Perhaps the most significant limitation of the study is one that has been felt acutely by community leadership. At what point on the spectrum is it best to intervene, and what tools are available and most effective? Many efforts have focused on managing the health consequences of social and environmental stressors through screening and treatment of disease. Other programs have been designed to influence health behaviors and choices that are proximate risk factors for disease. Less has been done to strengthen social supports and social networks [41] or to create buffers or support resiliency, although some early childhood interventions hold promise [42]. If we continue to focus on modifying the ‘‘surface causes’’ [43] of poor health, and fail to address neighborhood conditions and underlying social inequities, we should not be surprised at the persistence of health disparities in poor communities.