610 Book Reviews letter" is suggested. Published by the University of Ala- bama it offers an update of clinical and community health education programs nationally, and reviews new research and national legislation on the expanding practice of health education. In the physician's office, or in public debate over national health care priorities, health education is demon- strating itself to he more than a popular ideology. As cost effective preventive mecl~cine, health education is succeed- ing at improving compliance with medical regimens, reduc- ing hospital days, and promoting preventive behavior to reduce health risks. In the legal sphere, educating individ- uals to make responsible decisions based on an informed partnership with their health care provider, has been linked to a reduction in the costs of malpractice litigation. For administrators, educators, social scientists and clinicians Health Education Planning: A Diagnostic Approach offers a blueprint for the application of behavioral science theory to the political problems of planned change in public health and preventive medicine. Tufts Unirersit)" School of Medicine Department of Community Medicine Boston. MA. U.S.A. STEPHANIE EVANS Patteras of Time in Hospital Life: A Sociological Perspec- five, by EVIATARZERUBAVEL. University of Chicago Press, IL, 1979. 157 pp. $13.50 Patterns of Time in Hospital Life describes the multitude of overlapping and interacting schedules within a university hospital in order to portray the "sociotemporal" order of the organization. The task is well done and the observa- tions made are incisive. The book is based on a detailed observation and inter- view study of the medical ward and emergency room of an American teaching hospital. The first chapter presents the various work schedules and describes the "rigid rhythmi- ctty Of the hospital life: the daily, weekly, monthly, and year long schedules which predict an individual's life in great detail at the start of each year. The second chapter outlines the many interactions of physician and nursing schedules. In particular, the author explains the pattern of abutting work loads that allows the institution to provide for the continuous "coverage" of patients and the smooth transition between providers. Chapter 3 carries the theme of work load distribution to the levd of individual groups; the hospital teams. In Chapter 4, the author discusses how hospital life has engendered its own set of time descriptors based on different aspects of institutional life, such as resi- dent schedules ('the rotation'), nights on call. and even patients (the "quick' admission). The final chapter focuses on the dynamic aspects of hos- pital's 'sociot.emporai" order. Sp~fically. the impersonality of the system that allows doctors and nurses to shift from one job to the next. Since the institution requires only that some intern, any intern, does a given job, the unique attri- butes of a given worker become unimportant. Though this would appear to sterilize the hospital environment even further, without these enormously complex, interacting and overlapping schedules, hospital routine as it is known today would be impossible. From these observations, the author argues that the sociotemporal order of hospital schedules, forms the foundation for the equitable distribu- tion and the 'temporal anchoring" of the work within the institution. In other words, it underlies the 'moral' and "cognitive" order of the organization. This simple Observation slices to the center of hospital life. By laying out and rationalizing the scheduling morass, the author has demystified it. The process opens opportu- nities to challenge th~ current organizational structure with the hope of redesigning modern hospital routine to better serve the needs of patients and staff. Patterns is a slender, quickly-read volume but its simple message offers insight into some of the more sacred aspects of hospital life. It is recommended to hospital planners and academics and especially to those who, like the reviewer, make up the schedules. Primary Care Program Massachusetts General Hospital Harrard Medical School Boston, MA. U.S.A. JOHN D. GOODSON Birth Control An International Assessment, edited by M. POTTS and P. BHIWANDIWALA, MTP Press, Lancaster, England, 1979. 305 pp. £12.95 This collection of 17 essays, many by prominent figures in the international family planning movement, treats two main topics: family planning programmes in six Asian countries, and the status of birth control technology. There are also chapters on the family planning aspects of mater- nal and child health, law, research, and programme fund- ing. The country accounts are the core of the book: their purpose is to show that, despite extensive evidence of fail- ure, family planning programmes can succeed. Readers should be alert to the social costs of such success, which are either minimized or dismissed by the authors. There are two main interpretations of the phenbmenon of rapid population growth. The international family plan- ning movement, as represented by the agencies contribut- ing to this book (Population Crisis Committee, Inter- national Fertility Research Program, Population Services International, International Planned Parenthood Federa- tion. and the United Nations Fund for Population Activi- ties), believes that population growth causes underdevelop- ment. As expressed by Datta Pal in his report on the Indian sterilization programme, "large scale unemploy- ment and destitution in the country [are] due to tremen- dous increase in population growth". (p. 116). A second view sees population growth as a symptom of underdevelopment. If many underdeveloped countries are experiencing more poverty and joblessness, it is because economic growth, in the context of existing national and international structures, is accompanied by increasing ine- quality, as many ILO World Employment Programme studies have shown [1]. To attribute all third world prob- lems to overpopulation is reductionist; to imply that struc- tural problems can be solved by birth control is tanta- mount to proposing a "technological fix'. According to the symptomatic view. people have large families because they are poor [2]; even young children contribute their labour and may mean the difference between survival and econ- omic disaster. In the absence of genuine, redistributive economic development, programmes to limit family size will make these people poorer. Belief in the causal role of population growth in under- development is so strong in family planning circles that the movement is closed to economic, social and political view- points that conflict with or challenge its objectives. The consequent isolation is manifest in each of the chapters of this book, as the examples given below will show. The movement is deaf to even the most vociferous of popular protests. In the past decade, opposition to birth control as a new form of domination increased in both the first and third worlds. At the 1974 World Population Conference in Bucharest, a number of underdeveloped countries pro- tested against the imposition of population control pro- grammes by industrialized market economies as solutions to third world problems. This repudiation impressed UNFPA Director Rafael Salas as merely "a series of acri-