Health and well being: more equal countries do it better

Richard Wilkinson stopped by LKY recently to give us the low down on some awesome research featured in his new book “The Spirit Level: Why Equality is Better for Everyone”. Buy it here on Amazon. I’ve seen it on the top picks shelf at Borders and having flicked through its a very accessible read. Richard is an Emeritus Prof. at Nottingham University in the UK, he looks at social epidemiology – asking questions like what are the social determinants of poor (and good) health? Richard and co author Kate Pickett have compiled an impressive dataset across that takes economic equality (the gap between the top 20% and bottom 20% of earners) and correlates this with health and social indicators like mental health / violence prevalence. They also constructed an index of health and social problems, the 1st of its kind globally. More about sources here.

In our book, for all of our international comparisons, we use the 20:20 ratio measure of income inequality from the United Nations Development Programme Human Development Indicators, 2003-6. As survey dates vary for different countries (from 1992 to 2001), and as the lag time for effects will vary for the different outcome we examine, we took the average across the reporting years 2003-6.  For the US comparisons we use the 1999 state-level Gini coefficient based on household income produced by the US Census Bureau.

So what do results show?

Take obesity. Richard and Kate found that more equal societies have less obese populations. OK so the observations look pretty dispersed, especially if you exclude outliers Japan and USA, but Richard assured us that all graphs displayed show statistically significant relationships between variables. We’re seeing more obesity in low income groups: cheap, processed and nutrient poor food is more affordable; could it be that in market democracies (more capitalist, less equal) that simply having more choice impacts obesity levels? Or is this to do with better / more education in more equal societies?

Here’s an interesting one on trust, using data from the World Values Survey. More equal societies have more cohesive communities where people trust each other more. Trust may seem like an intangible, fluffy measure of well being but its not. We all intuitively agree that its important and the authors point out why; countries with lower levels of trust also have higher incidence of violence. Scandinavian countries and the Netherlands fare the best with highest trust levels. Richer market democracies fall further down the regression line and check out Singapore at the bottom (!)

Governments and policy makers are increasingly interested in “social capital” or social cohesion, trust, and involvement in community life. Everyone knows these are an important part of the quality of life and make a difference to what a society feels like to live in, but there has been little recognition that greater equality is an important pre-condition for strengthening community life.

At the risk of waxing lyrical about this book, Richard highlighted some compelling psychosocial risk factors for ill health - these include low social status, weak social affiliations and stress in early life (pre + post natal). I reflected on Singapore’s situation- massively high levels of income inequality (you breathe it out here), and definitely an anomaly in terms of “hard” health indicators like child mortality (the lowest in the world). But, when it comes to “soft” health / social indicators like trust levels, there’s clearly tons of room for improvement.

Finally, here’s a message to sharp tongued critics of the author’s methods and the correlation doesn’t = causality argument:

To suggest that these relationships are causal does not involve a major departure from what we know already.  Within countries we know that all the components of our Index of Health and Social Problems are strongly related to social status: the further down the social ladder the more common they become.  The new part of the picture is simply that if you stretch out the social status differences all the problems related to social status become more common. Rather than postulating entirely new causal processes we are therefore only providing a bit more information about the relationships that have always been recognised.

People who have studied the graphs on this web site and in The Spirit Level carefully will have noticed that there is a clear tendency for countries which do badly on one outcome to do badly on others.  We show evidence that 10 or 12 different problems tend to move together. That implies that they share an underlying cause. The association between inequality and our Index of Health and Social Problems is very close and no one has yet suggested an alternative.

And no, I didn’t get the impression that the authors are calling for rampant socialism- rather, a bit of sensible reflection on the limits of economic growth and the recognition that equality is better for everyone. Progressive, perhaps not yet a sexy or widely accepted idea in Asia where progress is still measured in material wealth, but a starting point for critical thinking about what makes a happier and healthier society.