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To the Editor: By focusing solely on behavioral factors as the underlying cause of deaths, Dr Mokdad and colleagues¹ may have perpetuated the argument that these preventable deaths are the individual's responsibility alone. By contrast, a growing body of research has reported significant relationships between health and a variety of social determinants, including income, race, ethnicity, sex, and occupation.^2-3 The relationship between health and these social determinants may not operate exclusively through differences in the prevalence of behavioral risk factors.⁴

For instance, people living in households with incomes of at least $25 000 live 3 to 7 years longer than those living in households with incomes of $10 000 or less.² Furthermore, poverty is a significant risk factor for obesity.⁵ Paying more attention to social determinants of health does not obviate efforts to address behavioral risk factors but, instead, places some of the responsibility for improving the population's health on the efforts . . . [Full Text of this Article]

M. Nawal Lutfiyya, PhD
lutfiyya@uic.edu

Eric Henley, MD, MPH
Department of Family and Community Medicine
University of Illinois-Chicago, College of Medicine at Rockford

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