[Vision2020] New Scientist: Inequality: Of wealth and health

[Art Deco]

  *New Scientist*


<http://www.newscientist.com/article/mg21528752.400-inequality-of-wealth-and-health.html>
 Inequality: Of wealth and health

   - 30 July 2012 by *Liz
Else*<http://www.newscientist.com/search?rbauthors=Liz+Else>

   [image: how do you stack up? <i>(Image: Danny Lehman/Corbis)</i>]

how do you stack up? *(Image: Danny Lehman/Corbis)*

1 more image<http://www.newscientist.com/articleimages/mg21528752.400/1-inequality-of-wealth-and-health.html>

*The rising affluence of the 1 per cent may not only mean there is less for
everyone else. What does inequality mean for your health?*


THE richest 1 per cent of society has pulled away from the rest of the
population at a quickened pace in the past few decades. This asymmetrical
distribution of wealth is nothing new - humans have lived in lopsided
societies for millennia. But the new question is whether their wealth
affects everyone else's health. There may be economists who argue that
inequality isn't bad for the health of the economy, but it is becoming more
difficult to make the case that it doesn't harm the health of humanity.
Growing evidence shows that greater inequality brings with it more crime,
worse public health and social ills that affect every tier of society.

In recent decades, the proportion of wealth controlled by the top
percentile has ballooned (see "Inequality: Who are the 1 per
cent?<http://www.newscientist.com/article/mg21528752.100-inequality-who-are-the-1-per-cent.html>").
But a global portrait shows that absolute poverty has actually dropped
during that time. According to 2008 World Bank figures, 1.29 billion people
live in absolute poverty, defined as getting by on less than $1.25 per day,
down from 1.94 billion in 1981. The UN's millennium goal is to cut poverty
by half from 1990 levels by 2015.

So increasing wealth at the top doesn't seem to drive more people into
absolute poverty. However, once you move beyond destitution, another
damaging problem is exposed: how you stack up against those around you in
social and economic terms affects your health. Michael Marmot, an
epidemiologist at University College London specialising in the health
effects of inequality, sees the problem as one of relative poverty. Its
ills are well documented and numerous: reduced access to nutritious food,
healthcare and education and increased likelihood of exposure to violence
have a significant impact on mental and physical health, as well as
opportunities for socioeconomic advancement. "We shouldn't be thinking only
of absolute destitution," he says.

Thomas McDade, a biological anthropologist at Northwestern University and
director of Cells to Society <http://www.ipr.northwestern.edu/c2s/> at the
Center on Social Disparities and Health at the Institute for Policy
Research in Evanston, Illinois, says that additional research has unveiled
a more challenging landscape. "Increasingly, we're coming to understand
that even if you have a stable job and a middle-class income, then your
health is not as good as that of someone who is in the 1 per cent. There is
something more fundamental about social stratification that matters to
health and the quality of social relationships."

The issues of relative poverty are more nuanced than meeting basic needs
for food and shelter. A hundred years ago it might have been whether you
could afford to eat meat once a week - or have an indoor toilet. Today it
might be whether you can afford to mark your child's birthday with a party,
Marmot says. "It matters because of what it means: can I participate in
society?"
The great divide

Relative poverty goes hand in hand with inequality. "What we find is that
the bigger the inequalities, income, educational, social, in a whole
variety of ways, the bigger the health inequalities," Marmot says.

One of the measures used to assess economic disparities within a society is
known as the Gini coefficient, which ranges from 0 - everyone earns the
same - to 1 - one person takes it all (see
graph<http://www.newscientist.com/articleimages/mg21528752.400/1-inequality-of-wealth-and-health.html>).
Most countries fall between 0.25
(Denmark<http://stats.oecd.org/Index.aspx?QueryId=26068>)
and 0.63 (South Africa <http://data.worldbank.org/indicator/SI.POV.GINI/>).
Studies have revealed the association between higher Gini scores and worse
health outcomes, which include increased risk of premature birth and higher
mortality rates.

A meta-analysis <http://www.bmj.com/content/339/bmj.b4471.full> conducted
by S. V. Subramanian at the Harvard School of Public Health, and
colleagues, showed that the US, with a Gini score of 0.36, had nearly
900,000 deaths that could have been avoided compared with nations with
scores lower than 0.29. The UK, with a score of 0.33, had nearly 12,000
such avoidable deaths.

This analysis also revealed a threshold effect, in which detrimental
effects on public health are only observed after inequality reaches a
certain level. In this case, a Gini score of 0.3. "There's always going to
be some degree of inequality," Subramanian says, but what matters is how
drastic the degree is, or how quickly it shifts.

In the past two decades, more than three-quarters of the countries
belonging to the Organisation for Economic Co-operation and
Development<http://www.oecd.org>have seen a growing gap between the
rich and poor. "It's not just the idea
of a threshold, but also how inequality has grown over time," Subramanian
says. He and his colleagues stress that as inequality increases, more
research on the link with poor health is urgently needed.

According to a 2011 report <http://www.cbo.gov/publication/42729> compiled
by the US Congressional Budget Office, between 1979 and 2007, the average
after-tax household income (adjusted for inflation) among the top 1 per
cent of the US population grew by 275 per cent. Among the top fifth, it
grew by 65 per cent; in the top two-thirds, by nearly 40 per cent; and in
the bottom fifth, income grew by just 18 per cent.

The divergence in pay, with the top 1 per cent taking a larger share,
amplifies inequality. Ultimately, says Marmot: "We're using the 1 per cent
as shorthand for a bigger issue."

How does having less relative to your peers undermine health? Study after
study identifies the culprit as stress. Not day-to-day fretting, but
persistent psychological and physiological reactions to external threats
that cannot necessarily be addressed or avoided. Much of this research
focuses on those living in impoverished communities, but these associations
only diminish by degree as you ascend the economic ranks of a society.
"Socioeconomic status, and social stratification in particular, is a very
powerful determinant of health - for populations and for individuals," says
McDade.
Toxic stress

Unrelenting stress is toxic because it can turn the body's defence system
against itself. Neuroendocrinologist Bruce McEwen at Rockefeller University
in New York says the stress response that evolved to protect us from harm
can be hijacked and actually cause harm when the stress never abates. In a
normal situation, the introduction of stress causes the body to deliver a
boost of energy - by sending a surge of glucose to the muscles - and to
increase heart rate, blood pressure and breathing to get oxygen to the
muscles in a hurry. At the same time, blood vessels constrict and clotting
factors increase - ready to slow bleeding in case you are wounded. These
responses are part of a fight-or-flight survival kit, and once the stress
has passed, these should subside.

But for people under unremitting stress, this response never quite switches
off - leaving sugar levels unregulated, high blood pressure, increased risk
of blood clots, depressed sex drive and an immune system buckling under the
strain. Prolonged exposure to stress hormones can have other effects as
well, including affecting the brain by altering the structure of neurons
and their connections, which in turn can influence behaviour and change
hormonal processes.

In the well-known Whitehall II
study<http://www.ucl.ac.uk/whitehallII/research/findings/2011_working_hours>,
which followed more than 10,000 UK civil servants since 1985, Marmot and
his colleagues found that reported stress levels were amplified as you
descended the organisational hierarchy - with corresponding declines in
health. Workers on the bottom of the heap were far more likely to suffer
coronary heart disease than those at the top.

In a 2009 study<http://www.pnas.org/content/early/2009/03/27/0811910106.abstract>,
Michelle Schamberg and Gary Evans at Cornell University in New York looked
at the role stress plays in the educational performance gap between those
from richer and poorer backgrounds. The researchers hypothesised that
childhood stress might impair working memory. They assessed 195
17-year-olds, about half of whom grew up below the poverty line and half in
middle-income families.

To measure the amount of stress the children endured over the years, the
researchers drew on a measure called allostatic load, with higher numbers
indicating higher levels of exposure to stress. It is the sum of six risk
factors: blood pressure (systolic and diastolic); concentrations of three
stress-related hormones (cortisol, adrenalin and noradrenalin); and body
mass index.

On average, the figures were higher for the poor children than for those
from the middle-income families. A discrepancy in working memory broke down
along the same lines. The 17-year-olds who lived in poverty could hold an
average of 8.5 items in their memory at a time, compared with the
better-off children, who could run to 9.4. When Evans and Schamberg ran
statistical analyses to control for the effects of allostatic load, the
relationship between upbringing and working memory disappeared; the
deficits seen in the poorer children seemed to be down to their experience
of stress.

The Centers for Disease Control and Prevention in Atlanta, Georgia, have
also accumulated several decades' worth of data about stress and childhood.
As part of ongoing studies <http://www.cdc.gov/ace/index.htm> into
childhood risk factors, researchers came up with a stress scoring system.
The method shows how, as the number of adverse experiences increases, so
does the risk of health problems ranging from alcoholism and chronic
obstructive pulmonary disease to heart disease and suicide attempts.

And in an intriguing 2007
study<http://scan.oxfordjournals.org/content/2/3/161.abstract>,
Peter Gianaros at the University of Pittsburgh, Pennsylvania, examined the
correlation between the way people classify themselves in terms of
socioeconomic status, and the size of the perigenual area of their anterior
cingulate cortex, a region of the brain involved in self-control, the
experience of emotion and the regulation of reactions to stress. In an
experiment with 100 men and women, Gianaros found that the lower the
participants ranked themselves in terms of socioeconomic status, the
smaller the volume of this area.

It is a preliminary finding, but McEwen speculates that awareness of one's
own circumstances is likely to be a factor. "If you're living in a place
like New York City with huge gradients of differences between rich and
poor, you're going to know where you are. You're going to have the sense
that 'I'm not able to do this or that'. It's going to have even more of an
effect on how you view yourself and how you behave."

The uberwealthy, then, affect everyone else by extending the measuring
stick by which we gauge our own successes and opportunities. But there are
also other important ways in which they affect those below them.

"The magnitude of inequality damages social cohesion," says Marmot. "The
rich live separate lives from the rest of us, live in different
neighbourhoods, send their children to different schools." When the wealthy
pay directly for the necessary services in their lives, they become less
willing to spend tax money on everyone else, which begins to erode public
services and creates a hierarchy of quality. "The whole argument against a
service for the poor and a different one for the rich is that a service for
the poor is a poor service," Marmot says. "That really says we are not one
society."

Then there are health differences that change as you go up through
society's ranks. A 2007
survey<http://www.federalreserve.gov/econresdata/scf/files/CDCfinal.pdf>by
the US Federal Reserve found that the wealthiest people were more
likely
to describe themselves as being in good or excellent health. This group
also expected to live longer, while those with the least also had the
lowest expectations for their longevity.

Health follows a social gradient, but Marmot argues that at some point, as
wealth increases, the additional rise in health becomes very shallow. "The
difference between somebody earning $1 million and $2 million is just not
detectable in the evidence," he says. "You don't keep getting more and more
benefit from more and more income." The extra millions piled on top aren't
going to make the 1 per cent live much longer, but even a small amount of
extra income could make a huge difference to the health of a swathe of the
population below.

The policy implications seem obvious, if politically contentious: a more
even distribution of wealth would improve health on national and global
scales. But that appears unlikely to happen without a radical shift in
western political culture; in recent times governments of all political
persuasions have presided over growing inequality.

As the divide between the top percentile and everyone else widens,
inequality is an issue that will not go away. And as the body of evidence
accumulates, a clearer picture is emerging of inequality and its relation
to health, self-worth, the ability to participate in society and to take
control of one's life. Knowledge, as they say, is power - especially in the
hands of 99 per cent of the population.

*Liz Else is associate editor at New Scientist*
  [image: Issue 2875 of New Scientist
magazine]<http://www.newscientist.com/issue/2875>

-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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