Coming second in the game of life – Kate Pickett

“We don’t want to behead the big poppies,” said Boris Johnson in July. But for Kate Pickett, his “leveling” ambitions will require a flattening of the entire social divide.

The not entirely social winners? – a wedding reception on the Thames (Ian Luck / shutterstock.com)

There was enough athletic competition in the summer to remind us how hard it can be not to be quite the winner. In England there was great excitement when the national soccer team reached the final of the European Championship, only to lose there on penalties to Italy. There was almost immediately a backlash of racism and hatred towards the players who missed those crucial final shots on goal.

At the US Open tennis tournament, the women’s final was played by two talented teenagers who had both done spectacularly to get this far – but the disappointment of runner-up Leylah Fernandez was hard to see. And at the Tokyo Olympics, one competitor after another said to the cameras, ‘I’m not here for second place; I’m not here for silver. ‘

But in life, unlike in sport, is the second one surely good enough? We can’t all be winners, but if we have a good education, a good job, and all of our material needs, is that enough for our health and wellbeing?

In some ways it is true: nobody needs excessive income or wealth to be healthy, and too large an income gap between rich and poor is detrimental to the health of the population and the good functioning of society. But it is also true that, like in sports, being the winner is not that important.

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Social slopes

Almost all major causes of death and illness show social inequalities. They are not only more common among the poor and the lower classes of society, while they are rare among the rest of the population. Instead, there is a steady gradient in the incidence of various diseases and causes of death between each level of the social ladder. So while morbidity and mortality are certainly highest among the worst-off, if you are not entirely at the top of the income bracket, not entirely in the top social class, or not well educated, there is a risk of poor health. Illness and death are still a little higher than those directly above you.

This is an almost ubiquitous pattern around the world. We see it in life expectancy and infant mortality, in health behaviors like smoking and obesity, chronic diseases, heart attacks, infections, and most cancers. There are one or two exceptions, particularly breast and prostate cancer, but otherwise there are social health gaps everywhere.

In the graph below, the bars show life expectancy for men and women in England, with the population divided into ten groups, from those most deprived on the left to those least deprived on the right. When we look at such charts, we usually notice the differences between the top and the bottom – here a life expectancy of 9.5 years between the most deprived and least deprived men and 7.7 years between the most deprived and least deprived Men least disadvantaged women.

Life expectancy at birth by decile and gender, England 2018

But with every step from prosperity to misery, from right to left, both men and women, on average, lose a little bit of life expectancy. Men in the least disadvantaged group live an average of about 82 years, about a year and a half less than men in the least disadvantaged group of all. Women in the second best group live just over 85 years, but women in the top group live about a year longer.

These are surprising penalties for being among the least disadvantaged instead of making it into the top 10 percent. No one in the top 20 percent is denied any material necessity, and no one is likely to lack the knowledge to make healthy decisions. Nevertheless, people in the second decile still die younger and suffer from almost all acute or chronic diseases more often than in the first.

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Status matters

What these social gradients tell us is how important the social environment is – it’s status itself that matters. If you have a little less status than the one at the top, you are not doing as well as if you are the highest status. If we are to address health inequalities, we need to level the entire gap, not just try to tackle health problems from the bottom up.

While social gradients are almost ubiquitous in the health sector, the steepness of the gradient varies from place to place. Societies with lower economic inequalities have a widespread tendency to have smaller absolute differences in health. Reducing inequalities in income, wealth, education and social class will help society as a whole – not just the poorest or those in dire need. We would all be winners if the playing field was leveled.

Covid-19 of course also has a social gradient. It was never an “equality disease,” as some claimed early on. It’s too late for the pandemic we are in, but some serious social and economic leveling would help us cope with whatever might come next.

This is a joint publication by Social Europe and IPS-Journal

Kate Pickett is Professor of Epidemiology, Associate Director of the Center for Future Health, and Associate Director of the Leverhulme Center for Anthropocene Biodiversity, all at the University of York. She is co-author with Richard Wilkinson on The Spirit Level (2009) and The Inner Level (2018).

source https://www.bisayanews.com/2021/09/27/coming-second-in-the-game-of-life-kate-pickett/