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Thank you for highlighting the growing body of evidence that links unemployment, poverty, and inequality to poor health. Those who care about improving population health, however, must do much more.

Emphasizing the connection between economic determinants and poor health is essential, but it is simply the starting point. Merely asserting (without evidence) that lowering unemployment poverty and unemployment will improve health, but then failing to systematically develop the evidence, is an inadequate--indeed, an unacceptable--response.

What is urgently needed is for the government agencies and foundations that fund research into improving public health, and for public health scholars at universities and other academic institutions, to develop and implement a series of carefully controlled experiments, using large-scale experimental and control groups, that test specific interventions for reducing unemployment and poverty on health outcomes.

A number of controlled experiments on reducing poverty and unemployment, such as the New Hope Project in Milwaukee, Wisconsin, have been carried out in recent years. They were not structured, however, to yield extensive evidence about whether the strategies tested for raising earnings and employment levels--in New Hope's case, primarily through offering Transitional Jobs and supplementing earnings--yielded not only reductions in poverty and unemployment (which, in the case of New Hope, was shown to be the case) but also improvements in health.

What governments, foundations, and scholars who care about improving health need to do is put together controlled experiments aimed at reducing poverty and unemployment that specifically capture health outcomes. It's not that complicated to design such experiments. With adequate resources, it's not that hard carry them out.

The question is: Do the people who care about improving health have the will--I would say, the courage--to cross this experimental Rubicon? Or are they going to continue to talk (and talk and talk and talk and talk) about the socio-economic determinants of health, but do nothing credible about figuring out which specific changes in those determinants actually make a specific difference in health outcomes?

I hear the talk loud and clear. So far, however, I'm not seeing anyone in the public health world who's willing to cross the Rubicon.

David should look at the randomized trial of public housing - Moving To Opportunity (MTO) - yes, looking at health outcomes was an afterthought, but it was added......

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