Annals of Health Law
INTERVENING AT THE RIGHT POINT
infectious and noncommunicable diseases (“NCDs”).61 This is Link and
Phelan’s first criterion: the fact that SES is strongly correlated with myriad
diseases suggests that it is a fundamental cause of disease. The second
characteristic of a fundamental cause, that it contextualizes multiple risk
factors, is also not difficult to grasp in the case of SES. Low SES is not
simply a determinant of risky sexual behavior. It also substantially
determines an array of other known risk factors for disease, including but
not limited to, poor and dangerous housing,62 low educational attainment,63
smoking,64 and poor nutrition,65 as well as exposures to environmental66 and
occupational hazards,67 violence,68 and racism and discrimination69 (each of
61. See generally, WHO CSDH, Final Report, supra note 23; WHO GLOBAL HEALTH
OBSERVATORY, WORLD HEALTH STATISTICS 2012, 127-28, (2012) http://www.who.int/
gho/publications/world_health_statistics/2012/en/ index.html (last visited January 5, 2013).
62. See generally, WHO CSDH, Final Report, supra note 23, at 60-71; James Krieger
& Donna L. Higgins, Housing and Health: Time Again for Public Health Action, 92(5) AM.
J. PUB. HEALTH 758, 758-60 (2002). For this note and notes 52-58 infra, it is important to
note that the literature documenting connections between the mentioned variable and SES
are immense and complex. For each of them, the few citations are merely illustrative, and
serve to substantiate the general point that, whatever the complexity of the evidence base,
robust correlations between SES and health are well-settled.
63. See Nikki L. Aikens & Oscar Barbarin, Socioeconomic Differences in Reading
Trajectories: The Contribution of Family, Neighborhood, and School Contexts, 100(2) J. ED.
PSYC. 235 (2008); M. David Low et al., Can Education Policy Be Health Policy?
Implications of Research on the Social Determinants of Health, 30(6) J. HEALTH POL., POL’Y
AND L. 1131 (2005); Amy J. Orr, Black-White Differences in Achievement: The Importance
of Wealth, 76 SOC. OF EDUC. 281 (2003).
64. See supra notes 30-31 & accompanying text.
65. See WHO CSDH, Final Report, supra note 23, at 49-55; see also Lindsay McLaren,
Socioeconomic Status and Obesity, 29 EPI. REV. 29 (2007).
66. See generally Marco Martuzzi et al., Inequalities, Inequities, Environmental Justice
in Waste Management and Health, 20(1) EUR. J. PUB. HEALTH 21 (2010); Martina Kohlhuber
et al., Social Inequality in Perceived Environmental Exposures in Relation to Housing
Conditions in Germany, 101(2) ENVTL. RES. 246 (2006).
67. See, generally, WHO CSDH, Final Report, supra note 23, at 60-83; see also M.G.
Marmot et al., Employment Grade and Coronary Heart Disease in British Civil Servants,
32(4) J. EPI. & CMTY. HEALTH 244 (1978). This paper constitutes the first report of the
results of the Whitehall I Study, which, along with its subsequent counterpart, Whitehall II,
constitutes one of the most significant epidemiological studies of the last half-century. See
Daniel S. Goldberg, In Support of a Broad Model of Public Health: Disparities, Social
Epidemiology, and Public Health Causation, 2(1) PUB. HEALTH ETHICS 70 (2009); Gopal
Sreenivasan, Health Care and Equality of Opportunity, 37(2) HASTINGS CTR. REP. 21 (2007)
(discussing the importance of the Whitehall studies).
68. See generally Mikko Aaltonen et al., Socio-Economic Status and Criminality as
Predictors of Male Violence: Does Victim’s Gender or Place of Occurrence Matter? 52(6)
BRIT. J. CRIMINOLOGY 1192 (2012); Michael A. Koenig et al., Individual and Contextual
Determinants of Domestic Violence in North India, 96(1) AM. J. PUB. HEALTH 132 (2006).
69. See generally David R. Williams, Race, Socioeconomic Status, and Health The
Added Effects of Racism and Discrimination, 896(1) ANNALS N.Y. ACAD. SCI. 173 (1999);
Saffron Karlsen and James Y. Nazroo, Relation Between Racial Discrimination, Social