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Bringing the Past to Life

Popular pharmacology segues to constructively critical chapters on the representations of international health professionals. This second section begins by introducing and then challenging key definitions and approaches. The author unpacks terms such as “community,” “household,” and “risk” without discarding them altogether. He also analyzes historically opposed strategies while suggesting the need for synthesis. Dichotomies in “health disparities vs. social inequalities” or “horizontal vs. vertical approaches” often reflect significant ideological differences. Yet perhaps more important, their exclusion of one another can impede potential collaborations and coordinated efforts. For instance, the use of DALYs and other statistical indices may fail to capture the complexity of health issues at different scales. However, with an understanding of their strengths and shortcomings, they can complement microlevel studies as diagnostic tools. Here, the criticisms are clearly laid out, but so are the opportunities for thoughtful integration. Perhaps the biggest challenge to integration lies with the power structures that shape the practice of global health. With programmatic examples, the reader learns the concept of biopower and the mutual transformations of economic, social, and symbolic capital. By wielding the power of the purse, politicians and funding agencies can not only set program agendas but also make and break professional careers while placing a market value on certain kinds of language over others. Pertinent examples descend from the top down, such as donors’ imposition of uniform requirements for TB control in DOTS programs around the world. They also rise from the bottom up, such as the researcher who attends professional meetings in order to learn the latest buzzwords for his or her next grant. Yet although pervasive, biopower is not monolithic. As with their recipient communities, the representations of donor communities are also subject to competing interests. Herein lie the opportunities for change. Although less effectively placed in a third and final section, Global Health concludes by outlining new and important areas for social science research—having effectively primed the reader with suggestions throughout the text. The recent concept of syndemics expands clinical notions of comorbidity by tracing specific interactions between infections, chronic diseases, and their surrounding social environments. Similarly, a framework of local biology examines how these interactions become embodied in developmental trajectories across the human life span. Beyond the rhetoric of participatory research, community models of illness and risk can make their own contributions to epidemiology and medical geography. Last (for the purpose of this review), there is a great need for social studies that can bridge the disciplinary and institutional fragments that have come to be known as global health. No text can fully capture the world of human health; Global Health is no exception. For instance, international mental health issues are notably absent. That said, Global Health is more of a journey through the social dynamics of perception, representation, and power rather than a survey of specific health problems. The former reflects the author’s particular strengths while illustrating broader issues for others to make further contributions. For this, Nichter has written an accessible text that is both critical and constructive, an inspiration as well as a lesson plan. It should be required reading for anyone considering the relevance of social science in global health.