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Bruce G. Link, PhD and Jo C. Phelan, PhD

The authors are with the Mailman School of Public Health, Columbia University, New York, NY. Bruce G. Link is also with the New York State Psychiatric Institute, New York, NY.

Correspondence: Requests for reprints should be sent to Bruce G. Link, Epidemiology of Mental Health Disorder, 100 Haven Avenue, Apt 310, New York, NY 10032 (e-mail: bgl1{at}columbia.edu.

In an accompanying commentary, Colgrove indicates that McKeown's thesis—that dramatic reductions in mortality over the past 2 centuries were due to improved socioeconomic conditions rather than to medical or public health interventions—has been "overturned" and his theory "discredited."

McKeown sought to explain a very prominent trend in population health and did so with a strong emphasis on the importance of basic social and economic conditions. If Colgrove is right about the McKeown thesis, social epidemiology is left with a gaping hole in its explanatory repertoire and a challenge to a cherished principle about the importance of social factors in health.

We return to the trend McKeown focused upon—post-McKeown and post-Colgrove—to indicate how and why social conditions must continue to be seen as fundamental causes of disease.

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