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336 – Happier, healthier… Why equality matters
07 November 2009 (19:14:42)

The more equal societies are, the fewer their social problems and the better their chance of tackling carbon emissions, says Professor Richard Wilkinson

Attitudes to inequality have traditionally differed sharply from one side of the political spectrum to the other. While some regard it as divisive and socially corrosive, others think it is a stimulus to effort, innovation and creativity. Arguments usually reflect little more than personal opinion. But in recent years it has become possible to compare how unequal incomes are in different countries and see what effect it really has. The results are dramatic.

In societies where income differences between rich and poor are smaller, the statistics show that community life is stronger, people feel they can trust others and there is less violence. Both physical and mental health tends to be better and life expectancy is higher. In fact almost all the problems related to relative deprivation are reduced: prison populations are smaller, teenage birth rates are lower, kids tend to do better at school (as judged by maths and literacy scores), and there is less obesity.

That is a lot to attribute to inequality, but all these relationships have been demonstrated in at least two independent settings: among the richest developed countries, and among the 50 states of the USA. In both cases, places with smaller income differences do much better. Some of these relationships have been shown in large numbers of studies – there are around 200 looking at the tendency for health to be better in more equal societies and about 40 looking at the relation between violence and inequality.

IMPORTANT EXPLANATION

As you might expect, inequality makes a larger contribution to some problems than others, and it is of course far from being the only cause of social ills. But it does look as if the scale of inequality is the most important single explanation of why so many health and social problems are many times as common in some societies as in others.

You might think that these patterns must arise simply because more unequal societies must just have more poor people among whom these problems tend to concentrate. But that is only a small part of the explanation. Much more important is that greater inequality seems to produce worse outcomes across the vast majority of the population. In more unequal societies, even middle class people on good incomes are likely to be less healthy, less likely to be involved in community life, more likely to be obese, and more likely to be victims of violence. Similarly, their children are likely to do less well at school, are more likely to use drugs and more likely to become teenage parents.

Although economic growth remains important in poorer countries, among the richest 25 or 30 countries, there is no tendency whatsoever for health or happiness to be better among the most affluent rather than the least affluent of these rich countries.

The same is also true of measures of wellbeing – including child wellbeing, of levels of violence, teenage pregnancy rates, literacy and maths scores among school children, and even of obesity rates. However, within each country, ill health and social problems are closely associated with income. The more deprived areas in our societies have more of most problems.

So what does it mean if the differences in income within rich societies matter, but income differences between them do not?

It tells us that what matters is where we stand in relation to others in our own society. The issue is social status and relative income. So for example, why the USA has the highest homicide rates, the highest teenage pregnancy rates, the highest rates of imprisonment, and comes about 28th in the international league table of life expectancy, is because it also has the biggest income differences. In contrast, countries like Japan, Sweden and Norway, although not as rich as the US, all have smaller income differences and do well on all these measures.

But why are we so sensitive to inequality? Why does it affect us so much?

Foremost among the psychosocial risk factors for poor health are three intensely social factors: low social status, weak friendship networks, and poor quality of early childhood experience.

Friendship, sense of control, and good early childhood experience are all highly protective of health, while things like hostility, anxiety, and major difficulties, are damaging. They key is the biology of long-term stress: it has such widespread effects – including damage to the immune and cardiovascular systems – that it has been likened to more rapid ageing.

This links back to inequality because inequality is socially divisive: it damages the quality of social relations. In the most unequal of the 50 states of the USA, 35 or 40% of the population feel they cannot trust others. That compares with perhaps only 10% in the more equal states. The international differences are at least as large.

Measures of the extent to which people are involved in local community life also confirm the socially corrosive effects of inequality. And, as if to prove the point, murder rates are consistently higher in more unequal societies. Bigger income differences give rise to bigger social distances and make social position and status competition more important.

Social status, friendship and early childhood come up in health research because they are pointers to underlying social anxieties, which are perhaps the most common sources of chronic stress in affluent societies. The insecurities and feelings of not being valued, which we may carry with us from a difficult early childhood, have much in common with the effects of low social status, and they can amplify or offset each other. Friendship fits into this picture because friends provide positive feedback: they enjoy your company, laugh at your jokes, seek your advice: you feel valued. In contrast, not having friends, feeling excluded, people choosing not to sit next to you, fills most of us with self-doubt. We worry about being unattractive, boring, unintelligent, socially inept, and so on.

There is now a large body of experimental evidence, which shows that the kinds of stress that have the greatest effect on people’s levels of stress hormones are ‘social evaluative threats’ – threats to self-esteem or social status, in any situation in which others can negatively judge performance.

It seems then that the most widespread and potent kind of stress in modern societies centre on our anxieties about how others see us, on our self-doubts and social insecurities. As social beings, we monitor how others respond to us, so much so that it is sometimes as if we experienced ourselves through each other’s eyes.

Shame and embarrassment have been called the social emotions: they shape our behaviour so that we conform to acceptable norms and spare us from the stomach-tightening we feel when we have made fools of ourselves in front of others. Several of the great sociological thinkers have suggested that this is the gateway through which we are socialised, and it now looks as if it is also how society gets under the skin to affect health.

Given that the social class hierarchy is seen as a hierarchy from the most valued at the top, to the least valued at the bottom, it is easy to see how bigger status differences increase the evaluative threat and add to status competition and status insecurity.

This perspective also explains why violence increases with greater inequality. The literature on violence points out how often issues of respect, loss of face, and humiliation, are the triggers to violence. Violence is more common where there is more inequality not only because inequality increases status competition, but also because people deprived of the markers of status (incomes, jobs, houses, cars, etc.) become particularly sensitive to how they are seen. What hurts about having second rate possessions is being seen as a second rate person.

Increased social hierarchy and inequality raise the stakes – and also the anxieties – about personal worth throughout society. We all want to feel valued and appreciated, but a society which makes large numbers of people feel they are looked down on, regarded as inferior, stupid and failures, causes suffering, resentment and wastes human resources.

QUALITY OF LIFE

For thousands of years the best way of improving the quality of human life has been to raise material living standards. We are the first generation to have got to the end of that process. No longer does economic growth improve health, happiness, or wellbeing. If we are to improve the real quality of life further, we have to direct our attention to the social environment and the quality of social relations.

What the evidence we have seen shows is that the quality of social relations is substantially determined by the scale of the material inequalities between us. Rather than continuing to tackle each problem separately – by spending more on medical care, more on police, social workers and drug rehabilitation units – we now know that by reducing material inequality it is possible to improve the psychosocial wellbeing and social functioning of whole societies.

During the next few decades, politics is likely to be dominated by the necessity of reducing carbon emissions. Greater equality has a crucial role to play in that process. First, consumerism is perhaps the most important obstacle facing policy to reduce carbon emissions. The good news is that reducing inequality decreases the pressure to consume because it reduces status competition. Greater equality starts to turn status competition into more cohesive community relationships.

Second, effective action on the environment depends, like never before, on people being concerned with the common good. There is, however, clear evidence that people in more equal societies are more public spirited and less out for themselves. More equal countries give more in foreign aid; they recycle a higher proportion of waste materials; they score better on the Global Peace index, and surveys show that business leaders in more equal countries think it more important that their governments abide by international environmental agreements.

But, even when people accept that greater equality has social and environmental benefits, they sometimes have a residual worry that creativeness and innovation – progress itself – depends on individual financial incentives and greater inequality. But if you take the number of patents granted per head of population as a reasonable measure of a society’s creativeness and innovation, then rest assured, more equal countries do better here too.

Richard Wilkinson is emeritus professor of social epidemiology, University of Nottingham Medical School. His latest book, written with Kate Pickett, is The Spirit Level: Why More Equal Societies Almost Always Do Better, published by Allen Lane in 2009, price £20

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