|
|
Volume 3: No. 1, January 2006
BOOK REVIEW
The Impact of Inequality: How to Make Sick Societies
Healthier
Author: Richard G. Wilkinson
The New Press,
New York, NY
Publication Date: January 2005
368 pages
Price: $26.95
ISBN: 1-56584-925-6
Suggested citation for this article: Szaflarski M. The
impact of inequality: how to make sick societies healthier [book
review]. Prev Chronic Dis [serial online] 2006 Jan [date
cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2006/
jan/05_0156.htm.
The Impact of Inequality: How to Make Sick Societies
Healthier, by Richard G. Wilkinson, is a sequel to his
book, Unhealthy Societies: The Afflictions of Inequality
(1). The premise of both books is that the structure of
social relations determines the health status of populations;
that is, the greater the social inequality (e.g., income
disparities) within a society, the poorer the health outcomes
(e.g., the higher the death rates). Wilkinson's first book focused on
documenting the relationship based on an emerging body of
evidence; his second book takes the next step by reviewing the
current state of knowledge, offering an explanation, and
suggesting potential solutions to the problem. With its carefully
assembled and weighted evidence and its clear and convincing
argument, the second book is an excellent resource for social scientists,
epidemiologists, public health officials, policy makers, and students.
This nine-chapter book addresses the
primary questions of how and why inequality negatively affects
individuals and populations. Chapters 2 through 4 describe the patterns of
association between inequality and health and social outcomes, underscoring that
“differences in inequality as small as those found between different market
democracies or different U.S. states produce very substantial social and health
effects.” Chapter 2 reviews evidence supporting the idea that the quality of social
relations is associated with income disparities, and Chapter 3
outlines psychosocial factors that contribute to ill health and
premature death, including low social status, poor social
affiliations, and negative childhood experiences, all of which can be
linked to inequality. The data presented in Chapter 4 build upon previous chapters and strongly indicate that
the more unequal
a society is, the worse its health: “The pathway runs from inequality, through
its effects on social relations and the problems of low social status and family
functioning, to its impact on stress and health.”
The remaining chapters explain the causal processes
responsible for these relationships. In Chapter 5, the author
uses violence as an example of a strong correlate of inequality
and discusses the contributions of low social status and
self-worth. Chapter 6 moves the theme forward and describes the
social processes responsible for social distances and
distinctions, including discrimination. In Chapter 7, race and
gender inequality are examined, revealing among other things an
interesting paradox: men appear to be more harmed by male
domination than women are. Chapter 8 examines the pathway from
the form of social organization (degree of inequality) through
stress and coping mechanisms to physiological factors
(e.g., cardiovascular, immune) that shape health status. Finally, in
Chapter 9, the author frames the problem of inequality and health
in terms of ideology and political objectives, revisiting the
traditional democratic values: liberty, equality, and
fraternity.
A systematic review of the existing research is one of the
book’s most important strengths. Wilkinson carefully
reviews studies to date citing supporting evidence as well as
negative findings. When comparing studies, he points out
methodological variations and offers explanations for differences
in findings. He chooses his examples with care, focusing on the
most robust and convincing research; for example, he examines
homicide as one type of violence and death rates as indicators
of population health, definitions of which are similar across
societies, allowing straightforward comparisons. The book also
highlights current and high-priority social issues such as
obesity and their links to social class throughout history.
In addition to the content, Wilkinson’s book is well-organized and written in language that can reach a more general
audience. What is somewhat unconventional is that some background
information (e.g., evolution of human societies and social
inequality) appears later in the book instead of at the beginning.
However, this strategy seems to work well for this book —
by presenting his argument and much of the supporting evidence in
the first half of the book, Wilkinson succeeds in getting his
point across more powerfully. There is one weakness to this scheme, however:
Chapters 5 and 6 contain information and examples already introduced in
previous sections, making
these chapters somewhat redundant and less effective.
The success of the book is based in part on the author’s
obvious passion for the topic and his sincere concern about the
social issue. To make his point, Wilkinson sometimes offers an
extreme opinion or example, such as “perhaps we should liken the
injustice of health inequalities to that of a government that
executed a significant portion of its population each year
without cause.” Wilkinson’s speculations provoke thought. He wonders, for example, how different the
government’s response to health disparities would be if the
income gradient in health were opposite to the existing one: that is, if
it were the higher income groups experiencing the worst health.
Although written from a particular viewpoint — that of
social justice and reform — the book does not attack
capitalism per se, and it does not impose an extreme ideology. Instead, the author’s view of social
progress exists within the framework of modern society, where the
market seems to be an inevitable element. Within that framework,
inequality can be reduced, quality of social relations improved,
and social stress decreased, all leading to improvements in
health and well-being.
Wilkinson ends the book on an optimistic note: although
differences in health inequalities across
societies and history exist, change is possible, and
inequalities can be reduced. As our moral universe expands along
the line of democratic values and as we become more sensitive to
the suffering and pain of others, the reduction of inequality and
the improvement of well-being across the social strata should
strengthen as political goals. This book is highly recommended to
anyone interested in health and its related social issues.
Magdalena Szaflarski, PhD
Institute for the Study of Health
Department of Family
Medicine
University of Cincinnati
Cincinnati, Ohio
Back to top
References
- Wilkinson RG. Unhealthy societies: the afflictions of
inequality. New York (NY): Routledge, Taylor & Francis Group; 1996.
Back to top
|
|
