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Photo by kind permission of Matt Stuart

Social Dysfunction: why inequality matters Richard Wilkinson Emeritus Professor of Social Epidemiology. Photo by kind permission of Matt Stuart. Income per head and life-expectancy: rich & poor countries. www.equalitytrust.org.uk. Source: Wilkinson & Pickett, The Spirit Level (2009).

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Photo by kind permission of Matt Stuart

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  1. Social Dysfunction: why inequality matters Richard Wilkinson Emeritus Professor of Social Epidemiology Photo by kind permission of Matt Stuart

  2. Income per head and life-expectancy: rich & poor countries www.equalitytrust.org.uk Source: Wilkinson & Pickett, The Spirit Level (2009)

  3. www.equalitytrust.org.uk Life expectancy in rich countries is no longer related to National Income per head Wilkinson & Pickett, The Spirit Level

  4. Mortality is related to income differences within societies PoorRich Median income of Zip code areasMRFIT data from Davey Smith et al. AJPH 1996

  5. www.equalitytrust.org.uk • Inequality... • How much richer are the richest 20% in each country than the poorest 20%? Income gaps How many times richer are the richest fifth than the poorest fifth? Wilkinson & Pickett, The Spirit Level

  6. Health and social problems are worse in more unequal countries www.equalitytrust.org.uk • Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Index of health and social problems Wilkinson & Pickett, The Spirit Level

  7. Neither health nor social problems are related to national income per head • Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Index of health and social problems Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk

  8. www.equalitytrust.org.uk Child well-being is better in more equal countries Wilkinson & Pickett, The Spirit Level

  9. www.equalitytrust.org.uk The UNICEF Index of Child Wellbeing is not related to National Income per head Wilkinson & Pickett, The Spirit Level

  10. www.equalitytrust.org.uk People in more unequal countries trust each other less Wilkinson & Pickett, The Spirit Level

  11. www.equalitytrust.org.uk People in more unequal states of the USA trust each other less Wilkinson & Pickett, The Spirit Level

  12. www.equalitytrust.org.uk Mental illness is more common in more unequal societies Wilkinson & Pickett, The Spirit Level

  13. www.equalitytrust.org.uk Infant Mortality Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009)

  14. Male mortality (25-64 yrs) and income inequality in US states and Canadian provinces. Source: Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA, Lynch JW. British Medical Journal 2000;320:898-902

  15. USA states Canadian provinces Homicide rates are higher in more unequal US states and Canadian provinces Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Can J Crim 2001; 43: 219-36.

  16. www.equalitytrust.org.uk Teenage Birth Rates are Higher in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009)

  17. www.equalitytrust.org.uk Imprisonment rates are higher in more unequal countries Wilkinson & Pickett, The Spirit Level

  18. More children drop out of High School in more unequal US states www.equalitytrust.org.uk Wilkinson & Pickett, The Spirit Level

  19. www.equalitytrust.org.uk Educational Scores are Higher in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009)

  20. www.equalitytrust.org.uk Social mobility is lower in more unequal countries Wilkinson & Pickett, The Spirit Level

  21. In summary... bigger income gaps lead to deteriorations in:- • Health • Drug abuse • Infant mortality • Life expectancy • Mental illness • Obesity • Social Relations • Child conflict • Homicide • Imprisonment • Social capital • Trust • Human Capital • Child wellbeing • High school drop outs • Math & literacy scores • Social mobility • Teenage births ...but not suicide...

  22. www.equalitytrust.org.uk Death rates are lower in more equal States for both richer and poorer Americans Wilkinson & Pickett, The Spirit Level

  23. Self-reported prevalence of illness by education % Diabetes Hypertension Cancer Lung disease Heart disease Source: Banks et al. JAMA 2006; 295: 2037-2045

  24. Literacy Scores of 16-25 year olds by Parents' Education 1 0.5 Sweden 0 Literacy score Canada -0.5 -1 United States -1.5 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Parents' Education (years) Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

  25. Health and social problems are worse in more unequal countries www.equalitytrust.org.uk • Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Index of health and social problems Wilkinson & Pickett, The Spirit Level

  26. More inequality Valued or Devalued? • More superiority and inferiority • More status competition and consumerism • More status insecurity • More worry about how we are seen and judged • More “social evaluation anxiety”(threats to self-esteem & social status, fear of negative judgements

  27. Psychosocial risk factors for ill health • Low social status • Weak social affiliations • Stress in early life (pre- and postnatally)

  28. What kind of stressful tasks raise stress hormones most? Cortisol response(effect size) Tasks with ‘social evaluative threat’ (uncontrollable) Other tasks Dickerson SS, Kemeny ME. Acute stressors and cortisol responses. Psychological Bulletin 2004; 130(3): 355-91.

  29. Gilligan J. Violence: Our Deadly Epidemic and its Causes. (G .P. Putnam 1996) " ...the prison inmates I work with have told me repeatedly, when I asked them why they had assaulted someone, that it was because 'he disrespected me', or 'he disrespected my visit' (meaning 'visitor'). The word 'disrespect' is central in the vocabulary, moral value system, and psychodynamics of these chronically violent men that they have abbreviated it into the slang term, 'he dis'ed me." p.106 A few pages further on Gilligan continues:- "I have yet to see a serious act of violence that was not provoked by the experience of feeling shamed and humiliated, disrespected and ridiculed, and that did not represent the attempt to prevent or undo this "loss of face " - no matter how severe the punishment, even if it includes death." p.110

  30. Social Status and Friendship • Two sides of the same coin: • Social status (dominance hierarchies, pecking orders) are orderings based on power, coercion and privileged access to resources – regardless of the needs of others. • Friendship, in contrast, is based on reciprocity, mutuality, social obligations, sharing and a recognition of each other’s needs.

  31. Stereotype threat. High & low socioeconomic statusgroups given ‘Advanced Progressive Matrices’ test Number of items correct “Not a test of ability” “Test of ability” Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.

  32. Data from: Piketty & Saez

  33. For more information: • a book … • … and a website http://www.equalitytrust.org.uk

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