Book Review

Epidemiologic Methods for Health Policy

By Robert A Spasoff
New York: Oxford University Press, 1999;
x + 228 pp; ISBN 0-19-511499-X; $63.95 (CAN)

When the editor contacted me to review a book whose title had both "epidemiology" and "health policy" in it, I groaned. Not because I am not interested in this area but because, to date, offerings in this area have not really delivered on the topic. They are either simply volumes of case studies or do not really describe the unique features of epidemiology when applied to health policy. This volume by Robert Spasoff actually delivers on the topic at hand, with the key word in the title being "methods." While the book is not a rigorous methodological work (the author deliberately goes lightly on the equations), it does give an excellent overview of the diverse range of methods that can be applied in the policy cycle.

The book is split into two main sections: "Concepts, Methods, and Data" and "The Policy Cycle." The first section covers the health policy process, basic epidemiologic methods that support policy and population health data. The opening chapter on policy may cause political scientists to cringe-this entire field is covered in a matter of pages. Imagine what all of epidemiology in the same space would look like! Also imagine how hard it would be to cover such a difficult topic in such a short space. Spasoff manages to cover the very difficult field of policy very neatly and clearly in a single chapter. His treatment should be an excellent introduction for those who are new to this field.

The chapters on epidemiologic tools and health data should be largely review for most readers with epidemiology training. Many diverse topics are brought together including several that are not covered in most introductory epidemiology textbooks. These topics are often very important to those in applied health settings like health departments or regional health authorities. Examples are record linkage, complex survey analysis and calculation of health expectancy. It is my experience that those who come to positions in such settings often have trouble getting on top of such topics. This volume should serve as a resource for these individuals. While the methodological coverage in each area is brief, there are many references provided for each topic.

The second section of the book steps through the policy cycle, starting with assessment of population health and assessment of potential interventions, and then considering policy choices, policy implementation and, finally, policy evaluation. In each section the role of epidemiologic methods or, more appropriately, the role that epidemiologists are often called upon to play, is reviewed. Again, many topics not readily found in other epidemiologic textbooks are covered here. A realistic appraisal of the role of epidemiology in the health policy process is provided. Spasoff acknowledges that policies will be based on a range of considerations, with epidemiologic data and research being just one of them.

One topic that I thought was missing from the book as I read through it was surveillance, with related issues such as time series analysis and mapping. However, these are tucked into the final chapter on policy evaluation, although the author does note they could have also been covered in the earlier chapter on measuring health status. Again these are methods whose application by epidemiologists is relatively new and often not easily found in introductory textbooks. Hopefully, potential readers who think the policy chapters are not relevant to them won't miss these excellent sections.

A major advantage for Canadian readers is that many of the examples are from this country. At the same time, there are also examples from the United States and Europe, particularly for the Netherlands, where epidemiologists have been able to play a major supporting role in health policy development. These examples are provided in separate boxes that are liberally dispersed through the entire book. The examples help to emphasize the applied nature of the book's content.

The major weakness is that the book does have very brief discussions of many of the methodologies. Those who actually want to apply the methods will likely have to proceed to the references. However, this should serve as an excellent overview for epidemiologists who find themselves working in settings where they are linked to the policy process or those who would like to learn more about it. The author developed the book from a course in Epidemiology and Health Policy, and the book should serve as an excellent textbook for those planning to offer such a course.

Overall rating:	Excellent
Strengths:	Provides summary of policy development and implementation cycle for epidemiologists Reviews a range of methods not generally found in general epidemiology textbooks
Weaknesses:	Some topics are covered very briefly
Audience:	Epidemiologists and health planners at all levels of government and in community agencies Researchers and academics wishing to apply their results Graduate students in epidemiology and health services research disciplines

Vivek Goel
Associate Professor and Chair
Department of Health Administration
University of Toronto
Toronto, Ontario   M5S 1A8

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