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Bandy X. Lee M.D., M.Div.
Bandy X. Lee M.D., M.Div.

Inequality as a Lethal Disorder

To mitigate disease and death, we need to understand it.

Poverty is the worst form of violence.” —Mahatma Gandhi

Economic inequality is often a symptom of societal disorder, but it is also a cause. The broken conditions of inequality often allow for all forms of disorder to happen.

The inequality crisis is currently escalating. At a time when health care, education, and communications are advancing rapidly, much of humankind is barely surviving from day to day. Inequality, in fact, is one of the most lethal forms of violence (Butchart and Engström, 2002). The excess rates of death and disability resulting from the social and economic inequality are measurable using life expectancy data. Past calculations have attributed between 10 and 20 million deaths per year to inequality (Høivik, 1977). The numbers are even greater now, and the Commission on Social Determinants of Health of the World Health Organization (WHO, 2008) has declared that social injustice is killing people on a grand scale.

Yet worldwide, just eight men possess the same wealth as the poorest half of humankind (Oxfam International, 2017). Eighty-two percent of the wealth created in 2017 went to the richest 1 percent of the global population. All over the world, poorly paid work for the many is supporting extreme wealth for the few. Large corporations play a key role in widening this gap. They use their power and influence to ensure government policy works in their interests. Around 56 percent of the global population lives on between $2 and $10 a day, and it takes just four days for a chief executive officer from one of the top five global fashion brands to earn what a Bangladeshi garment worker will earn in his entire lifetime (Oxfam International, 2018).

Today, a child born in a Glasgow, Scotland, suburb can expect a life 28 years shorter than another living only 13 kilometres away. A girl in Lesotho is likely to live 42 years less than another in Japan. In Sweden, the risk of a woman dying during pregnancy and childbirth is 1 in 17,400; in Afghanistan, the odds are 1 in 8. In this manner, social and economic policies that create and augment the differences between—and within—countries are crucial factors in whether a child will grow up to live a flourishing life (WHO, 2008).

British social epidemiologists Richard Wilkinson and Kate Pickett (2008) similarly conclude that egalitarian societies would do enormously better overall with only minor compromises from the wealthy. The association between income distribution and population health is remarkable, as in the example of the U.S. Despite being the richest nation on Earth, it has the widest income disparities of any other Western country and, as expected, a lower average life expectancy than those countries (Christopher, Himmelstein, Woolhandler, and McCormick, 2018). The United Nations, furthermore, issued a report criticizing the Trump administration’s policies for worsening the state of poverty and extreme poverty in the United States, which already has one of the lowest rates of intergenerational social mobility (Alston and Goodman, 2018).

That said, income inequality has increased in nearly all regions, although to varying degrees. The combination of large privatizations and increasing income inequality within countries has fueled the rise of wealth inequality among individuals. In Russia, as in the U.S., the rise in wealth inequality has been extreme (Alvaredo, Chancel, Piketty, Saez, and Zucman, 2018).

Although wages and earnings are measures of flow, wealth is a stock that families can use in case of economic need and vulnerability. Wealth inequality is much greater than income inequality. In the early 2000s, in the U.S., the wealthiest 1 percent of families held one-third of the total wealth, the next wealthiest 9 percent held another third, and the remaining 90 percent held the rest (Neckerman and Torche, 2007). Economic inequality is linked to perceived fairness and general trust and consequently individual-level happiness (Oishi, Kesebir, and Diener, 2011).

Residents of countries with higher income inequality have worse health, not just of the poor but of the rich (Subramanian and Kawachi, 2006). Greater income inequality is also associated higher levels of mental illness (Burns, Tomita, and Kapadia, 2014); murder and assault (Hsieh and Pugh, 1993); obesity and obesity-related death (Pickett, 2005); as well as drug abuse, teenage pregnancy, racism, incarceration, and a number of other societal problems (Wilkinson and Pickett, 2009). Such countries also have more sociopolitical instability in the form of assassinations, coups, and riots (Alesina and Perotti, 1996); worse institutions in terms of less efficient governments, higher regulatory burdens, and weaker rule of law (Easterly, 2007); and more corruption (Jong-Sung and Khagram, 2005). The wealthy have stronger motivations to minimize redistribution while at the same time having more power to influence institutions, given the relatively higher share of their resources (Buttrick and Oishi, 2017).

Economic inequality may further put the world at risk of both environmental and nuclear harm. Taming the planet’s climate or reducing nuclear weapons requires trust and cooperation, but these are difficult in the setting of economic inequality and exploitation. Income and wealth gaps accelerate the environmental crisis (Martinez-Alier, 2002), with increasing local and global conflicts over the sharing of the burdens of pollution and access to natural resources. Previous failures to reach consensus in climate summits have been attributed to, among other factors, conflicting policies of rich and poor countries, which disagree on the implementation of mitigation measures (Vasconcelos, Santos, Pacheco, and Levin, 2014). When there is greater income and wealth inequality between nations, there is an erosion of trust due to the ensuing social and cultural differences, and greater perceived need for military defense, including nuclear weapons for nations that can afford them.

Social and economic inequality is linked to disease, death, and other forms of harm. To better understand these societal ills, we must look at inequality as a disorder in itself.


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About the Author
Bandy X. Lee M.D., M.Div.

Bandy Lee, M.D., is a forensic psychiatrist at Yale School of Medicine and project group leader for the World Health Organization Violence Prevention Alliance. She also authored the textbook Violence.

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