Cities and sickness health care in urban America

Book reviews ence of this practical bent is a shortcoming of this book. Throughout, there is almost a sense that because their proposals are right and just, they will be accepted. For all the liberals’ many shortcomings, they did have a political coalition that was successful for 30 years and gave us 4 million, mostly good quality, housing units. The loose coalition of housing advocates. developers. and savings and loan institutions was, in an ironic way, one of the liberals’ main drawbacks as they tried to create a policy that all sides would embrace. The challenge for Hartman rf al is to forge a new coalition that would implement their progressive approach to housing. A second shortcoming of the book is the insufficient attention given to a critique of progressive housing options. There is some experience with limited equity cooperatives in the USA as well as experiments in tenant management. Since a change in the US is likely to be incremental and not

revolutionary. a more rigorous critique of incremental approaches and suggestions for new ones would have helped the book considerably. Finally, Hartman et N/ might have consulted with their European colleagues and done rather more comparative work. especially as regards the experience in the UK and FR Germany. Hartman and his colleagues deserve kudos for their vision of what housing policy should be. This book is valuable for analysts. policy makers and students who want an articulate statcment of the US housing crisis from the point of view of writers who are concerned about the poor at a time when such analyses are increasing11 rare. Phillip L. Clay and Elizabeth DeMille-Barnett Massachusetts Institute of Technology Cambridge, MA, USA

Cities, health and mumbo-jumbo CITIES AND SICKNESS Health Care in Urban America

force,

supported

ware.

is costly:

by expensive so costly

hard-

in fact that

Sage Urban Affairs Reviews, Volume 25, Sage, Beverly Hills, CA 1983, 303

users with insurance may face burdensome costs. In consequence. the state has progressively become more involved in underwriting these costs. via Medicare and Medicaid, but has not succeeded in really extending the necessary levels of care to those

PP

most in need.

edited by Ann Lennarson Scott Greer

even

Greer and

To an outsider. the US medical system offers a distressing paradox. In terms of the quality of cart‘ available. we arc dealing with a profession with unparalleled resources. Conversely. that profession does relatively little in the field of preventive medicine, with the result that the USA suffers from diseases virtually unknown in Europe, but verl familiar in non-developed countries: X~r~t.shioXor-. the product of malnutrition in infants. is one prevalent example. The manner in which the US health ccononiv dichotoliy.

is

financed

A

reflects

highly-paid

CITIES November

1984

this labour

This paradox. which Greer in his opening chapter characterizes as ‘dedicated workers in an undedicated system’ lies at the heart of the health system in this country. Yet it is passed over here in favour of a second theme. namely

the

relationship

‘cities and sickness’. urban

areas

are

and that there done on this. the chosen chapters:

Greer

between argues that

malevolent

has been little

In an attempt

theme.

places. research

to address

we ha\r

on urbanization

the disabled (Behney. (‘I trl): a political perspective (Schmandt and Wendel): voluntariam (Goldncr): urban health care (Ginzherp): and a world perspective (Roemer). Of course, these individual efforts quickly indicate that the simple cities equals sickness equation is simplistic. The size of city is important. but rural areas have in general many more indicators of poor health. Similarly. race and income constitute powerful intervening variahlcs. This should not surprise anyone who has read widely in the literature that connects urbanism and medicine. but it has clearly passed these editors by. I can think of several publications which have taken these chosen themes a good deal further in recent years; the journal So&l Scierlcc cfr~tl Merlkirw is conspicuously absent from the citations. and fuller bibliographies are available throughout Kirby. Knox and Pinch.’ The insularity of many of these chapters is underlined in the closing section on policy. These display ;I dreary emphasis upon the level of appearances (‘the politics of ambulances’) and a complete disregard for theoretical issues. In answer to the kc> question. ‘why do we pay the bill’?‘. we get only some Parsonian mumbojumbo that equates the 10% of the US GNP spent upon health with the tithes paid to the medieval church. Significantly. there is no refercncc to Vicente Navarro’s prodigious output. which has done a good deal (elsewhere) to raise the level of this type of research. In short, this collection offers ;I lame set of papers which are ;I long way behind the cutting edge of research. It does not enhance the Sage Urban Affairs serie\. which in general produces high qualit! wlumes. Not recommended. al);

here

and

ten

Andrew Kirby Department of Geography and Institute of Behavioral Science University of Colorado Boulder, CO, USA

health

status

(Palen and Johnson); urban hospital care 1937-X0 (Sager): the invcrsc care law (McKinlay. (‘I rrl): the mentally-ill and the elderly (Greel-. c’/

‘A.M. Kirby, P.L. Knox and S.P. Pinch. eds, Publrc Service Provrsron and Urban Development, St Martins, New York, 1984.

623