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Photo by kind permission of Matt Stuart Inequality, Health and Wellbeing Richard Wilkinson Emeritus professor of social epidemiology

Inequality, health and wellbeing annual... · Inequality, Health and Wellbeing. ... Life expectancy in rich countries is no longer related to National Income per head. 70 71 72 73

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  • Photo by kind permission of Matt Stuart

    Inequality, Health and WellbeingRichard Wilkinson

    Emeritus professor of social epidemiology

  • Individual differences will explain who falls, but the height of the hurdles will explain how many fall

  • Walker, R. et al.Poverty in global perspective.

    Journal of Social Policy 2013; 42, 215-233

  • 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 o

    f maz

    es s

    olve

    d

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

    Status differentiation effects cognitive performance

    Chart1

    5.545.72

    6.114.28

    High Caste

    Low Caste

    Sheet1

    High Caste5.546.11

    Low Caste5.724.28

    Sheet2

    Sheet3

  • Life expectancy and GDP per person

  • 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

  • Carol Shively studies macaques in captivity

    Social hierarchy in non-human primates

    Robert Sapolsky studies baboons in the wild

  • 3.7 3.94.3 4.6

    4.8 5.25.3 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

    Japa

    nFi

    nlan

    dNo

    rway

    Swed

    enDe

    nmar

    kBe

    lgiu

    mAu

    stria

    Germ

    any

    Neth

    erla

    nds

    Spain

    Fran

    ceCa

    nada

    Swizt

    erla

    ndIre

    land

    Gree

    ceIta

    lyIs

    rael

    New

    Zeal

    and

    Aust

    ralia UK

    Portu

    gal

    USA

    Sing

    apor

    e

    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

    Inde

    x of

    hea

    lth a

    nd s

    ocia

    l pro

    blem

    s

  • Low Income Inequality (Gini) High

    UN

    ICEF

    Inde

    x of

    Chi

    ld W

    ellb

    eing

    Child Wellbeing is lower in more unequal countries

    Pickett & Wilkinson, Pediatrics 2015; 135 (1): S39-S47

  • Death rates of men 25-64yrs & income inequalityUS states and Canadian provinces

    Ross, Wolfson, Dunn, Berthelot, Kaplan, Lynch. British Medical Journal 2000;320:898-902

    Dea

    ths

    per 1

    00,0

    00 p

    opn

    Income inequality (median share)

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

  • www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level

    Mental illness is more common in more unequal societies

  • www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level

    Imprisonment rates are higher in more unequal countries

  • Data from Corak (2013), World Bank (2013)

  • Lancee B, Van de Werfhorst HG. Income inequality and participation: A comparison of 24 European countries. Social Science Research. 2012; 41(5):1166-78.

    Participation in local groups and voluntary organisations is lower in more unequal societies.

    Civ

    ic p

    artic

    ipat

    ion

    scor

    e

    Income inequality (MDMI)

  • Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk

    People in more unequal countries trust each other less

  • 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

    Chart1

    158.6200227956

    136.6553734085

    133.3989753432

    128.7166700272

    127.774288225

    131.6498947648

    126.4581603634

    112.6480730374

    107.9250623775

    104.566284719

    118.5305572779

    108.1828588705

    104.8845221654

    109.6285026311

    107.7536068044

    94.6083664474

    84.683751948

    83.1567003131

    65.538845896

    65.5869525509

    63.673812733

    82.8964301803

    99.5398321064

    112.6456008603

    66.1382962694

    59.3664702276

    56.857568076

    50.5273271359

    54.3634675933

    47.0735748489

    48.4945493689

    52.2776469299

    52.2825810879

    56.5479713571

    49.2543782229

    43.8258126217

    39.3482638454

    34.6264846114

    15.0190103974

    27.2416075065

    28.1827561813

    31.7068210371

    21.7723327911

    23.4128666994

    35.3887661543

    38.4305376353

    39.1373243559

    28.4911137432

    33.6261057919

    26.9393735331

    8.7935328878

    17.3995828531

    7.2874765973

    16.8247998769

    19.4348563444

    33.1117377058

    31.7512100001

    25.382727261

    22.8355860233

    29.6764933112

    Low

    High

    Income Inequality

    Homicides per million people

    Sheet1

    Set 1Set 2Active

    Points=50Points=10

    xyxy

    0.4719782826158.6200227956

    0.4667037049136.6553734085

    0.4475541778133.3989753432

    0.4505041732128.7166700272

    0.4505082991127.774288225

    0.4376747865131.6498947648

    0.43684308126.4581603634

    0.4458140923112.6480730374

    0.444736209107.9250623775

    0.4387698592104.566284719

    0.4217420562118.5305572779

    0.4236182939108.1828588705

    0.423632734104.8845221654

    0.4267855862109.6285026311

    0.4277702933107.7536068044

    0.432588275394.6083664474

    0.429702228584.683751948

    0.441793087683.1567003131

    0.446996837965.538845896

    0.451757059165.5869525509

    0.425644087763.673812733

    0.416039067482.8964301803

    0.407665962499.5398321064

    0.3989421576112.6456008603

    0.389746955266.1382962694

    0.395757658159.3664702276

    0.403946822256.857568076

    0.407026094350.5273271359

    0.413600670154.3634675933

    0.414975269947.0735748489

    0.415701423648.4945493689

    0.417027548552.2776469299

    0.417515776552.2825810879

    0.419938351356.5479713571

    0.420946780349.2543782229

    0.419994046143.8258126217

    0.419891585339.3482638454

    0.418935756634.6264846114

    0.41377290715.0190103974

    0.410911966227.2416075065

    0.410785783828.1827561813

    0.409793857531.7068210371

    0.405931349721.7723327911

    0.405069731323.4128666994

    0.401111308435.3887661543

    0.399022931738.4305376353

    0.399019837639.1373243559

    0.39467219628.4911137432

    0.389889283133.6261057919

    0.381007998926.9393735331

    0.35728526238.7935328878

    0.369575893117.3995828531

    0.37145109497.2874765973

    0.382639087316.8247998769

    0.384458597819.4348563444

    0.385619350533.1117377058

    0.390873989931.7512100001

    0.390169494125.382727261

    0.394574891122.8355860233

    0.395399381429.6764933112

    Sheet2

    Sheet3

  • Cuernavaca, Mexico

  • Armed Response - Pretoria, South Africa.

  • Bowles & Jayadev, NYT 2014

    Prot

    ectiv

    e se

    rvic

    e em

    ploy

    ees

    per 1

    0,00

    0 w

    orke

    rs

    Societies with wider Income differences need more guard labor

    The proportion of guard labor grew with inequality.USA 1979-2000

    Inequality (Gini)

  • Bigger material differences create bigger social distances and increase social class differentiation

  • 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)

    Lite

    racy

    sco

    re

    Sweden

    Canada

    United States

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

  • 0

    10

    20

    30

    40

    50

    Low High Low High Low High Low High Low HighEngland

    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

  • 0

    5

    10

    15

    Singlemothers

    Low HighFather's occupational class

    Infa

    nt d

    eath

    s pe

    r 10

    00 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

  • Layte R, Whelan CT. Who Feels Inferior? A Test of the Status Anxiety Hypothesis of Social Inequalities in Health. European Sociological Review, 2014.

    Status Anxiety across income deciles for high, medium and low inequality countries

    Stat

    us A

    nxie

    ty

    Income deciles

    High inequality

    Medium inequalityLow inequality

    Countries with:-

  • 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 stress cause the biggest rise in stress hormones?

  • The Dominance Behavioural System

    Johnson SL, Leedom LJ, Muhtadie L. The Dominance Behavioral System and Psychopathology.

    Psychological Bulletin, 2012; 138(4): 692-743.

    Findings:-

    Anxiety and depression are related to subordination, to submissiveness and to the desire to avoid subordination.

    Mania and narcissistic traits are related to inflated self-perceptions of power.

    Externalizing disorders, mania proneness, and narcissistic traits are related to heightened dominance motivation and behaviour.

  • Messias E, Eaton WW, et al. . Economic grand rounds: Income inequality and depression across the United States: an ecological study." Psychiatric Services, 2011; 62(7): 710-2.

    Depression is more common in more unequal statesPe

    rcen

    t of p

    opul

    atio

    n de

    pres

    sed

    in p

    ast 2

    wee

    ks

    Income Inequality (Gini)

  • Burns JK, et al.. Int J Soc Psychiatry, 2013; 60(2), 18596.

    Income inequality and schizophrenia

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

    Self enhancement increases in more unequal societies

  • Two recent studies show that inequality increases conspicuous consumption and

    consumerism

    People in more unequal areas of the USA are more likely to buy high status cars

    Data from internet searches shows that people in more unequal states are more likely to search for status goods

  • Iacoviello M. Household Debt and Income Inequality, 19632003. Journal of Money, Credit and Banking 2008;40(5):929-65.

    Household Debt and Income Inequality USA

  • Gains of the past are being undone

    Taylor-Robinson D, Whitehead M, Barr B. BMJ 2015

  • Changes in death ratesof pensioners aged over 85 by local authority 2011-12

    Loopstra R, et al.. Austerity and old-age mortality in England: a longitudinal cross-local

    area analysis, 20072013.Journal of the Royal Society of Medicine2016;109.3: 109-116.

  • Fig 1 Infant mortality rate (95% confidence interval) by socioeconomic classification, 2008-15.

    David Taylor-Robinson, and Ben Barr BMJ 2017;357:bmj.j2258

    2017 by British Medical Journal Publishing Group

  • Belfield C, Cribb J, Hood A, Joyce R. Living Standards, Poverty and Inequality in the UK: 2015. (Institiute for Fiscal Studies, 2015).

    Trends in Income inequality Gini and 90:10 ratio. Institute For Fiscal Studies, BHC, GB.

  • USA

    UKGermany

    IrelandAustralia

    SwedenNetherlands

    Percent of all income going to top 1% 1930-2014

    Source: World Top Incomes Database

    % o

    f inc

    ome

    rece

    ived

    by

    riche

    st 1

    %

  • Colin Gordons 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)

    40

  • 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%

  • Companies paying CEOs above the median performed less well than those paying below the median

    Marshall R, Lee L. Are CEOs paid for performance? MSCI 2016

    10yr performance of 429 large publicly quoted companies

    Cum

    ulat

    ive

    shar

    ehol

    der r

    etur

    ns

  • What can be done?

    Taxes & benefits

    Stop tax avoidance

    End tax havens

    Make taxation progressive again

    Income differences before tax

    Increase economic democracy -employee ownership etc

    Strengthen trade unions

  • Economic democracy:-

    turns companies from being pieces of property into communities

    reduces pay ratios within companies transforms the experience of work redistributes wealth & reduces unearned income improves productivity makes companies more environmentally &

    socially responsible

    Boards can include employee, community and consumer representatives

  • 45

  • The Effects of Income inequality

    EVIDENCE OF CAUSALITYPickett KE, Wilkinson RG. Income inequality and health: a causal review. Social Science & Medicine 2015;128: 316-26

    THEORY & PSYCHOSOCIAL PROCESSESWilkinson RG, Pickett KE. The enemy between us: The psychological and social costs of inequality.European Journal of Social Psychology, 2017; 47, 11-24. http://dx.doi.org/10.1002/ejsp.2275

    CREATING THE SOCIETY WE WANTWilkinson RG, Pickett KE. A Convenient Truth: A Better Society for Us and the Planet. Fabian Society, London 2014. http://www.fabians.org.uk/publications/a-convenient-truth/

    http://dx.doi.org/10.1002/ejsp.2275

  • Local Authority Budget cuts 2010-11 to 2014-15 and premature mortality

    Taylor-Robinson D et al. BMJ 2013; 347: bmj.f4208

    Premature mortality rate (

  • The index of health inequality measures the proportion of illness that correlates with income status. Source: Hertzman C. American Scientist, 2001; 89 (6): 538-45

    Life expectancy is worse where health inequalities are larger

  • Doorslaer E. et al. J Health Economics 1997; 16: 93-112

    Health inequalities are larger where income differences are larger

  • OECD (2015), "In It Together", http://www.oecd.org/social/in-it-together-why-less-inequality-benefits-all-9789264235120-en.htm.

    Income Inequality 1995-2012

  • Carol Shively studies macaques in captivity

    Social hierarchy in non-human primates

    Robert Sapolsky studies baboons in the wild

  • Plasma fibrinogen by employment gradeamong Civil Servants, Whitehall II.

    Brunner E, Davey Smith G, Marmot M, et al. Lancet 1996; 347: 1008-1013

    (Adjusted for age, ethnic origin and womens menopausal status)

  • Womens preference for more masculinized faces is stronger in more unequal societies

    Brooks R, Scott IM, et al. Proceedings of the Royal Society, B, 2011; 278: 810 12

  • 56

    Psychosocial risk factors for ill health

    Low social status

    Weak social connections

    Stress in early life (pre- & post-natal)

  • The Jekyll & Hyde of Public Health?

    Friendship in contrast, is based on reciprocity, mutuality, social obligations, sharing and a recognition of each others needs.

    Social status (dominance hierarchies, pecking orders) are orderings based on power, coercion and privileged access to resources regardless of the needs of others.

  • Companion Spanish: Compaero; French: Copain

    from the Latin Con (with) and Pan (bread)

    - someone with whom you eat bread

  • Marshall Sahlins, Stone Age Economics (1974)

    Gifts make friends and friends make gifts

  • Brands owned by the big ten food multinationals

    Oxfam and ww.behindthebrands.org

  • Kondo et al, BMJ, 2009; 339: b4471

    Inequality and mortality over time: multilevel cohort studies

  • Time lags between changes in inequality and changes in health

    Zheng H. Do people die from income inequality of a decade ago? Social Science & Medicine 2012;75(1):36-45.

    Lillard DR, Burkhauser RV, Hahn MH, Wilkins R. Does early-life income inequality predict self-reported health in later life? Evidence from the United States. Social Science & Medicine 2015;128(0):347-55.

  • Charles Cooley (1864-1929)

    Many people of balanced mind and congenial activity scarcely know that they care what others think of them, and will deny, perhaps with indignation, that such care is an important factor in what they are and do. But this is an illusion. If failure or disgrace arrives, if one suddenly finds that the faces of men show coldness or contempt instead of the kindliness and deference that he is used to, he will perceive from the shock, the fear, the sense of being outcast and helpless, that he was living in the minds of others without knowing it, just as we daily walk the solid ground without thinking how it bears us up.

    Human Nature and the Social Order. 1902, p.207

  • Alan Bennett, Untold Stories, Faber/Profile, 2005

    (My parents) putdownmost of their imagined shortcomings to their not having been educated, education (was) to them a passport to everything they lacked: self-confidence, social ease and above all the ability to be like other people.Put simply and as they themselves would have put it, both my parents were shy, a shortcoming they thought of as an affliction while at the same time enshrining it as a virtue.I assured them, falsely, that everybody felt much as they did but that social ease was something that could and should be faked.Well, you can do that, Dad would say, you've been educated, adding how often he felt he had nothing to contribute. I'm boring, I think. I can't understand why anybody likes us. I wonder sometimes whether they do, really.

  • School bullying is much more common in countries with bigger income differences.11-year-olds in 37 countries (r = .62)

    Elgar FJ. et al. School bullying, homicide and income inequality. International Journal of Public Health 58, 237-245, 2013.

    Income inequality (Gini)

    % o

    f 11y

    r old

    s w

    ho b

    ullie

    d ot

    hers

    tw

    o or

    mor

    e tim

    es p

    er m

    onth

  • 66

    Teenage Birth Rates are Higher in More Unequal Rich Countries

    Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

  • Credit Lyonnais Securities Asia. Bloomberg Businessweek

    Rank total shareholder return in relation to CEO pay rankamong Australias largest 200 companies

    Stoc

    k re

    turn

    rank

    CEO pay rank

  • Slide Number 1Slide Number 2Slide Number 3Slide Number 4Status differentiation effects cognitive performanceSlide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Health and social problems are worse in more unequal countriesSlide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Slide Number 23Slide Number 24Slide Number 25Slide Number 26Slide Number 27Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Gains of the past are being undoneSlide Number 36Slide Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number 41Slide Number 42Slide Number 43Slide Number 44Slide Number 45Slide Number 46Slide Number 47Slide Number 48Slide Number 49Slide Number 50Slide Number 51Slide Number 52Slide Number 53Plasma fibrinogen by employment gradeamong Civil Servants, Whitehall II.Slide Number 55Slide Number 56Slide Number 57Slide Number 58Slide Number 59Slide Number 60Inequality and mortality over time: multilevel cohort studiesSlide Number 62Slide Number 63Slide Number 64School bullying is much more common in countries with bigger income differences.11-year-olds in 37 countries (r = .62)Slide Number 66Slide Number 67Slide Number 68