Groups with money, knowledge, power, prestige and connections keep their health advantage across changing diseases and treatments, because those resources can be redeployed to whatever the current risk is.
Link and Phelan's 1995 argument explains a pattern that defeats disease-specific accounts: eliminate one mechanism and the gradient reappears through another. When smoking was universal there was no class gradient in it; when the evidence arrived, the advantaged quit first. The resource is general, so intervening on any single intermediate cause moves the gradient sideways rather than closing it.
In practice
- A screening programme offered equally to everyone is taken up unequally, and the gap in outcomes widens as the programme succeeds.
- A new treatment reaches the best-connected patients first, whatever the eligibility criteria say.