I just read Professor Richard Wilkinson’s “The Impact of Inequality” (ISBN-13: 978-1-59558-121-1). I first read Wilkinson’s work on the impact of inequality on health in the BMJ back in the early 1990s. I found his research remarkable and disturbing at the same time. Essentially what he was highlighting was that in developed countries absolute income levels were not a determinant of health. Instead, what seemed to cause the greatest harm was the size of the gap between rich and poor. In other words, income inequality within a society impacts on many parameters of health, from infant mortality to life expectancy and many disease rates in between. This was a bit puzzling. We mostly believe that poverty, of the kind where your basic material needs of food, water and sanitation are not met, is indeed deadly, but that relative poverty ie the extent to which people feel poor compared to others in society could be deadly? How could that be? Was it true?
Well, over a decade has passed and dozens of more studies have shown the link between inequality and health. In “The Impact of Inequality”, Wilkinson sets out the case very clearly and then provides an explanation for the findings. In a nutshell, he shows that psychosocial stress has an enormous impact on health, and that the key element underpinning this stress is how we think others perceive us. Shame is a strong social force. We feel it when we are not respected, when we are judged to be inferior or to have failed, when we told we are just not “good enough” or when we are dismissed as irrelevant. Social status is the root of much of this shame in all societies, but especially in unequal societies which have strong hierarchies based on dominance and competition. The biological mechanism for this stress is the body’s inflammatory response. When experiencing stress, the human organism activates cellular and hormonal systems to increase defences and prepare the subject for “fight or flight” as a fundamental survival mechanism. Years of such inner responses produces an “allostatic load” – a fairly new measure for the accumulated inflammatory activity. A high allostatic load is associated with an enormous range of chronic diseases.
Let me just cite one example. In societies where there is great economic inequality, blood cholesterol levels are higher than those in more equal societies. These high lipid levels are part of the body’s inflammatory response. The reductionist, technological, “fix” for this is to prescribe statins for more and more people for greater and greater proportions of their lives. This isn’t exactly a matter of stable doors and bolted horses but even if the statins do what they say on the tin, the problem just shifts elsewhere. Unequal societies experience lower life expectancy, particularly in those who live in the poorest strata. If they don’t die early from heart disease, they die early from something else. The answer, if we take on board what Wilkinson shows us, is political. It’s about creating more humane, more caring, more “affiliative” societies by tackling the fundamental issue of inequality.
Heroes Not Zombies 
This post is extremely interesting on so many levels.
The recent studies being done in the US regarding health between the rich and the poor have been showing astounding results not because of healthcare, but because of diet.
Poor people eat more junk food filled with chemicals and artificial stuff because it is cheaper and easy to store and access. Rich people eat lower percentage fatty meats, more fresh produce and less processed foods. Therefore increasing health right there.
I think your studies in the psychological base make complete sense to the physiology of a patient. State of mind makes a huge difference to health and wellbeing.
Did you read about the cardiologist who makes a point of telling all of his patients after surgery that they did great in the surgery and that they are going to be fine? That his rate of healing in the patients simply because they believed that they would be fine increased a massive percentage!
Great stuff doc.
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