Desires, inequality, discontent, and illness
Unless politicians reverse it, the trend of recent years towards greater income inequality is likely to increase; this has been recognised right across the political spectrum. It is chiefly inequality, rather than low income itself, which generates discontent, consumption desires, and consequent feelings of financial anxiety. Research has found that those of low social status desire more possessions than those of higher status.28 This is probably because they have a greater need to try and bolster their ego through acquiring the trappings of 'success'. As the incomes of the wealthy have been increasing so much faster than other incomes since the 1980s, the discontent arising from this comparison has grown.
While happiness within any individual industrial country increases slightly from the bottom to the top of the income scale, this seems to be due largely to people comparing their situation with that of others. As incomes rise throughout society over the years, average levels of happiness do not increase.29 Moreover the average happiness of one industrial nation compared to others bears no relation to their differences in average income. However most evidence shows that the greater the inequality within a nation, the more unhappy its citizens tend to be.30
As inequality erodes happiness, it is not surprising to find that it also harms health. Research findings on inequality and health are complex, and have some inconsistency. However I will summarise a large volume of evidence to explain how inequality has this effect.
Absolute poverty causes illness in the developing countries of Africa, Asia, and South America. However in advanced nations, on which this discussion is focused, it is inequality rather than poverty itself which is a major cause of illness and death.31 Differences between developed nations in income per head are not significantly related to differences in life expectancy between those nations. But within any one country, life expectancy, and health, increases at each level ascending the income scale, showing that poverty is not the relevant factor.32 Both the rates of sickness absence, and mortality, of British civil servants, were found to be greater in each successive pay grade going down the hierarchy. Social class differences in illness have increased with inequality in recent decades despite the fact that the incomes of all social strata have risen. As Japan's inequality fell from 1970 to 1990, its life expectancy rose much more than in Britain, where inequality, and the social class differences in death rates, both rose.
The inequality-illness link has been found to be partly due to differences in levels of education within the population. This is because inequality has its harmful effects largely through the medium of social status, which is more directly measured by education.
Research shows that the scale of the inequality-illness link is too great to be caused by differences between social strata in either health-relevant lifestyle (smoking, diet, etc.), or access to medical care, whose influence is less.33
A victim of inequality speaks
While carrying out my research I encountered a man who bore prominent psychological scars of inequality. He had also had a serious physical illness a few years earlier. He clearly feels that no one values him, either personally or economically. He is a mature student on a low income. He says 'Those bastards in the boardrooms getting £60 per hour . . . make me really angry'. He had once aspired to be 'a yuppie', with a 'black BMW and pretty woman'. Now, although he would like 'a nice soulmate', his self-confidence is such that he feels no woman would be 'interested in a 41-year-old balding bachelor'. He makes no complaint about the physical condition of his flat, which he says he loves because 'it's my home'. But then he describes it as 'crap', because he feels it puts him 'in close proximity with . . . thieves, low life, drug abusers . . . and other assorted "housing estate" tenants'. He feels other people would take advantage of him if they had the chance. He rarely obtains enjoyment from life. He has certain hopes, but says he has no chance of achieving any of them. As he lacks social support, and feels devalued by being poor in a society of whose inequality he is keenly aware, he is one of many at great risk of becoming ill.
References
28Lita Furby, 'Possessions: toward a theory of their meaning and function throughout the life cycle', in Paul B. Baltes (ed.), Life-span Development and Behavior, vol. 1 (Academic Press, 1978), 297-336, esp. 324
29David G. Blanchflower and Andrew J. Oswald, 'Well-being over time in Britain and the USA' (paper submitted to the NBER Summer Institute Presentation, 2000; accessed at 5, 8 Journal of Public Economics, 2004, 1359-86
30Michael Marmot and Richard G. Wilkinson, 'Psychosocial and material pathways in the relation between income and health: a response to Lynch et al', British Medical Journal 322, 1233-6; Alberto Alesina, Rafael Di Tella, and Robert MacCulloch, Inequality and Happiness: Are Europeans and Americans Different? (Centre for Economic Policy Research, 2001, Discussion Paper No. 2877), accessed at
31Michael Marmot, 'The influence of income on health: the views of an epidemiologist', Health Affairs, March/April 2002, 31-46, esp. 37; Richard S. Cooper, Joan F. Kennelly, Ramon Durazo-Arvizu, Hyun-Joo Oh, George Kaplan, and John Lynch, 'Relationship between premature mortality and socioeconomic factors in black and white populations of US metropolitan areas', Public Health Reports 116, 464-73, esp. 468; Nancy A. Ross, Michael C. Wolfson, James R. Dunn, Jean-Marie Berthelot, George A. Kaplan, and John W. Lynch, 'Relation between income inequality and mortality in Canada and in the United States: cross-sectional assessment using census data and vital statistics', British Medical Journal 320, 898-902
32Marmot, 'The influence of income on health (see above), 36, 38, 39; Ichiro Kawachi and Bruce Kennedy, The Health of Nations: Why Inequality is Harmful to your Health, (The New Press, 2002), 57-60
33Mikko Laaksonen et al., 'Do health behaviour and psychosocial risk factors explain the European East-West gap in health status?', European Journal of Public Health 11, 65-73; Kawachi and Kennedy, Health of Nations(see above), 59-60; Leiyu Shi, James Macinko, Barbara Starfield, John Wulu, Jerri Regan, and Robert Politzer, 'The relationship between primary care, income inequality, and mortality in US states, 1980-1995', Journal of the American Board of Family Practice 16, 412-22, tables 2, 3, 4