John T. Pardeck (Ed.), Family Health Social Work Practice: A Macro Level Approach.

Westport, CT: Auburn House, 2002. $ 67.95 hardcover.

Family health social work is based on a radical set of principles, values, and beliefs that recognize the critical role of family as primary. Continuing the philosophy and efforts of social work legend, Mary Richmond, this holistic approach brings together a time tested perspective to social work blending individual, ecological, and systems theories and acknowledging the physical, mental, emotional, social, economic, cultural, and spiritual dimensions of human life. Central to family health theory and practice is consideration of unique aspects of contemporary family life, such as neighborhood and culture, often overlooked by other practitioners of other clinical methods. At last, here is a perspective that unites family and health, and in addition to being family centered, will inform the foundation of social work teaching and practice.

As an emerging field the research and literature in this area of study and practice has been sparse. The editor, John T. Pardeck, urges a more thorough and critical review of the relevant material and calls upon students and educators to commit to further research. The goal of this edited volume was to go beyond direct practice, broaden our understanding of the predicament of health care today, and stimulate a change process by focusing on macro level issues. As a result the text makes a significant contribution to the advancing knowledge regarding family health social work.

Organized into nine straightforward chapters the contributions include selections on clinical practice, community intervention, policy and program development and program administration. A social work scholar and family health pioneer, the editor writes five of these chapters to introduce the family health social work specialization, review the literature, describe various assessment tools, and outline a cornerstone of theoretical thinking in this practice, the Minuchin family stress

model. Much of this will be familiar to seasoned practitioners, however a significant section is Pardeck's analysis of family policy in the United States. While mindful to not place blame he offers some explanations for why a comprehensive family policy in the USA remains elusive, and highlights some of the hurdles remaining before affordable and accessible healthcare, housing and social services for all Americans becomes a basic human right. I read between the lines, looking for solutions and strategies, as he describes several bleak and eroding systems. However, I was most influenced by the poignant question raised: "How long can a society tolerate the widening gap between rich and poor families, the tragedy of children going without health care, and the disgrace of families literally living on the streets in many large American cities?" An attempt to suggest an answer to this vital question soon became jostled by a reminder that politics are complex. Usually national reform requires more than what is implied by the comment from the controversial Professor Edward C. Banfield: "Every political system is an accumulation of habits, customs, prejudices and principles that have survived a long process of trial and error and of ceaseless response to changing circumstances. If the system works well on the whole, it is a lucky accident--the luckiest, indeed, that can befall a society."

Other contributors add their expertise in the remaining material that covers a family health organizational model, a family health perspective on social and economic justice, adapting family health principles to Hispanic migrant health care, and developing and managing family health programs. While these authors provided an overview of key macro family health concepts and principles, they varied in style and had redundant information. An example was the repetitive definition of family health practice that served to bloat the book. On the other hand their attention to inclusiveness was refreshing, and the updates on the rapidly changing health care system and recognition that our society's current family structure is indeed a mosaic made a noteworthy impression. Their work illustrated how modern families grapple with health care issues in the context of their cultures, communities, and larger social systems, and they emphasized the value of formulating policies and programs "outside the box". In addition to supporting the message of family health practice, their critical thinking stresses the importance of social work involvement in the nuances of politics, public policy, program development, and administration.

The family health paradigm from a macro level approach provides solid reading for learning within the classroom, clinical environments, and policy planning arenas. This resourceful text includes information on methods and skill requirements, as well as government and public policy reforms and recommendations. We can assume that at some point of our lives, we will have to interface with the health care industry either as a provider, patient, or caregiver. A personal experience often ignites the political and professional spirit, and the family health social work prototype offers us new perspective and hopes to keep facing into the wind. Distinguished from other social work concentrations this rising field of practice provides a holistic understanding of family behavior and health in the social environment and gives momentum toward the possibility of greater acceptance of human differences, responsibility for unmet social needs and health care reform.

Marsha Blachman

University of California at Berkeley