The problems of relative deprivation: Why some societies do better than others

Abstract

In this paper, we present evidence which suggests that key processes of social status differentiation, affecting health and numerous other social outcomes, take place at the societal level. Understanding them seems likely to involve analyses and comparisons of whole societies.

Using income inequality as an indicator and determinant of the scale of socioeconomic stratification in a society, we show that many problems associated with relative deprivation are more prevalent in more unequal societies. We summarise previously published evidence suggesting that this may be true of morbidity and mortality, obesity, teenage birth rates, mental illness, homicide, low trust, low social capital, hostility, and racism. To these we add new analyses which suggest that this is also true of poor educational performance among school children, the proportion of the population imprisoned, drug overdose mortality and low social mobility.

That ill health and a wide range of other social problems associated with social status within societies are also more common in more unequal societies, may imply that income inequality is central to the creation of the apparently deep-seated social problems associated with poverty, relative deprivation or low social status. We suggest that the degree of material inequality in a society may not only be central to the social forces involved in national patterns of social stratification, but also that many of the problems related to low social status may be amenable to changes in income distribution.

If the prevalence of these problems varies so much from society to society according to differences in income distribution, it suggests that the familiar social gradients in health and other outcomes are unlikely to result from social mobility sorting people merely by prior characteristics. Instead, the picture suggests that their frequency in a population is affected by the scale of social stratification that differs substantially from one society to another.

Introduction

A typical approach to examining contextual area effects on health is to start by controlling out the compositional effects of the socioeconomic characteristics of the population in those areas (Diez-Roux, 1998; Merlo, 2003; Pickett & Pearl, 2001). Because individual characteristics usually have the most powerful influence on the local health profile, researchers adjust for them in order to see whether there are residual positive or negative health effects associated with features of the area itself.

At the local area level the proportion of people with various socioeconomic characteristics may be primarily a distributional issue—how does an area become a deprived area, inhabited by a disproportionate share of poorer, less well-educated people, while a neighbouring area attracts better off people (Macintyre, Maciver, & Sooman, 1993; Tunstall, Shaw, & Dorling, 2004)? However, on another level this is not a question about the distribution in physical space of people with given characteristics, it is instead about the social forces which create those characteristics in the first place. What determines the proportions of people in the wider society belonging to different social classes, in different income groups, with different levels of educational qualifications? The answer to a question like that may seem to depend on the outcome of hundreds of different processes covering every aspect of poverty and wealth creation: educational policies and teaching methods, social mobility, cycles of deprivation, the durability of class cultures—to name but a few, all involving the complexities and minutiae of interactions between individuals, their social environments, and the wider society. However, in this paper we will show that a wide range of problems associated with relative deprivation (including ill health, teenage births, violence, low trust, the educational performance of school children, imprisonment, drug abuse, and obesity), are all strongly related to one factor—societal measures of income distribution.

Rather than being left with the infinite complexities of different determinants of people's standard of health, education, propensities to violence, risks of teenage pregnancy, imprisonment, etc., and trying to formulate separate policies which might have an impact on each of these, it may be that there are also some simpler patterns. If the distribution of each of these health and social problems is related to relative deprivation within societies, and also all tend to be more common in more unequal societies, then perhaps this tells us something fundamental about the impact of the processes of social differentiation within the population.

In this paper, we consider income inequality as both an indicator and a determinant of the scale of social stratification in a society. The range of outcomes which we shall show are statistically related to income distribution suggests that income inequality is related to deep-seated processes of social differentiation. Rather than thinking of populations as made up of basically similar people who—by luck or judgement—have become attached to different incomes and make up societies with different levels of income inequality, we suggest that the social processes related to income distribution are involved in the deeper ways our personal and class characteristics are constituted (Bourdieu, 1984). As Williams (1995) argues, in discussing Bourdieu's complex concept of “habitus” it “is the (class-related) habitus which … determine(s) not only lifestyles and the chances of success…but also class-related inequalities in health and illness” and, as we would argue, also determines class-related inequalities in many other outcomes. The social processes which become structured round income distribution probably also include many of the early childhood influences on social and cognitive development which seem to affect both health and social mobility and are important in social class differentiation (Ben-Shlomo & Kuh, 2002).

Our theory is that processes of social status differentiation, including whether a society has a more or less hierarchical class structure, are intimately related to the scale of income distribution. For several reasons we believe, along with others, that these processes are structured primarily at the national level. As Taylor and Flint (2000) state, “classes have most commonly defined themselves on a state-by-state basis”. Our thinking is not only based on the fact that the distribution of income reflects market incomes (earned and unearned) from the national economy, plus the effects of varying degrees of redistribution resulting from national systems of taxes and benefits; it is also informed by our recent review of the literature on income inequality and health (Wilkinson & Pickett, 2006). We found, as had been noted in previous studies and commentaries (Franzini, Ribble, & Spears, 2001; Wilkinson, 1997), that population health is most reliably related to income distribution when income differences are measured across nation-states and other large geo-political units. Indeed, the evidence suggested a graded relationship such that small area studies in parishes, neighbourhoods and counties showed either weak or non-existent relationships; studies of states, regions and cities tended to show stronger, more consistent relationships; and studies comparing nation-states showed the strongest and most consistent evidence. This observation is given additional weight by the fact that the same pattern was independently reported in an earlier review of studies looking at the relationship between income inequality and violence (Hsieh & Pugh, 1993).

We realise that there has been considerable debate within the disciplines of economic and political geography concerning the spatial scales at which social processes are structured, and the complex ways in which systems operating at different scales interact. However, as Brenner (2001, p. 606) points out “Whether or not the scalar structuration of a given social process generates sociologically or politically significant outcomes is an empirical question that can only be resolved through context-specific inquiries” (Brenner, 2001). We are sensitive to Marston's point that “contemporary writing about scale in human geography has failed to comprehend the real complexity behind the social construction of scale” (Marston, 2000) and her argument that the emphasis has too often been on the functional agency of “the international economy” or to “national social formations”, while “other social practices are cordoned off in their respective localities” ignoring the fact “that even the most privileged social actors…are no less (locally) situated than the workers they seek to command” (Marston, Jones, & Woodward, 2005). Nevertheless, the role of nationally constituted social differentiation in relation to health and social outcomes remains an open question, and one that can be empirically examined.

Income inequalities in large areas can of course be decomposed into income inequalities within and between their smaller constituent areas (Lobmayer & Wilkinson, 2002). And of course social comparisons with neighbours may sometimes have detectable effects on health. Nevertheless, as Ballas asks, “do (people) compare themselves to “peer groups” in their neighbourhood, city, region, country or possibly to diaspora groups in other countries or with people of whom they know little? There are many other kinds of non-geographical groups…to which we may compare ourselves and with whom we consider ourselves to be of a similar social standing. It is far from clear how reference groups are constituted” (Ballas, Dorling, & Shaw, 2007). As we have argued previously, the health of people in a deprived neighbourhood is worse not because of inequalities within that neighbourhood, but because they are deprived in relation to the wider society. To give a particularly dramatic example, consider that in 1996, black American men had a median income of $26,522 and an average life expectancy of only 66.1 years. In comparison, men in Costa Rica had a mean income (at purchasing power parity) of only $6410, yet their average life expectancy was 75 years (Marmot & Wilkinson, 2001). To call any local level of income an effect of “absolute” income (or education or deprivation), and to assume that its relation to health is independent of the wider context is to forget that poor areas are poor in relation to the wider society.

Rather than ignoring the fabric of people's lives which, as Marston (2000) pointed out are always locally situated, we are suggesting that social classes are constituted in relation to each other partly through what may look like action at a distance—through the effects of the population class structure outside one's immediate locality.

We start our empirical investigation by summarising previously published evidence suggesting that the societal scale of income inequality is related to morbidity and mortality, obesity, teenage birth rates, mental illness, homicide, low trust, low social capital, hostility, and racism. We then go on to test new hypotheses, that poor educational performance among school children, the proportion of the population imprisoned, drug overdose mortality and low social mobility are also related to greater income inequality. We would emphasise that the issue throughout is not that greater income inequality means simply greater inequality in outcomes localised within societies, but that greater income inequality is associated with a higher prevalence of ill health and social problems in a society as a whole, regardless of its social distribution.