If you plot a graph of the wealth of nations against the health of their citizens, it is clear that, up to a point, the more you spend the better the health outcomes. But if you then analyse the health of the rich countries that cluster at the top of the graph, where extra spending has ceased to buy significant gains in health, something very interesting emerges. The more equal the society, the better the health of its citizens. And not just their health: on a wide range of social measurements equal societies score better. In contrast, societies where a small percentage of people hold most of the wealth, everyone, rich or poor, is less healthy, less comfortable and less fulfilled. In UK, one of the least equal countries, we have never been so anxious about being happy.
‘The Spirit Level’, written by two British epidemiologists, examines the phenomenon in detail, plotting physical and mental health, teenage pregnancy rates, children’s educational performance, community violence and levels of trust against the level of inequality in 23 countries of the rich world, and also against the level of inequality in the states of the USA. In almost every case, the problems are worse, often much worse, in unequal societies. There is no evidence that this is due to confounding factors: inequality appears to be at the root of many of the social ills which occupy news headlines.
Intuitively, the idea seems right. Gang warfare and the demand for respect which fuels it are responses to inequality. The rich may try to isolate themselves in gated communities, but electronic barriers, security guards and razor wire cannot entirely eliminate the fear and anxiety which must gnaw away at their enjoyment and their health. The cost of managing the problems of inequality suck money from the services which should be promoting equality: responding to the democratically expressed wish of its citizens to control antisocial behaviour, the government of California now spends more on prisons than on education.