Why Greater Equality Makes Societies Stronger
Richard Wilkinson and Kate Pickett

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A clear, well organized book that pulls together wide-ranging research on the relationship between wealth inequality, and social and individual health. Wikipedia The Spirit Level and Amazon have good pages on the book. One reviewer is quoted in Wikipedia this way:

Richard Reeves in The Guardian called the book “a thorough-going attempt to demonstrate scientifically the benefits of a smaller gap between rich and poor(.)”… Later noting that, “The Spirit Level is strongest on Wilkinson's home turf: health. The links between average health outcomes and income inequality do appear strong, and disturbing”.

One note – a spirit level is the English phrase for what we in the U.S. would call a carpenters’ level.

Wilkinson and Pickett are UK epidemiologists who start from a familiar place – wondering why life expectancy and happiness do not improve in nations that advance from moderate wealth to profound wealth as measured by per-capita GDP. The authors then draw a correlation between a wide divide separating the rich and poor, and bad social and individual health outcomes. To make this argument they compare places with wide divides with those of less wealth division. Along with this the authors provide a theory for why societies with a wide wealth gap have worse outcomes and discuss some general patterns in policies designed to address the issue.

The short version of the policy recommendation is this: it does not matter how wealth inequality is reduced (whether by redistribution – as in the Scandinavian nations or some U.S. states such as Vermont – or through socially unifying norms that prevent great inequality in the first place – as in Japan or New Hampshire) the result is the same. They argue that reductions in inequality move the numbers.

In a sense the key to The Spirit Level is a survey and synthesis of many, many separate pieces of research, and the application of a framework to them. Wilkinson and Pickett base the book on what the authors cite as numerous and consistent studies of a great variety of social and personal health and wealth metrics. They by-and-large use standard measurements – for example when talking about wealth (i.e. GDP) and inequality (the Gini coefficient). The list they tick though can be seen in keywords of the chapter titles of the second section: mental health and drug use, physical health and life expectancy, obesity, educational performance, teenage births, violence, imprisonment, social mobility…

The direct and methodical way they seem to consistently move through the lists is one of the book’s strengths.

Wilkinson and Pickett argue that negative results come from persistent levels of stress (and stress hormones) in people who live in unequal communities. They compare these levels of stress to similar kinds of stress artificially produced in primates in a laboratory setting. This – and the metrics that describe the outcomes of inequality – places an often expressed, intuitive argument about the importance of social bonds to human well-being in an experimentally verifiable framework, and for that alone the book is worth considering.

The comparison to primates, and the introduction of a biological basis for negative results of inequality induced stress, also puts the discussion squarely in evolutionary terms.

One of the smarter things Wilkinson and Pickett do is take the patterns in the data for nations and see if the pattern remains consistent for U.S. states. It does. The states function as a control group and their findings suggest the pattern should be easily replicated.

One of the other important arguments in the book centers on whether the benefits of greater equality are enjoyed by the poor and rich or just the poor. Some critics of the book have said the issue is not inequality per se, but poverty per se. Wilkinson and Pickett argue that inequality also harms those on the upper end of the scale.

They show compelling metrics in comparative U.S. and U.K. rates of chronic illnesses - the wealthy in the U.S. have similar or higher rates of diabetes, hypertension, cancer, lung disease, and heart disease than the poor in the U.K. This could devolve into an argument about socialized medicine, and whether the system of health care finance qualifies as a policy that reduces inequality, but setting aside that argument the authors also find better health outcomes for the poor in more equal Sweden than for the wealthy in more unequal England and Wales - the U.K. having more equality than the U.S. but less than the Scandinavian countries. The authors describe a study of working age men.

Sweden, as the more equal of the two countries, had lower death rates in all occupational classes; so much so that their highest death rates - in the lowest classes - are lower than the highest class in England a Wales.

They put forward similar results on child mortality and various studies comparing the wealthy and poor U.S. counties.

Their theoretical underpinnings can be a little confusing for a reader not familiar with the arguments. But the book is written for the general public, and once the theory is understood, the rest of the book very clear, directly structured, and simple to follow.

Although the book presents a grim picture of the damage inequality does to people, Wilkinson has suggested in the work and in subsequent interviews that the work is ultimately a hopeful one. He argues that reducing wealth inequality, while difficult, can produce results in what are some notably stubborn problems, such as the persistence of depression and crime in wealthy societies.

As one would expect of a work with broad political implications of this kind, criticism of The Spirit Level has generally come from quarters ideologically opposed to its findings. Reviewers in The Wall Street Journal and other places have also criticized Wilkinson and Pickett’s use of statistics; it seems that these two lines of criticism, statistical and ideological are at some level inseparable. One central complaint is that the authors have drawn too many implications from too little data, that (for example) the use of regression line graphs over-simplifies a complex picture.

Without needing to dig into too much detail, a reader should know that regression lines are a standard tool of economics and the social sciences. Some of Wilkinson and Pickett’s graphs do make very broad arguments. In chapter two they condense numbers for nine separate social problems in the developed nations into a single axis, and compare how they do according to levels of inequality. In a separate chart they put individual income on the second axis. As one would expect they find a strong regression line correlation in the first graph and not in the second.

This is probably going to be too much for some ideologically oriented readers to swallow, no matter how it is graphed.

But following the pattern they use later in the book Wilkinson and Pickett then repeat the same analysis for U.S. states - condensing the numbers for nine separate social problems into a single axis, and comparing how the states do according to levels of inequality, then in a separate chart again putting individual income on the second axis. Replication of results adds confidence, and ultimately Wilkinson and Pickett’s arguments seem compelling. Certainly by the end of The Spirit Level, when they have repeated the process for numerous, numerous separate metrics in separate instances.