There isn't a typical epidemiologist. Some of
us work investigating local outbreaks of disease; some describe the
health of the population; others do research and teaching.
Epidemiology is the study of the distribution and
determinants of health and disease in populations rather than
individuals. I'm Professor of Epidemiology at the
University of York. I do some teaching, but most of my time is
spent on research. I work at home some days, usually when I'm
writing. At the university, I'll be mostly meeting with colleagues,
analysing and interpreting data, or designing new projects.
When I left university after studying
anthropology, I moved to the US to study nutritional
sciences. I thought I would have a career working with the most
disadvantaged. I thought I would spend my life involved in research
and policy aimed at solving malnutrition in the poorest countries
of the world. I thought America and the UK didn't need me.
But it didn't take me long to realise that the
US, despite spending more per capita on health care than
any other country in the world, had developing-world levels of
health and social problems in many areas.
There was no need to travel to Africa, South America, or
Asia to study infant mortality, stunting, or hunger. They
were there on the doorstep. That was a real shock to me. I find
myself deeply shocked to know how many people are hungry in the UK
now.
In 2003, I moved back to England and began working with
Richard Wilkinson, the pioneering epidemiologist
researching income inequality. We began to look at a wider range of
health and social problems, theorising that, if a bigger gap
between rich and poor leads to more health problems through
psychosocial pathways, then other social ills should also be
increased.
We wrote The Spirit Level to try and
communicate these important findings to a wider audience
than the small group of academics who were reading our research
papers.
There is a paradox about health in rich
societies. There's no association at all between average
levels of income, or spending on health care, and life expectancy
in rich countries. Yet within each of those countries there is a
strong gradient in health by income. In the UK, you can expect to
live about eight years longer if you live in the wealthiest areas
rather than in the poorest.
What this shows is the importance of relative social
status for health. It's not your wealth that protects
health, but the status and social benefits - including a good early
childhood and positive social networks - that go with it.
There's also a powerful tendency for more unequal
societies to become socially dysfunctional, to have more
violence, higher teenage birth-rates, worse child well-being, more
people in prison, lower educational achievement, and lower social
mobility. There's less trust and social cohesion in more unequal
societies.
Economists and environmentalists are now showing that
inequality is bad for economic growth and stability, and
for the development of sustainable economies. Evidence suggests
that inequality has a powerful causative role, increasing
status-anxiety and people's insecurity and downward prejudice.
Research shows that most people value greater
equality; but they are woefully unaware of how unequal
their societies actually are. They underestimate the gap between
rich and poor, while at the same time wishing it to be smaller.
When Americans were shown unlabelled representations of the income
distributions of the US and Sweden, an overwhelming majority
preferred the Swedish income-distribution. I don't think we are
"content" with inequality, but we're not given a lot of information
on how unequal our societies are, and how much better some others
do.
I think our work has done a lot to open up a debate on
inequality and fairness. A lot of politicians and
policymakers will now discuss inequality, which is a step in the
right direction. Many local authorities in the UK have established
Fairness Commissions, which have made practical recommendations to
reduce local inequality.
Our current government is enacting policies and laws
that have put the greatest burden of economic crisis on to the
shoulders of the poor, and this is obviously moving in the
wrong direction. But social movements take time, and at least the
debate and conversations have started. We listen to the
Today programme every morning, and hear about teenage
births, imprisonment, hunger. . . No one ever mentioned inequality.
Now we do hear inequality mentioned; so it is a first step.
After the 43 bishops signed the letter calling on the
Government to step back from cuts to welfare, the Church
feels very much an ally. Archbishop Sentamu sponsored the York
Fairness Commission, and has been bravely outspoken on this issue.
Other faith groups have also been supportive, including Quakers and
Methodists. All of the world's major faiths say important things
about equality, fairness, compassion, and human community; so our
work provides empirical support for these tenets.
Most recently, we have been working with the royal
government of Bhutan, whose focus on well-being is
informed by their Buddhist faith and culture. We're working with a
lot of colleagues from across the world - environmental scientists,
people who are interested in well-being and economics - and
reporting to the United Nations next year.
The previous King said, rather flippantly, that Bhutan
is more interested in Gross National Happiness than GDP.
They have made Gross National Happiness central to all of their
policy-making; so the UN asked them to lead on this new development
paradigm because they'd shown such different leadership.
Happiness is perhaps what we mean by
"well-being". It includes health, community vitality,
ecologi-cal resilience, use of time, culture, social support,
political participation. It's very hard to achieve all of those
things without some degree of equality.
We're writing a new book, much more about the
individual experience of inequality - pathways from inequality to
poor health and other outcomes.
I had so many ambitions, including joining the
army because of a comic-book heroine I admired, being a ballet
dancer, and that sort of thing. But I was brought up to think hard
about how to make a useful contribution to society, and with values
that would have made it difficult for me to focus only on money or
status.
Nobody has had more influence on me than
Richard. Nobody has thought for longer or more creatively
about inequality, and I feel honoured to share my personal and
working life with him. We are married now.
Having my children, Harry and Bronwen, now aged
21 and 18, probably had the biggest impact on my life. Children
make you see the world differently. You want to make it a better
place for them; and you feel connected to children and families
everywhere, and want to make things better for them, too.
I regret working too hard, always, and feeling
torn between causes.
I'd like to be remembered for having been part of a
movement that shifted the world towards well-being,
community, sustainability, and equality, instead of focusing on
individualism, money, and status.
I read voraciously. Fiction has always opened
up new worlds, but I admire all those who can communicate complex
ideas in simple ways.
In the Bible? The rich man, the camel, and the
eye of the needle.
I love the sound of our cat Molly's scratchy
purring.
I get angry hearing politicians, journalists, and
internet commentators refer to some of the poorest and
most vulnerable in our society as "shirkers", "scroungers" and
"scum".
I'm happiest cooking for friends and family,
and walking in the hills.
I don't pray, but I try to practise
mindfulness; so I can be well enough to keep working hard.
I'd like to be locked in a church with Barack
Obama. I'd encourage him to be bold and confident in his
leadership. He could do so much to create a more equal society, and
that would encourage other leaders to do the same.
Professor Pickett was talking to Terence Handley
MacMath.
The Spirit Level: Why equality is better for everyone by
Richard Wilkinson and Kate Pickett is published by Penguin (£10.99
(CT Bookshop Use code CT618
£9.90); 978-0-241-95429-4).