Gòmez, E. J.Geopolitics in Health: Confronting Obesity, Aids, and Tuberculosis in the Emerging BRICS Economies. Baltimore: Johns Hopkins University Press. 2018. ISBN‐13: 978‐1421423616

The so-called BRICS economies – Brazil, India, China, Russia and South Africa – are in a more favourable economic situation than less developed nations, because they have access to additional funding and infrastructure. Nevertheless, they are still seeking their place in the sun alongside the industrialised nations. In recognition of the fact that these countries share some similarities in terms of economic strategies, but not in the area of international politics, the book Geopolitics in health: Confronting obesity, aids, and tuberculosis in the emerging BRICS economies by Gomez starts by posing the interesting question of how these countries have navigated major contemporary health emergencies. The book focuses on three epidemics of significance in modern times: tuberculosis in Russia and South Africa, obesity in Brazil, India and China, and AIDS/HIV in all five countries. This methodological choice, although well motivated, has notable pros and cons. The decision to focus on these three diseases is interesting and convincing, because, as emphasised in the text, these epidemics have long been part of the global health agenda, and the epidemiological data available and proposed in the book shows a different diffusion of these diseases among BRICS countries. However, this means that the policies regarding obesity in Russia and South Africa and tuberculosis in Brazil, China and India are not analysed, and as such raises the question of why these are not health priorities for those BRICS countries. Undoubtedly, the non-management of diseases is an interesting element that would have added another element of depth to the analysis. The thesis proposed in the book is particularly interesting and convincing: responses to the epidemics discussed differ because the countries have varying relations with the international community, which can mean that different activities create pressure, not only in terms of political and health reforms, but also in relation to the needs of citizens. It would also have been interesting to test this hypothesis at the European level or using other health issues, for example in the context of vaccination. The introduction of the themes concerning geopolitical positioning and bureaucratic-civil societal partnerships is also effective. Geopolitical positioning relates to the responses that political leaders give in response to international criticism and pressures, in this case, in reference to health management. These responses, according to Gòmez, can be either positive or negative. It is unsurprising, then, that Gòmez suggests that health bureaucracy relies on both civic organisations and non-governmental organisations to improve responsiveness to epidemics. Gomez also convinces the reader that a centrist policy response to epidemics is possible only when there is positive geopolitical positioning and a strong partnership between health bureaucrats and civil society. Among the countries analysed, only Brazil, relative to AIDS/HIV and obesity, seems to have found a suitable balance through the social health movements and NGO community able to work with health bureaucrats at micro, meso and macro level. In contrast, the Indian social health movements are not so organised and legitimated to work with or engage the centralised health bureaucrats (HIV/AIDS) and some health issues are still considered a problem of social class or culture (e.g. obesity). As in India, also in China the nutrition transition has not been supported by a cultural transition, meaning obesity epidemic was not perceived as a health issue. The positions of Russia and South Africa are classified as outliers of the model, serving as examples of negative geopolitical positioning, for two different reasons. In South Africa the antiapartheid movements and civil societies movements, historically focused on black population rights, the great attention to HIV/AIDS and the cultural idea that tuberculosis is a disease for poors, has not facilitated the creation of bureaucratic-civil movements. Finally, according to Gòmez, in Russia, traditionally inclined to define itself as a world leader, the violations of civil liberties and censorship of the press and media have not permitted NGOs to work with communities in the field of HIV/AIDS and to create strong partnerships between bureaucrats and social health movements in the field of tuberculosis. In conclusion, the book offers a particularly interesting observation concerning the responses to AIDS/HIV in the five BRICS countries, with implications for other commentators addressing the cultural dimension of tuberculosis and the sociology of obesity. The comparative analysis, even if partial, is useful in wide-ranging ways; for example, the observation of obesity in the context of economic growth rather than stagnation will be relevant to research in European contexts. The use of a historical-political key is exciting for those involved in health policies, global health and health promotion. Moreover it is rewarding to report, once again, that the presence of enlightened leaders and the building of collaborative paths within civil society are essential engines of transformation in healthcare, driving national and international policies in the field of health and throughout society.