Tough, in his article on the link between childhood trauma and poor adult health, makes an admirable case for why doctors should be concerned with social problems. However, he fails to take the field of public health to task for cultivating the impression that its sole objectives are immunizations and access to primary care. As researchers clarify the causal connections between inequality and health, public-health professionals must use their expertise to address the political needs of the poor and underserved by promoting tax structures and social policies that will improve population health. The medical community’s political voice has thus far been muted on these issues. The conclusion that poverty is stressful is hardly news. But doctors pushing policymakers to take responsibility for the very real biological effects of inequitable policies would be.

Sarah Wylie

University of Washington

School of Public Health

Seattle, Wash.


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