Blair's Shame

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Review of 'The Impact of Inequality', Richard G Wilkinson, Routledge £19.99

Richard Wilkinson's new book comes out at an important time. A recent report commissioned by the Department of Health showed that health inequalities have got worse under Labour. Shockingly, men in social class 1 live more than eight years longer than men in social class 5.

The right would like to blame this bad health on the poor, arguing that it is due to choosing unhealthy behaviour like smoking. But addiction to nicotine is not a choice but a response to stress. Secondly, research such as the Whitehall 2 study has shown consistently that unhealthy behaviour explains less than half of the gradient of ill health.

So what does cause the lower paid workers' additional bad health? This is the subject of a fascinating debate. On one side, neo-materialists (like George Davey Smith) stress direct material conditions, such as poor housing causing childhood breathing problems. On the other side, psycho-social theorists like Wilkinson argue that in rich countries the effects of inequality operate less directly. Lower income leads to lower status, which affects our psychogical and biological functioning, and makes us sick. The more hierarchical a society, the more people experience insecurity about how other people see them. From childhood we rank ourselves against each other by the number of possessions we can persuade our parents to buy. This leads to violence and intimidation, but also to depression, stress and anxiety, which literally puts a strain on our bodies.

Both groups of writers are broadly on the left, and want to see more equal societies. Wilkinson's book is an important blow against Blair's claim that only poverty, not inequality, matters. Wilkinson argues that in rich countries the health of the population is determined more by how equal the country is than by its average income. Life expectancy in the US (the richest country in the world, but one of the most unequal) lags behind most other developed countries.

However, there are problems with Wilkinson's account. His dismissive approach to material causes of ill health is linked to his failure to analyse capitalism adequately. He remarks on page 66 that many material causes could be solved 'simply by ensuring that the benefits of economic growth extended to all sections of society'. Yet the problem is an economic system with a relentless drive to accumulate more at any price. There are clear material effects (from war to pollution) of Britain's fossil fuel economy, and increasing consumption levels will certainly not help.

While Wilkinson understands that poverty is a social relation, he takes this to mean that its impacts in richer countries are only through psychosocial mechanisms. However, more material goods for some can make health worse for the rest. For example, if no one owns a car then places will be accessible without one, but if half of people own a car then there will be greater road danger, less space for poor kids to play, and further to travel to jobs and services.

Instead of dismissing material causes, we need to integrate neo-materialist and psycho-social accounts with an analysis of the dynamics of global capitalism. After the book's devastating critique of neo-liberalism, Wilkinson ends up supporting such mild, market-based reforms as employee share ownership. But this is no solution to an increasingly dysfunctional and unhealthy system, which threatens the very existence of our species.