Richard WilkinsonEmeritus Professor of

Social EpidemiologyUniversity of Nottingham

&

Kate PickettSenior Lecturer in Epidemiology

University of York

http://www.equalitytrust.org.uk

Health is related to income differences within rich societies but not to those between them

Within societiesBetween (rich) societies

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

70

71

72

73

74

75

76

77

78

79

80

Electoral wards in England & Wales ranked by deprivation score

Life

exp

ecta

ncy

(yea

rs)

Mostdeprived

www.equalitytrust.org.uk

Gezondheid hangt samen met inkomensverschillen binnen rijke samenlevingen maar niet met inkomensverschillen tussen rijke samenlevingen

Tussen (rijke) samenlevingen Binnen samenlevingen

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

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Inkomen per hoofd en levensverwachting: in rijke en arme landen

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

www.equalitytrust.org.ukSource: Wilkinson & Pickett, The Spirit Level (2009)

Hoeveel rijker zijn de rijkste 20% dan de armste 20%?

Index van: • Levensverwachting• Wiskunde en

geletterdheid • Kindsterfte• Moorden• Detentiegraad• Tienerzwangerschappen

• Vertrouwen• Obesitas• Geestelijke problemen –

incl. drugs- en alcoholverslaving

• Sociale mobiliteit

Health and Social Problems are Worse in More Unequal Countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Gezondheidsproblemen en sociale problemen zijn groter in meer ongelijke landen

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

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Gezondheidsproblemen en sociale problemen zijn niet gerelateerd aan het gemiddeld inkomen in rijke landen

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

drug & alcohol addiction• Social mobility

Child Well-being is Better in More Equal Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Welzijn van kinderen is groter in meer gelijke (rijke) landen

Child-Wellbeing is Unrelated to Average Incomes in Rich Countries

Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

Welzijn van kinderen is niet gerelateerd aan gemiddelde inkomens in rijke landen

Health and social problems which are substantially worse in more unequal societies

International data:• Social Mobility / sociale mobiliteit• Hours worked / werkuren• Child conflict / kinderconflicten• UNICEF Child well-being Index / index

kinderwelzijn (UNICEF)

US states data:• High school drop-out rate /

veel schoolverlaters

Data available for countries and for states of the USA:

• Social capital/ sociaal kapitaal

• Drug abuse/ druggebruik

• Trust/ vertrouwen• Homicides/ moorden

• Maths & literacy scores/ Wiskunde en geletterdheid

• Obesity/ obesitas

• Teenage birth rates/ tienerzwangerschappen

• Life expectancy/ levensverwachting

• Imprisonment rates/ detentiegraad

• Infant mortality/ kindersterfte

• Mental illness/ psychische ziekten

• Low birth weight/ laag geboortegewicht

[Smoking and suicide are the only counter examples we have found]

Gezondheidsproblemen en sociale problemen die substantieel groter zijn in meer ongelijke samenlevingen

Beschikbare data voor landen en voor staten van de VS:

Levels of Trust are Higher in More Equal Rich Countries

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

Vertrouwen is groter in meer gelijke (rijke) landen

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

www.equalitytrust.org.uk

Het voorkomen van psychische ziekten is groter in meer ongelijke (rijke) landen

Homicide and income inequality: US States and Canadian Provinces

0

30

60

90

120

150

180

0.35 0.38 0.41 0.44 0.47

Income Inequality (Gini)

Ho

mic

ide

s p

er

mill

ion

pe

op

le

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.

Teenage Birth Rates are Higher in More Unequal Rich Countries

www.equalitytrust.org.uk

Meer tienerzwangerschappen in meer ongelijke (rijke) landen

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

Druggebruik komt meer voor in meer ongelijke landen

Rates of Imprisonment are Higher in More Unequal Countries

www.equalitytrust.org.uk

Meer gevangenen in meer ongelijke landen

Almost everyone benefits from greater equality.

Bijna iedereen geniet van grotere gelijkheid.

Usually the benefits are greatest among the poor but extend to the majority of the population.

Normaal zijn de voordelen het grootst voor de armen, maar dit geldt voor de meerderheid van de bevolking.

Infant Mortality by Social Class: Sweden and England & Wales

0

2

4

6

8

10

12

14

16

18

I II IIIN IIIM IV V SinglePrnt

Unclass.

E & W

Sweden

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

Infa

nt M

orta

lity

rate

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

-1.5

-1

-0.5

0

0.5

1

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

Parents' Education (years)

Lite

racy

sco

re

Sweden

Canada

United States

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

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

Gezondheidsproblemen en sociale problemen zijn groter in meer ongelijke landen

Australia

Austria

Belgium Canada

Denmark

Finland

France

Germany

Greece

Ireland

Israel

Italy

Japan

Netherlands

New Zealand

Norway

Portugal

Spain

Sweden

UK

USA

Worse

Better

UN

ICE

F in

dex

of c

hild

wel

l-bei

ng

0 10 20 30Lone parents as % of all households with dependent children

Single parents and child wellbeing

Alleenstaande ouders en kinderwelzijn

Why are we so sensitive to inequality?

Waarom zijn we zo gevoelig voor ongelijkheid?

What kind of stress most reliably raises cortisol levels?

Welk soort van stress doet het niveau van cortisol (stresshormoon) verhogen?

A meta-analysis of 208 laboratory studies of cortisol responses to acute stressors found that “Tasks that included social-evaluative threat (such as threats to self-esteem or social status), in which others could negatively judge performance, particularly when the outcome of the performance was uncontrollable, provoked larger and more reliable cortisol changes than stressors without these particular threats.”

Uit een meta-analyse van 208 laboratorische studies van cortisol (stresshormoon) reacties op acute stressverwekkers blijkt dat taken met een sociaal-evaluatieve bedreiging (zoals bedreigingen van het zelfvertrouwen en sociale status), waarin anderen negatief konden beoordelen, ontlokken grotere en meer betrouwbare cortisol veranderingen dan stressverwekkers zonder deze bedreigingen.

What kind of stress most reliably raises cortisol levels?

Welk soort van stress doet het niveau van cortisol (stresshormoon) verhogen?

"Humans are driven to preserve the social self and are vigilant to threats that may jeopardize their social esteem or status.”

“Mensen zijn gedreven om het sociale zelf te bewaren en zijn op hun hoede voor bedreigingen die hun sociaal vertrouwen of status in gevaar brengen.”

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

Inequality and Sustainability

Consumerism is one of the greatest threats to sustainability

Because inequality increases status competition, it also increases consumerism. People in more unequal societies work longer hours because money seems even more important.

Consumentisme is een van de grootste bedreigingen van duurzaamheid

Omdat ongelijkheid statuscompetitie verhoogt, verhoogt het ook het consumentisme. Mensen in meer ongelijke samenlevingen werken langere uren omdat geld nog belangrijker lijkt.

Inequality and Sustainability Concern for the common good is a crucial resource if we are to reduce carbon emissions

Because inequality harms the quality of social relations, people become more self-interested, less public spirited, less concerned with the common good. This is shown in the amount of overseas aid countries give, in the proportion of waste recycled, in how countries score on the global peace index, and in how important business leaders think it is that their governments abide by international environmental agreements.

Betrokkenheid bij het gezamenlijk goed is cruciaal als we de CO²-uitstoot willen verminderen

Omdat ongelijkheid de kwaliteit van sociale relaties aantast, worden mensen meer egocentrisch en minder betrokken bij het gemeenschappelijk goed. Dit is bewezen in de hoeveelheid overzeese hulp landen geven, in de hoeveelheid afval dat gerecycleerd wordt, in hoe landen scoren op de vredesindex, en in hoe belangrijk zakenmensen denken over de belangrijk dat de overheid toetreedt tot internationale milieu-overeenkomsten.

http://www.equalitytrust.org.uk

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