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‘They are dying of hopelessness’: how inequality affects our mental health

‘They are dying of hopelessness’: how inequality affects our mental health

Richard Wilkinson and Kate Pickett talk to Nick Spencer and Katherine Ajibade about inequality, mental health, religious faith, and economic democracy

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In 2009, The Spirit Level took the reading public by storm, charting in detail the links between inequality and social ills. A decade later, Richard Wilkinson and Kate Pickett have returned to a subject they never left, publishing The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing.

Nick Spencer and Katherine Ajibade talked to the authors in their publishers’ offices in London about inequality, mental health, religious faith, and “economic democracy”.

NS: Your previous book The Spirit Level was published nearly a decade ago, so I guess my first question is, why now?

KP: To a great extent, in The Inner Level we are synthesising new research that has come out since The Spirit Level was published – some of it inspired by The Spirit Level or testing various predictions that we had laid out, and it takes a while for that new evidence to come through and for us to respond to it… as well as finding time to write! The timing for this one feels right given the emphasis and concerns around mental health and wellbeing in the population at the moment. Had we finished it earlier there may have been less receptivity.

RW: It is an appropriate time given the findings from the Mental Health Foundation, showing 74% of the population find it hard to cope with stress, 32% have had suicidal thoughts, and 16% have self–harmed at some point in their life.

Would a fair way of depicting the difference between The Spirit Level and The Inner Level be The Spirit Level is about inequality within society, and The Inner Level is inequality and what it does within ourselves?

KP: I think that characterisation is absolutely right. Another way that we think about it is that a lot of people reading The Spirit Level may have thought, ‘Those outcomes do not apply to me. I’m not going to have a teenage pregnancy. I’m not going to commit homicide. I’m not going to prison etc.’ What they think really matters for them are not those problems ‘out there’ but rather how they feel, and actually inequality matters for that too and that is what this book highlights.

There is an increased awareness of mental health issues than there was a decade ago. Do you think that ‘austerity’ is related to this?

KP: We see academic studies now that show an increase in suicide rates are linked to benefit sanctions and increased mortality, particularly among the elderly, seems to be linked to being in hospital for prolonged periods of time because they can’t get access to the social care that should be there for them. Stress–related mortality is rising and evidence also shows that the rates of smoking in pregnancy has gone up in women who live in Bradford.

RW: The decline in death rates has been coming down for generations. To see it rising now amongst the most vulnerable in society is a really important sign. 

KP: If you look at our young… a rise in zero–hour contracts, precarious employment, and the stagnation of wages – the sense that however well you do in school there may still be nothing there for you when you are leave is also evidence of this. If you do research with people who are experiencing the impact of austerity, the main experience they describe is one of stigma and shame. It is the social and psychological impact of those austerity measures that matters the most to them rather than the material impact.

It struck me that there are two angles to this: an acute one, meaning people who have suffered specifically, and another which is more general, meaning that if, as a culture or a society, you pin your worth on ever increasing earnings and then that declines for ten years, even if you haven’t suffered at the hands of the benefit system, your self–esteem is eroded and your sense of self–worth goes with it…

KP: And you start to feel left behind in a society where the top 1% continues to take more.

RW: People have suggested that economic growth is an essential feature of societies with great inequality; that you have to have economic growth to make great inequality tolerable because it allows people to feel that they are living better than they did ten years ago, that they are making progress.

Or at least the promise of economic growth which is at the centre of the American dream…

RW: There is a big movement in the States concerning the rising death rates of white middle class Americans. The main part of that is an expression of feeling that they have been surpassed.

KP: They are dying of hopelessness.

A hostile reading of the book would say you pin too much on inequality and you read a causal relationship there when it is correlative. How would you respond to this?

KP: We have heard the phrase ‘correlation does not prove causation’ a lot over the years and I would say, sometimes that’s exactly what it does show. You start with the correlation and then you have to understand whether it is real or not. If it’s not real, then maybe it’s due to the data, the analysis or perhaps something else explains that correlation. So what you do in observational science, like we do, is you put all the evidence together to see if it explains that correlation in a robust way… I would now say that that evidence base is extremely robust.

RW: We have over 500 references for all the studies that form the background and make us confident of this picture.

KP: Those who posit that it is something else have never provided an adequate explanation that fits the data as well as this explanation of what inequality does and how it affects our psycho–social well–being.

RW: What we have to explain is why a whole range of social problems are more common in societies like Britain and America, than in societies like Sweden and Japan. They may be different problems but they all have a similar international pattern. What the problems have in common is that they are all problems with social gradients. They are all more common at the bottom of the social scale. So an explanation has to involve something that would plausibly affect all sorts of outcomes related to social gradients and nobody has produced an explanation like this.

RW: There are people with an unexamined set of racist assumptions. For example, when someone produced a study showing that homicide was more prominent in more unequal states, they said it was probably more common with proportion of African Americans in each state. The tendency is to think about people at the bottom of the hierarchy and misunderstand it as something that has to do with that particular group of people. People constantly misunderstand the effects of being at the bottom of the social ladder and interpret it as if it’s part of the culture, ethnicity, and genetics of some group. And that is an endlessly repeated mistake.

KP: In other kinds of science how you prove cause is by doing an experiment, and obviously we can’t do that with inequality. But what we have seen over the past decade are more and more studies that look at change in inequality and change in outcomes. We can’t experiment, but we can certainly look at change over time.

RW: The main mistake of our critics is to think that our research is all there – ours is a tiny proportion of all the research.

Do the phenomena you have been studying closely track levels of inequality? Is there any elasticity in the relationships? So if you see slight shifts in equality would one also see shifts in the things you are writing about or is it more of a fluid relationships?

KP: Yes, in general, but always with exceptions, because other things affect them too. Inequality is not the only cause of homicide.

RW: Inequality is important because it’s a common factor.  

KP: For some things it is possible to track the impact of inequality and then they diverge, but if you look internationally you still see that pattern.

RW: We need more work on this, because some researchers are showing that inequality that affects children can have long term effects, even though those effects may take 3–12 years to come through.

Where does the causality buck stop? Could you make the argument inequality is in actual fact a symptom of a prevalent culture of individualism?

KP: There have been explicit tests for this but another set of evidence that speaks to that is the relationship between the level of income and inequality and different outcomes across American states. That is a very individualistic culture but some of the states that do better are Western states that are perhaps more individualist than Eastern ones. The patterns there can’t really be explained by differences in individualism.

RW: We argue in one chapter that there are two sides to human nature. We have characteristics which are about living in an egalitarian society – sharing, reciprocity, cooperation – and we also have characteristics that are probably pre–human that deal with dominance hierarchies, and how to play the dominance game. You have to play the game that is suitable to the environment.

KP: So if you’ve had an outbreak of individualism it’s probably because you’ve had an outbreak of inequality rather than the other way around.

The danger is it becomes a self–fulling prophecy because the more unequal society is, the more likely you are to protect your own interests, which makes society less civil minded and more unequal.

KP: I would argue that it would definitely be easier to break the inequality than it would be to mess with human nature or culture.

A study undertaken by Theos a few years ago showed a positive correlation between religious practice and positive wellbeing. Is that a picture you recognise and how would explain this?

RW: Aaron Antonovsky [the Israeli American Sociologist] has talked a lot about a sense of coherence being really important to positive wellbeing; you know, can you make sense of what is happening around you? It’s a concept that came out of the Holocaust. What we know about the protective effects of friendship are part of this same picture, or even that health is better for people who have pets – those relationships are crucially important.  Involvement in religious groups means you’re more likely to be part of a social group.

KP: I would stress two things: one is the sense of the community that goes with a lot of religious practice and attendance. But also the meditative, mindfulness aspects in all kinds of religious and practice.

That makes sense because if your identity and self–worth is dependent on something that isn’t contingent and is grounded in sustaining, permanent, faithful love, you are more likely to withstand what life throws at you, including what life throws at you materially.

KP: If you think about the major world religions, the values at their core tend to be very egalitarian. They are about how to engage in reciprocal relations and how you care for other people.

You don’t get many sermons on the benefits of ruthlessness. I think there are links between that and what you talk about in your last chapter on “economic democracy”. Faith groups are, at best, a pool of reciprocity and mutuality. They are places where you can have the benefits of friendship. It strikes me that there is a parallel between that principle and what you’re suggesting in terms of the economic reform we need, in terms of co–operatives and employee–owned companies, and employee representation on boards. These are the kinds of institutions or bodies that are, theoretically, based on reciprocity and mutuality rather than only profitability.

KP: Isn’t it a Quaker concept that everyone has an element of the divine in them Richard?  

RW: Yes it is.

KP: Richard was brought up Quaker, which is why I thought he might know. In a sense, what economic democracy ought to be bringing is a secular version of that into a workplace, so that everyone in the workplace has something valuable to contribute and should be valued for that contribution, therefore everyone should be represented, therefore everyone should have a voice. And I do see parallels between that and a religious gathering that is based on mutual respect.   

I think the parallel is very close, because if you think about some of the more enlightened businesses from the 19th century, they were run by Quakers – there was that mutuality and that respect. Your last chapter offers specific ideas about what can practically be done. Can you summarise those?

RW: We are in favour of redistribution and dealing with tax avoidance, but we must embed greater equality more deeply in our society and we think that should be done by greater economic democracy, and greater representation on boards growing over time.

KP: Yes, ‘the growing over time’ notion is an important element of what we are recommending because we are talking about incremental changes that could start happening now but over time would lead to a much greater economic democracy.

RW: The evidence shows that more democratic models in the work place sees higher productivity. For example, Robert Oakeshott who writes on employee ownership, says an employee buyout changes a company from a piece of property into a community, which I think is extremely important. It is more difficult for directors and senior management when they suddenly become answerable to a body of employees, because the employees know so much more about the company, and what went right and what went wrong in the last year. This fits very much within the model noted by Kate, in that everyone is valuable and everyone does have something to contribute.

KP: I’d add to that, we are also in favour of people being kinder to each other too!

I am particularly interested in the idea that mutual ownership improves productivity. You could make an argument, couldn’t you, that this should cash out anyway in the long run and might well happen naturally so why force it?

KP: Yes it might well happen naturally and in fact that sector is growing. The employee ownership association membership has increased massively.  

RW: They say the employee owned sector has grown in the British economy by 9% a year for three years running.

KP: So if it is growing at this level, I would say we would like to speed it up a bit. If the benefits are not only that those companies perform well but they are also beneficial in reducing inequality, promoting self–esteem, then, yes, let’s speed it up. There could be incentives to help companies move towards those models to help grow it faster so that more people can benefit.

The danger is, isn’t it, that you re–engage with these models, they do well and then someone sells them off…

KP: So you’ve got to build in those protective models… it’s all very feasible.

What’s the political weather like for this, in your opinion?

KP: Not bad, I don’t think.

RW: I think the evidence shows that more democratic companies do better, with smaller income differences, and the evidence we show in our last chapter is that companies where the CEO is paid the most do less well in terms of shareholder returns. We’ve always regarded CEOs as the people who knew best about the business, but perhaps now they are the people who are stopping important changes in structure and progress.

KP: I think there was general shock at watching the top executives from financial institutions being quizzed on their own organisations and having to say, ‘No, I don’t have any special training’ or ‘No, I don’t have years of experience’… I think that opened people’s eyes quite a lot. But we’ve forgotten it already and that’s the danger. That’s why we keep on writing things – because people do forget!

Are there some countries that are much better at “economic democracy”?

RW: Yes, we talk about Germany and its long term legislation on employee representation. There’s Spain and northern Italy.

KP: But even if you looked at a country where capitalism is prevalent, you could still find a very strong employee owned sector because the two different kinds of capitalism can coexist. It doesn’t have to be a revolutionary shift all at once.

That’s a comment that Justin Welby has made, that we need a much greater range of ownership models in the UK economy. The book your most reminded me of was Thomas Piketty and his Capital in the 21st Century, not only in his data emphasising the growth in inequality, but also in his conviction that this is a political problem rather than an economic one and it is therefore amenable to political solutions. Would you see yourselves as fellow travellers with Piketty?

KP: Complementary rather than fellow travellers, because he’s much more about finding the causes of inequality; we look at the consequences .

RW: That’s the big difference. But I don’t think there is anything inconsistent about the two. In fact, it’s good to have the two sides together.


The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing is published by Allen Lane 


 Image by Romolo Tavani’s available under a Shutterstock licence 

Nick Spencer

Nick Spencer

Nick is Director of Research at Theos. Nick is an acclaimed author of books and reports, most recently The Evolution of the West (SPCK, 2016) and Atheists: The Origin of the Species (Bloomsbury, 2014).

Posted 13 June 2018

Economy, faith, Mental Health, Physchology, Welfare


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