Richard Wilkinson Emeritus Professor of Social Epidemiology - - PowerPoint PPT Presentation

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Richard Wilkinson Emeritus Professor of Social Epidemiology - - PowerPoint PPT Presentation

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Richard Wilkinson Emeritus Professor of Social Epidemiology University of Nottingham & Kate Pickett Professor of Epidemiology University of York http://www.equalitytrust.org.uk 1 Income per head and life-expectancy: rich & poor

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Richard Wilkinson

Emeritus Professor of Social Epidemiology University of Nottingham

&

Kate Pickett

Professor of Epidemiology University of York http://www.equalitytrust.org.uk

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Income per head and life-expectancy: rich & poor countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Among the rich countries life expectancy is not related to national differences in average income

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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…but life expectancy is related to income within rich societies

Source: Wilkinson & Pickett, The Spirit Level (2009)

70 71 72 73 74 75 76 77 78 79 80

Least deprived Most deprived

Electoral wards in England & Wales by deprivation score

Life expectancy (years)

www.equalitytrust.org.uk

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How much richer are the richest 20% than the poorest 20%?

www.equalitytrust.org.uk

Source: Wilkinson & Pickett, The Spirit Level (2009)

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7 Index of:

  • Life expectancy
  • Math & Literacy
  • Infant mortality
  • Homicides
  • Imprisonment
  • Teenage births
  • Trust
  • Obesity
  • Mental illness – incl.

drug & alcohol addiction

  • Social mobility

Health and Social Problems are Worse in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Health and Social Problems are not Related to Average Income in Rich Countries

Index of:

  • Life expectancy
  • Math & Literacy
  • Infant mortality
  • Homicides
  • Imprisonment
  • Teenage births
  • Trust
  • Obesity
  • Mental illness – incl.

drug & alcohol addiction

  • Social mobility

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Child Well-being is Better in More Equal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Child-Wellbeing is Unrelated to Average Incomes in Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Levels of Trust are Higher in More Equal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

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Levels of Trust are Higher in More Equal US States

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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The Prevalence of Mental Illness is Higher in More Unequal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Infant Mortality Rates are Higher in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Drug Use is More Common in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

Index of use of: opiates, cocaine, cannabis, ecstasy, amphetamines

www.equalitytrust.org.uk

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Teenage Birth Rates are Higher in More Unequal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Homicide and income inequality: US States and Canadian Provinces

30 60 90 120 150 180 0.35 0.38 0.41 0.44 0.47

Income Inequality (Gini) Homicides per million people More equal More unequal

Source: Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Canadian Journal of Criminology 2001; 43: 219-36.

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Rates of Imprisonment are Higher in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Social mobility is higher in more equal countries

www.equalitytrust.org.uk

Intergenerational income mobility data from: Blanden J. (2009) Centre for Economic Performance, LSE. Paper No' CEEDP0111.

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Indicator International data US data r p-value r p-value Trust

  • 0.66

<0.01

  • 0.70

<0.01 Life expectancy

  • 0.44

0.04

  • 0.45

<0.01 Infant mortality 0.42 0.04 0.43 <0.01 Obesity 0.57 <0.01 0.47 <0.01 Mental illness 0.73 <0.01 0.18 0.12 Education score

  • 0.45

0.04

  • 0.47

.01 Teen birth rate 0.73 <0.01 0.46 <0.01 Homicides 0.47 0.02 0.42 <0.01 Imprisonment 0.75 <0.01 0.48 <0.01 Social mobility 0.93 <0.01

  • Index

0.87 <0.01 0.59 <0.01

Correlations & p-values: Index of Health & Social Problems

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Almost everyone benefits from greater equality. Usually the benefits are greatest among the poor but extend to the majority of the population

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Infant Mortality by Social Class: Sweden and England & Wales

2 4 6 8 10 12 14 16 18 I II IIIN IIIM IV V Single Prnt Unclass.

E & W Sweden

Source: Leon DA, Vagero D, Olausson PO. BMJ 1992; 305; 687-91

Infant Mortality rate

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Literacy Scores of 16-25 year olds by Parents' Education

  • 1.5
  • 1
  • 0.5

0.5 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

Parents' Education (years) Literacy score

Sweden Canada United States

Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

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24 Index of:

  • Life expectancy
  • Math & Literacy
  • Infant mortality
  • Homicides
  • Imprisonment
  • Teenage births
  • Trust
  • Obesity
  • Mental illness – incl.

drug & alcohol addiction

  • Social mobility

Health and Social Problems are Worse in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Psychosocial risk factors for ill health

  • Low social status
  • Weak social affiliations
  • Stress in early life (pre- and postnatally)
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ACTH Cortisol Tasks with both social-evaluative threat and uncontrollability Other tasks

Effect size

Source: Dickerson SS & Kemeny ME. Psychological Bulletin 2004; 130(3): 355-91

What kind of stress most reliably raises cortisol levels?

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“Not a test of ability”

5 6 7 8 9 10 11 12 13

High SES Low SES

“Test of ability”

Effect of stereotype threat: Verbal GRE: high & low SES

Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.

Number of items correct

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“Not a test of ability”

5 6 7 8 9 10 High SES Low SES

“Test of ability”

Effect of stereotype threat Advanced Progressive Matrices Test: high & low SES

Croizeta JC; Dutrevis M. Socioeconomic Status and Intelligence. J Poverty 2004; 8(3): 91-107.

Number of items correct

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Stereotype Threat

The effect of caste identity on children's performance

Caste Unannounced Caste Announced

1 2 3 4 5 6 High Caste Low Caste

Number of mazes solved

Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004

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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

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Source: Bowles S, Park Y. Economic Journal 2005; 115 (507): F397–F412. 2005.

Working hours are longer in more unequal countries

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Inequality and household debt (as % of financial assets)

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Australia Austria Belgium Canada Denmark Finland France Germany Greece Ireland Israel Italy Japan Netherlands New Zealand Norway Portugal Spain Sweden UK USA

Worse Better 10 20 30 Lone parents as % of all households with dependent children

Single parents and child wellbeing

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The effects of inequality - a two stage process 1. adult experience of inequality 2. passed on to children – epigenetics?

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Inequality (Gini) Great Britain 1961 - 2008

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The public and policy response?

more:- Police Doctors Social Workers Drug rehabilitation units Educational Psychologists But…services are expensive and only partially effective.

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http://www.equalitytrust.org.uk For more information:

… a book and a website…

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Social Status and Friendship

Two sides of the same coin: Social status (dominance hierarchies, pecking

  • rders) 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.

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Dunbar R. Brains on two legs: group size and the evolution

  • f intelligence In: Tree of Origin: F de Waal. (ed) 2001.

The Social Brain: the neocortex is a larger proportion of the brain in primate species with larger social groups

Average social group size Neocortex ratio

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www.equalitytrust.org.uk

World average CO2

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More equal countries are more generous foreign aid donors

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Business leaders in more equal countries give a higher priority to complying with international environmental agreements

With permission from R De Vogli & D Gimeno

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More equal countries recycle more waste

Source: Wilkinson & Pickett, The Spirit Level (2009)

Australia France Germany Italy Japan Portugal Spain Sweden Switzerland UK USA

Best Worst Low High Income Inequality

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Twenge JM, Baumeister RF, DeWall CN, Ciarocco NJ, Bartels JM. Social exclusion decreases prosocial behavior. Journal of Personality and Social Psychology 2007; 92(1): 56-66.

1 2 3 4 5 6 7 8 9

$ d

  • n

a t e d E x p e r i m e n t s P e n c i l s p i c k d u p P r i s n r ' s D i l e m 1 P r i s n r ' s D i l e m 2 P r i s n r ' s D i l e m 3 $ d

  • n

a t e d Future alone/rejected Future belonging/accepted

Social exclusion decreases prosocial behaviour: 7 experiments

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Why are we so sensitive to inequality?

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Trends in income inequality 1979-2005/6 (Gini coefficient, Great Britain.)

Brewer M, Goodman A, Muriel A, Sibieta L. Poverty and Inequality in the UK: 2007. Institute of Fiscal Studies, London.

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Inequality Debt Debt

  • P. Krugman Inequality and Crisis: coincidence or causation?

Data from: Picketty-Saez, Historical Statistics, Federal Reserve.

Inequality and Household Debt 1913-2007

Household debt as % of income Inequality: richest 1% share

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More equal societies are more innovative

www.equalitytrust.org.uk

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More Adults are Obese in More Unequal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Children Experience More Conflict in More Unequal Societies

Source: Wilkinson & Pickett, The Spirit Level (2009)

11, 13 & 15 yr olds fighting, bullying, and finding peers not kind & helpful

www.equalitytrust.org.uk

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More Children Drop Out of High School in More Unequal US States

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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Cognitive Score: Socioeconomic status more important than starting point

High Cognitive Score at 22 months Low Cognitive Score at 22 months

2 3 4 5 6 7 8 9 10 Child’s age (years)

Cognitive score percentile position at each age (I Feinstein. Inequality in cognitive development. 1970 British Births. Economica 2003; 70: 3-97) (from The Marmot Review 2010)

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Educational Scores are Higher in More Equal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009)

www.equalitytrust.org.uk

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The changing relation between life expectancy and income.

Reproduced from World Bank, World Development Report 1993

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10 20 30 40 50 60 70 80 90 100 Nations States, Regions, Cities Small areas Wholly Supportive Unsupportive

Review of 168 analyses of the relation between income inequality and health.

Percent

Wilkinson RG, Pickett KE. Income inequality and health: a review and explanation of the evidence. Social Science and Medicine 2006; 62: 1768-84.

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Source: Bagehot, On equality. The Economist, 19th August 2010