A conversation with the University of York Epidemiologist

Kate Pickett: I’m Kate Pickett. And I’m a Professor of Epidemiology at the University of York in England.

Question: What is the relationship between economic growth and life expectancy?

Kate Pickett: What we find is, in the rich developed market democracies, there’s no longer any relationship between average levels of income in a country and life expectance. So, you can have a country like the USA, or Norway, that’s twice a rich as another country like Greece for instance, and that doesn’t seem to affect life expectancy at all. And the same is true of happiness. Happiness isn’t related to average levels of income in a country either. Now, that’s not true of the developing world when you don’t have enough, when people are lacking food or shelter, or the basic material necessities. Then economic growth is really important. But in our rich, developed democracies, it no longer makes any difference. So, we seem to have come to an end of what economic growth can do for us in terms of life expectance, happiness, well-being and that sort of thing.

If you look at the United States, over the past few decades, you’ve become twice, three times a rich as you used to be, levels of happiness haven’t improved at all.

Question: How does social inequality affect our health?

Kate Pickett: I think this is where it helps that Richard Wilkinson, my co-author and I, we’re epidemiologists, and so we study levels of population health. And one thing we really learned over the past 30 years in epidemiology is the importance of psycho-social factors for health. Things like low social status, or social affiliation, social networks, whether or not you have friends, and the stresses of early childhood. All of those things have turned out to be really important for health. And we have quite a good understanding now of the biology of chronic stress. So, all of these things are working as stresses, low social status, lack of friends or social networks, stress in early childhood. And chronic stress affects our biology, our physiology in lots of different ways. It affects our immune system, our hormonal responses, it affects our cardiovascular health. And that’s quite well understood. And so we have also known for a long time that the people at the bottom of society, the poorer people in our societies, people living in the most deprived neighborhoods have much higher levels of stress and much worse health than those who are more affluent or have higher social status.

Question: Is there a threshold for when economic growth stops affecting life expectancy?

Kate Pickett: Yeah, it’s not so much about the threshold, the threshold changes over time. It’s really just seeing that although life expectancy continues to improve over time, that’s not related to average levels of income anymore in the rich countries. Instead, what we find is really important is the level of income and equality that is the gap between the rich and the poor. That’s what seems to matter these days for our health and social well being.

Question: Why are humans prone to developing unequal societies?

Kate Pickett: Well, I think we’ve lived in every kind of society. I mean, for a lot of our existence as human beings, we’ve lived in fairly egalitarian, hunter/gather societies. But we’ve also lived in very hierarchical tyrannies as well. We clearly can manage to exist in both and develop all kinds of different societies. Why hierarchy seems to matter, why status differences matter so much and so the gap between rich and poor matters, is because as human beings, we are very sensitive to social relationship. We have an evolved psychology that makes us very aware about how others judge us.

If you think about it, some of the most difficult things to do, or the most potentially embarrassing situations wherein, those where other people can judge us negatively. Rather like what I’m doing now, which might go out and been seen by hopefully thousands of people and they might think I’m doing a good job, or a bad job, and being aware of that can make us feel very embarrassed, be very aware of how others judge us, and that really affects our psychology and our biology in very profound ways.

So, if we’re looking at societies where the social distances between people are bigger as they are in unequal societies, there’s just more potential for all of us to feel we are judged negatively by others and to feel that our status really matters, that it’s really important.

Question: What is the Social-Evaluative Threat?

Kate Pickett: Social-Evaluative Threat that’s a term psychologist’s use. There are two psychologists who looked at all the studies that other researches have done on what kind of stresses most reliably raise our cortisol levels. What kinds of stress most reliably stress us? And they usually do this kind of work by inviting students into the laboratory and asking them to do unpleasant tasks. The might ask them to solve math problems or to write about an unpleasant experience, or be videotaped doing something. And the question these researchers asked was, which kind of stress most reliably raises our stress hormone levels? And they found it was ones which contained a social-evaluative threat. So, it’s not so much having to do math problems, it’s having to read out your real marks at the end and your scores and share them with other people. It’s tasks in which other people can judge you negatively, that most reliably make you feel stressed.

Question: How does status anxiety link with consumerism?

Kate Pickett: Well, in our modern societies, we don’t really need to consume more stuff for basic survival. We consume, we shop, and we want to earn more money to show our status. And so, owning things that demonstrate that we are keeping up, keeping up appearances that show we are a valued member of society, that’s why we consume so much. In more unequal societies that competition for status is more important. And so, in more unequal societies there is a stronger drive toward status competition and consumerism. All of those things matter more, matters more to earn more money, not because you need more money for basic things, but you need to show your status relative to other people in society.

Question: What is the link between greater inequality and public health?

Kate Pickett: We look at more and less equal countries, and let me describe what I mean by that. We use income equality as a measure of how hierarchical a society is, how unequal it is. And so we’re comparing – we’re looking at countries and looking at how much richer the top 20% of the population are compared to the bottom 20%. It’s ratio of the top fifth to the bottom fifth of incomes. And in more equal countries like Japan, Sweden, Denmark, Finland, the top 20% earn about 3 ½ to 4 times as much as the bottom 20%. And in the more unequal countries like the UK, where I’m from, the USA, Portugal, Australia, Singapore, it’s 7 ½ to 9 times as much. So, that’s the scale of inequality that we’re looking at.

And what we do in our book is take that scale of income differences and look to see how it affect a range of health and social problems in different societies. And we find that more unequal societies have lower levels of trust, higher levels of mental illness, worse physical health, more obesity, their children do less well in schools, there are more teenage births, more violence, as you just mentioned, a greater percentage of the population is in prison and social mobility is lower as well. So, everything seems to get worse in more unequal societies. This is a general social dysfunction. And because this is politically quite sensitive, we thought we’d test it all out again in separate setting. So, we compared the 50 states of the USA as a sort of independent test, and again, we look at levels of income and equality in the 50 different states and compare that tot heir level of health and social problems. And it’s a remarkably consistent picture. So that all those health and social problems are worse in the more unequal states.

And we think this human sensitivity to social relationships is the underpinning cause of all of those problems. You asked about violence, and in a more unequal society, of course, there are more people who don’t have access to the kinds of things that give us status, money, jobs, cars, employment, those sorts of things. And in a society where social judgments can be harsher, those at the bottom are going to be much more sensitive to threats to their status. And we know from the work of prison psychiatrists, for instance, that being disrespected, or humiliated, or potentially losing face is the most common trigger for violence of all. So, I think that’s the link between greater inequality and high levels of violence.

And the differences are huge. If we compare, for instance, the American states and Canadian Provinces, in the more equal of those, there are about 15 million, sorry, 15 murders per million residents per year. And in the more unequal, it’s about 150. So that’s a ten-fold difference, ten times the murder rate in the more unequal places than the more equal ones.

Question: What is the connection between sustainability and equality?

Kate Pickett: Yeah. I mean, I think this goes back to the idea I was talking about earlier that, in a sense, in the rich developed countries we’ve come to the end of what economic growth can do for us in terms of better quality of life. We also know that we’ve got to constrain economic growth to deal with the challenges of climate change. And we need to develop more sustainable economies. And we think that equality has an important role to play here in several different ways. The first is the increased status competition that I talked about in more unequal societies. That drives consumerism. And we know that high levels of consumerism are a major cause of high levels of carbon emissions and that we need to rein in consumerism to cope with climate change. So, I think more equal societies will be better places to be able to do that because there will be less drive to consume.

Also because we find that levels of trust are much higher in more equal places, social cohesion is better. People are more willing to act together for the common good, there’s a greater public spiritedness and people are less out for themselves. And we see that in more equal countries, this translates into the way the population acts with respect to the planet and with respect to other countries. For instance, more equal countries donate more in foreign aid. A greater portion of their national income is given in foreign aid and they do better at recycling across a whole variety of waste goods. And in more equal countries, business leaders are more likely agree that their government should comply with environmental regulations. So, there are all kinds of ways in which more equal societies seem better able to act for the common good.

But there’s a third thing as well, and I think this is really important because I think a lot of people have thought in the past that we need a certain level of inequality to drive aspirations and creativity. And we’ve actually found that using a sort of proxy measure of innovation, we use the number of patterns grounded per head of population, sort of a measure of innovation and creativity, and we find that there is a significant tendency for more equal countries to have a higher level of patterns grounded per capita than the more unequal ones. Probably because in more unequal societies educational achievement is lower and social mobility is lower. So, they’re wasting a much higher proportion of their potential human capital.

So in terms of consumerism, acting in a public spirited way, and being creative and innovative, it looks as if greater equality might be a very necessary precondition as far as coping with climate change.

Question: What practical steps can countries take to enhance equality?

Kate Pickett: I think the first thing to note is that not only do we find that inequality is related to a whole range of social problems, we also find that it affects the vast majority of the population, and I think that’s really key to getting greater support for measures that would make our societies more equal. Greater equality won’t just benefit the poorer in our society; the benefits seem to extend all the way up the population so that even among the wealthier, more educated, affluent sections of our populations, they are healthier and do better in a more equal society. So, I think that’s really key.

But we also find that it is the level of inequality that matters for all of these health and social problems and it doesn’t seem to matter how that greater equality is achieved. So we often point to the contrasts between Sweden and Japan, for instance. Both of them are at the more equal end of the spectrum and they do very well in terms of health and social problems. But they achieve their greater equality in very different ways.

Sweden has quite large income differences to start with and redistributes through taxes and benefits, whereas Japan has smaller income differences to start with. And that doesn’t seem to matter, it’s the level of inequality of equality that they achieve that matters. And we find the same contrast actually among the U.S. states. So, we have two states bordering each other, Vermont and New Hampshire, culturally very alike, but New Hampshire has very low levels of state expenditure and taxation and Vermont much higher. So, New Hampshire looks a bit more like Japan and Vermont a bit more like Sweden. But because they are among the more equal states, they do very well in terms of health and social problems.

So we don’t advocate any particular way of achieving greater equality. There are big state interventions that could work such as higher tax rates on higher incomes, or raising minimum wage levels. But there are sort of small state solutions as well that are around institutions, how companies decide to set their salary structures. And it does seem that where there is more economic democracy, more employees on the board for instance, or promotions from within a company, more employees owning shares in a company. Income differences within those institutions are kept smaller. So, there are lots of different ways that greater equality can be achieved

Question: Why do Cubans live longer on average than Americans?

Kate Pickett: Sure. If you look at the international rankings of life expectancy, yes, the U.S.A. does particularly badly among the rich developed countries, which is fairly recent. You used to be one of the high performers in terms of life expectancy. And it’s interesting; actually, that the U.S.A. and Japan have rather swapped places after the Second World War and Japan was a very unequal country with very poor levels of life expectancy, whereas America was very equal and performed very well internationally with life expectancy. And since that time, you’ve swapped places. So that America has become much more unequal and slipped down the rankings of life expectancy and Japan has become much more equal and now has the highest life expectancy in the world, and crime rates have come down, etc. And there are countries that are much poorer. You mentioned Cuba, but we can also look at Costa Rica, and some of the other Latin American countries and some of the poorer European countries, such as Greece that achieve life expectancies as high, or higher than the United States without that higher level of affluence.

Question: Is the U.S. inherently unequal?

Kate Pickett: Although the U.S.A. does come very near the top in terms of income inequality today among the rich capitalist countries, only Singapore does worse in our dataset. This isn’t a sort of fixed American problem. In the past, after the Second World War and right up through the 1970’s, you were one of the more equal of the western developed countries. And so, it’s not anti-American to suggest that American society might become more egalitarian, more equal. That’s actually very characteristic of your fairly recent past. And it’s certain true of the founding principles on which your country or society is based.

And so, although I think Americans have perhaps gotten used to high levels of inequality in the very recent past, you do have a long tradition of a more egalitarian ethos and of smaller income differences in your society. And so, I think the American Dream isn’t dead, although levels of social mobility are much slower here, educational performance is suffering, you can look to your past, I think, to recover that hope and that optimism and see it as a very true American ambition to have the kind of society that offers a fair opportunity for everybody.

 Recorded on: January 15, 2010