Photo by kind permission of Matt Stuart Inequality: the enemy between us? Richard Wilkinson Emeritus Professor of Social Epidemiology.

Photo by kind permission of Matt Stuart

Inequality: the enemy between us?

Richard Wilkinson Emeritus Professor of Social Epidemiology

3

4

Income per head and life-expectancy: rich & poor countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level

Life expectancy in rich countries is no longer related to National Income per head

70

71

72

73

74

75

76

77

78

79

80

Local Neighbourhoods(in England & Wales)

Life

exp

ecta

ncy

(yea

rs)

Richest Poorest

Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk

Life expectancy is strongly related to income within rich countries

3.7 3.94.3 4.6 4.8

5.2 5.3 5.6 5.6 5.6 5.76.1 6.2

6.7 6.8 6.87.2

8.5

9.7

4.0

8.0

7.0

3.4

Income gapsHow many times richer are the richest fifth than the poorest fifth?


Inequality...How much richer are the richest 20% in each country than the poorest 20%?

Wilkinson RG, Pickett KE. Income inequality and social gradients in mortality. American Journal of Public Health 2008; 98(4): 699-704.

The more strongly a death rate is related to income, the more strongly it is affected by

inequality.

Social Gradients

• Life expectancy• Math & Literacy • Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness – incl. drug &

alcohol addiction• Social mobility

Wilkinson & Pickett, The Spirit Level

Index of: • Life expectancy• Math & Literacy

• Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness

– incl. drug & alcohol addiction

• Social mobility

www.equalitytrust.org.uk

Health and social problems are worse in more unequal countries

Ind

ex o

f h

ealt

h a

nd

so

cial

pro

ble

ms


Neither health nor social problems are related to national income per head




• Social mobility

Ind

ex o

f h

ealt

h a

nd

so

cial

pro

ble

ms


Child well-being is better in more equal countries


The UNICEF Index of Child Wellbeing is not related to National Income per head


People in more unequal countries trust each other less


People in more unequal states of the USA trust each other less


Mental illness is more common in more unequal societies

17

Infant Mortality Rates are Higher in More Unequal Countries


0

30

60

90

120

150

180

Income Inequality

Ho

mic

ide

s p

er

mill

ion

pe

op

le

Low High

Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Can J Crim 2001; 43: 219-36.

Homicide rates are higher in more unequal

US states and Canadian provinces USA states

Canadian provinces


Imprisonment rates are higher in more unequal countries

20

Teenage Birth Rates are Higher in More Unequal Rich Countries



Social mobility is lower in more unequal countries

Social Relations

• Child conflict• Homicide• Imprisonment• Social capital• Trust

In summary... bigger income gaps lead to deteriorations in:-

Human Capital

• Child wellbeing• High school drop outs• Math & literacy scores• Social mobility• Teenage births

Health

• Drug abuse• Infant mortality• Life expectancy• Mental illness • Obesity

…but not suicide

Indicator International US 50 StatesCensus GiniUN 20:20 OECD Gini

r p r p r p

Child wellbeing -071 <0.01 -0.68 0.01 - -

Trust -0.66 <0.01 -0.66 0.03 -0.70 <0.01

Life expectancy -0.44 0.04 -0.27 0.24 -0.45 <0.01

Infant mortality 0.42 0.04 0.54 0.01 0.43 <0.01

Obesity 0.57 <0.01 0.41 0.06 0.47 <0.01

Mental illness 0.73 <0.01 0.32 0.30 0.18 0.12

Education score -0.45 0.04 -0.46 0.05 -0.47 .01

Teen birth rate 0.73 <0.01 0.64 <0.01 0.46 <0.01

Homicides 0.47 0.02 0.44 0.04 0.42 <0.01

Imprisonment 0.75 <0.01 0.51 0.02 0.48 <0.01

Social mobility 0.93 <0.01 0.83 <0.01 - -

Index 0.87 <0.01 0.75 <0.01 0.59 <0.01

Correlations: different measures and settings

Child wellbeing is better in more equal US states Higher average income makes little difference

1. The evidence shows that problems related to social status within societies get worse when social status differences are increased

2. Inequality affects so many outcomes because it increases status differences and so intensifies all the ways in which class and status imprint themselves on us from early childhood onwards

3. The creation of a classless society depends on reducing material differences

Three Propositions

Wilkinson & Pickett, The Spirit Level




• Social mobility

www.equalitytrust.org.uk

Health and social problems are worse in more unequal countries

Ind

ex o

f h

ealt

h a

nd

so

cial

pro

ble

ms

0

5

10

15

Singlemothers

Low HighFather's occupational class

Infa

nt

dea

ths

per

100

0

England & Wales

Sweden

Leon, D. A., D. Vagero, et al. (1992). "Social class differences in infant mortality in Sweden: comparison with England and Wales." Brit Med J 305(6855): 687-91.

The benefits of greater equality are not confined to the poor but extend to all social classes

Infant mortality by class: Sweden compared with England & Wales

28

Literacy Scores of 16-25 year olds by Parents' Education

-1.5

-1

-0.5

0

0.5

1

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Parents' Education (years)

Lit

era

cy

sc

ore

Sweden

Canada

United States

Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

Research: points to remember

• Class hierarchy and size of areas

• Multilevel models and individual income

Income Inequality and Mortality Working age Men in 528 cities in 5 countries

150

200

250

300

350

400

450

500

550

600

0.14 0.15 0.16 0.17 0.18 0.19 0.20 0.21 0.22 0.23 0.24 0.25 0.26 0.27 0.28

Median Share of Income

Ag

e ad

just

ed d

eath

rat

es

United States

United Kingdom

Canada

Australia

Sweden

Source: Ross N, Dorling D, et al. Metropolitan income inequality and working age mortality. Journal of Urban Health 2005; 82(1): 101-110.

New YorkLondon

Toronto

Sydney Melbourne

GlasgowNew Orleans

More inequality

• More superiority and inferiority• More status competition and consumerism

• More status insecurity

• More worry about how we are seen and judged

• More “social evaluation anxiety”(threats to self-esteem & social

status, fear of negative judgements

Valued or Devalued?

33

Psychosocial risk factors for ill health

Low social status

Weak social connections

Stress in early life (pre- and postnatally)

Plasma fibrinogen by employment gradeamong Civil Servants, Whitehall II.

Brunner E, Davey Smith G, Marmot M, et al. Lancet 1996; 347: 1008-1013

(Adjusted for age, ethnic origin and women’s menopausal status)

Holt-Lundstad et al, PLoS Medicine 2010;7:e1---316

Friendship is at least as important for health as smoking and drinking

Stephen Suomi Director of the Laboratory of Comparative Ethology, US

National Institute of Child Health and Human Development

0

0.2

0.4

0.6

0.8

1

Other tasks

Tasks with ‘social evaluative threat’ (uncontrollable)

Co

rtis

ol

resp

on

se (e

ffec

t si

ze)

Dickerson SS, Kemeny ME. Acute stressors and cortisol responses. Psychological Bulletin 2004; 130(3): 355-91.

What kind of stressful tasks raise stress hormones most?

Loughnan S, et al. Economic Inequality is linked to biased self-perception. Psychological Science, 2011; 22: 1254

In more unequal countries people abandon modestyand exaggerate their merits

“Not a test of ability”

5

6

7

8

9

10 High SES

Low SES

“Test of ability”

Effect of stereotype threat Advanced Progressive Matrices Test: high & low SES

Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.

Num

ber o

f ite

ms

corr

ect

40

Gilligan J. Violence: Our Deadly Epidemic and its Causes. (G .P. Putnam 1996)

" ...the prison inmates I work with have told me repeatedly, when I asked them why they had assaulted someone, that it was because 'he disrespected me', or 'he disrespected my visit' (meaning 'visitor'). The word 'disrespect' is central in the vocabulary, moral value system, and psychodynamics of these chronically violent men that they have abbreviated it into the slang term, 'he dis'ed me." p.106

A few pages further on Gilligan continues:- "I have yet to see a serious act of violence that was not provoked by the experience of feeling shamed and humiliated, disrespected and ridiculed, and that did not represent the attempt to prevent or undo this "loss of face " - no matter how severe the punishment, even if it includes death." p.110

The effects of inequality - a two stage process

1. adult experience of inequality

2. passed on to children – epigenetics?

Australia

Austria

Belgium Canada

Denmark

Finland

France

Germany

Greece

Ireland

Israel

Italy

Japan

Netherlands

New Zealand

Norway

Portugal

Spain

Sweden

UK

USA

Worse

Better

UN

ICE

F in

dex

of c

hild

wel

l-bei

ng

0 10 20 30Lone parents as % of all households with dependent children

Single parents and child wellbeing

Trends in income inequality mid-1980s to

mid-2000s

Percentage changes in the Gini coefficient

Source: OECD Factbook 2010: Economic, Environmental and Social Statistics . OECD 2010

Change in Gini

44

http://www.equalitytrust.org.uk

For more information:

… a book

and a website…

Social Status and Friendship

Two sides of the same coin:

Social status (dominance hierarchies, pecking orders) are orderings based on power, coercion and privileged access to resources – regardless of the needs of others.

Friendship, in contrast, is based on reciprocity, mutuality, social obligations, sharing and a recognition of each other’s needs.

Dunbar R. Brains on two legs: group size and the evolution of intelligence In: Tree of Origin: F de

Waal. (ed) 2001.

The Social Brain: the neocortex is a larger proportion of the brain in primate species with larger social groups

Aver

age

soci

al g

roup

siz

e

Neocortex ratio

Photo by kind permission of Matt Stuart

Trends in income inequality 1979-2005/6 (Gini coefficient, Great Britain.)

Brewer M, Goodman A, Muriel A, Sibieta L. Poverty and Inequality in the UK: 2007.

Institute of Fiscal Studies, London.

Three Questions

• Is this just picking and choosing data?

• What about other countries?

• What about causality?

Photo by kind permission of Matt Stuart Inequality: the enemy between us? Richard Wilkinson Emeritus Professor of Social Epidemiology.

Documents

head slide

spirit level index

spirit level life expectancy

spirit level mental

wilkinson rg

pickett ke

spirit level child wellbeing

social problems