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R Wilkinson Spirit Level lecture November 2010
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R Wilkinson Spirit Level lecture November 2010

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  • The public and policy response?
    more:-
    Police
    Doctors
    Social Workers
    Drug rehabilitation units
    Educational Psychologists
    But…services are expensive and only partially effective.
  • Most important sources of chronic stress – relative risks and population attributable risk
    Pointer – underlying source of stress: Social anxiety
    Eyes of others
    Social Gateway
  • A meta-analysis of 208 laboratory studies of cortisol responses to acute stressors found that “Tasks that included social-evaluative threat (such as threats to self-esteem or social status), in which others could negatively judge performance, particularly when the outcome of the performance was uncontrollable, provoked larger and more reliable cortisol changes than stressors without these particular threats.” (p.377)
    "Humans are driven to preserve the social self and are vigilant to threats that may jeopardize their social esteem or status.” (p.357)
  • Len Syme – MRFIT – smoking
  • Transcript

    • 1. Richard Wilkinson The Spirit Level A joint event between
    • 2. 2 Richard Wilkinson Emeritus Professor of Social Epidemiology University of Nottingham & Kate Pickett Professor of Epidemiology University of York http://www.equalitytrust.org.uk
    • 3. 3 Income per head and life-expectancy: rich & poor countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 4. 4 Among the rich countries life expectancy is not related to national differences in average income Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 5. 5 …but life expectancy is related to income within rich societies Source: Wilkinson & Pickett, The Spirit Level (2009) 70 71 72 73 74 75 76 77 78 79 80 Leastdeprived Mostdeprived Electoral wards in England & Wales by deprivation score Lifeexpectancy(years) www.equalitytrust.org.uk
    • 6. 6 How much richer are the richest 20% than the poorest 20%? www.equalitytrust.org.ukSource: Wilkinson & Pickett, The Spirit Level (2009)
    • 7. 7
    • 8. 8 Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Health and Social Problems are Worse in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 9. 9 Health and Social Problems are not Related to Average Income in Rich Countries Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 10. 10 Child Well-being is Better in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 11. 11 Child-Wellbeing is Unrelated to Average Incomes in Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 12. 12 Levels of Trust are Higher in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009)
    • 13. 13 Levels of Trust are Higher in More Equal US States Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 14. 14 The Prevalence of Mental Illness is Higher in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 15. 15 Infant Mortality Rates are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 16. 16 Drug Use is More Common in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) Index of use of: opiates, cocaine, cannabis, ecstasy, amphetamines www.equalitytrust.org.uk
    • 17. 17 Teenage Birth Rates are Higher in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 18. 18 Homicide and income inequality: US States and Canadian Provinces 0 30 60 90 120 150 180 0.35 0.38 0.41 0.44 0.47 Income Inequality (Gini) Homicidespermillionpeople More equal More unequal Source: Daly M, Wilson M, Vasdev S. Income inequality and homicide rates in Canada and the United States. Canadian Journal of Criminology 2001; 43: 219- 36.
    • 19. 19 Rates of Imprisonment are Higher in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 20. 20 Social mobility is higher in more equal countries www.equalitytrust.org.uk Intergenerational income mobility data from: Blanden J. (2009) Centre for Economic Performance, LSE. Paper No' CEEDP0111.
    • 21. 21 Almost everyone benefits from greater equality. Usually the benefits are greatest among the poor but extend to the majority of the population
    • 22. 22 Infant Mortality by Social Class: Sweden and England & Wales 0 2 4 6 8 10 12 14 16 18 I II IIIN IIIM IV V Single Prnt Unclass. E& W Sweden Source: Leon DA, Vagero D, Olausson PO. BMJ 1992; 305; 687-91 InfantMortalityrate
    • 23. 23 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.
    • 24. 24 Index of: • Life expectancy • Math & Literacy • Infant mortality • Homicides • Imprisonment • Teenage births • Trust • Obesity • Mental illness – incl. drug & alcohol addiction • Social mobility Health and Social Problems are Worse in More Unequal Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 25. 25 Why are we so sensitive to inequality?
    • 26. 26 Psychosocial risk factors for ill health  Low social status  Weak social affiliations  Stress in early life (pre- and postnatally)
    • 27. 27 ACTH Cortisol Tasks with both social-evaluative threat and uncontrollability Other tasks Effectsize Source: Dickerson SS & Kemeny ME. Psychological Bulletin 2004; 130(3): 355-91 What kind of stress most reliably raises cortisol levels?
    • 28. 28 Gilligan J. Violence: Our Deadly Epidemic and its Causes. (G .P. Putnam 1996) " ...the prison inmates I work with have told me repeatedly, when I asked them why they had assaulted someone, that it was because 'he disrespected me', or 'he disrespected my visit' (meaning 'visitor'). The word 'disrespect' is central in the vocabulary, moral value system, and psychodynamics of these chronically violent men that they have abbreviated it into the slang term, 'he dis'ed me." p.106 A few pages further on Gilligan continues:- "I have yet to see a serious act of violence that was not provoked by the experience of feeling shamed and humiliated, disrespected and ridiculed, and that did not represent the attempt to prevent or undo this "loss of face " - no matter how severe the punishment, even if it includes death." p.110
    • 29. Social Status and Friendship Two 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.
    • 30. 30 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 Numberofmazessolved Source: Hoff K, Pandey P, World Bank Policy Research Working Paper 3351, June 2004
    • 31. Inequality and Sustainability Consumerism is one of the greatest threats to sustainability Because inequality increases status competition, it also increases consumerism. People in more unequal societies work longer hours because money seems even more important. Concern for the common good is a crucial resource if we are to reduce carbon emissions Because inequality harms the quality of social relations (increasing violence, reducing trust, cohesion and involvement in community life), people become more self-interested, less public spirited, less concerned with the common good. This is shown in the amount of overseas aid countries give, in the proportion of waste recycled, in how countries score on the global peace index, and in how important business leaders think it is that their governments abide by international environmental agreements.
    • 32. www.equalitytrust.org.uk WorldaverageCO2
    • 33. Source: Bowles S, Park Y. Economic Journal 2005; 115 (507): F397–F412. 2005. Working hours are longer in more unequal countries
    • 34. More equal countries are more generous foreign aid donors
    • 35. More equal countries recycle more waste Source: Wilkinson & Pickett, The Spirit Level (2009) Australia France Germany Italy Japan Portugal Spain Sweden Switzerland UK USA Best Worst Recycling(averagerank) Low High Income Inequality
    • 36. In more equal countries business leaders give a higher priority to complying with international environmental agreements With permission from R De Vogli & D Gimeno
    • 37. 37 InequalityDebt Debt P. Krugman Inequality and Crisis: coincidence or causation? Data from: Picketty-Saez, Historical Statistics, Federal Reserve. Inequality and Household Debt 1913-2007Householddebtas%ofincome Inequality:richest1%share
    • 38. Trends in income inequality 1979-2005/6 (Gini coefficient, Great Britain.) Brewer M, Goodman A, Muriel A, Sibieta L. Poverty and Inequality in the UK: 2007. Institute of Fiscal Studies, London.
    • 39. 39 http://www.equalitytrust.org.uk For more information: … a book and a website…
    • 40. More equal societies are more innovative www.equalitytrust.org.uk
    • 41. 42 More Adults are Obese in More Unequal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 42. The public and policy response? more:- Police Doctors Social Workers Drug rehabilitation units Educational Psychologists But…services are expensive and only partially effective.
    • 43. Dunbar R. Brains on two legs: group size and the evolution of intelligence In: Tree of Origin: F de Waal. (ed) 2001. The Social Brain: the neocortex is a larger proportion of the brain in primate species with larger social groupsAveragesocialgroupsize Neocortex ratio
    • 44. Children Experience More Conflict in More Unequal Societies Source: Wilkinson & Pickett, The Spirit Level (2009) 11, 13 & 15 yr olds fighting, bullying, and finding peers not kind & helpful www.equalitytrust.org.uk
    • 45. More Children Drop Out of High School in More Unequal US States Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 46. Cognitive Score: Socioeconomic status more important than starting point High Cognitive Score at 22 months Low Cognitive Score at 22 months 2 3 4 5 6 7 8 9 10 Child’s age (years) Cognitivescore percentilepositionateachage (I Feinstein. Inequality in cognitive development. 1970 British Births. Economica 2003; 70: 3-97) (from The Marmot Review 2010)
    • 47. Educational Scores are Higher in More Equal Rich Countries Source: Wilkinson & Pickett, The Spirit Level (2009) www.equalitytrust.org.uk
    • 48. 50 Australia Austria Belgium Canada Denmark Finland France Germany Greece Ireland Israel Italy Japan Netherlands New Zealand Norway Portugal Spain Sweden UK USA Worse Better UNICEFindexofchildwell-being 0 10 20 30 Lone parents as % of all households with dependent children Single parents and child wellbeing
    • 49. 51 The effects of inequality - a two stage process 1. adult experience of inequality 2. passed on to children – epigenetics?
    • 50. 52 www.foe-scotland.org.uk www.business-school.ed.ac.uk