Inequality: the enemy between us? Richard Wilkinson Emeritus Professor of Social Epidemiology

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 3.9 4.3 4.6 4.8 5.2 5.3 5.6 5.6 5.6 5.7 6.1 6.26.7 6.8 6.8 7.2

8.5

9.7

4.0

8.07.0

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%?

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

• 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

Inde

x of

hea

lth a

nd s

ocia

l pro

blem

s


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




• Social mobility

Inde

x of

hea

lth a

nd s

ocia

l pro

blem

s


Child well-being is better in more equal countries


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

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Infant Mortality Rates are Higher in More Unequal Countries


0

30

60

90

120

150

180

Income Inequality

Hom

icid

es p

er m

illio

n pe

ople

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

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Teenage Birth Rates are Higher in More Unequal Rich Countries



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

Exceptions:suicide?

Indicator International US 50 StatesCensus GiniUN 20:20 OECD Gini

r p r p r pChild wellbeing -071 <0.01 -0.68 0.01 - -Trust -0.66 <0.01 -0.66 0.03 -0.70 <0.01Life expectancy -0.44 0.04 -0.27 0.24 -0.45 <0.01Infant mortality 0.42 0.04 0.54 0.01 0.43 <0.01Obesity 0.57 <0.01 0.41 0.06 0.47 <0.01Mental illness 0.73 <0.01 0.32 0.30 0.18 0.12Education score -0.45 0.04 -0.46 0.05 -0.47 .01Teen birth rate 0.73 <0.01 0.64 <0.01 0.46 <0.01Homicides 0.47 0.02 0.44 0.04 0.42 <0.01Imprisonment 0.75 <0.01 0.51 0.02 0.48 <0.01Social mobility 0.93 <0.01 0.83 <0.01 - -Index 0.87 <0.01 0.75 <0.01 0.59 <0.01

Correlations: different measures and settings

Zheng H. Social Science & Medicine 2012; 75: 36-45.

Mor

talit

y: O

dds

Rat

io

Lag time - Years

Lag times: marginal impact of a 0.01-unit increase in the Gini on individual mortality risk over time

Wilkinson & Pickett, The Spirit Level




• Social mobility

www.equalitytrust.org.uk

Health and social problems are worse in more unequal countries

Inde

x of

hea

lth a

nd s

ocia

l pro

blem

s

0

5

10

15

Singlemothers

Low HighFather's occupational class

Infa

nt d

eath

s pe

r 100

0

England & WalesSweden

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

25

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)

Lite

racy

sco

re

Sweden

Canada

United States

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

These relationships reflect deep-seated social processes.

What are they?How do they work?

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

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?

Even low levels of stress raise death rates

Russ TC, Stamatakis E, Hamer M, Starr JM, Kivimäki M, Batty GD. Association between psychological distress and mortality: pooled analysis of 10 prospective cohort studies. BMJ 2012; 345: e4933.

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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)

Cor

tisol

resp

onse

(effe

ct s

ize)

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

Rising narcissism among American college students(meta-analysis of 85 samples 1979-2006)

Nar

ciss

istic

Per

sona

lity

Inve

ntor

y

Twenge JM, Konrath S, Foster JD, Campbell WK, Bushman BJ. Egos inflating over time. J Personality 2008; 76(4): 875-901.

Rising income inequality in Britain 1979-2011In

equa

lity

(Gin

i)

Cribb J, Joyce R, Phillips D. Living standards, poverty and inequality in the UK: 2012. Institute for Fiscal Studies, London 2012

What can be done?Taxes & benefits

• Stop tax avoidance

• End tax havens

• Make taxation progressive again

Income differences before tax

• Stronger Trade Unions

• Increase company democracy - employee ownership etc

• Promote more directors from within companies

Sustainability needs greater equality

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%

Pay differentials• Pay ratios in public sector usually between 1:10 and 1:20

• Average for FTSE 100 companies 1:300

• 78% of public think the pay gap is too large, but only 27% support higher welfare benefits. (Brit Soc Atts Survey)

• Greater London Assembly committed (16th June 2010) to pay differences of 1:20, with a long term goal of 1:10.

• Hutton Report suggested public sector 1:20

• Brit Soc Atts Survey: Appropriate pay for unskilled worker: £16,000, for CEO of large company: £100,000. i.e. ratio of less than 1:7

• Fairness Commissions have recommended Living Wage

• Referendum in Switzerland (Nov 2013) limiting pay differentials to 1:12

• WageMark – a new standard (like Fair Trade) to be launched for companies with pay differences less than 1:8

• Mondragon Cooperatives between 1:3 and 1:9. Ave 1:5

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http://www.equalitytrust.org.uk

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Inequality: the enemy between us? Richard Wilkinson Emeritus Professor of Social Epidemiology