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

Photo by kind permission of Matt Stuart

Inequality: the enemy between us?

Richard Wilkinson Emeritus Professor of Social Epidemiology

3

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?


Inequality...How much richer are the richest 20% in each country than the poorest 20%?

Outcomes with 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


Neither health nor social problems are related to national income per head




• Social mobility

Ind

ex o

f h

ealt

h a

nd

so

cial

pro

ble

ms


Child well-being is better in more equal countries


The UNICEF Index of Child Wellbeing is not related to National Income per head


People in more unequal countries trust each other less


People in more unequal states of the USA trust each other less


Mental illness is more common in more unequal societies

16

Infant Mortality Rates are Higher in More Unequal Countries


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


Imprisonment rates are higher in more unequal countries

19

Teenage Birth Rates are Higher in More Unequal Rich Countries


Income inequality & bullying in 37 countriesIncome inequality & bullying in 37 countries

Elgar FJ, Craig W, Boyce W, Morgan A, Vella-Zarb R. Income Inequality and School Bullying: Multilevel Study of Adolescents in 37 Countries. J. Adolescent Health 2009; 45(4): 351-359 .


Social mobility is lower in more unequal countries

Wilkinson & Pickett, The Spirit Level




• Social mobility


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

24

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.

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)

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?

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.

“Not a test of ability”

5

6

7

8

9

10 High SESLow SES

“Test of ability”

Effect of stereotype threat on IQ test performancehigh & 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

Loughnan S, et al. Economic Inequality is linked to biased self-perception. Psychological Science, 2011; 22: 1254

In more unequal countries people abandon modestyand emphasise their achievments

33

The effects of inequality - a two stage process

1. adult experience of inequality

2. passed on to children – epigenetics?

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.

What can be done?

Taxes & benefits

• Stop tax avoidance

• End tax havens

• Make taxation progressive again

Income differences before tax

• Increase company democracy - employee ownership etc

• Promote more directors from within companies Sustainability needs

greater equality

Islington Fairness Commission

Commissioners included 9 Councillors (all parties), Council CEO, Chief Execs of Islington NHS, local Chamber of Commerce and Trades Council, Police chief, 3 academics, 2 from charitable sector. (MPs attended as observers).

Ran for one yearSeven themed public meetings around the borough (500+ attendees)Testimony from residents and expertsWritten submissions from the public (100+)Satellite activities: problem solving team; door-knocking on estates;presentations to community groupsInterim Report in February 2011Final Report – Closing the Gap – in June 201119 recommendations

Implementation

• Living Wage• Pay differentials• Debt• Jobs for young people• Islington Reads• Good Neighbours• Public space• Antisocial behaviour• Housing supply

For more information see Closing the Gap.Final Report of the Islington Fairness Commission

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Equality and Sustainability

• Reducing carbon emissions does not mean reducing the real quality of life

• Great inequality intensifies consumerism

• People in more equal societies are more public spirited, better able to act for the common good

Photo by kind permission of Matt Stuart

41

http://www.equalitytrust.org.uk

For more information:

… a book

and a website…

Bigger income differences intensify the idea that some people are worth much more than others

• We come to judge each other more by status• More stressful social comparisons and insecurity

about personal ‘worth’.• The ‘self-conscious emotions’ become more

problematic• Some tough it out: narcissism, hubris, anti-social

personality disorder?• Others succumb to the intensified ‘social evaluative

threat’: low self-esteem, fears of inadequacy, social anxiety, depression, social phobia?

Indicator International data US data

r p-value r p-value

Trust -0.66 <0.01 -0.70 <0.01

Life expectancy -0.44 0.04 -0.45 <0.01

Infant mortality 0.42 0.04 0.43 <0.01

Obesity 0.57 <0.01 0.47 <0.01

Mental illness 0.73 <0.01 0.18 0.12

Education score -0.45 0.04 -0.47 .01

Teen birth rate 0.73 <0.01 0.46 <0.01

Homicides 0.47 0.02 0.42 <0.01

Imprisonment 0.75 <0.01 0.48 <0.01

Social mobility 0.93 <0.01 - -

Index 0.87 <0.01 0.59 <0.01

Correlations & p-values: Index of Health & Social Problems

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

Share of total income received by the richest 1% Canada 1920-2007

Yalnizyan A. The rise of Canada’s richest 1%. Canadian Centre for Policy Alternatives, 2010

Source: J. Roine, D. Waldenström, Journal of Public Economics 2008; 92: 366–387

Trends in income distribution in Western countries 1903–2004Ri

ches

t 1%

sha

re o

f tot

al in

com

e

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

50

Stereotype Threat

The effect of caste identity on children's performance

Caste Unannounced

Caste Announced

0

1

2

3

4

5

6

High Caste

Low Caste

Num

ber

of m

azes

sol

ved

Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004

Well-being and long-term illness related to feeling shamed

Data from Swedish Liv & Halsa survey 2004. Starrin B, Wettergren A. Shame and humiliation in narrative social life. (forthcoming).

Number of ways people felt shamed in last 3 months

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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

Educational Scores are Higher in More Equal Rich Countries


Children Experience More Conflict in More Unequal Societies

Source: Wilkinson & Pickett, The Spirit Level (2009)

11, 13 & 15 yr olds fighting, bullying, and finding peers not kind & helpful


More Children Drop Out of High School in More Unequal US States


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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

The ultimate irony...

The Scream still speaks to people with $120 million to

spare

Ratio

of t

op to

bott

om 2

0% o

f inc

omes

Source: HRSDC , (CANSIM Table 202-0703). Statistics Canada, 2009.

The widening gap between top and bottom 20% of incomes in Canada

Rising income differences in Canada

post-tax income 1976-2009

Source: Statistics Canada, CANSIM table 202-0705

Inco

me

Ineq

ualit

y: G

ini

Quintiles of Vancouver Census Dissemination Areas

% F

air o

r Poo

r Se

lf-ra

ted

heal

th

Least deprived Most deprived

Health ‘Fair or Poor’ by neighbourhood deprivation: Vancouver 2003

Source: Schuurman N, Bell N, Dunn JR, Oliver L, J. Urban Health 2007; 84(4): 591-603

Male mortality (25-64 yrs) and income inequality in US

states and Canadian provinces.

Source: Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA, Lynch JW. British Medical Journal 2000;320:898-902

http://www.bmj.com/content/vol320/issue7239/images/large/rosn4890.f1.jpeg

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

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