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Interview: Kate Pickett epidemiologist

15 March 2013

'I find myself deeply shocked to know how many people are hungry in the UK now'

There isn't a typical epidemiologist. Some of us work investigating local outbreaks of disease; some describe the health of the population; others do research and teaching.

Epidemiology is the study of the distribution and determinants of health and disease in populations rather than individuals. I'm Professor of Epidemiology at the University of York. I do some teaching, but most of my time is spent on research. I work at home some days, usually when I'm writing. At the university, I'll be mostly meeting with colleagues, analysing and interpreting data, or designing new projects.

When I left university after studying anthropology, I moved to the US to study nutritional sciences. I thought I would have a career working with the most disadvantaged. I thought I would spend my life involved in research and policy aimed at solving malnutrition in the poorest countries of the world. I thought America and the UK didn't need me.

But it didn't take me long to realise that the US, despite spending more per capita on health care than any other country in the world, had developing-world levels of health and social problems in many areas.

There was no need to travel to Africa, South America, or Asia to study infant mortality, stunting, or hunger. They were there on the doorstep. That was a real shock to me. I find myself deeply shocked to know how many people are hungry in the UK now.

In 2003, I moved back to England and began working with Richard Wilkinson, the pioneering epidemiologist researching income inequality. We began to look at a wider range of health and social problems, theorising that, if a bigger gap between rich and poor leads to more health problems through psychosocial pathways, then other social ills should also be increased.

We wrote The Spirit Level to try and communicate these important findings to a wider audience than the small group of academics who were reading our research papers.

There is a paradox about health in rich societies. There's no association at all between average levels of income, or spending on health care, and life expectancy in rich countries. Yet within each of those countries there is a strong gradient in health by income. In the UK, you can expect to live about eight years longer if you live in the wealthiest areas rather than in the poorest.

What this shows is the importance of relative social status for health. It's not your wealth that protects health, but the status and social benefits - including a good early childhood and positive social networks - that go with it.

There's also a powerful tendency for more unequal societies to become socially dysfunctional, to have more violence, higher teenage birth-rates, worse child well-being, more people in prison, lower educational achievement, and lower social mobility. There's less trust and social cohesion in more unequal societies.

Economists and environmentalists are now showing that inequality is bad for economic growth and stability, and for the development of sustainable economies. Evidence suggests that inequality has a powerful causative role, increasing status-anxiety and people's insecurity and downward prejudice.

Research shows that most people value greater equality; but they are woefully unaware of how unequal their societies actually are. They underestimate the gap between rich and poor, while at the same time wishing it to be smaller. When Americans were shown unlabelled representations of the income distributions of the US and Sweden, an overwhelming majority preferred the Swedish income-distribution. I don't think we are "content" with inequality, but we're not given a lot of information on how unequal our societies are, and how much better some others do.

I think our work has done a lot to open up a debate on inequality and fairness. A lot of politicians and policymakers will now discuss inequality, which is a step in the right direction. Many local authorities in the UK have established Fairness Commissions, which have made practical recommendations to reduce local inequality.

Our current government is enacting policies and laws that have put the greatest burden of economic crisis on to the shoulders of the poor, and this is obviously moving in the wrong direction. But social movements take time, and at least the debate and conversations have started. We listen to the Today programme every morning, and hear about teenage births, imprisonment, hunger. . . No one ever mentioned inequality. Now we do hear inequality mentioned; so it is a first step.

After the 43 bishops signed the letter calling on the Government to step back from cuts to welfare, the Church feels very much an ally. Archbishop Sentamu sponsored the York Fairness Commission, and has been bravely outspoken on this issue. Other faith groups have also been supportive, including Quakers and Methodists. All of the world's major faiths say important things about equality, fairness, compassion, and human community; so our work provides empirical support for these tenets.

Most recently, we have been working with the royal government of Bhutan, whose focus on well-being is informed by their Buddhist faith and culture. We're working with a lot of colleagues from across the world - environmental scientists, people who are interested in well-being and economics - and reporting to the United Nations next year.

The previous King said, rather flippantly, that Bhutan is more interested in Gross National Happiness than GDP. They have made Gross National Happiness central to all of their policy-making; so the UN asked them to lead on this new development paradigm because they'd shown such different leadership.

Happiness is perhaps what we mean by "well-being". It includes health, community vitality, ecologi-cal resilience, use of time, culture, social support, political participation. It's very hard to achieve all of those things without some degree of equality.

We're writing a new book, much more about the individual experience of inequality - pathways from inequality to poor health and other outcomes.

I had so many ambitions, including joining the army because of a comic-book heroine I admired, being a ballet dancer, and that sort of thing. But I was brought up to think hard about how to make a useful contribution to society, and with values that would have made it difficult for me to focus only on money or status.

Nobody has had more influence on me than Richard. Nobody has thought for longer or more creatively about inequality, and I feel honoured to share my personal and working life with him. We are married now.

Having my children, Harry and Bronwen, now aged 21 and 18, probably had the biggest impact on my life. Children make you see the world differently. You want to make it a better place for them; and you feel connected to children and families everywhere, and want to make things better for them, too.

I regret working too hard, always, and feeling torn between causes.

I'd like to be remembered for having been part of a movement that shifted the world towards well-being, community, sustainability, and equality, instead of focusing on individualism, money, and status. 

I read voraciously. Fiction has always opened up new worlds, but I admire all those who can communicate complex ideas in simple ways.

In the Bible? The rich man, the camel, and the eye of the needle.

I love the sound of our cat Molly's scratchy purring.

I get angry hearing politicians, journalists, and internet commentators refer to some of the poorest and most vulnerable in our society as "shirkers", "scroungers" and "scum".

I'm happiest cooking for friends and family, and walking in the hills.

I don't pray, but I try to practise mindfulness; so I can be well enough to keep working hard.

I'd like to be locked in a church with Barack Obama. I'd encourage him to be bold and confident in his leadership. He could do so much to create a more equal society, and that would encourage other leaders to do the same. 

Professor Pickett was talking to Terence Handley MacMath.

The Spirit Level: Why equality is better for everyone by Richard Wilkinson and Kate Pickett is published by Penguin (£10.99 (CT Bookshop Use code CT618  £9.90); 978-0-241-95429-4).

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