Economic inequality and health

By Zubeida Mustafa
Source: Dawn

HERE is some new and very interesting information on the health of people. Professor Richard Wilkinson, an expert in public health and a social epidemiologist, has analyzed widespread public health data from the sociological angle to determine the physical and mental wellbeing of people.

His findings? “However rich a country is, it will still be more dysfunctional, violent, sick and sad if the gap between the social classes grows too wide. Poorer countries with fairer wealth distribution are healthier and happier than richer, more unequal nations.”

This seems quite plausible. Medical science has irrefutably established that many diseases with physical symptoms and also organic causes are rooted in the mental make-up of a person. These are, what psychiatrists term as, psychosomatic illnesses. Stress, which is one most important single factor affecting a person’s physical as well as mental health, is created by psychological factors. It is known to exacerbate nearly every illness and breaks down a person’s resistance to infections.

According to Wilkinson, the stress of living at the lowest rung — economically and socially — is more damaging to a person’s health than many other factors. “The stress of disrespect and lack of esteem” are more killing, Wilkinson believes as he writes in The Impact of Inequality: How to Make Rich Societies Healthier. That is why he says the life expectancy in Bangladesh is higher than in Harlem, New York’s poorest neighbourhood where the blacks lead a demeaning life.

This is to an extent confirmed by casting a cursory glance at the Human Development Report, 2004. Among the rich countries, the United States has the highest Gini index (which measures the inequality of income and consumption in a country — the lower the value the better the equality) — 40 as against 25 for Sweden. The US has the lowest age expectancy in these countries — 77 years as against 80 in Sweden.

The poor countries with an unequal distribution of poverty show the same pattern. Compare the three countries of the subcontinent in South Asia. Pakistan has the greatest inequality of wealth (a Gini index of 33). India and Bangladesh are neck and neck with 32.5 and 31.8 respectively). The life expectancy in Pakistan, Bangladesh and India is 60.8, 61.1 and 63.7 years respectively.

Of course this is a rough measure but it points to another major damaging aspect of unequal wealth distribution — the human aspect. When a person is constantly exposed to the inequalities rampant in society — the proliferation of television channels and their easy accessibility ensures that the luxurious lifestyles of the rich and their ostentation are made visible to the poor — it is but natural that the deprived classes will resent their lot.

The consumer society that is being created in Pakistan as a result of the market oriented economy is also creating stress among the people. The high quantum of advertisements in the media is giving rise to a consumer culture which most people cannot afford. That creates stress especially in people who resort to leasing and bank borrowing to spend on luxury and then fail to repay their loans.

This is not just an economic problem. It is a social problem too. People have come to identify respect and status with money. The old values when knowledge and virtue gave a man public esteem have vanished.

If the government’s policies are such as to perpetuate and exaggerate the inequalities, the resentment of the have-nots will be directed at the authorities as well as at the affluent.

The first manifestation of the negative feelings that come in those who are the deprived lot is in the poor state of their health. Next comes an escalation in the crime rate. And finally a breakdown of the social and political structures. This is something the policymakers should look into carefully.

As for public health, the general perception is that the meagre investment in health in the public sector and poverty is the main cause of the poor health indicators. This is true. But it is equally true that many of the diseases have a different underlying cause. At times, the health professionals have found that it is more because of depression and low self-esteem that many people are chronically ill rather than because of malnutrition or lack of treatment for a medical problem. Thus poor health also promotes poverty since it lowers productivity, leads to absenteeism from the workplace as well as from educational institutions. This vicious cycle has to be broken.

It is only government intervention that can help bring about an equal distribution of wealth and break the poverty trap. While policies to create employment, curb inflation, increase the real purchasing power of the people and diversify the economy will certainly help, there is also the need to take the focus away from consumer goods.

A UN report issued last Thursday, titled The World Social Situation: The Inequality Predicament, stated that despite unprecedented economic growth in recent years, the rich have become richer and the poor even poorer. It speaks of “persistent and deepening” inequality and says the “chasm between the formal and the informal economies” is growing while “the gap between skilled and unskilled workers, the disparities in health and education and the inequality in the opportunities for social, economic and political participation” are on the rise.

According to the report the world is more polarized today than it was 10 years ago, when world leaders met at the summit for social development held in Copenhagen in 1995. At that meeting, they had promised to confront profound social challenges and place people at “the centre of development”. That has not been done.

What is worse is that the thrust towards globalization has enhanced the inequality between and within countries. The report confirms that these inequalities have had negative consequences in many areas, including employment, job security and wages.

Once again a summit is to be held in New York in September to address this issue. Coming on the eve of this meeting, the report offers solutions to inequality, by stressing the need to adjust the economic imbalances not just within nations, but also among them, noting that 80 per cent of the world’s domestic product belongs to one billion people living in the industrially developed world, while the remaining 20 per cent is shared by five billion people living in the Third World.

Are we back to square one? In the seventies, the world’s poor led by the Algerian President Houari Boumedienne were asking for a new economic order. The difference is that today their hands are tied tighter than before.