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

3 Income per head and life-expectancy: rich & poor countries Source: Wilkinson & Pickett, The Spirit Level (2009)

Wilkinson & Pickett, The Spirit Level Life expectancy in rich countries is no longer related to National Income per head

Richest Poorest Wilkinson & Pickett, The Spirit Level Life expectancy is strongly related to income within rich countries

Income gaps How many times richer are the richest fifth than the poorest fifth? Wilkinson & Pickett, The Spirit Level Inequality... How much richer are the richest 20% in each country than the poorest 20%?

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Outcomes with 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 Health and social problems are worse in more unequal countries Index of health and social problems

Wilkinson & Pickett, The Spirit Level Neither health nor social problems are related to national income per head 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

Wilkinson & Pickett, The Spirit Level Child well-being is better in more equal countries

Wilkinson & Pickett, The Spirit Level The UNICEF Index of Child Wellbeing is not related to National Income per head

Wilkinson & Pickett, The Spirit Level People in more unequal countries trust each other less

Wilkinson & Pickett, The Spirit Level People in more unequal states of the USA trust each other less

Wilkinson & Pickett, The Spirit Level Mental illness is more common in more unequal societies

16 Infant Mortality Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009)

Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Can J Crim 2001; 43: Homicide rates are higher in more unequal US states and Canadian provinces USA states Canadian provinces

Wilkinson & Pickett, The Spirit Level Imprisonment rates are higher in more unequal countries

19 Teenage Birth Rates are Higher in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009)

Income inequality & bullying in 37 countries Elgar FJ, Craig W, Boyce W, Morgan A, Vella-Zarb R. Income Inequality and School Bullying: Multilevel Study of Adolescents in 37 Countries. J. Adolescent Health 2009; 45(4):

Wilkinson & Pickett, The Spirit Level Social mobility is lower in more unequal countries

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 Health and social problems are worse in more unequal countries Index of health and social problems

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): 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

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

Income differences increase social class differentiation Bigger income differences make:- Class more important The social pyramid higher and more hierarchical The quality of social relations deteriorates

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?

28 Psychosocial risk factors for ill health  Low social status  Weak social connections  Stress in early life (pre- and postnatally)

Other tasks Tasks with ‘social evaluative threat’ (uncontrollable) Cortisol response (effect size) Dickerson SS, Kemeny ME. Acute stressors and cortisol responses. Psychological Bulletin 2004; 130(3): What kind of stressful tasks raise stress hormones most?

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.

“Not a test of ability”“Test of ability” Effect of stereotype threat on IQ test performance high & low SES Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): Number of items correct

Loughnan S, et al. Economic Inequality is linked to biased self-perception. Psychological Science, 2011; 22: 1254 In more unequal countries people abandon modesty and emphasise their achievments

33 The effects of inequality - a two stage process 1.adult experience of inequality 2.passed on to children – epigenetics?

Trends in income inequality /6 (Gini coefficient, Great Britain.) Brewer M, Goodman A, Muriel A, Sibieta L. Poverty and Inequality in the UK: Institute of Fiscal Studies, London.

What can be done? Taxes & benefits Stop tax avoidance End tax havens Make taxation progressive again Income differences before tax Increase company democracy - employee ownership etc Promote more directors from within companies Sustainability needs greater equality

Islington Fairness Commission Commissioners included 9 Councillors (all parties), Council CEO, Chief Execs of Islington NHS, local Chamber of Commerce and Trades Council, Police chief, 3 academics, 2 from charitable sector. (MPs attended as observers). Ran for one year Seven themed public meetings around the borough (500+ attendees) Testimony from residents and experts Written submissions from the public (100+) Satellite activities: problem solving team; door-knocking on estates; presentations to community groups Interim Report in February 2011 Final Report – Closing the Gap – in June recommendations

Implementation Living Wage Pay differentials Debt Jobs for young people Islington Reads Good Neighbours Public space Antisocial behaviour Housing supply For more information see Closing the Gap. Final Report of the Islington Fairness Commission

38 Equality and Sustainability Reducing carbon emissions does not mean reducing the real quality of life Great inequality intensifies consumerism People in more equal societies are more public spirited, better able to act for the common good

Photo by kind permission of Matt Stuart

41 For more information: … a book and a website…

Bigger income differences intensify the idea that some people are worth much more than others We come to judge each other more by status More stressful social comparisons and insecurity about personal ‘worth’. The ‘self-conscious emotions’ become more problematic Some tough it out: narcissism, hubris, anti-social personality disorder? Others succumb to the intensified ‘social evaluative threat’: low self-esteem, fears of inadequacy, social anxiety, depression, social phobia?

IndicatorInternational dataUS data rp-valuer Trust-0.66< <0.01 Life expectancy <0.01 Infant mortality <0.01 Obesity0.57< <0.01 Mental illness0.73< Education score Teen birth rate0.73< <0.01 Homicides <0.01 Imprisonment0.75< <0.01 Social mobility0.93< Index0.87< <0.01 Correlations & p-values: Index of Health & Social Problems

Share of total income received by the richest 1% Canada Yalnizyan A. The rise of Canada’s richest 1%. Canadian Centre for Policy Alternatives, 2010

Source: J. Roine, D. Waldenström, Journal of Public Economics 2008; 92: 366–387 Trends in income distribution in Western countries 1903–2004 Richest 1% share of total income

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

50 Stereotype Threat The effect of caste identity on children's performance Caste Unannounced Caste Announced Number of mazes solved Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004

Well-being and long-term illness related to feeling shamed Data from Swedish Liv & Halsa survey Starrin B, Wettergren A. Shame and humiliation in narrative social life. (forthcoming). Number of ways people felt shamed in last 3 months

52 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

Educational Scores are Higher in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009)

Children Experience More Conflict in More Unequal Societies Source: Wilkinson & Pickett, The Spirit Level (2009) 11, 13 & 15 yr olds fighting, bullying, and finding peers not kind & helpful

More Children Drop Out of High School in More Unequal US States Source: Wilkinson & Pickett, The Spirit Level (2009)

56 Single parents and child wellbeing

The ultimate irony... The Scream still speaks to people with $120 million to spare

Ratio of top to bottom 20% of incomes Source: HRSDC, (CANSIM Table ). Statistics Canada, The widening gap between top and bottom 20% of incomes in Canada

Rising income differences in Canada post-tax income Source: Statistics Canada, CANSIM table Income Inequality: Gini

Quintiles of Vancouver Census Dissemination Areas % Fair or Poor Self-rated health Least deprived Most deprived Health ‘Fair or Poor’ by neighbourhood deprivation: Vancouver 2003 Source: Schuurman N, Bell N, Dunn JR, Oliver L, J. Urban Health 2007; 84(4):

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: