Health related behavior is defined broadly to encompass all activities that have a significant effect on health care utilization and health care delivery (including culture, social behavior, expenditures, and health policies). This Oxfam publication is based on material originally published in Development and Health, a journal devoted to health and developmental issues.

Practitioners and policy makers involved in health promotion or interested in the study of health behavior will find this book very helpful as it provides useful information about the pitfalls and constraints to be taken into account in health promotion policies, especially in developing societies. At the same time, the book offers the reader sufficient information about the social, cultural, and behavioral determinants of the health of women in developing societies. Most importantly, the book presents several aspects of health as seen through the lens of the social and health worker.

The book begins with a survey of the methodological issues relevant to the study of women's health and moves to a discussion of the factors that constrain or inhibit health utilization. Throughout the book, the articles draw the reader’s attention to how macro level issues (such as Structural Adjustment Policies) can affect the cost of care as well as the utilization of health care services among poor women.

Another interesting aspect of the book is its concern with mental and psychosocial health issues, a subject infrequently discussed in the discourse about health care in developing societies. For instance, in the article "The Psychosocial Effects of Conflict in the Third World", Derek Summerfield asks a few interesting questions about the relationship between population processes such as migration (forced or voluntary) and mental health. What are the health consequences of post-traumatic stress syndrome on people from the third world? How have the various wars and conflicts prevalent in the developing world for the past three decades affected the lives of these people? Similar issues are articulated by Patel et al. who argue that mental health issues are genuine areas for research, and for intervention programs.

Sundari Ravindran’s chapter on "Methodological Issues in Women’s Health Research" provides a framework that considers the interaction between social, economic, political, and cultural factors in applied health status research, and in health utilization.

Anne LaFond’s piece, "Deterrents to Immunization in Somalia: A Mother’s Attitudes", is an important contribution to the literature on child survivorship. The question asked here revolves around the best way to provide intervention strategies aimed at the health needs of young children. In this regard, LaFond draws on her experience in Somalia to alert program administrators in the developing world of the need to consider the structural and social constraints in existence in these societies since they can impede the acceptance of new ideas/innovations.

One of the interesting chapters in the book is Betsy Hartman’s "Population Control in the New World Order." Hartman examines the population control movement and how its activities can affect basic human rights, especially the rights of women. She argues interestingly that with the end of the Cold War, there has been a shift in ideology from military expenditures to population control. The latter, she argues, has been refurbished and polished with feminist and environmental themes and marketed with the latest means of communication. In the North, the current emphasis is on immigration control, while in the South, efforts are geared to using what she refers to as "double-speak" (choice, female empowerment, environmental concerns, etc.) in discussing the population question in the developing world. Yet, in their attempts to reduce high birth rates in the developing world, Hartman argues that the advocates of population control have failed to consider the factors that determine the demand for children in the first place: increased infant mortality levels, the labor needs of agrarian societies, as well as the limited economic opportunities in these societies. While Hartman does not negate the need for contraception, she argues that the way planning is implemented undermines the health systems and targets women unfairly. Thus, to her, blaming poverty and environmental degradation, a typical Malthusian conception of population vis-à-vis development, obscures the real cause of the global population crisis--the inequities inherent in the socio-economic systems whereby resources are concentrated in the hands of a few.

The impact of AIDS is considered from the perspectives of changing gender and social relations. In "Widowhood and Orphans: Property Disputes in Rakai District, Uganda", Chris Roys informs the reader of some of the consequences of Africa’s AIDS epidemic in relation to property and inheritance rights. While the issue of property rights and succession is one of the social problems facing many African societies, Roys argues that in the case of Rakai, the problems have been accentuated by the AIDS virus in that region of Uganda. In part, the problems derive from the early morbidity and mortality linked to the AIDS epidemic. Yet Roys suggests that there is the need to look at the main cause of the conflict between family members on property rights. The clan system, which is patrilineal and makes it difficult for women to inherit property, is seen as at the root of the "inheritance debacle" in Rakai. The empowerment of women, especially economic self sufficiency and changes in the laws of inheritance, are expected to help women in this regard.

Hillary Hughes's article on "Evaluating HIV/AIDS Programs" examines ways to assess a successful intervention program. She argues that a successful program often depends on the level of organization already in existence in the community as well as the involvement of the community. In this way, not only would knowledge of the existence of the disease be beneficial, but it would encourage "local content" and participation.

The list of references and the annotated bibliography is extensive and should be useful for a wide range of people--absolute beginners, health care workers involved in capacity building, and people with experience but little formal training in health promotion planning or evaluation. I would not hesitate in recommending this book to anybody with an interest in health evaluation and program planning in the developing world.

Baffour Takyi
Department of Sociology
The University of Akron