Chiang explains that the spread of the Great Depression from the US to the rest of the world allowed people to recognize that no matter how hard they worked, individuals had difficulty escaping from poverty when social conditions were poor. The situation in healthcare is similar. When individuals in good health are subjected to difficult living circumstances, those circumstances give rise to stresses, risks and accidents that can ruin their health.
江東亮表示，如同貧窮議題，1929 年美國經濟大恐慌蔓延全球後，人們才體悟，當社會環境不好時，個人再怎麼努力，仍舊難逃窮困；健康情況亦然，也許個人健康條件不錯，但當環境不利時，種種生存和生活上的壓力或風險意外，都可能成為拖垮健康的殺手。