Social Dysfunction:
why inequality matters
Richard Wilkinson
Emeritus Professor of Social Epidemiology
Photo by kind permission of Matt Stuart
2
Income per head and life-expectancy: rich & poor countries
3
Source: Wilkinson & Pickett, The Spirit Level (2009)
www.equalitytrust.org.uk
Life expectancy in rich countries is
no longer related to National Income per head
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Mortality is related to income differences within societies
Poor
Rich
Median income of Zip code areas
MRFIT data from Davey Smith et al. AJPH 1996
5
Inequality...
How much richer are the richest 20% in
each country than the poorest 20%?
Income gaps
How many times richer
are the richest fifth than
the poorest fifth?
9.7
8.0
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
po
re
Sin
ga
ga
l
US
A
Po
r tu
UK
7.2
6.7 6.8 6.8 7.0
It a
ly
Isr
Ne
ae
l
w
Ze
ala
nd
Au
st r
ali
a
6.1 6.2
d
No
rw
ay
Sw
ed
en
De
nm
ar k
Be
l gi
um
Au
st r
ia
Ge
rm
an
Ne
y
t he
r la
nd
s
Sp
ai n
Fra
nc
e
Ca
na
da
Sw
i zt
erl
an
d
Ir e
lan
d
Gr
ee
ce
lan
Fin
Ja
pa
n
4.6 4.8
4.3
3.9 4.0
3.7
3.4
5.6 5.6 5.6 5.7
5.2 5.3
8.5
Index of:
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness
– incl. drug &
alcohol
addiction
• Social mobility
Index of health and social problems
Health and social problems are worse
in more unequal countries
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Index of:
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness
– incl. drug &
alcohol
addiction
• Social mobility
Index of health and social problems
Neither health nor social problems are
related to national income per head
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Child well-being is better in more equal countries
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
The UNICEF Index of Child Wellbeing is not
related to National Income per head
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
People in more unequal countries
trust each other less
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
People in more unequal states of
the USA trust each other less
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Mental illness is more common in
more unequal societies
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Infant Mortality Rates are Higher in More Unequal Countries
15
Source: Wilkinson & Pickett, The Spirit Level (2009)
www.equalitytrust.org.uk
Male mortality (25-64 yrs) and income inequality in US
states and Canadian provinces.
Source: Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA,
Lynch JW. British Medical Journal 2000;320:898-902
Homicide rates are higher in more unequal
US states and Canadian provinces
180
USA states
Canadian provinces
Homicides per million people
150
120
90
60
30
0
Low
Income Inequality
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.
Teenage Birth Rates are Higher in More Unequal Rich Countries
18
Source: Wilkinson & Pickett, The Spirit Level (2009)
www.equalitytrust.org.uk
Imprisonment rates are higher in
more unequal countries
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
More children drop out of High School
in more unequal US states
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Educational Scores are Higher in More Equal Rich
Countries
Source: Wilkinson & Pickett, The Spirit Level (2009)
www.equalitytrust.org.uk
Social mobility is lower in more unequal countries
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
In summary... bigger income gaps lead
to deteriorations in:Health
Social Relations
•
•
•
•
•
Child conflict
Homicide
Imprisonment
Social capital
Trust
...but not
suicide...
•
•
•
•
•
Drug abuse
Infant mortality
Life expectancy
Mental illness
Obesity
Human Capital
•
•
•
•
•
Child wellbeing
High school drop outs
Math & literacy scores
Social mobility
Teenage births
Death rates are lower in more equal States
for both richer and poorer Americans
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Self-reported prevalence of illness by education
50 %
40
England USA
30
20
10
0
England
Low
High
Diabetes
Low
High
Hypertension
Low
High
Cancer
Low
High
Lung disease
Source: Banks et al. JAMA 2006; 295:
2037-2045
Low
High
Heart disease
Literacy Scores of 16-25 year olds by
Parents' Education
1
0.5
Literacy score
Sweden
0
Canada
-0.5
-1
United States
-1.5
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Parents' Education (years)
26
Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.
Index of:
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness
– incl. drug &
alcohol
addiction
• Social mobility
Index of health and social problems
Health and social problems are worse
in more unequal countries
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Valued or
Devalued?
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
Psychosocial risk factors for ill health
 Low social status
 Weak social affiliations
 Stress in early life (pre- and postnatally)
29
Cortisol response (effect size)
What kind of stressful tasks raise
stress hormones most?
1
0.8
0.6
0.4
0.2
0
Tasks with ‘social
evaluative threat’
(uncontrollable)
Other
tasks
Dickerson SS, Kemeny ME. Acute stressors and cortisol
responses. Psychological Bulletin 2004; 130(3): 355-91.
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
31
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.
Stereotype threat. High & low socioeconomic status
groups given ‘Advanced Progressive Matrices’ test
Number of items correct
10
High SES
Low SES
9
8
7
6
5
“Not a test of ability”
“Test of ability”
Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.
Richest 10%, Income Percentage
Data from: Piketty & Saez
For more information:
a book …
… and a
website
http://www.equalitytrust.org.uk
35