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December 21, 2007


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I'm glad you're keeping track of these studies. I'm reminded of a recent study I saw that said that "inflammation" is a leading (or ultimate?) cause of death. But when pressed, the doctors behind this idea said, well, it's both cause and effect of disease.

Here, Margalit and Wolff's book "Disadvantage" may be of interest. They talk about the clustering of disadvantage. So it may well be very hard to figure out if, say, low SES is causing a) bad health or b) lack of insurance or c) both. . . . and if c), then if a) is largely due to b) or due to some independent force of low SES (say, driving up cortisol levels).

Hey Frank,

All good points, and many of the chapters in Marmot & Wilkinson's Social Determinants of Health (2d ed.) adduce similar points. Some of the sociologists' work on social conditions as fundamental causes of disease may be relevant here (the seminal article is Link & Phelan's 1995 piece, and Lutfey & Freese followed up in the last few years).

I'm actually only currently making my way through this literature. Regardless, I've never objected per se to the claim that lack of access is correlated with poor health. What bothers me is (a) that this relationship is widely taken for granted instead of established by solid evidence; and (b) that there is already excellent evidence that certain social, public health, and primary prevention interventions have a robust relationship with population health. As such, in thinking of the notions of relative priority that policy analysis demands, IMO, there is a case to be made for moving the latter much higher up the scale than it currently is.

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