Review

Challenging exclusion

HEALTH AND EXCLUSION: policy and practice in health provision
Michael Purdy & David Banks (eds)
Routledge, 1999, £16.99

Health and Exclusion is a thought provoking but straightforward read. It deals extensively with inequalities in health and health care, providing a damning commentary on this and previous governments’ social and economic policies.

The book examines the significant impact of poverty on health and documents examples of exclusion relating to health and health care, discussing the contribution of managerialism, health promotion strategies, and the part that clinicians themselves play in the process of exclusion.

Simply put, this book contains essential reading for health professionals and students of the social sciences, as the publishers suggest, though I would expect that experienced professionals would already be aware of much of the contents. I admit that it stimulated my writing pages of notes from personal observations, and it should make a good read for members of the public who are interested in the subject as well.

The authors suggest that although health professionals have little influence over the means needed to tackle the structural causes of poverty and inequalities, they do have important roles to play in the provision of health care and education. Importantly, they should challenge ‘policies that promote health exclusion’.

Although it seems a little late for clinicians to help empower patients and clients, now that consumerism is running rife through all areas of society, the authors rightly assert the desire to achieve that aim. Indeed, the democratisation of all areas of health and health care, including greater ‘industrial democracy’ for the workforce itself, appears to be essential if we want to see the NHS people wish for. This book supports the need to rid society of the unnecessary evils of poverty and social exclusion.