The Spirit Level

1. Income inequality has profound effects on societal health and wellbeing

We have now seen that almost all problems which are more common at the bottom of the social ladder are more common in more unequal societies.

Pervasive impact: Income inequality affects a wide range of social and health outcomes, including:

• Life expectancy
• Mental health
• Drug abuse
• Educational performance
• Teenage births
• Obesity
• Violence and crime rates
• Social mobility

Magnitude of effects: The differences between more and less equal societies are substantial:

• Problems can be 3-10 times more common in unequal countries
• These effects apply across entire populations, not just to the poor
• Even small reductions in inequality can lead to significant improvements

Evidence base: The relationship between inequality and social problems is supported by:

• Comparisons across rich, developed countries
• Data from the 50 U.S. states
• Consistent patterns across multiple health and social issues

2. Trust and social cohesion decline as inequality increases

Greater equality seems to strengthen community life, people trust each other more and are more engaged in social or community activities, and less violence.

Erosion of trust: As income differences widen, people are less likely to trust one another:

• In Sweden, 66% of people feel they can trust others
• In Portugal, only 10% believe most people can be trusted
• Similar patterns are seen across U.S. states

Community breakdown: Inequality weakens social bonds and civic engagement:

• People become less involved in community activities
• Social support networks deteriorate
• Sense of shared identity and common purpose diminishes

Consequences: Low trust and weak social cohesion lead to:

• Increased social isolation
• Higher crime rates
• Reduced social mobility
• Less effective democratic institutions

3. Mental health issues and drug use rise with greater inequality

The populations of rich countries have got to the end of a long historical journey.

Prevalence of mental illness: More unequal societies have significantly higher rates of mental health problems:

• In the most unequal countries, up to 26% of adults experience mental illness annually
• This is more than three times the rate in the most equal countries (8%)

Types of disorders: Inequality is strongly associated with:

• Anxiety disorders
• Mood disorders
• Substance abuse

Drug use patterns: Illegal drug use is more common in unequal societies:

• This holds true for opiates, cocaine, cannabis, and other substances
• The relationship is seen both internationally and among U.S. states

Underlying factors: Increased mental health and drug issues may be driven by:

• Greater social stress and status anxiety
• Weaker social support systems
• Reduced access to mental health resources

4. Physical health and life expectancy suffer in more unequal societies

The big idea is that what matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed.

Life expectancy: More equal societies have longer average lifespans:

• In the U.S., life expectancy is 1.2 years shorter than in Greece, despite much higher average incomes
• The gap between the most and least equal developed countries is over 4 years

Health gradients: Health disparities exist across all levels of society:

• Even among the middle and upper classes, health is better in more equal countries
• The social gradient in health is steeper in more unequal societies

Specific health issues: Inequality is associated with higher rates of:

• Infant mortality
• Obesity
• Heart disease
• Certain cancers

Mechanisms: Inequality affects health through various pathways:

• Chronic stress from social comparisons
• Reduced social cohesion and support
• Limited access to healthcare and health-promoting resources

5. Educational performance is negatively impacted by income inequality

If we want to know why one country does better or worse than another, the first thing to look at is the extent of inequality.

Academic achievement: More equal societies tend to have better educational outcomes:

• Higher average test scores in math and literacy
• Lower high school dropout rates
• Better overall educational attainment

Social gradient in education: Inequality exacerbates educational disparities:

• Steeper differences in performance between socioeconomic groups
• Reduced social mobility through education

Early childhood impacts: Inequality affects educational trajectories from an early age:

• Differences in cognitive development visible by age 3
• Gap widens throughout schooling years

Underlying factors: Inequality undermines education through:

• Reduced investment in public education
• Increased stress and instability in family environments
• Lower expectations and aspirations in disadvantaged groups

6. Violence and imprisonment rates increase with higher inequality

If you don't want to feel small, incapable, looked down on or inferior, it is not quite essential to avoid low social status, but the further up the social ladder you are, the easier it becomes to feel a sense of pride, dignity and self-confidence.

Violent crime: More unequal societies have significantly higher homicide rates:

• Up to 10 times higher in the most unequal vs. the most equal countries
• Similar patterns observed across U.S. states

Imprisonment: Incarceration rates are strongly linked to inequality:

• The U.S. imprisons 576 people per 100,000, compared to 40 per 100,000 in Japan
• This reflects both higher crime rates and more punitive justice systems

Root causes: Inequality fuels violence through:

• Increased social stress and competition
• Erosion of social trust and cohesion
• Greater perceived injustice and status anxiety

Cycle of disadvantage: High imprisonment rates in unequal societies:

• Disproportionately affect marginalized communities
• Perpetuate cycles of poverty and social exclusion
• Strain public resources that could be used for prevention and rehabilitation

7. Reducing inequality benefits everyone, not just the poor

The vast majority of the population is harmed by greater inequality.

Widespread gains: Improvements from reducing inequality extend across society:

• Health benefits seen even among middle and upper classes
• Lower crime rates improve safety for all
• Stronger social cohesion enhances quality of life at all levels

Economic advantages: More equal societies tend to have:

• Greater economic stability
• Higher social mobility
• More sustainable consumer behavior

Societal resilience: Reduced inequality leads to:

• Improved public health, reducing healthcare costs
• Better educational outcomes, enhancing workforce productivity
• Stronger democratic institutions and civic engagement

Psychological benefits: Lower inequality fosters:

• Reduced status anxiety and social stress
• Greater sense of shared purpose and community
• Improved overall wellbeing and life satisfaction

8. Technological changes and employee ownership can help reduce inequality

Rather than simply waiting for government to do it for us, we have to start making it in our lives and in the institutions of our society straight away.

Technological opportunities: Digital innovations can promote equality:

• Reduced marginal costs for many goods and services
• Expanded access to information and education
• New models for collaborative and shared ownership

Employee ownership: Democratizing workplaces can reduce inequality:

• Improved distribution of profits and decision-making power
• Enhanced job satisfaction and productivity
• Greater alignment between corporate and societal interests

Policy approaches: Governments can support these trends through:

• Tax incentives for employee ownership schemes
• Investment in digital infrastructure and education
• Updating regulations to support new economic models

Cultural shift: Moving towards equality requires:

• Redefining success beyond material wealth
• Fostering a culture of cooperation over competition
• Emphasizing long-term sustainability over short-term gains

9. Addressing inequality is crucial for building sustainable, cohesive societies

Greater equality is the gateway to a society capable of improving the quality of life for all of us and an essential step in the development of a sustainable economic system.

Environmental sustainability: Reducing inequality is linked to environmental protection:

• Less pressure for unsustainable economic growth
• Reduced consumerism and status competition
• Greater political will for collective action on climate change

Social cohesion: More equal societies foster:

• Stronger sense of shared identity and common purpose
• Higher levels of civic engagement and democratic participation
• Improved social mobility and equal opportunities

Economic stability: Addressing inequality promotes:

• More balanced and sustainable economic growth
• Reduced financial volatility and systemic risks
• Greater resilience to economic shocks

Long-term vision: Building more equal societies requires:

• Sustained political commitment over decades
• Broad-based social movements for change
• Integration of equality goals across all policy areas

Last updated: July 26, 2024