Social determinants of health and disease: the role of small-scale projects illustrated by the Koster health project in Sweden and Ametra in Peru

two different health projects are evaluated in this paper. the koster health project taking place at the koster islands in sweden and the ametra project going on among the shipibo-conibo in peru. both projects focus more on the determinants of health than on sickness and more on the individual's subjective feeling of illness than on the biomedically "objectively" recognizable disease. "mobilization" and "responsibility"for the individual's own health are central concepts in both projects. in the theoretical part of the paper a human ecological perspective is suggested to analyse the interaction between human health and environmental changes. the author emphasizes the importance of interdisciplinary research when evaluating how the external determinants from the natural and social environment affect human beings and health. the human ecological approach is seen as a complement to the biomedical research. health and disease are two poles in a continuum. in a pluralistic society we should struggle towards the pole of health.