This is an exciting book on health and disease, how to prevent sickness and stay healthy, and first line management of common illnesses. It defines primary helath care (which is much talked about but not quite understood) and the inputs needed to achieve that. The book emphasizes that health is not just diagnosis of an illness and its management and that community involvement, education, rural development, agriculture, women’s development programmes–all contribute to it. It identifies the physician as the leader of the health team and stresses not just on drugs, but on environment, sanitation and safe water supply. The skills a doctor needs are stressed such as management of drugs and medical stores, and a list of commonly used drugs which should be available always, and what is the best buy in the limited amount of money. Unfortunately the doctor has no say in the matter–drugs are made available under different categories either by the central government or the state government and there could be several gaps too.

The diseases targetted for eradication by 2000 have been mentioned such as polio (strategy is mentioned in detail), leprosy, neonatal tetanus, iodine deficiency disorders and dracunculosis. It elucidates indicators of Health for All in the 21st Century (WHO outline objectives) which include increase in life expectancy, equity in health between and within countries, access to all the sustainable health systems and services, objective of eradication of leprosy by 2010 and that of vitamin A and iron deficiency by 2020. Various elements that have adverse effect on health have been stressed such as pollution, noise, pesticides, insecticides, various carcinogens in the work place, etc.

Nutrition and health has been written about in detail, specifically mentioning vitamin A and iron deficiency and emphasizing widespread under-nutrition. WHO, FAO, ICMR diet recommendations are given which however are considered to be on the higher side by many nutritionists. Breastfeeding has been stressed and Baby Friendly Hospital Initiative has been mentioned as well as the breastfeeding code. One wishes there was more emphasis on complementary feeding (weaning is an inappropriate terminology) amount, frequency etc. since maximum malnutrition is between 6 months to 2 years. There is confusion between timing of complementary feeding 4,5 or 6 months. It is accepted that 4 months is too early and while WHO recommends 6 months, I would personally opt for 5-6 months to give it a little flexibility.

There is up to date information along with references on the treatment of tuberculosis and leprosy, AIDS, and Hepatitis B and C get adequate importance.

Maternal and child health gets due importance with emphasis on antenatal and natal care, training of TBAs and equipment and skills needed at the first referral unit. Problem of low birth weight and Barker’s hypothesis has also been stressed. Reproductive health and services expected to be available are described at different levels of service delivery and the shift from a target driven programme to the paradigm shift and now RCH is also dealt with.

Life style diseases have been mentioned highlighting the preventive measures. Disability, its prevention and rehabilitation have been dealt with briefly.

The book is not just a drab description of diseases but the emphasis is on prevention and various inputs needed for that. There are suitable flow charts, figures and statistics. A simple introduction to statistics and how to interpret them is also included. There is a detailed bibliography at the end of each chapter.

Several national programmes get a brief mention but the National Nutrition Policy and the Integrated Child Development Services programme is missing from the list. Even the Ninth Five Year Plan is not mentioned.

It is a refreshing book with a difference, which everyone interested in health and disease must read. However, for the medical practitioners to practice the art of medicine in the way ably suggested in the book, it is essential that they be taught the right priorities and provided opportunities to acquire the requisite knowledge.

A little more emphasis on the discrimination against the girl child including feticide and infanticide would have been welcome–after all females comprise half the population of the country. In an otherwise excellent book, the main author being described as the ex H.O.D. is rather incongruous! Some abbreviations can be jarring.

Shanti Ghosh,
5, Sri Aurobindo Marg,
New Delhi 110 016,
India.