"The Spirit Level" by Richard Wilkinson and Kate Pickett
by John Repp
The more unequal the distribution of wealth in a modern society, the more hierarchical the society, the worse will be the physical health, the mental health and the social problems of the society. The amounts are measurable and quite enough to seriously affect the lives of millions. The research has been widely replicated. This is not a trivial problem and the research reveals a real surprise. The level of income inequality has more influence on the health of a population than either the spending on health care, the distribution of health care or the life style choices of the people.
This book which will come out in the US in December 2009 is written by a pair of epidemiologists from England. The research project of which it is part was started there in 1967 almost twenty years after England created the National Health Service (NHS). The Whitehall I Study of male civil servants found that the death rate among the men in the lowest grade of civil service (for example messengers or doorkeepers) was three times higher than the men at the executive level. With NHS all the men in the study had the same access to health care. A later study found that the poor life style choices of the lower level civil servants such as excessive smoking, drinking, and lack of physical exercise accounted for only one-third of the difference in the death rate.
In the course of furthering the research, Richard Wilkinson and Kate Pickett put medical data like life expectancy and infant mortality rates alongside figures showing the level of economic inequality for 20 of the world’s richest nations. To get an independent test bed, they did the same with each of the 50 states in the U.S. They then expanded the research to include figures on a number of social problems like trust, mental illness, drug addiction, obesity, educational performance, teenage pregnancy, violent crime, incarceration rates, and social mobility. All these problems show the same pattern on the scatter charts. The more inequality in a society, the worse the problems.
The Spirit Level has a powerful message. The authors and early reviewers think that if the results of these studies “permeate the public mind” politics will change. They have established a website to get their results out to the world: http://www.equalitytrust.org.uk
The ideas discussed in this book are new even for many progressive people. There are reasons why these discoveries have just been made. When comparisons between people with different levels of income within a society are made, the poor do worse as Whitehall proved. It is easy to assume an increase in the living standard of the society will lift up the poor and the problems will lessen. That is the basis of the two centuries old liberal idea of material progress. But when comparisons are made between different advanced societies, and the internationally comparable data has only been available in recent years, the research finds that the problems have very little relation to the average level of income but much to do with income inequality. To quote the authors: “what matters in rich countries may not be your actual income level and living standard, but how you compare with other people in the same society.”(p.13)
There is other evidence that material advancement is no longer the great engine of progress in rich countries. Surveys from recent times show the link between economic growth on the one hand, and increased life expectancy and a sense of well-being on the other, no longer holds. In fact, for about 30 of the richest countries, surveys show an increase in anxiety and depression. Many people are starting to wonder if modern society is worth the effort. This is a world historic change that we have yet to fully understand. If we cannot get more health and happiness with more economic growth, what can we do? Clearly, we can build more equal, less hierarchical societies with collective political action by an engaged citizenry. “Rather than blaming parents, religion, values, education or the penal system, we will show that the scale of inequality provides us with a powerful policy lever on the psychological wellbeing of all of us.” (p.5)
We need to remember that these studies are looking at existing societies, not some utopia described in a revolutionary manuscript. Japan, Sweden, Finland and Norway consistently score the best while the UK, Portugal and the United States score the worst. In the more equal group of countries, the top twenty percent of their population together receive income three to four times the bottom twenty percent; whereas in the more unequal countries the top twenty percent have seven to nine times more than the bottom twenty percent. In other words, the rate of inequality is about twice as much in the more unequal societies. But the size of the differences in health and social problems is much larger and quite sobering: “rates of mental illness are five times higher in the most unequal compared to the least unequal societies. Similarly, in more unequal societies people are five times as likely to be imprisoned, six times as likely to be clinically obese, and murder rates may be many times higher…..life expectancy is 4.5 years shorter for the average American than it is for the average Japanese.” (p. 181)
Many people immediately assume since the more unequal societies have more poor people, it is the higher numbers of the poor that cause higher rates of health and social problems. But the incidence of health and social problems are higher at every income level in the more unequal societies. The majority of the people are hurt by greater inequality and this is why the differences between the more equal societies and less equal societies are so great. The skeptics fail to recognize some very important processes affecting their own lives and the societies of which they are a part.
Why are more unequal societies plagued with unnecessary health and social problems? Conversely, why are societies that are more equal, healthier places to live with fewer social problems? Many times in the history of science empirical facts or correlations of facts are discovered but the mere discovery of facts does not change the science. Only when the mechanism is found which causes the facts and/or correlations does the science change. People noticed for years that the east coast of Africa and the west coast of South American had very similar profiles. But it was not until the mechanism of the spreading sea floor was discovered that the theory of tectonic plates was accepted. Likewise the idea of evolution was around before Darwin. His grandfather had written about it. But Darwin discovered a mechanism for evolution, natural selection, and the science changed. So what is the mechanism linking inequality and poor health (and other problems)?
The short answer is stress. The more unequal the society, the more stress, the more competition, the less community there is throughout the society. Psychologists studying the sources of stress in modern society have identified the most powerful stressor of all for human beings. It is a situation in which other people could negatively judge a person’s performance while the person could not avoid failure. This identification was based on a measure of cortisol, the central stress hormone, in the saliva or blood, not just on the reports of the subjects. This most powerful of all stressors is exactly what happens every day in very unequal societies as people at all levels are judged by their “betters” as “less than” and can do very little about it.
Medical science has proven that while acute stress is normal, chronic continuing stress causes all sorts of problems in the human body like immune system suppression, growth failure in children, infertility in women, impotence in men, fat deposits around the mid-section, sleeping problems, digestive problems and neuron damage to name just a few. This is true not just for human beings. Wilkinson and Pickett describe some experiments with macaque monkeys. In the wild these animals form status hierarchies that affect their access to food and mates. In captivity it is possible to insure that all have the same diet and live in the same material conditions. By moving the animals between groups, experimenters can also control an individual’s social status since some can be dominant in some groups but not in others. Animals which lose status experience “a rapid build-up of atherosclerosis in their arteries” (p. 192). In another experiment with macaques the dominant monkeys had more good brain chemicals like dopamine and serotonin than the subordinates. When all were taught how to give themselves cocaine, the subordinates took a lot more as if self-medicating against the bad feelings caused by low status.
A very important chapter in The Spirit Level concerns the important links between equality and environmental sustainability. The authors think global climate change and its effects will dominate the politics of the 21st century. They believe that reaching sustainability will require reducing material consumption in the rich countries. We already learned that increasing consumption in the rich countries over the last several generations did not increase well-being while increasing equality can decrease social and health problems. Therefore, the authors reason, an increase in equality in rich societies might allow a decrease in consumption without decreasing well-being. In addition, as Britain learned during WWII, policies that involve sacrifice must be equitable to gain the support of the citizenry. Another link is the status anxiety created by increasing inequality and competition which then feeds shopping addictions. Conversely, increasing equality can dampen consumption compulsions and replace them with the satisfaction of more community that increased equality makes possible. These are powerful synergies that we need to harness to get to sustainability.
As a lifelong progressive, when I read this book I thought to myself “We have finally got the goods! This is evidence-based politics. The right-wing has no arguments left. ” But when I read further I realized that in fact the right has not lost on all their issues, in particular their fear of powerful government. The authors explain that the greater equality need not be achieved by a government using taxation and spending for public benefit like the Scandinavian experience. It is only the end result of equality that matters. The case of Japan and New Hampshire are cited as examples of places where greater equality exists but government taxation and spending is relatively low because the income differences are smaller before taxes. Even in 20 of the largest American cities, 40% of the largest 200 employers are universities and medical institutions with smaller income differences than in the private sector. The real source of increasing inequality is the large private corporations and the governmental policies that follow their agenda. For private corporations the authors propose employee buyouts combined with more participation by all employees in management. Here action by civil society, a change in political will and new law are required.
If we think about the demands for liberté and égalité that were shouted in the streets of Paris during the French Revolution we realize that the issues discussed in The Spirit Level have been around for a long time. In 1789 liberté meant not being dependent on the feudal nobility and landed aristocracy. Today the large corporations and the governments that support them have taken the place of the nobility and the monarchy. The new concern of our time is environmental sustainability. This book provides the empirical evidence to prove that equality is as necessary as liberty for a good society and that without equality, environmental sustainability, is not possible.
