Richard Wilkinson on the Black Report 2005:
Nothing has changed since 1980: Life expectancy differences continue to widen. This is the biggest social injustice and human rights abuse in the developed world.
Underlying factors: income inequalities (which are now higher than they were before the Thatcher years). This is not an egalitarian society.
Things may have been worse without Labour’s tax and benefits reforms. Labour has recently started to reduce inequality. Real improvements have been made in child health. The proportion of children living in poverty has moved from 1 in 4 to 1 in 5.
This is as far as we can go in considering what has actually changed.
Underlying causes: Psychosocial factors – self-esteem; perception of self in relation to others.
What does health inequality do to people? It doesn’t just impact on health. There is a link between deprivation and education, mortality and teenage pregnancy, etc.
We shouldn’t just be talking about health. Reducing health inequalities would impact on many other aspects of life.
What drives national changes or improvements? Social gradients.
The way to improve health as fast as possible is to reduce health inequalities. Differences make the most difference. Social gradients are linked to inequality. Income inequality is linked to wider social class differences.
Inequality is an obstacle to an ideal of greater human harmony – it’s not a matter of reaching utopia. The differences matter. Why? It’s a matter of how you feel you are seen by others – an important source of stress.
Equality increases… Mistrust decreases
Equality decreases… Mistrust increases
Income equality increases… Involvement in community life increases
Equality decreases… Violence increases
Why? Violence is triggered by people feeling that they are looked down upon.
Societies that are hierarchical: Society deteriorates, impacting upon health
Psychosocial risk factors for poor health: Social status (control autonomy)
Friendship (quality of social relations)
Early life (pre and post natal)
We know ourselves through eachothers’ eyes. The biggest stresses are situations where we can be judged negatively. Why are we sensitive to social stress?
Friendship and social status are two sides of the same coin: mutuality vs orderings based on power. Other people can be the best and worst for you (supportive or competitive), therefore getting relationships right is essential for health.
Liberty – Autonomy not subservience
Equality – Social and economic not hierarchy
Fraternity – Social affiliations and friendships
Discussion – following Professor Richard Wilkinson’s speech
Questions and Comments
Is there not social mobility? If there is, then are health inequalities not so stark?
There is no data regarding the people at the ‘top’ – only those on middle incomes and below. Changing the proportions of people in each class could result in:
A reduction in the numbers of people in the bottom group (which would mean the top group becomes less extreme)·
No real change in actual differences
I advocate employee ownership. It’s not just a choice of state
What about teaching people to handle ‘negative judgments’?
I’m not suggesting we do nothing but reduce income inequality.