The poorer you are the more likely you are to face illness and even death.
The infant mortality rate among children of unskilled workers, for instance,
is twice that among children of professionals - a gap that has remained virtually
unchanged for a century.
Only in recent years, however, has the link between health and poverty become central to government policy. The 1999 White Paper on health accepted that the 'strong association between low income and health is clear' and that policy must aim to break it. Also in recent years has come an understanding that ill-health is linked not simply to being poor, but to being poorer than other people in your community or country. The work of Professor Richard Wilkinson, an economic historian at the University of Sussex, has revealed that people in rich countries with large disparities of income often have worse health than those in poorer but more equal societies. Greeks are healthier than Americans – and not just because of all that olive oil. Why? Because, Wilkinson believes, evolution has designed humans to respond badly to inequalities. Social policies and health initiatives, he argues, should take into account our evolved human nature.
Wilkinson suggests that in third world countries the limiting factor in health improvement is resources. The biggest killers here are infectious diseases - cholera, diphtheria, diarrhoea - and economic growth, by itself, can help improve health. But in developed countries, the major killers are the so-called 'diseases of affluence' - cancers or heart diseases. Here, there is no relationship between the overall wealth of a nation and the health of its citizens:
What matters to health is not absolute income and living standards, but relative income and social status... Among the developed countries it is the most egalitarian that have the highest life expectancy, not the richest.
It is easy to see why absolute poverty kills. Malnutrition and lack of housing
are not conducive to well-being. But why should relative poverty matter? If
you are comfortably well off anyway, why should the fact that you are poorer
than your neighbour lead to cancer or heart disease? Because, in the words
of the writer Marek Kohn, 'Above the threshold of want, health and happiness
are affected more by psychology than by standards of living.' And the reason
for this, Kohn and Wilkinson believe, lies in our evolutionary history.
Humans, especially human males, are evolved to be sensitive to differentials in status, such as rank, prestige and reputation. From an evolutionary viewpoint the importance of social status is that it is correlated with reproductive success. High status males leave more descendants than those of low status. Losing out in the evolutionary struggle seems to affect the health of individuals. Among baboons, for instance, low status males show greater signs of arterial sclerosis; are more obese; are more resistant to insulin; have higher levels of more dangerous blood fats; and appear more anxious.
Wilkinson believes that the same is true of humans. People living in more hierarchical societies - where the difference between high and low status is much greater - are more likely to show chronic levels of stress which can cause illness and even death.
According to Wilkinson, egalitarian societies are friendlier and hence less stressful. In such societies,
People are more likely to trust each other and are less hostile and violent towards each other... Among the fifty states of the USA, the proportion of people who feel that they can trust others tends to be much higher in states where income differences are smaller. People in more egalitarian states find each other more helpful and are more likely to belong to voluntary clubs and associations.
Evolutionary psychologists suggest that humans have evolved tendencies to
be both selfish and altruistic. Early humans lived in highly egalitarian societies
in which everyone, whether of high or low status, shared resources equally.
In such societies, say evolutionary psychologists, our instincts to dominate
were constrained by what they call 'counter-dominance' tendencies - instincts
to form more egalitarian social structures.
Modern Western societies, on the other hand, with their 'winner take all' attitudes, reward selfishness at the expense of our altruistic instincts. Hence they are less friendly, trusting, cohesive and healthy. What is needed, therefore, are social policies that nurture our more egalitarian tendencies. As with much evolutionary discussion, there is considerable vagueness about what such policies entail. Wilkinson seems to favour redistributive taxation and salary caps, swingeing taxes on luxury items, and measures to build trust and cohesion in local communities. Kohn suggests that the link between inequality and ill-health can help revitalise the left:
An evolutionary left... would offer an alternative to the rambling protest and resigned acquiescence into which the left is currently divided. It would show why inequality and solidarity are as necessary in the world of images and information as they were in the world of industrial labour. And it would discover a new version of the old maxim - that unity is health.
The evolutionary argument about health and wealth is a compelling one, and
backed up with some detailed empirical evidence. But it is also dogged by
the same kinds of problems that trouble other attempts to apply evolutionary
theory to social policy. The arguments about human nature are shaky. And the
political consequences are far from benign.
The attempts to link social behaviour and human nature are, on the one hand, speculative, and, on the other, banal. For instance Richard Wilkinson suggests that 'There are reasons for thinking that strong selective pressures have endowed us with a desire for friendship and a tendency to find rejection or a lack of friends a source of anxiety.' I doubt if anyone would dispute that most humans are happier with friends around them. But I'm not sure what it adds to stock of human knowledge to suggest that this is the product of 'strong selective pressures'.
At the same time, many of the facts about health inequalities simply do not fit into kind of evolutionary story plotted by Wilkinson. For example, if the relationship between hierarchy and illness is the result of an evolved human nature, then we would expect to see men suffer more than women from the presence of inequalities. From an evolutionary perspective, status has much greater meaning for males than for females because for men, unlike for women, status is linked to reproductive success.
In fact, there is little difference in the way the two sexes respond to hierarchies. Inequality kills women as much as it kills men. Wilkinson suggests that this is because 'women are sensitive to the status of their partners'. In other words, women get ill worrying that their husbands or boyfriends belong to the wrong golf club or go to the wrong nightclub.
This is just the kind of ad hoc argument that makes many people skeptical about evolutionary psychology in the first place. Darwinian theory predicts that there should be a sex difference in responses to social inequalities. The facts don't reveal such a difference. Never mind. We can always find another explanation to fit. If evolutionary psychology can predict both that there will be sex differences and that there won't be sex differences, it will inevitably be proved right - but it will also become irrelevant to the task both of understanding human nature and of formulating social policy.
Far from being rooted in an objective understanding of human nature, the evolutionary arguments about health and wealth reflect many of our contemporary political prejudices and preoccupations. The reinterpretation of health inequalities in psychological rather than material terms fits neatly into our penny-pinching times. Rather than find material resources to improve health, governments look these days to boost self-respect and strengthen social cohesion. Take for instance New Labour's preoccupation with 'social exclusion'. This is, as Tony Blair put it at the launch of the Social Exclusion Unit in December 1997, 'a very modern problem, and one that is more harmful to the individual, more damaging to self-esteem, more corrosive for society as a whole, more likely to be passed down from generation to generation, than material poverty'.
The government's emphasis on social exclusion and self-esteem seems, however, to have provided the means not so much of improving health or reducing inequalities as of creating a new framework of social regulation. In 1995 the prestigious health think tank the King's Fund published a report entitled Tackling Inequalities in Health, the aim of which was to shape government policy.
The report proposes four levels of policy intervention: 'strengthening individuals'; 'strengthening communities'; 'improving access to essential facilities and services'; and 'encouraging macro-economic and cultural change'. There are in fact few suggestions about how one could improve access to facilities or encourage economic change. The report concentrates instead on the first two levels of intervention: strengthening communities and strengthening individuals.
Among ways to strengthen communities, the King's Fund suggests:
Social control of illegal activities and of substance abuse; socialisation of the young as participating members of a community; limiting duration and intensity of youthful 'experimentation' with dangerous and destructive activity.
I'm not sure how these initiatives would reduce health inequalities, but
they would certainly help institute a greater degree of social control. As
the London GP and author Michael Fitzpatrick puts it, 'Tackling health inequalities
has become redefined as community policing to deal with problems of drugs,
crimes and even youthful exuberance (now known as "anti-social behaviour").'
As for strengthening the individual, the King’s Fund suggests that the government should aim 'to make up perceived deficiencies in knowledge, practical competence or stress management among people experiencing disadvantage, and to encourage the acquisition of personal or social skills to change their ways of life or to be more resilient in the face of adversity'. These include programmes such as 'Stress management education for people working in monotonous conditions’
and 'counselling services for people who become unemployed to prevent the associated decline in mental health'. The sociologist David Wainwright rightly warns that such programmes, far from tackling the problems of inequality, 'Comprise a handful of psychological tricks to enable people to accept the unacceptable and endure the unendurable'
The King's Fund report does not explicitly draw upon Darwinian ideas. But its programme for improving health bears a striking resemblance to that promoted by many evolutionary psychologists. Both emphasise the psychological, rather than the material, consequences of inequality, and both call for the creation of a comprehensive government framework of regulation to curb unhealthy, irresponsible and risky behaviour. Evolutionary psychology makes sense in the age of Oprah Winfrey when governments seek not to throw money and resources at people, but rather to throw people into therapy and counselling.
From an evolutionary viewpoint, unhealthy and antisocial behaviours arise from a mismatch between the environment in which human psychology was forged and contemporary conditions. Behaviours that were advantageous in the Stone Age may be destructive today. For instance, Darwinian theory suggests that young males are designed to take risks as they compete with each other to gain social dominance. In the Stone Age such behaviour allowed women to sort out the studs from the chumps. Today, say evolutionary psychologists, it simply leads to teenage joy riding, drug taking and hooliganism. By understanding human nature the government can create the kinds of environments in which such behaviour can be regulated and restrained. It is easy to see why this argument should appeal to an age that sees change as the product of individual therapy and government regulation rather than social action.
I began this series of talks by suggesting that all political philosophies draw upon particular visions of human nature. The problem with evolutionary psychology is that it embodies an inadequate understanding of what it to be human, and hence leads to inadequate political policies. Humans are clearly evolved beings with an evolved psychology. But we are not just evolved beings whose behaviour needs to be regulated and curbed and counselled. We are also rational agents able to rise above our evolved tendencies and who, through collective action, can transform both ourselves and our world. Evolutionary psychologists too often forget that insofar as humans are 'political animals' we are not really like other animals at all. It’s a lesson that politicians, above all, should take to heart.