Edited by Daniel Callahan, Washington DC, Georgetown University Press, 2000, 186 pages, £32.50.

When my family and I were hiking in northern New York state we got lost. I waved down a passing car and inside I could just about, through the haze of purple cigarette smoke, make out a couple of very obese people in the car; they looked like mother and son. They very kindly agreed to take us to our car, several miles away, and during the journey I asked them what had brought them to this remote mountain road. “We come here once a week to draw water from a mountain stream”, said the elderly woman. “Most people round here don't know how to keep healthy”, she and her son opined almost in unison.

This experience, for me, captured many of the attitudes those of us in the West have towards health, health promotion, and disease prevention. This cameo shows how difficult …