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Dying and Living in the Neighborhood. A street-level view of America’s Healthcare Promise

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’This might be helpful to the public health leaders, frontline clinicians, and policymaker in US’

Title: Dying and Living in the Neighborhood. A street-level view of America’s Healthcare Promise

Author: Prabhjot Singh

Publisher: John Hopkins University Press

Reviewer: Paul Watson, RN Dip HE, BA(Hons), SCPHN, PSHE, PGCE, PGDip, QTLS. College Nurse, Peterborough Regional College

What was it like?

In Dying and Living in the Neighborhood, Dr Prabhjot Singh argues that we must look beyond the walls of the hospital and into the neighbourhoods where patients live and die to address the troubling rise in chronic disease. He does this by drawing from research in sociology and economics to look at how the US healthcare systems are designed and how the development of technologies like the internet enable us to rethink strategies for assembling healthier neighbourhoods. In part one, Singh presents the story of Ray, a patient whose death illuminated how he had lived, his neighbourhood, and the forces that accelerated his decline. In part two, he introduces nationally recognised pioneers who are acting on the local level to build critical components of a neighbourhood-based health system. In the process, he encounters a movement of people and organisations with similar visions of a porous, neighbourhood-embedded healthcare system. Finally, in part three he explores how civic technologies may help forge a new set of relationships among healthcare, public health, and community development.

What were the highlights?

I found this to be a well written book that read and flowed well. Unfortunately I do not have a detailed knowledge or understanding of the health systems in US. While this book was about that very subject I don’t know, that I have a vastly improved knowledge now. This is because the writing style was narrative and it read more like a novel, rather than a factual account or reference book. With this in mind I was then slightly confused that at the back of the book were pages of notes to support and enhance the main text, more akin to a reference or medical journal.

While Singh states, in many ways the basic notion that neighbourhoods need to be engaged in health care, that community-based medicine needs to be made a priority, he is less cogent in advancing specific ways in which we can move toward “total population health,” as one of his chapter titles puts it, and shift medicine away from its current model.

Strengths & weaknesses:

While economists and politicians have suggested countless ways to review the overpriced and underperforming US system, Singh offers a deeper, and humane diagnosis of the problems. This book could encourage new thinking and creative approaches towards a more effective and decent US health care system if the right people read it. The author takes a unique approach with a personal story to convincingly argue that healthcare needs to build from the community out to the medical sector, rather than from the hospital in. With compelling storytelling, and calls for connecting the American system to people and their neighbourhoods, almost quite literally turning it on its head. He understands that good health has more to do with what happens in neighbourhoods than in health care institutions.

Who should read it?

This might be helpful to the public health leaders, frontline clinicians, and policymaker in US who could read this book to better understand how they can contribute to a more integrated and supportive healthcare system, and although at times repetitive, this book merits discussion for anyone interested in curing a sick health care system. Singh looks at what really causes disease and is a must-read for new physicians looking to understand sources of power and ways to leverage it in today’s health care system.



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