This is a book with a big idea, big enough to change political thinking, and
bigger than its authors at first intended. The problem they originally set
out to solve was why health within a population gets progressively worse
further down the social scale; they estimate that together they have clocked
up more than 50 person-years gathering information from research teams
across the globe. Their eureka moment came when they thought of putting the
medical data alongside figures showing the extent of economic inequality
within each country. They say modestly that since dependable statistics both
on health and on income distribution are internationally available, it was
only a matter of time before someone put the two together. All the same,
they are the first to have done so.
Their book charts the level of health and social problems — as many as they
could find reliable figures for — against the level of income inequality in
20 of the world’s richest nations, and in each of the 50 United States. They
allocate a brief chapter to each problem, supplying graphs that display the
evidence starkly and unarguably. What they find is that, in states and
countries where there is a big gap between the incomes of rich and poor,
mental illness, drug and alcohol abuse, obesity and teenage pregnancy are
more common, the homicide rate is higher, life expectancy is shorter, and
children’s educational performance and literacy scores are worse. The
Scandinavian countries and Japan consistently come at the positive end of
this spectrum. They have the smallest differences between higher and lower
incomes, and the best record of psycho-social health. The countries with the
widest gulf between rich and poor, and the highest incidence of most health
and social problems, are Britain, America and Portugal.
Richard Wilkinson, a professor of medical epidemiology at Nottingham
University, and Kate Pickett, a lecturer in epidemiology at York University,
emphasise that it is not only the poor who suffer from the effects of
inequality, but the majority of the population. For example, rates of mental
illness are five times higher across the whole population in the most
unequal than in the least unequal societies in their survey. One
explanation, they suggest, is that inequality increases stress right across
society, not just among the least advantaged. Much research has been done on
the stress hormone cortisol, which can be measured in saliva or blood, and
it emerges that chronic stress affects the neural system and in turn the
immune system. When stressed, we are more prone to depression and anxiety,
and more likely to develop a host of bodily ills including heart disease,
obesity, drug addiction, liability to infection and rapid ageing.
Societies where incomes are relatively equal have low levels of stress and
high levels of trust, so that people feel secure and see others as
co-operative. In unequal societies, by contrast, the rich suffer from fear
of the poor, while those lower down the social order experience status
anxiety, looking upon those who are more successful with bitterness and upon
themselves with shame. In the 1980s and 1990s, when inequality was rapidly
rising in Britain and America, the rich bought homesecurity systems, and
started to drive 4x4s with names such as Defender and Crossfire, reflecting
a need to intimidate attackers. Meanwhile the poor grew obese on comfort
foods and took more legal and illegal drugs. In 2005, doctors in England
alone wrote 29m prescriptions for antidepressants, costing the NHS £400m.
Status anxiety and how we respond to it are basic, it seems, to our animal
natures. In an experiment with macaque monkeys, the animals were housed in
groups, and the social hierarchies that developed among them were observed.
Then the monkeys were taught to administer cocaine to themselves by pressing
a lever. The dominant monkeys in each group were relatively abstemious, but
the subordinate monkeys took a lot of cocaine to medicate themselves against
the pain of low social status. In a similar experiment, high-status monkeys
from different groups were housed together, so that some of them became low
status. The downwardly mobile monkeys accumulated abdominal fat and
developed a rapid build-up of atherosclerosis in their arteries, just like
humans.
The different social problems that stem from income inequality often,
Wilkinson and Pickett show, form circuits or spirals. Babies born to teenage
mothers are at greater risk, as they grow up, of educational failure,
juvenile crime, and becoming teenage parents themselves. In societies with
greater income inequality, more people are sent to prison, and less is spent
on education and welfare. In Britain the prison population has doubled since
1990; in America it has quadrupled since the late 1970s. American states
with a wide gap between rich and poor are likelier to retain the death
penalty, and to hand out long sentences for minor crimes. In California in
2004, there were 360 people serving life sentences for shoplifting.
California has built only one new college since 1984, but 21 new prisons.
Whereas societies with high income differentials are exceptionally punitive,
in Japan imprisonment rates are low and offenders who confess their crimes
and express a desire to reform are generally trusted to do so by the
judiciary and the public.
The authors’ method is objective and scientific, so that the human distress
behind their statistics mostly remains hidden. But when they quote from
interviews conducted by social researchers, passion and resentment flood
into their book. A working-class man in Rotherham tells of the shame he felt
having to sit next to a middle-class woman (“this stuck-up cow, you know,
slim, attractive”); how he felt overweight and started sweating; how he
imagined her thinking, “listen, low-life, don’t even come near me. We pay to
get away from scum like you”. In half a page it tells you more about the
pain of inequality than any play or novel could.
It might be said that The Spirit Level merely formulates what everyone has
always felt. Western European utopias have almost all been egalitarian.
Polls in Britain over the past 20 years show that the proportion of the
population who think income differences too big is on average 80%. But what
is new about their book, the authors insist, is that it turns personal
intuitions into publicly demonstrable facts. With the evidence they have
supplied, politicians now have a chance to “do genuine good”. By reducing
income inequality, they can improve the health and wellbeing of the whole
population. How this should be effected, Wilkinson and Pickett do not think
it is their job to say, but increasing top tax rates or legislating to limit
maximum pay are possibilities they suggest. They warn, though, that
short-term remedies like this could be reversed by a change of government,
and that we need to find ways of rooting greater equality more deeply in our
society. This is their book’s mission, and they have set up a not-for-profit
trust (equalitytrust.org) to make the evidence they set out better known.
One illusion that, cheeringly, they hope to dispel is that the super-rich
are some kind of asset we should all cherish, rather than, from the
viewpoint of social health, the equivalent of the seven plagues of Egypt.
The Spirit Level by Richard Wilkinson and Kate Pickett
Allen Lane £20 pp416
