Disease ecology and a reformist alternative: The case of infant mortality

This paper attempts to shed some light on the recent debate between those who advocate a reformed medical geography and those who respond that reform is not necessary. We show that disease ecology and a reformist alternative display certain tendencies in the ways in which they address issues of health and disease. We use the example of geographic variations in infant mortality rates to show how two non-positivist perspectives from social theory, political economy and humanism, support a reformist viewpoint, while also acknowledging the value of a complementary disease ecology approach. Two concepts, the social construction of health and illness and social relevance, are used to portray the political economy approach; humanism is described in terms of the meaning of individual experience and the importance of place. The paper concludes with a discussion of the respective roles of disease ecology and a reformist approach in models of infant mortality and a summary of the main differences between the two perspectives. Copyright (C) 1997 Elsevier Science Ltd