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The first longitudinal study linking smoking status, social class and survival has been published online in the BMJ. The data have, in my view, profound implications for policy makers who claim that long term health inequalities can be reduced by addressing 'downstream' / proximal health determinants and/or disease outcomes. I am circulating details of the article and my BMJ rapid response in the hope of generating debate on this important issue. Gruer L, Hart CL, Gordon DS, Watt GCM. Effect of tobacco smoking on survival of men and women by social position: a 28 year cohort study. BMJ 2009;338:b480 doi:10.1136/bmj.b480 Available online at: http://www.bmj.com/cgi/content/full/338/feb17_2/b480 Scott-Samuel A. What the Renfrew / Paisley data really tell us about tackling health inequalities: the need to refocus upstream. Available online at: http://www.bmj.com/cgi/eletters/338/feb17_2/b480 **************************************************************************** Dr Alex Scott-Samuel EQUAL (Equity in Health Research and Development Unit) Division of Public Health University of Liverpool Whelan Building Quadrangle Liverpool L69 3GB UK Tel (+44)151-794-5569 Fax (+44)151-794-5588 http://pcwww.liv.ac.uk/~alexss e-mail [log in to unmask] ****************************************************************************