The high cost of inequality

For years now I've engaged in conversations with urban health workers regarding the effect of poverty itself, poverty as a self-understanding or psychic reality on overall health outcomes.  The impact of the "wealth gap" on people who live in inner city poverty has been obvious to me for a long time.  Economic status in a market-driven, ad-filled, consumer society that measures even human value in material terms must have a negative impact on the soul's of low-income folks.  It's part of what's back of teens going beserk over a pair of Nike's. 

Or take access to health care.  One of the reasons that universal, national health care is so important for public health improvement may relate to just this value proposition.  If my nation, my larger community believes that I am valuable enough to receive a health care plan/card regardless of my net worth or annual income, the provision of that benefit alone will likely improve my overall health.  I've felt that way for a long time. 

Nicholas Kristof provides insight into a body of serious research that confirms my hunch.  I'd love to hear your reaction after you've read what he says. 

Equality, a True Soul Food

By NICHOLAS D. KRISTOF
Published: January 1, 2011
The New York Times

John Steinbeck observed that “a sad soul can kill you quicker, far quicker, than a germ.”
That insight, now confirmed by epidemiological studies, is worth bearing in mind at a time of such polarizing inequality that the wealthiest 1 percent of Americans possess a greater collective net worth than the bottom 90 percent.

There’s growing evidence that the toll of our stunning inequality is not just economic but also is a melancholy of the soul. The upshot appears to be high rates of violent crime, high narcotics use, high teenage birthrates and even high rates of heart disease.

That’s the argument of an important book by two distinguished British epidemiologists, Richard Wilkinson and Kate Pickett. They argue that gross inequality tears at the human psyche, creating anxiety, distrust and an array of mental and physical ailments — and they cite mountains of data to support their argument.

“If you fail to avoid high inequality, you will need more prisons and more police,” they assert. “You will have to deal with higher rates of mental illness, drug abuse and every other kind of problem.” They explore these issues in their book, “The Spirit Level: Why Greater Equality Makes Societies Stronger.”

The heart of their argument is that humans are social animals and that in highly unequal societies those at the bottom suffer from a range of pathologies. For example, a long-term study of British civil servants found that messengers, doormen and others with low status were much more likely to die of heart disease, suicide and some cancers and had substantially worse overall health.

There’s similar evidence from other primates. For example, macaque monkeys are also highly social animals, and scientists put them in cages and taught them how to push a lever so that they could get cocaine. Those at the bottom of the monkey hierarchy took much more cocaine than high-status monkeys.

Other experiments found that low-status monkeys suffered physical problems, including atherosclerosis in their arteries and an increase in abdominal fat. And as with monkeys, so with humans. Researchers have found that when people become unemployed or suffer economic setbacks, they gain weight. One 12-year study of American men found that when their income slipped, they gained an average of 5.5 pounds.

The correlation is strong around the world between countries with greater inequality and greater drug use. Paradoxically, countries with more relaxed narcotics laws, like the Netherlands, have relatively low domestic drug use — perhaps because they are more egalitarian.

Professors Wilkinson and Pickett crunch the numbers and show that the same relationship holds true for a range of social problems. Among rich countries, those that are more unequal appear to have more mental illness, infant mortality, obesity, high school dropouts, teenage births, homicides, and so on.

They find the same thing is true among the 50 American states. More unequal states, like Mississippi and Louisiana, do poorly by these social measures. More equal states, like New Hampshire and Minnesota, do far better.

So why is inequality so harmful? “The Spirit Level” suggests that inequality undermines social trust and community life, corroding societies as a whole. It also suggests that humans, as social beings, become stressed when they find themselves at the bottom of a hierarchy.

That stress leads to biological changes, such as the release of the hormone cortisol, and to the accumulation of abdominal fat (perhaps an evolutionary adaptation in preparation for starvation ahead?). The result is physical ailments like heart disease, and social ailments like violent crime, mutual distrust, self-destructive behaviors and persistent poverty. Another result is the establishment of alternative systems in which one can win respect and acquire self-esteem, such as gangs.

Granted, humans are not all equal in ability: There will always be some who are more wealthy — and others who constitute the bottom. But inequality does not have to be as harsh, oppressive and polarized as it is in America today. Germany and Japan have attained modern, efficient economies with far less inequality than we have — and far fewer social problems. Likewise, the gap between rich and poor fell during the Clinton administration, according to data cited in “The Spirit Level,” even though that was a period of economic vigor.

“Inequality is divisive, and even small differences seem to make an important difference,” Professors Wilkinson and Pickett note. They suggest that it is not just the poor who benefit from the social cohesion that comes with equality, but the entire society.

So as we debate national policy in 2011 — from the estate tax to unemployment insurance to early childhood education — let’s push to reduce the stunning levels of inequality in America today. These inequities seem profoundly unhealthy, for us and for our nation’s soul.