The Spirit Level

The authors cite World Health Organization surveys to show that countries with higher levels of inequality, such as the US and UK, have much higher rates of mental illness than nations with lower inequality, like Japan and Germany. Meanwhile, in their analysis of mental illness and equality in US states, the authors admit that there is no relationship. However, there appears to be a correlation between children’s mental health problems and inequality within the states.

The authors reflect on how people’s mental health can be informed by “status anxiety”: people’s concern that they do not have enough material wealth in comparison to others. They cite economist Robert Frank’s work on “luxury fever,” or people’s desire to access the same luxuries as the elite, as an example of how status anxiety can encourage worry and overspending. Economist Richard Layard claims people can develop “an addiction to income” and overwork themselves at the expense of their personal relationships, making them vulnerable to mental health problems (69).

The authors refer to the UN’s World Drug Report to show the correlation between drug use and income inequality. Pickett and Wilkinson claim that this can be explained because low status is “painful,” and people seek relief through drug use.

They point to a study on monkeys which showed that subordinate monkeys used much less cocaine than dominant monkeys, who had higher levels of dopamine in their brains (71).

Over the 19th century, many countries reformed public infrastructure such as drainage, sewage, garbage disposal, and more. These improvements decreased infectious diseases and lengthened people’s lifespans. With infectious illness on the decline in developed countries, chronic illnesses, such as cancer and heart disease, became the leading causes of death. While researchers initially blamed lifestyle choices as the main cause behind these diseases, they later found that stress is a major factor. A long-term study of British civil servants found that lower-status employees had much higher death rates than upper-level employees. The authors acknowledge that the lower-earning people were more likely to smoke, and be obese and sedentary; however, they also claim that job stress and feeling a lack of control over one’s work also contribute to poor health. Wilkinson and Pickett believe that these studies show that social status informs everyone’s health, and that if someone’s social status is low, they are less likely to feel the sense of control, optimism, and happiness that would benefit their mental and physical health.

Social status and social networks create “psychosocial factors” which play a role in our health. The authors cite studies which demonstrate the protective effect that strong social networks have on individuals’ health. For example, people with more friends and an active community life are less likely to get sick, and they are more likely to recover from injury and illness faster than people who are lonely or isolated. Other studies show a link between dangerous neighborhoods and shortened life spans, even for people who die of natural causes. Numerous studies have shown that “social capital,” or one’s connectedness to others, is a good predictor of health, with more socially connected people enjoying better health.

The authors address healthcare spending, claiming that it has little influence on the health and lifespan of the population. For instance, the US spends more money per person on healthcare than any other developed country but has a lower average life expectancy than most. Infant mortality also correlates to income inequality, with less equal countries generally having higher infant mortality rates, with some exceptions. Pickett and Wilkinson refer to one of their studies, published in the British Medical Journal, which shows that “egalitarian societies tend to be healthier” (80). The authors remind the reader that, if their interpretation is correct, nearly everyone in society would benefit from a more egalitarian society.

Wilkinson and Pickett transition to discussing how acute and chronic stress is proven to harm physical health. According to the authors, having a lower position in society causes people to become stressed, and therefore unhealthier. As a final example, the authors compare two historical situations. In wartime Britain, working-class incomes rose while middle-class incomes fell slightly, creating a more egalitarian income, and during this time the average UK lifespan rose. In contrast, Russia’s average life expectancy has been falling since the early 1990s when the country switched to a market economy and experienced a rise in income inequality.

Obesity is on the rise across all developed nations, and experts have blamed a variety of causes including the availability of processed and high calorie foods, a decline in physical work and exercise, people’s lack of cooking knowledge, and more. Wilkinson and Pickett explain that statistical analyses of obesity have revealed that it has a steep “social gradient,” with poorer people being more likely to be obese than their middle class or upper class counterparts (90). As obesity in general has increased, this social gradient has steepened, making the class differences starker.

The authors compare data from different countries which shows a relationship between income inequality and obesity, with unequal countries such as the US having higher rates of obesity than more egalitarian countries like Japan. They present a similar correlation between inequality and obesity in individual US states and note that the relationship between children’s obesity and inequality is even stronger. Studies show that people in more unequal societies eat more and exercise less. The authors argue that long-term stress also plays a significant role in the obesity crisis, since stress prompts people to eat more processed comfort foods and makes it more likely that they will store fat around their abdomens. The authors cite studies which show that food can be powerfully addictive and people can form a dependence on food akin to drug addiction.

Within countries, the relationship between obesity and poverty is more pronounced for women. The authors theorize that this may be because obese women face more barriers to social mobility than obese men due to job market and relationship discrimination. People in different social classes have different relationships with their bodies; for instance, wealthier women are more likely to actively manage their weight with dieting than lower-earning women.

The thrifty phenotype theory postulates that when pregnant women are stressed, their unborn babies are affected by stress hormones, which prepare them for an equally stressful life. This means that they are born more vulnerable to obesity, diabetes, and cardiovascular disease throughout their lives. The authors argue that obesity is not the result of a lack of nutritional education and is highly correlated with income. While they acknowledge that individual interventions have some merit, they believe that reducing inequality would decrease people’s overall stress and therefore help them break addictions to unhealthy foods.

The authors maintain that there is a connection between a country’s income inequality and educational success. One study administered standardized tests to teenage students from developed countries to compare their knowledge. Wilkinson and Pickett show that there is a correlation between inequality and poor educational performance. Unequal countries such as the US and Portugal had the lowest average scores, while more equal countries like Finland, Japan, and Sweden had the highest scores. Within the US, more unequal states such as Mississippi and Kentucky had much higher drop-out rates than states with more equal incomes, like Utah and Alaska. Intriguingly, studies have shown that reading test scores are related to income inequality, with participants from more equal countries performing better than people from more unequal places. This finding was replicated by analyzing individual US states and Canadian provinces.

Wilkinson and Pickett acknowledge that more equal countries tend to have robust social programs that help ease family stresses, thereby helping kids grow up in a safer and more stable environment. For instance, countries such as Sweden offer paid parental leave and early childhood education programs. Vulnerable kids who participate in these programs are less likely to turn to crime and earn more as adults. The authors support these initiatives and point out that governments could see such programs as investments.

There is compelling evidence that inequality can have a direct effect on individuals’ ability to perform. One study demonstrated that lower and upper-caste boys in India performed at a similar level of ability doing a puzzle activity. However, when each participant had to reveal their names, families, and castes, the lower caste boys’ performance suffered, while the higher caste boys had more success than before. A study on Black and white high schoolers in the US yielded similar results, and the phenomenon has been observed in enough studies to earn a name: the “stereotype threat” (113). Social evaluation anxiety is so profound, it can be easily triggered by social conditions and change student performance.

The authors argue that inequality affects educational success by creating different social classes which maintain their attitudes to education. Anthropologist Gillian Evans found that many working-class parents in East London did not emphasize academic achievement and had more permissive parenting about homework. Ironically, studies show that children’s aspirations are higher in more unequal countries, even while their educational success is lower, on average.