In the progressive public health tradition, Meredeth Turshen criticizes conventional approaches to disease and offers an alternative framework based on the concept that health and illness are socially produced throughout the world. Using contemporary and historical accounts of great moments and great debates in public health, Turshen exposes the failure to improve health even when a specific program like smallpox vaccination succeeds. Her analyses incorporate theoretical contributions from Marxism and feminism.

The book is divided into four parts. Part 1 outlines current and alternative approaches to health, theories of disease causation, the policies and practices that follow from these theories, and issues of equity and access to health care. A chapter of women's health in three African countries illustrates these concepts. Part 2 describes limits to conventional public health, using case histories of plague control, dioxin decontamination, sanitary reform, and smallpox and malaria eradication. In Part 3, Turshen presents case histories of preventive medicine, nutrition and agribusiness, mental health, and AIDS in Africa to suggest new approaches based on an alternative model of social production. Part 4 looks to the future of public health. It examines basic issues in integrating public health research, training, and services, and concludes with an agenda for action.

Privatizing Health Services in Africa analyzes the disappearance of public health in the form of state services in Africa, and the growth of a private market in health care that will serve primarily an urban elite. Meredeth Turshen considers the implications of introducing private insurance in countries with growing unemployment, a shrinking formal job sector, and a lack of social security programs or other safety nets. She debates the pros and cons of shifting the delivery of health services to the nongovernmental sector in the context of new concepts of the role of the state. Many of the schemes to privatize the purchase and sale of pharmaceuticals reverse decades of United Nations work challenging the power of the multinational drug industry.  Turshen weighs these policy changes in light of the World Bank’s eclipse of the World Health Organization as the premier UN health policy agency.  Until now, no book has disputed the World Bank’s plans to privatize health care in Africa.  This is the first book-length analysis of policy changes in light of monetarism and globalization.

Throughout the book, Turshen examines the implications of privatization for gender equity.  She also provides a case study of Zimbabwe and comparative material from Malawi, Mozambique, and Zambia. Her study makes a contribution to current debates on the impact of structural adjustment policies on health and the design of health services in the Third World.