Health Education Research, Vol. 17, No. 3, 374-376,
June 2002
© 2002 Oxford University Press
BOOK REVIEW |
Handbook of Rural Health
Sana Loue and Beth E. Quill (eds) Kluwer/Plenum, New York, 2001 370 pp, ISBN 0-306-46479-9, $90
Department of Health Policy and Management
School of Rural Public Health
Texas A & M University System Health Science Center
Bryan, TX 77802 USA
The strength of an edited volume always hinges on the quality of the individual chapters, the format and content, and the relevance of the work to those of us working in the targeted field of inquiry. I shall comment on each of these dimensions in turn.
Loue and Quill have assembled chapter authors who have made substantive contributions to their respective fields. Any text that begins with a chapter on rural health policy by Keith Mueller is starting off on the right foot. Mueller raises the issue of the overarching battle to either bring resources to the people or bring people to the resources. Although the two approaches conflict, he notes the historical give-and-take between the two perspectives and sets the table for the policy advocacy efforts that lie in front of us. Although Mueller would argue that rural health advocates have made some progress in the past decade, he would also summarize the current state of rural heath systems as inadequate at best. Most important, he argues that we must depart from our traditional ways of thinking about the barriers to improved rural health and identify the unique issues in rural health that should be considered in an overall national health policy. This requires thinking creatively about building rural health policy from a grass roots perspective, focusing directly on the needs of rural Americans, and considering their needs as frequently similar, although differing in magnitude, from the rest of the country.
One criticism of the text, as with many collected works, is the extreme heterogeneity in the scope of the various chapters. Some provide an in-depth theoretical or analytical presentation of a topic. For example, the Aday et al. chapter provides a strong theoretical presentation of some of the very critical equity issues with which we all struggle on a regular basis. Others provide much shorter, often cursory discussions of a topic. Certainly there are intentional differences between some of the early chapters that set the stage for the text and the shorter, substantively focused chapters that follow. Nevertheless, some chapters provide sound material upon which we might stimulate graduate instructional dialogue, while others appear much more sophomoric and would be more suitable for undergraduate settings. A single text cannot be all things to all people.
A second issue with the text is as much humorous as a source of true criticism. The second chapter identifies methodological concerns with the study of rural health issues. A fundamental methodological issue identified is the lack of a universally accepted definition of rural—a flaw in the field that leads to different numerators and denominators on a regular basis. This is evidenced by the fact that almost every chapter begins with a reference to the number of rural Americans or the proportion of the US population that is rural. Yet, these figures vary considerably from chapter to chapter.
The format of the book is logical and facilitates the introduction of key rural health issues and content. The first five chapters of the book construct a foundation for the detail that follows by providing an overview of the history of rural health policy, research methods, and critical public health and ethical issues facing rural America today. An underlying assumption is that the reader has some understanding of what public health is all about. The early chapters provide some very useful contextual information. The text then provides chapter-level detail about 11 critical rural health issues currently receiving attention. This logical approach follows the Public Health 2010 goals by touching on critical topical areas. The text then closes with three chapters that discuss general approaches, including a chapter by Robinson and Guidry that touches on some key workforce issues. This is a nice way to wrap up the textbook by addressing another critical issue facing the public health movement in this country, particularly in rural America.
Of course, the most critical issue with a textbook is its relevance to those who regularly use textbooks—in this case, the faculty and students interested in rural public health issues. Loue and Quill have provided the field with a text that first provides a generic foundation from which we can examine critical issues in rural health systems, then quickly covers many of the key substantive areas. As a faculty member at a school of rural public health, I have been seeking textbooks that target this topic for a few years. Several options exist, depending upon whether the emphasis is on the exposure to general public health information [e.g. (Lee and Estes, 2001
; Turnock, 2001)], a topical presentation of substantive issues with a good grounding in public health practice [e.g. (Skutchfield and Keck, 1997)] or a more data-based presentation of the health problems facing rural America [e.g. (Ricketts, 1999)].
Certainly the Loue and Quill text provides a much more direct and traditional approach to targeting rural public health issues than the Ricketts volume. The usefulness of this text likely hinges on the setting in which a course in rural health is delivered. If the targeted students are already exposed to a strong foundation in public health principals, this text provides exposure to some of the pressing issues of rural health. But it does not provide great depth on most topics. Further, if the students are not already well grounded in public health concepts, they may miss some of the important issues. Although it does not provide sufficient grounding in general public health constructs for the introductory graduate level course, it does provide some chapters that are very useful in public health courses focused on rural health.
References
Lee, P. R. and Estes, C. L. (eds) (2001) The Nation's Health, 6th edn. Jones & Bartlett, Ontario.
Ricketts, T. C. (ed.) (1999) Rural Health in the United States. Oxford University Press, New York.
Scutchfield, F. D. and Keck, C. W. (1997) Principles of Public Health Practice. Delmar, New York .
Turnock, B. J. (2001) Public Health: What It Is and How It Works. Aspen, Gaithersburg, MD.
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