Equality and Pursuit of Happiness

Two years ago two British public health researchers have written the definitive book about the United States, which I got around to reading this weekend, 235 years after we we threw them out. In “The Spirit Level” Richard Wilkinson and Kate Pickett explore the mystery about why equality makes societies stronger in almost every way and why inequality makes any society weaker.Only in recent years has reliable data been available to allow comparison across many nations for a wide range of health and social issues, as well as detailed measures of the distribution of wealth between and within nations. The subject is relevant on July 4th because they cast an especially clear eye at the United States, and the wide differences between our various states.

The big idea is that once a society has passed a certain level of economic well being (think Portugal or Greece) additional average wealth doesn’t make as much difference to the quality of life that you’d think. Once you have generally available clean water, safe food, decent housing and basic medical care other factors have a lot more to do with happiness and well being. The most reliable way of predicting the health of a society–or a particular state in our Union–is the degree of inequality between the citizens.It makes sense that poor people would have lower health. But why would relatively rich people in an unequal society also have worse health than their counterparts in a more equal society?  People in Greece spend about half of what people in the US do on health but they tend to live about 1.2 years longer. Why? And why would I raise the issue on July 4th?

You’ll have to read the book to fully grasp their answer to the question (The Spirit Level, Bloomsbury Press, 2009). But just look around to answer the second. In my lifetime the semi-United States have witnessed huge growth in our economy, but nearly all of the benefit has gone to the rich, creating a vast and deepening divide between them and the large number left behind. The United States today is a very, very different pattern of citizens with quite different prospects. I write as one of the accidental winners. A public school kid born to a teacher and civil engineer, I went to Wake Forest back when it was for middle class kids who couldn’t afford Duke (or get into UNC!). When my parents passed away, they left each of us five kids about $15,000, which is to say we were born to honorable work, not wealth. I’ve traveled to many countries for this and that reason, so I know to be grateful for where and when I was raised.

But that nation is largely in the past, as Wilkinson and Pickett gracefully point out. And we face growing sense of conflict among ourselves, constrained by real limits to our growth and real competition for our privileged status.  The fundamental structural inequality taking root in the United States is showing up in predictable rates of disease, violence, anxiety, depression. In short anything related to social phenomenon is acerbated by patterns of inequality.If you doubt this, let me invite you to spend a day in our emergency room, or at The Church Health Center or one of the Christ Community Health Clinics where reality is not ingnored.

While these are big patterns, they are not inevitable or irreversable. For instance, the authors chart the large differences between nations and states in terms of whether people trust each or not. In Norway over 80% of respondents say they could trust pretty much everybody in the country. They noticed, as I have, that it is common for coffee shops to leave blankets outside on chairs so that customers can linger in the cool over coffee. I’ve seen people leave their babies in strollers outside the window of coffee shops. It would not cross their minds that anyone should think this odd, dangerous or foolish. What could happen? Ask anyone in Mississippi, the state with greatest inequality and lowest trust (17%!)(page 52-3). Does inequality produce lack of trust; or does lack of trust produce inequality? The causal arrow goes both ways, but the result is polytoxic producing generational patterns of problems including a chasm between those trying to fix the problems in government and also in private healthcare such as my own Methodist LeBonheur Healthcare. Inequality produces distance, which produces ignorance, which produces misunderstanding and more distrust and lack of collaboration and and and and. People don’t trust their doctors, much less the abstractions called “executives” of huge organizations like hospitals.

There is much to learn here from our British friends, but the most basic is that we cannot expect to merely grow our way out of inequality. And that is simply not possible, especially as we must all make our choices in the context of increasingly clear environmental limits. “Modern societies will depend increasingly on being creative, adaptable, inventive, well-informed and flexible communities, able to respond generously to each other and to needs wherever they arise. Those are characteristics not of societies in hock to the rich, in which people are driven by status insecurities, but of populations used to working together and respecting each other as equals.”(p263) Sounds like America to me, at least what it was. And could be again.

This has very practical implications for our work in Memphis where we have built a “web of trust” among 357 congregations to care for members and neighbors and advance the health of the whole community. Inclusion, invitation, generosity, transparency, flexibility, connectivity–all among people dealing constantly with gross evidence of inequality on some of the toughest soil in world.To give health a chance, build trust.

I appreciate the Brits for reminding us of what is worth fighting for as we go back to work tomorrow. Check out their website: http://www.equalitytrust.org.uk

About garygunderson

Vice President, Faith Health, Wake Forest Baptist Medical Center in Winston-Salem, NC. Author, Leading Causes of Life, Deeply Woven Roots, Boundary Leaders and Religion and the Heath of the Public. Secretary, Stakeholder Health (Health Systems Learning Group).
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