Book Review: The Spirit Level
Wednesday, June 13, 2012 at 04:38PM
Dr. Harriet Fraad

Richard Wilkinson and Kate Pickett, The Spirit Level. New York, 2009. Reviewed by Harriet Fraad.

The Spirit Level brilliantly establishes and meticulously documents the powerful connections between the personal and social tragedies afflicting members of vastly inegalitarian wealthy nations like the United States. Scourges of inequity rob parents of the security and support they need to raise the adventurous, healthy, intellectually advanced children who are America’s future. Here are the 10 scourges of inequity that Wilkinson and Pickett identify:

The United States is the most unequal of the 21 richest nations in the world. We also lead the world in each of the social misfortunes listed above. How are each of these afflictions related? How do they work to undermine the psychogenic pump? Let us go down the list knowing that this is only a short book review essay and the Spirit Level  itself merely scratches the surface of the reality it describes. All of the tragedies it describes are comingled. I will discuss them in small groups knowing they are branches growing from the trunk of inequality that unites and sustains them.

The first group of problems I will discuss are the low levels of trust between people, mental illness, homicide and imprisonment rates. Inequity is the primary factor shaping trust and distrust of others. In those US states and in other nations, greater income equality is directly related to trust in other people (Wilkinson and Pickett, 2009 55-62). Partly that is because an important element of trust is a sense of security. If your life is precarious and your livelihood is insecure and inadequate, a sense of well being and confidence in the future are seriously eroded. Those who prosper in unequal economies are threatened by “those others” the have-nots who may steal what you have. In any case “They” are different. “They” live in poor housing. “They” attend different kinds of schools. “They ”dress’ in the “wrong” clothes. “They” do not belong to the same community. “They” are dangerous.

One case in point is New Orleans. New Orleans is a city with gross inequalities in income within a state which is has the greatest income inequality in the United States. When Hurricane Katrina struck in August, 2005, the wealthy did not help the poor, nor did the generally wealthier whites often come to the aid of African Americans whose areas suffered the worst of the flooding. The mortality rate for the poorer blacks was four times the rate for the wealthier whites (Brunkard, J., Namuland, G., and Ratard, R. 2005).

A dramatic cameo of what this means happened when a small prosperous section of New Orleans that was safe, greeted a stream of African Americans whose part of town was flooded (Thompson, Jan. 5, 2005). It happened in a community called Algiers Point. Algiers Point is a neighborhood within a neighborhood, a small cluster of ornate, immaculately maintained 150-year-old houses within the larger Algiers district. Algiers Point is white and prosperous, while the rest of Algiers across a bridge, is predominantly African American and poor. The difference in wealth between the two areas is stark.

When the hurricane hit, Algiers Point was spared. As word spread that the area was dry, desperate people began heading toward Algiers Point, some walking over bridges, others traveling by boat. Facing an influx of refugees, the residents of Algiers Point could have pulled together food, water and medical supplies for the flood victims. Instead, a group of white, Algiers men worked to seal off the area, blockading the roads in and out of the neighborhood by dragging lumber and downed trees into the streets. They stockpiled handguns, assault rifles, shotguns and at least one Uzi and began patrolling the streets in pickup trucks and SUVs. The newly formed white militia shot 11 African Americans who tried to cross to dry land. They forced countless others back into their dangerously flooded neighborhood.

Here gross inequalities in wealth were compounded by race. The scenario presents a dramatic cameo of what happens to trust within a system of gross inequality. Vigilante whites explained when questioned that they were “protecting themselves’ against thefts they expected from “them.”

A similar pattern emerges between nations. Nations with the greatest income equality, have the most extensive trust of others (Wilkinson and Pickett, 2009, 52). They are the most peaceful nations. They are also the most generous to other nations and the UN (Wilkinson and Pickett, 2009 60-61). The reverse is also true.

Not surprisingly, mental illness also burgeons with inequality. The US is the most inegalitarian among the world’s wealthy nations. The US is only about a fifth of the world’s population, however we consume 66% of the world’s psychiatric medications (Fraad, 2009). As inequality has increased in the US over the past 20 years, there has been a 400% increase in the use of anti depressant pills (Pratt, Brody, and Gu, Oct. 2011).  This is not a sign of our mental health. One in four Americans have been mentally ill within the past year (Wilkinson and Pickett, 2009, 65). The wealthy nations with the greatest income equality like Germany, Spain, Italy and Japan report that 8% of their citizens have been mentally ill. Americans are more than four times as likely to be mentally ill than their more egalitarian counterparts. It actually makes sense that people afflicted with the greatest anxiety about making ends meet and the worst prospects for a relatively comfortable family life, people with the lowest sense of trust in people’s goodness, will also be the most anxious and depressed. American children are in similar mental trouble. Six million children in the US are diagnosed with mental illness (Gaviria, January 8, 2008).

This of course relates to another group of the scourges effecting unequal nations those of homicide and imprisonment rates. The “structural violence” the inequality of opportunity, education, medical care, and general life chances in grossly unequal societies has its counterpart in the individual physical violence perpetrated by those members of society who feel denied, shamed, and humiliated by their inability to gain the markers of social status in society, income, legitimate social standing and respect. It is overwhelmingly men who commit violent offenses.

Men commit ten times the homicides that women do (Rank, August 10, 2011). It is also mainly men whose social status confers sexual attractiveness and respect (Wilkinson and Pickett, 2009 133-134). In other words the structural social violence of gross inequality of opportunity breeds the personal violence of crimes like homicide. Not surprisingly, the most unequal among the wealthy nations, the US, has the highest homicide rates, more than ten times the rate of more egalitarian nations like Japan or Norway, Denmark, and Belgium.

Personal violence is matched by imprisonment. Here the inequality of economic and social opportunity spurs greater rage and personally violent crime which condemns poor US citizens to prison. The nations with the greatest equality, have the lowest rates of imprisonment. We incarcerate our citizens at a rate six times higher than Canada, England, and France, seven times higher than Switzerland and Holland, and ten times higher than Sweden, Japan, and Finland (Street, 2011).

In a parallel development, more egalitarian US states like New Hampshire, have imprisonment rates that are four times lower than the imprisonment rates in grossly unequal states like Louisiana or Texas  (Wilkinson and Pickett, 2009, 148-149). Quality legal representation costs at least $300 per hour. Without the ability to access quality legal counsel, people are far more easily condemned to prison.

CEOs in profit gauging corporations are not liable to prison for theft. Instead, they are lauded for their “success”. They then contribute generously to politicians who serve them by skewing the “justice system” to benefit those at the top.

Just as status is granted to men on the basis of economic standing, status is granted to women on the basis of looks and sexual attractiveness. The result is that the rate of teen pregnancy in our vastly unequal nation is ten times greater than the rate in the most egalitarian nations (Wilkinson and Pickett 2009,122). Not surprisingly, the rate of teen pregnancy in the most unequal states in the US is also disproportionately high (Guttmacher Institute January, 2010). It is no surprise that the poorer the US population, the higher the teen pregnancy rate (Wilkinson and Pickett, 2009 122). Teen pregnancy impairs two lives at once.
I will now consider three other interrelated consequences of inequality: Lower life expectancy, higher infant mortality, and our epidemic of obesity. Even though the US spends more money for health care than any other of the 21 wealthy nations, we are the top nation for infant mortality and one of the lowest for life expectancy (Wilkinson and Pickett, 2009 82). In fact our exorbitant health care system achieves results that are most similar to a poor, third world nation, Cuba. Cuba pays approximately $193.00 a person in health care costs (Fitz, January 6, 2011) whereas we pay over $5,000 a person (Wilkinson and Pickett 2009, 80). Cuba invests in preventative care. The US spends its vast monies on insurance company charges, high physician fees, and expensive high tech treatments.

Stress is a major contributor to illness and lowered life expectancy in the US. As a wealthy nation, the kinds of diseases that used to kill Americans such as Smallpox, Cholera, and Polio have been eradicated through inoculations and basic sanitation. The biggest killers in the 21 wealthy nations are heart disease and cancer. These diseases are in considerable part caused by stress. What are the stressors that put Americans ahead of other wealthy nations?  Unlike the other wealthy European nations, the United Sates does not have worker protection laws, nor do we have a free or subsidized quality education programs for daycare or college, nor do we have childcare supports or subsidy for single mothers even though fully 40% of US children are born to single mothers (Fraad, 2011, 203, Holland, June 15, 2011).

In addition, the highest stress jobs are actually the lowest jobs in status, pay and control. They are jobs such as messengers and doorkeepers. The US is the nation with the lowest union organization which provides a way that workers in low level jobs have a modicum of control. America is also the loneliest of the 21 wealthy nations. Although that may be changing with the rapid spread of Occupy movements, we have been a nation with minimal social connection since the decline in equality in the 1970s (Putnam, 2000). Social connection is an antidote to stress. Obesity is another health risk related to stress. All of these stresses are most acutely felt by the 99%, the dispossessed in America. However, they effect everyone, including the super rich. All signs of lower life expectancy in America point to inequality.

The scourge of obesity is a relatively new phenomenon in the US. America leads the world in obesity. Almost one out of every 3 US adults is obese and fully 75% of Americans are overweight (Wilkinson and Pickett, 2009, 89). In 1970 when the US was the most egalitarian of wealthy nations only 15% of US adults were obese. We have doubled in size as we became least equal. How does that work?

People under stress eat for comfort. They tend to eat foods that are high in fats, sugar and carbohydrates which are “comfort” foods. These are foods that most easily contribute to overweight. In addition we are a nation without effective limits on the paid promotion of fast food, no matter what its terrible consequences. The poor in America are particularly afflicted (Trust for America’s Health, The Robert Wood Johnson Foundation July 7, 2011, CDC, July 21, 2011). Not surprisingly, the fattest Americans have not graduated from high school and earn less than $15,000 a year. The poorest US state is also the fattest, Mississippi, with other poor Southern states like Alabama and Louisiana close behind. Wealthier and more egalitarian states have fewer obese residents. However, once again, all are effected. There is no US state without at least 20% obese residents. The US is the only wealthy nation with obesity rates over 20%. The most egalitarian nations have the lowest obesity rates. Even our children are overweight or obese. Fully 17% of US children are obese with poorer children in the most unequal states, the fattest of all (CDC, July 21, 2011). Inequality leads Americans of all ages to literally eat our hearts out.

It cannot be surprising that poor educational performance accompanies the other woes our unequal America. As inequity deepens, children’s scores descend. Now that 37% of America’s young families live in poverty (Taverniese, 2011) our children are subject to just the kind of environments that constrict learning.
Optimal conditions for learning include a quiet place to study, educated parents, books in the home, involved parents and an atmosphere in which learning is valued (Wilkinson and Pickett, 2009, 103). None of these are present for children born into scarcity and unemployment. Our government does not have the kinds of compensatory programs that other wealthy nations have and some poor nations also have. Among the 21 wealthy nations, America is sixteenth in literacy (Wilkinson and Pickett, 2009, 106). The nations below us or on our low level are poorer nations like Portugal, Greece, Italy, Spain and Israel. None of the other wealthiest nations share our lowly position. None share our level of inequity either. That is why we have a lower literacy rate than a poor Island like Cuba (UNESCO 2010) which invests heavily in education for all ages and shares its meager resources in a more egalitarian way.

The last of the 10 scourges of inequality in which America leads is low social mobility. This is arresting because for 150 years from 1820 to 1970, our nation was the only nation on earth in which each generation did better than the last. Sadly, that is over (Fraad, 2009, Wolff, 2009). However, the myth of upward mobility continues leaving those who are stuck at the bottom trapped and blaming themselves for their lowly position. In unequal societies people orient their self esteem around dominance over others. In more egalitarian societies people tend to orient themselves towards inclusiveness and empathy (Wilkinson and Pickett, 2009, 168). The ramifications for all are evident. Unequal opportunity most powerfully afflicts those who are most vulnerable, children. Living in poor and often violent and isolated neighborhoods usually means danger, inferior schools, and stressed, often desperate parents.

This brings us back to the original premise of The Spirit Level. We are reintroduced to the scourges of inequity in which America leads the developed world. These are the scourges that make the United States a falling star:

We have done better. We can now.

CDC. July 21, 2011. “Data and Statistics.” U.S. Obesity Trends.”
National Obesity Trends
 [Data from the National Health and Examination Survey (NHANES)]

CDC Data and Statistics. July 21, 2011
“Obesity Rates Among All Children in the United States.”
(Data from the National Health and Nutrition Examination Survey (NHANES))

Brunkard J, Namulanda G, Ratard R. “Hurricane Katrina Deaths, Louisiana, 2005.” US National Library of Medicine National Institutes of Health

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