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Don’t Shoot the Messenger

I recently listened to the sociologists-epidemiologists Richard Wilkinson and Kate Pickett discussing their book The Spirit Level on NPR. A few days later, they were on Book TV and soon I was reading a lengthy piece on them in the London Review of Books. The publicity worked and I bought the book. By the way, a spirit level is the same as a bubble level, the carpenter’s device containing a bubble in liquid to ensure whatever’s being constructed is plumb.

The Spirit Level is an unsettling book. In fact, it might actually change some of the fixed thinking that hampers us from becoming a truly healthy and happy nation. The book’s authors aren’t ideologues, they don’t rant or have an axe to grind. They’re a pair of British scientists analyzing statistics and what they’ve uncovered is seriously disturbing.

The authors begin by exploring the concept of income inequality, which exists in every developed country and in every one of our individual US states. Income inequality is simply the spread between the richest people and the poorest. And among developed countries, the US has by far the widest gap of income inequality, followed the UK and (oddly) Portugal.

The lowest income-gap nations are the Scandinavian countries (who use a leveling taxation) and Japan (where everyone’s salaries are similar). The states with the widest income gaps are Alabama, Mississippi, and Louisiana. Narrowest are New Hampshire, Vermont, and Minnesota.

The authors move on to examine the social consequences of income disparities. Intuitively, I suspect you already know the answers.

Here’s what happens with wide income inequalities, in countries and in states:
poor overall health of all citizens, with mental illness (including drug addiction and alcoholism), obesity, and increased infant mortality and teen pregnancy. There’s also anxiety, drug use, violent crime, more depression, an increased prison population, decreased educational opportunities and performance, decreased status of women, an increased sense of hopelessness, decreased community and governmental cooperation, and a greater distrust of others. Oh, and lower life expectancy.

Key to all this is that the effects don’t occur only among the poorer people. For example, the infant mortality rate among the richest Americans is higher than among the poorest of Scandinavians. Income inequality affects everyone.

The fact that the US is the world leader in these traits is, well, sobering.

If you were asked to define what characteristics would make any society dysfunctional, whether a community, state, or nation, you couldn’t do better than to read that list aloud. Bad as the situation is, income inequality is getting progressively worse.

The authors’ data also show that even if you’re comfortably ensconced among the rich in one of the wide income gap nations or states, you’re not as emotionally well off as you may think. In fact, you’re anxious about the fragility of your status, you drink and eat too much, and you take a lot more antidepressants than people in the smaller-gap nations. The joy you think should accompany your high income eludes you.

As Americans, historically we’ve admired rugged individualism, and many of us cringe at the thought of government interference and controls. We believe everyone should pull themselves up by their own bootstraps, should “try harder.”

The Spirit Level shows this thinking isn’t really very healthful at all.

And so, while some of my health tips suggest ways to eat for health or what vitamins to take, this one suggests that a new perspective for our country might be the healthiest step of all.

Next week, a completely different topic: middle-age weight gain, exercise, and weight loss. You’ll not be thrilled with the data that’s emerged, but as the title recommends, don’t shoot the messenger.

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Here’s a special invitation for patients of Dr. Kelley who are currently being treated for Lyme disease. Dr. Kelley’s new, four-week Lyme Academy starts on October 4, continuing over the following three Tuesdays.


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