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Most inspiring public health books…

I always love the Christmas and New Year season, when all the “best books of the year” lists come out in all the newspapers. So I thought, why can’t it be Christmas in March! There are a number of books that have really refreshed my commitment to public health and international development, like getting a professional vitamin b shot. Also, I like sharing books with colleagues – it puts you on the same page, and sparks new ideas.

So I thought I’d share a list of the seven nine most inspiring (the list has expanded). Not the best, there are some scholarly and literary works I deleted from the list, but the ones that make you glad to go to work, glad to buckle down to meet a deadline and glad to head off into rural hot wherever with questionable drinking water.

It was a pleasure revisiting these books as I compiled the list, especially as it sent me off to chat to friends and relatives about which books they recommended. I have to send thanks to Lisa Parker who helped me prioritize which books to include and a few people who recommended “The Immortal Life of Henrietta Lacks” on facebook.

I hope people reading this can email me their ‘most inspiring’ list as well….

The story of turning back HIV is one of India’s big public health success stories, and Ashok Alexander was at the centre of it as the lead of the Gates Foundation’s Avahaan program. I enjoyed reading this book because I know many of the people in it – and it’s great to see their hard work immortalized. It’s also important because it tells the story of reaching out to the most marginalized sectors of the population, and realizing that their health status is caught up in their social marginalization. To address their health needs you also need to address the violence they experience, their social isolation, and their poverty. The HIV epidemic bought the social dimension of health to the forefront of our minds, and we should never forget it.

In public health, it’s always important to find out what different stakeholders want, need, prioritize, and know. Therefore, a lot of my work includes qualitative research. I really love it. It’s a chance to step away from data and the facts and engage fully with people and their stories. It gives richness, resonance and insight into everything else. I also think I’m quite good at it which surprises me because I actually love talking quite a lot. This book is all about how important it is to listen well. Not so much a ‘how-to’, as a ‘why you should’. I liked it because even though I am a good listener in a research context, I would like to be a more mindfully good listener in other contexts too.

This book tells the story of cancer cells taken from an African American woman, Henrietta Lacks in 1951, and subsequently used for all sorts of research all over the world. Every month, 300 articles about research using HeLA cells are published. It also tells the story of the bewildered family of Henrietta, who suffered terribly from the loss of their kin. Twenty years after her death, they didn’t understand what it meant that her cells were still living. The children felt completely violated, compounding their worst fears about the medical establishment and their own powerlessness. With little formal education, the research dollars and research gains for medical science seem like a slap in the face when they do not enjoy good health and could not afford health insurance. They are anguished at the thought of all the medical experiments the cells have been through, thinking that Henrietta must feel this pain.

This book is inspiring for a couple of reasons. First of all, it is a chilling warning against the dehumanizing effect of research, rekindling a commitment to vigilance in maintaining ethics in an academic environment where researchers too easily get carried away. The researchers described have unquestioned faith in the benefit and value of their work, and yet this book describes subjects and their families who feel totally violated, and millions wasted in producing fallacious results. It is a reminder of the need for respect, clear communication and consent between researcher and subject. While this isn’t directly argued in the book, I think the story makes a good argument for a sense of accountability to research subjects and beneficiaries – not just to donors and employers.

The book was also inspiring because of the author’s commitment to the story and to the Lacks family. Demonstrating a better way, Rebecca Skloot spent years conducting research with the family, sharing findings with them at every step and helping them understand more about Henrietta Lacks, medical research and the scientific gains made with her cells; while also documenting their own stories. It is heartening to see now the Lacks have their own website, so they can also contribute to their own narrative.

A recent NY times article by Rebecca Skloot (from the 23/03/2013) tells us European researchers recently published the genome of Henrietta Lacks without the family’s permission. No-one has learned anything! Another reminder of the need for ethical oversight of research.

The original NY Times review can be read here. A recent Guardian article (8/8/13) about formal recognition of Henrietta as the source of HeLa cells can be read here.

This is a book about how to motivate people, it’s not exactly a public health book. And yet, when we see public health systems in different parts of the world, on of the most abiding characteristics is demotivated health workers. Based on strong evidence from cognitive science it argues that incentives demotivate people for creative or intellectual tasks. They work fine for routine tasks, but not anything that requires problem solving or creative input. It outlines the three key factors to keep people motivated, engaged and “in the zone”; mastery, autonomy and purpose.

Another thing that is great about the book is how well the content is laid out to increase usability. As someone who devotes a lot of time trying to ensure data, reports or briefs are actually used – I really appreciated this effort. He also has a cool website.

This biography of Paul Farmer is inspiring because he is such a committed, accomplished and clever person. I have heard Paul Farmer

speak twice, and both times he struck me as too clever. I am glad to be have read this book and admire him from afar. Founder of Partners in Health, Farmer is known for his work among the Haitian poor.

Some of the interesting messages I got from this were the strong differences between a public health and clinical perspective – a clinician is duty-bound to the patient in front of him/her, and a public health person will look to maximize health benefits to the population. In his clinic in rural Haiti, Farmer’s team spent squillions getting a paediatric cancer patient treatment in Boston. I think a public health person who have suggested palliative care for that individual patient, and then spent the money providing clean water or other infrastructure that provides health benefits, and saves the lives, of many. This clinicians’ commitment gave Farmer an amazing sense of urgency that helped Partners in Health battle to reduce the cost of medications, increasing access to drugs for the poor. However, the lack of systems thinking though seems to mean that resources are not necessarily allocated in an optimum way. There is a nice review of the book by Abraham Varghese, another doctor and writer, here.

I really like Atul Gawande’s writing, and this book was fascinating – I first read the story as a New Yorker article years ago. I then bought the book and read 90% on a train to Bijapur, and then I left it on the train. So this review is based on the parts that I actually read.

Gawande draws from the experience of the airline industry in creating pilot checklists, and applies it to the operating theatre. It emphasizes listening to all team members – and pausing before a big operation to make sure all key steps have been taken. After work I have done in India to support the empowerment of nurses, this is revolutionary in itself – getting doctors to pause and listen to nurses! Wah!

The data suggest the checklist is effective in preventing surgical mistakes and infections. I like the message that tenacious problems have simple solutions, and also that innovative solutions can also be good common sense. I have always lived by “to do” lists, and in fact love writing “best books” lists.

This is a great read about how in 1854 John Snow used maps to discover the cause of cholera in London – the Broad street communal pump. It’s a detective story, but also a great exploration of how health and geographies intersect. It describes how the population density of cities nurtured a cesspit of disease until the development of modern sewerage systems. Once there was proper water and sanitation cities could become centers of creativity, innovation and cosmopolitanism. Too often we think of health as about doctors and nurses and care providers – this book reminds us that at the core of good health is a proper water and sanitation system.

It is also an ode to “consilient” or cross-disciplinary thinking – as John Snow was able to bring together patient observations, an understanding of the urban environment, review of statistics to come to his conclusion that cholera was not caused by miasma, but transmitted through touch. I would love to see the book transformed into something interactive, like a museum display, or even a computer game.

As a Bangaldeshi first (he was born in modern-day Bangladesh), Amartya Sen seemed like the right thinker to guide my early career while I was at UNICEF Bangladesh Country Office. I really enjoyed the message that money is not the measure of all things – it reorients an understanding of to poverty as a deprivation of capabilities, or the ability to enjoy freedoms. That is ill health prevents you from enjoying a happy family, community and work life and so is an indicator of poverty. This thinking guided work in understanding the effects of social exclusion on health and wellbeing, as part of the Commission on the Social Determinants of Health. While he sometimes repeats himself, I like all of Sen’s work, and “The Argumentative Indian” was a pleasure to read.

This book is a must-read, it describes a complete disconnect between doctors and a refugee Hmong family with an epileptic daughter in Merced, California. The Hmong understanding of the cause of epilepsy is spiritual – as per the title of the book. The devoted family are suspicious of western medicine and administer the prescribed drugs sparingly, in balance with other traditional remedies. The doctors, increasing frustrated by the Hmong community, regard this non-compliance as parental neglect and have the child removed from the family and put into care.

In this heart-breaking book, two different systems of medicine and good intentions, are mutually misunderstood. In the end the child experiences seizures so severe she is left brain-dead. A medical review finds that it is not traditional medicine, or non-compliance that kills her, it is a hospital infection, brought on by anti-epilepsy drugs that have a side-effect of compromising the immune system.

This book is a great reminder to all public health practitioners with a strong commitment and faith in their own scientific training to pause and listen to the communities they are working with. It also suggests that patient rights, as opposed to what science says is right, needs to take precedence.

I read and review a lot of books about public health! See also reviews of Decisive by Chip and Dan Heath; Connected by Christakis and Fowler; Winners Take All by Anand Giridharadas; Reverse Innovation in Health Care by Vijay Govindarajan and Ravi Ramamurti; Dreamland; The Age of Opportunity by Laurence Steinberg; The Silo Effect by Gillian Tett; An Uncertain Glory by Dreze and Sen; and Epic Measures

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