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To the Editor: In his Commentary, it is encouraging to see Dr Marmot¹ move from redescribing the correlation between poverty and ill health to focus on the mediating causal mechanisms linking social factors to health outcomes. However, the tendency of such models to place primacy on the causal role of a single mechanism is brought into question by research and other disciplines.

Regarding the purportedly central role of "social status," there is limited evidence that materially deprived populations see themselves as "inferior," "lower status," or are even conscious of health inequalities.² More recent evidence suggests that it is predominantly low-income people who perceive social hierarchies and even then, not as a central construct, but alongside community breakdown, anger, and alienation related to circumstances.³

The failure of economics to develop successful predictive models is testimony to the danger of oversimplifying complex open systems in search of a small number of pivotal . . . [Full Text of this Article]

Alexander M. Clark, PhD, BA(Hons)
Alex.Clark@ualberta.ca

Sue L. Lissel, MA
University of Alberta
Edmonton

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