[Book Review of] Bambra, C. (ed) Health in Hard Times: Austerity and Health Inequalities, Bristol: Policy Press. 2019. 288pp. ISBN 978-1-4473-4485-8

Book Review Bambra, C. (ed) Health in Hard Times: Austerity and Health Inequalities, Bristol: Policy Press. 2019. 288pp. ISBN 978-1-4473-4485-8 Following the financial crises of 2007-2008, European countries have been forced to implement austerity measures as a means to reduce their deficit and increase their economic growth. In England, austerity has led to an increase in health disparities, particularly among the most vulnerable such as the unemployed, low-income women, in particular mothers, older people and those with mental health conditions. Although the effects of austerity measures on the social determinants of health at a national level has been widely acknowledged, little is known about how austerity has affected the health of certain communities at specific areas within the country. The book edited by Clare Bambra broke new ground as instead of using the traditional approach of quantitative research it drew on a mixed method case study approach for studying the geographical inequalities in health. Through the use of a longitudinal household survey, extensive archival research, ethnographic observations, qualitative interviews, documentary research and photographic data the book sheds light on the reality of the inhabitants of Stocktonon-Tees in an Age of Austerity. The book also makes an important contribution to Health and Social Science fields by showing how different disciplines such as Sociology, Social Policy, History, Geography and Epidemiology are useful for understanding local health inequalities. In seeking to understand the aetiology of health inequalities, this case study makes explicit how gender interacts with socioeconomic status and locality. The importance of intersectionality for understanding health inequalities is particularly evident in chapter seven by Amy Greer Murphy. Very few authors so far have employed an intersectional analysis for understanding the geographical inequalities in health. Drawing upon the accounts of mothers living in Stockton-on-Tees, Murphy shows that women and their children are placed in a more disadvantaged position than men in the context of financial insecurity leading to a poor mental health experience. The important role of mothers at a time of austerity has also been highlighted by Rebecca O’Connell, Abigail Knight and Julia Brannen in their book Living Hand to Mouth (2019). By focusing on food and eating in everyday life, O’Connell, Knight and Brannen show how family practices have been affected by austerity measures. The way austerity impacts upon family life is brilliantly elucidated in chapter four by Kayleigh Garthwaite. Garthwaite advances research on health inequalities by paying attention to stigma, place and perception in the everyday life of the inhabitants of two contrasting areas in Stockton-on-Tees. Place-based stigma is central in the everyday life of these people, which not only leads to a loss of their sense of identity and social interactions but also limits their access to other communities. The way in which austerity particularly impacts upon vulnerable families and communities is well demonstrated in chapter three by Ramjee Bhandari. Bhandari notes that material factors related to the income and employment status of the household are key for understanding the health gap. The health of members from vulnerable families in Stockton-on-Tees, that is, ‘with low incomes, with members on out of work benefits, and/or who are long-term sick and disabled’ (pp.96), are more likely to suffer from what has been termed as deprivation amplification. The importance of material factors as an explanatory element of health inequalities is also explored in chapter six by Akhter, Mattheys, Warren and Kasim when they analyse the gap in mental health and wellbeing between the most and least deprived neighbourhoods of Stockton-onTees. The authors make an important contribution by reinforcing the idea that political interventions on mental health should not focus only on behavioural aspects, but also on the influence of psychosocial and material factors. The impact that austerity measures can have on mental health in Stockton-on-Tees is discussed by Kate Mattheys in ©2020 Foundation for the Sociology of Health & Illness Published by John Wiley & Sons Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA Sociology of Health & Illness Vol. xx No. xx 2020 ISSN 0141-9889, pp. 1–2 doi: 10.1111/1467-9566.13096 chapter five. Aspects such as unemployment and underemployment, low income and the high levels of deprivation of the area of residence had a negative impact on the mental health of the inhabitants of Stockton-on-Tees, contributing to worsening of the living conditions of this population. The comparative and historical analysis developed by Mike Langthorne in chapter two explores health inequalities in Stockton-on-Tees over two distinct periods, thus offering the reader the possibility of getting to know the case study in different contexts and circumstances. The author explores two major recessions, in particular elements of continuity and change that characterise them. Through the analysis of topics such as unemployment, housing, health and healthcare, Langthorne shows how austerity –in two different periods of history –had profound impacts on the organisational and relational dynamics that characterise Stockton-onTees. The case study is supported by a solid, clear and comprehensive theoretical framework. The arguments are explored logically throughout the various chapters without becoming too obvious or repetitive. To this cohesive theoretical basis is added an innovative and ambitious methodological architecture, without losing sight of the objectives and focus of the study. The book clearly demonstrates the importance of continuing to investigate geographical inequalities in health. The place where individuals live has strong implications on their lives and conditions them. Another important contribution is related to the importance of paying attention to the structural aspects to minimise health inequalities. In addition, it is crucial to recognise that during an Age of Austerity the impacts are not homogeneous, affecting the population differently. Thus, the welfare state should play an important role by ensuring that the population, in particular the most vulnerable, has a strong support network through the availability of efficient social policies. The book represents a valuable tool for those who seek to intervene politically, but also for those who want to understand the impact that austerity can have in accentuating health inequalities. Ana Patr ıcia Hil ario, F abio Rafael Augusto Instituto de Ci^ encias Sociais Universidade de Lisboa, Lisbon, Portugal Reference O’Connell, R., Knight, A. and Brannen, J. (2019) Living hand to mouth: Children and food in low-income families. London: Child Poverty Action Group. ©2020 Foundation for the Sociology of Health & Illness 2 Book Review