Much has been said and written about ecology and its relation to public

health. In the following paper the author has undertaken to develop

a philosophical conceptualization of this problem, in which human
ecology is the science of man-made systems in their relation to the
biophysical environment, within which public health is a system
of principles for action, a guide to planned activity in terms
of both the individual and the community.

HUMAN ECOLOGY AND PUBLIC HEALTH

Leo Kartman, Sc.D.

Nthe field of public health the pro-
I found change and flux in contempo-
rary social relationships is reflected by
complex activities on a global scale
spearheaded by the World Health Or-
ganization. Confronted throughout his
history by the devastation of infectious
diseases man now confronts nature with
the possibility of "eradicating," or at
least of controlling, many of these com-
municable maladies. Despite intense
nationalisms, rival socioeconomic and
political systems, and the jealous pres-
ervation of national sovereignties, the
nations are in accord that peace must
prevail in the world of infection and
pestilence, organic malfunction and
malignancy, and mental and emotional
aberration. Modern industrial civiliza-
tion continues to exacerbate that con-
tradiction between its retrograde social
relations and its sophisticated and ad-
vanced scientific condition. In newly
emerged nations these conflicting cur-
rents are reflected, for example, in the
spectacle of a declining infant mortality
occurring simultaneously with malnu-
trition, starvation, and death of young
children who, in the past, would never
have survived childbirth. Thus man is
faced with a dilemma in human ecology.
The answer to this and many similar
questions lies in our concept of human
ecology and public health. What follows
may be characterized as a "position
paper" to suggest problems on a theo-
retical level as a basis for dialogue.
Definitions and Beyond
I have referred to public health and
to human ecology, and I must confess
to a compulsion to offer definitions. Defi-
nitions are not suggested as an appeal to
authority but rather to generalize suffi-
ciently for the establishment of points of
reference and the temper of current
views. The rigidity and artificiality of
definitions could not be more apparent
than in the contemporary world of rapid
transformation in all human disciplines.
What is needed is an "extensional" (or
operational) definition that tells us what
to do rather than what to say, that makes
us aware of things, facts, experiences,
and the way they are related in the real
world, rather than the manner in which
they are spoken about.
The most recent edition (1961) of
"Webster's Third New International Dic-

MAY. 1967 737

tionary" (unabridged) has the following
to say:
Ecology-"The totality or pattern of relations
between organisms and their environment."
(This is one of several definitions.)
Human ecology-"A branch of sociology that
studies the relationship between a human
community and its environments; the study
of the spatial and temporal interrelationships
between men and their economic, social, and
political organization."
Public health-"The art and science dealing
with the protection and improvement of com-
munity health by organized community effort
and including preventive medicine and sani-
tary and social sciences."
When taken together, these defini-
tions allow the development of a dy-
namic concept. We start with the totality
of relations which, in human ecology,
embrace the man-made as well as the
natural environment. Public health then
becomes a portion of human ecology
concerned primarily with community
problems of well-being. The third salient
point in the definition is the idea of
"organized community effort" in public
health. All of this seems simple and
clear. Study a community in depth,
marshal all the salient facts with regard
to the objectives of the study, and
finally, when all the facts are gathered,
do something about it in an organized
and planned fashion. But is it that
simple?
The modern literature of public
health, social medicine, epidemiology,
and related fields speaks eloquently of
a rather poorly defined and uncertain
marriage of the two fields, ecology and
health.1 Some current phrases much in
evidence are: medical ecology, disease
ecology, medical geography, geographic
pathology, epidemiology of health, and
medical sociology. Thus, as Audy and
Wolff have suggested,2 "Epidemiologists,
ecologists, and social scientists have
separately been developing ideas and
methodologies of interest to each other
but there has been inadequate communi-
cation between them." This confusion
in communication is indicated in the
738
admonition of Gordon that, "As I speak
now of medical ecology, I wish to leave
no doubt that I view the term as
synonymous with epidemiology."3
Ecology is historically and funda-
mentally a biological science. As a dis-
tinct scientific discipline, ecology arose
in the latter 19th century. Yet there is
evidence of a Chinese calendar of 700
B. C. that recorded biological events,4
and ecological precepts were used by
Aristotle and Theophrastus in classifi-
cations of organisms. The German biolo-
gist Ernst Haeckel usually is credited
with first proposing the term ecology in
1869.
Ecology can be divided into autecol-
ogy, the study of individual organisms
or individual species, and synecology,
the study of groups of organisms. Thus
synecology again can be divided into
such fields as population ecology, com-
munity ecology, and ecosystem ecology.
In tum, these subdivisions again can be
subdivided and it would take nothing
less than a separate essay to define more
clearly the complexity and sophistica-
tion of contemporary ecologic thought
and technics. It is sufficient here to em-
phasize that ecology is a biological
discipline.5
It was inevitable that ecology as a
dynamic and expanding field should be
applied to man and the human commu-
nity. Darwin can probably be given
credit for the first modern analysis in
depth of biological and environmental
interaction and of man's place in nature.
Nevertheless the famous essay by Mal-
thus on population" was really an at-
tempt to formulate a general theory of
the dynamics of human populations
which, in essence, has been regarded
as a biological law, and in more recent
times as part of human ecology.7
The cognizance of human relation-
ships and the importance of community-
environmental interaction have deep
historic roots. It was the development
of social medicine, with its thread reach-
VOL. 57, NO. 5. A.J.P.H.

ing back to the Egyptian and Greco-
Roman civilizations, that gave much im-
petus to the evolution of modern soci-
ology.8 Today many health workers talk
about the "ecology of health," and med-
ical geographers hail the discovery of
"disease ecology."9 In actuality con-
temporary health scientists have been re-
discovering the environment.10 An anal-
ysis of the development of social medi-
cine indicates a long historic awareness
of these relationships. Nevertheless,
these important rediscoveries have a
new flavor for they come at a time when
man's view of himself is undergoing
profound change.
A major difficulty lies in the transi-
tion from animal ecology to human ecol-
ogy. Park usually is given credit for
the first systematic exposition of eco-
logic precepts in terms of social prob-
lems in the human community."' Work-
ing with biologic principles, he antici-
pated the now well-founded idea that
the human organism grows from birth
toward self-realization in a context of
specific relationships with and depend-
ence on other organisms.'2 In the 17th
century the idea of interdependence was
expressed beautifully by John Donne in
his 17th "Devotion" that stated in part:
"No man is an Island, entire of itself;
every man is a piece of the Continent,
a part of the main . .. any man's death
diminishes me, because I am involved
in Mankind. .-. ."13 Donne was far in
advance of his time as a humanist and
the implications of his ideas for human
ecology are still not fully realized today.
In our time, the problem is put as
follows: "The attempt now is to resolve
the various ecologic concepts . . . into a
statement of ecologic laws, conceived as
extending through the life processes of
all animate things as they constitute
groups, to include man, wild beasts, the
domestic animals, plants, pests and para-
sites."14 This is a unifying concept yet
there is a contained danger in a whole-
sale lumping of man and other or-
MAY. 1967
HUMAN ECOLOGY AND PUBLIC HEALTH
ganisms under the purview of general
"ecologic laws." We can recall that Mal-
thus conceived of man as acting like
other organisms which tend to repro-
duce up to the limit of the means of
subsistence, inevitably ending in famine,
disease, and general disaster. This has
been referred to as the "ecological fal-
lacy" or the "ecological dilemma."' The
fallacy is found in the view of man as
completely enmeshed by and dependent
upon the natural system. The dilemma
is found in the circumstance that man
is at the same time a part of nature, and
yet beyond nature.
The so-called ecologic dilemma first
came into prominence in the pseudo-
Darwinian sociology of the Organicist
school of 19th century sociology. The
biological precepts of Darwinian evolu-
tion were mechanically applied to hu-
man social relationships. These ideas,
which are usually referred to as social
Darwinism, had a great deal of influence
and have historic roots in the United
States dating from the latter 19th cen-
tury. Even in contemporary biology we
see tendencies to revive this ecologic
fallacy from time to time. A leading
contemporary biologist, in an original
and stimulating essay on the origin and
evolution of human culture, has said:
"I find it difficult in reading some
authors to be sure that they are not
confusing biological and cultural evolu-
tion-Emphasis on the animal aspect of
Man, so common in current literature,
and a generally fatalistic attitude re-
garding human behavior may be symp-
toms of false concepts and applications
of Darwinian evolution."'51
In the above connection I have to
mention a rather curious reversal of the
ecologic fallacy exemplified by the an-
thropomorphic view, a position adopted
by biologists now and then, past and
present, as a foundation for understand-
ing animal behavior.'6 In a study of the
ecology of rodents we find this passage
in a recent monographl7: "Detailed ob-
739
servation of lower forms raises doubts
as to the frequently implied absence of
symbolic communication, attitudes, and
value systems in forms other than man.
For example, there is the ethic of honor
your father and mother. Operationally,
rats exhibit behaviors indicating con-
formance to such a tenet." This is the
ghost of social Darwinism standing on
its head. By the logic of this sort of
comparative examination of social be-
havior (the author's title in part is
- . Sociology of the Norway Rat")
not only can rat behavior be shown to
contain within itself an expression of
human ethical behavior but, carried to
its logical end, I have no doubt that the
basis of human emotion, competition,
war, love, status seeking, and so forth
can be equated with the "value systems"
underlying the psychosociology of the
Norway rat and perhaps even the house
mouse. I trust that this tendency toward
a unification of animal and human ecol-
ogy does not become accepted generally
since it would place fetters upon the
study of human ecology and restrict
meaningful investigation for some time.
It seems important to differentiate
between the application of ecologic
principles and methods to the study and
solution of biological or biotechnical
problems-on the one hand, and their use
in the study of man himself on the other.
Ecologic methods are being used, for
instance, in the vital field of the con-
servation of natural resources. Ecolo-
gists contribute valuable observations
and experimentation in problems con-
nected with wildlife management, for-
estry, agriculture, pesticide residues,
stream pollution, fisheries, range man-
agement, and so on. A younger field is
that of radiation ecology in which prob-
lems of radioactive fallout, waste dis-
posal, and the fate of radioactive iso-
topes in different environments are
studied. Here also would be placed the
application of ecology to the natural his-
tory of disease. In addition, the concept
740
now must be extended to space bio-
technology and the field of extrater-
restrial exploration and life.
To the sociologist, ecology represents
one of the disciplines that has been taken
from the natural sciences and applied
to the study of human society.18 The
equilibrium attained by the human popu-
lation in a given region is referred to
as the "web of life." Man and his
cultural institutions are considered as a
part of this web in which a purposeful
evolution is superimposed on (or sub-
stituted for) the objective processes of
the natural world. To many sociologists
all of these interrelations are manifesta-
tions of a basic ecologic process, competi-
tion, which in its "pure" form is an im-
personal striving for advantage. How-
ever, when men become aware of their
antagonists they try to eliminate them
with the result that open, intense rivalry
and conflict occur. Sociologists have de-
veloped several schools of thought in hu-
man ecology ranging from the direct ap-
plication of the principles of biologic
ecology to a humanistic, society-oriented
discipline. This is a subject of immense
proportions and cannot be discussed
here, but one should point out that it is
the sociologists and social anthropolo-
gists who have been largely responsible
for developing and enriching the field of
human ecology.
The ecological view of humanity ap-
pears to have attracted sociologists, an-
thropologists, geographers, and biologists
to a common ground. More recently,
public health and medical scientists seem
to have joined these ranks in force.
Within the past decade public health
workers have adumbrated human ecol-
ogy in relatively simple terms. One
authority sees human ecology as the
"study of the relations between man
and his environment, both as it affects
him and as he affects it."7 Another
says that human ecology is the "study of
the mutual relations of man and his or-
ganic and inorganic environment, his
VOL. 57. NO. S. A.J.P.H.

adaptations, his struggle for existence,
his parasites, and the like."19 During an
earlier period, about World War I and
the following decade, a number of social
scienlists advanced the thesis that geog-
raphy is the science of human ecology.
The main concern was the way in which
physical factors influence human civili-
zation. Human geography was in-
terpreted as the ecological study of so-
ciety. The repercussions of these ideas
are seen in our own day in the equat-
ing of medical geography with what is
called "disease ecology."9
The above views are but very few
examples of definitions. It is fairly clear
that the term "human ecology" implies
the broadest possible view of human
beings, both as individuals and as popu-
lations, in terms of the ecosystem, that
is, the biologic, socioeconomic, political,
cultural, and emotional complexes in
their dynamic action and reaction. What-
ever man does, what he thinks, how
one man reacts to another man or to a
circumstance either natural or man-
made, how a human group functions
within itself and reacts to other groups
and to situations, how each thought,
emotion, habit, aberration is translated
into human activity, and how human
creativity arises, matures, or is repressed
-all of these and thousands of other
complex processes are of the warp and
woof of human ecology. "The entire
history of human civilization and tech-
nology is a history of human ecology in
so far as it concerns changed relations
towards nature, its domination and ex-
ploitation."20 One of the main concerns
of human ecology today would seem to
be a focusing of attention to the essen-
tial holism of human problems. This
overlapping and interpenetration has
been recognized for a long time and
many have pointed to the artificiality of
fragmenting and compartmentalizing re-
lated areas of investigation and practical
activity. The evidence still is all around
us in the piecemeal manner in which
MAY, 1967
HUMAN ECOLOGY AND PUBLIC HEALTH
leading problems are approached on
both national and local levels. And this
fragmentation is reflected in the organi-
zational framework of health agencies
and their practice of attacking problems
item by item.
The Individual and the Community
The increasing complexity of urban
and suburban population dynamics, the
tendency of industry to become more
highly technical, the introduction of
new man-made hazards such as ionizing
radiation, and the concomitant increase
in the incidence and diagnosis of mental
and emotional illness are reflected in the
more diversified and complex nature of
community health problems. Whereas in
the past mass disease was closely asso-
ciated with a natural origin connected
primarily with the external environment,
the mass diseases of today, in a Western
society like the United States, are pre-
dominantly social in origin and are more
integrated with characteristics of the hu-
man host and his socioeconomic environ-
ment. The chronic maladies and the be-
havioral disorders seem less amenable to
community-oriented control than are the
infectious diseases. Thus some authori-
ties suggest that modern public health
practice must envisage a change in
method even though the general princi-
ples guiding the control of community
health problems remain essentially the
same. This change consists of greater
emphasis upon the cooperation and in-
terest of the individual since in many
situations the individual no longer can
depend upon the community for protec-
tion and prevention.21 It is argued that
the field of public health education now
has greater significance since the "new"
public health is one in which there is
"a common effort by epidemiologist and
educator through the principles of hu-
man ecology."22
There can be little doubt that the pre-
cept of individual responsibility seems
741
germane to the framework of a develop-
ing complex industrial society of es-
sentially democratic content. Such a view
appears consistent with the idea that in a
democracy the education of the indi-
vidual is of basic importance and that
the ultimate result of education is the
emergence of the mature, responsible in-
dividual who is responsive to his own
needs in the sense that self awareness
leads to social health. Nevertheless, I
am convinced that the practical con-
cern now, and for a considerable period
in the future, is community health and
environmental health. Even though many
theorists in public health speak of infec-
tious disease almost in terms of histor-
ical curiosities, the facts show that such
illness as streptococcal infections, tuber-
culosis, salmonellosis, venereal disease,
and other communicable diseases still
remain serious threats to well-being
even in the most advanced countries.
The viral infections, although of long
standing, still are part of an expanding
medical universe and it has been sug-
gested that we are now entering the
antiviral era just as the 1930's ushered
in the age of antibacterials.
It is true, of course, that the develop-
ment of mass immunization and anti-
biotic therapy and prophylaxis has, to
a large extent, controlled the so-called
crowd diseases. Yet a leading authority
in this field has suggested that the cur-
rent situation represents a kind of truce
within which many bacterial diseases
are suppressed while their etiologic
agents continue to exist and to propagate
in the natural environment. This truce
may collapse at any time, as, for in-
stance, the sudden and tragic increase of
staphylococcal infections in hospitals.23
In the area of malignant disease the
enlightened individual has the advantage
of being motivated toward periodic
checks upon his health, and if already
sick he will more readily seek and follow
the indicated medical or surgical prac-
tice that offers a maximum chance for
742
recovery. Yet at present it must be
recognized that with a problem such as
cancer the multifactorial causes remain
relatively obscure. Intelligent action still
must wait for a much greater under-
standing of its ecology in man and such
an understanding primarily is a product
of collective research followed by mass
propaganda, all of which is directly de-
pendent upon the amount of money that
a given society is willing to spend for
investigation. Even when a reasonable
cause-effect relationship has been demon-
strated, as with the carcinogenic role
of tobacco, man-made obstacles as busi-
ness interests appear to raise barriers
that frustrate the individual in his
search for personal freedom from dis-
ease. The helplessness of the individual
in situations of this kind emphasizes the
contradiction between enlightenment on
the one hand, and the frustration of
intelligence by the very sociocultural
forces advocating and furthering that
enlightenment. This is an example of a
significant problem in the human ecol-
ogy of public health.
The hospital, like social institutions in
general, tends to maintain a status quo
in its attitudes and practices. Neverthe-
less a tendency toward change is dis-
cernible, determined in large measure
by nontechnical factors. The most out-
standing change is in the area of the
individual patient's attitude toward his
illness so that the patient's feelings about
self, about his doctor, and about the
hospital have become factors in the na-
ture of his treatment. Whereas in the
past a "humanitarian" motive dictated
that the patient be made comfortable,
the current view assumes that psycho-
social factors are of primary concern.
The patient now is to be given what is
called "comprehensive care" in which
his identity with the world outside the
hospital is maintained.24
The consequences of the trend have
implications for both the patient and the
physician. From the ecological stand-
VOL. 57. NO. 5. A.J.P.H.

point, the patient can begin to deal with
the "total" reality of his existence, with
the full implication of his consciousness
in terms of an active interest in creat-
ing conditions in which his illness will
be terminated. More than that, this in-
dividualization begins to square with the
new reality of a longer life span, i.e., the
responsibility and necessity of coping
with the problems of life rather than
with illness and death. The problems
of health have become paramount. "We
are faced with the fact that perhaps
one-half of all patients or more have
nothing wrong with them in terms of
prospective death. Can we say that there
is nothing wrong with them in terms of
prospective life ?"25
To the physician, the changing atti-
tude of the patient helps to pave the
way for an acceptance of the practice of
clinical epidemiology in the broad eco-
logic sense.26 In a field such as venereal
disease, where the attitudes of both the
patient and his physician are of critical
significance to programs of control and
prophylaxis, these tendencies to greater
involvement must in the long run create
the conditions for increasing social re-
sponsibility. A public health expert has
stated that the "pivot in an eradica-
tion program" for venereal disease "is
the doctor in private practice." The
practitioner must cooperate with public
health authorities in locating sexual
contact so that the complete epidemi-
ology of each case can be revealed. How-
ever, this same authority feels that "it is
not realistic to ask or expect the aver-
age physician today to spare the extra
hour or often more of time required for
a thorough probe for contacts. ...
Thus the ideal system is "for the physi-
cian to diagnose and treat, and then
call the public health epidemiologist ...
and request him to interview the pa-
tient as soon as possible." In this rela-
tionship the private physician is spared
the "active burden of epidemiology"
. . . but . . . "he must bear the moral
MAY, 1967
HUMAN ECOLOGY AND PUBLIC HEALTH
burden."27 I have strong doubts that
epidemiology can be separated from
morality, but that is a problem needing
exposition elsewhere.
If every physician actually would
notify the health authorities this would
mark a tremendous advance in view of
the fact that a survey in 1963 showed
that for every privately treated case of
infectious syphilis identified and re-
ported, approximately nine cases had
been identified, treated, and not re-
ported. Only a little more than 10 per
cent of cases of infectious syphilis
treated by private physicians are being
reported. In 1962, while about 20,000
cases were reported by clinics and phy-
sicians, closer to 100,000 more were
diagnosed and treated.28
The collaboration of the private physi-
cian with the public health epidemi-
ologist should tend to stimulate in the
medical practitioner an ecologic, or soci-
ologic outlook that has become a neces-
sity in the contemporary world of sharp
social change. It seems a bit sad that
public health workers must deal with
the politics of expediency. The neglect
of epidemiology still is based, to a large
extent, upon that figment of individual-
istic imagination-the privileged and
sacred physician-patient relationship. In
the context of a serious communicable
disease, specifically social in nature,
such a view is primitive indeed. Yet in
the United States the anachronism of
individualism persisting from the fron-
tier past into the present world of so-
cially-oriented democratic public health
practice continues to fetter the private
physician who has yet to take the critical
step of practicing clinical epidemiology
with emotional freedom and with a sense
of responsible personal choice. When
the physician has at last ceased to focus
his exclusive attention on the patient's
complaint, per se, he will assume the re-
sponsibility for involvement in the eco-
logic realities of the world surrounding
a particular patient, i.e., a concern for
743
the totality of welfare of his patient. The
result can be only in the direction of
socially responsible activity wherein the
needs of the individual and of the com-
munity are recognized and are merged.
Knowledge and Action
Knowledge implies the necessity for
action. Concern, when based upon
knowledge, is an empty emotion unless
it becomes part of action. The test of
how well we have understood the prob-
lems of public health in their wider so-
cial context is the test of the degree of
our concern to chart a course of action
and to maintain control over it. Tolstoy
once wrote a short story entitled "God
Sees the Truth But Waits." In the field
of human ecology and public health
many significant "truths" have been
grasped, but practical activity by a so-
cially responsible force quite often is
completely lacking. Silence never was
a hidden truth, it has been the mark
either of a deadening conformism or
of the deliberate attempt to prevent ac-
tion and innovation.
If we can develop a humanist eco-
logic view in public health, then we can
begin to approach man as a totality
without prejudice and with the candor
needed by true "generalists" as practic-
ing scientists-educators. Without some
guiding principle the discussion of hu-
man ecology and health bogs down into
a recital of special problems. Thus a
recent conference held at the New York
Academy of Medicine focused attention
on the biological, physical, and chemical
factors of the environment in relation to
human health, with emphasis on such
topics as pesticides, ionizing radiation,
and pollution. Experts and specialists
discussed these topics brilliantly, but
these matters have been talked about ad
infinitum in recent years. Nowhere in
these talks was there a realistic recog-
nition of the broader concepts and the
larger problems involved, except in the
744
paper presented by that eminent his-
torian of public health, Rosen, who paid
close attention not only to the social en-
vironment and the social context of
these problems, but pointed out the
necessity for planned changes in the so-
cial environment as a prerequisite for
the solution of these problems. Rosen's
paper is important because it goes be-
yond the mere observation of ecologic
relationships and tackles the more im-
portant area of human action and hu-
man decision to change these relation-
ships.10
One of the primary consequences of
scientific knowledge, it would appear, is
the launching of practical action to pre-
vent a particular concatenation of events
that is recognized as a threat to a com-
munity. It seems a sad truism that
catastrophes have occurred over many
decades and communities continue to
"do business as usual" as though the po-
tential for repetition is nonexistent. To
floods, cyclones, and earthquakes may
be added epidemics due to biologic
pathogens as well as to man-made toxic
agents and stresses such as social con-
flict and international war.
Admittedly, man cannot control na-
ture to the extent that its most awesome
disturbances are prevented. Neverthe-
less, if man takes his own ecology seri-
ously, he must begin to modify his way
of living in relation to his knowledge
that certain events are cyclic and that
others will recur from time to time. In
short, human ecology must abandon its
childhood, a state in which history has
little or no meaning. To the scientist
history is not only a record of past
events and past ideas, it is also in vary-
ing degree a basis for the prediction
of future events.
In my own field of public health I
have noted the activity of highly skilled
scientists and team of specialists on both
foreign and domestic assignments who,
over the years, have investigated all
sorts of epizootics and epidemics and
VOL. 57. NO. 5. A.J.P.H.

have conducted exhaustive surveys. They
have revealed and recorded an amazing
variety of infectious agents and their
epidemiologic complexities, and they
have written hundreds of reports and
have published other hundreds of
learned papers. The knowledge gained
has been amazing. Yet, for various
reasons, it has been difficult in many
cases to put the knowledge to work, to
initiate and carry out anticipatory ac-
tion, of action before the fact, of pro-
phylactic action as a major program in
public health.
In a context of human ecology the
basis of public health resides in the use
of specialized knowledge for the manipu-
lation of community forces. Thus, it
is necessary that specialists work to-
gether with social and political agencies
in the practical tasks facing communi-
ties so that the attack upon health prob-
lems becomes part of a program of so-
cial planning. If slums are cleared in a
metropolis, to be replaced by good hous-
ing, clean streets, and a general elimina-
tion of important environmental stres-
sors, the real benefits must accrue to the
former residents of these slums if the
original problems are not to be per-
petuated and even exacerbated. There
are too many examples of failures and
in these circumstances crowd diseases
are moved from one area to another
along with the social conditions that fa-
vor their endemicity. During an early
historic period the ecologic key to such
conditions was primarily economic since
a certain level of unemployment was ac-
cepted as being necessary for the mainte-
nance of profit through presssure on
the labor market. Today, poverty and
unemployment are officially looked upon
as evils, as social diseases, and by po-
litical legislation a nationwide program
has been developed to eliminate them.
Thus the current ecologic key is not so
much a matter of economics as it is of
politics. The complex hearings before
congressional committees bear witness to
MAY, 1967
HUMAN ECOLOGY AND PUBLIC HEALTH
the critical importance of politics as an
ecologic factor in the practice of public
health.
The struggle against poverty, as a
major program of human ecology, should
be examined carefully by every worker
in the fields of public health and medi-
cine. A close examination will reveal
that the ecology of human disease must
start with the social fabric and once
that becomes clearly defined the matters
of public health can be delineated and
analyzed in terms of their interrelation-
ships in that social fabric. The starting
point is not a disease or the prevalence
of infection, and it is not epidemiology,
it is the social unit. A study in "disease
ecology" begins with the socioeconomic
and behavioral status of a population,
defines that status in terms of the total
ecologic picture, and then proceeds to
the study of health problems that are
recognized as an organic part of the
totality of human relationships involved.
The outcome of such a study would be
to define health in terms of the social,
economic, and political realities in a
given community. This is the type of
knowledge that provides a basis for in-
telligent, democratic action.
The specialist may not recognize or
consider that human ecology implies re-
sponsibility. This is not surprising in a
culture where few scientists are con-
cerned with the social implications of
their work. The comfort of specializa-
tion dies hard, but there are occasions
when the social apathy engendered by
specialization is shaken from its roots.
I recall a parasitologist friend who, after
having earned his doctorate with a neat
dissertation on a tidy little experimental
project, went to India and plunged into
the parasitologic problems of workers in
a jute mill. He was overwhelmed by
the mass nature of parasitic problems
under Indian conditions as contrasted
with the innocuous status of the same
parasites in the United States. He spoke
about the pressing need to control these
745
parasites, some of which were virtual
curiosities at home and were being
maintained in the laboratory for use
in fascinating experiments the results of
which could be used to pad bibli-
ographies. I have had a similar ex-
perience.
How many times has someone stated,
"We don't know enough about the fac-
tors, the ecologic conditions that favor
these infections. We need more re-
search, more surveys, more investiga-
tions before we can go in and control,
let alone attempt to prevent." The road
to limbo is beautifully paved with sur-
veys and sophisticated experimental in-
vestigations. There is no end to the study
of basic epidemiologic mechanisms. Yet
I venture to assert that in spite of a
lack of complete knowledge in an area
such as bilharziasis in Puerto Rico, for
example, the means are at hand to re-
duce the problem to insignificance pro-
vided sufficient funds could be obtained.
Even more obvious is the circumstance
that the rash of encephalitis epidemics
in certain areas of the United States
during 1964 could have been prevented
by mosquito control programs ade-
quately financed and conscientiously
applied.
Of interest here is a statement made
in the "News Letter" of the American
Public Health Association, Epidemiology
Section, page 7, March, 1965, which
follows in part: ". . . today many po-
tential leaders in the field of public
health who have observed the gathering
of massive evidence concerning the dele-
terious effects of tobacco on health- have
failed to act upon such evidence be-
cause it is not yet perfectly complete.
Their inaction is perhaps especially a
product of the unfortunate concept, still
prevalent among epidemiologists, that
absolute or perfect proof of causality is a
possible and necessary basis for preven-
tive public health action . . . it is by
forthright exercise of . . . judgment of
the whole, undismayed by obstructive
'thread-picking' arguments, that the Epi-
746
demiologian renders his unique and vital
contribution to the solution of social
problems."
The modern public health worker en-
gaged in research has encountered this
dilemma many times: Should investi-
gation be arbitrarily halted or given
less emphasis at a certain stage and ma-
jor energies be devoted to control activi-
ties? It is my contention that the human
ecologist in public health must be con-
scious of the necessity for this choice
and that when the moment arrives he
must choose in favor of the "greatest
good for the greatest number." Oliver
Wendell Holmes put the matter pre-
cisely: "We need education in the obvi-
ous more than in investigation of the
obscure."29
We do not need more scientists in
public health, but more men and women
of understanding who do not fear the
ecologic implications of their science. We
need fewer compilers of data and more
specialists who think in creative gen-
eralities. The existing data pile has
reached a mass that already extends be-
yond our use of it. The data pile does
not insure progress automatically; it
does not give assurance that some uni-
versal good or some great utility shall
arise to rescue humanity from its ills.
The gathering of data often is a serving
of what has been referred to as the cult
of newness. Thus in practice this serv-
ing of the data pile becomes a process
of rejection and this amounts to a nega-
tion of creativity, since that which is re-
jected quite often has not been under-
stood or evaluated. Knowledge is re-
jected or conveniently forgotten be-
cause the continual seeking for "new-
ness" has become a -way of life sub-
servient to the insecurity of the indi-
vidual scientist operating in a world
where dispensers of funds demand new-
ness as the basic condition for their
generous grants. The ecologic implica-
tion of this unconscious rejection of
knowledge is the frustration of purpose-
ful action.
VOL. 57. NO. 5. A.J.P.H.

It is sometimes the case that the
stimulus for changed views and for ac-
tion comes from a source outside the
framework of a given field. Thus the
controversial book "Silent Spring" was
a catalyst to action by toxicologists and
by pesticide specialists who were merely
acting on the basis of information that
had accumulated for many years and
about which they were acutely aware.
The sessions of the Seventh Interna-
tional Congresses of Tropical Medicine
and Malaria, held in Brazil in 1963,
were impressive in their presentation of
a wealth of knowledge. Even the most
casual observer could conclude that
enough is known about many of the
most devastating tropical maladies to
reduce their incidence significantly and
to fundamentally alter their effects. Yet,
with the possible exception of the field
of malariology, there seems to have been
demonstrated an ever-widening chasm
between ecologic knowledge and the
necessary activity to use that knowledge.
In a message to the Congresses the then
President of Brazil, Joao Goulart, re-
minded the members that their responsi-
bility was concerned with matters far
more profound than the research to dis-
cover the natural mechanisms operating
in tropical diseases. He reminded them
of the danger of their abdication from
the responsibilities of human ecology in
the following words:
"I want to take this opportunity to remind
those present, particularly the representatives
of Latin America, African and Asiatic peoples
who, as much as the Brazilians, still live under
the burden of pauperism, that so-called tropical
diseases are much more the fruit of our un-
derdevelopment than the result of the generous,
though often slandered, climate of our coun-
tries. Your efforts . . . must not obscure the
fact that only a profound change in the social
and economic structures of our countries will
be able to solve the distressing problem of our
people's health."30
It is now three years after those words
were spoken to many of the world's
leading figures in tropical medicine. I
MAY, 1967
HUMAN ECOLOGY AND PUBLIC HEALTH
wonder how many remember and how
many have weighed the implications of
that message ?
A View of Human Ecology and
Public Health
The concept of human ecology and
public health suggests a consideration
of the unity of theory and practice as
the main concern of man as a social
being. The dynamic union of thought
and its application may be viewed as a
series of steps in a process of social
reproduction. More than that, the very
recognition of public health in a wider
context of human ecology is simultane-
ously a cognizance of the necessity for
transforming the human condition, of
consciously planning and manipulating
ways and means to so modify the bio-
social environment that forces are cre-
ated that will in turn fundamentally
change the problems of public health.
The active nature of human ecology
will become recognized because it op-
poses a spirit of humanism and personal
engagement against the objectivity and
essentially passive nature of ecologic
thought exemplified by the field of ani-
mal ecology. Man can observe the ecol-
ogy of animals, experiment with it, ex-
plain it, and modify it when the knowl-
ledge and means are at hand. In this
activity man observes, describes, and
manipulates a world outside himself. In
human ecology the fundamental and im-
mutable difference is that man deals
actively not only with the product of his
consciousness, culture, but also with the
very nature of that consciousness, its
epistemology, its subconscious motiva-
tions, and its morality.
In public health, as in all science, the
idea of amorality is a myth. This is a
lesson of human ecology. If this could
not be recognized in the past, the ques-
tion has been settled forever since
Hiroshima and Nagasaki. What more
profound problem in public health could
747
man have visited upon himself than in
the intensification and exacerbation of
the technical means underlying that su-
preme problem of human health-war?
It has become impossible for science
to claim objectivity in human matters.
Human ecology and public health can-
not be either objective or amoral but
must accept the concept of change as a
sacred morality. The consequences of
this view are not only the acceptance of,
but the built-in need for, directed
change as an organic factor in the
"system." Applying this temper to the
field of human disease, I suggest that
the practice of public health must
square with the precept in science that
creative research holds within itself the
future obsolescence of the products of
its own creativity. Max Weber has put
it this way: "Every scientific 'fulfill-
ment' raises new 'questions'; it asks
to be surpassed and outdated."3'
Sociology and anthropology are en-
gaged in the study of man, his cultures,
and his societies as they exist and as
they have existed in history and pre-
history. The idea of human ecology, on
the other hand, is only a semantic sub-
stitute for sociology and anthropology
unless it brings some new and significant
element into man's search for an under-
standing of himself. This element, as
I have already suggested above, is the
conception of human ecology as action-
oriented. This implies the difference be-
tween a study of "what is" or "what has
been" and an examination of "what can
be." More than that, due to the totality of
its view, human ecology becomes an ac-
tivity of man to transform the idea of
"what can be" into the reality of a quali-
tatively new "what is." Thus human
ecology becomes the theory and practice
of sociologic and anthropologic engineer-
ing. It becomes the self-cognizance of
the social sciences, their conscience, and
their ethos. To all areas of human
thought it brings the necessity for ac-
tion as a consequence of ecologic con-
sciousness.
748
The above formulations imply nothing
more nor less than the real objective of
public health, the goal of preventing
destructive maladjustments to the bio-
physical and the man-made environ-
ment. In this morality human ecology
and public health interpenetrate and are
transformed to function as any scientific
discipline, that is, to extend and deepen
practice by increasing its effectiveness
in terms of its own peculiar struggle with
the forces of nature and with the process
of social development that has been
superimposed upon nature. Setting aside
the impact of individual problems, of
segments of theory, of separate princi-
ples, of isolated examples of practice,
I want to emphasize that we are dealing
basically with systems as a totality, of
practical action appropriate to that to-
tality, representing an unending, un-
compromising, and self-conscious con-
frontation with the biologic, sociologic,
and psychologic complexities of human
life. This can be a most fruitful concept
for human ecology and public health, a
view that begins with the uniqueness of
man and his purposeful social Lamarck-
ism as distinguished from the Darwinian
ecology of nonhuman life.2
Those who advocate the view that
human freedom has a biological basis
present persuasive arguments in its fa-
vor.33 If this precept be correct, I would
suggest that the next step in evolution
will result from man's self-conscious
activity striving for a human basis of
freedom from biology. Whether or not
such a goal is attainable is of small conse-
quence. The importance of the idea is
that in the course of struggle toward
such a vision man will transform both
the material world and himself in the
process. History already demonstrates
impressive evidence for these trans-
formations. The essence of the idea is
illustrated in the remarks of Dr. Al-
bert Starr commenting on the highly
successful Edwards-Starr artificial heart
valve now being used by surgeons in
many countries. He said: "Our job is
VOL. 57, NO. 5, A.J.P.H.

not to design a valve identical to na-
ture's, not to see how close we can
come to duplicating a natural phe-
nomenon, but to overcome the clinical
problem of the diseased heart valve."34
In the future, I believe that the na-
ture of the transformation will be one
of greater humanity, of a human ecol-
ogy that finally becomes irrevocably
divorced from animal ecology. In that
sort of milieu the design and practice
of public health will be characterized
by a humanistic planning for the eradi-
cation of health problems and the transi-
tion to an almost exclusive preoccupa-
tion with the problems of conscious-
ness, of unexpressed reality, of mental
and emotional health in terms of both
the individual and the community. In
this context, as Julian Huxley put it, "the
highest and most sacred duty of man
is seen as the proper utilization of the
untapped resources of human beings."35
This I consider to be a prime objective
of human ecology and public health.
Human ecology is the science of con-
ceptualizing biological systems (human
beings) operating primarily within an
extra-biological world of their own crea-
tion (society, culture, historical aware-
ness). Thus human ecology is the sci-
ence of man-made systems, their herita-
bility and mutability, and their relation
to the biophysical environment. Human
ecology is partly biology and in part
sociology and anthropology. But beyond
these, it has its own peculiar jurisdic-
tion, its own unique character. This is
its transcendent nature which projects
it beyond the biologic and cultural en-
vironments and, while including these
factors, it functions on a higher action-
oriented level with the conscious pur-
pose of changing the human condition
toward desirable goals. Thus ultimately,
human ecology is the theory and prac-
tice of human freedom. Within this
purview, I see public health as a system
of principles for action, a guide to
planned activity that seeks to negate
MAY, 1967
HUMAN ECOLOGY AND PUBLIC HEALTH
those factors of dis-ease that tend to in-
hibit the intelligent, conscious, and pur-
poseful struggle of humanity toward a
state of personal and social freedom.
REFERENCES
1. Bates, M. In: Medicine and Anthropology. I. Gald-
ston (ed.). New York, N. Y.: International Univer-
sities Press, 1959, p. 56.
2. Audy, J. R., and Wolff, R. J. In: Symposium,
Division of Public Health and Medical Sciences,
Tenth Pacific Science Congress, Honolulu, 1961,
6 pp. mimeo.
3. Gordon, J. E. In: Proceedings of the Conference on
Genetic Polymorphisms and Geographic Variations
in Disease. B. S. Blumberg (ed.). Washington, D. C.:
Gov. Ptg. Office, 1960, p. 67.
4. Brewer, R. Occasional Papers. C. C. Adams Center for
Ecologic Studies, No. 1, 1960.
5. Odum, E. P. Fundamentals of Ecology. (2nd ed.).
Philadelphia, Pa.: Saunders, 1959.
6. Malthus, T. R. An Essay on Population. New York:
Dutton, Everyman's Library (2 vols.), 1914, first
published in 1798.
7. Rogers, E. S. Human Ecology and Health. New York:
Macmillan, 1960.
8. Rosen, G. In: Handbook of Medical Sociology. H.
E. Freeman; S. Levine; and L. G. Reeder (eds.).
New York: Prentice Hall, 1963, p. 17.
9. May, J. M. The Ecology of Human Disease. New
York: MD Publications, 1958. J. M. May (ed.).
Studies in Disease Ecology. New York: Hafner, 1961.
10. Rosen, G. Human Health, Community Life, and the
Rediscovery of the Environment. A.J.P.H. 54:1
(Suppl.), 1964.
11. Park, R. E. Am. J. Soc. 42,1, 1915.
12. Montagu, A. On Being Human. New York: Henry
Schuman, 1950.
13. Untermeyer, L. The Concise Treasury of Great
Poems (Permabooks Edition). New York: Doubleday,
1958, p. 98.
14. Gordon, J. E. Am. J. M. Sc. 235:337, 1958.
15. The arguments of the Organicists can be found in
Gumplowicz, L. The Outlines of Sociology. Tr. by
F. W. Moore. Philadelphia: American Academy of
Political and Social Science, 1899. See also the
following: Blum, H. F. Am. Scientist 51:32, 1963;
Hofstadter, R. Social Darwinism in American
Thought, 1860-1915. Philadelphia: University of Penn-
sylvania Press, 1945; Kartman, L. Sc. Monthly 62:
337, 1948; Kartman, L. Am. Scientist 44:296, 1956.
16. Katz, D. Animals and Men: Studies in Comparative
Psychology. London: Penguin Books, 1953.
17. Calhoun, J. B. The Ecology and Sociology of the
Norway Rat. PHS Publ. No. 1008. Washington, D. C.:
Gov. Ptg. Office, 1963.
18. Groves, E. R., and Moore, H. E. An Introduction
to Sociology. New 'York: Longmans, Green, 1940,
pp. 47-64.
19. Francis, T., Jr. Am. J. M. Sc. 237:677, 1959.
20. Bodenheimer, F. S. Animal Ecology To-Day. Dr.
W. Junk, The Hague, Netherlands, 1958, p. 237.
21. Martin, W. J. M. Officer 104:273, 1960.
22. Gordon, J. E. Changing Accents in Community
Disease. A.J.P.H. 53:141, 1963.
23. Koprowski, H. In: Man and His Future. G. Wol-
stenholme (ed.). Boston, Mass.: Little, Brown, 1963,
p. 196.
24. Bloom, S. W. The Doctor and His Patient. New
York: Russell Sage Foundation, 1963, p. 157.
25. From an unpublished address in 1954 by I. Starr to
first year medical students in a study of the soci-
ology of medical education, Columbia University.
Qiioted by Bloom, 24 pp. 157-158.
749
26. Paul, J. R. Clinical Epidemiology. Chicago, Ill.: ology. H. H. Gerth and C. W. Mills (eds.). New
University of Chicago Press, 1958. York: Oxford University Press, 1946, p. 129.
27. Brown, W. J. In: Syphilis and Other Venereal Dis- 32. TIhis distinction between Lamarckian and Darwinian
eases. J. B. Youmans (ed.). Med. Clin. N. America evolution has been pointed out by P. B. Medawar
48,3:573-581, 1964. (The Future of Man, Basic Books, New York, 1960,
28. Fleming, W. L. Ibid., pp. 587-612. pp. 98-99) who suggests that social evolution is
Lamarckian in the sense that the social environment
29. Quoted by Adlai E. Stevenson in an address at the imprints "non-genetical information which we can
Annual Banquet of Planned Parenthood-World Popu- and do pass on."
lation, New York City (Oct.), 1963. See The Popu- 33. Dobzhansky, T. The Biological Basis of Human
lation Crisis and the Use of World Resources. S. Freedom. New York: Columbia University Press,
Mudd (ed.), Vol. 2, World Acad. of Art and Sc. 1956; Gerard, R. W. Philos. Science 9:92, 1942;
(Dr. W. Junk, The Hague, Netherlands, 1964) p. Dubos, R. Am. Scientist 53:4, 1965.
xiii. 34. From an interview reported in Today's Health (Jan.),
30. Anonymous. J. Trop. Med. & Hyg. 66:269, 1963. 1964, pp. 52-53.
31. Weber, M. In: From Max Weber: Essays in Soci. 35. Huxley, J. Quoted by Dobzhansky, ibid.
Dr. Kartman is scientist director, Communicable Disease Center, PHS,
Technology Branch (San Francisco Field Station, 15th and Lake St., Bldg. 18),
San Francisco, Calif. 94118.
This paper was submitted for publication in August, 1966.

Cigarette Contents
Following is a table giving the average tar and nicotine per cigarette in
milligrams:
Tar Nicotine Tar Nicotine
Brand Type* (mg) (mg) Branid Type* (mg) (mg)
Marvel KF 8.3 0.32 Chesterfield R 27.0 1.18
Cascade KMF 9.1 0.34 Lucky Strike R 27.1 1.42
Carlton KF 9.7 0.74 Oasis KMF 27.1 1.38
King Sano KFD 12.0 0.39 Lucky Strike KF 27.3 1.42
Duke KF 12.3 0.46 Chesterfield KF 27.6 1.72
Life KF 13.6 0.97 Raleigh KF 27.8 1.98
True KF 15.8 0.80 Philip Morris R 28.8 1.37
Kent KF 18.8 1.10 Belair KMF 29.7 2.11
Montclair KMF 21.1 1.15 Old Gold R 29.7 1.63
Spring KMF 21.7 1.16 du Maurier KF 30.0 1.96
Galaxy KF 22.1 1.43 Players R 31.0 1.67
Marlboro KF 22.4 1.24 Camels R 31.3 1.69
Winston KF 22.9 1.32 Camels KF 32.4 1.77
Old Gold KF 23.0 1.32 York K 32.4 1.69
Waterford KF 23.0 1.40 Pall Mall K 33.0 1.75
Lark KF 23.1 1.26 Half & Half KF 33.6 1.99
Philip Morris KF 23.2 1.46 Domino K 34.1 1.48
Newport KMF 23.3 1.34 Old Gold K 34.8 1.89
Viceroy KF 23.4 1.68 Masterpiece KF 35.9 2.23
Salem KMF 23.6 1.43 Kool RM 36.3 2.21
Paxton KMF 23.8 1.43 Fatima K 36.7 1.73
Parliament KF 24.0 1.44 Philip Morris K 37.2 2.11
L&M RF 24.9 1.12 Brandon K 38.5 2.35
Benson & Hedges RF 25.0 1.55 Benson & Hedges 100 KF 39.3 2.29
Tempo KF 25.1 1.68 Holiday K 41.1 2.45
Tareyton KF 25.3 1.35 Tareyton K 41.5 1.97
Alpine KMF 26.4 1.52 Pall Mall KF 41.6 2.20
Kool KMF 26.6 1.88 Raleigh K 43.4 2.64
*
K-king (80-100 mm), R-regular (70 mm); F-filter, M-menthol, D-denicotinized.
(This is the material referred to in the editorial which appears on page 730 of this Journal.
The list was published in the New York Times, March 15, 1967.)

750 VOL. 57, NO. 5. A.J.P.H.