The book's cover is a bleak, black and white photograph of unemployed miners scavenging on a coal tip, while a container of slag cascades down above them. It is an appropriate image, as the material within presents an unremitting account of the misery heaped on South Wales during the Depression. The broad context of the research is the ‘healthy or hungry thirties’ debate, on whether the worst effects of the slump were ameliorated by an incipient welfare state founded upon growing national prosperity. Thompson addresses the issue systematically, dealing first with the impact of joblessness on the family economy, then analysing the effects of deprivation on social provision, before culminating in a discussion of health outcomes. The style is old-school social and economic history, and the approach throughout is to contrast South Wales' experience with that of England and Wales, graphically illustrating the extent of regional disadvantage. Thompson is at home with both quantitative and qualitative methodologies. His documentary sources range from contemporary reports, administrative records and autobiography, but such evidence is carefully framed within detailed statistical analysis, often at the micro-level of local government district. The fine-grained data on unemployment, health services, housing, death rates and infant mortality will surely provide a key reference point for future work on the region.

The early chapters quantify the scale of joblessness and the economics of welfare benefits, then explore the coping arrangements of the poor. Women are at the centre of the story of the ‘shock absorber’ strategies which safeguarded the family, such as managing debt, negotiating rent arrears and sacrificing food consumption to maximize that of the male breadwinner. Urban historians will be most interested in the central sections of the book, where Thompson deals with housing and slum clearance, focusing particularly on the small towns of the valleys. Though clearly insufficient when set against the scale of need, he finds some evidence for the good quality of local authority housing and its contribution to the reduction of over-crowding. The public health aspects of the built environment are also discussed, with medical officer of health reports fruitfully used to examine issues such as water, sanitation and space for leisure. This is an important contribution, given the usual tendency of public health historians to assume attention had switched after 1900 to curative services. Thompson's own take on the ‘mixed economy’ of medicine is not simply to restate evidence of Welsh under-provision, but also to emphasize the persistence of informal and irregular healing, prominent in the biographical sources. The concluding chapters illustrate the demographic impact of the Depression. South Wales' excess mortality over that of England and Wales was striking, with female disadvantage again a marked feature: for example, in Merthyr in 1931–35 the excess mortality of women aged 15–24 was 221 per cent of the national rate. And while Wales shared in the general downward trend in infant mortality, the district level analysis demonstrates that this was reversed for neonates in the most depressed communities.

Where does all this leave the ‘healthy or hungry thirties’ debate, given that recent quantitative work by scholars such as Lee, Southall and Congdon broadly confirms the optimist position first staked out by Jay Winter? Thompson wisely takes an equivocal stance, noting for example that the excess female mortality he detected was not peculiar to the 1930s, but was an aspect of the ‘mortality landscapes of these industrial communities during the late nineteenth and early twentieth centuries’ (p. 199). Nonetheless, if his regional study does not pretend to overturn the national picture of long-run improvement, it surely demonstrates with greater clarity than hitherto just how disastrous the localized impacts of joblessness on health could be.