In the past couple of years the work of an epidemiologist Richard Wilkinson, based at the University of Nottingham Medical School, has made a huge contribution to our understanding of well-being and, in the process, blown a hole in the rationale for a great deal of UK economic, health and social policy.
The nub of Wilkinson’s argument is that pronounced income inequality in a society leads to health inequalities as well as a raft of health and social problems such as teenage pregnancy, violence and poor educational attainment. He shows that the UK is more unequal than many other western societies and argues that this is why we have such mounting social problems. So if we are interested in flourishing lives we have to pay attention to equality issues.
Wilkinson set out his argument in 2005 in a book entitled The Impact of Inequality: How to make sick societies healthier. He then co-authored The Spirit Level: Why more equal societies almost always do better with Kate Pickett which was published in 2009. In the following summary of this inequality thesis at points we simply refer to Wilkinson and at others to Wilkinson and Picket.
The basic argument
Wilkinson argues that although class differences appear to be disappearing in contemporary societies, as is ‘absolute material want’, poor people have, on average, lower life expectancy than their richer neighbours. He also argues that social problems and various aspects of unhappiness are also much more common in the poorest areas. This does not mean to say that affluence or low income necessarily lead to specific health outcomes. If you look at American states, for example, there is little or no relation between longevity and income. What matters, Wilkinson argues, is not so much the amount of money we have but our ‘socioeconomic status’. In other words, it is not spending power as such which matters but what Wilkinson calls ‘psychosocial factors’. This term is used to mean the social patterning of psychological responses.
In The Spirit Level Wilkinson and Pickett base their analysis on data from 23 rich countries as well as data from the 50 American states. They say that in the main this shows that the following problems are much more pronounced in countries with higher levels of income inequality.
Health inequalities: At the end of the 1990s there was an average gap of 7.3 years in mortality between rich and poor people in unequal societies. This can rise to as much as 28 years in some American states. They argue that research shows these differences cannot simply be explained by differences in health behaviours.
Mental illness: They argue that ‘inequality is causally related to mental illness’; that rates of mental illness are five times higher in the most unequal societies compared to the least unequal. Illegal drug taking is also higher.
Obesity: Unequal societies are more likely to have higher levels of obesity, with poor people most at risk, partly because of the attractions of ‘comfort eating’. Indeed the rate of obesity is six times higher in the most unequal, compared to the least unequal, societies.
Divorce rates: There have been larger rises in more unequal societies. This then creates more stress for children.
Teenage pregnancy: This is more prevalent in unequal societies. Indeed in the USA the rate of teenage pregnancy is four times the EU average.
Violence: Wilkinson and Pickett argue that the strongest evidence or the negative effects of inequality is violence figures. The reasons for this are explored below.
Imprisonment: Unequal societies are more punitive. People are five times more likely to be imprisoned in the most unequal societies than the least unequal.
Social mobility: Inequality leads to less social mobility. Inequality ‘solidifies the social structure’ and also depresses educational attainment for the poor.
Women’s position: In general women are less likely to be in higher status jobs in unequal societies and they also have worse health than women in more equal societies.
Wilkinson and Pickett argue that the problem of inequality is not just for poor people: everyone suffers. The life expectancy figures even for rich people is lower in unequal societies than more equal ones. The reason they advance for this is that unequal societies have lower levels of trust than more equal societies. This lack of trust leads to more hostility, fear and lower levels of community participation. In this way everyone suffers.
In the data they present the societies which are most unequal, and have the biggest health inequalities and social problems, are the USA, the UK, Portugal, Australia and New Zealand. The least unequal are the Scandinavian countries and Japan.
But why should equality have such profound effects on individuals and societies? This is the topic of the next section.
'The Impact of Inequality: How to make sick societies healthier', Wilkinson, R. G., 2005, New Press.