Inequality: the enemy between us?
Richard Wilkinson
Emeritus Professor of Social Epidemiology
Photo by kind permission of Matt Stuart
3
Income per head and life-expectancy: rich & poor countries
4
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
Life expectancy is strongly related to
income within rich countries
80
Life expectancy (years)
79
78
77
76
75
74
73
72
71
70
Richest
Poorest
Local Neighbourhoods
(in England & Wales)
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
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
UK
Po
r tu
ga
l
US
A
Sin
ga
po
re
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
www.equalitytrust.org.uk
The more strongly a death rate is related to
income, the more strongly it is affected by
inequality.
Wilkinson RG, Pickett KE. Income inequality and social gradients in
mortality. American Journal of Public Health 2008; 98(4): 699-704.
Social Gradients
•
•
•
•
•
•
•
•
•
Life expectancy
Math & Literacy
Infant mortality
Homicides
Imprisonment
Teenage births
Trust
Obesity
Mental illness – incl. drug &
alcohol addiction
• Social mobility
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
17
Source: Wilkinson & Pickett, The Spirit Level (2009)
www.equalitytrust.org.uk
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.
Imprisonment rates are higher in
more unequal countries
Wilkinson & Pickett, The Spirit Level
www.equalitytrust.org.uk
Teenage Birth Rates are Higher in More Unequal Rich Countries
20
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
Correlations: different measures and settings
Indicator
International
UN 20:20
OECD Gini
US 50 States
Census 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
Child wellbeing is better in more equal US states
Higher average income makes little difference
Three Propositions
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
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
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
Infant deaths per 1000
15
England & Wales
Sweden
10
5
0
Single
mothers
Low
Father's occupational class
High
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.
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)
28
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
600
United States
United Kingdom
Canada
Australia
Sweden
Age adjusted death rates
550
New Orleans
Glasgow
500
New York
London
450
400
350
300
Sydney
Melbourne
Toronto
250
200
150
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
Source: Ross N, Dorling D, et al. Metropolitan income inequality and working age
mortality. Journal of Urban Health 2005; 82(1): 101-110.
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 connections
 Stress in early life (pre- and postnatally)
33
Plasma fibrinogen by employment grade
among Civil Servants, Whitehall II.
(Adjusted for age, ethnic origin and women’s menopausal status)
Brunner E, Davey Smith G, Marmot M, et al. Lancet 1996; 347: 1008-1013
Friendship is at least as important for health
as smoking and drinking
Holt-Lundstad et al, PLoS Medicine 2010;7:e1---316
Stephen Suomi
Director of the Laboratory of Comparative Ethology, US
National Institute of Child Health and Human Development
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.
In more unequal countries people abandon modesty
and exaggerate their merits
Loughnan S, et al. Economic Inequality is linked to biased self-perception.
Psychological Science, 2011; 22: 1254
Effect of stereotype threat
Advanced Progressive Matrices Test: high & low SES
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.
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
40
The effects of inequality - a two stage process
1.
adult experience of inequality
2.
passed on to children – epigenetics?
Single parents and child wellbeing
Sweden
Better
Netherlands
Finland
Norway
Denmark
Spain
Italy
Greece
Belgium
Ireland
Portugal
Canada
Germany
Austria
France
Japan
Australia
USA
Israel
New Zealand
UK
Worse
0
10
20
Lone parents as % of all households with dependent children
30
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
For more information:
… a book
and a
website…
http://www.equalitytrust.org.uk
44
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.
Average social group size
The Social Brain: the neocortex is a larger proportion of the
brain in primate species with larger social groups
Neocortex ratio
Dunbar R. Brains on two legs: group size and the
evolution of intelligence In: Tree of Origin: F de
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?