In the maelstrom of current public health debate over the social determinants of health, this book offers a well-balanced discussion on the roots of prevalent strains of thought on the matter. While this area of research deals in complex problems, it is often dominated by those who deploy rather categorical, partisan positions, citing from a wide range of contradictory statistical studies. Stephen Kunitz brings a measured, balanced and independent perspective to bear on the debate, taking a step back from current arguments to look at the fundamental issues through a socio-historical lens. Part I describes how ideas about the costs and benefits of industrialization, and about the causes of disease, have been used by writers from different ideological persuasions to explain the health of populations. Part II focuses on some of the ideas that have been particularly influential in contemporary debates: factors such as standard of living, community and its loss, inequality, and globalization. The fact that these have been used to support differing explanations of the determinants of population health suggests that there are no easy generalizations in a field with so many discrepant findings. Scientists often ignore anomalous findings in the interests of advancing a particular paradigm, until the anomalies outweigh the norm and a new paradigm is created. This book argues that in considering social determinants of health, no meaningful over-arching explanations may be possible. Rather, it is by immersion in the reality of particular contexts - work settings, historical periods, geopolitical regions, and governmental credos - that we may gain a better understanding of the way in which socialforces shape patterns of health and disease.

Across the contiguous 48 states, populations in states with more activist civic cultures have lower mortality than states that do not follow this model. Several different factors can be pointed to as causes for this discrepancy - net income, class inequality, and the history of settlement in each of the different states and regions. These observations are true of Non-Hispanic Whites and African Americans but not of American Indians, and Hispanics, neither of which is fully integrated into the state political culture and economy in which it resides. In Regional Cultures and Mortality in America, the struggles these various populations face in regard to their health are explored in terms of where they reside.

In this book, the first long-term follow-up study of alcohol use among Native Americans, a physician and sociologist and an anthropologist examine the data on three groups of Navajos whom they first interviewed about their use of alcohol in 1966. The authors find verification for their initial hypothesis that young men who would have been classed as alcoholic often stop or moderate their drinking as they age. They also find that there is considerable diversity in the patterns of alcohol use among both women and men. Stephen J. Kunitz and Jerrold E. Levy study the histories of those who have died as well as those who have survived since the first study was done. They show that, compared to those who have survived, the former were more likely to have been solitary drinkers and were on average younger at the time when they were first interviewed. The authors also present data for the entire Navajo population on changing mortality from alcohol-related causes from the 1960s to the present; they compare alcohol-related death rates among Navajos to those among rural Anglos in Arizona and New Mexico; they analyze two family histories - one of a family with severe alcohol problems, the other of a family with none - that illustrate how traditional patterns of wealth have shaped the way people have learned to use alcohol; they study the factors that may have led to the emergence of a solitary, unrestrained drinking style among some Navajos; and they describe the changes in treatment programs and the transformation of traditional healing systems as they are integrated into a bureaucratized health care system.

Based on interviews with more than a thousand Navajo Indian men and women, this book examines the associations between childhood experiences and behaviour and the development of alcohol dependence in adulthood. Because Navajo life has changed markedly over the past two generations, it also examines the role of urbanization and universal school in reshaping Navajo youth and considers the implications for changing patterns of alcohol use in adulthood. In addition the book explores a wide range of timely issues such as domestic violence, factors associated with resistance to alcohol abuse as well as remission and recovery, the treatment and prevention of alcohol dependence, and the implications of pursuing either population-based preventive interventions or interventions focused on high risk individuals or groups.

This book discusses the various social, political, and cultural forces that shape the distribution of diseases in populations. It is based on a series of comparative studies of the historical and contemporary disease patterns of the indigenous peoples of America north of Mexico, Polynesia, and Australia. The purpose of the comparisons is to control in a quasi-experimental way certain crucial variables in order to examine the impact on health of other variables. The comparisons are made at increasingly more refined levels of analysis. Thus, once disease ecology has been held roughly constant, one can see more clearly the ways in which colonial policy and political institutions have shaped the affairs of indigenous peoples. And once policy has been held constant, one can see more clearly how culture can make a difference. And once culture has been held constant, one can see how gender and status make a difference.
Kunitz argues that very few broad generalizations adequately explain the distribution of diseases in populations and that to truly comprehend such patterns one must understand the local social context as well the biological characteristics of diseases. The book is thus an argument for the importance of local knowledge as a complement to the universalizing sort of knowledge that we associate with science.

Stephen Kunitz's work raises crucial issues for public policy in the medical field, and will be valuable for social scientists, physicians, and health professionals concerned with the social context of public health and other medical facilities.