Vol. 16. N os. 1/2, 1999 Journal of the Australian Populalion Association

BOOK REVIEWS

HelpAge International. The Ageing and Development Report: Poverty, Independence and the WorM's OMer Peopk. London: Earthscan Publications Ltd. 1999. xvi + 201pp. s

The issue of ageing tends to be regarded as a concern of developed countries rather than developing countries. After all, life expectancies are higher in the developed world and fertility has been lower for longer. But this book is not about ageing in the demographic sense. Rather it is about the issues facing older people and their governments in a range of settings in the developing world.

In contrast to the well-informed debate and policy of developed countries, the social and economic issues involved in population ageing in the developing world suffer from a dearth of data leading both to their neglect and to the rise of numerous misconceptions. Published in the International Year of Older Persons, this book

reviews the state of our knowledge of the situation of older people in developing and transitional countries ... and seeks to examine the impact which social and economic development policies have had - - and could have - - on older people struggling to overcome poverty and disadvantage (p.xi).

It does this is four parts. The issue of ageing tends to be regarded as a concern of developed rather

Part I deals with the issues of 'ageing and development'. These include the human rights of the elderly, coping with conflict and with change, gender, health and economic security. Poverty and exclusion from mainstream activity are identified as the greatest threats to the older person's wellbeing. Thus poverty, and not changing family/community values, is the main contributor to the erosion of independence and autonomy in old age. The nine chapters of Part I demonstrate in different ways how the elderly are for the most part invisible in policy, planning and practice. This applies particularly to women who make up the majority of the elderly and who suffer the triple 'whammy' of gender, widowhood and age. The productivity of older people and their often pivotal contribution to community life are not recognized in development terms. Rather, they are viewed as inactive recipients of support.

These issues are illustrated in Part II with case studies of Latin America and the Caribbean, India, Cambodia, Tanzania, Zimbabwe and Eastern and Central Europe. Part III provides ageing and development data. This includes a review of the status of policies on ageing and older people in 46 countries, a review of the status of ageing in 18 bilateral (induding Australia) and seven multilateral aid agencies and a collection of statistical data. Part IV comprises the United

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Nations Principles for Older Persons and a statement on HelpAge International.

Though the demographic process of ageing is not made explicit, this is a useful sourcebook for students of demography and development. It is also essential reading for those involved in formulating and delivering development aid programs at the local and national level.

Heather Booth Demography Program

Research School of Social Sciences The Australian National University

Colin Mathers, Theo Vos and Chris Stevenson. The Burden of Disease and Inju[y in Amtrah'a. Canberra: Australian Institute of Health and Welfare. 1999. xxviii + 245pp. [Also available: The Burden of Disease and Injmy in Austral ia- Summary Report. viii + 31pp.]

In the first half of the 1990s, the Harvard School of Public Health and the World Health Organization undertook the Global Burden of Disease Study (World Bank 1993; Murray and Lopez 1996a, b). This study made extensive use of a new metric, the disability adjusted life year (DALY), which measures years of 'healthy' life lost through death or disability from injury and disease. In the late 1990s, the Australian Burden of Disease and Injury Study was undertaken by the Australian Institute of Health and Welfare. This book presents its results.

The DALY is a composite measure equal to the sum of years of life lost due to premature mortality (YLL) and years lost due to disability (YLD). It thus integrates fatal and non-fatal disease outcomes in a single measure while allow- ing the two parts to be separately assessed. In this study it is used to assess the burden of 176 disease and injury categories. Not surprisingly, the inclusion of both death and disability in the DALY measure produces a substantially different picture than either mortality or morbidity measures alone. Whereas cardiovascular disease and cancer account for 59 per cent of male YLL and 67 per cent of female YLL, these diseases account for 42 per cent of the male and 40 per cent of the female burden of disease as measured by the DALY. This is because of the relatively small impact of these diseases on YLD. The major cause of the non-fatal disease burden is mental disorder, including inter alia substance abuse, depression and anxiety, accounting for 27 per cent of YLD. This cause alone accounts for 13 per cent of the overall burden of disease (DALY). Nervous system disorders, which include dementia, account for a further 16 per cent of YLD and nine per cent of DALY.

In addition to the analysis by disease, the study assesses the morbidity and mortality burden attributable to ten risk factors. In total, these account for between one-third and one-half of the burden of disease and injury in Australia in 1996. Of the risk factors considered, tobacco smoking is responsible for the greatest burden of disease: 12 per cent in males and seven

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per cent in females. Physical inactivity accounts for a further six and seven per cent respectively. Hypertension, alcohol consumption (both harmful and beneficial effects), overweight and obesity, lack of fruit and vegetables in the diet, high blood cholesterol, use of illicit drugs, occupation and unsafe sex are further factors considered.

Socio-economic inequalities are also examined, based on the ABS area-of- residence measure of relative socio-economic disadvantage, SEIFA (ABS 1998). This type of analysis underestimates true inequality based on socio- economic disadvantage at the individual level. Nonetheless, the provisional analysis suggests that the total disease burden per 1,000 population in the bottom socio-economic quintile is 37 per cent higher for males and 27 per cent higher for females than the burden for males and females in the top quintile.

Whilst these are some of the highlights of the studg the report provides a great deal of detailed information and is comprehensive in its assessment of the burden of disease in Australia in 1996. Nevertheless, the study is described as provisional and developmental, providing a framework for more detailed analyses, and has identified a number of areas where more work is required. These include the availability of more comprehensive data, especially on the incidence, prevalence and severity of disease conditions; the provision of Australian disability weights for the estimation of YLD (the study used Dutch and international weights); improved epidemiological modelling; and a number of methodological issues to improve the validity and applicability of the DALY metric.

The Australian study is one of relatively few national burden of disease studies that have been completed, though an increasing number are now under- way. The high quality and thoroughness of the study assure that not only is Australia at the forefront of burden of disease research, but the experience gained through this study will contribute to international development in this area. Further, the information made available by the study will prove invaluable in informing health policy on the prevention and treatment of disease and injury in Australia in the early years of the new millennium.

Heather Booth Demography Program

Research School of Social Sciences The Australian National University

References

Australian Bureau of Statistics (ABS). 1998. 1996 Census of Population and Housing: Socioeconomir Indexes for Areas. Information paper. Cat. No. 2039.0. Canberra.

World Bank. 1993. IVorld Development Report 1993: Investing in Health. New York: Oxford University Press. Murray, Chris J. and Alan D. Lopez. 1996a. The Global Burden of Disease: A Comprehemive Assessment of

Mortak~ and Disabik'~ from Diseases, Injuries and Risk Factors in 1990 and Projected to 2020. Vol. 1, Global Burden of Disease and Injury Series. Cambridge MA: School of Public Health, Harvard Universi~

Murray, Chris J. and Alan D. Lopez. 1996b. GlobalHealth Statistics. Vol. 2, Global Burden of Disease and Injury Series. Cambridge MA: School of Public Health, Harvard Universi~.

E u g e n e Odum. Ecological Vignettes: Ecological Approaches to Dealing with Human Predicaments. Amsterdam: Harwood Academic Publishers. 1998. xvi + 269 pp. Hardcover A$88, paperback A$35.

The American ecologist, Eugene Odum, has enjoyed a long and distinguished career and is still publishing in his eighties. While the second part of Ecological Vignettes consists of twenty-six 'essays and commentaries' previously published during 1970-95 the first is made up of eight new chapters. These contain about twenty 'vignettes': 'memorable, provocative statements designed to attract your attention at least long enough for you to read the explanations' (p.xv), each of which presents a basic ecological principle and discusses its relevance for the solution of contemporary environmental problems. Odum is a dedicated teacher and his aim in this work, addressed to a wide audience, is to raise the level of 'ecological literacy'. The unusual format of the book may make it difficult to use as a university-level text - - his earlier work (Odum 1993) is better suited for that - - but anyone teaching population and environment or human ecology courses will find in Ecological Vignettes a wealth of illustrative material to draw on for class preparation, and exceptionally clear explications of fundamental ecosystem principles which can easily be read by high school students as well as undergraduates.

The main argument of the book is simple enough: if we humans are to survive the demographic youth-to-maturity transition we must, among other things, learn how to control growth ... and deal with the increasing costs in energy and resources required to maintain order when population density and human-made infrastructures (such as dries) become very large and complex. Also, we need to recognize the importance of the kind of cooperation and mutual aid that we observe in successful natural communities that manage to prosper when resources become scarce (p.30).

The concept of population plays a key role in the argument, but as is often the case among ecologists (Johnson 1999) its treatment, especially in the opening chapter, is less than satisfactory. Odum argues from certain parallels between the modern demographic transition and the maturational processes (succession, climax) of a natural ecosystem (e.g. a rainforest). For him there is a critical difference in paths approaching the limits to growth between those which follow a sigmoid S-curve and those whose growth curve is initially exponential resulting in 'overshoot', but in the case of human population he does not explain how these paths are related systematically to the underlying dynamics of fertility and mortality, nor does he comment on the range of empirical trajectories taken by different societies in modern times. In Chapter 1 world population is described as 'now five billion' (it reached that mark around 1987), and the statement that 'interaction between people in crowded cities seems to increase violence and pollution without a decrease in birth rates' (p.5) is simply wrong if, as seems to be the case, it is meant to imply that the birth rates in urban areas in developing countries are no lower than in rural areas.

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Nonetheless the environmental problems Odum discusses are real, and if some of us are critical of his conceptualization of population dynamics (and social oganization) this only underscores the need for social demographers to be more critically involved in these issues. Odum has a coherent perspective on these issues and advocates ecology as an integrative discipline. There is a need for more productive dialogue and integration of concepts from both sides. Demographers tackling population and environment issues could make more use of ecological concepts. Demographers, for instance, have argued there are no insurmountable problems to feeding the world's population well into the twenty-first century (Dyson 1996). Odum points out that the limits to growth here centre not just on producing the required amount of food, nor even on finding the additional sources of energy needed to increase food production; there are also severe limits set by the environmental effects of pollution and waste 'created by the concentration and conversion of energy' (p.70). The vital question now shifts from whether we can produce enough food to feed ten billion people to whether we can live with the ecological consequences when we do. Odum draws lessons from the way nature handles similar problems, notably the way 'successful natural communities' like coral reefs and rainforests are able to sustain a vibrant diversity and richness of life despite a scarcity of essential nutrients like potassium and nitrogen in their environments. They do this by a combination of structural differentiation, whereby different species occupy different niches, and efficient recycling of scarce resources, so the latter in effect are never lost to the community as waste. Arguing by analogy like this when discussing human predicaments has its pitfalls, of course, and Odum's succinct and pithy characterizations of our place in the biosphere are no substitute for the detailed institutional analysis needed for sound policy formulation. Odum's vignettes are well worth reading, however, for their theoretical elegance and provocative insights. It seems to this reviewer they are more helpful in sharpening analytical questions about human involvement in environmental change than in suggesting realistic solutions.

Adrian Hayes Demography Program

Research School of Social Sciences The Australian National University

References Dyson, Tim. 1996. Population andFood." GlobalTrends andFuture Pro~ects. London and New York: Routledge. Johnson, D. Gale. 1999. Review of Garrett Hardin, The Ostrich Factor: Our Population Myopia.

Population and Deve~pment Redew 25(3):593-597. Odum, Eugene. P. 1993. Ecology and Our Endangered Ia~e-Support Systems. Second edition. Sunderland M.A:

Sinauer Associate~

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