HEAL04 - Changing the public, political and policy debate

Submitting Institution

University of York

Unit of Assessment

Public Health, Health Services and Primary Care

Summary Impact Type


Research Subject Area(s)

Medical and Health Sciences: Public Health and Health Services
Economics: Applied Economics

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Summary of the impact

Pickett and Wilkinson's research, summarised in The Spirit Level (Penguin), argued that the level of income inequality in rich, developed market democracies strongly influences their performance on a wide range of health and social indicators. Since 2009, the book has contributed to a significant shift in public debate across the world — at grassroots level, in the media and in legislative assemblies — and has shaped political thinking, legislation and policy making.

Underpinning research

The Spirit Level (1) was based on a programme of research jointly conducted by Pickett and Wilkinson and published in 16 widely cited articles in peer-reviewed journals.

Using both ecological and multi-level cross-national comparisons, the research compared life expectancy, infant mortality, mental health, levels of violence, teenage birth rates, drug abuse, child wellbeing, obesity rates, levels of trust, the educational performance of school children, imprisonment and social mobility, and found that societies with lower levels of income inequality perform consistently better (2 - 5). The picture is consistent whether comparing rich countries or the 50 states of the USA, and the magnitude of the effect is very large: for example, there are ten-fold differences in teenage birth rates, three-fold differences in rates of mental illness and two-fold differences in infant mortality between more and less equal societies.

The York-based research by Pickett and Wilkinson which underpins The Spirit Level established that levels of absolute standards of living, measured as Gross National Income per capita are unrelated to levels of health and wellbeing in rich nations, whereas income differences are key. It is relative income, one's status within the social hierarchy of a society, which matters more than absolute income. Importantly, greater inequality seems to produce worse outcomes for the vast majority of the population (6). Analyses comparing people in more equal societies with their counterparts at the same socioeconomic position in less equal societies showed that whilst those lower down the social hierarchy benefit most from greater equality; even those near the top benefit.

The pathways linking inequality to health and social problems are psychosocial. Foremost among the psychosocial risk factors for poor health are three intensely social factors: low social status, weak social support, and a poor quality of early childhood experience. To improve the quality of life, The Spirit Level suggests that attention must be paid to the social environment and the quality of social relations, and that reducing material inequality will improve the psychosocial wellbeing and social functioning of whole societies.

Pickett (L, then SL, then Prof; 2003 -) and Wilkinson (Prof at the University of Nottingham until retirement in 2008 and Honorary Visiting Professor at York, 2005 — present).

References to the research

1. Wilkinson R and Pickett K. The Spirit Level: Why Equality is Better for Everybody. London: Penguin (2009). The Spirit Level has sold more than 150,000 copies in its English edition and is published in 23 foreign editions. The book was awarded the 2010 Bristol Festival of Ideas Book Prize and the 2011 Political Studies Association Publication of the Year Award. The New Statesman named it one of the Top Ten Books of the Decade. (UK edition 1559 citations, according to Google Scholar).

2. Wilkinson RG, Pickett KE. Income inequality and health: A review and explanation of the evidence. Social Science and Medicine 2006; 62:1768-1784. DOI: 10.1016/j.socscimed.2005.08.036 (705 citations).


3. Wilkinson RG, Pickett KE. The problems of relative deprivation: why some societies do better than others. Social Science & Medicine. 2005;65:1965-1978. DOI: 10.1016/j.socscimed.2007.05.041 (184 citations).


4. Pickett KE, Wilkinson RG. Child well-being and income inequality in rich societies: Ecological cross sectional study. BMJ 2007; 335(7629):1080-1086. DOI:10.1136/bmj.39377.580162.55 (100 citations).


5. Wilkinson RG, Pickett KE. Income inequality and social dysfunction. Annual Review of Sociology, 2009; 35:493-511. DOI: 10.1146/annurev-soc-070308-115926 (81 citations).


6. Wilkinson RG, Pickett KE. Income inequality and social gradients in mortality. American Journal of Public Health 2008 98: 699-704. DOI: 10.2105/AJPH.2007.109637 (81 citations).


Related grants: Pickett KE. 2007-2012. Deprivation, difference and early development: Healthy societies for healthy families, Career Scientist Award, NIHR, £318,953.

Pickett K, Wilkinson R. 2012-2013. Discussing Inequality: Materials for the classroom and beyond. ESRC, £92,846.

Details of the impact

Improving Public Understanding of Social Issues

In order to increase awareness of the research findings and the consequences of inequality and to campaign for change, in 2009 Pickett and Wilkinson established The Equality Trust (TET). This is a not-for-profit educational and campaigning organisation (www.equalitytrust.org.uk) with core funding from the Joseph Rowntree Charitable Trust. Through this they created the One Society campaign to work with policy-makers, employers, other decision-makers and influencers who have significant power to affect rates of income inequality (www.onesociety.org.uk). TET produces research digests and updates that are widely cited in the media and has 23 UK local groups and 28 international groups, including 8 in the USA. The Trust also has 8000+ followers on Twitter and 7000+ on Facebook. Pickett and Wilkinson, through TET, have directly contributed to public understanding and debate through more than 600, predominantly non-academic, conferences keynotes and seminars, including national, foreign and international government ministries and agencies, the UK Cabinet Office, health authorities, political party conferences, universities, trade unions, faith groups, NGOs, think tanks and charities (e.g., the United Nations, Canadian parliament, US Congress, and the OECD — in the UK, USA, Australia, New Zealand, Bhutan, Czech Republic, Spain, Sweden, Norway, Austria, Belgium, Ireland, Turkey, Italy, Denmark, Belgium, Iceland, Canada, Germany, Singapore, Switzerland, Brazil and Malta). They have also been invited to disseminate their research in magazines, newspapers, and popular journals.1

Shaping and Informing Political Debate

In the lead up to the last General Election, TET asked parliamentary candidates to sign the Equality Pledge, which described Pickett and Wilkinson's research, and asked them to "actively support the case for policies designed to narrow the gap between rich and poor" — it was signed by 75 MPs who entered the new parliament, including 11 Conservatives, 18 Liberal Democrats (including 2 cabinet ministers), 1 Green and 45 Labour MPs. Pickett & Wilkinson were consulted by the Liberal Democrat's Policy Consultation on Inequality and by the Green Party Strategy group, each of which was developing manifesto commitments to greater equality and fairness. Prime Minister David Cameron In his Hugo Young lecture, prior to the election, said "Research by Richard Wilkinson and Katie Pickett has shown that among the richest countries, it's the more unequal ones that do worse according to almost every quality of life indicator".2 Ed Milliband wrote about the importance of academic research for changing politics in The New Statesman, saying "The Spirit Level by Richard Wilkinson and Kate Pickett is a book in the best of that tradition."3 Following the election, BBC 4 journalist Mukul Devichand said "Both Prime Minister David Cameron and Labour leader Ed Milliband appear to be disciples of The Spirit Level."4

Contributing to Campaigns for Change

Local Equality Trust groups are active in campaigning, using the research base as evidence. For example, the London branch, My Fair London, developed a pledge for candidates in the London Mayoral election, stating "we draw heavily on The Spirit Level".5 Equality Bristol produced an `Equality Declaration' for local election candidates to sign. The Newport group successfully campaigned for the setting up of a local Fairness Commission.

The Spirit Level has been extensively reviewed, discussed, and referred to by commentators, politicians and others in the international printed media (from the Financial Times and The Economist to The New York Times; quotes are available at: www.equalitytrust.org.uk/node/200), on radio, television (including the BBC and CNN), the internet, and in legislative assemblies including both Houses of Parliament in England, the Scottish Parliament, the Welsh Assembly, the New Zealand, Australian and Canadian parliaments.6

Inspiring the Production of Cultural Artefacts

A Spirit Level Documentary is in production by award-winning independent documentary maker Christopher Hird of Dartmouth Films and directed by Kathryn Round. The film raised $70,000 in 40 days through crowd sourcing and has received grants from the Tudor Trust and the City of Sydney.

The ESRC funded Pickett, through its Follow-On Fund, to produce The Young Persons Guide to Inequality, educational materials for 16-19 year olds, based on The Spirit Level. These include: a Theatre in Education Learning Module, Kuan's Wonderland (a novel with study guide), a statistics learning module, Economicum, a game for learning about economics and inequality, collections of videos and other art based on The Spirit Level. All free online:www.equalitytrustr.org.uk/education.

Influencing policy

There is growing international recognition of The Spirit Level research: head of the International Monetary Fund, Christine Lagarde, said "Now all of us have a better understanding that a more equal distribution of income allows for more economic stability, more sustained economic growth, and healthier societies with stronger bonds of cohesion and trust."7 United Nations Secretary General, Ban Ki-Moon, quoting from The Spirit Level said "Social and economic inequalities can tear the social fabric, undermine social cohesion and prevent nations from thriving. Inequality can breed crime, disease and environmental degradation and hamper economic growth."8 Nobel Prize winning economist, Paul Krugman, wrote, "Wilkinson-type views about the corrosive effects of inequality are going seriously mainstream."9 Wilkinson was a keynote speaker at the High Level Meeting on Wellbeing and Happiness at the UN in New York in April 2011, which resulted in UN resolution 65/309 Happiness: towards a holistic approach to development, which recognised that "gross domestic product...does not adequately reflect the...wellbeing of people in a country"

In terms of UK policy impact, The Spirit Level has perhaps been most influential in the establishment and outcomes of local Fairness Commissions.10 Since 2010, twelve Local Authorities, (Birmingham, Blackpool, Islington, Leicester, Liverpool, Newcastle, Newport, Portsmouth, Sheffield, Southampton, Tower Hamlets, York) have established `Fairness Commissions', to investigate and implement ways of reducing inequality in their areas such as recommending and campaigning for, the payment of a Living Wage. Wilkinson was a Commissioner for Islington and York, and Pickett for York. All Fairness Commissions cite The Spirit Level as inspiration for their formation and objectives and all that have reported so far support the implementation of a Living Wage and pay ratios. Pickett was appointed in July 2013 to the independent Living Wage Commission. The Spirit Level also influenced the High Pay Commission,11 and the UK Drug Policy Commission.12

The Equality Act which received Royal Assent in 2010 included a duty that local and national public bodies must `have regard to the desirability of reducing socio-economic inequalities' in their decision-making. The Spirit Level was cited in the Lords debate.13 Introducing the Equality Bill, the then Labour Government's Equalities Office quoted The Spirit Level in support of the socio-economic duty.14

In addition, The Spirit Level has been cited in numerous policy documents, including: Fair Society, Healthy Lives: The Marmot Review http://www.ghwatch.org/; Global Health Watch 3 http://www.ghwatch.org; Action for Children, Backing the Future: Why Investing in Children if Good for Us All http://www.ncw.gc.ca/l.3bd.2t.1ils%40-eng.jsp?lid=433; WHO Europe, Mental Health and Resilience in Europe www.mentalhealth.org.uk/publications/mh- resilience-inequalities/; WHO Europe, Addressing the Social Determinants of Health: the Urban Dimension and the Role of Local Government.
http://www.euro.who.int/data/assets/pdf_file/0003/145686/HCP_Liege_09- SocDem_government.pdf ; Canadian National Council of Welfare, The Dollars and Sense of Solving Poverty http://www.ncw.gc.ca/l.3bd.2t.1ils%40-eng.jsp?lid=433;TUC, Fairness and Prosperity https://www.tuc.org.uk/tucfiles/49/FairnessandProsperity.pdf; New Economics Foundation, The Great Transition http://www.neweconomics.org/publications/great-transition Demos, Reinventing the Firm http://www.demos.co.uk/publications/reinventing-the-firm The Children's Society The Good Childhood Report http://www.childrenssociety.org.uk/what- wedo/research/initiatives/good-childhood-inquiry/buy-book

Sources to corroborate the impact

  1. See for example: Wilkinson R, Pickett K. Inequality: it's not the politics of envy. The Common Good, Summer 2008, issue 198, page 12. Pickett K, Wilkinson R. Inequality rise is to blame for `broken society.' Yorkshire Post, 12 Mar 2009. Wilkinson R, Pickett K. Poverty is not the problem. Church Times, 27 Mar 2009. Pickett K, Wilkinson R. Child wellbeing and income inequality in rich countries. Poverty 2009; 133:6-9. Wilkinson R, Pickett K. Equality of what? Runneymede Quarterly Bulletin, June 2009; 358: 5. Pickett KE. Health and wellbeing. In: Deprivation and Risk: The Case for Early Intervention. Action for Children, London, 2010. Pickett KE, Wilkinson RG. The Spirit Level: Why The American Service Sector Is All About Servitude. Huffington Post, 2010. http://www.huffingtonpost.com/kate-pickett/the-spirit-level- why-the_b_478313.html. Wilkinson R, Pickett K. In defence of equality. Prospect, 2010. Kate Pickett on the nation's health — why can't we close the gap between rich and poor? http://scienceblog.cancerresearchuk.org/2010/09/21/kate-pickett-on-the-nations-healt-why- cant-we-close-the-gap-between-rich-and-poor/. Wilkinson R, Pickett K. Mind the many gaps... New Scientist 16 April 2011.
  2. Cameron D. Hugo Young Lecture. 2009 10 Nov. http://www.respublica.org.uk/item/ResPublica-mentioned-in-Camerons-speech-ggtc
  3. Milliband E. What this country needs is Labour with a new vision. New Statesman 2010 Aug 26. http://www.newstatesman.com/uk-politics/2010/08/labour-movement-society-party
  4. Devichand M. The Spirit Level: Britain's new theory of everything? BBC News Radio 4 2010 12 Oct. http://www.bbc.co.uk/programmes/b00v6lkp
  5. My Fair London. Plan of Action for a Fairer London: A challenge to candidates for Mayor of London from London Equality Group. www.myfairlondon.org.uk/plan-of-action/2012
  6. House of Commons Debates Hansard 19 Oct 2009 (pt 0012), 6 Apr 2010 (pt 0005), Lords Hansard text 5 Jan 2010 (pt 0011), 2 Jun 2010 (p t0007). www.publications.parliament.uk/
  7. Lagarde C. Speech at World Economic Forum, Davos. 2013 23 Jan. http://www.imf.org/external/np/speeches/2013/012313.htm
  8. Moon B-K. Remarks at informal General Assembly Thematic Debate on Inequality. http://www.un.org/apps/news/infocus/sgspeeches/statments_full.asp?statID=1918#.UfDb943E PO4: United Nations, 2013.
  9. Krugman P. Economics of marginalization and hopelessness. New York Times 2012; 12 May.
  10. Sillett J, O'Donnell C. Fairness Commissions. Policy Briefing. London: Local Government Information Unit, 2013.
  11. High Pay Commission. Cheques with balances: why tackling high pay is in the national interest. London: High Pay Commission, 2011.
  12. UK Drug Policy Commission. A fresh approach to drugs. London: UK Drugs Policy Commission, 2012: www.ukdpc.org.uk/publication/a-fresh-approach
  13. The Lord Bishop of Chester. Speech in House of Lord's debate. Lords Hansard 15 Dec 2009, col 1449.
  14. Department for Culture, Media & Sport and Government Equalities Office. Creating a fairer and equal society. https://www.gov.uk/government/policies/creating-a-fairer-and-more-equal-society, 30 Apr 2013