photo by kind permission of matt stuart inequality: the enemy between us? richard wilkinson emeritus...
TRANSCRIPT
Photo by kind permission of Matt Stuart
Inequality: the enemy between us?
Richard Wilkinson Emeritus Professor of Social Epidemiology
4
Income per head and life-expectancy: rich & poor countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Life expectancy in rich countries is no longer related to National Income per head
70
71
72
73
74
75
76
77
78
79
80
Local Neighbourhoods(in England & Wales)
Life
exp
ecta
ncy
(yea
rs)
Richest Poorest
Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk
Life expectancy is strongly related to income within rich countries
3.7 3.94.3 4.6 4.8
5.2 5.3 5.6 5.6 5.6 5.76.1 6.2
6.7 6.8 6.87.2
8.5
9.7
4.0
8.0
7.0
3.4
Income gapsHow 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%?
Wilkinson RG, Pickett KE. Income inequality and social gradients in mortality. American Journal of Public Health 2008; 98(4): 699-704.
The more strongly a death rate is related to income, the more strongly it is affected by
inequality.
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
www.equalitytrust.org.uk
Health and social problems are worse in more unequal countries
Ind
ex o
f h
ealt
h a
nd
so
cial
pro
ble
ms
www.equalitytrust.org.ukWilkinson & 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
Ind
ex o
f h
ealt
h a
nd
so
cial
pro
ble
ms
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Child well-being is better in more equal countries
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
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
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Mental illness is more common in more unequal societies
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Infant Mortality Rates are Higher in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
0
30
60
90
120
150
180
Income Inequality
Ho
mic
ide
s p
er
mill
ion
pe
op
le
Low 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.
Homicide rates are higher in more unequal
US states and Canadian provinces USA states
Canadian provinces
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Imprisonment rates are higher in more unequal countries
20
Teenage Birth Rates are Higher in More Unequal Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Social mobility is lower in more unequal countries
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
Indicator International US 50 StatesCensus GiniUN 20:20 OECD 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
Correlations: different measures and settings
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
Three Propositions
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
Ind
ex o
f h
ealt
h a
nd
so
cial
pro
ble
ms
0
5
10
15
Singlemothers
Low HighFather's occupational class
Infa
nt
dea
ths
per
100
0
England & Wales
Sweden
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.
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
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Literacy Scores of 16-25 year olds by Parents' Education
-1.5
-1
-0.5
0
0.5
1
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Parents' Education (years)
Lit
era
cy
sc
ore
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
Income Inequality and Mortality Working age Men in 528 cities in 5 countries
150
200
250
300
350
400
450
500
550
600
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
Ag
e ad
just
ed d
eath
rat
es
United States
United Kingdom
Canada
Australia
Sweden
Source: Ross N, Dorling D, et al. Metropolitan income inequality and working age mortality. Journal of Urban Health 2005; 82(1): 101-110.
New YorkLondon
Toronto
Sydney Melbourne
GlasgowNew Orleans
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?
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Psychosocial risk factors for ill health
Low social status
Weak social connections
Stress in early life (pre- and postnatally)
Plasma fibrinogen by employment gradeamong Civil Servants, Whitehall II.
Brunner E, Davey Smith G, Marmot M, et al. Lancet 1996; 347: 1008-1013
(Adjusted for age, ethnic origin and women’s menopausal status)
Holt-Lundstad et al, PLoS Medicine 2010;7:e1---316
Friendship is at least as important for health as smoking and drinking
Stephen Suomi Director of the Laboratory of Comparative Ethology, US
National Institute of Child Health and Human Development
0
0.2
0.4
0.6
0.8
1
Other tasks
Tasks with ‘social evaluative threat’ (uncontrollable)
Co
rtis
ol
resp
on
se (e
ffec
t si
ze)
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?
Loughnan S, et al. Economic Inequality is linked to biased self-perception. Psychological Science, 2011; 22: 1254
In more unequal countries people abandon modestyand exaggerate their merits
“Not a test of ability”
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6
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8
9
10 High SES
Low SES
“Test of ability”
Effect of stereotype threat Advanced Progressive Matrices Test: high & low SES
Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.
Num
ber o
f ite
ms
corr
ect
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
The effects of inequality - a two stage process
1. adult experience of inequality
2. passed on to children – epigenetics?
Australia
Austria
Belgium Canada
Denmark
Finland
France
Germany
Greece
Ireland
Israel
Italy
Japan
Netherlands
New Zealand
Norway
Portugal
Spain
Sweden
UK
USA
Worse
Better
UN
ICE
F in
dex
of c
hild
wel
l-bei
ng
0 10 20 30Lone parents as % of all households with dependent children
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
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
Aver
age
soci
al g
roup
siz
e
Neocortex ratio
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.