<i>Globalization, Health and the Environment: an Integrated Perspective </i>‐ Edited by Guest, G.

Guest, G. ( Ed . ) Globalization, Health and the Environment: an Integrated Perspective . Oxford : Alta Mira Press , 2005 . xi + 274pp . ISBN 0-7591-0581-2 The SHI editors are due an apology: this fascinating collected volume has been on my desk far too long. I have been dipping into it periodically, and reading each chapter has been an absorbing and provocative endeavour during that time. But returning from a month studying yoga living in India has brought the content more sharply to attention at last. In the three years since I was last in Pune, Maharashtra, the effects of globalisation on health and the environment have become brutally evident: the increase in private motorised traffic to a level of permanent congestion and appalling air quality; widely available and desirable new food items, such as processed cakes and snacks; the hugely widened gap between the newly IT rich and the ever-poorer street dwellers; the new shopping malls featuring Western chain store clothing to which the rich aspire; the renewed use of DDT spraying in poor busti areas – and so on. This volume is rich in anthropological detail, with seven chapters providing case studies of the particular effects of globalisation on health, in relation to cultural adaptation by indigenous populations to global forces. David Casnagrande provides a disturbing account of how ‘inchoate consumer capitalism’ has resulted in the commodification of ethnomedical knowledge among the migratory Tzeltal Mayans in Mexico. Ann McElroy discusses how the health ecology of Canadian Inuit communities has been influenced by political changes, and specifically the establishment of the Nunavut new territory. She usefully defines health ecology as ‘the study of cultural, environmental and biological variables as a synergistic system affecting health’, and uses this framework to provide a complex and rigorous analysis of changes in diet and access to traditional foods, through a series of narrative accounts of ‘memories of the past’. While George Luber's account of the Explanatory Models of the epidemiology of ‘second hair’ illness identifies the ‘dietary effects of the commodification of the agricultural system’ in various related communities, he also emphasises that ‘attention to the impact of globalization on the health of indigenous populations . . . can also provide avenues to explore in the effort to alleviate some of the health disparities that are all too apparent’. And this is the ultimate tone of the volume; a ‘fine balance between hope and despair’ as Rohinton Mistry has it. The fine balance is established in the Introduction, so that the focus of our reading can be clear: ‘As you, the reader, engage and contemplate the contents of this book, we ask that you, too, maintain a solution-oriented ember in the back of your mind’. The editors explicitly eschew ‘a “doom and gloom” view of our humanity's future on this planet’, or any simplistic prescription for reform. The fourth part of the volume looks closely at policy initiatives, albeit through a rather limited number of examples (my gloominess seeps back in a little: are there no others worthy of inclusion?). The overall conclusion, articulated in Paul Epstein and Greg Guest's final chapter on the history of the ‘architecture for sustainable development’, is, not surprisingly, that there is a need for a new international economic order with a resilient regulatory, institutional and financial framework’, so that ‘greater equity and healthier ecosystems can lead to positive health outcomes for all’. This is of course a major challenge, and not just to those of us working in health and social policy fields. The editors are right to claim that we need better understanding of the processes that are responsible for the environmental and health problems we face, and these contributing chapters do offer vivid and germane exemplars of ways of researching and revealing these. In the Introduction, Greg Guest and Eric Jones cite the World Health Organization's estimate that ‘poor environmental quality is directly responsible for about 25% of the world's burden of disease’. Ultimately, though, humanity is part of the environment: we shape it and are shaped by it, but it is also inseparable from our existence. It is a cliché to say that all our actions must be locally and globally accountable, but I share with these authors a sense of the urgency with which we need to ensure that the processes of globalisation do not continue to damage the health of the already disadvantaged, by whatever means we can. This volume is a valuable contribution to understanding not just why this is so crucial, but how we may take reasoned action for change.

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