The Spirit Level: Why Greater Equality Makes Societies Stronger (16 page)

A 17-year-old in New Jersey described how being able to buy fast food proves your financial status, shows that you have money in your pocket and are not having to wait for the welfare cheque at the end of the month.

A 37-year-old man said he spent half his wages on fast food. On the day he was interviewed he had been to McDonalds three times and was planning to go to Kentucky Fried Chicken and a Chinese take-out shop before the day was out. But the fast-food restaurants had a meaning for him that went well beyond the cheap food. Despite working, he was homeless and they had become his sanctuary:

He has no home of his own and shuttles between his aunt’s place in Brooklyn and a friend’s apartment in a Harlem housing project [estate]. ‘The atmosphere makes me feel comfortable and relaxed and you don’t have to rush,’ he says as he admires the hamburger restaurant’s shiny floors and the picture of George Washington Carver [a famous nineteenth-century black American] on a wall. Lulled by the soft piped-in music, he nods off for a moment and then adds: ‘ain’t no hip-hop, ain’t no profanity. The picture, the plants, the way people keep things neat here, it makes you feel like you’re in civilization.’

A member of a Hispanic street gang eats all his meals at fast-food restaurants, boasting that he hasn’t eaten a meal at home since he was 16:

Kids here don’t want to eat their mother’s food . . . everyone is tired of their mother’s food – rice and beans over and over. I wanted to live the life of a man. Fast food gets you status and respect.

FAT IS A FEMININE ISSUE?

Our own work, like the studies of other researchers, shows that the relation between income inequality and obesity is stronger for women than for men. In the World Health Organization’s study in twenty-six countries the social gradient in obesity is seen more consistently, and tends to be steeper, for women than for men. In the 2003 Health Survey for England, the positive association between low socio-economic status and obesity is very clear for women but among men there is no association.
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It might be that these patterns result from obesity having a stronger negative effect on social mobility for women, than for men. Maybe obese young women suffer more discrimination in labour markets and the marriage market, than obese young men. Or maybe low social status is more of a risk factor for obesity in women than in men. Two studies within British birth ‘cohorts’ offer some clues. These studies are surveys of large samples of people born at the same time, and followed from birth. A study of people born in 1946 found that upwardly mobile men and women were less likely to be obese than those whose social class didn’t change between childhood and adulthood.
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In the 1970 cohort obese women, but not men, were more likely never to have had gainful employment and not to have a partner.
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In the USA and in Britain, female obesity in adolescence has been linked to lower earnings in adulthood.
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–
132
Although not limited to women, a recent survey of more than 2,000 Human Resource professionals found that 93 per cent would favour a normal-weight job applicant over an equally qualified overweight candidate. Nearly 50 per cent of these professionals felt that overweight people were less productive; almost 33 per cent felt that obesity was a valid reason not to hire somebody; and 40 per cent felt that overweight people lacked self-discipline.
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Although being overweight clearly hampers social mobility, our own analysis of trends within women born in Britain in 1970 suggests that this doesn’t explain the social gradient in obesity among women and, even in middle age, low social class is linked to weight gain.
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YOU CAN NEVER BE TOO RICH OR TOO THIN

Social class differences in the importance of body size and in the body image towards which women aspire also seem to contribute to the social gradient in obesity. In the past, women with voluptuous bodies were much admired, but in many modern, richer cultures, being thin signals high social class and attractiveness. British women in higher social classes are more likely to monitor their weight and to be dieting than women in lower social class groups, and are also more dissatisfied with their bodies.
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Women who move down the social scale seem to place less emphasis on thinness and are more satisfied with their bodies. Changes in marital status also play a role: in a US study, women who married gained more weight than women who remained single or women who divorced or separated.
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And not all women want to be thin – for example in inner-city African-American communities, thinness can be associated with an image of poverty, hunger and being on welfare, as well as AIDS and drug addiction. As one 19-year-old woman put it:

I’ve been a voluptuous female all my life. If I start losing a lot of weight, people will think I’m on drugs . . . in the ghetto, you just can’t afford to look too thin.

Her words are a reminder of the ways in which social class is related to being overweight in the developing world, where only the affluent can afford to be fat. In wealthy countries, it looks as if women in higher social classes are more likely to have aspirations to thinness and be more able to achieve them.

But while women’s body weight may be most affected by social factors, men are certainly not immune. A recent 12-year study of working-age men in the USA found that if they became unemployed, they gained weight.
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When their annual income dropped they gained, on average, 5.5 lbs.

THE THRIFTY PHENOTYPE

One additional idea that suggests a causal link between higher levels of income inequality in a society and higher body weights is known as the ‘thrifty phenotype’ hypothesis. Put simply, this theory suggests that when a pregnant woman is stressed, the development of her unborn child is modified to prepare it for life in a stressful environment. It isn’t yet clear whether stress hormones themselves do the damage, or whether stressed foetuses are less well nourished, or both things happen, but these ‘thrifty phenotype’ babies have a lower birthweight and a lower metabolic rate. In other words, they are adapted for an environment where food is scarce – they are small and need less food. In conditions of scarcity during our evolutionary past this adaptation would have been beneficial, but in our modern world, where stress during pregnancy is unlikely to be due to food shortages and babies are born into a world of plenty, it’s maladaptive. Babies with a thirfty phenotype in a world where food is plentiful are more prone to obesity, to diabetes and to cardiovascular disease. As this book shows, societies with higher levels of income inequality have higher levels of mistrust, illness, status insecurity, violence and other stressors, so the thrifty phenotype may well be contributing to the high prevalence of obesity in them.

THE EQUALITY DIET

It is clear that obesity and overweight are not problems confined to the poor. In the USA, about 12 per cent of the population are poor, but more than 75 per cent are overweight. In the UK, social class differences in women’s obesity can be seen all the way up the social ladder. While obesity affects only 16 per cent of ‘higher managerial and professional’ women, just below them, 20 per cent of lower managerial and professional women are obese. It’s hard to argue in the face of these facts that the obesity epidemic is due to poor nutritional knowledge among the uneducated. In a study of middle-aged British women,
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84 per cent knew they should be eating five fruits and vegetables each day, and another study showed that obese people are better than thinner people at guessing the calorie content of snack foods.
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Another piece of evidence that it’s relative, not absolute, levels of income that matter for obesity comes from studies in which people are asked to describe subjectively their place in the social hierarchy. Researchers show subjects a diagram of a ladder and tell them that at the top are people with the highest status, and at the bottom people with the lowest status, and then ask them to place an ‘X’ on the ladder to mark their own standing. It has been shown that this measure of subjective social status is linked to an unhealthy pattern of fat distribution
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and to obesity
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– in other words, obesity was more strongly related to people’s subjective sense of their status than to their actual education or income.

If we can observe that changes in societal income inequality are followed by changes in obesity, this would also be supportive evidence for a causal association. An example of a society that has experienced a rapid increase in inequality is post-reunification Germany. After the fall of the Berlin Wall, inequality increased in the former East Germany,
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and there is evidence from studies following people over time that this social disruption led to increases in the body mass index of children, young adults and mothers.
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Health and social policies for obesity treatment and prevention tend to focus on the individual; these policies try to educate people about the risks associated with being overweight, and try to coach them into better habits. But these approaches overlook the reasons
why
people continue to live a sedentary lifestyle and eat an unhealthy diet,
how
these behaviours give comfort or status,
why
there is a social gradient in obesity,
how
depression and stress in pregnancy play a role. Because behaviour changes are easier for people who feel in control and in a good emotional state, lessening the burdens of inequality could make an important contribution towards resolving the epidemic of obesity.

*
BMI = weight in kg/(height in m)
²

*
The data on adult obesity within the USA were made available to us by Professor Majid Ezzati from Harvard University School of Public Health. Professor Ezzati bases his calculations of the prevalence of obesity in each state on actual measures of height and weight.

8

Educational performance

Our progress as a nation can be no swifter than our progress in education. The human mind is our fundamental resource.

John F. Kennedy, Special message to the Congress
on Education, 20 February 1961

Across the developed world, and across the political spectrum, everybody agrees about the importance of education. It’s good for society, which needs the contributions and economic productivity – not to mention the tax – of a skilled workforce, and it’s good for individuals. People with more education earn more, are more satisfied with their work and leisure time, are less likely to be unemployed, more likely to be healthy, less likely to be criminals, more likely to volunteer their time and vote in elections.
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In 2006, according to the US Department of Labor, if you had been to high school but didn’t graduate with a diploma, you earned an average of $419 per week. That sum rose to $595 if you had the diploma, up to $1,039 if you’d gone on to college and got a bachelor’s degree, and rose to over $1,200 for an advanced degree.
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THE HOME ADVANTAGE

Although good schools make a difference, the biggest influence on educational attainment, how well a child performs in school and later in higher education, is family background. In a report on the future of education in Britain, Melissa Benn and Fiona Millar describe how:

One of the biggest problems facing British schools is the gap between rich and poor, and the enormous disparity in children’s home backgrounds and the social and cultural capital they bring to the educational table.
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,p. 23}

Children do better if their parents have higher incomes and more education themselves, and they do better if they come from homes where they have a place to study, where there are reference books and newspapers, and where education is valued.
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Parental involvement in children’s education is even more important.