‘It’s as if the social fabric is torn apart by inequality’

Could you tell us about your talk at the European Congress?

The title is 'Inequality – the enemy between us', so I'll be discussing the impact of income inequality on mental health. I'll give an overview of the pathways that link income inequality, measured at the societal level – so the gap between rich and poor – and the higher prevalence and incidence of mental ill health for individuals in those places. The basic descriptive finding is that there is more mental ill health in places with more inequality – but I will also try to unpack and unravel that, and show why that is. I'll focus on inequality as a hazard in itself, but also talk about what that does to society, to people's resilience, and their resources. 

What are some of those pathways between societal inequality and mental ill health?

In our two books, Richard Wilkinson and I summed up the psychosocial impact of what it means to live in a society where the gap between rich and poor is larger, and the way that that makes your position within the social hierarchy more salient and more important. For a society which has a very steep hierarchy, where you are on the ladder matters more than in societies with a flatter structure where everybody is more similar. When the material differences between us get larger, when the income differences get bigger, the social distances do as well; the social pressures increase and the downward pressure of the weight of inequality increases.

It's always worse to be at the bottom whether or not your society is more or less equal, but the degree to which that is worse differs with the level of inequality, and the degree to which you're affected depends on where you are in that hierarchy. In those societies where you've got those greater social distances, the rungs are further apart and it's harder to move up or down them. You're also judged more by where you come in the hierarchy when it is more entrenched and steeper. So, money matters because that's how you show where you come in the hierarchy.

You mentioned some of the psychosocial impacts of societal inequality, beyond mental health.

We have at times been accused of having a theory of everything. And although it didn't start out that way, the more you look, the more you uncover the damage done by inequality. Our work has focused on health outcomes, but those are not just mental ill health outcomes. We see lower life expectancy in more unequal places, higher levels of infant mortality, we see greater levels of obesity. Health always has a social gradient – there's more ill health at the bottom of society – but things are worse in more unequal societies.

There's also a separate set of outcomes that probably originate through the same processes of how people do and do not feel judged by others, combined with the impact of inequality on levels of trust. We have low levels of trust in more unequal societies and higher levels of violence – the murder rate is higher, the rate of imprisonment is higher, the rate of intimate partner violence is higher. Along with lower trust, you can also see lower civic participation, lower cultural participation, there are more riots and more political polarisation – it's as if the social fabric is torn apart by inequality. 

Are the drivers of inequality in these more unequal societies similar, or does it depend where you are in the world?

Countries are where they are at in terms of their inequality for different reasons. Sometimes those are deeply historical and sometimes they're more recent. Japan used to be a very unequal society, then after the Second World War, it became much more equal – mostly because of things that were imposed upon it by America. At the same time America, interestingly, was becoming more unequal than it had been.

Sweden became more equal because of conscious decision-making about trying to improve the country for the population – they expressed it as trying to make Sweden the people's home.

We saw huge rises in inequality in a lot of countries through the 1980s because of neoliberal economics, which involved pursuing economic growth at all costs. Inequality was seen as collateral damage, the idea being that eventually, we would get 'trickle down' that would make everything better… of course, we never actually got the trickle down. 

There are also different reasons that countries become more equal – it could be because of an external threat, war, or a threat of communism, where greater equality is seen as an important mechanism through which you might garner population support for particular things. I suppose that's also a slightly hopeful message – there's not just one way to become a more equal society.

Are there any global trends in whether inequality is increasing or decreasing – especially after the Covid-19 pandemic?

Inequality across the entire world was reducing a bit prior to the pandemic, which was probably mostly due to the impact of China getting rid of extreme poverty. But if you look within countries – and that's the equality we have studied, how unequal it is within a country – most countries in the world in recent years have not got better. They've tended to get worse. There was a trend in Latin America for quite some time of countries really working hard towards greater equality, but that was starting to stall even before the pandemic.

The pandemic certainly has exacerbated inequalities. It's not been a hugely hopeful set of trends. A lot of people thought the global financial crisis – clearly a crisis driven by extreme inequality in many ways – would force more positive change. A lot of economists at that point thought we would have to do things differently, but then things didn't change much. Then, of course, we had austerity as a consequence of that, as a political choice in many places which exacerbated inequality.

If you look at Britain, we had a financial crisis, then we had a decade of austerity, and then we had a pandemic, and now we've got a cost-of-living crisis. It's a chain of crises that followed on from that 1980s rise in inequality. We are now the most unequal country in Western Europe, we have been for a long time. We show no signs of seriously trying to do anything about that. Not that I want to depress you.

Don't worry, I'm a millennial...

I think millennials really get interested in the role of inequality when we start to think about the climate crisis. Inequality drives how important money is and people striving for status, then that drives over-consumption and consumerism, and that's a barrier obviously to tackling the climate emergency – reining in consumption, becoming a more sustainable society. But inequality also destroys trust and it's then harder to make those decisions for our society that we need to become more sustainable.

So inequality is a barrier to tackling the climate emergency. But also, all of our research on the impact of inequality suggests that if you tackle it for whatever reason, you will get quality-of-life benefits. And so that's a hopeful piece of it. If you've tackled inequality because you've got to cope with climate change, you actually are going to end up with a better society and a better quality of life for everybody. Many people think if we have to tighten our belts and rein in consumption, we'll all be miserable – but that's not true.

That's heartening to hear… I know many people in my age group and from GenZ just look around and see growth for growth's sake, and it's frustrating.

Which is why there is quite a strong post-GDP movement around wanting societal goals that are not just focused on growth at all costs or growth for growth's sake, but instead focused on growing wellbeing. That movement recognises the centrality of inequality as an issue – if you want to grow wellbeing, you've got to tackle inequality. Wellbeing economics is an important new movement. There's a group called the WEGO – the Wellbeing Economy Governments and so far, there is Iceland, Finland, Scotland, Wales, New Zealand, and Canada.

These are governments that are trying to pursue different goals… they're not all getting it all right, of course. But I think in the post-Covid world there's a heightened recognition that that's what we need to do. We do have a pandemic of mental ill health. All over the world there are increases in mental health problems for children, adolescents and adults. So there is a recognition that tackling that involves tackling the wider social determinants of health – it's not just about providing more therapy or services.

Could you tell me about some of the approaches countries have used to successfully tackle inequality?

There's two main strategies. The first one that people would think of is through redistribution, so you try and redistribute income and wealth. You might increase income taxes, you might introduce a land or wealth tax, you might increase your social security network, you could choose to give a universal basic income… all sorts of mechanisms that that you could pick, which are all good. The risk with those approaches is that a new government can overturn them and change the social security system quite quickly. This government effectively imposed a two-child limit, through various benefit caps, the bedroom tax etcetera.

During the pandemic, we saw our government making choices about supporting people's incomes in very rapid time and at very large scale. We gave a £20 uplift on Universal Credit and we provided people with furlough – 80 per cent of their of their incomes. But although all of those measures can be overturned by governments, we do want more of those redistributive mechanisms.

The other main strategy would be to try and reduce income differences in the first place, so you have less need to redistribute. You try to keep a smaller gap in those incomes at source. The key strategies, in this case, are to do with increasing economic democracy: having more employee representation on company boards, particularly the boards that set salaries, having stronger unions, having more cooperatives, mutuals, employee-owned companies, social enterprises rather than for-profits. Anything that extends democracy into the workplace tends to have this dampening effect on income inequality.

If you think about your work structure and who's at the top and who's at the bottom, and if you've got everybody in that institution involved in thinking, right, well, what should the pay ratios look like? How much should the top person get and how much should the bottom person get? People would still allow difference, but they would never vote for the kinds of differences that we see today. Top CEOs in the FTSE 100 make more in the first few hours of January than what their average-paid workers will get in the whole year. That rise in those sorts of differences has been recent and really rapid… it didn't used to be like that anywhere.

When you extend that kind of agency to people through more democratic workplace principles and practices, that's more robust. Because when you give rights to people, and you give power and agency to people, it gets harder to take it away from them. 

Do you have any thoughts on Universal Basic Income? I know there's resistance to the idea, but that seems like it would help with reducing inequality?

That was in the last Labour manifesto prior to the last general election, it was in the Corbyn manifesto, so probably won't be in the next Labour Party manifesto. But there is a real increasing interest in basic income: the Welsh Government is doing a pilot of a basic income for young adults leaving care. They are giving £1,600 a month to all care leavers at 18 and they get it for two years. I'm part of the team that's going to be evaluating the impact of that.

That sounds like an expensive 'handout', but if it actually provides security and agency to people who are at a critical time in their lives, then its economic benefits might be huge. If people are able to use it to stay in education, become entrepreneurs, get training of various kinds, learn to drive, move into better housing at a critical point in their lives, they potentially get set on a track that means they will cost society less throughout their lives.

I think people tend to fear basic income: they worry that it's giving people money for nothing, that if we all had basic income we'd sit around and do nothing, but actually, when it's explained to people they can understand it. It could also go a long way to improving trust… if people felt that the government cared enough about them to give them a basic income, then that might have a really salutary impact.

At the moment there's lots of unanswered questions about basic income and we do need more pilots, more tests and evaluations of the benefits and potential harms, but there's real interest in it. We might not yet be at a point where an incoming government is going to commit to it, but lots of local and combined authorities are really interested in being places for pilots. There's lots of discussion about whether children should get a basic income, whether it should start during pregnancy. A few years ago nobody talked about it, it was seen as a completely crazy idea, so things could change.

Are there any other projects you know of or are involved in which are trying to reduce inequality in this way?

There's a lot of focus on early years and getting things right in the early years. I am part of a project called ActEarly which is funded by the UK Prevention Research Partnership, and along with Claire Cameron at UCL I lead a theme within that called Healthy Livelihoods. It's about trying to see whether and how families' livelihoods can be improved to improve the health and wellbeing of the people in those families. We've been interested in things like the co-location of welfare and benefits advice in health settings – helping people get access to the benefits they are entitled to, as there is a huge amount of under-claiming.

I'm also part of a project that is trying to change food systems. A big campaigning issue for us is the extension of free school meals to all children in families where somebody's receiving Universal Credit. There are a lot of poor children who don't actually fall below the threshold to access free school meals, and we are ultimately pushing for free school meals for everybody.

We're going to see more early years provision from this government which is good, too. I think that's primarily driven by their concerns about workplace productivity and the economy but it's good for families if there's more provision of childcare so that women can work.

A big study I'm involved with at the moment is called Age of Wonder which we've just started and will run for seven years. That's a study of young people growing up in Bradford and we've been following them since birth. Born in Bradford is a birth cohort study that's been going on since 2007 and those young people are now in secondary school. We are following them for seven years through to adulthood to see what life is like for them in adolescence, seeing what protects their health and what damages it.

This is very much a co-produced study, taking the insights and contributions and concerns of young people into account in terms of what we ask about and what we focus on. Mental health and wellbeing is a big, important part of that study. We're trying to focus on the positives as well as the negatives – not just what is damaging to people's mental health and wellbeing, but what is protective and preventive and helpful.