The social class determinants of income inequality and social cohesion.
ABSTRACT The authors argue that Wilkinson's model omits important variables (social class) that make it vulnerable to biases due to model mis-specification. Furthermore, the culture of inequality hypothesis unnecessarily "psychopathologizes" the relatively deprived while omitting social determinants of disease related to production (environmental and occupational hazards) and the capacity of the relatively deprived for collective action. In addition, the hypothesis that being "disrespected" is a fundamental determinant of violence has already been refuted. Shying away from social mechanisms such as exploitation, workplace domination, or classist ideology might avoid conflict but reduce the income inequality model to a set of useful, but simple and wanting associations. Using a nonrecursive structural equation model that tests for reciprocal effects, the authors show that working-class position is negatively associated with social cohesion but positively associated with union membership. Thus, current indicators of social cohesion use middle-class standards for collective action that working-class communities are unlikely to meet. An erroneous characterization of working-class communities as noncohesive could be used to justify paternalistic or punitive social policies. These criticisms should not detract from an acknowledgment of Wilkinson's investigations as a leading empirical contribution to reviving social epidemiology at the end of the century.
Article: Rational Choice and Class VotingRationality and Society - RATION SOC. 01/1994; 6(2):243-270.
- [show abstract] [hide abstract]
ABSTRACT: Wilkinson's "income inequality and social cohesion" model has emerged as a leading research program in social epidemiology. Public health scholars and activists working toward the elimination of social inequalities in health can find several appealing features in Wilkinson's research. In particular, it provides a sociological alternative to former models that emphasize poverty, health behaviors, or the cultural aspects of social relations as determinants of population health. Wilkinson's model calls for social explanations, avoids the subjectivist legacy of U.S. functionalist sociology that is evident in "status" approaches to understanding social inequalities in health, and calls for broad policies of income redistribution. Nevertheless, Wilkinson's research program has characteristics that limit its explanatory power and its ability to inform social policies directed toward reducing social inequalities in health. The model ignores class relations, an approach that might help explain how income inequalities are generated and account for both relative and absolute deprivation. Furthermore, Wilkinson's model implies that social cohesion rather than political change is the major determinant of population health. Historical evidence suggests that class formation could determine both reductions in social inequalities and increases in social cohesion. Drawing on recent examples, the authors argue that an emphasis on social cohesion can be used to render communities responsible for their mortality and morbidity rates: a community-level version of "blaming the victim." Such use of social cohesion is related to current policy initiatives in the United States and Britain under the New Democrat and New Labor governments.International Journal of Health Services 02/1999; 29(1):59-81. · 1.24 Impact Factor
- American Sociological Review. 01/1993; 58(2):182-196.
Inequalities in Health
THE SOCIAL CLASS DETERMINANTS OF INCOME
INEQUALITY AND SOCIAL COHESION
Carles Muntaner, John Lynch, and Gary L. Oates
The authors argue that Wilkinson’s model omits important variables (social
class) that make it vulnerable to biases due to model mis-specification.
Furthermore, thecultureof inequality
determinants of disease related to production (environmental and occupational
hazards) and the capacity of the relatively deprived for collective action. In
of violence has already been refuted. Shying away from social mechanisms
such as exploitation, workplace domination, or classist ideology might avoid
conflict but reduce the income inequality model to a set of useful, but simple
and wanting associations. Using a nonrecursive structural equation model that
tests for reciprocal effects, the authors show that working-class position is
negatively associated with social cohesion but positively associated with union
membership. Thus, current indicators of social cohesion use middle-class
standards for collective action that working-class communities are unlikely to
meet. An erroneous characterization of working-class communities as
noncohesive could be used to justify paternalistic or punitive social policies.
These criticisms should not detract from an acknowledgment of Wilkinson’s
investigations as a leading empirical contribution to reviving social
epidemiology at the end of the century.
I. FURTHER COMMENTS ON WILKINSON’S REPLY
What follows is several comments on Richard Wilkinson’s reply (1) to our
article (2) on his “income inequality and social cohesion” model (3). Wilkinson’s
reply spans a review of findings on income inequality and health, an expansion of
This work was supported by funds from NIH and CDC, project numbers Z01 MH02610-04,
Z01 MH02610-05, U48/CCU310821, and the Benedict Foundation (Dr. Muntaner).
This article is in two parts: part I by Drs. Muntaner and Lynch; part II by Drs. Muntaner, Oates,
International Journal of Health Services, Volume 29, Number 4, Pages 699–732, 1999
© 1999, Baywood Publishing Co., Inc.
his hypotheses on the relation between social cohesion and health, and a reply to
some of our criticisms. Because Wilkinson does not respond to a number of
issues we raised—for example, international dependency as determinant of
national income inequality; the role of political factors as determinants of income
inequality and population health; exploitation as explanation for income
inequalities; the need for formal definitions of social cohesion, functional forms
of its relation with health, and the exchange aspect of social cohesion (its
potential negative effects on health); the social psychology and the ethology of
social cohesion; the impact of income inequality among individuals in different
class locations; the policy implications of current research programs on social
cohesion; and the systemic approach to social inequality—we direct the reader to
the original article (2) and we concentrate here on Wilkinson’s reply.
Thus, we provide new arguments for incorporating social class in models of
social inequalities in health; we critically examine the support for the
psychological hypotheses that Wilkinson proposes as proximal determinants of
health; we challenge the notion that research on income inequalities per se
generates support for reducing social inequalities; and we provide a
philosophical framework that reveals some fundamental differences between the
“income inequality/social cohesion” model and other models of social
inequalities in health. Because Wilkinson criticizes us for not providing data1in
our analysis on the role of social class in his model (“a bald assertion that is
simply a matter of changing class relations” (1, p. 539)), we provide empirical
evidence in part II of this response. In part II we show that social cohesion is
shaped by class relations, and that Wilkinson’s measurement of social cohesion
excludes working-class forms of collective action.
Wilkinson’s reformulation of his income inequality, social cohesion, and
health model still does not explain the origins of income inequality (1). In
our previous critique (2) we proposed a series of economic and political
determinants of income inequality, and we addressed the public health
implications of placing this artificial boundary in the problem being analyzed.
Thus, omission of economic and political variables that might have an impact
on income inequality and population health may lead to biased estimates of
the aggregate relationship between income inequality and mortality rates. The
field of international studies, where social class and income inequality
700 / Muntaner, Lynch, and Oates
Epidemiologic pragmatism (e.g., as in “race” or “income” categories without hypotheses)
defends itself against realism (a synthesis of rationalism and empiricism) with accusations of “lack of
data.” However, more data on “race inequalities in health” do not provide any explanation and
precisely function as a deterrent of serious investigations on economic, political, and cultural racism
are considered predictors of democratization (rather than health), provides a
precedent for the current debate in public health. Following Bollen and
This omission [of direct measures of class structure] creates grave
problems in interpreting the coefficient estimate for income inequality.
The omitted variables are probably correlated with both income inequality
and political democracy, so the coefficient for income inequality is
biased. . . . Thus, although the coefficient estimate for income inequality
may indicate the operation of unspecified aspects of the class structure,
the exclusion of direct measures of the class structure means that we
cannot judge which particular classes play key roles in the process of
For example, even crude dichotomous class categories can account for 25 percent
of earnings inequalities as measured by the Theil Index (6).
A second methodological problem originates in Wilkinson’s interpretations of
these macro correlations (3). Ecological correlations of income inequality and
mortality or morbidity rates could emerge at the aggregate level even if income
inequality per se had no impact on individual mortality or morbidity risk (7).
Recently, though, with the incorporation of methods that take into account the
clustering of individuals into larger social units (8, 9), Sobaader (10) and
Kennedy and colleagues (11) have provided evidence that income inequality
indeed has an effect on individual health risk. However, in these studies, the
strength of the association between income inequality is lower than typically
reported by Wilkinson (3). This is in part due to the addition of aggregate (e.g.,
county poverty and absolute income) and individual level (e.g., income)
covariates (10) and to the fact that the strength of the relation between income
inequality and health depends on the level of aggregation (10). For example, the
effect of census tract income inequality on individual risk of anxiety disorders
can be weak because race and class segregation makes neighborhood incomes
homogeneous (12).2This is an instance where knowledge of political and
economic mechanisms, those that generate segregation above the neighborhood
level, is necessary to choose the appropriate level of aggregation to test for
income inequality effects.
Social Class and Income Inequality / 701
Multilevel analyses, though originally developed to estimate contextual effects, can be used to
emphasize the effects of individual behavior on health (e.g., 13). In fact, survey methods, because they
cannot measure the contextual nature of individual behavior itself, place the real limit on teasing apart
“individual” and “social context” contributions to individual health.
On “Misconceived Materialism,” “Outmoded Prejudices,”
and Other Red Scares
Wilkinson (1) states that our example on the recent increases in mortality in
the former Soviet Union (2) implies an endorsement of the centrally planned
economy that characterized that country before the “merchant capitalist” period
of the 1990s. We find this inference unjustified. Our point is that a sudden change
in the class structure (i.e., a political and economic change) had a major effect on
the health of its population (14). We did not deal with the potential causes of
declining population health since the mid-1960s, a phenomenon that we
acknowledged, however (2). Increased exploitation, which can exist in centrally
planned economies (1; see Economic Subsystem in 2, p. 73), could account for
this decline. The political oppression of labor organizations in the Soviet Union,
which Muntaner and Llorente (15) noted almost two decades ago, could also
account for that trend. In fact, because Wilkinson’s population health model calls
for reducing income inequality but leaves intact class relations, it gives implicit
support to any social system that reduces income inequalities regardless of
its class structure (e.g., the Soviet Union’s state socialism or the new example
(1, pp. 537–538)). On the other hand, the implications of a class exploitation
model (2) lead to the implicit rejection of both these social systems despite their
relative success in reducing income inequality. With regard to “misconceived
materialism” (1, p. 540), our example of a class system (2, Appendix) shows that
there is no manual/nonmanual labor distinction. Neither do we have any “out-
moded prejudice”3against psychosocial factors affecting health (16–18). The
issue is that psychosocial factors need to be integrated with social relations rather
than approached as isolated individual perceptions of relative inequality position
(17; see below).
Social Class: Relational and Stratified
Wilkinson states that class is mostly determined by income differences, mak-
ing class de facto an attitudinal response of individuals to their relative position
in the distribution of income. This framework does not specify where income
comes from, which is ultimately from production, as value is ultimately created
from labor, not the other way around (19). Similarly, the thought experiment pre-
sented by Wilkinson (1, p. 537) is unrealistic because he does not detail the rela-
tions of production in that society, only unequal distribution of incomes. As we
showed earlier (2, Appendix), a mere statement about lack of ownership (a legal
702 / Muntaner, Lynch, and Oates
Wilkinson's preoccupation with novelty often makes him overlook previous research. See the
section “Psychology in a Social Vacuum,” below.
criterion) does not describe the economic and political processes that take place
in the production of goods and services.
Contrary to Wilkinson’s interpretation, the presented class framework (2, p.
73) is not dichotomous (e.g., capitalist vs. worker) but integrates class relations
within a continuum. Muntaner and his collaborators have conducted several stud-
ies that show associations between relational/stratified class indicators and health
(e.g., wealthy capitalist, poor capitalist; large capitalist, small capitalist; worker,
manager; supervisor, worker) (4, 17, 20–22). Wilkinson is correct when he points
out that Boswell and Dixon’s rate of surplus value uses income (23). However,
theories of exploitation provide social mechanisms for the emergence of eco-
nomic inequality beyond income (e.g., wealth) and yield multiple measures that
are empirically distinct from income inequality (e.g., according to the role of
business services, depreciation, or benefits and pension plans in the calculation
of the rate of surplus value (24)). Therefore, the rate of surplus value is preferable
to catch-all income inequality indicators that do not specify social mechanisms
(24). Similarly, measures of “SES” (socioeconomic status) are strong predictors
of health outcomes but explain little (17), while its component indicators (occu-
pational stratification, income, educational credentials) are interrelated through
different social mechanisms (e.g., status attainment, inter- or intra-generational
mobility, age, labor markets, institutions) (eg., 25) and have unique effects on
PSYCHOLOGY IN A SOCIAL VACUUM:
WILKINSON’S CULTURE OF INEQUALITY
Wilkinson’s culture of inequality fulfills the urgent need for explaining the
micro effects of social inequalities. This is yet another instance where class anal-
ysis provides a more encompassing framework than the “income inequality and
social cohesion model.” The task of class analysis is precisely to understand not
only how macro structures (e.g., class relations at the national level) con-
strain micro processes (e.g., interpersonal behavior) but also how micro pro-
cesses (e.g., interpersonal behavior) can affect macro structures (e.g., via collec-
tive action) (27).
Wilkinson is certainly correct in addressing the lack of research on the psycho-
logical effects of inequality. While there is a substantial scholarship on the psy-
chology of racism and sexism, little research has been done on the effects of class
ideology (i.e., classism). This asymmetry could reflect that in most wealthy dem-
ocratic capitalist countries, income inequalities are perceived as legitimate while
gender and race inequalities are not (4). Most work on the psychology of inequal-
ity and classism has been qualitative (28–32). Most of these ethnographies, as
well as some recent empirical studies (33, 34), point to the relational aspects of
classism (e.g., the educated upper middle class holding views of inferiority about
the working class or its most deprived elements).
Social Class and Income Inequality / 703