Following the collapse of the Cuban economy in the early 1990s, epidemiologists in the Cuban Ministry of Health noticed dramatic increases in reported outbreaks of ciguatera fish poisoning (CFP) in some coastal communities. This article summarizes the results of a comparative case study which applied an ecosystem approach to human health to investigate this issue. Situated learning and complexity theories were used to interpret the results of the investigation. CFP outbreaks are influenced by a complex set of interactions between ecological and socioeconomic processes. This study found that the level of organization of the local sports fishing community and the degree of degradation of the local nearshore marine ecosystem appear to be key factors influencing the diverging levels of CFP outbreaks recorded in the 1990s in the communities studied.