Review of "Deconstructing Health Inequity"

I just completed Deconstructing Health Inequity: A Perceptual Control Theory Perspective by Tim Carey, Sara Tai & Robert Griffiths. It’s a fantastic book and particularly interesting to me because it is all about how to do PCT-based research, explained in the context of research on health inequity. The whole book is great but the detailed “deconstruction” of a conventional research study (conventional because it is based on the ol’ cause-effect model of behavior) in Chapter 7 is worth the entire price of admission. The book is a great read and I think it would be an excellent companion to my own book on PCT-based research The Study of Living Control Systems. I was so impressed by the book that I submitted a 5 star review of it the book listing at Amazon. And here it is:

This is an extremely well-documented, well-reasoned and well-written explanation of why individuals, rather than aggregates, should be the basic building block of health policy research. Using the example of research on health inequity, the book explains how aggregate-based research that uses a causal model of individual behavior – that is, the conventional approach to doing health policy research – can produce misleading results and be used to promulgate misleading conclusions. The central theme of the book is that individuals are controllers rather than responders. The behavior of individuals is, therefore, properly explained by a theory of how control works; Perceptual Control Theory (PCT) is such a theory. Controllers vary their actions as necessary in order to produce consistent results the face of changing circumstances and other disturbances that would prevent such consistency. PCT explains how this controlling works.

The authors brilliantly point out that all those involved in health inequity research are controllers – both the subjects of the research and the researchers themselves – and they provide compelling evidence that this fact has influenced the direction of this research and the conclusions drawn from it. The authors provide concrete suggestions about how to go about doing health policy research based on an understanding of individuals as controllers rather than responders. Such research would be aimed at finding what results individuals are having difficulty controlling so that they can be helped to control them better.

The authors are well aware of the fact that their proposals are quite revolutionary and that readers, who are controllers themselves, are likely to find them disturbances to be resisted. So, the authors Preface the book with caution that “If you are satisfied with the current state of play in the health inequity field, this book will not be for you”. This is one of the few points in the book with which I disagree. I believe this book is for anyone involved in the field of health inequity research – indeed, anyone involved in a field of policy research of any kind – regardless of their satisfaction with the current state of that field. Whether you end up agreeing with the authors or not, at least you will have been confronted with interesting new ideas, backed by rigorous analysis and copious scholarship. The book could be the start of a very useful (and, I believe, essential) dialog in the health inequity (and general policy) research community.

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