Health and Care in Ageing Societies: A New International Approach provides valuable discussion on the complex nature, policy process and approaches used in health and care policy provision in different regions of the world. In this fascinating exploration into the complexities of this area, Lloyd uses the Ethics of Care approach as a basis to underpin her arguments. She also demonstrates the limitations of neoliberal models for the provision of health and care for the older person. This book engages the reader in a broad range of discussions relating to ageing, health and care in the international context. Each reader will benefit differently from each of the chapters depending on their level of familiarity with the concepts discussed.

As a newcomer to certain of these concepts, I found the introductory chapter challenging. However, this was a necessary challenge to understand the complexities involved in the global health, care and ageing debate. This introduction provides background to the Ethics of Care approach and Lloyd acknowledges that the discourse on ageing, health and care is both ‘complex and contentious’ (p. 1). Two overarching principles for health and care are presented, the first being the attempts to minimise the gap between life expectancy and healthy life expectancy; and the second relating to governments’ aims to keep spending on health and care in check. Lloyd argues that these principles are embedded in the policy agenda, and provides a coherent discussion relating to their consideration in policy making.

Arguments throughout the book are based on the author's stance on the Ethics of Care approach. This approach maintains the ‘rejection of the characterisation that humans are essentially self-sufficient and independent’ (p. 4), and it is argued that this is particularly relevant to older people, as the Ethics of Care model does not differentiate between older (dependent) and younger (independent) persons, but sees dependency as inherent throughout the lifecourse. In a highly engaging second chapter, Lloyd raises questions about dependency ratios and global inequalities of health, with discussion about the ‘multiple meanings of age’ (p. 11). She critically analyses the Global Burden of Disease Project commissioned by the World Bank, and discusses the concepts of life expectancy, mortality rates and ‘double burden’ (p. 17).

Within Chapter Three, focus is placed on conceptualising health, care and the lifecourse, and this chapter is of particular relevance to those with an interest in gerontology. Lloyd provides arguments against the biomedical approach to health, and focuses on the merits of Antonovsky's Salutogenic approach, whereby ‘most people are neither healthy nor diseased, but occupy a position somewhere on a continuum between the two’ (p. 34). The discussion around health and identity was particularly engaging, and provides the reader with concepts for deliberation. In Chapter Four, Lloyd invites the reader to consider the evidence available to substantiate whether policies make a difference to health. This chapter succeeds in provoking questions as to the purpose and value of global policy-making in the context of political gain and global crises, such as the current economic recession. The Capabilities approach is presented (p. 62) and discussed in relation to policies on health, and it is acknowledged that this approach is particularly relevant due to its close association with social development.

The final chapters cover ageing, health and care, and their representation in the international policy context. Lloyd discusses a wide range of issues including health promotion, ageism and health needs in later life. She offers historical context which enables the reader to understand how decisions are made, such as the development of the Millennium Development Goals, and debates strengths and limitations of international health-care systems. The key strengths of these chapters lie in the arguments around the active ageing agenda, and global inequalities in access to care for older people. These discussions highlight inequities and enable the reader to consider the merits of health policy globally in relation to the older person. Lloyd summarises from an Ethics of Care perspective that ‘the need for care in circumstances of dependency and a loss of capacity for self-care raises major questions about human vulnerability and interdependence’ (p. 129): a statement which leaves the reader wanting to explore these questions further.

To my mind the only limitation of this book is the assumption that the reader understands themes such as Ethics of Care and neoliberalism: defining these at the beginning would have provided a useful background to the discourse. This book provokes thought and challenges assumptions, and is highly recommended to students, academics and policy makers with an interest in ageing, health and social care policy in the international arena.