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In Reply: Dr Clark and Ms Lissel caution against arguing for a single mechanism in understanding the link between poverty and ill health. I agree. First, as my Commentary points out, we are not trying simply to understand why people in poverty are in poor health, but why health follows a social gradient through the whole of society. Any appeal to a single mechanism of poverty will not do justice to the evidence.

Second, I do not argue for the primacy of "social status" as if it were one single mechanism. I state that relative differences in status translate into absolute differences in life chances. In considering these life chances, we need to focus on the circumstances in which people live and work.

Clark and Lissel's argument for complexity and for considering "influential causal mechanisms [that] defy quantification" could be taken as a counsel of despair for the researcher and . . . [Full Text of this Article]

Michael Marmot, MBBS, MPH, PhD, FRCP, FFPHM
m.marmot@ucl.ac.uk
Department of Epidemiology and Public Health
University College London
London, England

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