How Inequality Causes Ill Health

Newsflash: it doesn't. But people still believe it.

Regardless, courtesy of some girl at Glasgow Uni Fresher's Fair - whom my friend fancied enough to ask on a date - here's the argument:

In Public Health research circles, there's this infamous observation called 'The Glasgow Effect' which shows how indicators such as life expectancy, mortality rates, morbidity, acute sickness or ill health are worse in Glasgow than many other places - even when controlling for all kinds of things. Compared to historically and culturally similar cities such as Liverpool or Manchester, the effect still persists. Sometimes, it is even given as a within-Glasgow-inequality example, showing how life expectancy drops almost linearly for every stop on the Glasgow subway.

This, my nice new acquaintance informed me, is solely due to inequality. Inequality causes social ills; health inequality causes the Glasgow effect (what kinds of inequality she refused to specify, but I'd suppose some general feature of income, social status, privilege or likes on instagram). This story is very old indeed, perhaps most famously associated in recent years with the writers of The Spirit Level, Pickett & Wilkinson. It repeatedly pops up, despite its obvious shortcomings and data-manipulations.

Moreover, her idol, Scottish Public Health persona Sir Harry Burns gave this formulation in an interview with The Guardian:

He says forcefully that he has always been driven by science and by evidence and, implicitly, not by ideology. "Unless you have evidence all you have is opinion," he says. Evidence tells him that the most successful societies are those with strong social bonds, connection and cohesion. (my emphasis)

At best, this garbage sort of social reasoning falls prey to the oldest fallacy in the book: correlation does not imply causation. But, more intriguingly, if person A in place X is more likely to fall ill and die before their time simply because there's a Person B in place Y sufficiently close to X, who is healthier, richer or has more likes on instagram - couldn't we solve this problem easy enough by removing person B from the picture?

Or, as I suggested to this young fit, western and privileged university student, both of us could intentionally eat terrible food and give away all our assets - that would narrow the inequality-rate-however-defined, and so should reduce the suffering of these people, shouldn't it?

If inequality as some magical force causes people to fall ill, couldn't we simply banish the outliers responsible for unequal outcomes to Far-Far Away and we have no more problems?

Of course not. Because inequality itself doesn't do anything. Individual actions, including their cultural convictions, however, do. And, exactly like her idol Sir Burns pointed out, those are affected by social bonds and connections. Not to mention that current medical research points to excessive alcohol consumption, smoking and poor intake of vegetables as culprits - good luck improving "social bonds" and "connections" by taking a Scotsman's drink from his hand...

Alright, so get out of the way, and let people create those bonds. Last time I checked law-enforcement, politicians, doctors in heroic strides for the public health, city councils, journalists or any state agency for that matter, are completely unable to build any of those ties. Why? Because individuals create those bonds. Tradition, culture, family, values, football - whatever - makes them occur. Not politicians or political campaigns or indignant university students trying to recruit you to some righteous cause.

Ironically, a research report (endorsed by Sir Burns and his left-wing fan crowd) came out earlier this year, pointing finger to "Westminister social engineering" (read: Thatcher) as the culprit behind Glasgow's infamous effect. You want to close some inequality gap via social engineering when social engineering seems to have caused your "problem" in the first place? In other words, maybe it's time to get out of the way, stop regulating people's lives, allow them to associate freely and drop the equality assumption.

At the end of our conversation came the most laughable yet predictable comment imaginable; she got defensive, and I was given a (honestly, quite horrible) story of her teenage life, followed by what in her mind surely was a killer argument: "So you don't think we should do anything at all to help people like me?"

As if that was the topic.

Additional Reading: three of the most prominent Economists in Sweden (Andreas Bergh, Therese Nilsson & Daniel Waldenström) recently published their critical research on the topic. Check it out!