Toward an ecosocial view of health

sThe changing patterns of health in the United States justify both celebrat ion and dismay. We can celebrate declining mortality rates, increased life expectancy, and improvements in diagnostic and therapeutic technologies. Bu t public health was caught by surprise by the return of infectious disease; the gap in health outcomes between rich and poor and between whites and bl acks increases; there is a growing discrepancy between what is technically possible and the actual health status; and despite its greater expenditures on health, the United States lags behind the other developed countries in health outcomes. The authors examine four reasons for this: we do not buy m ore health care, only pay more for it; we receive more health care, but muc h of it inappropriate, ineffective, or harmful; only some of us get more he alth care; and we have created a way of life that makes us sick, then spend more to repair the damage. Major failures arise when problems are understo od too narrowly. An ecosocial perspective attempts to look at the whole. It rejects as false the dichotomies social/biological, physical/psychological , genetic/environmental, lifestyle/environment, examining their interrelati ons rather than assigning them relative weights. In addition to looking at average differences among populations, the authors examine patterns of vari ability in health outcomes.