The Spirit Level. Why Equality is Better for Everyone

Do politicians read books? It might be a better World if more of them read The Spirit Level, especially this updated version which responds to some of the partisan attacks on the original, 2009 edition. Interestingly, after the August 2011 riots in England, many commentators mentioned The Spirit Level in their reactions: crime and the breakdown of trust within communities are predicted by widening income inequalities. When the present, patrician government referred to a “Feral Underclass Cut Off From Society” one letter to The Guardian (Wood, 2011) noted they had coined a new acronym: FUCOFS.

For readers with an interest in public mental health, the prevalence of anxiety, depression and drug use disorders are predictable from social inequalities, as are other health issues like teenage pregnancy or obesity. All the important regression calculations in this book relate to developed (industrialised) countries – the authors discuss briefly the problems of absolute poverty (i.e. destitution) within poor countries, but their “big idea” is clearly aimed at policy‐makers in the UK and USA. It is a pretty big idea, one that covers a wide range of behaviours from recycling to homicide! Most of the data they present is associated with inequalities in Income (because International comparisons are practical using this measure), but a minor weakness of this book is that evidence from other researchers suggests a similar health impact from other measures of “status” such as levels of education or employees' perceived control over their work.

Sadly, for this edition, partisan politics is again seeking to attack the significance of widening inequalities in the UK: the tell‐tale marker for ill‐informed attacks is that they refer to “poverty” (Driscoll, 2011) rather than the book's actual topic, equality.

Overall, I would strongly recommend The Spirit Level as thought‐provoking reading for graduate students such as those doing a Masters in Public Health. At the recent conference “Health and Wellbeing – the 21st Century Agenda” (RSPH, 2011) Michael Marmot summed up the need for change well:

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  Social injustice is killing people on a grand scale. A toxic combination of bad policies, economics and politics, is in large measure responsible for the inequalities in health that we see.