Letters.

P.C. medicine

To the Editors:

When Anthony Daniels reviewed my book Mind the Gap: Hierarchies, Health and Human Evolution (February 2001), he got me badly wrong. Many of us started out with ideas rather like his, but research over the last twenty years has made those views untenable. My book explains why it is the most egalitarian, not the richest, countries in the developed world that are the healthiest.

The United States is richer and spends much more on medical care than any other country in the developed world. Yet its life expectancy is lower than in some twenty other developed countries. Several dozen research papers using different data sets show that societies with larger income differences between rich and poor tend to be less healthy. This is not about comparisons between what we have and some unreachable total equality. It involves comparisons between existing societies. Societies with narrower income differences, like Japan and Sweden, are healthier than the U.S., where they are much wider. Within the U.S., the more equal of the fifty states are healthier than the more unequal, and among the 280 or so U.S. metropolitan areas, the more equal are healthier than the less equal. Daniels omits all the evidence and dismisses the case by suggesting i) that the differences are unimportant, 2) that increasing equality entails a lot of killing, and 3) by suggesting I am nostalgic for East European Communism. First importance. For the U.S. to catch up with Japanese life expectancy is a task equal to the abolition of all heart disease. The difference in death rates between more and less unequal cities in the USA is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, HIV, suicide, and homicide. On nostalgia for Communism, he clearly failed to read my work from a NATO Science Committee analyzing the failure of health in Eastern Europe throughout the 1970s and 1980s when the East-West health gap opened up. As for killing in the name of equality, are statistical analyses of the effects of the greater equality in New Hampshire than in New York, or in Sweden compared to the U.S., so threatening that Daniels has to tar me as a despot?

The evidence shows that a greater burden of relative deprivation costs a society dearly in health, in violence, and in the quality of the social fabric. Let us learn from the evidence rather than allowing ourselves to be duped into such a dangerously ostrich-like approach to it.

Richard G. Wilkinson University of Sussex

Anthony Daniels replies