Richard WilkinsonEmeritus Professor of
Social EpidemiologyUniversity of Nottingham
&
Kate PickettSenior Lecturer in Epidemiology
University of York
http://www.equalitytrust.org.uk
Health is related to income differences within rich societies but not to those between them
Within societiesBetween (rich) societies
Source: Wilkinson & Pickett, The Spirit Level (2009)
70
71
72
73
74
75
76
77
78
79
80
Electoral wards in England & Wales ranked by deprivation score
Life
exp
ecta
ncy
(yea
rs)
Mostdeprived
www.equalitytrust.org.uk
Gezondheid hangt samen met inkomensverschillen binnen rijke samenlevingen maar niet met inkomensverschillen tussen rijke samenlevingen
Tussen (rijke) samenlevingen Binnen samenlevingen
Income per head and life-expectancy: rich and poor countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Inkomen per hoofd en levensverwachting: in rijke en arme landen
How much richer are the richest 20% than the poorest 20%?
www.equalitytrust.org.ukSource: Wilkinson & Pickett, The Spirit Level (2009)
Hoeveel rijker zijn de rijkste 20% dan de armste 20%?
Index van: • Levensverwachting• Wiskunde en
geletterdheid • Kindsterfte• Moorden• Detentiegraad• Tienerzwangerschappen
• Vertrouwen• Obesitas• Geestelijke problemen –
incl. drugs- en alcoholverslaving
• Sociale mobiliteit
Health and Social Problems are Worse in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Gezondheidsproblemen en sociale problemen zijn groter in meer ongelijke landen
Health and Social Problems are not Related to Average Income in Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Gezondheidsproblemen en sociale problemen zijn niet gerelateerd aan het gemiddeld inkomen in rijke landen
Index of: • Life expectancy• Math & Literacy • Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness – incl.
drug & alcohol addiction• Social mobility
Child Well-being is Better in More Equal Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Welzijn van kinderen is groter in meer gelijke (rijke) landen
Child-Wellbeing is Unrelated to Average Incomes in Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Welzijn van kinderen is niet gerelateerd aan gemiddelde inkomens in rijke landen
Health and social problems which are substantially worse in more unequal societies
International data:• Social Mobility / sociale mobiliteit• Hours worked / werkuren• Child conflict / kinderconflicten• UNICEF Child well-being Index / index
kinderwelzijn (UNICEF)
US states data:• High school drop-out rate /
veel schoolverlaters
Data available for countries and for states of the USA:
• Social capital/ sociaal kapitaal
• Drug abuse/ druggebruik
• Trust/ vertrouwen• Homicides/ moorden
• Maths & literacy scores/ Wiskunde en geletterdheid
• Obesity/ obesitas
• Teenage birth rates/ tienerzwangerschappen
• Life expectancy/ levensverwachting
• Imprisonment rates/ detentiegraad
• Infant mortality/ kindersterfte
• Mental illness/ psychische ziekten
• Low birth weight/ laag geboortegewicht
[Smoking and suicide are the only counter examples we have found]
Gezondheidsproblemen en sociale problemen die substantieel groter zijn in meer ongelijke samenlevingen
Beschikbare data voor landen en voor staten van de VS:
Levels of Trust are Higher in More Equal Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009)
Vertrouwen is groter in meer gelijke (rijke) landen
The Prevalence of Mental Illness is Higher in More Unequal Rich Countries
www.equalitytrust.org.uk
Het voorkomen van psychische ziekten is groter in meer ongelijke (rijke) landen
Homicide and income inequality: US States and Canadian Provinces
0
30
60
90
120
150
180
0.35 0.38 0.41 0.44 0.47
Income Inequality (Gini)
Ho
mic
ide
s p
er
mill
ion
pe
op
le
More equal More unequal
Source: Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Canadian Journal of Criminology 2001; 43: 219-36.
Teenage Birth Rates are Higher in More Unequal Rich Countries
www.equalitytrust.org.uk
Meer tienerzwangerschappen in meer ongelijke (rijke) landen
Drug Use is More Common in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009)
Index of use of: opiates, cocaine, cannabis, ecstasy, amphetamines
www.equalitytrust.org.uk
Druggebruik komt meer voor in meer ongelijke landen
Rates of Imprisonment are Higher in More Unequal Countries
www.equalitytrust.org.uk
Meer gevangenen in meer ongelijke landen
Almost everyone benefits from greater equality.
Bijna iedereen geniet van grotere gelijkheid.
Usually the benefits are greatest among the poor but extend to the majority of the population.
Normaal zijn de voordelen het grootst voor de armen, maar dit geldt voor de meerderheid van de bevolking.
Infant Mortality by Social Class: Sweden and England & Wales
0
2
4
6
8
10
12
14
16
18
I II IIIN IIIM IV V SinglePrnt
Unclass.
E & W
Sweden
Source: Leon DA, Vagero D, Olausson PO. BMJ 1992; 305; 687-91
Infa
nt M
orta
lity
rate
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.
Index of: • Life expectancy• Math & Literacy • Infant mortality• Homicides• Imprisonment• Teenage births • Trust• Obesity• Mental illness – incl.
drug & alcohol addiction• Social mobility
Health and Social Problems are Worse in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Gezondheidsproblemen en sociale problemen zijn groter in meer ongelijke landen
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
Alleenstaande ouders en kinderwelzijn
Why are we so sensitive to inequality?
Waarom zijn we zo gevoelig voor ongelijkheid?
What kind of stress most reliably raises cortisol levels?
Welk soort van stress doet het niveau van cortisol (stresshormoon) verhogen?
A meta-analysis of 208 laboratory studies of cortisol responses to acute stressors found that “Tasks that included social-evaluative threat (such as threats to self-esteem or social status), in which others could negatively judge performance, particularly when the outcome of the performance was uncontrollable, provoked larger and more reliable cortisol changes than stressors without these particular threats.”
Uit een meta-analyse van 208 laboratorische studies van cortisol (stresshormoon) reacties op acute stressverwekkers blijkt dat taken met een sociaal-evaluatieve bedreiging (zoals bedreigingen van het zelfvertrouwen en sociale status), waarin anderen negatief konden beoordelen, ontlokken grotere en meer betrouwbare cortisol veranderingen dan stressverwekkers zonder deze bedreigingen.
What kind of stress most reliably raises cortisol levels?
Welk soort van stress doet het niveau van cortisol (stresshormoon) verhogen?
"Humans are driven to preserve the social self and are vigilant to threats that may jeopardize their social esteem or status.”
“Mensen zijn gedreven om het sociale zelf te bewaren en zijn op hun hoede voor bedreigingen die hun sociaal vertrouwen of status in gevaar brengen.”
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
Inequality and Sustainability
Consumerism is one of the greatest threats to sustainability
Because inequality increases status competition, it also increases consumerism. People in more unequal societies work longer hours because money seems even more important.
Consumentisme is een van de grootste bedreigingen van duurzaamheid
Omdat ongelijkheid statuscompetitie verhoogt, verhoogt het ook het consumentisme. Mensen in meer ongelijke samenlevingen werken langere uren omdat geld nog belangrijker lijkt.
Inequality and Sustainability Concern for the common good is a crucial resource if we are to reduce carbon emissions
Because inequality harms the quality of social relations, people become more self-interested, less public spirited, less concerned with the common good. This is shown in the amount of overseas aid countries give, in the proportion of waste recycled, in how countries score on the global peace index, and in how important business leaders think it is that their governments abide by international environmental agreements.
Betrokkenheid bij het gezamenlijk goed is cruciaal als we de CO²-uitstoot willen verminderen
Omdat ongelijkheid de kwaliteit van sociale relaties aantast, worden mensen meer egocentrisch en minder betrokken bij het gemeenschappelijk goed. Dit is bewezen in de hoeveelheid overzeese hulp landen geven, in de hoeveelheid afval dat gerecycleerd wordt, in hoe landen scoren op de vredesindex, en in hoe belangrijk zakenmensen denken over de belangrijk dat de overheid toetreedt tot internationale milieu-overeenkomsten.
http://www.equalitytrust.org.uk
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