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\title{Why Equality is Good for our Health}
\date{June 1, 2009}
\author{Kate Pickett}
\subtitle{If it benefits everyone to live in a more equal society, what is to be done? \textbf{Kate Pickett} discusses the main message of her recent book.}






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If it benefits everyone to live in a more equal society, what is to be done? ***Kate Pickett** discusses* the main message of her recent book.


\textbf{Radical Anthropology:} Congratulations on your book, \emph{The Spirit Level: why more equal societies almost always do better,} coauthored with \textbf{Richard Wilkinson.} The book offers a mass of evidence to show that more unequal societies do worse on a whole array of health and welfare indicators. Some left activists might think: Isn’t this kind of obvious? What would you say is new and remarkable about these findings?


\textbf{Kate Pickett:} Thank you, I think it is tine that people on the left have felt for a long time that more unequal societies must be bad for our health and social wellbeing, and indeed there is a body of research linking income inequality to levels of violent crime and a more contested evidence base for the effects of inequality on population health. There are two major new and remarkable aspects of the evidence we present in \emph{The Spirit Level.}


First, we show that a wide range of health and social problems are affected by levels of income inequality, including levels of trust, mental illness, life expectancies and infant mortality, obesity, educational performance, teenage births, homicides, rates of imprisonment and social mobility. And we can show these links in two separate tests — among the rich, developed countries and, independently, among the 50 American states. The correlations are strong and statistically significant. Second, we show that inequality seems to affect almost everybody, not just the poor or those with low social status. It is hard to compare people’s health and wellbeing at the same socioeconomic position across different societies, but in the few studies that have been able to do this, it is clear that health and educational performance are better even at the top of the social hierarchy in more equal societies. As an example, death rates are lower in more equal American states, even among those that live in the most affluent counties. And even for the most highly educated parents, their children will have higher education scores in more equal countries than their counterparts in more unequal ones.


Taken together, these findings show that the instincts and feelings that many people have — that inequality is not only morally wrong and unjust but also harmful to the social fabric — are based on a reality that can be demonstrated empirically. So our book makes the link from ‘knowing’ to ‘showing’.


\textbf{RA:} You mention people’s ‘instincts’ that inequality is morally wrong and unfair, harmful to wider society, and in the book you highlight our evolutionary heritage in hunter-gatherer egalitarianism. We do seem to be happier when we are among our equals. Yet many of the social ills associated with greater inequality seem to arise because of something equally natural — our innate tendency for status-seeking. So which is the tine ‘human nature’? Can we explain the paradox?


\textbf{KP:} I don’t think we have a paradox: we are sensitive to the social world.


The structure of that social world then shapes our responses to it; we have different responses to different environments. In a more egalitarian world we can be collaborative and busting; in a dog-eat-dog world, we need to seek as much power and status as we can.


I think that the important aspect of our psychology that we need to understand in this context is how we know ourselves through the eyes of others, rather than any innate tendency to status-seeking. As humans, we can clearly adapt to all kinds of social structures, and although we have lived most of our human heritage in fairly small egalitarian groups, we have also lived in extreme tyrannical hierarchies, and everything in between. Status matters more in more unequal societies because it has a greater impact on our access to resources — whether that is meat in a hunter-gatherer tribe, or a high income and private education in modern Britain.


You say that we are happiest when among our equals. But I think it is more accurate to say we are happiest when among our friends (usually chosen from among our equals), because they like us and value being with us.


\textbf{RA:} That’s a very encouraging answer for anarchists or community activists since it implies that ultimately we have the fate of our communities in our hands. But is the political will there to acknowledge and act on your findings? At the moment it seems just the opposite. On the one hand, we have the bankers backsliding into yet more bonuses. Then in summer 2009 we heard John Denham, New Labour Minister for Communities, saying that the 1960s ideal of equality is ‘redundant’ — trying to divert resources to people at the bottom of the social scale ‘alienates’ those in the middle. How do you react to that?


\textbf{KP:} Political will is clearly needed to bring about changes in the level of inequality in the UK. We can think of political will as arising from two sources: from politicians and policy makers who want to change society and make it more equal; and from the general public demanding changes to promote equality from politicians and policy-makers. Change would obviously be easiest if both groups were aligned in wanting greater equality. Surveys repeatedly show us that people think that income differences are too big, and worry that society is increasingly focused on materialism and status, at the expense of quality of life. Research from the Harwood Institute for Public Innovation in the USA found that Americans were “deeply ambivalent about wealth and material gain”. They wanted society to “move away from greed and excess toward a way of life more centred on values, community, and family” and when brought together in focus groups people were “surprised and excited to find that others share(d) their views”.


In the UK, the Fabian Society recently completed research for the Joseph Rowntree Foundation on public attitudes to inequality. Although people were not opposed to high incomes if they deserved them through ability or performance, after the economic crisis they started to question whether high salaries really were deserved. The majority also supported progressive tax and benefit systems, and targeted help for those most in need. When shown evidence of the impact of inequality on health and social problems, they showed “strong support for a social vision based upon improving quality of life for everyone and were prepared to support certain egalitarian policies in this context”. So I think the evidence shows that the general public is already disposed to prefer more equality and would welcome a shift to a society that emphasized a better quality of life for all. The public’s political will is in place. And the evidence that we lay out in \emph{The Spirit Level} could be used as an evidence-base to support a call for a new social and political vision. What we seem to be lacking is a politician or mainstream political party willing to make that social vision a reality. We are at a critical turning point for our society — we can’t afford to go back to an emphasis on runaway economic growth at any cost, we must constrain our energy consumption and CO\textsubscript{2}emissions, and we have a public yearning for something different. It’s an opportunity for profound change and I hope that politicians and policy makers will have the courage to seize the moment.


\textbf{\emph{RA:}} You point to the critical nature of our time for our society and the whole planet. How do you link issues of equality in the richer nations to the world’s great problems of sustainability in the light of global warming? What about countries where wellbeing can still be significantly improved by economic growth?


\textbf{KP:} First, you need to understand the shape of the relationship between economic growth and health and wellbeing. As Figure 1 shows, as countries get richer, life expectancy improves, but only up to a point. Beyond a certain level of economic growth, among today’s rich market democracies, there is no association at all between levels of average income and health and wellbeing. A similar graph for happiness looks just the same. So poorer countries need to continue to pursue economic growth, but it is no longer beneficial for rich countries.


Second, you need to understand the shape of the relationship between carbon emissions and health and wellbeing\dots{}it’s the same! Figure 2 shows that as developing countries expand their economies and start to emit more CO\textsubscript{2}, their populations gain in health, but rich market democracies are characterized by incredibly high rates of carbon emissions that bring no benefits in terms of quality of life. Rich countries need to constrain economic growth and emissions, and they can do that without damaging health and wellbeing.


As rich countries contract their growth and emissions and poorer countries pursue the economic growth they need, countries ought to converge at a point of optimal quality of life without excessive emissions, putting them in the upper left corner of Figure 2 (where Costa Rica is already). This would reduce global inequalities, as well as addressing problems of climate change.


\textbf{\emph{RA:}} Among the rich democracies, more homogenous populations such as Japan or Sweden regularly do well while the more ethnically diverse USA and UK do persistently badly on such indicators as life expectancy, infant mortality, obesity rates, educational performance, levels of violence, and imprisonment rates. Could it be that discrimination against ethnic minorities is fundamental here, and really confounded with income inequality effects?


\textbf{KP:} As you point out, at first glance\textsubscript{:l}. it looks as if the more ethnically homogeneous countries do better than those which are more diverse. But the picture isn’t quite that simple. Spain, for example, has a larger migrant population than its neighbour, Portugal, but is more equal and has fewer health and social problems. And Sweden and the USA have similar proportions of foreign-born residents. Also, an international study, using data on the ethnic mix in each country, found that ethnic diversity did not explain the inequality and poor health. Among the 50 American states income inequality does tend to be higher in states with higher proportions of African-American residents. Some researchers have suggested that this accounts for the relationship between inequality and health, while others show that this is not the case. Importantly, in the more unequal states health is worse for both the African American and the white populations. Insofar as ethnic divisions are related to inequality and may contribute to its effects it isn’t ethnicity itself that matters. Instead, ethnicity can serve as a marker of low social status, attracting stigmatisation, prejudice and discrimination. Rather than ethnic diversity involving quite separate pathways from those through which inequality has its effects, they involve very much the same processes.


\textbf{\emph{RA:}} Is there anything you can say specifically about effects of inequality on women and their lives? Particularly, when analysing data on social ‘evils’ which correlate with higher levels of inequality in rich democracies, teenage pregnancy is one of the indicators you put up alongside mental illness, ding addiction, violence, and high imprisonment rates. While it’s easy to see that young mums and their children are in danger of falling into cycles of deprivation, isn’t there a problem of stigmatising their strategies here? From an evolutionary perspective, first pregnancy at age 18 or 19, say, may be a perfectly viable strategy. And your own data show that teenage births increase where job opportunities decrease, and \emph{vice versa.} So aren’t these young women making sensible choices? After all, it’s not their fault if society is adjusting itself to our evolutionary heritage.


\textbf{KP:} First, with respect to the impact of inequality on women’s lives in general, we show that women’s status is significantly better in more equal countries, such as the Scandinavian countries, as well as in the more equal US states. Japan is a notable exception. Where the overall income differences in society are greater, women have lower income relative to men, are less likely to be highly educated and to be participants in political processes, such as voting or holding office.


But you asked specifically about teenage motherhood, and whether or not having children at a young age is a reasonable strategy, both in terms of our evolutionary heritage and when opportunities for young women are limited. And you ask if we are in danger of stigmatising the choices of young women. Society already stigmatises teenage motherhood. In our book we point out that teenage motherhood is not a problem because these mothers are young, but because teenage motherhood in the context of many rich countries is inextricably linked with deprivation, social exclusion and the intergenerational transmission of poverty and disadvantage. This isn’t true everywhere — in Japan, 86\% of teenage mothers are named, as are more than half of young mothers in Greece and Italy. But many young women in the UK, USA and elsewhere do seem to be choosing early motherhood because society isn’t offering them jobs or education. That lack of opportunities is what should cause public outrage.


We also discuss in \emph{The Spirit Level} the evolution of different reproductive strategics, which make sense in different contexts. If we learn, while growing up, that other people can’t be trusted, that relationships are unpredictable and that resources are scarce (all of which are more likely in a more unequal society), then reaching sexual maturity and becoming sexually active earlier and having a larger number of children with multiple partners might have been (in evolutionary terms) a successful strategy. But in our modern societal context, which values and rewards long periods of education and career training, the postponement of childbearing becomes a marker of successful adulthood. A society that placed less value on income and status would be more likely to respect all the timings and the structures by which families are formed.


\textbf{RA:} ‘Inequality is structural violence’ is one heading in your chapter on violence. Not everyone resorts to violence. But as recent epidemics of postcode violence and knife crime seem to show, the youngest and poorest men both suffer and perpetrate the most. What can your work say about how to prevent these cycles of violence?


\textbf{KP:} More unequal societies suffer more violent crime and you’re right that it is young, poor men who are most likely to be victims and perpetrators. This is because threats to pride and status, which instigate feelings of humiliation and shame, are the most common trigger for violence. And young men have an evolved need to maintain status and face, because that determines their social and sexual success. But violent crime is almost unknown in some societies, so clearly environmental conditions determine levels of homicide and violent crime.


As we show that levels of trust and social cohesion are higher in more equal societies and the quality of family life and education is better, and social mobility higher, I think that some of the pathways that link inequality to violence are clear.


Early life exposure to violence and abuse and a lack of strong male role models are an issue for far too many of our young men, as are the influence of negative peer groups, the high levels of conflict and bullying in our schools and the lack of meaningful employment, training, and leisure opportunities. Even within the most violent countries, such as the UK and USA, most of us don’t react violently to put-downs and threats to status, because we are buffered by our education and nice houses, our cars and our jobs, our friends and colleagues who think well of us — all the trappings of our status and potential. If we want to prevent violence, then we need to value and respect our boys and young men and make sure that society provides them with the means to value their own lives and potential. They need an educational cumculum that appeals to them, jobs and apprenticeships that offer them a worthwhile experience of work and a living wage. And we desperately need a concerted political effort to reduce the horrendous impact of the current economic crisis on youth unemployment. Many of the health and social problems that our society faces today, including the homicide rate, can be Paced back to the consequences of mass unemployment and rising inequality in the 1980s. We need to learn from those lessons and we need to learn fast.


\textbf{RA:} Have you got involved in any practical or political initiatives as a result of this scientific research?


\textbf{KP:} Yes, we have. We’ve felt a responsibility to try and make all the evidence of how badly societies are damaged by inequality better known. Together with a colleague, Bill Kerry, we set up a not-for-profit organisation, The Equality Trust, to educate and campaign on the benefits of a more equal society. We’ve been given some initial, core funding by the Joseph Rowntree Charitable Trust, which enabled us to employ a policy and campaigns manager, Kathryn Busby.


At the Trust’s website \href{http://www.equalitytrust.org.uk}{www.equalitytrust.org.uk}, you can download slides, showing the evidence from \emph{The Spirit Level,} a lecture on DVD, and read summaries of the evidence and answers to frequently asked questions. You can sign the Equality Charter, sign up for our newsletter, make a donation, give us your ideas and join or form a local equality group. We’re also encouraging people to campaign with us and to develop their own political actions — hoping to create a groundswell of opinion in favour of greater equality.


This autumn, we’ll be speaking at all the party fringe conferences and then watching to see how the party manifestos develop, ahead of next Spring’s election. We’ll be doing everything we can to make the need for greater equality better known.


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\textbf{Kate Pickett,} PhD, is Professor of Epidemiology at the University of York and a National Institute for Health Research Career Scientist. She is a co-founder of The Equality Trust.


Her latest book, co-authored with \textbf{Professor Richard Wilkinson,} \emph{The Spirit Level: why more equal societies almost always do better,} was published by Allen Lane in 2009.









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The Ted K Archive





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Kate Pickett

Why Equality is Good for our Health

If it benefits everyone to live in a more equal society, what is to be done? \textbf{Kate Pickett} discusses the main message of her recent book.

June 1, 2009


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