ' (p. 53) .

This sets the stage for McMichael to advance a 'provisional thesis' (p. 70) to account for the prevalence pattern of 'Type II' (non-insulin-dependent) diabetes in the world today. The prevalence of Type II among major population groups varies by more than a factor of ten, and the variation is still striking even after controlling for obesity. Europeans have low rates. Assuming that reduced insulin sensitivity was the 'background' genotypic condition 15,000 years ago McMichael speculates that a few Neolithic populations might have diverged from this condition and developed a more insulin sensitive metabolism. Moreover those few populations could well have included the proto-Europeans, who were after all among the first to develop settled agriculture, implying a diet with more carbohydrates again. Middle Eastern farmers domesticated not only plants, but also goats, sheep, and later cattle. 'From around 7,000-8,000 years ago these agrarian communities began consuming milk and milk products. The result, today, is that genetically based tolerance of lactose (milk sugar) is much more prevalent in European than in most non-European populations' (p. 70).

Genetic adaptation of populations to diets with differing glycaemic loads could help account (in conjunction with dietary changes and obesity levels) for their different levels of glucose intolerance and frank diabetes. McMichael's line of reasoning takes more twists and turns than I can repeat here, and lack of direct confirmatory evidence means much of it remains speculative. As the late Stephen Jay Gould (2002: 910) remarked, paleoanthropology has 'more minds at work than bones to study'. But his account shows how mismatches between biology and environment can affect population health. 'Patterns of health and disease are the product of antecedent biological evolution interacting with current social and physicalenvironmental conditions' (p. 87). Other selection pressures he discusses, aside from food availability, are climate (leading to adaptations in skin pigmentation and the immune system) and infection (Chapter 3 includes a fascinating account of the co-evolution of parasite and host in the case of malaria).

Chapters 4-9 explore how a succession of changes in human ecology during the period of recorded history have affected patterns of health and disease by virtue of their impact on the co-evolutionary interplay between microbes and humans. This interplay is ubiquitous wherever there are human populations and is older than 'history' itself. When early humans became meat-eaters they exposed themselves to various animal parasites; when they migrated out of Africa they encountered unfamiliar microbes. In these chapters, however, McMichael emphasizes three broad historical transitions. The first corresponds to the rise of settled agriculture and the concentration of population in the early civilizations of the Middle East, Egypt, South Asia, East Asia and Central and South America. This created a new web of relationships among animals, humans and microbes, facilitating the migration of microbes from animal to human populations. 'Smallpox arose via a mutant pox virus from cattle. Measles is thought to have come from the virus that causes dis-temper in dogs, leprosy from water buffalo, the common cold from horses, and so on' (p. 101). Most of the well-known infectious 'crowd' diseases appear to have developed during this transition; although the 'leap' from animal species to humans can still occur today, of course, as HIV and SARS attest: writing before the recent SARS outbreak McMichael notes: 'in southern China, the intimate pig/duck farming culture creates a particularly efficient environment in which multiple strains of avian viruses infect pigs. The pigs act as "mixing vessels", yielding new recombinant-DNA strains of virus which may then infect the pig-tending humans ' (pp. 88-89) . Each of the ancient civilizations acquired its own repertoire of locally evolving infectious diseases.

The second transition corresponds to the era of fluctuating contact among the Eurasian civilizations through trade and warfare from around 500 BC to AD 1500. McMichael builds on McNeill's (1976) thesis that this contact resulted in the transmission and swapping of microbes, leading to episodic epidemics followed by periods of gradual re-equilibration between the infectious agent and human host population. The complex aetiology of the Black Death in mid-fourteenth century Europe, for example, seems to include an outbreak of bubonic plague in China during the 1330s. 'After many turbulent centuries, this transcontinental pooling resulted in an uneasy Eurasian equilibration of at least some of the major infectious diseases' (p. 108).

The third great historical transition refers to Europe's exploration and conquest of distant lands, and (using language reminiscent of Diamond 1997) the export of 'its lethal, empire-winning, germs to the Americas and later to the south Pacific, Australia and Africa' (p. 89). The large Aztec and Inca populations had no herds of wild animals they could domesticate and remained relatively free of 'crowd' infectious diseases until they were decimated by smallpox, measles and influenza introduced by Europeans. Falciparum malaria and yellow fever were brought to the Americas in the seventeenth century by the trans-Atlantic slave-trade. In similar fashion the Aborigines of Australia suffered deadly epidemics following the arrival of Europeans on that continent. And within 80 years of Captain Cook's first visit to Hawaii in 1778 the native population declined from around 300,000 to less than 40,000. McMichael points out that the third transition was more a 'dissemination' of microbes that had co-evolved with the Eurasian population to other parts of the world than an 'exchange'; and he is sceptical that syphilis was really introduced to Europeans from the Amerindians, as is often claimed. In any event the third transition represents another major process re-equilibrating the balance between microbes and humans, this time across transoceanic populations.

Are we experiencing a fourth major historical transition today? Around 1970 many experts thought that tuberculosis, cholera and malaria would soon be conquered; it was time 'to close the book on infectious diseases', declared the US Surgeon-General (p. 88). But now these diseases are increasing again, and a host of other diseases or their pathogens have been newly identified; they include Lyme disease, hepatitis C and E, human herpes viruses 6 and 8, Ebola virus and Legionnaires' disease. Something 'unusual' seems to be happening to patterns of infectious diseases (p. 115). To explain this McMichael suggests we must look at contemporary human-induced social-environmental changes which provide new opportunities for microbes to invade and colonize the human body: worldwide urbanization, intravenous drug use, changing sexual practices, changes in medical practice (blood transfusion, organ transplants), intensive food production, poverty and inequality, irrigation, deforestation, eutrophication of rivers, and so on. In the last three chapters McMichael draws together these themes in a more prospective view, detailing the risks to population health inherent in the way we are currently 'depleting or disrupting many of the ecological and geophysical systems that provide lifesupport' (p. 283). Chapter 10 includes a discussion of the health impact of climate change. As in his earlier work (1993) McMichael adds his voice, with eloquence and authority, to the imperative of establishing more sustainable ways of living.

McMichael's book is impressive in the way it marshals research findings from diverse fields, and even more important for the way it clarifies our contemporary situation. However, in telling the story about population health from a social ecological perspective his narrative is ahead of his analytics. He criticizes the conventional epidemiological approach (taking the individual as the unit of analysis) for its reductionism, but gives no systematic exposition of his own more holistic conceptual framework detailing precisely how it is 'some important health-determining factors operate essentially at the population level' (p. 23). Similarly his conceptualization of anthropogenic environmental change (building on Peter Vitousek and others) is pretty all-embracing and not yet structured to help us focus on those parts or processes most relevant for population health. The persuasive force of this book comes more from the weight of its examples of social-ecological processes influencing patterns of health and disease in populations than from any systematic theory describing these relationships. McMichael is clearly aware of these limitations; we hope he can address them in future work. A more explicit analytics will facilitate a more felicitous telling of the story.

Experts and advanced students from any number of population-and healthrelated disciplines will find this book useful and stimulating. Demographers will especially like the way it clearly positions 'population' centre stage; and the book's central thesis is certainly a boost to those of us who like to see demography in a strategic position at the intersection of the human and natural sciences. For those working in family planning, there is a challenging section on the health consequences of modern reproductive interventions ( pp. 216-218).

Institutions which have supported this fine work deserve some credit too. McMichael was Professor of Epidemiology at the London School of Hygiene and Tropical Medicine when he wrote this book; he is now with the National Centre for Epidemiology and Population Health (NCEPH) at the Australian National University. The disciplinary structure of modern universities is not always conducive to bold synthetic research like McMichael's. This book shows how important it can be: in fact the future health of human populations could well depend on it. The basic proposition of this interesting and timely book is that 'irregular migration occurs because states make rules about who can legally cross their borders. Under conditions of globalization, these rules promote transnational economic activity, but limit who can work and stay ' (p. 235) . In other words, there is a contradiction between increasing globalization and a declining willingness to accept mobility of labour as opposed to capital and goods. This contradiction is especially apparent in the European Union and the United Kingdom, with which much of this book is concerned. Britain, France and the Netherlands had a long tradition of free entry for imperial subjects, which they eventually found politically embarrassing. They now have the practice of free entry for European Union subjects, which they may also find embarrassing as the EU extends to eastern Europe and even Turkey.

With its focus on Britain, this study sees irregulars as mainly those who arrive through legal means but then work, which they are forbidden to do. Peoplesmuggling, which has become so controversial, is not central to their analysis. Because the majority entering Britain do not need visas, it is easy to get in. Because there is no national identity card, it is easier to work illegally than in most European states. Serious criminal activity is a matter for the police, who are relatively indifferent to breaches of immigration rules.

The basic problem remains that Britain, like several other European states, does not really have an immigration program. Those who wish to remain permanently and to become citizens must either be closely related to those already there, or make a successful asylum application, or gain access to the very restricted working-visa or business-visa system. Only recently, and since the publication of this study, has the government moved towards developing a coherent system allowing a quota of permanent residents; it has done so in response to widespread hysteria, worked up by the populist media, against asylum seekers. One weakness of this study is that it concentrates on economic motivations; yet the recent surge of asylum seekers, as in Australia, includes many who are genuinely fleeing wars in Afghanistan and Iraq. The British situation is made more acute by many from collapsing African states, or Balkan Romanies, making well-based claims of ethnic persecution. These latter will probably have full access to Britain once their states have joined the European Union.

At the core of this study is an analysis in depth of irregular migrants living and working in London. The groups chosen are Brazilians, who have no strong historic connections with England; Poles, who have stronger links; and Kurdish Turks, the only ones who can make plausible claims to be asylum seekers. Other than some of the Kurds -who are highly politicized -the irregulars simply come to make more money than at home, have no real desire to settle permanently and are ready to work for low wages and below their level of qualification. One interesting feature of these irregulars, which may well apply generally, is that they are young and well educated. They may come from poor countries but they are not peasants or labourers. What little we know about asylum seekers suggests that they are also well educated and skilled. The difference is that they have few places left to go, whereas many of the openly 'economic irregulars' have every intention of returning home in due course.

Because they are relatively well-qualified, many of those studied here have access to the variety of non-government organizations which have sprung up to help them and represent them to the authorities. They are certainly not voiceless even if inclined to avoid direct contact with government for fear of deportation. Because London has a long history of immigrant labour in service industries, there does not seem to be much concern with the present situation. As host to millions of tourists it needs a mobile labour force, and it does not have a serious unemployment problem except in some declining enclaves in the East End. Many of those interviewed have worked illegally for years and have rarely encountered any attempt to discourage or remove them. There is a contrast between this liberal approach to casual labour and the much stricter attempts to discourage permanent settlement. However, the flood of asylum seekers in recent years is changing this. The book's publication was too early to account for the recent moves in Britain towards a regime reminiscent of that in place in Australia. As presented here the British authorities do not really mind people coming to work in low-wage industries because they do not expect them to settle. London is now so cosmopolitan that racial tensions are less politically significant than in some smaller cities which have recently experienced violent reactions.

As is regrettably common in texts published in Europe and North America, there are only passing references to Australia. This reflects our isolation, which also makes the 'dilemmas' of irregular migration less pressing than for states with long land boundaries or short sea crossings. However, Australia does have a complex, planned and longstanding immigration program, with some principles and practices extending back for over a century. This is in contrast to the United Kingdom situation studied at the heart of the book. Some issues which are of interest to Australian scholars and addressed by this book include: will irregular immigration increase despite increasingly rigorous attempts to prevent it? Does the admission of large numbers of students, tourists and working-holiday temporary migrants make this more likely to happen? Is flexibility needed in assessing asylum seekers as against 'economic migrants'? How can immigration policy be insulated against populist agitations and political expedience? Can Sydney hope to be a 'world city' without a degree of 'irregular migration' to supply transient labour in services? Does our expanding relationship with the island states of the South Pacific make regularization of immigration on a more generous basis more likely? Does it really matter if there are thousands of 'irregular migrants' working in the economy? How can people-smuggling, trafficking in women, drug-smuggling and terrorism best be controlled without Draconian restrictions on legitimate movement? This is an interesting and useful book. Its tendency to see all movement as essentially motivated by economic inequality is of prime importance, even if that is only part of the story. Globalization without liberal migration regimes, on this view, could be oppressive. But are the rich societies ready to modify this? This study ends on the note that 'globalisation has consisted in the development of the world economy under conditions most favourable for capital and the First World countries, and under terms that discriminated against the developing countries in the liberalisation of trade. … For these reasons, it is doubtful whether an international regime for managing migration, would be a step towards international justice' (p. 251).

Australian National University This volume offers anthropological accounts of the evolution, production, and consumption of various social policies in contemporary Japan. Consisting of nine chapters, it is a collection of papers prepared originally for an international conference. Chapter 1, by Goodman, discusses the evolution of applied anthropology, and explains what anthropology can offer to the studies of social policy. The anthropology of social policy is not only the study of meanings ascribed to slogans and symbols associated with the policy but also that of its production and consumption. As Goodman argues, social policies not only emerge from a particular socio-cultural context, but they also provide important clues to how social values are constructed and altered. Chapter 2, by Bestor, attempts to sketch a 'cultural biography' of civil society in contemporary Japan. It first traces the postwar development of the notion of civil society; it next examines the multiple uses of related terms such as civil society, volunteerism, NPO, and NGO; and then provides an example of the development of civil society by describing a sudden rise in volunteer activities and the enactment of the NPO law following the Hanshin earthquake in 1995. Instead of devoting many pages to explanations of the meanings of different terms, the chapter would have been more interesting if it were focused more on the processes that gave rise to volunteerism and the ensuing legislation by illustrating the interaction between volunteer activities and the policy responses.

In Chapter 3, Roberts analyses the problems associated with low fertility, by examining programs within the Angel Plan -the comprehensive policy to increase the rapidly falling birthrate -and public discourse associated with its implementation. Roberts demonstrates that the policy initiatives are not consistent with, therefore not effective in altering, the prevailing gender division of labour. By identifying some of the voices influencing the production and implementation of the policy, she also illustrates the nature of changing social norms and the roles of policy in bringing about such changes. Although some demographic facts are misrepresented, the chapter nevertheless offers vivid information regarding how the Plan is produced and consumed, therefore furthering our understanding of the importance and difficulties of balancing work and family in contemporary Japanese society.

In Chapter 4, Stevens and Lee analyse how two sets of government policies, those of the Ministry of Health and Welfare and the others of the Ministry of Justice, influence the provision of maternal and child healthcare for foreigners in Japan. They argue that legal and cultural stresses, exerted by the way the policies determine the eligibility and provisional guidance for healthcare, make it difficult for foreign women to have the care they need, and that in turn leads to higher-risk pregnancies. Public policies and laws are influenced by the perception of ethnicity, and the lack of policies to deal specifically with health problems of foreign mothers suggests a dual reality of health and welfare in different segments of the population. However, their arguments are not fully supported by empirical evidence, according to which the mothers who suffer higher health risks are those from developing countries in Southeast Asia whereas the risks for other foreign mothers are similar to, or significantly lower than, those for Japanese mothers. Providing that foreigners comprise vastly different groups, it seems necessary to account for their differences in socio-economic status, demographic features, and legal status before we determine whether foreign mothers indeed suffer higher health risks.

Chapter 5, by Ben-Ari, examines the interrelation between the organizational features of Japanese preschools and the way by which they are predicated on notions of normal development of children. Based on participant observations, visits to childcare institutions, and secondary analyses of administrative documents used by these institutions, Ben-Ari shows how organizational arrangements of institutions of early childhood education are related to the ways that children are socialized according to a uniform set of ideas that the state deems normal and ideal. This chapter is, like Chapter 3, an example of practical anthropology at its best. It offers useful and interesting information based on two primary methods of applied anthropology: field work and content analysis of documents.

In Chapter 6, Goodman analyses the 'discovery' of child abuse in Japan and the development of social policy to deal with the problem. His view is that the upsurge of reported cases of child abuse in the 1990s was largely a result of the campaigns by the media and child-welfare institutions. Mothers are found to be the main abusers of children, and these groups viewed the increasing child abuse as a consequence of nuclearization of the family, combined with the prevalent myth of motherhood. Goodman shows that through the implementations of regulations and policies, this discovery altered the relationship between the state and parents by giving greater powers to authorities to intervene in what had previously been seen as the exclusive and private domain of the family.

Chapter 7, by Thang, offers an overview of programs to promote interaction between the elderly and school-aged children and teenagers in Japan. Through an attempt to interpret intergenerational interactions in the context of the Japanesestyle welfare society, Thang seeks to show the needs for and significance of intergenerational interaction programs. Although we cannot deny the need for programs to promote intergenerational interactions, I cannot help feeling that such programs are supplementary in an array of policies designed to support and care for the elderly. Given the rapidity of population ageing and the pervasiveness of its socio-economic, demographic, and political consequences, more attention should be paid to how these programs are related to mainstream elderly policies such as the Golden Plan and the Long-Term Care Insurance, and to how these policies and programs together alter the perceptions and treatment of the elderly in contemporary Japan.

In Chapter 8, Tsuji examines the evolution of death-related policies in Japan over the last 130 years. Tsuji shows that mortuary practice is shaped by interplay among policies, individual actors, and traditions, being conditioned by wider socio-economic and demographic changes. Though it is a little too long on explanations of prewar development, I found the chapter interesting and informative, illustrating skilfully that since Meiji the government has used death policies to exert control over the family and individuals, and that mortuary practices have changed in recent decades in the face of constraints driven by low fertility.

Chapter 9, by Mackie, discusses some of the ways in which social policy affects individuals differently. It argues that the archetypal citizen in the contemporary Japanese political system is a male, heterosexual, able-bodied, fertile, white-collar worker. This in turn suggests that our understanding of citizenship can be broadened if we view citizens as embodied individuals whose positions are situated somewhere in a spectrum, shaped and constrained by legal and institutional structures. While the typology of citizens provided by this chapter is useful in understanding how citizenship is defined by the society, it falls short of explaining how changes in social policy are related to changes in the notion of citizenship in contemporary Japan.

There are general weaknesses in the volume, stemming largely from the very nature of the enterprise. In all, however, the volume provides useful insights into how problems and policy issues shared by many industrialized countries are tackled in Japan. Thus it will be of interest not only to Japan specialists but also to those who are interested in social policy in industrialized societies in general. 

is an ambitious book. The first book in a series on the Australian economy and society, it provides informative analyses about education, work, and welfare in Australia over the last decades of the twentieth century. This important work on contemporary Australia creatively presents data on shared and divergent attitudes among Australians, social trends over time, comparisons among social groups, and comparisons with other nations. The book is distinctive in using large, representative samples of Australians and persons from other nations to make conclusions and inferences. Three principal sources of data are used: the International Social Science Surveys/Australia, the International Social Survey Program, and the International Survey of Economic Attitudes. Combined, the three surveys yield a sample numbering over 50,000 individuals. The surveys are nationally representative and, depending upon the topic under investigation, permit the authors to make generalizations to the populations as a whole. With the improvements in measurement theory and survey questionnaire design, the authors can provide authoritative statements about people's attitudes and behaviours within countries and compare Australians' attitudes and behaviours to those of persons in other nations. With some exceptions, the nations with which Australia is most often compared are English-speaking or European. Two chapters that provide interesting applications of the comparative analysis approach using survey data are Chapter 15, 'Conflict between the Unemployed and Workers in 20 Nations' and Chapter 9, 'Participation in the Labour Force'. The tabulations in each chapter develop the authors' stories as eloquently as the accompanying narratives.

Furthermore, the large amounts of data collected from the surveys permit the authors to exploit more advanced multivariate techniques. Throughout the book, various multivariate modelling strategies are used to better understand relationships between such topics as education and earnings; job complexity and earnings; upbringing and attitudes about trade unions; and risky lifestyles and ideals about societal responsibility for diseases. Obviously, in the interests of science and effective policy development, debate should surround the methods used and the conclusions reached. Notwithstanding the need for such debate, the book carefully documents its methods and justifies the statistical approaches taken. Readers concerned about empirical social science will welcome the multivariate models featured in the book, especially since most of its predecessors, which aimed for the same grand scale and scope, often omitted multivariate models. That omission was rarely made by choice, but was usually due to data constraints.

Attention to methods, creative use of surveys, and strategically placing findings in national and international contexts produce some fascinating findings in the book. Some of the more notable findings include workers' desires for job security, even if it means less pay; stronger support for trade unionism among public service employees than among blue-collar workers; Australians' desires to see the influence of unions no further weakened after many years of sustained government efforts to do so; a tension between Australians' feeling sorry for their fellow Australians who have suffered from diseases as outcomes of risky health behaviours on the one hand, yet also feeling one must take responsibility for one's own life-style choices on the other hand. And, lastly, a finding that Australians do more complex jobs than their counterparts in five European nations, but that complexity is not the most important determinant of salaries. Rather, the apparent determinants of Australian salaries are status and maleness.

The book accomplishes its goal of clearly and concisely presenting its findings and interpreting what they mean for contemporary Australian life. Topic VI, 'Retirement', which contains three chapters, is a good example of the clarity and compactness of the writing style and presentation of facts. However, readers may sometimes find the book too dense and the huge number of graphs, figures, statistics, replicated survey questions, and technical notes distracting instead of illuminating. Perhaps the commendable effort to document rigorous scientific analyses is occasionally counterproductive.

Overall, the work is essential reading and it offers researchers, policymakers, and others concerned about Australia's future a myriad of social and economic data in one source. If this book is indicative of future volumes in the series, then the series will have great utility.

Guns, Germs and Steel: The Fates of Human Societies

Planetary Overload: Global Environmental Change and the Health of the Human Species

Plagues and People