It is often assumed that in our Western society inequalities between different strata of society have all but been eliminated. Access to health services, it is claimed, is available to all, and there is no reason to suspect that any one social class is unduly deprived.
The opposite, however, is much more likely to be correct, according to accumulating information relating to availability of healthcare based on data from worldwide statistics. These show that there is a great disparity in health, including tendency to various diseases and even significant reduction in life expectancy, where there are significant societal inequalities.
One of the earliest studies about the effect of deprivation on health was the well-publicised ‘Whitehall’ study, where it was shown that government employees in London who held lowly jobs such as low-level clerks, were far more likely to be affected by stress disorders and more liable to health problems like heart and lung disease than those enjoying the higher echelons of power. This was a clear indication that those who could least control their destiny were more at risk of health disorders.
This study was further expanded by David J.P. Barker and his colleagues at the University of Southampton who showed a definite association between the social conditions of pregnant women and eventual health outcomes for their children later on in life.
This emphasised the fact that social inequalities affected even the unborn child and expressed themselves later in life as an increased tendency to heart attack, lung infections and the like.
This phenomenon has been explained on the ‘thrifty phenotype’ hypothesis. It suggests that those born in less than optimal conditions are more likely to have “a smaller body size, a lowered metabolic rate and a reduced level of behavioural activity… adaptations to an environment that is chronically short of food”. As they grow older, and find themselves in a more affluent environment, they are more likely to develop disorders such as obesity and diabetes.
More recent studies summarised in a very interesting book The Spirit Level: Why Equality is Better for Everyone (by Richard Wilkinson and Kate Pickett) have shown beyond doubt that countries where income inequalities are greatest are also those where one finds increased health issues.
Among countries with the largest discrepancy between rich and poor we find the US on top of the list, followed by Portugal, and the UK. At the bottom of this list, that is, countries with the least degree of income inequalities, we find Japan, Finland, Norway and Sweden.
An ‘Index of health and social problems’ was developed based on data obtained from the World Bank, the WHO, OECD, and others, and this showed a significant correlation with income inequality. A similar correlation was found between an index of child wellbeing as developed by UNICEF and income inequality.
It is important to stress that what seems to be significant in these studies is not the actual national income, or the income earned by the individual, but, more importantly, on the discrepancy between one class of individuals and another.
People seem to be happier living in poorer conditions which affect everybody, rather than when they are better off but surrounded by opulence and affluence from which they are excluded. It is relative rather than absolute poverty that seems to be the determining factor.
It is interesting to note that the proportion of people in a country who describe themselves as ‘happy’ or ‘very happy’ seems to bear no correlation with the national income per person: There are as many who fall into this category in places like Tanzania, Nigeria and Vietnam, with an national income per person below $5,000, as there are in Norway and the US with incomes in excess of $50,000.
Malta and Portugal fall in-between, with an average income of $20,000 and a ‘happiness score’ in excess of 80 per cent.
Recent data issued by National Statistics Office (2010) show that those households in the highest income bracket spend 3.4 times the annual household consumption compared with those households in the lowest group. Although these figures are not directly comparable with the above data, they would indicate that in Malta the degree of social inequality is not excessive, and compares with Scandinavian countries in this respect (with a ratio of around four), whereas some countries, including the UK and US have ratios in excess of six.
It should be now clear that among the relatively affluent countries in the Western world, health and social problems correlate strongly with inequality. This holds particularly for those conditions which we normally associate with social class gradients, namely reduced life expectancy, heart disease, increase in the incidence of obesity (particularly in women), mental problems, teenage birth rates, children with education problems, and so forth.
It would also follow that the best way to tackle health and other social problems within society would be to strive to reduce inequality within society.