Book reviews

which experience rapid population growth, such as those around Sella- field and Dounreay, population mix- ing may promote epidemics of infec- tion as immigrants from diverse places of origin bring in a variety of infections to which overall herd im- munity is low.

The last 11 papers deal with re- search not based in the UK, includ- ing an interesting letter by John Goldsmith detailing facilities in the USA, which would support either a radiation-linked hypothesis or Kin-

len’s infection hypothesis. The com- plexity of research in this field is demonstrated by the contribution of Cook-Mozaffari et al., who show similar excesses in lymphoid leu- kaemia and other conditions in c&24 year olds for areas around nuclear facilities and areas where a nuclear facility was planned but never built. This demonstrates the extreme cau- tion which must be applied when examining the evidence on child- hood cancers and nuclear instal- lations. Results are often contradic- tory, the numbers of cases available for analysis small, and the statistical analysis difficult. In fact. one of the bonuses of research into this topic has been the impetus it has given to the development of more advanced statistical analysis techniques for in- vestigating the distribution of rare cancers.

In summary, I would recommend

this text as a fairly comprehensive presentation of the evidence which can act as useful reference to estab- lished researchers in this field, or as a good introduction to the topic for others. However, if you are looking for answers. beware. You will prob- ably find that any particular theory you favour as to the cause of child- hood cancers around nuclear in- stallations will be supported and re- futed by various researchers in the text. The jury is still out on this issue.

Ian H. Langford

University of East Anglia

Health and Society in Twentieth- century Britain H. Jones Longman London (1994) 204 pp

Paperback ISBN 0 582 00459 4

Helen Jones claims that her book is concerned with the way in which the social history of twentieth-century Britain has affected the health of differing groups in society, and fo- cuses on the ways in which relation- ships between social groups have affected inequalities in the standards of health. In particular, three main themesxlass, gender and ethnicity are selected. It would be difficult to cover the necessary ground in simple descriptive narrative form at any satisfactory level in 200 pages, but with the added problem of an am- bitious conceptual framework, it is

hardly surprising that the end prod- uct does not fully deliver the goods.

Each chapter examines a chrono- logical period. The last chapters covering the period from 1945 add little that is new. Chapter 7 covers much the same ground as sociology and social policy texts, while Ch. 8 largely summarizes the standard literature on inequalities in health,

but does not include the recent more optimistic material on the degree of inequalities in services.

The historical chapters devote dif- ferential amounts of space to the period, with the two wars getting most and the inter-war period lag- ging behind. In addition, some topics are highlighted at the expense of others. The author’s knowledge and interests seem to have resulted in an uneven and unbalanced coverage. The decision to relegate health ser- vices to a passing role is problematic for three reasons. First, the standard ‘McKeown thesis’ which suggests that factors other than the environment make little difference to mortality has been challenged [Szreter, S. (1988) ‘The importance of social intervention in Britain’s mortality decline c. 1856 1914: a re-interpretation of the role of public health’, Social History of

Medicine, 1, pp. l-371 and in any case it confines medicine’s contribution to adding years to life rather than life to years. Second, Jones herself gives examples of services making a dif-

ference (e.g. p. 19). Third. it is gen-

erally the case that we know a lot more about health than health care in this period. This is shown by the fact that Jones’s material on health care is fairly simplistic with gross generalizations, thin referencing and marred by assertions without evi- dence. In short, the book’s treat- ment of health care is likely to leave many readers confused.

The welcome features of the book include a wide range of sources and

attention to neglected themes and topics, such as occupational health and health and safety. However. both features create their own prob- lems. First, in her desire to highlight neglected areas, Jones tends to neg- lect the more familiar ones. For ex-

ample, we learn more about women in the Auxiliary Forces in World

War I than about health services in the entire twentieth century. Second, some sources are subject to greater scrutiny and criticism than others. In particular, the optimistic thesis (which points to increasing levels of health) is cross-examined much more than the pessimistic thesis. At times, Jones comes close to being the mirror-image of the state medical establishment in the inter-war period, whom she criticizes. ‘Re-

search findings which were embar- rassing . were ignored or belit- tled’ (p. 3) also applies to her text. Important critiques of work refer- enced by Jones are ignored rather than being confronted (for example, there is no reference to Fox [Fox, E. (1991) ‘The Jewish Maternity Home and Sick Room Helps Society 189% 1939: a reply to Lara Marks’, Social

History of Medicine, 4. pp. 117-1221 on p. 9). On the other hand. work which supports Jones’s case is largely accepted uncritically.

The importance of geography is indicated at a number of points, but largely as a stick with which to beat improvements in mortality rates. If they suggest even a remote possibil- ity that things were improving, it is quickly pointed out that the aggre- gate figures hide a great deal of spatial variation. However, how large were these variations? Given the fact that there always has been, and probably always will be, spatial

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Book reviews

variations in health status and health services, were they declining over time? Did they show that, in some ways, the poorer areas received more services?

In conclusion, the text will be a useful supplemental reading on health status in twentieth-century Britain, especially in bringing to attention some neglected topics. However, it seems difficult to see it as a main course text.

Martin Powell University of Hertfordshire

Statistics for the Environment V. Barnett and K. Feridum Turk- man (eds) John Wiley Chichester (1993) 427pp f49.95 ISBN 0 471 93467 4

This comprehensive edited volume contains papers presented to the Stat- istics in Public Resources, Utilities and in Care of the Environment (SPRUCE) Conference held in Lis- bon in 1992. The silhouetted tree on the green cover, however, manages to symbolize the aims of the enterprise more neatly than this rather convol- uted acronym. In fact, SPRUCE began as a collaboration between the statistics departments of the Universities of Lisbon and Sheffield intended to bring together statis- ticians, probabilists and other academics interested in environ- mental issues. The Lisbon Confer- ence was the first tangible product of this initiative. It was convened to demonstrate the role of statistics in assessing risk, consequence and effect from quantitative evidence as applied to the protection of the en- vironment, the supply of energy and the garnering of resources. The book

addresses this agenda in six parts dealing with ‘Environmental Moni- toring and Sampling’, ‘Measuring Levels and Consequences of Pol- lution and Contamination’, ‘Climato- logical and Meteorological Issues’, ‘Water Resources’, ‘Dynamics of Fish Populations’ and ‘Forestry: Supply and Conservation’ which, perhaps in deference to the principle of insufficient reason, each contain three contributions.

From the perspective of medical geography, only part two is of sub- stantial interest. It begins with a paper by Peter Diggle on ‘Point Pro- cess Modelling in Environmental Epidemiology’. The contents review the premises of his research on spa- tial clustering and space-time in- teraction in relation to one or more point sources of pollution, which was stimulated largely by the debate ab- out the possible links between radi- ation leaks from nuclear installations and the raised incidence of child- hood leukaemia in their vicinity. In ‘Estimation of Quantiles in Air- borne Pollution’, Lindgren, Zetter- qvist and Holmstedt develop a model for the concentration of nitro- gen oxides around natural gas fur- naces which, in northern Europe, have become increasingly prevalent sources of noxious emissions since the development of the North Sea resource. ‘A Stochastic Model for Times of Exposure to Air Pollution from a Point Source’ (Davidson and Ramesch) replicates the atmospheric transportation of radonuclides re- leased from nuclear installations. Particular attention is paid to ranges between 100 and 1000 km from the source and exposure through wet (high concentration) deposition.

The limited number of contri- butions with a medical connotation,

however, should not detract from this book’s obvious merits. It con- tains many materials that should be- come essential reading for anyone with a research interest in statistical and mathematical modelling in geography. The applications not only include problems already famil- iar to geographers, such as global warming (Smith), solute transport (Young and Lees) and the growth of tropical rain forests (Nokoe), but also fascinating analyses of less com- monly encountered topics like optimal harvesting models for wilderness areas (Reed) and the management of chinook salmon populations in the San Joaquin river system, California (Speed). A second feature of most contributions is the way spatial representations and space-time processes are routinely built into the model designs. This development contrasts sharply with the 1970s when joint conferences between geographers and statisticians often contained papers from the latter that treated spatial effects as a rather irritating and complicating distraction. Perhaps the most com- pelling reason for reading this volume is the way most contributors tailor their models to meet the specific needs of the problem in hand. Quan- titative geographers, who recently have tended to be brought up on a diet of packaged statistics and GIS, will learn much from this free-wheeling approach to the environment.

The standard of editing and pre- sentation is exceptionally high and plenty of text separates the equa- tions. Thoroughly recommended for any library shelf.

Richard Thomas University of Manchester

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