Health Wealth & Inequality

Illustration by Paul Petard
Illustration by Paul Petard

The link between poverty and ill-health is well documented but a new study shows a direct correlation between inequality and health – the more equally income is distributed, the healthier society.

An article from Black Flag #219 (2000)

Submitted by Fozzie on January 21, 2021

According to the Wealth of the Nation report published in October, average income in Britain has risen under the Labour Government — but distribution of wealth remains a story of increasing inequalities, particularly evident on a regional basis.

The report, based on four million households nationwide, was first conducted in Summer 1996. This second study, from data collected in 1999 indicates how people have fared under New Labour. The answer is, unsurprisingly, not that well. Nationally, there has been an average rise in income of 9.6% to £21,365. However, some areas in the South and parts of London have seen substantial rises in earnings while others have seen very low growth rates. The Outer Hebrides has even seen a fall in income. The figures do not take inflation into account.

Unsurprisingly the highest average household incomes are in Greater London and the South East. These are the only regions where average household income is ahead of the national average (and income in these regions is 40% higher than the north of England). The wealthiest people in the country are concentrated in London, with those in central London, Blackfriars, Barbican and Belgravia, with average household incomes of £50,000+ skewing the average London-wide.

While some will take the fact that Surrey residents enjoyed an average household income 71% higher than those in Tyne & Wear as an example of a North-South divide, it is obviously a class-divide. By grouping people into regions, the disparities of income within those regions is lost. As Proudhon once said, "there is no such liar as an average."

In 1996, before he came into office, Tony Blair pledged to bring about 'greater equality'. "If the next Labour government has not raised the living standards of the poorest by the end of its time in office it will have failed," he said. In fact the figures show that inequality has increased under Labour.

Health and Inequality

The effects of this wealth inequality are wide-reaching. For example, poor people are more likely to be sick and die at an earlier age, compared to rich people.
Another study, published in December as a book, The Widening Gap, indicates that the health gap between rich and poor in Britain is the widest on record and is continuing to grow. The researchers state that increasing inequality in income, lifestyle, educational opportunities and jobs is resulting in thousands of extra deaths in the most deprived inner cities. The death rate among people under 65 is now more than two-and-a-half times higher in the worst parts of Glasgow than in the prosperous Southern communities of Esher and Wokingham.

The book highlights the fundamental role of poverty in creating and maintaining the health gap. The health gap mirrors gaps in income, education and employment levels. The average household income in Springburn, Glasgow, is £13,697 compared with £24,490 in Wokingham, Berkshire. Unsurprisingly, chronic illness and infant mortality are higher in Springburn. The researchers say the gap between rich and poor has widened faster in Britain and that levels of poverty are higher than in much of Europe. Life expectancy for professional men is now 9.5 years more than for male unskilled manual workers. For women it is 6.4 years more. Inequality of power and wealth kills.

Previous research also indicates that the degree of inequality is important (i.e. the size of the gap between rich and poor). According to an editorial in the British Medical Journal

"what matters in determining mortality and health in a society is less the overall wealth of that society and more how evenly wealth is distributed. The more equally wealth is distributed the better the health of that society." [Vol. 312, April 20, 1996, p. 985]

In other words, absolute levels of wealth are less important than relative levels. Health is a product of social life and increasing inequality in wealth leads to increasing inequality in health.

Research in the USA found overwhelming evidence of this. George Kaplan and his colleagues measured inequality in the 50 US states and compared it to the age-adjusted death rate for all causes of death, and a pattern emerged: the more unequal the distribution of income, the greater the death rate. ["Inequality in income and mortality in the United States: analysis of mortality and potential path-ways," British Medical Journal Vol. 312, pp. 999-1003] This measure of income inequality was tested against other social conditions besides health. States with greater inequality in income distribution also had higher rates of unemployment and incarceration, a higher percentage of people receiving income assistance and food stamps, a greater percentage of people without medical insurance, greater proportion of babies born with low birth weight, higher murder rates, higher rates of violent crime, higher costs per-person for medical care and police 'protection'. Moreover states with greater inequality of income distribution also spent less per person on education, had fewer books per person in the schools, and had poorer educational performance.

As the gap grows between rich and poor (indicating an increase in social hierarchy within and outside workplaces) the health of a people deteriorates and the social fabric unravels. Being at the bottom of the social ladder has psychological effects in addition to the hardships of substandard housing, nutrition, air quality, recreational opportunities, and medical care enjoyed by the poor (see George Davey Smith, "Income inequality and mortality: why are they related?" British Medical Journal, Vol. 312, PP. 987-988).

Redistribution or Revolution?

All this is not to suggest that those at the bottom of hierarchies are passive victims (as middle class reformers like to think) —far from it. Those at the bottom are constantly resisting the negative effects of hierarchy and creating non-hierarchical ways of living and fighting. This constant process of self-activity and self-liberation can be seen from the labour, women's and other movements — in which, to some degree, people create their own alternatives based upon their own dreams and hopes. Anarchism is based upon, and grew out of, this process of resistance, hope and direct action. It is these movements which will ultimately solve the social problem and create a society based on liberty, equality and solidarity (and good health for all!).

The growing gap between rich and poor has not been ordained by god, nature or some other superhuman force. It has been created by a specific social system, its institutions and workings — a system based upon authoritarian social relationships which effect us both physically and mentally. This social system itself has, in the past, reduced inequality. In the 1960s and 1970s the gap narrowed. "Just as a gap can widen so it can narrow," the authors of The Widening Gap argue but "the trends of growing inequality show no sign of abating and the consequences of such a widening gap are dire." Anarchists would agree. However, ultimately, as the experience of the 1980s show, reforms can be destroyed and undermined. Without a 'redistribution' of power along with the wealth any reform can be reversed. Only when we finally abolish capitalism and the state that protects it, can equality be achieved so that people are no longer subjected to the exploitation that shortens their lives.

The authors of The Widening Gap also argue that it is their

"firm belief that if health inequalities... are to be reduced, as is the stated aim of the Government, then policies which actively address the reduction of poverty and of inequality through redistribution [of income and wealth] must be pursued."

They add: "The costs would be borne by the rich." However, the logic of 'redistribution' fails to understand that we, the working class, create the wealth that accumulates in the hands of the few. We are not 'redistributing' wealth — we are returning it to its rightful owners! Rather than redistribute wealth we should be ensuring that it never leaves our hands to begin with. And that requires a 'redistribution' of power — that is, the creation of a culture of resistance that wins re-forms by self-managed organisation, direct action and solidarity on the way to creating a new world.