Attempts to link disease with "risk factors"  is naive and simplistic.  Besides,
the research that includes systemic and structural
determinants of health, points out that these "risk factors"  themselves are
caused by other factors and are mediated by even more
factors.  The Health Canada web site on population health include a wonderful
set of references that points out the complexity of
health determinants.  It is very convenient for government officials and health
workers to individualize health problems and blame
the victims of government and societal policies as being somehow responsible for
 their own health problems.

The web site
http://www.hc-sc.gc.ca/hppb/phdd/determinants/e_determinants.html#income
provides and introduction to these "made in Canada"  principles of health
promotion.

Also, see  "Social Determinants of Health: The Solid Facts"  at
http://www.who.dk/healthy-cities for the real low down on health determinants.



                         What Makes Canadians Healthy or Unhealthy?

                         This deceptively simple story speaks to the complex set
 of factors or
                         conditions that determine the level of health of every
Canadian.

                         "Why is Jason in the hospital?
                         Because he has a bad infection in his leg.
                         But why does he have an infection?
                         Because he has a cut on his leg and it got infected.
                         But why does he have a cut on his leg?
                         Because he was playing in the junk yard next to his
apartment building and there was some sharp, jagged
                         steel there that he fell on.
                         But why was he playing in a junk yard?
                         Because his neighborhood is kind of run down. A lot of
kids play there and there is no one to supervise them.
                         But why does he live in that neighborhood?
                         Because his parents can't afford a nicer place to live.

                         But why can't his parents afford a nicer place to live?

                         Because his Dad is unemployed and his Mom is sick.
                         But why is his Dad unemployed?
                         Because he doesn't have much education and he can't
find a job.
                         But why ...?"

                         - from Toward a Healthy Future: Second Report on the
Health of Canadians

                         There is a growing body of evidence about what makes
people healthy. The Lalonde Report set the stage in
                         1974, by establishing a framework for the key factors
that seemed to determine health status: lifestyle,
                         environment, human biology and health services. Since
then, much has been learned that supports, and at
                         the same time, refines and expands this basic
framework. In particular, there is mounting evidence that the
                         contribution of medicine and health care is quite
limited, and that spending more on health care will not result
                         in significant further improvements in population
health. On the other hand, there are strong and growing
                         indications that other factors such as living and
working conditions are crucially important for a healthy
                         population.

                         The evidence indicates that the key factors which
influence population health are: income and social status;
                         social support networks; education; employment/ working
 conditions; social environments; physical
                         environments; personal health practices and coping
skills; healthy child development; biology and genetic
                         endowment; health services; gender; and culture.

                         Each of these factors is important in its own right. At
 the same time, the factors are interrelated. For example, a
                         low weight at birth links with problems not just during
 childhood, but also in adulthood. Research shows a
                         strong relationship between income level of the mother
and the baby's birth weight. The effect occurs not just
                         for the most economically disadvantaged group. Mothers
at each step up the income scale have babies with
                         higher birth weights, on average, than those on the
step below. This tells us the problems are not just a result
                         of poor maternal nutrition and poor health practices
associated with poverty, although the most serious
                         problems occur in the lowest income group. It seems
that factors such as coping skills and a sense of control
                         and mastery over life circumstances also come into
play.

                         The following Underlying Premises and Evidence Table
provides an overview of what we know about the ways
                         the determinants influence health.  The source
documents are:

                         Toward a Healthy Future: Second Report on the Health of
 Canadians  and
                         Strategies for Population Health: Investing in the
Health of Canadians.

http://www.hc-sc.gc.ca/hppb/phdd/determinants/e_determinants.html#income