Dennis Raphael in his article 'Cause & Effect' tells us that poor health practices are not just associated with low socioeconomic status but that other factors come into play such as coping skills and a sense of control over life circumstances. Marmot, with his dissertation on the social gradient, did try to explain this gradient by reference to risk factors such as diet, smoking, obesity etc. These factors explain about 25 - 35% of the gradient but the rest is unexplained. However Len Syme, Professor of Epidemiology, University of California, Berkeley, put forward a hypothesis to explain the remainder of the gradient, ie. the ability of individuals to have mastery over their lives. Therefore the less opportunity and training you have, the less ability you have to influence the events that affect your life and the psycho-social factors of being less connected, having less social support and being less resilient consequently impinge on your life and your health. Furthermore if you want people to change their behaviour and develop good health habits, you cannot make proclamations from the top down. People need to be empowered to participate in the events that affect their life. For example Albert Bandura's Social Cognitive Theory, uses the concepts of 'role modeling' to set a high standard and 'self-efficacy' by which he means 'the exercise of control'. If, however, self-efficacy is not a deep personal trait, or if it is only associated with high income groups, perhaps this attitude of self-reliance and autonomy needs to be encouraged, possibly even taught as a means for achieving control over one's life. According to Len Syme, if an important dimension in the social class gradient is this idea of 'control', then it should be taught early in life. Thus if you empower an individual with this knowledge then they should be able to adjust their circumstances, reduce disease risk factors and improve their health.