 In sum, there is a reasonable case to be made that many health inequalities are caused by a number of socially controllable factors outside of the traditional health care system. Such social determinants of health may include income, occupational rank, education, social status, and racial discrimination. We would caution, however, that more evidence is needed to establish the proposed causal pathways, and that some of the evidence we discuss is contentious. For example, Anne Case and Christina Paxson (2011: F185) argue that much of the gradient Marmot, Bosma, et al. (1997) attribute to job control in Whitehall II can be explained by participants’ early life health and socioeconomic status, suggesting that “occupational grade may be more of a marker of poorer health than a cause of poorer health”.