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The authors find, not surprisingly, that where there are great disparities in wealth, there are heightened levels of social distrust. They argue convincingly that wide inequality is bad for a society, and that more equal societies tend to do better on many measures of social health and wealth.
But if wide inequality is socially dysfunctional, then why are certain countries, such as the United States, becoming so unequal? Largely because of the increasing gains to be had by being just a bit better than other competitors in a system becoming ever more competitive. Consider executive pay. After the s, the two pay scales diverged. In , the big-company CEO took home roughly 40 times; by , it was times. By , just before the Great Recession, CEO pay packages had ballooned to about times what the typical worker earned.
Recent supports suggest that the upward trajectory of executive pay, temporarily stopped by the economic meltdown, is on the verge of continuing. To make the comparison especially vivid, in the CEO of General Motors—then the largest company in the United States—took home around 66 times the pay and benefits of the typical GM worker at the time.
What explains this trajectory? Have top executives become greedier? Have corporate boards grown less responsible? Are CEOs more crooked? Are investors more docile? Is Wall Street more tractable? Big companies and their unions directly negotiated pay scales for hourly workers, while white-collar workers understood that their pay grades were indirectly affected.
Large corporations resembled civil service bureaucracies. Top executives in these huge companies had to maintain the good will of organized labor. They also had to maintain good relationships with public officials in order to be free to set wages and prices; to obtain regulatory permissions on fares, rates, or licenses; and to continue to secure government contracts. It would have been unseemly of them to draw very high salaries. Since then, competition has intensified. With ever greater ease, rival companies can get access to similar low-cost suppliers from all over the world.
They can streamline their operations with the same information technology their competitors use; they can cut their labor force and substitute similar software, culled from many of the same vendors. They can just as readily outsource hourly jobs abroad.
They can get capital for new investment on much the same terms. They can gain access to distribution channels that are no less efficient, some of them even identical Wal-Mart or other big- box retailers. They can attract shareholders by showing even slightly better performance, or the promise of it. The dilemma facing so many companies is therefore how to beat rivals. Even a small advantage can make a huge difference to the bottom line.
In economic terms, CEOs have become less like top bureaucrats and more like Hollywood celebrities or star athletes, who take a share of the house. Even adjusting for inflation, Beltran got 40 times as much as Mantle. In the world of finance, the numbers are yet greater. Top investment bankers and traders take home even more than CEOs or most Hollywood stars.
The Wall Street meltdown took its toll on some of these hedge funds and their managers, but by the end of many were back. This economic explanation for these startling levels of pay does not justify them socially or morally. It only means that in our roles as consumers and investors we implicitly think CEOs, star athletes, and Hollywood celebrities are worth it. As citizens, though, most of us disapprove.
Polls continue to show that a great majority of Americans believes CEOs are overpaid, and that inequality of income and wealth is a large problem. It has become the financial equivalent of hydrodynamics: Large streams of income create even larger pools of wealth. But even then, they remained immense. As citizens, we may feel that inequality on this scale cannot possibly be good for us, and Wilkinson and Pickett supply the evidence that confirms our gut sense of unease.
Such inequality undermines the trust, solidarity, and mutuality on which responsibilities of citizenship depend. It creates a new aristocracy whose privileges perpetuate themselves over generations one of the striking findings in these pages is that America now has less social mobility than many poorer countries.
And it breeds cynicism among the rest of us. This is not to say that the superrich are at fault. But the market is a creation of public policies. And public policies, as the authors make clear, can reorganize the market to reverse these trends.
The Spirit Level shows why the effort to do so is a vital one for the health of our society. But this book is not just another set o f nostrums and prejudices about how to put the w orld to rights. The focal problem initially w as to understand w hy health gets worse at every step down the social ladder, so that the poor are less healthy than those in the middle, who in turn are less healthy than those further up.
The same methods can, how ever, also be used to understand the causes o f other kinds of problems - not just health. The research which underpins w hat we describe comes from a great m any research teams in different universities and research organizations. Replicable methods have been used to study observable and objective outcomes, and peer-reviewed research reports have been published in academic, scientific journals.
This does not mean that there is no guessw ork. Initial theories and expectations are often called into question by later research findings which make it necessary to think again. We would like to take you on the journey we have travelled, signposted by crucial bits o f evidence and leaving out only the various culs-de-sac and w rong turnings that wasted so much time, to arrive at a better understanding o f how we believe it is possible to improve the quality of life for everyone in modern societies.
A t an intuitive level people have alw ays recognized that inequality is socially corrosive. But there seemed little reason to think that levels o f inequality in developed societies differed enough to expect any measurable effects. The reasons which first led one o f us to look for effects seem now largely irrelevant to the striking picture which has emerged. M an y discoveries owe as much to luck as judgement. With internationally com parable inform ation not only on incomes and income distribution but also on different health and social problems, it could only have been a matter o f time before someone came up with findings like ours.
The emerging data have allowed us, and other researchers, to analyse how societies differ, to discover how one factor is related to another, and to test theories more rigorously. It is easy to imagine that discoveries are more rapidly accepted in the natural than in the social sciences - as if physical theories are som ehow less controversial than theories about the social w orld.
Controversies in the natural sciences are usually confined to the experts: most people do not have strong views on rival theories in particle physics. But they do have views on how society w orks. In , Ignaz Semmelweiss discovered that if doctors washed their hands before attending wom en in childbirth it dram atically reduced deaths from puerperal fever.
But before his w ork could have much benefit he had to persuade people - principally his medical colleagues - to change their behaviour. H is real battle w as not his initial discovery but w hat follow ed from it. H is views were ridiculed and he w as driven eventually to insanity and suicide. M uch o f the medical profession did not take his w ork seriously until Louis Pasteur and Joseph Lister had developed the germ theory o f disease, which explained w hy hygiene w as important.
We live in a pessimistic period. As well as being w orried by the likely consequences o f global warm ing, it is easy to feel that many societies are, despite their material success, increasingly burdened by their social failings. And now , as if to add to our w oes, w e have the economic recession and its aftermath o f high unemployment. But the knowledge that we cannot carry on as we have, that change is necessary, is perhaps grounds for optimism: maybe w e do, at last, have the chance to make a better w orld.
The extraordinarily positive reception o f the hardback editon o f this book confirms that there is a widespread appetite for change and a desire to find positive solutions to our problems. We have made only minor changes to this edition. Details o f the statistical sources, methods and results, from which we thought most readers w ould w ant to be spared, are now provided in an appendix for those with a taste for data.
Chapter 13 , which is substantially about causation, has been slightly reorganized and strengthened. We have also expanded our discussion o f what has made societies substantially more or less equal in the past. Because w e conclude that these changes have been driven by changes in political attitudes, w e think it is a mistake to discuss policy as if it were a matter of finding the right technical fix.
A s there are really hundreds o f w ays that societies can become more equal if they choose to, w e have not nailed our colours to one or other set o f policies. If correct, the theory and evidence set out in this book tells us how to make substantial improvements in the quality o f life for the vast m ajority o f the population.
Y et unless it is possible to change the w a y most people see the societies they live in, the theory w ill be stillborn. We have therefore set up a not-for-profit organization called The Equality Trust described at the end o f this book to m ake the kind o f evidence set out in the follow ing pages better known and to suggest that there is a w ay out o f the w oods for us all.
We are also grateful to the Joseph Row ntree Charitable Trust, especially Stephen Pittam, for supporting our efforts to disseminate this research via The Equality Trust; and Kathryn Busby and Bill K erry whose hard w ork has made it a going concern. Kate Pickett thanks the University of Y o rk and her colleagues for their generous support. Figures 3. Figure 6. All other Figures are our ow n, and can be freely reproduced with acknowledgement.
T he cartoon s on pp. They show relationships, either: i internationally, com paring rich countries or 2 in the USA, com paring different states. The different health and social outcomes are shown on the vertical line the y-axis on the left side o f the graph.
On most o f the graphs, there are tw o features. First there is a scatter o f points, either o f rich countries, or o f US states, so that readers can see exactly how each society com pares to others. This line is not chosen by us, but is calculated by statistical softw are to give the line which best fits the trend through the data points. It is also possible to calculate how unlikely it is that the pattern we see could result from chance alone.
W e have only included a best fit line through the points if the relationship would be very unlikely to occur by chance. When a graph has no best fit line it means that there is no evidence o f a relationship. This pattern tends to occur with problems that we think o f as bad, such as violence: y-axis x-axis If the line slopes steeply dow nw ards from left to right, it shows that the health or social outcome is much less common in more unequal societies.
We see this pattern for things that we think o f as good, such as trust: y-axis x-axis A w ider scatter o f points on the graph means that there are other important influences on the outcome. Else small aid is wealth for daily gladness; once a man be done with hunger, rich and poor are all as one. Euripides, Electra It is a rem arkable parad ox that, at the pinnacle o f human material and technical achievement, w e find ourselves anxiety-ridden, prone to depression, w orried about how others see us, unsure o f our friendships, driven to consume and with little or no com munity life.
H o w is it that w e have created so much mental and em otional suffering despite levels o f w ealth and com fort unprecedented in hum an history? Often w hat w e feel is missing is little more than time enjoying the com pany o f friends, yet even that can seem beyond us. We talk as if our lives w ere a constant battle for psychological survival, struggling against stress and em otional exhaustion, but the truth is that the lu xu ry and extravagance o f our lives is so great that it threatens the planet.
A s a result they often felt isolated. Rather than uniting us with others in a com m on cause, the unease w e feel about the loss o f social values and the w a y w e are draw n into the pursuit o f m aterial gain is often experienced as if it were a purely private am bivalence which cuts us o ff from others.
A s voters, we have lost sight o f any collective belief that society could be different. Instead o f a better society, the only thing alm ost everyone strives for is to better their ow n position - as individuals - within the existing society. The contrast between the m aterial success and social failure of m any rich countries is an im portant signpost. It suggests that, if we are to gain further improvements in the real quality o f life, w e need to shift attention from m aterial standards and econom ic grow th to w ays o f im proving the psychological and social wellbeing o f whole societies.
H ow ever, as soon as anything psychological is mentioned, discussion tends to focus alm ost exclusively on individual remedies and treatments. Political thinking seems to run into the sand. It is now possible to piece together a new, com pelling and coherent picture o f h ow we can release societies from the grip o f so much dysfunctional behaviour.
A proper understanding o f w h at is going on could transform politics and the quality o f life for all o f us. It w ould change our experience o f the w orld around us, change what w e vote for, and change w hat we demand from our politicians. In this book we show that the quality o f social relations in a society is built on material foundations.
Rather than blaming parents, religion, values, education or the penal system, we w ill show that the scale o f inequality provides a pow erful policy lever on the psychological wellbeing o f all o f us. Ju st as it once took studies of weight gain in babies to show that interacting with a loving care-giver is crucial to child development, so it has taken studies o f death rates and of income distribution to show the social needs o f adults and to demonstrate how societies can meet them.
The financial collapse shifted attention to the broken econom y, and while the broken society w as sometimes blamed on the behaviour o f the poor, the broken econom y w as w idely attributed to the rich. Stimulated by the prospects o f ever bigger salaries and bonuses, those in charge o f some o f the most trusted financial institutions threw caution to the w ind and built houses o f cards which could stand only within the protection o f a thin speculative bubble.
But the truth is that both the broken society and the broken econom y resulted from the grow th o f inequality. For thousands o f years the best w a y o f im proving the quality o f human life w as to raise material living standards. When the w o lf w as never far from the door, good times were simply times o f plenty.
But for the vast m ajority o f people in affluent countries the difficulties o f life are no longer about filling our stomachs, having clean w ater and keeping w arm. M ost o f us now wish w e could eat less rather than more. A nd, for the first time in history, the poor are - on average - fatter than the rich.
Econom ic grow th, for so long the great engine o f progress, has, in the rich countries, largely finished its w o rk. The populations o f rich countries have got to the end o f a long historical journey. The course of the journey we have made can be seen in Figure i. A m ong poorer countries, life expectancy increases rapidly during the early stages o f economic development, but then, starting among the middle-income countries, the rate o f improvem ent slow s dow n.
A s living standards rise and countries get richer and richer, the relationship between economic grow th and life expectancy weakens. Eventually it disappears entirely and the rising curve in Figure i. T h at has already happened in the richest thirty or so countries - nearest the top right-hand corner o f Figure i.
The reason w h y the curve in Figure i. W hat has changed is that the improvements have ceased to be related to average living standards. W ith every ten years that passes, life expectancy am ong the rich countries increases by between two and three years. This happens regardless o f economic grow th, so that a country as rich as the U S A no longer does better than Greece or N ew Z ealand , although they are not much more than h alf as rich.
Rather than m oving out along the curve in Figure i. Looking at the data, you cannot help but conclude that as countries get richer, further increases in average living standards do less and less for health. W hile good health and longevity are im portant, there are other components o f the quality o f life. But just as the relationship between health and economic grow th has levelled off, so too has the relationship w ith happiness. Like health, h ow happy people are rises in the early stages o f economic grow th and then levels off.
In some societies not saying you are happy m ay sound like an adm ission o f failure, while in another claim ing to be happy m ay sound self-satisfied and smug. But, despite the difficulties, Figure 1. In a few countries, such as Jap an , the U S A and Britain, it is possible to look at changes in happiness over sufficiently long periods o f time to see whether they rise as a country gets richer. The evidence shows that happiness has not increased even over periods long enough for real incomes to have doubled.
So whether we look at health, happiness or other measures o f wellbeing there is a consistent picture. In poorer countries, economic development continues to be very im portant for human wellbeing. Increases in their material living standards result in substantial improvements both in objective measures o f wellbeing like life expectancy, and in subjective ones like happiness.
But as nations join the ranks o f the affluent developed countries, further rises in income count for less and less. This is a predictable pattern. A number o f developed countries have n ow had alm ost continuous rises in average incomes for over 1 5 0 years and additional wealth is not as beneficial as it once w as.
The trends in different causes o f death confirm this interpretation. It is the diseases o f poverty which first decline as countries start to get richer. The great infectious diseases - such as tuberculosis, cholera or measles - which are still com mon in the poorest countries today, gradually cease to be the m ost im portant causes o f death.
A s they disappear, we are left with the so-called diseases o f affluence - the degenerative cardiovascular diseases and cancers. W hile the infectious diseases o f poverty are particularly com m on in childhood and frequently kill even in the prime o f life, the diseases o f affluence are very largely diseases o f later life. One other piece o f evidence confirms that the reason w hy the curves in Figures 1. Diseases like heart disease, stroke and obesity used to be more com m on am ong the rich.
But from about the 19 5 0 s onw ards, in one developed country after another, these patterns reversed. Diseases which had been most com mon am ong the better-off in each society reversed their social distribution to become m ore com mon am ong the poor. The dram atic reductions in carbon emissions needed to prevent ru n aw ay clim ate change and rises in sea levels m ay mean that even present levels o f consumption are unsustainable - particularly if living standards in the poorer, developing, w orld are to rise as they need to.
W hat should we turn to if not to economic grow th? One o f the most pow erful clues to the answ er to this question comes from the fact that we are affected very differently by the income differences w ithin our own society from the w ay w e are affected by the differences in average income betw een one rich society and another. In Chapters 4 - 1 2 we focus on a series o f health and social problems like violence, mental illness, teenage births and educational failure, which within each country are all more com mon among the poor than the rich.
A s a result, it often looks as if the effect o f higher incomes and living standards is to lift people out o f these problem s. H ow ever, when w e m ake com parisons between different societies, we find that these social problem s have little or no relation to levels o f average incomes in a society. Take health as an exam ple. Instead o f looking at life expectancy across both rich and poor countries as in Figure 1. Figure 1. Y et within any o f them death rates are closely and system atically related to income.
The death rates are for people in zip code areas classified by the typical household income o f the area in which they live. On the right are the richer zip code areas with low er death rates, and on the left are the poorer ones with higher death rates. Although w e use Am erican data to illustrate this, similar health gradients, o f varying steepness, run across alm ost every society.
H igher incomes are related to low er death rates at every level in society. N ote that this is not sim ply a matter o f the poor having worse health than everyone else. W hat is so striking about Figure 1. Richer people tend, on average, to be healthier and happier than poorer people in the same society.
But com paring rich countries it makes no difference whether on average people in one society are alm ost twice as rich as people in another. There are tw o plausible explanations. One is that w hat matters in rich countries m ay not be your actual income level and living standard, but how you com pare with other people in the same society.
The other possibility is that the social gradient in health shown in Figure 1. Perhaps the healthy tend to m ove up the social ladder and the unhealthy end up at the bottom. This issue w ill be resolved in the next chapter. D o more and less equal societies suffer the same overall burden o f health and social problems? Poverty or inequality? Poverty is not a certain small amount of goods, nor is it just a relation between means and ends; above all it is a relation between people. Poverty is a social status.
It has grown. In the last chapter w e saw that economic grow th and increases in average incomes have ceased to contribute much to wellbeing in the rich countries. But w e also saw that within societies health and social problems remain strongly associated w ith incomes. In this chapter we w ill see whether the am ount o f income inequality in a society makes any difference.
Figure 2. A t the top are the most equal countries and at the bottom are the most unequal. The length o f the horizontal bars shows how much richer the richest 20 per cent of the population is in each country com pared to the poorest 20 per cent.
W ithin countries such as Ja p an and some o f the Scandinavian countries at the top o f the chart, the richest 20 per cent are less than four times as rich as the poorest 20 per cent. A t the bottom o f the chart are countries in which these differences are at least twice as big, including tw o in which the richest 20 per cent get about nine times as much as the poorest. Instead o f the top and bottom zo per cent, w e could com pare the top and bottom 10 or 30 per cent. O r w e could have looked at the proportion o f all incomes w hich go to the poorer h alf o f the population.
T ypically, the poorest h alf o f the population get something like zo or 25 per cent of all incomes and the richest h alf get the rem aining 75 or 80 per cent. Other more sophisticated measures include one called the Gini coefficient. If income w as shared equally and everyone got exactly the same perfect equality , the Gini w ould equal o. The low er its value, the more equal a society is. The m ost com m on values tend to be between 0. T o avoid being accused o f picking and choosing our measures, our approach in this book has been to take measures provided by official agencies rather than calculating our own.
We use the ratio o f the income received by the top to the bottom 20 per cent whenever w e are com paring inequality in different countries: it is easy to understand and it is one o f the measures provided ready-m ade by the United N ations. W hen com paring inequality in U S states, w e use the Gini coefficient: it is the m ost com m on measure, it is favoured by economists and it is available from the U S Census Bureau.
In m any academic research papers w e and others have used tw o different inequality measures in order to show that the choice o f measures rarely has a significant effect on results. H aving got to the end o f w h at economic grow th can do for the quality o f life and facing the problem s o f environm ental damage, w hat difference do the inequalities show n in Figure 2. It has been known for some years that poor health and violence are more com mon in more unequal societies.
H ow ever, in the course o f our research w e became aw are that alm ost all problem s w hich are more com m on at the bottom o f the social ladder are more common in more unequal societies. A lm ost all o f them contribute to the widespread concern that m odern societies are, despite their affluence, social failures.
In order to be confident that our findings were sound w e also collected data for the same health and social problems - or as near as we could get to the same - for each o f the fifty states o f the U S A. This allow ed us to check whether or not problem s were consistently related to inequality in these tw o independent settings. The result is an index show ing h ow com mon all these health and social problem s are in each country and each US state. Things such as life expectancy are reverse scored, so that on every measure higher scores reflect w orse outcomes.
W hen looking at the Figures, the higher the score on the Index o f H ealth and Social Problems, the w orse things are. For inform ation on h ow w e selected countries show n in the graphs w e present in this book, please see the Appendix. W e start by show ing, in Figure 2. With increasing inequality to the right on the horizontal axis , the higher is the score on our Index o f Health and Social Problems.
H ealth and social problems are indeed more com m on in countries with bigger income inequalities. The tw o are extraordinarily closely related - chance alone w ould alm ost never produce a scatter in which countries lined up like this.
T o emphasize that the prevalence o f poor health and social problem s in w hole societies really is related to inequality rather than to average living standards, w e show in Figure 2. It shows that there is no sim ilarly clear trend tow ards better outcomes in richer countries. This confirms w hat w e saw in Figures 1. H ow ever, as well as know ing that health and social problems are more com m on am ong the less w ell-off within each society as shown in Figure 1.
T o check whether these results are not just some odd fluke, let us see whether similar patterns also occur when w e look at the fifty states o f the U S A. We were able to find data on alm ost exactly the same health and social problems for U S states as w e used in our international index. The evidence from the U SA confirms the international picture. The position o f the U S in the international graph Figure 2.
We should note that part o f the reason w hy our index combining data for ten different health and social problem s is so closely related to inequality is that com bining them tends to emphasize w hat they have in com mon and dow nplays w hat they do not.
This evidence cannot be dismissed as some statistical trick done with smoke and m irrors. W hat the close fit show n in Figure 2. Could these relationships be the result o f some unrepresentative selection o f problems? It combines forty different indicators covering m any different aspects o f child wellbeing. We removed the measure o f child relative poverty from it because it is, by definition, closely related to inequality.
Either the circumstances people live in cause their problem s, or people end up nearer the bottom o f society because they are prone to problem s which drag them down. The evidence w e have seen in this chapter puts these issues in a new light. The view that social problem s are caused directly by poor m aterial conditions such as bad housing, poor diets, lack o f educational opportunities and so on implies that richer developed societies w ould do better than the others.
But this is a long w ay from the truth: some o f the richest countries do worst. The problem s 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. W hat matters is where w e stand in relation to others in our ow n society. O f course a small proportion o f the least w ell-off people even in the richest countries sometimes find themselves w ithout enough money for food.
H ow ever, surveys o f the 1 2. W hat this means is that when people lack money for essentials such as food, it is usually a reflection o f the strength o f their desire to live up to the prevailing standards. Y o u m ay, for instance, feel it more im portant to maintain appearances by spending on clothes while stinting on food. A s A dam Smith emphasized, it is im portant to be able to present oneself creditably in society without the shame and stigma o f apparent poverty.
Instead, the effects are - as w e shall see - w idespread in the population. W e pay doctors and nurses to treat ill-health, police and prisons to deal w ith crime, remedial teachers and educational psychologists to tackle educational problem s, and social w orkers, drug rehabilitation units, psychiatric services and health prom otion experts to deal with a host o f other problem s. These services are all expensive, and none o f them is more than partially effective. M eanw hile, all these problems are most com m on in the most deprived areas o f our society and are m any times more com m on in more unequal societies.
Before proceeding, in the follow ing chapters, to look at h ow the scale o f income differences m ay be related to other problem s, we should say a few w ord s about w hat we think income differences tell us about a society. We believe that this is w hat income inequality is measuring. Where income differences are bigger, social distances are bigger and social stratification more important. It w ould be nice to have lots o f different indicators o f the scale o f hierarchy in different countries - to be able to com pare inequalities not only in income, but also in wealth, education and power.
While additional measures which can be com pared between countries might become available in the future, at the moment w e must rely simply on income inequality. But w hat is perhaps surprising is how much this measure tells us even on its own. The first pointer is that only the health and social problems which have strong social class gradients - becoming more com mon further dow n the social hierarchy - are more com mon in m ore unequal societies.
This seems to be a general phenomenon: the steeper the social gradient a problem has within society, the more Strongly it w ill be related to inequality. H ealth problem s such as breast cancer, which are not usually more com mon am ong the less w ell off, are unrelated to inequality. Some had calculated how much inequality there w as in local neighbourhoods and looked to see if it w as related to average death rates in those neighbourhoods. Still others had looked at regions and states, or done international studies com paring w hole countries.
When we reviewed all this research, a clear pattern emerged. W hile there w as overwhelm ing evidence that inequality w as related to health when both were measured in large areas regions, states or w hole countries , the findings were much more m ixed when inequality w as m easured in small local areas. This makes perfect sense if w e think about w hy health tends to be worse in more deprived local areas.
It is instead that they are unequal - or deprived - in relation to the rest o f society. W hat matters is the extent o f inequality right across society. We concluded that, rather than telling us about some previously unknown influence on health or social problem s , the scale o f income differences in a society w as telling us about the social hierarchy across which gradients in so m any social outcomes occur.
Because gradients in health and social problems reflect social status differences in culture and behaviour, it looks as if material inequality is probably central to those differences. We should perhaps regard the scale o f material inequalities in a society as providing the skeleton, or fram ew ork, round which class and cultural differences are form ed. O ver time, crude differences in wealth gradually become overlaid by differences in clothing, aesthetic taste, education, sense o f self and all the other m arkers o f class identity.
Think, fo r instance, o f how the com paratively recent emergence o f huge income differences in Russia w ill come to affect its class structure. W hen the children o f the new Russian oligarchs have grow n up in grand houses, attended private schools and travelled the w orld, they w ill have developed all the cultural trappings o f an upper class.
Although there has alw ays been prejudice against the nouveau riche, wealth does not remain new for ever: once the furniture is inherited it becomes old money. And it is surely because material differences provide the fram ew ork round which social distinctions develop that people have often regarded inequality as socially divisive. The evidence shows that reducing inequality is the best w a y o f im proving the quality o f the social environment, and so the real quality o f life, for all o f us.
A s w e shall see in Chapter 1 3 , this includes the better-off. It is clear that greater equality, as well as im proving the wellbeing o f the w hole population, is also the key to national standards o f achievement and how countries perform in lots o f different fields. W hen health inequalities first came to prominence on the public health agenda in the early 19 8 0 s, people w ould sometimes ask w hy there w as so much fuss about inequalities.
They argued that the task o f people w orking in public health w as to raise overall standards of health as fast as possible. In relation to that, it w as suggested that health inequalities were a side issue o f little relevance. We can now see that the situation m ay be alm ost the opposite o f that. N ational standards o f health, and o f other im portant outcomes which we shall discuss in later chapters, are substantially determined by the amount o f inequality in a society. Reducing inequality is the best w a y o f doing both.
In the rich countries, it is now the sym bolic importance o f wealth and possessions that matters. W hat purchases say about status and identity is often more im portant than the goods themselves. Put crudely, second-rate goods are assumed to reflect second-rate people. Possessions are m arkers o f status everywhere, but in poorer societies, where necessities are a much larger part o f consumption, the reasons w hy more equal societies do better m ay have less to do with status issues and more to do with fewer people being denied access to food, clean w ater and shelter.
It is only am ong the very richest countries that health and wellbeing are no longer related to Gross N ational Income per person. In poorer countries it is still essential to raise living standards and it is most im portant among the poorest.
In those societies a more equal distribution o f resources will mean fewer people w ill be living in shanty tow ns, with dirty w ater and food insecurity, or trying to scrape a living from inadequate land-holdings. Ralph Waldo Emerson, The Conduct o f Life H o w is it that we are affected as strongly by inequality and our position within society as the data in the last chapter suggest? Before exploring - as we shall in the next nine chapters - the relations between inequality and a w ide range o f social problem s, including those in our Index o f H ealth and Social Problem s, w e w ant to suggest w h y human beings might be so sensitive to inequality.
It is individuals - not the societies themselves - w ho have poor health, are violent or become teenage mothers. Although individuals do not have an income distribution, they do have a relative income, social status or class position in the wider society.
So in this chapter we w ill show the w ays in which our individual sensitivity to the w ider society explains w hy living in more unequal societies might have such profound effects. T o understand our vulnerability to inequality means discussing some o f our com mon psychological characteristics. T o o often when we speak or w rite about these issues, people misinterpret our purpose.
The best w a y o f responding to the harm done by high levels o f inequality w ould be to reduce inequality itself. Rather than requiring anti-anxiety drugs in the w ater supply or mass psychotherapy, w hat is most exciting about the picture we present is that it show s that reducing inequality w ould increase the wellbeing and quality o f life for all o f us.
Far from being inevitable and unstoppable, the sense o f deterioration in social wellbeing and the quality o f social relations in society is reversible. Understanding the effects o f inequality means that w e suddenly have a policy handle on the wellbeing o f w hole societies. Individual psychology and societal inequality relate to each other like lock and key. One reason w hy the effects of inequality have not been properly understood before is because o f a failure to understand the relationship between them.
H ow ever, Je an Tw enge, a psychologist at San Diego State University, has put together impressive evidence that w e really are much more anxious than w e used to be. By review ing the large number o f studies of anxiety levels in the population carried out at different dates, she has documented very clear trends. She found broadly com parable studies m easuring anxiety levels in the U S A at various times between 1 9 5 2 and 1 9 9 3. W hat they showed w as a continuous upw ard trend throughout this forty-year period.
Her results for men and wom en are shown in Figure 3. Each dot in the graph shows the average level o f anxiety found in a study recorded against the date it w as undertaken. The rising trend across so m any studies is unm istakable. Data from samples covering 52, individuals.
The worsening trend also fits w hat w e kn ow has been happening in related conditions such as depression. There are now large numbers o f studies show ing substantial increases in rates o f depression in developed countries. Some studies have looked at change over the last half century or so by com paring the experience o f one generation with another, while taking care to avoid pitfalls such as an increased awareness leading to more frequent reporting o f depression.
In Britain, for exam ple, depression measured am ong people in their m id-zos w as found to be twice as com mon in a study o f 10 ,0 0 0 or so people born in 19 7 0 as it had been in a sim ilar study carried out earlier o f people in their m id-zos bom in 19 5 8. Am ong adolescents, these have been accom panied by increases in the frequency o f behavioural problem s, including crime, alcohol and drugs.
W e are not suggesting that they were triggered by increased inequality. It is possible, how ever, that the trends between the 19 7 0 s and 19 9 0 s m ay have been aggravated by increased inequality. When com pared over time, in much the same w ay as the trends in anxiety are shown in Figure 3. So w h at could have been going on? The answ er turns out to be a picture of increasing anxieties about how w e are seen and w hat others think o f us which has, in turn, produced a kind o f defensive attempt to shore up our confidence in the face o f those insecurities.
The defence involves a kind o f self-prom oting, insecure egotism which is easily mistaken for high self-esteem. This might seem like a difficult set o f issues to pin dow n, particularly as we are talking about general trends in w hole populations. But let us look briefly at the evidence which has accum ulated since the self-esteem movement o f the 19 8 0 s, which show s w hat has been happening. O ver the years, m any research groups looking at individual differences in self-esteem at a point in time rather than at trends in population averages over time began to notice tw o categories o f people w ho came out with high scores.
In one category, high self-esteem went w ith positive outcomes and w as associated with happiness, confidence, being able to accept criticism , an ability to m ake friends, and so on. They were people w ho showed tendencies to violence, to racism, w ho were insensitive to others and were bad at personal relationships. The other seemed to be prim arily defensive and involved a denial o f weaknesses, a kind o f internal attempt to talk oneself up and maintain a positive sense o f oneself in the face of threats to self-esteem.
It w as and is therefore fragile, like whistling in the dark, and reacts badly to criticism. People with insecure high self-esteem tend to be insensitive to others and to show an excessive preoccupation with themselves, with success, and with their image and appearance in the eyes o f others. D uring the com paratively short time over which data are available to com pare trends in narcissism w ithout getting it m ixed up with real self-esteem, Tw enge has show n a rising trend.
She found that by zoo 6, two-thirds o f Am erican college students scored above w hat had been the average narcissism score in 19 8 2. The recognition that w h at w e have seen is the rise o f an insecure narcissism - particularly am ong young people - rather than a rise in genuine self-esteem now seems w idely accepted. There are now good pointers to the main sources o f stress in modern societies.
M uch o f the research has been focused on a central stress hormone called cortisol which can be easily measured in saliva or blood. There have now been numerous experiments in which volunteers have been invited to come into a laboratory to have their salivary cortisol levels measured while being exposed to some situation or task designed to be stressful.
Social evaluative threats were those which created the possibility for loss o f esteem. They typically involved the presence o f an evaluative audience in the experiment, a potential for negative social com parison such as scoring w orse than someone else, or having your perform ance videoed or recorded, so creating the potential for later evaluation. The finding that social evaluative threats are the stressors which get to us most pow erfully fits w ell w ith the evidence o f rising anxiety accom panied by a narcissistic defence o f an insecure self-image.
A quite separate strand o f health research corroborates and fills out this picture. One o f the most im portant recent developments in our understanding o f the factors exerting a m ajor influence on health in rich countries has been the recognition of the importance o f psychological stress.
But w hat matters to us in this chapter is that the most powerful sources o f stress affecting health seem to fall into three intensely social categories: low social status, lack o f friends, and stress in early life. All have been shown, in m any well-controlled studies, to be seriously detrimental to health and longevity.
M uch the most plausible interpretation o f w hy these keep cropping up as m arkers for stress in modern societies is that they all affect - or reflect - the extent to which w e do or do not feel at ease and confident with each other. Insecurities which can come from a stressful early life have some similarities with the insecurities which can come from low social status, and each can exacerbate the effects o f the other.
Friendship has a protective effect because w e feel more secure and at ease with friends. Friends make you feel appreciated, they find you good com pany, enjoy your conversation - they like you. If, in contrast, w e lack friends and feel avoided by others, then few o f us are thick-skinned enough not to fall prey to self-doubts, to worries that people find us unattractive and boring, that they think w e are stupid or socially inept.
H o w people see you matters. W hile it is o f course possible to be upper-class and still feel totally inadequate, or to be lower-class and full o f confidence, in general the further up the social ladder you are, the more help the w orld seems to give you in keeping the self-doubts at bay.
If the social hierarchy is seen - as it often is - as if it were a ranking o f the human race by ability, then the outw ard signs o f success or failure the better jobs, higher incomes, education, housing, car and clothes all make a difference. T o do well for yourself or to be successful is alm ost synonym ous with m oving up the social ladder. H igher status alm ost alw ays carries connotations o f being better, superior, more successful and more able.
Social com parisons increasingly show you in a positive light - whether they are com parisons o f wealth, education, job status, where you live, holidays, or any other markers o f success. By playing on our fears o f being seen as o f less w orth, advertisers m ay even contribute to the level of violence in a society.
It w as Thom as Scheff, emeritus professor o f sociology at the University o f C alifornia, Santa B arbara, w ho said that shame was the social em otion. Shame and its opposite, pride, are rooted in the processes through which w e internalize how w e imagine others see us. N o r o f course does it stop in childhood: our sensitivity to shame continues to provide the basis for conform ity throughout adult life.
People often find even the smallest infringement o f social norms in the presence o f others causes so much em barrassm ent that they are left wishing they could just disappear, or that the ground w ould sw allow them up.
Although the D ickerson and Kem eny study found that it was exposure to social evaluative threats which most reliably raised levels o f stress horm ones, that does not tell us how frequently people suffer from such anxieties. A re they a very com mon part o f everyday life, or only occasional? An answ er to that question comes from the health research show ing that low social status, lack o f friends, and a difficult early childhood are the most im portant m arkers o f psychosocial stress in modern societies.
If our interpretation o f these three factors is right, it suggests that these kinds o f social anxiety and insecurity are the most com m on sources of stress in modern societies. W hy does the social evaluative threat seem so great? A plausible explanation is the break-up o f the settled communities o f the past. People used to gro w up know ing, and being know n by, m any o f the same people all their lives.
Although geographical m obility had been increasing for several generations, the last half century has seen a particularly rapid rise. A t the beginning o f this period it w as still com m on for people - in rural and urban areas alike - never to have travelled much beyond the boundaries o f their immediate city or village com munity.
M arried brothers and sisters, parents and grandparents, tended to remain living nearby and the com m unity consisted of people w ho had often known each other for much o f their lives. Fam iliar faces have been replaced by a constant flux o f strangers. A s a result, w ho we are, identity itself, is endlessly open to question. A nd at the core o f our interactions with strangers is our concern at the social judgements and evaluations they might m ake: h ow do they rate us, did w e give a good account o f ourselves?
It is w ell know n that these problems are particularly difficult for adolescents. W hile their sense o f themselves is most uncertain, they have to cope in schools o f a thousand or more o f their peers. It is hardly surprising that peer pressure becomes such a pow erful force in their lives, that so m any are dissatisfied with w hat they look like, or succumb to depression and self-harm. Rather than being entirely separate spheres, how much status and wealth people achieve - from unskilled low -paid w o rk to success, money and pre-eminence - affects not only their sense o f themselves, but also how positively they are seen even by friends and fam ily.
Our need to feel valued and capable human beings means w e crave positive feedback and often react w ith anger even to implied criticism. Social status carries the strongest messages o f superiority and inferiority, and social m obility is w idely seen as a process by which people are sorted by ability. Instead o f accepting each other as equals on the basis o f our com m on humanity as w e might in m ore equal settings, getting the measure o f each other becomes more im portant as status differences widen.
Between strangers it m ay often be the dom inant feature. If inequalities are bigger, so that some people seem to count for alm ost everything and others for practically nothing, where each one o f us is placed becomes more im portant. Greater inequality is likely to be accom panied by increased status com petition and increased status anxiety.
It is not sim ply that where the stakes are higher each o f us w orries more about where he or she comes. It is also that w e are likely to pay more attention to social status in how w e assess each other. Surveys have found that when choosing prospective m arriage partners, people in more unequal countries put less em phasis on rom antic considerations and more on criteria such as financial prospects, status and am bition, than do people in less unequal societies.
In Jap an , people choose a much more self-deprecating and self-critical w a y o f presenting themselves, which contrasts sharply with the much more self-enhancing style in the U S A. While Am ericans are more likely to attribute individual successes to their ow n abilities and their failures to external factors, the Japanese tend to do just the opposite.
This Japanese pattern w as also found in T aiw an and China. Rather than getting too caught up in psychological term inology, w e w ould do well to see these patterns as differences in how far people value personal modesty, preferring to maintain social bonds by not using their successes to build themselves up as more able than others.
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