Book Review: The Politics of Health in Europe

argument to draw: he has to describe the trends within Europe at the micro, meso and meta level, highlight the points of crisis, dissect the alternatives on offer and provide a critique of them. In parts it becomes difficult to keep track of Teague’s own position as each perspective is laid out and systematically criticized. In the final sections his position does become clearer where he calls for a pragmatic reform of the European Social model. The reform should have three dimensions: a greater democratization of EU institutions (including the social dialogue); a new political space that enhances the association between national states and the European Union; and revamped labour market institutions to promote a new form of European economic citizenship. However, Teague is keenly aware of the difficulties and complexities that such a reform package gives rise to and goes on in the final part to discuss three complicating dilemmas facing European and national policy-makers. These are the insider/outsider, the centralization/decentralization and the public/ private dilemmas. Each of these is pulling European state policies in different ways, for instance in devising ways to tackle labour market exclusion; how far to sanction the decentralization of bargaining; deciding the best blend of public and private provision regarding training. Inevitably such a wide canvas with such a complex set of inter-relationships means that Teague cannot be prescriptive in his suggestions for the future of the European Social model. He signs off by saying that ‘Europe will have to live with less encompassing and restrictive labour market regulatory regimes. Employment protection has to be more selective, though not necessarily less meaningful’ (p. 209). But he is optimistic in seeing the possibility of a new ‘deliberative democracy’ taking root where much more learning, exchange and emulation takes place at various levels, and which reforms labour markets and employment practices piecemeal without the installation of a single monolithic model of behaviour.

dissect the alternatives on offer and provide a critique of them. In parts it becomes difficult to keep track of Teague's own position as each perspective is laid out and systematically criticized. In the final sections his position does become clearer where he calls for a pragmatic reform of the European Social model. The reform should have three dimensions: a greater democratization of EU institutions (including the social dialogue); a new political space that enhances the association between national states and the European Union; and revamped labour market institutions to promote a new form of European economic citizenship. However, Teague is keenly aware of the difficulties and complexities that such a reform package gives rise to and goes on in the final part to discuss three complicating dilemmas facing European and national policy-makers. These are the insider/outsider, the centralization/decentralization and the public/ private dilemmas. Each of these is pulling European state policies in different ways, for instance in devising ways to tackle labour market exclusion; how far to sanction the decentralization of bargaining; deciding the best blend of public and private provision regarding training.
Inevitably such a wide canvas with such a complex set of inter-relationships means that Teague cannot be prescriptive in his suggestions for the future of the European Social model. He signs off by saying that 'Europe will have to live with less encompassing and restrictive labour market regulatory regimes. Employment protection has to be more selective, though not necessarily less meaningful' (p. 209). But he is optimistic in seeing the possibility of a new 'deliberative democracy' taking root where much more learning, exchange and emulation takes place at various levels, and which reforms labour markets and employment practices piecemeal without the installation of a single monolithic model of behaviour. This is a stylish and clearly written account of legislated health politics in Europe. The book has some interesting background material about the sample of five countries covered, which are Italy, Sweden, France, Germany and the UK. A major premise of the book is that health services across many advanced industrial countries are increasingly state-processed, both administratively and financially. As the author puts it, the particular focus of the book is the public aspects of health and health care in a context of distinctively European politics. The book is advertised as an advanced textbook by the series editors and is precisely that.

Peter Cressey
The book begins by justifying its own creation, its themes and title. It asks the questions: why health? why politics? and why Europe? The answers given are that health matters; politics are inevitable in the largescale social and economic organization of health services; and because the comparative basis of the book is that of large liberal democracies. Expanding on why health matters, the author includes its all-pervasive role in modern democratic societies, almost to the point of being a leisure activity like shopping (reviewer's interpretation not author's). In addition, when discussing 'why politics', the distributive role of health care in economics as well as its overall cost is mentioned.
The author is honest and not too ambitious for the comparative material used in the book. In fact, he acknowledges that comparisons are difficult for many reasons but that some useful and realistic comparisons can be made if care is taken when handling the data. At the very least, comparisons can sometimes be interesting explorations of different policymaking and health-care systems. The references and notes are impeccable and the health statistics not too overwhelming. All of which make it a good introduction to comparative health care and an excellent textbook for postgraduate students looking for precise dates and chronological accounts of healthservice structures and activities in a range of European countries. The author confesses that much of the material in the book was originally used for teaching so it has been well tried and tested on students and others, and modified accordingly -an essential ingredient for a successful textbook. As an advanced textbook and detailed teaching aid, the book scores highly against other material published. Students of health policy and politics need go no further than this book for source references to other work in the field, both past and current. Nor could they do much better for a general comparative history of legislated policy changes.
However, this brings me on to a number of more critical comments on the book. Indicators of the author's personal interest and involvement in specific policy areas are evident in the book and this in itself is no bad thing for a teaching aid. However, these upset the balance of the book in places. For example, the chapter on public health has a heavy and not sufficiently justified skew towards policies for dealing with AIDS and HIV in the countries under comparison. Other -just as important -aspects of the politics of public health are mentioned but are given minor supporting parts in the chapter.
The book has an air of highly developed academic professionalism but, more intriguingly, a covert intellectual feel to it. It is impossible, therefore, not to speculate on some missed opportunities to raise the book out of textbook status. Almost hidden among the facts and figures listed and described, there are small gems of observation and understanding about the more subtle politics of health-service provision which the author fails, or chooses not to take further. It is as if the development of these insights rates less highly than the production of tables of statistics and policy-making chronologies. Perhaps the preference for delivering a textbook overrides the desire for an intellectual discussion.

Patricia Day
University of Bath, UK