Wilkinson & Pickett (2009) The Spirit Level

                    A Synopsis of the book:  The Spirit Level (2009)                           by Richard Wilkinson and Kate Pickett

INEQUALITY: THE PRIME SUSPECT

    There are many variables that could be associated with increased risks for, and higher incidences of, various societal ills—ills such as chronic poverty, chronic illness, infant mortality, high crime rates, social bullying, social mistrust, school dropout rates, unwanted pregnancies, etc. It wouldn’t be too surprising, for instance, if a few of these problems were linked to the overall economic prosperity of various societies, with more highly developed and richer societies doing better at avoiding, controlling, or minimizing such problems. Or, perhaps differing levels of medical care in different societies may help to make some of these problems smaller in some locales and more pronounced in others. It would be rather surprising, however, if one and the same variable was found to be strongly associated with better and worse outcomes for almost all of such problem areas. And yet it now appears that there truly is one variable that is more highly associated with poor social outcomes in general than is any other single factor that has been examined.

    That one key variable turns out to be the amount of income inequality existing among the members of a social group, i.e. the relative sizes of all the differences between every pair of individual incomes for members of that particular group. In groups where there are extremes of income concentrated among a small proportion of the population, as for instance when more than 20% of total yearly income belongs to fewer than 1% of the people in that group, then social problems of the type listed above are markedly more severe than they are in populations where incomes are much more evenly distributed across all group members. This is the important conclusion documented by Richard Wilkinson and Kate Pickett in their book The Spirit Level, published in 2009. The implications of that conclusion are likely to be very far reaching. [The Spirit Level was initially published by Allen Lane publishers in the U.K., a division of the Penguin Group. In 2010 it was published in the USA by Bloomsbury Press, with a forward by Robert B. Reich. All page citations below refer to the 2010 Bloomsbury edition.]

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    In the preface to their book, Wilkinson & Pickett explain that in the beginning their research had been intended to determine the workings of the key variables that underlie large national differences in life expectancy.  It became clear at once that life expectancy was lowest among the poor, and that it appeared to be higher the further up the social ladder that you looked. But why? Was it simply that poor people couldn’t afford medical care and died early as a result? Was it because poor people were more exposed to medical risk factors like poor diet and unsanitary living conditions and polluted environments?

    Wilkinson & Pickett begin The Spirit Level with a graph showing the relationship between average income per person (in dollars) and average life expectancy (in years) for approximately 120 countries around the world. In the countries with low average income (less than about $15,000 per year per person) national average life expectancy is seen to be moderately low, but also highly variable. Life expectancy is less than 50 years in much of undeveloped Africa, yet it is above 70 years in some other undeveloped countries such as China and Albania. In economically developed countries however, with citizens who enjoy moderate to high average personal incomes, average life expectancy is rather higher, ranging between 75 and 85 years, and it shows no average increase with higher national incomes. Thus in Japan average life expectancy is nearly 82 years while the average income is about $29,000. Yet in the U.S.A. average life expectancy is about 5 years below that of Japan even though the average U.S. income is about 25% greater than in Japan. In Portugal the average per-capita income is half of that in the U.S.A., yet average life expectancy in Portugal is only a few months less than in the U.S.A. Clearly, in economically developed nations, national average income does not relate to, nor does it help one to predict, national life expectancy.

    Wilkinson & Pickett also note that, over the past few decades, average life expectancy has increased by a few years in all the developed countries. Thus, the reason that life expectancy appears to be unrelated to economic development in these countries is not because the people living there have reached some biological limit for life expectancy. The average limits that have been reached appear to be those resulting from sufficient access to basic food, hygiene, shelter, and medical care, once basic national economic development and political stability have been achieved. However, it turns out that life expectancy does still vary a great deal according to personal income within each of the economically advantaged countries, but not between them.

    Wilkinson & Pickett show that within each of the developed countries there is a clear link between average income and average life expectancy, one that shows no sign at all of disappearing at the higher levels of income. The average American and the average Portuguese live about the same length of time despite great differences in their respective incomes. But inside both the U.S. and Portugal, those who are relatively more wealthy live longer than those of average wealth, who in turn live longer than those even less well off, all in a nearly continuous decline across the entire income spectrum. Something about the relative differences among the incomes of people who are all citizens of the same national state clearly relates to longevity in a fashion that that average absolute income does not. Income inequality appears to affect life expectancy, even if the amount of income per se does not.

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    Longevity is only one variable reflecting overall health and overall quality of life. Wilkinson & Pickett began to suspect that a variety of other social indicators relating to the quality of life in a population might also be linked in some fashion to the degree of income inequality or equality in the population. To study this question more closely requires a measure of “inequality” that can be applied reliably and consistently to many different populations, each with its different statistics reflecting, for instance, income levels among its various citizens.

    One very simple measure of income inequality, one that the authors use to illustrate how different nations can be from each other, is to compare the total amount of income received by the poorest 20% of the population to the total amount received by the richest 20% of the population. Wilkinson & Pickett present a graph illustrating these ratios for twenty-three economically developed nations. Measured in this fashion, income inequality was found to vary considerably among these different countries. Inequality was lowest in Japan, where the wealthiest 20% received a little less than four times the total income received by the poorest 20%. Inequality was about “average” in Canada, where the same ratio was just under six times more income going to the wealthiest 20%. The ratio was highest for the USA and for Singapore where the wealthiest 20% received respectively 8.5 and 9.5 times the income total received by the poorest 20% of their citizens. This amounted to more than twice the level of inequality (measured in this fashion) than was seen in Japan.

    There are other ways to measure income inequality. One might compare the wealthiest 5% with the poorest 5%. One might compare the wealthiest 50% with the poorest 50%. One might use the proportion of the total population income that would have to be removed from those with more than average income and distributed among those with less than the average income so as to give everyone the exact same amount. Fortunately, all of these statistical variations tend to produce very similar rankings of inequality for those countries or groups being compared.

    A particularly sophisticated statistic for measuring degrees of inequality is called the Gini coefficient. The Gini has the advantage that it is sensitive to inequalities throughout an entire population, not just between two or more aggregated portions of that population. The Gini takes the value of 0.00 when every member of some population possesses the exact same amount of the variable being measured (e.g. income). It takes the value of 1.00 if the total amount of some variable is possessed by just one person.  So a Gini of 1.00 defines maximum inequality while 0.00 defines maximum equality.

    In studies of income inequality, the Gini is often found to be around 0.25 in relatively more equal populations, and it is often around 0.50 in populations that are comparatively high in inequality. Gini values are generally preferred as measures of inequality, and these were used by Wilkinson & Pickett whenever they were available. But often Ginis are not available, in which case the ratio of the total income possessed by the top versus the bottom 20% of the population was the index of inequality used by Wilkinson & Pickett for comparing the degrees of relative inequality in different populations. In every case, the raw data that Wilkinson & Pickett report in their book came from UN agencies, from government statistics, or from census data.

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    Wilkinson & Pickett first consider more than longevity as a sign of a healthy society. They write:

In the course of our research we became aware that almost all problems which are more common at the bottom of the social ladder are [also] more common in more unequal societies. It is not just [true for] ill-health and violence, but also…a host of other social problems. Almost all of them contribute to the widespread concern that modern societies are, despite their affluence, social failures. [pg. 18]

Wilkinson & Pickett were able to find reliable data for twenty developed nations, reflecting up to ten types of health or social problems. They were also able to get almost all of the same data (i.e. for the first nine of these same ten problem areas) for each one of the fifty states in the USA. These ten variables (health issues and social problems) were:

  • Life expectancy (as before)
  • Infant mortality rates
  • Rates of mental illness
  • Rates of obesity
  • Rates of early school leaving
  • Teenage birth rates
  • Homicide rates
  • Imprisonment rates
  • The degree to which people lack trust in the people around them
  • Social immobility (e.g. rates for earning no more than did one’s parents)

    Each nation was scored on each of these variables. For each variable, the twenty national (or fifty state) scores were numerically transformed in a fashion that moved the average of all the transformed scores to zero, with their standard deviation (i.e.their variability) equal to plus and minus 1.00. This had the effect of assuring exactly equal weight (importance) to every one of the ten “problem” variables when these were combined. Finally, Wilkinson & Pickett averaged the ten scores for each nation to form a single national score that they called their IHSP score (Index of Health and Social Problems). Thus, for each of the twenty nations, and also for each of the fifty American states, they had one IHSP score (reflecting the relative severity of problems and the general quality of life in that population) and, separately, one “Inequality” score (reflecting the degree of income inequality in the same population).

    In The Spirit Level, Wilkinson & Pickett present a two-dimensional scatter-plot for the twenty developed nations, illustrating and linking both the degree of income inequality and the corresponding IHSP scores. Increasing inequality was indicated along the horizontal axis and increasing “problem” scores were indicated along the vertical axis. For these twenty developed nations, all twenty data points in this plot can be seen to lie close to a rising straight line, thus exhibiting a marked association between the two variables across the full range of both dimensions. At the bottom on both scales lies Japan, lowest in inequality and lowest in average degree of the combined social problems. At the top of both scales lies the USA, with the highest degree of inequality and the highest combined score reflecting social problems. In between, the other 18 nations generally scatter proportionally along both dimensions. Thus, the degree of national inequality in personal incomes can be used to predict rather closely the scores reflecting the level of combined social problems found in each of these nations.

    But mightn’t the severity of the ten combined social problems simply reflect differences of average living standards (average per-capita incomes) in these nations? The same type of scatter plot, substituting per-capita incomes in the twenty nations instead of the degree of inequality, shows no relationship at all to the social problems scores. The USA and Norway have the highest two per-capita income scores, yet the USA has the highest total of social problems while Norway has the third lowest total of these same problems. The UK and Japan both have average per-capita income scores but Japan has the lowest degree of problems while the UK has quite a high level of these problems. It is true that Portugal has the lowest per-capita income score of all and it has the second highest social problems score. But the country with the highest social problems score is the USA, and it has the highest average per-capita income. Average living standard is clearly no help at all in predicting social problems in a nation.

    Are the data that so clearly link inequality to social problems in twenty developed nations simply some sort of fluke? To help decide that question Wilkinson & Pickett examined the relationship between these same two variables across the fifty states in the USA. The scatter-plot of income inequality versus the combined social problems index (the IHSP) for the fifty states looks very similar to that seen for the twenty developed nations. Again we see the data points clustered around a rising straight line, with the lowest social problems seen in states with low levels of income inequality while the highest levels of social problems are generally seen in states with high inequality.

    In this data set, however, not all the points lie as close to the “best-fit” line as they did for the twenty nations. There are four states in particular that do not appear to fit the trend illustrated strongly by the other forty-six states.  Alaska has the lowest income inequality of all fifty states, yet it has an average level of social problems on the IHSP scale, a level that is well above the bottom end of the “best-fit” line.  New York has the highest income inequality of all fifty states, yet it has an IHSP score that is actually below the U.S. average, well below the top end of the “best-fit” line. Connecticut and Massachusetts also lie far below the “best-fit” line, both of them with more than average income inequality yet notably lower than average IHSP-related problems.  But with these four exceptional states excluded, there again can be seen a dramatic clustering of the other forty-six states showing a very strong relationship between the overall income inequality in those states and the degree of the nine social problems (excluding social immobility rates, for which no data were available) that were combined in the states’ IHSP scores.

    Wilkinson & Pickett do not speculate on why Alaska exhibits relatively more social problems than might have been expected with so much economic equality present, nor why the three big New England states, with such significant income inequality, still do relatively well on the social-problems index. They do however look at the per-capita income versus IHSP scores for all fifty states and there they find a weak tendency for states with higher per-capita income to average slightly lower (better) IHSP scores. Alaska and New York have very similar per-capita income scores, both slightly above average for all fifty states. Connecticut and Massachusetts rank first and third of all the states in per-capita income, and do better than average on the IHSP measure. What is clear, however, is that per-capita income cannot be used to explain the strong linkage seen between inequality and social-problem levels among the fifty USA states, or among those twenty developed nations for which the required data were available.

    Finally, Wilkinson & Pickett asked themselves if the nine or ten variables they used for their combined IHSP index of social problems might have been unrepresentative or special in some unnoticed fashion. They decided to look at one other combined index similar to the IHSP. The United Nations Children’s fund (UNICEF) has created its own combined index for “child-wellbeing,” one that utilizes forty different variables (indicators) to come up with an overall “wellbeing” score for each nation’s children. Wilkinson & Pickett used this index, after removing the rate of child poverty that was part of it, since that factor is itself highly related to income inequality. Here too they found that greater income inequality in a country was associated with lower UNICEF “wellbeing” scores for the children in twenty-two developed countries. The strength of association was not as great as it had been for the IHSP measure, but the pattern was still very clear. And here too, when this UNICEF index was plotted against national per-capita income there was no sign of any relationship at all. So once again, it was the degree of income inequality, not low income per se, that was found to be strongly associated with health and social problems.

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    Wilkinson & Pickett next consider some implications of the findings they have so far reported. They write:

The problems in rich countries are not caused by the society not being rich enough (or even by being too rich) but by the scale of material differences between people within each society being too big. What matters is where we stand in relation to others in our own society. [pg. 25]

They go on to note that in America those who live below the poverty line (defined by an absolute income level, not some proportion of the average income) often find that they don’t have enough money to buy food. Yet surveys show that 80% of these same people have air-conditioning, almost 75% of them own a vehicle, and nearly a third of them also have a computer, a dishwasher, or a second car. Wilkinson & Pickett go on to say:

What this means is that when people lack money for essentials such as food, it is usually a reflection of the strength of their desire to live up to the prevailing standards. You may, for instance, feel it more important to maintain appearances by spending on clothes while stinting on food. …As Adam Smith emphasized, it is important to be able to present oneself creditably in society, without the shame and stigma of apparent poverty. However, just as the gradient in health ran right across society, from top to bottom, the pressures of inequality and of wanting to keep up are not confined to a small minority who are poor. Instead the effects are—as we shall see—widespread in the population. [pp. 25-26]

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    Although income inequality is the only type of inequality for which clear and objective measures are available, there are other types of inequality that may also have adverse effects on the overall quality of the life that societies enjoy. Inequality in overall wealth is not the same thing as income inequality, and it may play an additional role in augmenting social problems. Inequalities in social class and status may play a further role. Inequality in social power—the ability to access legal help, or advanced medical help, or educational opportunities—may play an important role in augmenting social stress and discord. Until there are clear and objective ways to measure these different forms of inequality, all of which are likely to be highly correlated with income inequality, we can only work with this one measure. But Wilkinson & Pickett note that even just this one measure of inequality can be highly informative.

    Wilkinson & Pickett then cite certain studies suggesting to them that the amount of income inequality in a population reflects the degree to which that population has become stratified by various status and class distinctions organized in a hierarchical fashion. They write:

We should perhaps regard the scale of material inequalities in a society as providing the skeleton, or framework, round which class and cultural differences are formed. Over time, crude differences in wealth gradually become overlaid by differences in clothing, aesthetic taste, education, sense of self and all the other markers of class identity. …And it is surely because material differences provide the framework round which social distinctions develop that people have often regarded inequality as socially divisive. [pg. 28-29]

    Wilkinson & Pickett then ask why people might be so sensitive to inequality, and to answer this question they examine certain aspects of human psychology. But first they make it clear that they will not advocate attempts to change that psychology, instead they will advocate efforts to reduce inequality. Then they summarize the work of the psychologist Jean Twenge, who has documented strong evidence of increasing levels of stress and anxiety in the American population over a 40-year period starting in 1952. Since inequality in the USA did not start to rise until the middle of this period, inequality per se was not a direct cause of that overall trend.

    Parallel trends were found over the same period for feelings of social insecurity, or, in the modern jargon, what are called feelings of anxiety in the face of “social evaluative threat.” This term refers to a threatening sense that one is being judged negatively—that one will likely be found wanting, not smart enough, not capable enough, unlikeable or unworthy. It is the sort of anxiety many people feel while anticipating a school exam, or a speech they must give, or a job interview, or appearing in court.

    Medical research has repeatedly documented the deleterious effects of psychological stress on human health and illness. Moreover it has discovered an important signal and measure of bodily stress reflected in levels of the chemical cortisol, which can be easily measured from a little saliva or blood. From experiments that used different stressors while measuring the cortisol levels they produce, it has become very clear that situations provoking social evaluative threats tend to be the most common and the strongest sources of stress in North America. In summarizing the significance of such findings Wilkinson & Pickett write:

What matters most…is that the most powerful sources of stress affecting health seem to fall into three intensely social categories: low social status, lack of friends, and stress in early life. …They all [appear to] affect—or reflect—the extent  to which we do or do not feel at ease and confident with each other. [pg. 39]

    These three “social categories” are then examined more closely and a few of their links to status-inequality are drawn out. Low status is common during childhood. It is generally feared during adolescence. To overcome such fear requires friends, and experiences with social success. But in a society that is highly stratified into hierarchical status levels, where income inequality is marked, there are always those who are noticeably more “successful” with whom to compare yourself, providing you with more reasons to feel relatively deprived, inadequate, and at risk. In such stratified societies, opportunities for social comparison and evaluation become culturally and commercially amplified, by advertisers and by their clients who hope to sell to you reassuring trappings of status: your clothes, your cars, your vacations, your gadgets. Feeling shame and feeling inferior, feeling that life hasn’t been and won’t be fair, are the stressors that most erode your health; and these are just the kind of stressors that are amplified in consumer societies that are high in inequality.

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  Wilkinson & Pickett turn next to a series of explorations into how income inequality and status inequality might come to cause, or to be associated with, each of the ten components of the authors’ IHSP index introduced earlier. They choose to begin with a consideration of social trust and mistrust, and the different forms these take in different settings and groups of people. Wilkinson & Pickett introduce this topic saying:

Early socialists and others believed that material inequality was an obstacle to a wider human harmony, to a universal human brotherhood, sisterhood or comradeship. The data we present in this chapter suggest that this intuition was sound: inequality is divisive, and even small differences seem to make an important difference. [pg. 52]

    One measure of social trust was provided by the “European and World Values Survey” conducted by a consortium of university researchers. This survey was given to a large random sample of citizens in 23 countries. A similar survey was conducted by the U.S. government, in 41 American states. For each population surveyed, a “trust” score was obtained. It consisted of the overall percentage of those surveyed who agreed with the statement: “Most people can be trusted.” Average national agreements ranged from about 10% (in Portugal) to about 65% (in Sweden, Denmark, and Norway). There was a clear trend seen, with countries having greater inequality showing lower agreement that people can be trusted. Among the 41 American states surveyed the trend was even more striking. Here too the agreement scores ranged from a low of about 15% (in Mississippi) to about 65% (in North Dakota). But across the American states the clustering around the “best-fit” line appeared greater. Increasing income inequality was seen to be strongly associated with declining belief that others could be trusted.

    In the USA taken as a whole, during the years between 1960 and 2004, agreement with the statement that “Most people can be trusted” dropped from an initial level of about 60% to less than 40%. Over the same time period, inequality in America remained low for a time, then began rising dramatically. Wilkinson & Pickett present a scatter-plot of the average yearly trust scores in America, and the corresponding sizes of the Gini index of income inequality across those same years. While inequality increased (from an initial Gini of 0.35 to 0.44 in 2007) average trust levels declined. These data persuaded Wilkinson & Pickett that it is increasing inequality that leads to an erosion of social trust and not falling trust levels that lead to increasing inequality.

    Wilkinson & Pickett then show that longevity is longer in trusting societies than in suspicious and mistrustful ones. They go on to trace various links between low trust levels and both decreasing cooperation and increasing isolation in communities. For example, people’s willingness to pick up hitch-hikers began dropping just as inequality started to rise in the 1970s. And soon came a notable rise in the numbers of people who live in gated communities. Sales of sophisticated “home-security” services also started rising. Neighbours no longer were relied upon to protect and assist neighbours. Hired professionals now did so. Charitable giving was also found to be lower in the more unequal societies, another sign that trust may be a casualty of inequality. Wilkinson & Pickett conclude this chapter asserting that “greater material equality can help to create a cohesive, co-operative community, to the benefit of all.” [pg. 62]

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    In their next chapter Wilkinson & Pickett look at mental illness rates, and the degree of drug use, in countries and in American states that vary in inequality. While fully comparable data on “mental illnesses” are hard to achieve in different cultures and nations, the authors do find some suggestive confirmations that higher inequality often accompanies higher rates of mental illness and illegal drug use. But here the trends are sometimes weak or absent in certain populations (e.g. across American states), or in some sub-populations (e.g. among men, but not women.)

    The following chapter then looks at inequality in relation to both longevity (expanding what they had already demonstrated) and susceptibility to various diseases or health problems. The authors first give a brief history of changes in the causes of death over the past century, as sanitation and treatments for infectious diseases were improved.  They describe the first major longitudinal studies of heart disease in working men and the surprises emerging from those studies. It had been expected that executives would be most prone to stress and to heart attacks, but the results showed just the opposite. Employees earning the lowest salaries had death rates three times higher than did executives. When the study was expanded to include women employees and other diseases, low job status was found to be associated with higher incidences of many “illnesses” including some cancers, lung disease, gastrointestinal disease, depression, suicide, and absence from work. The higher the level of work status, the healthier were the workers.

    After holding constant the effects of risk factors such as obesity, smoking behaviour, lack of daily exercise, etc., most of these trends remained clear, with increasing risks seen when status (and pay for work) was lower. Wilkinson & Pickett report:

Of all the factors that…researchers have studied over the years, job stress and people’s sense of control over their work seem to make the most difference [to their health.] …Low social status has a clear impact on physical health, and not just for people at the very bottom of the social hierarchy. [pg.75]

They continue, saying,

Besides our sense of control over our lives, other factors which make a difference to our physical health include our happiness, whether we’re optimistic or pessimistic, and whether we feel hostile or aggressive toward other people. [pg. 76]

Low social status makes it hard to feel particularly happy, and makes it easier to feel aggressive and suspicious toward others. Wilkinson & Pickett then go on to cite research showing that those who have good friends and close family ties have better resistance to illnesses and also show faster recoveries from many illnesses.

    Wilkinson & Pickett end this chapter with a telling review of the simultaneous changes in both income inequality and civilian health observed in Britain during each of the two world wars. They report:

Increases in life expectancy for civilians during the war decades were twice [as great as] those seen throughout the rest of the twentieth century. …[Yet} material living standards declined during both wars. However, both wars were characterized by full employment and considerably narrower income differences—the result of deliberate government policies to promote co-operation with the war effort. During the Second World War, for example, working class incomes rose by 9.2 per cent, while incomes of the middle class fell by 7 per cent; rates of relative poverty were halved. …Crime rates also fell. [pp. 84-85]

Wartime rationing, of food and gasoline and status-linked luxuries, with it’s facilitation of a sense of shared social commitment and effort, created much more equality, leading both to healthier people and healthier communities.

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    Next, Wilkinson & Pickett look at obesity, and the factors that appear to have promoted it over the past half century. As suggested earlier, they find a clear link between the degree of income inequality in a population and the rate of obesity seen in that population. The links are there across the developed nations, across the 50 American states, in adults and in teenagers, and particularly so for women. Genetic causes of obesity are weak, if present at all. Cultural and psychological factors seem to be most significant in the recent rise of obesity, particularly because eating is a common response to stress, and because relative poverty leads to increased preferences for inexpensive, high-caloric foods and drinks as a way to save income for acquiring more important status-related items. Increased income inequality is also related to reduced exposure to exercise, augmenting the tendency to obesity. The human body tends to lay down abdominal fat if it is under stress, but when not under stress the same diet produces less fat and that fat is usually concentrated in the hips and thighs. Diets and food preferences can also be linked to status differences. Income inequality appears to amplify many of these linked effects, resulting in higher rates of obesity and poorer general health.

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    The next chapter of The Spirit Level is devoted to a consideration of educational performance and its links to income inequality. For developed nations, and across the American states, the greater is the inequality in the population the worse are the corresponding secondary school math and literacy scores on standardized tests. In the fifty American states, there is a particularly strong association between the level of inequality in each state and the proportion of students who drop out of high school before graduation. Here too, however, the three states of New York, Connecticut, and Massachusetts, with rather high degrees of inequality but better than average graduation rates, are partial exceptions to the general trend; excluding them makes the remaining association dramatically strong.

    Wilkinson & Pickett then explore some of the reasons that appear to contribute to these findings. Inequality is associated with several stress-related factors that impact parents of pre-school and school age children. Higher levels of inequality also appear to be associated with fewer educational opportunities and more restrictive access to better education. In populations that are more highly unequal, school children also seem to be exposed to more “social evaluative threats,” and less peer support, all leading to discomfort at school and an interference with learning.

    Next Wilkinson & Pickett look at corresponding levels of inequality and birth rates among teenagers. Again, the association is noticeable. And it is even more pronounced among teenagers aged 17 and below.  The association of inequality with teenage pregnancy rates appears to be even stronger than for teenage birth rates, although data on aborted pregnancies and miscarriages are less reliable than those for births. Societies high in inequality seem to have more problems and more stressors that lead to a variety of social symptoms, of which early, unplanned pregnancy is another example.

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    Two of the clearest social ills associated with social and income inequality are higher crime rates and episodes of physical violence. Both these problems are found most often in socially stratified populations and populations high in inequality. In their next two chapters Wilkinson & Pickett present data from a number of different studies showing strong links between rising levels of inequality and variables such as homicide rates, children’s involvement in fighting, rates of incarceration and the severity of punishments given to criminals. These different variables were each found to be associated with inequality even after the degree of per-capita income is held constant.

    Violent crime is primarily a male phenomenon, one that is highly concentrated among men between 15 and 35 years of age. Those who study violent crimes report that these are almost always provoked by uncontrolled anger following feelings of helplessness in the presence of humiliation, a grave loss of face, or strong public shaming. A small remaining sense of self-respect and personal honour often feels like the one thing a criminal still has left; so he resorts to violence following a new perceived insult.  Wilkinson & Pickett discuss a number of potential ways that high levels of inequality might contribute to episodes of feeling shamed, humiliated, or ostracized.

    As much as violence itself is a problem, the fear of violence, of bullying, or of having your possessions stolen, can also be more troubling in societies that are highly unequal than are such fears in societies lower in inequality. These fears can have a significant effect on one’s quality of life and one’s general health. Fears of violence and crime are indeed found to be higher and more prevalent in unequal societies, in the same way that mistrust of others was earlier shown to be higher where inequality was high.

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    Then finally, Wilkinson & Pickett examine the association of increasing degrees of inequality with decreasing opportunities for personal advancement and social mobility. Democracies all claim to value and promote “equal opportunity,” offering to all an equal and good chance to improve one’s current economic and social position, and, to better the fortunes of one’s children. When social mobility is low, parents and their children will have very similar incomes at similar stages of their lives. In that case, knowing a family’s income level will be relatively predictive of the income of a child’s family when that child grows to the same age. Thus, higher correlations between the two sets of income (for parents and their grown children) signal lower levels of social mobility. However, when these same correlations are low, it is because social mobility is greater, showing that opportunities for rising from a lower status (and, for falling from higher status) are greater.

    To gauge the extent to which inequality and social mobility may be linked, Wilkinson & Pickett searched for this type of correlational study carried out at different times (or places) with high and low levels of income inequality. Studies of this kind are rare because they are so costly in time and effort. However, one such study was carried out by researchers at the London School of Economics. They were able to get representative samples of fathers and sons in eight different European and North American countries. For each country they looked at the correlation between father’s incomes at the time of their son’s birth, and, the incomes of those same sons when they had reached the age of 30. These correlations were found to be modest in size in four Scandinavian countries and Canada, somewhat higher in Germany, quite a bit higher in the U.K. and very high (relatively speaking) in the USA. Plotting these correlations against the Gini measure of income inequality for the same eight nations revealed a marked degree of association: the lower the correlations (reflecting higher “mobility” for son’s incomes), then the lower was the income inequality in the same nations. The USA and UK ranked first and second in income inequality and they also ranked first and second lowest of all countries in “social mobility,” as this was reflected in relatively unchanged incomes over one generation. Of the eight nations studied, only Canada strayed very far from the “best fit” line. Canada had moderately high income inequality, yet it still had one of the highest scores for “social mobility” in this study. It is telling that America, self-described as “the land of opportunity,” offered to its children the least promise of advancement in income across the eight nations studied here.

    A somewhat different approach, also linking income inequality to reduced social mobility, comes from survey data gathered in the USA during each decade from 1950 to the year 2000. These data showed that the level of association between father’s-and-son’s incomes dropped slightly and continuously between 1950 and 1980. By 1980, using a father’s income to predict that of his son, would reduce the uncertainty about the grown son’s ranking on the same income variable by only about 10%. Thus, the “mobility” of young Americans was considerable in those days. But in the two decades after 1980, knowing the father’s prior income reduced uncertainty about the son’s ranking by 20% (in 1990) and then by 30% (in the year 2000). Thus, “mobility” by children, into better (or worse) jobs than their parents, had dropped considerably. The income of sons was more often becoming just like the income of their fathers. This changing pattern, from 1950 to 2000, closely matched another: the degree of income inequality in America during those same five decades. Inequality too had started out low and dropped very slightly until shortly before 1980, after which it had began to rise, slowly at first, and then quite rapidly. Wilkinson & Pickett are persuaded, then, that increasing inequality in America slightly led, and became one contributing cause of, the subsequent decline in America’s social opportunity and mobility. This same decline was also observed in the U.K., with its similar pattern of increasing inequality, but not in Scandinavia with its much lower levels of inequality.

    Wilkinson & Pickett cite another reason for their conclusion. The eight nations that differed in social mobility (discussed earlier) differed in another variable that was highly correlated with their social mobility scores, namely: the percentage of all school funding (from elementary through secondary school) paid for out of the public purse and available to all parents. In Norway, highest in social mobility and lowest in income inequality, just over 97% of all school funding was supplied by national and local governments. In America, lowest in social mobility and highest in income inequality, only 68% of all school funding came from governments. Schooling is (or was) the primary factor enabling social mobility for children everywhere. But only where there is low income inequality does there seem to be maximum opportunity for most children to realize their educational potential.

    Wilkinson & Pickett go on to point out further ways that increased inequality may limit opportunities for social mobility. They note:

A third type of evidence that may confirm the correlation between income inequality and social mobility is the way in which greater social distances become translated into greater geographical segregation between rich and poor. …The rich are willing to pay to live separately from the poor, and residential segregation along economic lines increased throughout the 1980s and 1990s. The concentration of poor people in poor areas increases all kinds of stress, deprivation, and difficulty—from [long commutes,]… worse schools, poor levels of service, exposure to gang violence, pollution and so on. [pp. 162-63]

    Wilkinson & Pickett then describe studies suggesting how snobbery, prejudice, and distinct class cultures become hallmarks of highly unequal societies, and how these attitudes serve to create limits on the mobility of those in the lower classes who may be hoping to “better” their situation.

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    In the final four chapters of The Spirit Level, Wilkinson & Pickett discuss certain steps that appear necessary in order to produce a dramatic lowering of national and regional inequalities in income and wealth. More equality in income and wealth could help in turn to reduce current inequalities in political power, in physical health, in access to justice, and access to education. In the preface to The Spirit Level, Wilkinson & Pickett reveal that they had considered titling their book Evidence-based Politics, to emphasize the analogy between “evidence-based” medical therapies and those political and economic “therapies” that governments and administrators might better employ to treat the ills suffered by societies and institutions (even corporations) for which politicians, executives, and managers have become society’s designated caretakers. I plan to examine a variety of proposed policies for reducing inequality (including the policies suggested by Wilkinson & Pickett) in a separate essay at a later time.

    The Spirit Level is a rewarding read, with many virtues. Two of its biggest virtues are that it makes very clear (1) how broad is the ambit of all varieties and aspects of “Health,” and (2) how closely dependent are most of those aspects on the degree of social equality that is to be found in the social environments where we live and work. For this reason, The Spirit Level deserves and rewards close study by a wide public audience.

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© J. Barnard Gilmore     Kaslo, British Columbia     September, 2013

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