Photo by kind permission of Matt Stuart
How bigger income differences
damage us all
Richard Wilkinson
Emeritus Professor of Social Epidemiology
3
Income per head and life-expectancy: rich & poor countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
‘‘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.
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Life expectancy in rich countries is
no longer related to National Income per head
70
71
72
73
74
75
76
77
78
79
80
Local Neighbourhoods
(in England & Wales)
Life e
xpecta
ncy (
years
)
Richest Poorest
Wilkinson & Pickett, The Spirit Level www.equalitytrust.org.uk
Life expectancy is strongly related to
income within rich countries
3.7 3.94.3
4.6 4.85.2 5.3
5.6 5.6 5.6 5.76.1 6.2
6.7 6.8 6.87.2
8.5
9.7
4.0
8.0
7.0
3.4
Japan
Fin
land
No
rway
Sw
eden
Denm
ark
Belg
ium
Au
str
iaG
erm
an
yN
eth
erl
ands
Sp
ain
Fra
nce
Canada
Sw
izte
rland
Irela
nd
Gre
ece
Italy
Isra
el
New
Zeala
nd
Au
str
alia
UK
Po
rtugal
US
AS
ingap
ore
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%?
Health and social problems with social gradients
and internationally comparable data
• Life expectancy
• Math & Literacy
• Infant mortality
• Homicides
• Imprisonment
• Teenage births
• Trust
• Obesity
• Mental illness – incl. drug &
alcohol addiction
• Social mobility
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
Ind
ex o
f h
ealt
h a
nd
so
cia
l p
rob
lem
s
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 Ind
ex o
f h
ealt
h a
nd
so
cia
l p
rob
lem
s
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Child well-being is better in more equal countries
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Child Wellbeing is not related to National Income per head
Low Income Inequality (Gini) High
Ch
ild
Wellb
ein
g
Inequality and Child Wellbeing (UNICEF Rpt 2013)
Pickett & Wilkinson, Pediatrics. (forthcoming)
Inequality change 2000-2010 (gini)
Ch
ild
well
be
ing
Ch
an
ge 2
000
-2010
Changes in inequality and child wellbeing (UNICEF Index)
Pickett & Wilkinson, Pediatrics. (forthcoming)
Source: FJ Elgar, American Journal of Public Health 2010;100:2311–2315
Trust and income inequality in 33 countries
16
Infant Mortality Rates are Higher in More Unequal Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
Relation between infant mortality and GNP per
head, at high, medium and low income inequality
Hales S, Howden-Chapman P, Salmond C, Woodward A, Mackenbach J..
Infant mortality, gross national product & income distribution. Lancet 1999;
354: 2047
0
30
60
90
120
150
180
Income Inequality
Ho
mic
ide
s p
er
millio
n p
eo
ple
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 provinces
USA states
Canadian provinces
Elgar FJ, Aitken N. European J Public Health 2011; 21(2): 241-6.
Income inequality and homicide in 33 countries
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Imprisonment rates are higher in
more unequal countries
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Mental illness is more common in
more unequal societies
More recent analyses have
shown that inequality is also
linked to a higher prevalence
of:-
• depression
• psychotic symptoms
• schizophrenia
• status anxiety
• reduced willingness to
help others
Elgar FJ, Craig W, Boyce W, Morgan A, Vella-Zarb R. Income Inequality and School Bullying:
Multilevel Study of Adolescents in 37 Countries. J. Adolescent Health 2009; 45(4): 351-359 .
Income inequality & bullying in 37 countries
24
Teenage Birth Rates are Higher in More Unequal Rich Countries
Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
www.equalitytrust.org.ukWilkinson & Pickett, The Spirit Level
Social mobility is lower in more unequal countries
(Gini)
High
Low
www.equalitytrust.org.uk
Wo
rld
avera
ge C
O2
If all countries converged on the world average CO2
emissions, high life expectancy could be achieved for all
- even on the basis of existing technology
150
200
250
300
350
400
450
500
550
600
0.14 0.15 0.16 0.17 0.18 0.19 0.20 0.21 0.22 0.23 0.24 0.25 0.26 0.27 0.28
Ag
e a
dju
ste
d d
ea
th r
ate
s
Median Share of Income
Income Inequality and Death RatesWorking age Men in 528 cities in 5 countries
United States
United Kingdom
Canada
Australia
Sweden
Source: Ross N, Dorling D, et al. Metropolitan income inequality and working age
mortality. Journal of Urban Health 2005; 82(1): 101-110.
New York
London
Toronto
Sydney Melbourne
GlasgowNew Orleans
Effect of a 0.01 unit
increase in Gini
coefficient on
deaths 1986-2006
among 701,179
respondents.
(125,391 deaths)
Data from U.S. National Health Interview Survey (NHIS) 1986-2004 with mortality follow-up data 1986-2006.
Zheng H. Do people die from income inequality of a decade ago? Social Science & Medicine 2012; 75: 36-45.
Changes in income inequality affect mortality 3-12 years later
0
5
10
15
Single
mothers
Low HighFather's occupational class
Infa
nt
death
s p
er
1000 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
31
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)
Lit
era
cy s
co
re
Sweden
Canada
United States
Source: Willms JD. 1997. Data from OECD Programme for International Student Assessment.
Income differences increase social class differentiation
Bigger income differences:-
• Class becomes more important • The social pyramid is higher
and more hierarchical• The quality of social relations
deteriorates
0
0.2
0.4
0.6
0.8
1
Other
tasks
Tasks with ‘social
evaluative threat’
(uncontrollable)
Co
rtis
ol re
sp
on
se
(eff
ect
siz
e)
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?
Loughnan S, et al. Economic Inequality is linked to biased self-perception. Psychological Science, 2011; 22: 1254
Self enhancement increases in more unequal
societies
Stereotype Threat
The effect of caste identity on children's performance
Caste
Unannounced
Caste
Announced
0
1
2
3
4
5
6
High Caste
Low Caste
Num
ber
of
mazes s
olv
ed
Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004
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%
Share of all income (before tax) received by the richest 1%
Leibbrandt, M. et al. (2010), Trends in South African Income Distribution and Poverty since
the Fall of Apartheid, OECD Social, Employment and Migration Working Papers, No. 101
An increasing share of South Africa’s income
has gone to the richest 10%
Countries with stronger Trade Unions are less unequal
(data for 16 OECD countries 1966-1994)In
equalit
y (
Gin
i )
% of labour force in trade unions
Gustafsson B, Johansson M. In search for a smoking gun: what makes income
inequality vary over time in different countries? LIS Working Paper 172; 1997.
Colin Gordon’s analysis of Historical Statistics for the US, unionstats.com, Piketty and
Saez 2003, and World Top Incomes Database. Economic Policy Institute, Washington DC.
Trade Unions membership (% workforce) and
Share of Income going to top 10% (USA, 1918-2008)