Sapolsky

Malcolm Young: “One of the things you write about, a few times, inequality, just how destructive and damaging inequality is. It’s a major public health crisis for us.”

Robert Sapolsky: “It certainly is. It’s a massive one. Scientific American has an issue coming out on inequality in the United States and I have an article in there on the health effects of it. When you look at the upper 10 percentile of income in this country and the bottom 10 percentile, life expectancy difference is more than 20 years. This is the scale of difference between Bethesda, Maryland and Angola. When you look at these issues there it’s just an enormous, enormous difference. Virtually every disease out there from cardiovascular, to psychiatric, to gastrointestinal, to inflammatory etc. show a socioeconomic gradient. The further you are down the SES (Socioeconomic Status) ladder, the worse your health. The more prevalence of disease, the worse the impact it has. And what’s been one of the most striking things, like incredibly smart people have been studying this for 50 years, why you see an SES gradient in every westernized country that’s been examined. So obvious answer poor people have less access to health care. That doesn’t explain it in the slightest because you see the gradient in countries with socialized medicine, universal health care, and you see the gradient for diseases where it doesn’t matter how many doctors checkups you get it doesn’t affect the incidence of juvenile diabetes and still you get the gradient. Ah ok, it’s because poor people have higher rates of smoking, higher rates of drinking to excess, higher rates of imprudently living next to toxic waste dumps, you control for those, that explains only about a third of the variability. Ah, poor people can’t afford to have the protective factors. You don’t get the vacations, you don’t get the health clubs, you don’t get, that explains a tiny percentage of the variability. What’s it’s about is the psychological stress of being poor. And the best evidence for that is it’s not so much being poor, it’s feeling poor. This was work pioneered by Nancy Adler here at UCSF looking at people’s objective socioeconomic status vs subjective. How do you feel you’re doing compared to other people? And it turns out your subjective SES is a better predictor of your health than your objective. It’s not being poor, it’s feeling poor. And what is it that is the surest way of making the poor feel poor? Rubbing their noses in it. Work by a guy named Richard Wilkinson in the UK showing income inequality, independent of absolute levels of income, is the thing that drives the socioeconomic gradient. It’s not being poor. It’s being poor surrounded by the haves and being reminded of it over and over. So the final piece of that is work done by a guy at Harvard Public Health named Ichiro Kuwachi who’s shown what happens when you have high degrees of income inequality in a community, social capital goes down. People stop trusting each other. People stop having a sense of efficacy. ‘Social capital’, this is this term that sociologist Robert Putnam came up with, with this sort of famous book of his encompassing this notion of bowling alone. The number of people in the United States who bowl has been climbing for years. The number of people who are in bowling leagues has been plummeting, social connectedness, that is the metaphor for it. And you want to study vast amounts of social capital, you ask two questions of people in a community: ‘On the average can you trust people or not?’ And ‘How many organizations do you belong to?’ And it turns out when income inequality goes way up what happens is people stop trusting each other. Their trust is built around symmetrical reciprocating relationships, and by definition, what a steep hierarchy does is make it impossible to have easy symmetrical relationships because there’s less symmetry. The second question you ask people ‘How many organizations do you belong to?’, because when inequality becomes rampant tenant unions unions don’t work very well. People don’t bother joining unions of any sort. People don’t join organizations because you have no sense of collective efficacy. Those are the mediators. So it’s not so much being poor, it’s feeling poor. Which consists of being reminded of it by inequality because you then wind up in communities that are less healthy, less safe, less kind, less generous, and that winds up being the mediator for that. And that one’s a catastrophe.