A Good News Story: Close the Gap

Richard Wilkinson observes, “we had always regarded classification by social class as simply a proxy for the real determinants of health that we saw that we imagined were material factors – like diet and what you’re working with and what you’re exposed to at work and maybe housing, air pollution, things like that. Now it looks more and more like social status itself is an important determinant of health. There is now a growing realization that most health issues are caused, or worsened, by poverty and inequality.”1 In countries like the UK and America, people in richer areas can live up to 14 years longer than people in poor areas. Research shows health is responsive to changes in income, and that the death rates of the poor are more responsive to changes in income than the death rates of the rich are. Effective interventions would create a good news story.

Themistocles, concerned that the majority of the Greek allies wanted to retreat, sent a messenger to Xerxes to inform him that the Greek army was in disarray and with a prompt attack they might at once be destroyed. Shortly, Aristicidas appears and informs the council they are unable to sail away as the enemy surrounds them on all sides. To this Themistocles replies, “you have brought good news” as the Greeks were unwilling to fight are now compelled. The battle was therefore inevitable in the place which Themistocles, with the audacity of a genius, has forced on his fellow citizens. The Battle of Salamis was one of the most significant naval battles in ancient Greece, between the Greek city-states and their perpetual enemy, Persia. The defeat at Salamis shifted the war in Greece’s favor, and led to Persia’s ultimate demise. Many historians agree that the Battle of Salamis was the single most important battle of ancient Greece and potentially of all human history. This victory influenced the growth and preservation of Athenian democracy and influenced Western civilization’s core ideas of freedom and individual rights.

The ‘free marketplace’ is a grand illusion for those in power to promote in order to justify dominance over those who are less privileged. Today ‘positive self-image’ is linked to a fundamentalist (i.e. must not and hence can not be questioned) belief: the benefits of trickle-down economics of tax cuts for the rich creates well-paying jobs for the middle class The idea is simple: The more money the people on top make, the more the people below will benefit from the dripping down of that prosperity. The hidden agenda here, of course, is the rationalization of inequality. By linking the welfare of working-class Americans directly to the prosperity of the rich, the neoliberals protect the insulated interests of corporations and the wealthy without the fear of backlash. Society pays a price for inequality. There is an association between health inequality and the huge social-class differences in death rates between rich and poor, between well educated and badly educated, between people in rich and poor areas.

The myth of the market as an evolutionary device serves as an explanation and a justification for, the presence of competition in all parts of social activities. The market was replaced with competition as the defining character of human relations including redefining individuals as consumers. Freud described the reality principle, the ability to evaluate the external world and differentiate between it and the internal world. The reality principle strives to satisfy the id’s desires in realistic and socially appropriate ways. In neoliberalism the reality principle is replaced by the performance principle. The performance principle presupposes particular forms of rationality for domination that stratifies society according to the competitive economic performance of its members. Domination is exercised by a particular group in order to sustain and enhance themselves in a privileged position. The neoliberal performance principle teaches us to conceive of social problems as personal problems – emphasizing individual responsibility while failing to address systemic state violence in all its manifestations – healthcare, education and the war on the poor.

Epigenetics is about integrating genes, the organism and the environment. From believing that our biological fates were written in our genes, we now recognize that the environment, and more specifically our perception of the environment, directly controls our behavior and genetic activity. Individuals are much more sensitive to exposures from their environment, diet and lifestyles than previously thought. Epigenetic marks or ‘imprinting’ affect gene expression without actually changing the DNA sequence. There is substantial evidence from animal and man demonstrating that both transient and more long-term epigenetic mechanisms have a role in the regulation of the molecular events. The dynamic nature of epigenetics means this is not written in stone – healthy eating, moderate exercise and minimizing stress will have a positive epigenetic effect.

Telomeres are the caps at the end of each strand of DNA that protect our chromosomes, like the plastic tips at the end of shoelaces. Without the coating, shoelaces become frayed until they can no longer do their job, just as without telomeres, DNA strands become damaged and our cells can’t do their job. For example, the immune system, which normally weakens as we age, is highly sensitive to shortening of telomeres. Many studies have shown that a group of highly stressed people have much shorter telomeres than less stressed people. Scientists believe that the key to understanding racial, ethnic and socioeconomic health inequalities lies in studying the connections between social conditions and biological mechanisms like telomeres.

It is now known that genetic change can occur much more quickly than previously thought, responding from messages coming from other genes, hormones, and from nutritional cues and learning. The news that the epigenome is highly sensitive and responsive to environmental influences, including toxic exposures, dietary factors, and behavioral impacts, serves to focus future state priorities. How we develop mentally and physically have a tremendous impact upon our inherent capabilities and our set of life options. Epigenetics explains how environmental factors can switch genes on and off, based on choices we make. As the environment can influence our genes, lifestyles can impact the expression of our genes. Early studies show an association between epigenetic marks (in the human genome) and socio-economic status.

Paul Piff observes, it’s really the people who feel subjectively lower on the social ladder or who are objectively poorer, who experience all the negative outcomes, whether it’s higher rates of obesity, or increased cardiovascular disease, or higher rates of depression. Inequality and differences in people’s levels of wealth shape the mind, shape the way people see the world and behave towards one another. Status, inequality, stratification, shape the basic things people do, like their tendencies to feel compassion, their tendencies to cooperate with others. A person’s levels of wealth, and their status relative to others in their society, shape their tendencies to prioritize themselves, feel entitled, to cooperate versus behave in self-interested ways, across a variety of different domains of social life.1

Wilkinson observes while the biggest effects of inequality are lower down in the social ladder, it looks as if increases in inequality are actually bad for the group as a whole. Simply, people on the bottom of the social ladder are affected more than people further up because inequality changes the whole social milieu. That social status itself was a really important determinant of health, was really confirmed from work on non-human primates. In these studies social status of non-primates was manipulated by moving animals between groups, and you could give them the same material conditions and feed them the same diets. Researchers saw that the stress effects of social status in those animals had remarkable parallels to social status changes under remarkably similar effects to what were observed associated with social status in human beings.

Social mobility isn’t actually randomly distributed across society; it’s actually concentrated in a particular subgroup, and in particular it’s concentrated among those who are already fairly high up in the hierarchy. Ranking systems are about whether we fight each other for access to basic necessities and status and power, while social status is recognizing each other’s need and share access that leads to friendship and reciprocity. Inequality pushes us away from the reciprocity towards competitive striving for personal, individual advantage, not recognizing the other’s needs. The fundamental issue is whether we fight each other for access to basic necessities, or whether we recognize each other’s need and share access. Ranking systems, which are about self-interest, and the sense of entitlement, get in the way of reciprocity and people coming together.

Neoliberal ideology today defines the social relationships of poor people and the attitude towards them that supports an economic system that creates inequality. Inequality is about dominance and looking after yourself, often at other people’s expense. While one finds the biggest effects of inequality are lower down in the social ladder, but it looks as if the vast majority of the population is adversely affected by increases in inequality. With each step up the inequality ladder, bigger income differences between rich and poor, the worse a country did in terms of life expectancy. Today’s trickle-down economics ensures the next generation in the workplace can not only expect to earn less than their parents, but are on track to enjoy poorer health. The emerging field of epigenetics suggests that by influencing the understanding of inequality it is possible to create a happy trickle-down effect.

Initially it was thought that differences in rates of disease had entirely material causes. Now we realize psycho-social factors mediated by chronic stress act as general vulnerability factors in health. Epigenetic risks explain how environmental factors can switch genes on and off, based on choices we make. We now realize we can change gene expression by the way we think about our lives and ourselves – epigenetic marks are reversible. To achieve the desired change we need to close the empathy gap between those who have and those who don’t. It is not only necessary to battle to close the empathy gap, but also the inequality gap. The resulting improvement in health is an important victory for the whole community. In particular, the substantial change in social status that occurs for the poor would be a good news story.

1 Paul Piff and Richard Wilkinson. What does inequality do to our bodies and minds? A social psychologist and an epidemiologist discuss (6 Aug 2014) http://ideas.ted.com/what-does-inequality-do-to-our-bodies-and-minds-a-social-psychologist-and-an-epidemiologist-discuss/

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