1. Inequality: the enemy between usRichard Wilkinson Emeritus Professor of Social Epidemiology University of Nottingham& Kate PickettSenior Lecturer in Epidemiology University of Yorkhttp://www.equalitytrust.org.uk

2. Income per head and life-expectancy: rich & poor countriesSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 3. Health is related to income differences within rich societiesbut not to those between themBetween (rich) societiesWithin societies80797877 Life expectancy (years)76757473727170edrivepMost td asdeprived Le Electoral wards in England & Wales ranked by deprivation scoreSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 4. How much richer are the richest 20% than the poorest 20%?Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 5. Health and Social Problems are Worse in More Unequal CountriesIndex of: Life expectancy Math & Literacy Infant mortality Homicides Imprisonment Teenage births Trust Obesity Mental illness incl.drug & alcoholaddiction Social mobilitySource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 6. Health and Social Problems are not Related to AverageIncome in Rich CountriesIndex of: Life expectancy Math & Literacy Infant mortality Homicides Imprisonment Teenage births Trust Obesity Mental illness incl.drug & alcoholaddiction Social mobilitySource: Wilkinson & Pickett, The Spirit Level (2009)www.equalitytrust.org.uk 7. Child Well-being is Better in More Equal Rich CountriesSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 8. Child-Wellbeing is Unrelated to Average Incomes in Rich CountriesSource: Wilkinson & Pickett, The Spirit Level (2009)www.equalitytrust.org.uk 9. Levels of Trust are Higher in More Equal Rich CountriesSource: Wilkinson & Pickett, The Spirit Level (2009) 10. The Prevalence of Mental Illness is Higher in MoreUnequal Rich CountriesSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 11. Drug Use is More Common in More Unequal Countries Index of use of: opiates, cocaine, cannabis, ecstasy, amphetaminesSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 12. Infant Mortality Rates are Higher in More Unequal CountriesSource: Wilkinson & Pickett, The Spirit Level (2009)www.equalitytrust.org.uk 13. More Adults are Obese in More Unequal Rich CountriesSource: Wilkinson & Pickett, The Spirit Level (2009)www.equalitytrust.org.uk 14. Teenage Birth Rates are Higher in More Unequal Rich CountriesSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 15. Homicide and income inequality:US States and Canadian Provinces 180 150Homicides per million people 120 90 60 300 0.35 0.38 0.41 0.440.47 More equalIncome Inequality (Gini)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. 16. Rates of Imprisonment are Higher in More Unequal CountriesSource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 17. Almost everyone benefits fromgreater equality.Usually the benefits are greatestamong the poor but extend to themajority of the population 18. Infant Mortality by Social Class:Sweden and England & Wales 18 E& W 16 Sweden Infant Mortality rate 14 12 10 8 6 4 2 0I II IIIN IIIM IVVSingle Unclass. PrntSource: Leon DA, Vagero D, Olausson PO. BMJ 1992; 305; 687-91 19. Literacy Scores of 16-25 year olds by1 Parents Education0.5 Sweden Literacy score0 Canada-0.5 -1 United States-1.5 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Parents Education (years)Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment. 20. Health and Social Problems are Worse in More Unequal CountriesIndex of: Life expectancy Math & Literacy Infant mortality Homicides Imprisonment Teenage births Trust Obesity Mental illness incl.drug & alcoholaddiction Social mobilitySource: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk 21. Why are we so sensitive to inequality? 22. Psychosocial risk factors for ill health Low social status Weak social affiliations Stress in early life (pre- and postnatally) 23. What kind of stress most reliably raises cortisol levels?A meta-analysis of 208 laboratory studies of cortisol responses toacute stressors found that Tasks that included social-evaluativethreat (such as threats to self-esteem or social status), in whichothers could negatively judge performance, particularly when theoutcome of the performance was uncontrollable, provoked largerand more reliable cortisol changes than stressors without theseparticular threats. (p.377)"Humans are driven to preserve the social self and are vigilant tothreats that may jeopardize their social esteem or status. (p.357)Source: Dickerson SS, Kemeny ME. Acute stressors and cortisolresponses: a theoretical integration and synthesis of laboratory research.Psychological Bulletin 2004; 130(3): 355-91 24. 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 itwas because he disrespected me, or he disrespected myvisit (meaning visitor). The word disrespect is central in thevocabulary, moral value system, and psychodynamics ofthese chronically violent men that they have abbreviated itinto the slang term, he dised me." p.106A few pages further on Gilligan continues:-"I have yet to see a serious act of violence that was notprovoked by the experience of feeling shamed andhumiliated, disrespected and ridiculed, and that did notrepresent the attempt to prevent or undo this "loss of face " -no matter how severe the punishment, even if it includesdeath." p.110 25. Stereotype ThreatThe effect of caste on childrens performance6High Caste5 Number of mazes solvedLow Caste43210 CasteCasteUnannounced AnnouncedSource: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004 26. Inequality affects us in two stages 1. Adult experience of inequality 2. Passed on to children (epigenetics?) 27. Working hours are longer in more unequal countriesSource: Bowles S, Park Y. Economic Journal 2005; 115 (507): F397F412. 2005. 28. Overdeveloped countries?High life expectancy can be achieved with low CO2 emissions www.equalitytrust.org.uk 29. Growth is a substitute for equality ofincome. So long as there is growth,(people feel) there is hope, and thatmakes large income differencestolerable.Henry Wallich, a former governor of AmericasFederal Reserve Bank and later professor ofeconomics at Yale. 30. In more equal countries business leaders give a higher priority to complying with international environmental agreements With permission from R De Vogli & D Gimeno 31. More equal countries recycle a higher proportion of waste materials 32. More equal societies are more innovativewww.equalitytrust.org.uk 33. Trends in income inequality 1979-2005/6 (Gini coefficient, Great Britain.) Brewer M, Goodman A, Muriel A, Sibieta L. Poverty andInequality in the UK: 2007. Institute of Fiscal Studies, London. 34. For more information:a book and a websitehttp://www.equalitytrust.org.uk 35. How does your pay compare with an MP? 36. The L-Curve: A graph of USincome distribution by David Chandlerhttp://www.lcurve.org 37. The L-Curve: A graph of USincome distribution by David Chandlerhttp://www.lcurve.org 38. The L-Curve: A graph of USincome distribution by David Chandlerhttp://www.lcurve.org 39. The L-Curve: A graph of USincome distribution by David Chandlerhttp://www.lcurve.org 40. The L-Curve: A graph of USincome distribution by David Chandlerhttp://www.lcurve.org 41. Sources of data for the Index of Health and Social problemsComponentInternational data US state dataTrustPercent of people who respond positively to the statementPercent of people who respond positively to the statement most most people can be trusted people can be trusted 1999-20011999 World Values Survey Reverse-codedGeneral Social Survey Reverse-codedLife expectancyLife expectancy at birth for men and women Life expectancy at birth for men and women 2004 2000 United Nations Human Development Report Reverse-codedUS Census Bureau, Population Division Reverse-codedInfant mortality Deaths in the first year of life per 1000 live birthsDeaths in the first year of life per 1000 live births 2000 2002 World Bank US National Center for Health StatisticsObesityPercentage of the population with BMI > 30, averaged for men Percentage of the population with BMI > 30, averaged for men and and womenwomen, 1999-2002 2002 Estimates from Prof Ezzati, Harvard University, based on NHANES International Obesity TaskForceand BRFSS surveysMental healthPrevalence of mental illness Average number of days in past month when mental health was not 2001-2003good WHO1993-2001, BRFSSEducationCombined average of maths literacy and reading literacyCombined average of maths and reading scores for 8 gradersth scores of 15-year olds 2003 2000 US Department of Education, National Center for Education OECD PISA Reverse-codedStatistics Reverse codedTeenage birth rate Births per 1000 women aged 15-19 years Births per 1000 women aged 15-19 years 1998 2000 UNICEF US National Vital StatisticsHomicidesHomicide rate per 100,000Homicide rate per 100,000 Period average for 1990-2000 1999 United Nations FBIImprisonment Log of prisoners per 100,000 Prisoners per 100,000 United Nations 1997-8, US Department of JusticeSocial mobilityCorrelation between father and sons incomeN/A 30-year period data from 8 cohort studies London School of Economics 42. Institutional change? Transforming the social environment peoplefeeling valued Economic democracy from companies aspieces of property to communities Other successful institutional structures An ethical consumer movement - supportingother forms of ownership & control 43. Health and social problems whichare substantially worse in more unequal societiesData available for countries and for states of the USA:- Low birth weight Mental illness Infant mortality Imprisonment rates Life expectancy Teenage birth rates Obesity Maths & literacy scores Homicides Trust Drug abuse Social capitalInternational data: Social Mobility US states data: High school drop-out rate Hours worked Child conflict UNICEF Child well-being Index[Smoking and suicide are the only counter examples we have found] 44. Living conditions & Poverty: USA 2005The poorest 12.6% (below Federal poverty line):-80% have air conditioning78% have a VCR or DVD player73% own a car or truck31% own more than one car55% have two or more TVs36% have a dishwasher36% have a computer43% own their homes10% in mobile homes 6% over-crowded (>1 per room) Childrens protein intake: 100% above recommended Most vitamins & minerals: well over recommended 45. More equal countries are more generous foreign aid donors 46. Correlations & p-values: Index of Health & Social Problems IndicatorInternational data US datar p-valuer p-value Trust-0.66