Richard Wilkinson
and Kate Pickett
* * *
THE INNER LEVEL
How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Well-being
Contents
List of Figures
Note on Data and Figures
Prologue
1 This is Not a Self-help Book
PART ONE
Inequality in the Mind
2 Self-doubt
3 Delusions of Grandeur
4 False Remedies
PART TWO
Myths of Human Nature, Meritocracy and Class
5 The Human Condition
6 The Misconception of Meritocracy
7 Class Acts
PART THREE
The Road Ahead
8 A Sustainable Future?
9 A Better World
Appendices
Resources
A List of Health and Social Outcomes Affected by Income Inequality
References
Acknowledgements
Follow Penguin
For
George and Annie Wilkinson
Sarah Colebourne and Helen Holman
And for the staff of The Retreat, York – at the forefront of treating the mentally distressed with respect since 1796
List of Figures
1. Health and social problems are more common in more unequal countries (Wilkinson and Pickett, 20101)
1.1 The more stress people experience, the higher their death rates (Russ et al., 201231)
2.1 Status anxiety is higher at all levels of income in more unequal countries (Layte and Whelan, 201457)
2.2 The prevalence of mental illness is higher in more unequal rich countries (Wilkinson and Pickett, 201059)
2.3 There is a social gradient in depression (McManus et al., 200969)
2.4 Humans act along two dimensions of behaviour: dominance/submissiveness and warmth/hostility
2.5 Income inequality and prevalence of depression across forty-five US states (Messias et al., 200696)
2.6 Income inequality and incidence of schizophrenia, 1975–2001 (Burns et al., 2014101)
2.7 Civic participation decreases in more unequal European countries (Lancee et al., 201237)
2.8 There was a bigger swing in the vote towards Donald Trump in counties with worse health (©The Economist Newspaper Limited, 2016108)
3.1 Income inequality is related to higher levels of self-enhancement bias (Loughnan et al., 2011112)
3.2 College students’ Narcissistic Personality Inventory scores appear to reflect the rise in US income inequality (Wilkinson and Pickett, 2017123)
3.3 Percentage of cars that cut off other vehicles at an intersection and pedestrians at a crossing, by vehicle status (Piff et al., 2012145)
3.4 The higher narcissism scores of upper-social-class people are reduced when they are primed to think about egalitarian values (Piff, 2014146)
4.1 Income inequality is related to higher levels of problem gambling in rich countries (Wilkinson & Pickett, 2017123)
4.2 Spending on advertising, as a percentage of GDP, increases with greater income inequality (Wilkinson and Pickett, 2017123)
4.3 Child well-being is worse in more unequal rich countries (Pickett and Wilkinson, 2015190)
4.4 Household debt rises with income inequality in the USA, 1963–2003 (Iacoviello, 2008199)
5.1 The volume of the neocortex as a proportion of the whole brain is related to average group size in different primate species (Dunbar, 2007208)
5.2 Children bully each other more in more unequal countries (Elgar et al., 2009233)
5.3 Women in more unequal societies prefer more masculine faces (DeBruine et al., 2010234; Brooks et al., 2011236)
6.1 Players born earlier in the year are more likely to play in National Hockey League teams (Baker and Logan, 2007277)
6.2 Children from families receiving welfare benefits and in working-class families hear fewer words than children in professional families (Hart and Risley, 1995296; Heckman, 2011297)
6.3 How family background shapes educational performance over time (Crawford et al., 2017298)
6.4 Income inequality is related to a wider gap in educational attainment among adults (OECD, 2000327)
6.5 Maths and literacy scores tend to be higher in more equal rich countries (Wilkinson and Pickett, 2006328)
6.6 Greater income inequality is associated with worse performance on the 2016 UNICEF Index of Child Well-being in Wealthy Countries (UNICEF, 2016336)
6.7 There is less social mobility in countries with bigger income differences (Corak, 2013337)
7.1 Museums and art galleries are much more popular in more equal countries (Szlendak and Karwacki, 2012377)
7.2 The age of criminal responsibility is younger in more unequal countries (Child Rights International Network, 2017382)
8.1 Life expectancy levels off at higher levels of economic development
8.2 GDP per head continues upwards, but Life Satisfaction and the Genuine Progress Indicator no longer rise with it (Kubiszewski et al., 2013392)
8.3 Business leaders in more equal countries regard it as more important to comply with international environmental agreements (Wilkinson et al., 2010414)
9.1 Trends in the income share of the richest 1 per cent (World Wealth and Income Database, 2016)
9.2 Where trade unions are weaker, inequality is greater (Gustafsson and Johansson, 1999424)
9.3 Changes in trade union strength and inequality in the USA, 1918–2008 (Eisenbrey and Gordon, 2012425)
9.4 Changing ratio of CEO pay to average pay of production workers in largest 350 US companies (Mishel and Sabadish, 2012439)
9.5 Company performance in the largest US companies is better where CEOs are paid less (Marshall, MSCI ESG Research Inc., 2016441)
With the exception of figures 2.8 and 9.5, all the figures are either our own or have been redrawn from the original sources and, on condition that they are credited to the original publications, they can be reproduced without our permission.
The cartoon here is reproduced with kind permission of Steven O’Brien. All other cartoons are reproduced with grateful acknowledgement to www.CartoonStock.com.
Note on Data and Figures
Most of the graphs we present in this book are charts linking income inequality to different health and social problems. Some show this relationship across different countries, others across the different states of the USA.
In our previous book, we aimed to present a consistent set of data by always using the same measure of inequality, the same set of countries and so on. As well as our own new analyses, in this book we present graphs and data that have been produced by researchers from all over the world. Each group of researchers has chosen, from official sources, the most appropriate measure of income inequality to use to answer their research questions, which countries or states and what years to include in the analysis, how to measure the outcomes they are interested in, how to analyse the data and draw the graphs. In each case, the researchers have carefully described their methods in the peer-reviewed journals and official reports that we use; all of these are included in the reference section at the back of this book and many are freely available online. Where possible, and when the data have been available publicly or through the kindness of other researchers, we have re-drawn graphs to be as easy to read as possible. All of the graphs we show come from reputable sources, almost all of them from academics publishing in peer-reviewed journals, and all of our own new analyses have also been peer-reviewed.
Although readers will see that there are differences in the countries studied, the years for which data are reported and the measures used, the most remarkable feature of this
variation is that the overall picture we see is so consistent.
‘It’s a great party. Everyone here is more insecure than I am!’
Prologue
The story so far …
The Spirit Level, published in 2009, showed that people in societies with bigger income gaps between rich and poor are much more likely to suffer from a wide range of health and social problems than those living in more equal societies.1 The evidence we presented in that book strongly implied that inequality has major psychological effects and that many of these problems are the result of increased social stress. In this new book we explore what these psychological effects and social stresses are: how inequality gets into our minds, how it increases anxiety levels, how people respond and what the consequences are for levels of mental illness and emotional disorders – how, in sum, living in a more unequal society changes how we think and feel and how we relate to each other. The picture we present is based partly on our own work but predominantly on a large body of research from academics around the world. The evidence drawn together here not only clarifies why more unequal societies are so dysfunctional, but also helps to identify the changes that would make social interaction better and improve everyone’s health and happiness.
The Spirit Level provided the starting point for this book; so much so, that those unfamiliar with it may find it helpful to have a brief summary of its findings here. First, our earlier book showed that the populations of societies with larger income differences tend to have worse health: lower life expectancy and higher rates of infant mortality, mental illness, illicit drug use and obesity. Greater inequality also damages social relationships: more unequal societies experience more violence (as measured by homicide rates) and higher rates of imprisonment; people trust each other less and community life is weaker. Inequality also damages children’s life chances; more unequal societies have lower levels of child well-being and educational attainment, more teenage births and less social mobility.
The same relationships between the scale of inequality and societal problems were evident whether we looked internationally at the scale of income inequality in different rich countries or when we analysed data for the fifty states of the USA. In both settings, bigger income differences correlated closely with worse outcomes.
The picture is remarkably clear and consistent. Take the USA as an example: compared to other rich countries it has the largest income differences between rich and poor and suffers from the highest homicide rates, the highest percentage of the population in prison, the highest rates of mental illness, the highest teenage birth rates, among the lowest life expectancy, low levels of child well-being and low maths and literacy attainment. Britain and Portugal, which during our research period were the next most unequal of the rich countries, also did very poorly on most of these outcomes. In contrast, more equal countries, such as the Scandinavian countries and Japan, did well. Figure 1 provides a simple summary of our findings for rich countries.
The identification of these patterns did not rest solely on our own work, but reflected findings from a large number of researchers in different academic disciplines in different countries. The first research papers showing that violence was more common, and health worse, in countries with bigger income gaps were published in peer-reviewed journals in the 1970s. Since then the number of published studies has grown and grown; there are now well over three hundred research papers that have examined health and homicide rates in relation to inequality in different parts of the world. Studies cover both developed and developing countries; some look at the relationship at a particular point in time, others at changes over time. Many have taken account of differences in average incomes and/or poverty, as well as other factors such as spending on public services. The vast majority show a consistent tendency for outcomes to be worse in more unequal societies.2 The evidence is now such that these correlations between income inequality and both health and social problems must be regarded as causal, reflecting the ways greater inequality damages societies, harming human health and well-being.3
The step from evidence of correlation to evidence of causality is obviously a crucial one. Why do we think it can be made confidently? Epidemiology has been centrally concerned with statistical evidence identifying the causes of disease and has therefore developed a set of criteria for judging whether relationships are likely to be causal. As well as the obvious point that causes must precede their effects, they also include the strength of the relationship, whether there is a ‘dose-response’ relationship – i.e., higher levels of inequality lead to successively worse outcomes – whether the relationship is biologically plausible, whether or not there are other likely explanations, and whether research results present a consistent picture. Judged on this basis, the evidence from several hundred research studies suggests that the relationship between larger income differences and a worsening of a wide range of health and social problems is indeed causal.3
Figure 1: Health and social problems are more common in more unequal countries.fn1 1
The evidence also satisfies the rather different criteria put forward by the philosopher of science Karl Popper. He emphasized that an important criterion for judging a good theory was whether it made new and testable predictions that later research confirmed. The theory that economic inequality has damaging social consequences has indeed led to many testable predictions, covering outcomes and causal mechanisms, which have been repeatedly confirmed.3, 4
NOT A THEORY OF EVERYTHING …
The Spirit Level was once described as being ‘a theory of everything’. That was intended to be flattering, but it isn’t true. It applies specifically to problems that have a social gradient (in other words, those which become more common with each step down the social ladder). We have known for decades that ill health, violence, child well-being, incarceration, mental illness, drug addiction and many other problems have social gradients. Whether you compare rich and poor areas, high and low social classes, or people with more or less education, these problems all occur more often at each step down the social ladder. What The Spirit Level showed was in fact simple: that the many seemingly distinct problems which we know are related to social status (whether measured by income, education or occupation)fn2 within our societies, get worse when bigger income differences make the status differences larger and more important. Position in the pecking order and the scale of status differences – inequality – play a causal role in problems with social gradients.
One of our more surprising findings was that inequality affects the vast majority of the population, not only a poor minority. Although its severest effects are on those nearer the bottom of the social ladder, the vast majority are also affected to a lesser extent. This means that if well-educated people with good jobs and incomes lived with the same jobs and incomes in a more equal society, they would be likely to live a little longer and less likely to become victims of violence; their children might do a little better at school and would be less likely to become teenage parents or to develop serious drug problems. The issue is, therefore, not so much whether more unequal countries do or do not have more poor people, but the way larger income differences across a society immerse everyone more deeply in issues of status competition and insecurity.
It is because inequality affects most people that the differences in rates of health and social problems between more and less equal societies are often very large indeed. We found that mental illness and infant mortality rates were two or three times as high in more unequal countries.1 Teenage birth rates, the proportion of the population in prison and, in some analyses, homicide rates were as much as ten times higher in more unequal societies.1
There is a widespread belief that the reason why so many problems tend to be more common lower down than higher up on the social ladder reflects the kinds of people who end up at either end – the idea that the capable and resilient climb up, while the vulnerable slip down into poverty and deprivation. The evidence of the effects of inequality pre
sents a fundamental challenge to this view. Insofar as societies work as sorting systems, moving the fit upwards and the unfit downwards, that would obviously contribute to a greater burden of ill-health and other problems nearer the bottom of society. But shifting people up or down the social ladder would not, in itself, change the total number of people with any particular characteristic in society. If, for example, social mobility sorted people according to whether they had fairer or darker hair, that would of course create a social gradient in hair colour, but it would not change the overall proportion of people with either light or dark hair. The same is true if people were sorted according to their vulnerability to illness or tendency to violence.
However, the effect of changing inequality in a society is precisely to change the overall burden of almost all the problems with social gradients. Bigger income gaps not only make these problems worse, but, because they have a larger effect on the poor than the better off, they make the social gradients in different outcomes steeper. The implication is that social gradients in health, the incidence of violence and children’s maths and literacy scores, among other measures, are not simply the result of a social sorting process. Something else must be going on. Our explanation is that these problems are driven by the stress of social status differences themselves, stresses which get worse the lower you are on the social ladder and the bigger the status differences. In effect, bigger income differences make status differences more potent.
By raising the stakes and making the differences more apparent, income and social position are seen as ever-more prominent indicators – measures almost – of a person’s worth. Each step down the status hierarchy matters more as we come increasingly to judge each other by status. It is not surprising that problems which are sensitive to social status within our societies get worse when status differences increase.
The Inner Level Page 1