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

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

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

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

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

7. 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?
Wilkinson & Pickett, The Spirit Level

8. 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):

9. Social Gradients Life expectancy Math & Literacy Infant mortality
Homicides
Imprisonment
Teenage births
Trust
Obesity
Mental illness – incl. drug & alcohol addiction
Social mobility

10. 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
Wilkinson & Pickett, The Spirit Level

11.
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

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

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

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

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

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

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

18. 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:

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

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

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

22. 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

23. 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

24. Child wellbeing is better in more equal US states Higher average income makes little difference

25. 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

26. 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
Wilkinson & Pickett, The Spirit Level 26

27. 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):

28. 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 Data from OECD Programme for International Student Assessment.

30. Research: points to remember
Class hierarchy and size of areas
Multilevel models and individual income

32. 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

33. 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

34. 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:

35. Friendship is at least as important for health as smoking and drinking
Holt-Lundstad et al, PLoS Medicine 2010;7:e

36. Stephen Suomi Director of the Laboratory of Comparative Ethology, US National Institute of Child Health and Human Development

37. 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):

38. 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

39. 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):

40. 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

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

42. Single parents and child wellbeing

43. 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

44. For more information:
… a book
and a website…

45. 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.

47. 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

48. Photo by kind permission of Matt Stuart

50. 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: Institute of Fiscal Studies, London.

51. Three Questions Is this just picking and choosing data?
What about other countries?
What about causality?