Sick Societies: Responding to the Global Challenge of Chronic Disease. Stuckler D, Siegel K (eds).

Sick Societies presents an in-depth and comprehensive analysis of the epidemiology, costs, politics and potential solutions to the growing burden of chronic diseases [often termed non-communicable diseases (NCDs)] faced by both developed and developing countries. The publication is timely given the UN High-Level Meeting on NCDs in September 2011 and it underlines the need for rapid strengthening of national and international actions on this agenda. It presents a cogent case on the importance of addressing the societal determinants of chronic disease in particular. Chapter 1 provides a very useful overview of the epidemiology of the emerging chronic disease epidemic, highlighting the considerable shortcomings of existing monitoring and surveillance systems and the need for their improvement. Discussion of within-country socio-economic patterning of chronic disease and their risk factors is somewhat brief. Chapter 2 focuses on the ‘causes of the causes’, tracing personal circumstance and individual behaviour to their societal determinants. It powerfully makes the case that trade liberalization, deregulation and urbanization collude to make ‘unhealthy options easier’ through a combination of low price, ease of access and heavy marketing. Chapter 3 discusses the social and economic costs of chronic disease, painting a stark picture of the impoverishing impact on individuals as well as the broader societal disbenefits. Chapter 4 has excellent sections on management and preventative strategies for chronic disease. However, some discussion about how governments might attempt to determine an optimal funding split between preventative and management strategies would have been helpful, particularly in the context of resource constrained settings. Chapters 5 attempts to delineate the sources and distribution of global health funding. This draws attention to the relative neglect of chronic disease within funding streams from governments, public health and development agencies and highlights some important conflicts of interest held by a handful of wealthy private global health donors. Perhaps the most fascinating section of the book is Chapter 6, which tackles the tricky but salient issue of the role of the food industry in combating chronic disease. The first part of the chapter is written by the team currently leading PepsiCo's global health and well-being strategy, who argue that the food industry has a vested interest in helping to improve population health and seeks partnerships with governments and public health agencies to achieve this. The second part of the chapter presents a critique of food industry strategies, arguing that such a partnership cannot exist when the goals of public health and industry fundamentally differ. The author then presents an extensive list of actions that corporations could take to develop the trust of governments, public health agencies and citizens so that such partnerships could be developed in future (good luck with that). Chapter 7 presents comparative case studies on chronic disease from Brazil, China, India, Mexico and South Africa that helpfully illustrate how these issues are being played out in individual country settings. In summary, Sick Societies is a highly ambitious and accessible book that succeeds in bringing together key material to make the case for accelerated action to address the global chronic disease epidemic. I would highly recommend it to anyone with an interest in chronic disease, especially to those working in this field, and as a key text for courses in global health and public health.