Book review: L. Leviton, C. Needleman and M. Shapiro, Confronting Public Health Risks: A Decision Maker's Guide, London: Sage, 1998, ISBN 0-8039-5356-9, 253 pp, £16.99.
✍ Scribed by Peter Bennett
- Book ID
- 101295476
- Publisher
- John Wiley and Sons
- Year
- 2000
- Tongue
- English
- Weight
- 53 KB
- Volume
- 15
- Category
- Article
- ISSN
- 0749-6753
No coin nor oath required. For personal study only.
✦ Synopsis
All those involved in the management of risks to public health should ®nd this book worth reading. This applies not only to those in the front line of dealing with the public, but those involved behind the scenes in scienti®c analysis or policy formulation. It is not a decision-maker's guide in the sense of a `how to do it' manual (in this respect the title is perhaps unfortunate). Rather, the book presents a series of case-studies with key lessons stemming directly from them and a good deal of further food for thought.
Though not all the cases are of this sort, the starting-point for discussion is of situations in which `expert' warnings about risks are not welcomed, with eective reference to Ibsen's An Enemy of the People. This usefully balances a frequent concentration on cases of the opposite type, in which the public disbelieves expert reassurances of safety. Clearly both mismatches (and others) are important.
Cases of well-intentioned scientists, administrators (and in some cases, activists) coming up against seemingly irrational'Ðbut actually quite understandableÐpublic attitudes are common enough. What is still valuable are carefully researched accounts of what has gone wrong and what lessons need to inform practice. Six (anonymized) cases form the core of the book, two on environmental risks, two on occupational health and two on HIV/AIDS programmes. All have strong local' featuresÐengagement or otherwise with local communities being the leitmotiv of the whole work. Lack of discussion of issues handled at a national or even international level (genetically modi®ed foods, say) is thus one limitation. Also, all the cases are from the USA, raising the question of how culture-speci®c the points made are. Though there are some distinctively US featuresÐ the Southern States can still teach most of us a thing or two about mistrust!Ðthe cases travel quite well. Readers from other parts of the world will ®nd much to recognize. However, over-familiarity with such stories is not yet a problem, and the lessons are important enough to bear repetition, particularly given much of the existing literature's preoccupation with `risk communication' in a rather narrow and apolitical sense.
A frequent barrier to learning from other people's experiences is that it is all too easy to see their foolishness and imagine oneself doing so much better. The even-handed and sympathetic accounts oered here do much to avoid this pitfall.
The six key issues drawn out are Ð the social construction of risk (by the various stakeholders) Ð the central importance of community support Ð the ethics of public health action Ð the need to build community capacity Ð fostering community participation, and Ð the process of negotiation Each of the six cases studies is presented as an exemplar of one issue. I had some problems with this approach, despite an attempt at integration in the ®nal chapterÐ which itself seemed somewhat cursory. It was not clear to me that each of the cases