How bigger income differences damage us all - Durban · 3 Income per head and life-expectancy: rich & poor countries Source: Wilkinson & Pickett, The Spirit Level (2009)

Photo by kind permission of Matt Stuart

How bigger income differences

damage us all

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

‘‘Cross-country data show almost no relation

between changes in life expectancy and

economic growth over 10, 20, or 40-year time

periods between 1960 and 2000. Many

countries have shown remarkable

improvements in health with little or no

economic growth...’’

Cutler D, Deaton A, Lleras-Muney A. The Determinants

of Mortality. J Economic Perspectives 2006; 20: 97–

120.

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 e

xpecta

ncy (

years

)

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 4.85.2 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

Japan

Fin

land

No

rway

Sw

eden

Denm

ark

Belg

ium

Au

str

iaG

erm

an

yN

eth

erl

ands

Sp

ain

Fra

nce

Canada

Sw

izte

rland

Irela

nd

Gre

ece

Italy

Isra

el

New

Zeala

nd

Au

str

alia

UK

Po

rtugal

US

AS

ingap

ore

Income gaps

How 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%?

Health and social problems with social gradients

and internationally comparable data

• 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


• 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

cia

l p

rob

lem

s


Neither health nor social problems are

related to national income per head

Index of:

• Life expectancy

• Math & Literacy


• Homicides

• Imprisonment

• Teenage births

• Trust

• Obesity

• Mental illness

– incl. drug &

alcohol

addiction

• Social mobility Ind

ex o

f h

ealt

h a

nd

so

cia

l p

rob

lem

s


Child well-being is better in more equal countries


Child Wellbeing is not related to National Income per head

Low Income Inequality (Gini) High

Ch

ild

Wellb

ein

g

Inequality and Child Wellbeing (UNICEF Rpt 2013)

Pickett & Wilkinson, Pediatrics. (forthcoming)

Inequality change 2000-2010 (gini)

Ch

ild

well

be

ing

Ch

an

ge 2

000

-2010

Changes in inequality and child wellbeing (UNICEF Index)

Pickett & Wilkinson, Pediatrics. (forthcoming)

Source: FJ Elgar, American Journal of Public Health 2010;100:2311–2315

Trust and income inequality in 33 countries

16

Infant Mortality Rates are Higher in More Unequal Countries


Relation between infant mortality and GNP per

head, at high, medium and low income inequality

Hales S, Howden-Chapman P, Salmond C, Woodward A, Mackenbach J..

Infant mortality, gross national product & income distribution. Lancet 1999;

354: 2047

0

30

60

90

120

150

180

Income Inequality

Ho

mic

ide

s p

er

millio

n p

eo

ple

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

Elgar FJ, Aitken N. European J Public Health 2011; 21(2): 241-6.

Income inequality and homicide in 33 countries


Imprisonment rates are higher in

more unequal countries


Mental illness is more common in

more unequal societies

More recent analyses have

shown that inequality is also

linked to a higher prevalence

of:-

• depression

• psychotic symptoms

• schizophrenia

• status anxiety

• reduced willingness to

help others

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 .

Income inequality & bullying in 37 countries

24

Teenage Birth Rates are Higher in More Unequal Rich Countries



Social mobility is lower in more unequal countries

(Gini)

High

Low

www.equalitytrust.org.uk

Wo

rld

avera

ge C

O2

If all countries converged on the world average CO2

emissions, high life expectancy could be achieved for all

- even on the basis of existing technology

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

Ag

e a

dju

ste

d d

ea

th r

ate

s

Median Share of Income

Income Inequality and Death RatesWorking age Men in 528 cities in 5 countries

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 York

London

Toronto

Sydney Melbourne

GlasgowNew Orleans

Effect of a 0.01 unit

increase in Gini

coefficient on

deaths 1986-2006

among 701,179

respondents.

(125,391 deaths)

Data from U.S. National Health Interview Survey (NHIS) 1986-2004 with mortality follow-up data 1986-2006.

Zheng H. Do people die from income inequality of a decade ago? Social Science & Medicine 2012; 75: 36-45.

Changes in income inequality affect mortality 3-12 years later

0

5

10

15

Single

mothers

Low HighFather's occupational class

Infa

nt

death

s p

er

1000 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

31

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 s

co

re

Sweden

Canada

United States

Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

Income differences increase social class differentiation

Bigger income differences:-

• Class becomes more important • The social pyramid is higher

and more hierarchical• The quality of social relations

deteriorates

0

0.2

0.4

0.6

0.8

1

Other

tasks

Tasks with ‘social

evaluative threat’

(uncontrollable)

Co

rtis

ol re

sp

on

se

(eff

ect

siz

e)

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?

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

Self enhancement increases in more unequal

societies

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

mazes s

olv

ed

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

Mishel L, Sabadish N. Economic Policy Institute Brief #331. Washington, May 2012

Changing ratio of CEO pay to average pay of production &

non-supervisory workers in top 350 US companies

Between 1979-2007 the income of the:-

Top 0.1% increased by 362%

Top 1% increased by 156%

Bottom 90% increased by17%

Share of all income (before tax) received by the richest 1%

Leibbrandt, M. et al. (2010), Trends in South African Income Distribution and Poverty since

the Fall of Apartheid, OECD Social, Employment and Migration Working Papers, No. 101

An increasing share of South Africa’s income

has gone to the richest 10%

Countries with stronger Trade Unions are less unequal

(data for 16 OECD countries 1966-1994)In

equalit

y (

Gin

i )

% of labour force in trade unions

Gustafsson B, Johansson M. In search for a smoking gun: what makes income

inequality vary over time in different countries? LIS Working Paper 172; 1997.

Colin Gordon’s analysis of Historical Statistics for the US, unionstats.com, Piketty and

Saez 2003, and World Top Incomes Database. Economic Policy Institute, Washington DC.

Trade Unions membership (% workforce) and

Share of Income going to top 10% (USA, 1918-2008)

Documents

How bigger income differences damage us all - Durban · 3 Income per head and life-expectancy: rich & poor countries Source: Wilkinson & Pickett, The Spirit Level (2009)