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Are more egalitarian societies more healthy societies?

Effects of inequality is a central topic of the contemporary political debate, and have been, in the form of egalitarian thought, a recurrent theme throughout the human history. Unlike in the history, however, the discussions about prospects and drawbacks of egalitarianism have moved far beyond the biblical notion of ‘everyone is created equal’, and take a more utilitarian view. Trekking close to this utilitarian view, I will analyze if more egalitarian societies do better or worse. While there are many ways to see inequality, such as inequality of opportunity or equal rights, most of the current debates are based on economic inequality. In one side, these talks are based on the relation between income inequality and social factors like health, education level and crime level, and on the other it takes the form of economic prospects of income inequality driven competition. While conclusions from both these arguments are quite contentious, they compel us to look at what level of inequality is desirable than answering the question on absolute terms. This acceptable ‘level’ of inequality is better captured through the need of equality in opportunity, which is an argument that is accepted quite universally, along with other arguments supporting equality in terms of morality and psychological factors. The notion of equal opportunity gives a solid argument in favor of lower inequality, while being able to relate it to economic differences as well.

When analyzing the effects of inequality, one inevitably needs to look at the different sides of inequalities that persist in the society. It is well accepted that everyone has the same rights and should receive the same treatment in front of law, and this idea of equal status is usually extended to include opportunity. The main debate here is about the economic inequality, and this again can be separated in to two aspects, income and wealth. The data used here measures mostly post tax income of households for international data, and GINI index for the data within the US. However there are other indicators such as pre-tax income or disposable income or indicators that measure the ratio between incomes of different sectors of income ladder. While wealth is more unequally distributed (Keister and Moller 2000), the abundance of data on income inequality across the globe makes it a more attractive choice in comparison. Another way to look at inequality is in terms of class and status. As John Goldthorpe argues, most of the social indicators correlate more with the inequality in status than with class inequality which is closely related to economic inequality (Goldthorpe 2009). Status however, correlates with class, and thus income and wealth (Goldthorpe 2009). On the other hand, inequality in status translates into inequality in opportunity such as education and access to healthcare. Thus, instead of class and status, I will focus on differences of economic standing and opportunity when discussing the effects on the ‘health’ of the society.

Inequalities in a society manifests differently in different aspects of the society. Thus, to identify a well functioning society, or a society whose social relationships are beneficial for most of its members, we need to look at several different indicators. The health of the society would be directly related to the health of the members of the society, along with other non economical factors such as level of education and prominence of crime. Economic indicators such as GDP per capita too can be taken in to account as it relates to the availability of facilities and technology for the citizens. Other arguments on the benefits of egalitarianism points to psychological factors such as how the brain responds to socially evaluative tasks, and moral dimensions, while one might also use the strength of democracy as a measure of strength of the social structure. These indicators together capture most of the various dimensions of the society, and looking at how inequality in its different forms affect these factors would give us a clear picture of its relation to the society as a whole.

The most important indicators in analyzing the health of a society are its social indicators. Arguably the most comprehensive set of evidence that relates income inequality to these indicators are available in the book by Richard Wilkinson and Kate Pickett, ‘The Spirit Level – Why Equality is Better for Everyone’. They compare the data in many different facets of society, the most important being their analysis of health problem, and find states with higher inequality tend to have lower health standards. The data they present compares the 50 most wealthy countries (with some exclusions, as they justify in the book,) and also the 50 states of the United States, and these indicate that there is a strong correlation of income inequality to life expectancy and infant mortality in both sets of data. They also show data supporting this claim in terms of obesity and child obesity (Wilkinson and Pickett 2010, 89-95). Apart from these data, a study done by these authors themselves looked at 153 different studies and analyzed income inequality and health, reaching to a conclusion that 70% of these studies supported the hypothesis that income inequality is correlated with bad health conditions (Wilkison 2005). Another factor this book considers is education, and again finds correlations between indicators such as school dropout rate and the 41 states in the US and the level of equality in those states. One of the other factors in measuring the well being of a society is its level of crime. While Wilkinson and Pickett cites data for homicide rates and level of illegal drug use to show similar correlations, there are also other studies which has studies crime rates in much more detail arriving at similar conclusions (Wilkinson and Pickett 2010, 139-141). For instance, an article published in the Journal of Law and Economics concludes that “crime rates and inequality are positively correlated within countries and, particularly, between countries, and this correlation reflects causation from inequality to crime rates, even after controlling for other crime determinants” (Fajnzlber, Lederman and Loayza 2002). One other interesting fact they point out in ‘Spirit Level’ is how societies with higher equality tend to have more trust in the members of these societies, not only members in their respective societies, but also in other societies (Wilkinson and Pickett 2010, 52-53). While the plethora of dimensions present in this book quite remarkably shows that high levels of inequality has an adverse correlation with the health of the society, the data and conclusions in the book are not without its critics.

While most of the reception to the content from Wilkinson and Picket’s book has been positive, there are some serious accusations about the content and conclusions in the book. As one of the critics remarked, “careful evaluation and analysis shows that very little of Wilkinson and Pickett’s statistical evidence actually stands up, and their causal argument is full of holes.” (Saunders 2010, 6) of the main criticisms has been about cherry picking the indicators and countries (Saunders 2010, 7). The authors respond to these criticisms on cherry picking the countries by describing their criteria, and in terms of indicators, there have not been any strong reply from the authors. Other criticisms include problems with outliers, and using data from different time periods. Some of the accusations are also based on the author’s use of different indicators in different circumstances. While the replies from the authors to these claims clarify some of their choices, the debate on the conclusions can only said to be ongoing. Hence, even though the vast range of data all points to a positive effect of equality to social indicators, we could only conclude that there still are not enough quality studies that are above all the criticism that still support these claims.

The critics of ‘Spirit Level’ are mainly concerned with the positive effects of inequality. Conventional wisdom is that the inequality is the driving force of competition, and thus is a stimulant to the economic development. This is a quite plausible argument, especially against absolute egalitarianism within the capitalist economic system. However, the research done on this relationship “does not find evidence of a positive relation between inequality and growth but finds some evidence in support of a negative relationship between inequality and growth” (Panizza 2002). A more solid argument in favor of inequality is its positive effect in driving entrepreneurship, which is backed by the data showing that “countries with higher levels of wealth inequality tend to have higher rates of entrepreneurship” (Lippmann, Davis and Alrich 2005). This argument, however, does not go much further. In terms of innovation, some of the most equal countries seem to be at the front; for instance japan is leading in the number of patents, and Finland and Sweden leading is in front with the highest proportion of scientific papers written per person (Social Science Bites n.d.).Thus the supposed benefits of income disparities does not seem to show up in empirical data at the contemporary levels of inequalities, and can only be regarded as having at best, a minor positive effect on social wellbeing.

Much stronger conclusions about the effects of inequality, however, can be made through an analysis of this in terms of inequality of opportunity. It is a widely accepted fact that equal opportunity is desirable, both in terms of moral arguments and economic arguments. Unequal opportunity in education means the society becomes inefficient in harnessing the talents of all its members, and lower levels of education which results leads to other social problems including lower health standards and higher crime. Inequality in access to healthcare and consumer markets is another hindrance to economy that reduces efficiency of the society and lowers the economic activity. Limited opportunities relates to lower social mobility and can in fact suppress the skills and creativity and drive down the ideal positive effects of competition that is expected to flourish with higher inequality. The importance of the argument however, lies in the fact that equal opportunity is inherently tied to the level of equality in income and wealth. For instance, income is strongly related to access to better neighborhoods and schools. These also dictate how much access an individual has to social and cultural capital, which inevitably changes his life chances. As a research published in Social Science Quarterly claimed, “As the extent of inequality increases in the United States […] the life chances of disadvantaged individuals diminish and are largely determined by the accident of their birth” (Albrecht and Albrecht 2007). Correlation of economic inequality to the inequality in opportunity differs across cultures as the cultural values and norms also play a role in access to opportunity. This might be the reason that most of the studies done with in a large number of countries does not seem to give a cohesive answer to the question at hand, as the cultures might dictate access to education, healthcare and other assets independently of the income inequality. Yet, from above arguments, it is evident that economic inequalities are related to opportunity inequality, and thus support the thesis that more equal societies could be more healthy societies.

The last aspect that is important in this discussion is the moral and psychological dimensions of inequality. If one looks at the problem with a strong materialistic metaphysical view and attributes most of the differences between individuals to their social interactions, it becomes impossible to approve such high levels of inequality which exists today. If the differences between individuals is socially determined, the there should not be any reason for one to deserve a better life than the other, and even if the differences are genetic, what would warrant one a worse life than other, just because their births are different? While these are purely philosophical questions, they are not without important insights in terms of sociology. A more subtle effect of inequality, or rather the debate supporting inequality, is that it emphasize the idea of individual responsibility and attribute success to characteristics of an individual than their social standing. This overemphasize the differences due to genetics, thus the responsibility of the society in bringing up individuals to be better citizens receive less weight. Consequently as the social responsibility becomes less important, the society becomes less motivated to give equal opportunity to its members. On the other hand, they come to accept harsher penalties for social deviance. This is evident from the correlation between prison population and income inequality (Wilkinson and Pickett 2010, 160-161). These trends also lead to social exclusion as in most cases it blames the victim rather than the society which victimizes who are less fortunate. In addition it could lead to higher stress in low income population. “There is emerging empirical evidence for this relationship between social-evaluative threat and cortisol responses” which increases stress levels in individuals (Dickerson and Kemeny 2004)). This ‘blaming the victim’ can actually lower the individual performances as they expect less of themselves. The effects should be similar to the effects on low caste school children who performed worse when their caste was announced (Hoff and Pandey 2004). While one might not agree with the purely philosophical argument for an egalitarian society, the negative effects of advocating inequality and personal responsibility is quite clear, as paves the way to lower equality in opportunity.

Thus, the negative effects of inequality are quite clear in the form of reduced equal opportunity even though empirical studies linking that to more solid social factors are still in the middle of a heated debate. With several different ways of measuring inequality and a multitude of social indicators to look at, cross national studies that span across nations with different cultural norms and values does not seem to solidly support the argument for an egalitarian society. This ambiguity, however is resolved when one investigate the prospects of equal opportunity, which is construed by the inequalities in income and wealth. This argument becomes stronger as the main arguments against lower inequality, the higher growth effects of inequality driven competition, is not supported by the evidence. With these facts, one can only conclude that decreasing current levels of inequality in most societies can only bring more inclusion and higher equal opportunity thus making them better societies overall. However, this argument is not extendable to societies which are much more egalitarian than today’s societies, as then the empirical data might point otherwise. While such extreme cases might be a problem for philosophy scholars, they can, in current case show the responsibility of the society in ‘creating’ a healthy individual is profound, thus validating the argument for a more equal society. Hence, even though the debate in empirical research can be inconclusive, the premise that more egalitarian societies are healthier societies is well rested on the shoulders of the social values supporting equal opportunity.

Works Cited

Albrecht, Don E., and Scott Albrecht. "The Benefits and Costs of Inequality for the Advantaged and Disadvantaged." Social Science Quaterly, 2007: 382-403.

Dickerson, Sally S., and Margaret E. Kemeny. "Acute Stressors and Cortisol Responses: A Theoretical Integration and." Psychological Bulletin, 2004: 355-91.

Fajnzlber, Pablo, Daniel Lederman, and Norman Loayza. "Inequality and Violent Crime." Journal of Law and Economics, 2002: 1-40.

Hoff, Karla Ruth, and Privanka Pandey. Belief Systems and Durable Inequalities: An Experimental Investigation of Indian Caste. World Bank Publications, 2004.

Keister, Lisa, and Stephanie Moller. "Wealth and Inequality In the United States." Annual Review of Sociology, 2000: 63-81.

Lippmann, Stephen, Amy Davis, and Howard Alrich. "Entrepreneurship and Inequality." Research in the Sociology of Work, 2005: 3-33.

Panizza, Hugo. "Income Inequality and Economic Growth: Evidence from American Data." Journal of Economic Growth, 2002: 21-41.

"Social Science Bites." Danny Dorling on Inequality.

Wilkison, Richard. "Income inequality and population health: A review and explanation of the evidence." Social Science and Method, 2005: 1768–1784.


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