Current medical definitions of health and disease are inadequate for an understanding of public health problems. The narrowest attribute causa tion to agents of disease (e.g., germ theory); the widest (e.g., medical ecology) take into account some social factors like behavior and culture. All focus on the individual rather than the collectivity. The evidence reviewed in this article, drawn mainly from England during the industrial revolution and the rise of capi talism, suggests that changes in health status are related to class struggle and to the international division of labor. An historical approach is adopted to expalin how health and disease came to be defined medically and why politics and economics were rejected as irrelevant to medicine. The holistic perspective of Marxism, which permits analysis of the dynamic interaction of public health, social organization, and the mode of production, is offered as the basis for a socialist alternative.
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