A "PERFECT STORM" OCCURS WHEN A CONFLUENCE OF many factors or events-no one of which alone is particularly devastating-creates a catastrophic force. Such confluence is rare and devastating. Over time and through disconnected events, US health care has evolved into a "perfect storm" that drives overutilization and increases the cost of health care.
Income, education, occupation, age, sex, marital status, and ethnicity are all correlated with health in one context or another. This paper reflects on the difficulties encountered in deriving robust scientific conclusions from these correlations or drawing reliable policy applications. Interactions among the variables, nonlinearities, casual inference, and possible mechanisms of action are discussed. Strategies for future work are suggested, and researchers are urged to pay special attention to possible interactions among health, genes, and socio-economic variables.
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