The role of ecology in the design of a health care system.

The weight of evidence does not support the hypothesis that the health status of the population is largely dependent on the quality and quantity of its medical services. Evidence to test this hypothesis is presented in a conceptual model of the relationship between health and disease and their care systems, suggesting that medical care is largely unrelated to the health status of the population. Examples of disease trends and distribution are presented to support the thesis that ecology is the primary determinant of the health status of the populationData from selected epidemiological studies point to poverty and air pollution as key factors in determining the pattern of mortality in the urban eco-system.