The Politics of International Health: The Children's Vaccine Initiative and the Struggle to Develop Vaccines for the Third World

In this book, Dr. Willam Muraskin traces the genesis and initial history of efforts over the past decade to accelerate the development and supply of newer, better vaccines for children in the developing world. Known as the Children's Vaccine Initiative (CVI), this idea was conThe second article in this section, by Mechanic, reviews the goals of any health care system and raises the question of what lessons may be gained by the U.S. health care system from a study of the health care system in other countries. A good example of how this book presents unified themes is that many of the main points addressed in the first article are also mentioned here, and applied to comparisons of the United States with other countries. This article helps readers become sensitized to important questions and issues before reading the four sections that focus on specific European countries. The third introductory article also raises a major theoretical issue: the convergence hypothesis. This short selection points out the need to consider both the universalism of medicine as an applied science and the particularism of medical practice in specific cultural settings. Another positive feature of the book is that each country-specific section includes three different selections, which often deal with different features of the health care system of each country. These selections are by American scholars who have written extensively on the particular country's health care system as well as some scholars from the country under study. This combination creates good balance within most of the sections, and collectively includes articles explaining the system and major trends within that country as well as articles that compare the system to the U.S. system. The sections are not identical. The three papers on Germany by Altenstetter, KirkmanLiff, and Scharf all focus on two major issues. The major themes include how Germany has coped with pressures from costs of care and pressures from the incorporation of the socialist system from East Germany into the West German health care system. Scharf focuses more on the consequences of unification of the two systems, while Kirkman-Liff focuses more on cost containment. The three Canadian papers have different foci. Charles and Badgley deal with the evolution of national health insurance in Canada, and especially emphasize the attempt to maintain universal access to high quality care at an affordable price. Fooks more narrowly focuses on a particular period, looking at cost control from 1989 to 1992. Beland covers only one province, Quebec, and its focus on primary care and preventive medicine. All three papers on Sweden are strong, and they make related points about the combination of the Swedish commitment to governmental provision of comprehensive services with a maximum of local initiative and control. Within this overall approach, Immergut emphasizes the historical and institutional foundations of the Swedish system. Saltman details the relationship between national and local governments and the interaction within a predominantly decentralized system. Von Otten emphasizes the cost containment theme. One of the strongest sections of the book is the presentation of up-to-date material on Great Britain. Because of the continuing ferment in that country over restructuring of the health care system, the three papers may lose their immediacy as time goes on, but they comprise the clearest presentations available now about changes in the National Health Service of Great Britain in the 1990s. Day and Klein's article was first published in 1991 and provides background for the Conservative government reforms. Appleby provides an evaluation of those reforms six years later. Light discusses lessons to be drawn from the British experience. This book would be very useful as a supplement to a graduate medical sociology course. It would be an excellent beginning book for the examination of comparative health care systems in sociology or in a public health program. While the authors are not all sociologists, a strong sociological perspective is provided in the introductory and concluding sections, strengthening the attention to broader comparisons and theories.