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

The public and policy response? more:- Police Doctors Social Workers Drug rehabilitation units Educational Psychologists But…services are expensive and only partially effective. 3

Income per head and life-expectancy: rich & poor countries 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 www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

Life expectancy is strongly related to income within rich countries Richest Poorest www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

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

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

Health and social problems are worse in more unequal countries 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 www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

www.equalitytrust.org.uk 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

Child well-being is better in more equal countries www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

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

People in more unequal countries trust each other less www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

People in more unequal states of the USA trust each other less www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

Mental illness is more common in more unequal societies www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

Infant Mortality Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Homicide rates are higher in more unequal US states and Canadian provinces USA states Canadian provinces 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 www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

Teenage Birth Rates are Higher in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Social mobility is lower in more unequal countries www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

In summary... bigger income gaps lead to deteriorations in:- Health Drug abuse Infant mortality Life expectancy Mental illness Obesity Social Relations Child conflict Homicide Imprisonment Social capital Trust Human Capital Child wellbeing High school drop outs Math & literacy scores Social mobility Teenage births …but not suicide

Correlations: different measures and settings Indicator International US 50 States Census Gini UN 20:20 OECD Gini   r p Child wellbeing -071 <0.01 -0.68 0.01 - Trust -0.66 0.03 -0.70 Life expectancy -0.44 0.04 -0.27 0.24 -0.45 Infant mortality 0.42 0.54 0.43 Obesity 0.57 0.41 0.06 0.47 Mental illness 0.73 0.32 0.30 0.18 0.12 Education score -0.46 0.05 -0.47 .01 Teen birth rate 0.64 0.46 Homicides 0.02 0.44 Imprisonment 0.75 0.51 0.48 Social mobility 0.93 0.83 Index 0.87 0.59

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

Health and social problems are worse in more unequal countries 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 www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level 26

Infant mortality by class: Sweden compared with England & Wales 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 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 -1.5 -1 -0.5 0.5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Parents' Education (years) Literacy score 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

Valued or Devalued? inequality More 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) Most important sources of chronic stress – relative risks and population attributable risk Pointer – underlying source of stress: Social anxiety Eyes of others Social Gateway 33 33

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

What kind of stressful tasks raise stress hormones most? Cortisol response (effect size) Tasks with ‘social evaluative threat’ (uncontrollable) Other tasks Dickerson SS, Kemeny ME. Acute stressors and cortisol responses. Psychological Bulletin 2004; 130(3): 355-91.

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 exaggerate their merits

Effect of stereotype threat Advanced Progressive Matrices Test: high & low SES Number of items correct “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

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

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

For more information: … a book and a website… http://www.equalitytrust.org.uk

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 Average social group size 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?