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WINNER, 2017 RACHEL CARSON PRIZE, SOCIETY FOR THE SOCIAL STUDIES OF SCIENCE

In 2002, Sierra Leone emerged from a decadelong civil war. Seeking international attention and development aid, its government faced a dilemma. Though devastated by conflict, Sierra Leone had a low prevalence of HIV. However, like most African countries, it stood to benefit from a large influx of foreign funds specifically targeted at HIV/AIDS prevention and care.

What Adia Benton chronicles in this ethnographically rich and often moving book is how one war-ravaged nation reoriented itself as a country suffering from HIV at the expense of other, more pressing health concerns. During her fieldwork in the capital, Freetown, a city of one million people, at least thirty NGOs administered internationally funded programs that included HIV/AIDS prevention and care. Benton probes why HIV exceptionalism—the idea that HIV is an exceptional disease requiring an exceptional response—continues to guide approaches to the epidemic worldwide and especially in Africa, even in low-prevalence settings.

In the fourth decade since the emergence of HIV/AIDS, many today are questioning whether the effort and money spent on this health crisis has in fact helped or exacerbated the problem. HIV Exceptionalism does this and more, asking, what are the unanticipated consequences that HIV/AIDS development programs engender?

In August 2004, South Africa officially sought to legally recognize the practice of traditional healers. Largely in response to the HIV/AIDS pandemic, and limited both by the number of practitioners and by patients’ access to treatment, biomedical practitioners looked toward the country’s traditional healers as important agents in the development of medical education and treatment. This collaboration has not been easy. The two medical cultures embrace different ideas about the body and the origin of illness, but they do share a history of commercial and ideological competition and different relations to state power. Healing Traditions: African Medicine, Cultural Exchange, and Competition in South Africa, 1820–1948 provides a long-overdue historical perspective to these interactions and an understanding that is vital for the development of medical strategies to effectively deal with South Africa’s healthcare challenges.

Between 1820 and 1948 traditional healers in Natal, South Africa, transformed themselves from politically powerful men and women who challenged colonial rule and law into successful entrepreneurs who competed for turf and patients with white biomedical doctors and pharmacists. To understand what is “traditional” about traditional medicine, Flint argues that we must consider the cultural actors and processes not commonly associated with African therapeutics: white biomedical practitioners, Indian healers, and the implementing of white rule.

Carefully crafted, well written, and powerfully argued, Flint’s analysis of the ways that indigenous medical knowledge and therapeutic practices were forged, contested, and transformed over two centuries is highly illuminating, as is her demonstration that many “traditional” practices changed over time. Her discussion of African and Indian medical encounters opens up a whole new way of thinking about the social basis of health and healing in South Africa. This important book will be core reading for classes and future scholarship on health and healing in Africa.

In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.

Contributors. Deborah A. Stone and Theodore R. Marmor, Judith Feder, Alice Sardell, Bruce C. Vladeck, Michael Lipsky and Marc A. Thibodeau, Daniel M. Fox, William E. McAuliffe, M. Gregg Bloche and Francine Cournos, Lawrence D. Brown, James A. Morrone

In this seminal collection of articles on health care in the Third World, sociological perspectives are applied to medical issues in revealing ways. Fourteen essays (all but two of which are original to this volume) examine the social production of health, disease, and systems of care throughout the developing world. The volume covers a range of areas—central Africa, Nigeria, Singapore, Taiwan, Indonesia, Nepal, China, United Arab Emirates, Oman, and Mexico—and a broad scope of topics, from emergency care, the AIDS epidemic, and women's health care, to public health programs and national health care policies.

Contributors address the central question of whether health systems in developing areas should emphasize the role of clinical medicine and individual physicians or community and preventive medical resources. The major health problems faced by these societies—inadequate sanitation, infectious disease, high infant-child mortality, and a lack of family planning—indicate the greater need for health educators and public health workers despite many poor nations' desire for Western doctors. Other topics that are examined include the process of seeking medical aid; the relationship between traditional and modern medicines; medical education, hospital care, and communication between doctors and patients in developing countries; and the relevance and application of sociology in Third World settings.

This volume seeks to draw attention to the significance of medical sociology for understanding Third World health problems and to show how examining developing societies may necessitate reframing or modifying some Western sociological notions. In addition, these essays stretch the boundaries of medical sociology to include Third World issues.