HEALTH AND WEALTH
INEQUALITIES IN THE UK
The Spirit Level
THE SPIRIT LEVEL
Written by Richard Wilkinson and Kate Pickett.
 They are epidemiologists – this means they study
the spread of disease in different countries and at
different times in history to discover cause of
disease and ways to prevent future outbreaks.
 “The Spirit Level” looks at the changing causes of
death in developed countries, and comes to the
conclusion that the more unequal a country is in
terms of wealth, the more social problems that
country is likely to face.
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THE PROBLEM IDENTIFIED
We are at the pinnacle of social and economic
development, and yet we have record levels of
mental and emotional suffering.
 Is there a problem with the way our society is
developing? Is this causing mental suffering
which is leading to physical illness?

There is a feeling that our society is becoming
increasingly individualistic. This means that
individuals are only interested in looking after
themselves, that they take less interest in what
the rest of the community are doing. We are
becoming more selfish and irresponsible and this
is leading to more and more people feeling
isolated, like they are no longer part of a society
or a community.
 Because human beings are naturally social
animals, this is running against our instincts and
causing illness.

Instead of a better society, the only thing almost
everyone strives for is to better their own
position.
 Our developed world has huge levels of material
success – we have loads of stuff, TV’s, I-phones,
crisps – but we also have massive social failure –
violent crime, “sink-estates”, depression,
addiction and obesity.
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JUNCTION IN HISTORY
For thousands of years the best way of improving
the quality of human life was to raise living
standards. When the wolf was never far from the
door, good times were simply the times of plenty.
 But for the vast majority of people in affluent
countries the difficulties of life are no longer
about filling our stomachs, having clean water
and keeping warm. Most of us now wish we
could eat less rather than more. And for the first
time in history, the poor are – on average – fatter
than the rich.
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ECONOMIC DEVELOPMENT NO LONGER
HELPING
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Economic growth, for so long the cause of
development, has in rich countries largely
finished its work. Not only have measures of
wellbeing and happiness stopped rising with
economic growth, but as richer countries have
grown even richer there have been long-term
rises in anxiety, depression and numerous social
problems
RICHEST COUNTRIES NO LONGER THE
HEALTHIEST
For rich countries, life expectancy seems to be no
longer linked to living standards.
 With every passing 10 years, life expectancy
among the rich countries increases by between 2
and 3 years, this is the same for most rich
countries (USA) and the weaker countries
(Greece and Spain).
 As countries get richer, further increases in
average living standards do less and less for
health

RICHEST COUNTRIES ARE NOT THE
“HAPPIEST”
And it is the same for measures of “happiness”,
getting richer adds little to the happiness of the
people.
 This is what is called in economics “the law of
diminishing returns”, the benefits from having
more and more money start to reduce as a
country gets richer.

“AFFLUENZA”
The diseases of poverty – the illnesses that tend
to kill large numbers of people in poorer countries
– TB, cholera and measles have ceased to be the
most important causes of death as countries get
richer. Instead the diseases of affluence (the
well-off) take over – degenerative cardiovascular
diseases and cancers.
 The diseases of poverty are often associated with
children and young adults and kills people in the
prime of life, the diseases of affluence are
diseases of later life.
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But in the last 50 years we have seen a change in
these diseases of affluence too. Diseases like
heart disease, strokes, obesity, lung and stomach
cancers used to be more common among the rich.
Heart disease was regarded as a businessman’s
disease and used to be the rich who were fat and
the poor who were thin. But after the 1950’s in
all rich countries the pattern reversed.
INEQUALITY IS THE DECIDING FACTOR
So here we can see an interesting development in
the pattern of health.
 It does not matter about the average income of a
developed country, it seems to be the level of
inequality that is the deciding factor in indicators
of health, happiness and wellbeing.
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Evidence shows that what seems to matter in rich countries
is not your actual income level and living standard, but how
you compare with other members of the same society –
what seems to matter is not average living standards – but
whether you are doing better of worse than other people –
where you come in the “pecking order”.
For example if you were getting B’s for every essay you did,
and you were in a class where you knew everyone else was
getting C’s and D’s, then you might feel like you were doing
really well, it might even go to your head a little bit. If,
however, you were in a class where everyone else got full
mark A’s every time you might start to feel a little
depressed, wondering where you were going wrong. If you
were in a class where everyone got B’s you’d probably feel
reasonably content.
POVERTY MORE THAN JUST NO MONEY
“Poverty is not just a certain small amount of
goods, nor is it just a relation between means and
ends, above all it is a relation between people.
Poverty is a social status”
 We all know this, judgements are made about
people who are poor. People who are poor often
try to hide it, people start to feel like it is their
own fault – when why should they feel this way?
This is deeply unfair, we have been socialised in
this society to think this way

UK- VERY UNEQUAL

In the UK the richest 20% of the population are 7
times richer than the poorest 20% - this makes us
one of the most unequal countries in the
developed world
GINI COEFFICIENT
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A way of measuring inequality developed by the
Italian mathematician and statistician Corrado Gini.
A Gini coefficient of 0 would indicate a society where
there was perfect equality, so everyone in the country
would have exactly the same amount of money and
property.
A Gini coefficient of 1 would indicate perfect
inequality, and so 1 person would have all of the
wealth and everyone else would have nothing.
In practice neither extreme actually exists in the
world, the most unequal countries are around the 0.7
mark, and the most equal are about 0.3 .
The Gini coefficient is quite a controversial method of
measurement, and different figures may be given
depending on what is measured -pre-tax, after-tax,
demography
MEASURING INEQUALITY
EFFECTS
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Problems which are more common in unequal
societies
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Level of trust
Mental illness – addiction
Life expectancy and infant mortality
Obesity
Children’s educational performance
Teenage births
Murder
Imprisonment rates
Social mobility
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Health and social problems are more common
amongst the least well off, but the problems as a
whole are worse in more unequal societies
There are two explanation as to why people nearer
the bottom of society suffer more problems
Either, the circumstances people live in cause their
problems..
Or, people end up nearer the bottom of society
because they are prone to problems which drag them
down.
But if it were the second of those two reasons then
richer countries would do better, this is not the case
so it has to be more to do with inequality.
WHY DOES INEQUALITY CAUSE SOCIAL
PROBLEMS?
Problems in rich countries are not caused by
society not being rich enough – or even too richbut by the scale of material differences between
people within each society being too big.
 What matters is where we stand in relation to
others in our society
 Poor people in rich societies often feel pressure to
spend money on appearances and scrape by on
basic needs
 “It is important to be able to present oneself
creditably in society without the shame and
stigma of apparent poverty” – Adam Smith

INCREASED DEPRESSION AND ANXIETY

Depression and anxiety are known to be linked to
inequality in the developed world. People in
developed countries have experienced substantial
rises in anxiety and depression. Among
adolescents these have been accompanied by
increases in the frequency of behavioural
problems, including crime, alcohol and drugs.
FALSE SELF-ESTEEM
Another surprising result of the rise in anxiety
has been the rise in self-esteem. But on further
inspection, this is not a positive rise.
 We are increasingly anxious about how we are
seen and what others think of us – because we
are insecure there is a defensive tendency to
falsely make out we are confident in the face of
insecurity. This defence often involves boasting
and selfish behaviour which can be mistaken by
others for self-esteem.
 People deny weakness, talk themselves up and
try to promote a positive view of themselves in
the face of perceived threats. This type of person
reacts badly to criticism
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FALSE SELF-ESTEEM CONTINUED
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People with insecure high self-esteem tend to be
insensitive to others and tend to shown an excessive
preoccupation with themselves, with success and with
their image and appearance in the eyes of others –
this is called ”threatened egotism or narcissism.
Psychologists have carried out tests on tasks designed
to cause stress – they have measured stress through
the release of cortisol into saliva. They concluded…
“Human beings are driven to preserve the social self
and are vigilant to threats that may jeopardise their
social esteem or status”
In other words we are driven to protect ourselves
from embarrassment – if we feel that we are not as
good as other people this causes shame – this
increases stress, and stress affects our bodies.
SOCIAL PRESSURE
How people see you matters. In general, the
further up the social ladder you are, the more
help the world seems to give you in keeping selfdoubts at bay.
 To do well for yourself or be successful in the
society we live in is all about moving up the social
ladder. The further up the social ladder you are,
the easier it becomes to feel a sense of pride,
dignity and self-confidence.
 One of the most common causes of violence is
that it is often triggered by loss of face and
humiliation when people feel looked down upon
and degraded.

THE BIOLOGY OF STRESS
IN CHILDHOOD
Researchers are increasingly recognising that
stress in early life, in the womb as well as in
infancy and early childhood, has an important
influence on people’s health through their lives.
Stress in early life affects growth, emotional,
social and mental development, as well as later
health and lifestyle choices.
 And the socio-economic status (class) of their
families also affect their long-term life chances.
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The Effects of Stress
The psyche affects the neural system and in turn
the immune system – when we’re stressed or
depressed or feel hostile, we are far more likely to
develop a host of bodily ills, including heart
disease, infections and more rapid ageing.
 Stress disrupts our body’s balance, interferes
with what biologists call “homeostasis” – the
state we’re in when everything is running
smoothly.
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When we experience some kinds of acute stress
or something that is traumatic, our bodies go into
“fight or flight” response. Energy stores are
released, our blood vessels constrict, clotting
factors are released into the bloodstream
anticipating injury and the heart and lungs work
harder.
 Our senses and memory are enhanced and our
immune system perks up. We are primed and
ready to fight or run away from whatever has
caused the stress.
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If the emergency is over in a few minutes, this
amazing response is healthy and protective, but
when we go on worrying for weeks or months and
stress becomes chronic, then our bodies are in a
constant state of anticipation of some challenge
or threat, and all those fight or flight responses
become damaging
Obesity
In the UK about 40% of the population were
overweight and less than 10% were obese. Now
2/3 of adults are overweight and over 1/5 are
obese.
 In the past the rich were fat and the poor were
thin, but these patterns are now reversed in rich
countries
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Obesity
Calorie intake and lack of exercise are important
in weight issues, but in addition it needs to be
noted that people with a long history of stress
seem to respond to food in different ways from
people who are not stressed. Their bodies
respond by depositing fat particularly round the
middle rather than lower down the hips and
thighs.
 Stress can also cause us to change the type of
food that we eat – for example stress eating or
comfort eating
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Obesity
People who are chronically stressed tend to overeat and gain weight or under-eat and lose weight.
 In experiments with rats, when animals are
stressed they tend to choose more fat and sugary
food.
 Recent research suggests that food stimulates the
brains of chronic over-eaters in just the same way
as drugs stimulate the brains of addicts
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Female obesity in adolescence has been linked to
lower earnings in adulthood.
 A recent survey of Human Resource professionals
found that 93% would favour a normal weight job
applicant over an equally qualified overweight
candidate.
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In Conclusion
The work of Wilkinson and Pickett proves that it
is not just poverty, but the amount of inequality
in a country which affects the health of the
people.
 Because the UK is one of the most unequal
countries in the developed world it is
experiencing higher levels of social problems
including violence, drug addiction, mental health
problems, obesity and low educational
attainment.
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