"bible.
' As a word of caution when
Planning for Health: Development and
Application of Social Change Theory.
Henrik L. Blum. Behavioral Publica-
tions, New York. 640 pp. 1974.
$24.95.
Planning for Health is a book that
can be read on several different levels:
as a text for aspiring health planners
and administrators, as a handbook for
the practitioner of health planning,
and as reference for those who seek
thought-provoking insights into the
conduct of health systems in the
United States. Its primary thrust is to
examine the critical question with
regard to health in the United States
today. Can we construct a health
system that is responsive to the actual
needs and desires of its clientele? Dr.
Blum thoroughly explores the dis-
heartening health statistics of our
resource-rich country; the wasteful
expenditures of the medical care dol-
lar; the inequities of a system where
consideration of consumer needs often
take a distant second place to those of
the purveyors; and the promulgation
of the myth that good medicine
correlates with good health. The
"macro"$ perspective of this disorgani-
zation is certainly vital to a country
which must, out of necessity, find
greater relevancy and performance of
its resource expenditures; Planning for
Health is directed to this point.
Comprehensive health planning
and its mandated community ap-
proach are areas of emphasis in Dr.
Blum's work. In his framework for the
development of a methodology for
planning, he adapts and synthesizes
theories from a broad array of disci-
plines: social change, urban planning,
economics, systems analysis, sociol-
ogy, and political science. Integrated
into the often complex theories are
clarifying "real world examples." The
reader will find the analysis of inter-
ventions into the problems of auto-
mobile accidents and the allocation of
monies for high cost specialty care
versus low cost care especially provoc-
ative.
An examination of the table of
contents will demonstrate that this
book is divided into four distinguish-
able divisions: (1) The Environment
for Planning; (2) Planning to Deter-
mine What Improvements are Wanted;
(3) Achieving the Improvements De-
fined as Desirable by Planning; and (4)
Measuring the Improvements Obtained
through Planning. It is a logical,
common sense approach based upon
solid theoretical grounding-the com-
munity health planner mired in the
unfathomable depths will undoubtedly
welcome this work as his second
A major constraint which the
reading this book: one should remain
cognizant of the major heading of each
section to maintain the framework of
the analysis. The extensiveness to
which each topic is covered can find
one groping among the "trees."
Though Planning for Health was
intended as a guide for those either
practicing or somehow involved in
community health planning, it is of
undeniable pertinence to all those
concerned with health-promoting
social change. The insights, philos-
ophies, and methodologies woven into
the body of Dr. Blum's work will be of
benefit to many whose task is rapidly
shifting away from the prevention of
illness to the positive promotion of
health. In terms of health care services,
the health practitioner will find useful
concepts embedded in the methodol-
ogies of "participatory democracy."
The past has been laden with uncount-
able cases of health efforts that were
irrelevant and/or inaccessible to the
populace served. Greater congruence,
suggests Dr. Blum, between the
energies expended by health organiza-
tions and the articulated needs of the
consumers may be achieved through
increased sensitivity and communica-
tion at the community level.
This is a comprehensive authori-
tative book that is recommended with-
out reservation. The extensive bibli-
ographies provided at the end of each
chapter are an added bonus of this
work.
Al Kondo
Staff Associate
APHA Minority Health Project
The Effects of Income on Fertility.
Julian L. Simon. Carolina Population
Center, University of North Carolina
at Chapel Hill. 210 pp. 1974.
The author's objective is to pre-
sent or refer to all of the data he could
find pertaining to the effect of income
considerations upon fertility, to make
sense of the material in the broad
context of economics, and to see how
it may be used for social policy.
In this sense the author is success-
ful. He divides his analysis into two
major streams of data: data related to
Less Developed Countries (LDC)
(South American, African, Asian), and
data related to More Developed Coun-
tries (MDC) (United States, Western
Europe). He analyzes both the long
range and the short range effect of
changes in income on fertility be-
havior.
author appropriately points out is that
the data only go so far as the middle
to late 1960s. Only one table presents
data later than 1970. He shows that
there is strong evidence that people
think rationally about fertility, both in
LDC and MDC and for every economic
and social class.
The major findings may be sum-
marized as follows: There appears to
be an influence of income on fertility
in the same direction for MDC.
Changes in personal income and unem-
ployment have a strong same direction
effect on fluctuations in fertility for
MDC. Unfortunately, the data are not
strong. There are several conflicting
partial effects of income on fertility
whose composite effects differ from
place to place. More detailed factor
analysis shows no systematic associa-
tion with income. In Europe and Asia
the data show that richer persons have
more children (this is pre-1930 data).
For LDC income incentives for fertil-
ity control are probably meaningful in
the short run. From a forecasting
viewpoint, education rather than in-
come is suggested as the best single
predictor of fertility decline and is
perhaps almost as good a predictor as a
multivaried forecasting device.
The data base presented is pro-
logued to additional analyses. The
author is successful in collecting and
presenting the data and in attempting
to analyze them. Unfortunately, in-
come and even economic effects may
not be adequate enough predictors
given the dynamics of the middle
1960s to the present and future time
when social policy more than any
other seems to weigh heavily on this
issue.
For those interested in the issue
primarily at a level of national projec-
tions, the book will be useful. For
those social theorists that are con-
cerned with economic influence as
opposed to others, it will be an
important collection of data upon
which to base more complex analyses.
The author indicates that he cannot on
this limited data base make a broad
social theory projection.
It is a useful and readable docu-
ment. The author states what he is
going to do in a useful introduction;
he summarizes what he has done in a
useful summary. In between is a
collection of the data promised with
appropriate caveats and constraints. A
good basic population monograph.
Gerald Sparer
Division of Health Services Evaluation
Health Resources Administration
Department of Health, Education,
and Welfare
BOOK R EV IEWS 87