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R. Wilkinson and K. Pickett (2010), The Spirit Level: Why Equality is Better for Everyone. London: Penguin. £9.99, pp. 347, pbk



R.Wilkinson and K.Pickett (2010), The Spirit Level: Why Equality is Better for Everyone. London: Penguin. £9.99, pp. 347, pbk - Volume 42 Issue 4 - CHRISTOPHER DEEMING
Journal of Social Policy
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R. Wilkinson and K. Pickett (2010), The Spirit
Level: Why Equality is Better for Everyone.
London: Penguin. £9.99, pp. 347, pbk
Journal of Social Policy / Volume 42 / Issue 04 / October 2013, pp 840 - 842
DOI: 10.1017/S0047279413000366, Published online: 30 July 2013
Link to this article:
How to cite this article:
CHRISTOPHER DEEMING (2013). Journal of Social Policy, 42, pp 840-842
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840 reviews
study: it is a painful consequence of the lack of attention to the impact of demand and broader
structural aspects of the labour market.
The report, Are ‘Cultures of Worklessness’ Passed Down the Generations?, complements
the book well. Also supported by the Joseph Rowntree Foundation, its meticulous, at times
deadpan, account of the search for what might be called the unholy grail of social security
debate raises many wider questions about the politics of policy as well as the labour market.
Myths about ‘them the poor’ as opposed to ‘us the taxpayers’ are always with us, but they gain
extra momentum at certain times. One much enlisted recently has portrayed a culture that
leads generations of families to ‘rest on’ or ‘languish on’ benefits, depending on whether you
prefer the verb of a Conservative Minister of Employment or a Labour Prime Minister.
Shildrick and her colleagues painstakingly document how their searches to find families
where no-one had worked for three generations failed. They chose two areas of long-term and
high unemployment in Middlesborough and Glasgow where the chances of success might have
been expected to be good. People working and living in the area knew all about such people, of
course, but not well enough, it turned out, to be able to identify any of them. The research team
asked, advertised, broadcast and interviewed, but to no avail. They relaxed their recruitment
criteria from three to two generations where no one had ever worked, but, to obtain the twenty
families they had set out to interview, they had to relax the criteria again, and again – eventually
reducing the criteria to two generations where someone in the older generation had spent at
least five years currently out of work and where at least one in the younger had never been
employed, whether or not they were living in the same house (p. 18). Very often these were only
a few years out of school and they had siblings in work.
Of particular value are their findings on commitment to work among their respondents
on the margin of the labour market – as strongly established as among those with more work
experience in their larger study. This is not so surprising when account is taken of others in
the household or relatives elsewhere who were in work, although often caught in the low-pay
no-pay trap examined in the book.
The authors note the strong belief of labour market practitioners in the three-generation
workless family despite their inability to identify any – ‘an interesting finding in itself’ (p. 18).
‘Of course, myths have a purpose’, distracting, covering up and justifying, as they note in the
final chapter of the book (p. 223). The use and abuse of myths in setting policy agenda deserve
more analysis, especially, I would suggest, for the ways that they divert attention from demand
and wider structural factors in the labour market. I would strongly recommend these studies
to anyone who wants to find out what is actually happening in the UK labour market today.
Byrne, D. (1999), Social Exclusion, Milton Keynes: Open University Press.
adrian sinfield
University of Edinburgh
R. Wilkinson and K. Pickett (2010), The Spirit Level: Why Equality is Better for Everyone.
Over half a century ago, social policy research clearly demonstrated the problem of poverty in
an unequal society, a problem that has never really gone away (Titmuss, 1938). More recently, Downloaded: 09 Sep 2013 IP address:
reviews 841
one particular book has done much to champion the cause for greater equality. In so doing,
it has reignited old debates about poverty and inequality in new and important ways. That
book is of course The Spirit Level by Richard Wilkinson and Kate Pickett a book that has
made a rare transfer from the academic world into the public domain, selling over 200,000
copies and with translations in more than twenty languages. The Spirit Level (currently) has
over 2,000 citations on Google scholar and Richard’s TED talk has over 1.6 million viewings,
making the importance of this work beyond question. In fact, The Spirit Level is probably the
most influential book in social policy published in the last decade.
The research argues, and attempts to demonstrate, that societies that are more unequal
experience significantly worse health and social problems. The study uses data for twenty-three
1. physical health (life expectancy)
2. mental health/illness
3. drug and alcohol addiction
4. children’s education performance
5. imprisonment rates
7. social mobility
9. homicides
10. teenage birth rate, and
11. infant mortality.
Building on earlier work (e.g., Wilkinson, 2005; Wilkinson and Pickett, 2006), Wilkinson
and Pickett provide a range of statistical evidence to support their view that inequality is bad
for society. They largely do this by using simple (but no less compelling) correlation techniques
that suggest a link between income inequality at the country-level and many of their wellbeing
indicators, as well as weak relationships between national average income per person and their
index of health and social problems. ‘Inequality has pernicious effects on societies’, the authors
observe, ‘eroding trust, increasing anxiety and illness, encouraging excessive consumption’.
The statistical evidence, the authors argue, makes an irrefutable case for greater equality.
What is more, the transformation of our societies requires a social movement that demands
greater equality towards improving the quality of life for all. The Equality Trust a not-for-
profit organisation that Wilkinson and Pickett co-founded promotes the evidence on why
inequality matters, arising out of The Spirit Level and you can also sign their Equality Charter
( All of which is very laudable and welcome in Social Policy circles.
Their statistical evidence, however, is fiercely disputed (Saunders and Evans, 2010;
Snowdon, 2010). Saunders and Evans, for example, speak of ‘wonky statistics’ and ‘spurious
correlations’. In sum, the associations in their graphs linking high levels of income inequality
with health and social problems between countries are called into question. The ‘clustering’ of
countries in The Spirit Level has also been criticised (familiar to Social Policy as the different
‘worlds’ or ‘regimes’ of welfare). The Nordic countries often appear at one end of the graphs
(doing well), and the (less equal) Liberal cluster often appears at the other end (doing less well).
In this review it is not necessary to get drawn into some of the (rather sterile) debates about
whether excluding a particular high income country or set of high income countries as ‘outliers’
alters the fit of a regression line in a simple linear regression model or not. Besides, many of
the issues over ‘selectivity’ already appear to be have been dealt with; Saunders’ picking and
choosing in his work is far more selective of countries than Wilkinson and Pickett (Rowlingson,
2011). Downloaded: 09 Sep 2013 IP address:
842 reviews
Instead, and this is the point I really want to emphasise, The Spirit Level has helped
to motivate important new research and findings on social inequality. In The Spirit Level,
Wilkinson and Pickett present a social or environmental contextual argument relating inter-
country variations in health and social outcomes to income inequality. According to the authors,
the reason why inequality causes an increase in social problems in more unequal societies is
people’s perceptions of inferiority or status anxiety. Inequality is a relative experience, which
implies that people evaluate their wellbeing compared with a reference point. Richard Layard
(2005) makes a similar argument about our frustration, and unhappiness, in the social context
of trying to ‘keep up with the Joneses’, and W.G. Runciman famously before that (Runciman,
1966). Still others maintain that individual compositional factors particularly the lack of
personal income or poverty within society matters greatly for the health and wellbeing of
those experiencing deprivation (Jen et al., 2009). In other words, it is not just the politics of
envy’ or ‘greed’ at play in rich societies, if at all, but the material deprivation experienced by
people living in society.
Answers to such fundamental, but complex questions matter and have been at the
heart of Social Policy debate for far too long; hopefully, there will be further opportunity
to address some of them under the current New Opportunities for Research Funding Agency
Cooperation in Europe call on Welfare State Futures and Inequalities ( [Theme
2]). NORFACE is a partnership between fifteen research councils, including the UK’s ESRC, to
increase cooperation in research and policy in Europe.
Certainly, there are good grounds for optimism; we now have access to high quality
datasets, from social surveys and administration systems that span the globe, as well as
sophisticated multilevel modelling techniques ( that did not exist when
my mentors Jerry Morris and Peter Townsend were mapping out this terrain (Black et al.,
Black,D.,Morris,J.N.,Smith,C.andTownsend,P.(1980), Inequalities in Health: Report of a Research
Working Group, London: Department of Health and Social Security.
Jen,M.H.,Jones,K.andJohnston,R.(2009), ‘Global variations in health: evaluating Wilkinson’s income
inequality hypothesis using the World Values Survey’, Social Science and Medicine, 68: 4, 64353.
Layard, R. (2005), Happiness: Lessons from a New Science, London: Allen Lane.
Rowlingson, K. (2011), Does Income Inequality Cause Health and Social Problems?, York: Joseph Rowntree
Runciman,W.G.(1966), Relative Deprivation and Social Justice: A Study of Attitudes to Social Inequality
in Twentieth-Century England, London: Routledge & Kegan Paul.
Saunders, P. and Evans, N. (eds.) (2010), Beware False Prophets: Equality, the Good Society and The Spirit
Snowdon, C. (2010), The Spirit Level Delusion: Fact-Checking the Left’s New Theory of Everything,London:
Democracy Institute.
Titmuss, R. M. (1938), Poverty and Population: A Factual Study of Contemporary Social Waste,London:
Wilkinson, R. G. (2005), The Impact of Inequality: Howto Make SickSocieties Healthier,London:Routledge.
Wilkinson, R. G. and Pickett, K. E. (2006), ‘Income inequality and population health: a review and
explanation of the evidence’, Social Science and Medicine, 62: 7, 176884.
christopher deeming
University of Bristol
Diabetes care has undergone a rapid change in delivery since the first lockdown from COVID-19 in March 2020. As such, services have had to reshape and transform into virtual diabetes reviews. Vulnerable communities with high diabetes incidence or risk have experienced health disparities, not least because of COVID-19, but also as a result of slower medication reviews and escalation of diabetes prescribing as required. This article critically examines the presenting inequalities in diabetes care provision in the UK. In particular focusing on the experience of minority ethnic populations, who experience inequality and health disparities, especially related to prescribing of newer medications in type 2 diabetes. Evidence from studies and reports underpins the debates presented about reconsidering diabetes care delivery and in particular listening to and working with local practices and their communities to disseminate health messages and provide person-centred educational opportunities.
Full-text available
In this new edition of his landmark book, Richard Layard shows that there is a paradox at the heart of our lives. Most people want more income. Yet as societies become richer, they do not become happier. This is not just anecdotally true, it is the story told by countless pieces of scientific research. We now have sophisticated ways of measuring how happy people are, and all the evidence shows that on average people have grown no happier in the last fifty years, even as average incomes have more than doubled. In fact, the First World has more depression, more alcoholism and more crime than fifty years ago. This paradox is true of Britain, the United States, continental Europe, and Japan. What is going on? Now fully revised and updated to include developments since first publication, Layard answers his critics in what is still the key book in 'happiness studies'.
This international comparative study analyses individual-level data derived from the World Values Survey to evaluate Wilkinson's [(1996). Unhealthy societies: The afflictions of inequality. London: Routledge; (1998). Mortality and distribution of income. Low relative income affects mortality [letter; comment]. British Medical Journal, 316, 1611-1612] income inequality hypothesis regarding variations in health status. Random-coefficient, multilevel modelling provides a direct test of Wilkinson's hypothesis using micro-data on individuals and macro-data on income inequalities analysed simultaneously. This overcomes the ecological fallacy that has troubled previous research into links between individual self-rated health, individual income, country income and income inequality data. Logic regression analysis reveals that there are substantial differences between countries in self-rated health after taking account of age and gender, and individual income has a clear effect in that poorer people report experiencing worse health. The Wilkinson hypothesis is not supported, however, since there is no significant relationship between health and income inequality when individual factors are taken into account. Substantial differences between countries remain even after taking account of micro- and macro-variables; in particular the former communist countries report high levels of poor health.
Whether or not the scale of a society's income inequality is a determinant of population health is still regarded as a controversial issue. We decided to review the evidence and see if we could find a consistent interpretation of both the positive and negative findings. We identified 168 analyses in 155 papers reporting research findings on the association between income distribution and population health, and classified them according to how far their findings supported the hypothesis that greater income differences are associated with lower standards of population health. Analyses in which all adjusted associations between greater income equality and higher standards of population health were statistically significant and positive were classified as "wholly supportive"; if none were significant and positive they were classified as "unsupportive"; and if some but not all were significant and supportive they were classified as "partially supportive". Of those classified as either wholly supportive or unsupportive, a large majority (70 per cent) suggest that health is less good in societies where income differences are bigger. There were substantial differences in the proportion of supportive findings according to whether inequality was measured in large or small areas. We suggest that the studies of income inequality are more supportive in large areas because in that context income inequality serves as a measure of the scale of social stratification, or how hierarchical a society is. We suggest three explanations for the unsupportive findings reported by a minority of studies. First, many studies measured inequality in areas too small to reflect the scale of social class differences in a society; second, a number of studies controlled for factors which, rather than being genuine confounders, are likely either to mediate between class and health or to be other reflections of the scale of social stratification; and third, the international relationship was temporarily lost (in all but the youngest age groups) during the decade from the mid-1980s when income differences were widening particularly rapidly in a number of countries. We finish by discussing possible objections to our interpretation of the findings.
Beware False Prophets: Equality, the Good Society and The Spirit Level
  • P Saunders
  • N Evans
Saunders, P. and Evans, N. (eds.) (2010), Beware False Prophets: Equality, the Good Society and The Spirit Level, London, Policy Exchange.
Poverty and Population: A Factual Study of Contemporary Social Waste
  • R M Titmuss
Titmuss, R. M. (1938), Poverty and Population: A Factual Study of Contemporary Social Waste, London: Macmillan.
Does Income Inequality Cause Health and Social Problems?
  • K Rowlingson
Rowlingson, K. (2011), Does Income Inequality Cause Health and Social Problems?, York: Joseph Rowntree Foundation.
The Spirit Level Delusion: Fact-Checking the Left's New Theory of Everything
  • C Snowdon
Snowdon, C. (2010), The Spirit Level Delusion: Fact-Checking the Left's New Theory of Everything, London: Democracy Institute.