This document summarizes research showing that more equal societies tend to have better outcomes on measures of health and social problems. It presents data showing that within wealthy countries, life expectancy and child well-being are more strongly linked to income inequality than average national income. Charts and studies are presented showing links between inequality and higher rates of issues like mental illness, homicides, teenage births, and lower social mobility. The research suggests that reducing inequality through policies like progressive taxes, stronger unions, and more shared company ownership could generate benefits including improved population health and sustainability.

1. Photo by kind permission of Matt Stuart
Why more equal societies do better
Richard Wilkinson
Emeritus Professor of Social Epidemiology

2. 2

3. 3
Income per head and life-expectancy: rich & poor countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

4. ‘‘Cross-country data show almost no relation
between changes in life expectancy and
economic growth over 10, 20, or 40-year time
periods between 1960 and 2000. Many
countries have shown remarkable
improvements in health with little or no
economic growth...’’
Cutler D, Deaton A, Lleras-Muney A. The Determinants
of Mortality. J Economic Perspectives 2006; 20: 97–
120.

5. www.equalitytrust.org.uk
WorldaverageCO2

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

7. 70
71
72
73
74
75
76
77
78
79
80
Local Neighbourhoods
(in England & Wales)
Lifeexpectancy(years)
Richest Poorest
Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk
Life expectancy is strongly related to
income within rich countries

8. 3.7 3.9
4.3 4.6 4.8
5.2 5.3 5.6 5.6 5.6 5.7
6.1 6.2
6.7 6.8 6.8
7.2
8.5
9.7
4.0
8.0
7.0
3.4
Japan
Finland
Norway
SwedenDenmark
Belgium
AustriaGermanyNetherlands
Spain
France
CanadaSwizterland
Ireland
Greece
Italy
Israel
New
ZealandAustralia
UK
Portugal
USASingapore
Income gaps
How many times richer
are the richest fifth than
the poorest fifth?
Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk
Inequality...
How much richer are the richest 20% in
each country than the poorest 20%?

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

10. www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
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
Indexofhealthandsocialproblems

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

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

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

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

15. www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Mental illness is more common in
more unequal societies

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

17. 0
30
60
90
120
150
180
Income Inequality
Homicidespermillionpeople
Low High
Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Can J Crim 2001; 43: 219-36.
Homicide rates are higher in more unequal
US states and Canadian provincesUSA states
Canadian provinces

18. www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Imprisonment rates are higher in
more unequal countries

19. 19
Teenage Birth Rates are Higher in More Unequal Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk

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

21. Social Relations
• Child conflict
• Homicide
• Imprisonment
• Social capital
• Trust
Bigger income gaps lead to
deteriorations in:-
Human Capital
• Child wellbeing
• High school drop outs
• Math & literacy scores
• Social mobility
• Teenage births
Health
• Drug abuse
• Infant mortality
• Life expectancy
• Mental illness
• Obesity

22. Indicator International US 50 States
Census GiniUN 20:20 OECD Gini
r p r p r p
Child wellbeing -071 <0.01 -0.68 0.01 - -
Trust -0.66 <0.01 -0.66 0.03 -0.70 <0.01
Life expectancy -0.44 0.04 -0.27 0.24 -0.45 <0.01
Infant mortality 0.42 0.04 0.54 0.01 0.43 <0.01
Obesity 0.57 <0.01 0.41 0.06 0.47 <0.01
Mental illness 0.73 <0.01 0.32 0.30 0.18 0.12
Education score -0.45 0.04 -0.46 0.05 -0.47 .01
Teen birth rate 0.73 <0.01 0.64 <0.01 0.46 <0.01
Homicides 0.47 0.02 0.44 0.04 0.42 <0.01
Imprisonment 0.75 <0.01 0.51 0.02 0.48 <0.01
Social mobility 0.93 <0.01 0.83 <0.01 - -
Index 0.87 <0.01 0.75 <0.01 0.59 <0.01
Correlations: different measures and settings

23. Zheng H. Social Science & Medicine 2012; 75: 36-45.
Mortality:OddsRatio
Lag time - Years
Lag times: marginal impact of a 0.01-unit increase
in the Gini on individual mortality risk over time

24. Kondo et al, BMJ, 2009; 339: b4471
Inequality and mortality over time:
meta-analysis of multilevel cohort studies

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

26. 0
5
10
15
Single
mothers
Low High
Father's occupational class
Infantdeathsper1000
England & Wales
Sweden
Leon, D. A., D. Vagero, et al. (1992). "Social class differences in infant mortality
in Sweden: comparison with England and Wales." Brit Med J 305(6855): 687-91.
The benefits of greater equality are not confined
to the poor but extend to all social classes
Infant mortality by class: Sweden compared with England & Wales

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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)
Literacyscore
Sweden
Canada
United States
Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.

30. More
inequality
• 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
Valued or
Devalued?

31. Social Status and Friendship
Opposite 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.

32. Companion
Spanish: Compañero;
French: Copain
from the Latin “Con” (with)
and “Pan” (bread)
- someone with whom you eat bread

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Psychosocial risk factors for ill health
 Low social status
 Weak social connections
 Stress in early life (pre- and postnatally)

34. 0
0.2
0.4
0.6
0.8
1
Other
tasks
Tasks with ‘social
evaluative threat’
(uncontrollable)
Cortisolresponse(effect
size)
Dickerson SS, Kemeny ME. Acute stressors and cortisol
responses. Psychological Bulletin 2004; 130(3): 355-91.
What kind of stressful tasks raise
stress hormones most?

35. Loughnan S, et al. Economic Inequality is linked to biased
Self enhancement increases in more unequal
societies

36. Rising narcissism among American college students
(meta-analysis of 85 samples 1979-2006)
NarcissisticPersonalityInventory
Twenge JM, Konrath S, Foster JD, Campbell WK, Bushman BJ.
Egos inflating over time. J Personality 2008; 76(4): 875-901.

37. Mishel L, Sabadish N. Economic Policy Institute Brief #331. Washington, May 2012
Changing ratio of CEO pay to average pay of production &
non-supervisory workers in top 350 US companies
Between 1979-2007 the income of the:-
Top 0.1% increased by 362%
Top 1% increased by 156%
Bottom 90% increased by17%

38. Rising income inequality in Britain 1979-2011Inequality
(Gini)
Cribb J, Joyce R, Phillips D. Living standards, poverty and inequality in
the UK: 2012. Institute for Fiscal Studies, London 2012

39. What can be done?
Taxes & benefits
• Stop tax
avoidance
• End tax havens
• Make taxation
progressive
again
Income differences
before tax
• Stronger Trade
Unions
• Increase company
democracy -
employee
ownership etc
• Promote more
directors from
within companies
Sustainability needs
greater equality

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http://www.equalitytrust.org.uk
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