578

Global Comparative Assessments in the Health Sec- tor: Disease Burden. Exoenditures and Intervention Packages. C. J. L. !&ray & A. D. Lopez (editors). Geneva: World Health Organization, 1994. viii+ 196~ Price Sw.fr. ZO/US$18 (in developing countries SW. r. P’ 14). ISBN 92-4-156175-O.

When the World Development Report 1993 *Investing in Health’ was published, there was some concern that the detailed analytical basis for many of its recommenda- tions was unavailable. This analytical basis consisted of an assessment of the world health situation in terms of the ‘burden of disease’ due to more than 100 causes, for 5 age groups, sex, and various geographical regions; and calculations of the cost-effectiveness of interventions against those diseases. One of the ways in which these calculations were used was to define minimum packages of essential clinical and public health interventions that governments shouId ensure were universally available.

Information on the analyses was subsequently publish- ed in 8 papers in the Bulletin of the World Health Organiz- ation in 1994. This book brings together those papers, and adds to them many more tables from the burden of disease analysis. Chapters in Part 1 describe the methods of the burden of disease analysis and the main results. Particularly valuable for those bemused by the new indi- cator of burden developed in the analysis, the DALY (dis- ability adjusted life year), is a justification for the choice of that particular indicator and an explanation of how it is calculated. Other readers may be more interested in the explanations of how mortality and disability by cause, age-group, sex and region were estimated.

Part 2 reviews the resources available to health sys- tems, including external assistance, and what these re- sources can purchase. Given the speed with which mini- mum packa es are being defined at country level, the chapter exp tuning how the package proposed in the ‘i* World Development Report was defined and its likely cost and effectiveness is particularly useful.

The book will be of interest to a variety of different types of reader. For the more academic reader, there are interesting debates on methodological issues and a wealth of data on disease burden. Those more interested in pol- icy implications can examine how the minimum packa e recommendations were derived, and consider the imp fi - cations of conducting such an analysis at country level. Finallv. all readers will find snianets of fascinatina infor- matio&for example that US dealth expenditure-& 41% of global health expenditure, and that disease-specific ex- ternal assistance per DALY caused by a disease amounts to $75 for leprosy, $4 for STDslHIV, and $0.15 for acute respirato

7 infections. Perha

3 s donors as well as coun-

tries shou d apply the princlp es espoused in this book? Anne MUs

Department of Public Health and Policy Health Policy Unit London School of Hygiene and Tropical Medicine KeppeEStreet _ - - London, WClE 7HT, UK

Lecture Notes on Tropical Medicine, 4th edition. D. R. Bell (editor). Oxford: Blackwell Scientific, 1995: xii+368 p. Price E14.95. ISBN 0-632-03839-X

The P .’ ust edmon of Dion Bell’s paper-backed book was published in 1981; 2 further editions were launched in 1985 and 1990, and it has been very widely used by stu- dents, both under- and post-graduate, at man world’s leading medical centres -by no means east the 4

of the

London and Live the latest edition, 7?

01 Schools of Tropical Medicine. In ell (now retired from active medical

P ractice) has sought the collaboration of 6 Liverpool col- eagues: R. Fox (tuberculosis), C. Gilks (HIV infection), D. Theakston (snake bite) and M. Molvneux, D. Smith, and G. B. Wiatt who have contribuied td numerous chanters. The first 3 sections (which comnrise 21 of the 43 ihapters) are devoted to trdpical diseasi presenting as

a febrile illness (headed by malaria), diarrhoea, and dis- ease associated with soil-transmitted hehninths. Sub- sequent chapters deal with tapeworms, flukes, filarial W&E, ana&nia, leprosy, dermatology, and snake bite. Therefore, the book does not seek to cover the whole field of tro&cal medicine, and cerolinty not ‘medicine in the tropics’; standard texts will be required to fdl the gaps.

The editor’s expressed intention is to ‘give practical help to doctors and other health workers encountering problems with tropical diseases, especially in developing countries’; he also aims ‘to give sound guidance on the solution of these problems in more sophisticated set- tings’. As in previous editions, the editor’s clear, didactic style comes to the fore. The format has been up-graded _ - and is arguably more appealing; presentation of tables, life-cvcles. and mans is certainlv more succinct, The 31 colou> plates are iseful, but they are reproduced on a very small scale. Most (but by no means all) chapters end with suggestions for ‘further reading’; the lists vary in length from one to 11 references, but they are not all up- to-date. Again, some, but certamly not all, chapters in- corporate ‘questions, problems and cases’; the answers are to be found at the back of the book.

Clearly, this will remain the Liverpool School’s best- selling paperback, but personally I would prefer more comprehensive coverage, unanimity of style throughout the text, and certainly more recent references.

G. C. Cook Hos ital for Tropical Diseases St P ancras Way London, NW1 OPE, UK

Healthy Travel: Bugs Bites & Bowels. J. Wilson Ho- warth. -London: Ca‘ro an Price E7.99. ISBN 1-86 %

Books, 1995, xii+228 pp. 110-45-2.

Increasing numbers of adventurous travellers and more exotic destinations pose a wide varietv of health problems for travellers. P&paring travellers to appreciate the risks of travel and educatine them to deal with the bewilderin ing task. ?

range of problems t&y encounter is a daunt- he thin line between informing and frighten-

ine, between sound knowledge and journalistically inter- estmg ‘fact’, has always to be considered.

The author has, overall, provided a balanced view of the issues likely to be encountered by exotic travellers. I;z;;a

b eterllent; pre-travel

-the problems o P reparatipn leads on t: preventmg travellers

diarrhoea and some practical information on manage- ment. ‘Bites’, including the range of medically important ‘biters’ in a table, should make readers aware of the on- slaught they face. Malaria is sensibly covered, with em- phasis on mosquito bite avoidance, althou concern with drug toxicity and side-e

h the frequent tf ects may not

answer the most- frequent1 chemooroDhvlaxis. The reau ar case histories hi&light 9

asked questions &out

messaies &I problems anld lighten the text. Tie ma- terial 1s accurate and well researched, with a bibliography containing relevant papers and reviews for lay readers to seek more detailed information. With such a large variety of topics, sometimes related information such as hazards of the seas has become separated from nasty marine crea- tures, which are

9 laced in the chapter on dangerous and

unpleasant anim s. This book will be useful for travel& taking more

than a package holiday. The reasonable perspective of likely probiems and sensible coverage could reduce health problems during travel. The single authorship makes it easy to read and the list of information sources and retail product suppliers (excluding the USA) will be useful when planning a journey.

Travel Clinic Hospital for Tropical Diseases St Pancras Way London, NW1 OPE, UK

R. H, Behrens