Photo by kind permission of Matt Stuart
Social Dysfunction: why inequality matters
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
5
Poor Rich Median income of Zip code areas
MRFIT data from Davey Smith et al. AJPH 1996
Mortality is related to income differences within societies
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 & 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
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
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
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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
Imprisonment rates are higher in more unequal countries
Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk
More children drop out of High School in more unequal US states
Educational Scores are Higher in More Equal 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...
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Death rates are lower in more equal States for both richer and poorer Americans
0
10
20
30
40
50
Low High Low High Low High Low High Low High
England
England USA
Diabetes Hypertension Cancer Lung disease Heart disease
Self-reported prevalence of illness by education
%
Source: Banks et al. JAMA 2006; 295: 2037-2045
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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.
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
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 affiliations
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?
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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
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”
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6
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8
9
10 High SES
Low SES
“Test of ability”
Stereotype threat. High & low socioeconomic statusgroups given ‘Advanced Progressive Matrices’ test
Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.
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