1. Photo by kind permission of Matt Stuart Social Dysfunction: why inequality matters Richard Wilkinson Emeritus Professor of Social Epidemiology

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

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

5. 5 Poor Rich Median income of Zip code areas MRFIT data from Davey Smith et al. AJPH 1996 Mortality is related to income differences within societies

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

7. 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 www.equalitytrust.org.uk Health and social problems are worse in more unequal countries Index of health and social problems

8. 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

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

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

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

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

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

15. 15 Infant Mortality Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

16. 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

17. Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Can J Crim 2001; 43: 219-36. Homicide rates are higher in more unequal US states and Canadian provinces USA states Canadian provinces

18. 18 Teenage Birth Rates are Higher in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

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

20. Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk More children drop out of High School in more unequal US states

21. Educational Scores are Higher in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

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

23. 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...

24. www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level Death rates are lower in more equal States for both richer and poorer Americans

25. Diabetes Hypertension Cancer Lung disease Heart disease Self-reported prevalence of illness by education % Source: Banks et al. JAMA 2006; 295: 2037-2045

26. 26 Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

27. 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 www.equalitytrust.org.uk Health and social problems are worse in more unequal countries Index of health and social problems

28. 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?

29. 29 Psychosocial risk factors for ill health  Low social status  Weak social affiliations  Stress in early life (pre- and postnatally)

30. 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): 355-91. What kind of stressful tasks raise stress hormones most?

31. 31 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

32. 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.

33. “Not a test of ability”“Test of ability” Stereotype threat. High & low socioeconomic status groups given ‘Advanced Progressive Matrices’ test Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107. Number of items correct

34. Data from: Piketty & Saez

35. 35 http://www.equalitytrust.org.uk For more information: a book … … and a website