In the same week that the Supreme Court overturned a century of precedent and made it legal for corporations to campaign for their favored candidates, I received a copy of Richard Wilkinson and Kate Pickett’s new book, The Spirit Level. What a sad and ironic convergence.
In the first couple of chapters Wilkinson and Pickett provide an overview of the relationship between economic inequality and various measures of health and wellbeing. There were two key findings. First, International studies of the relationship between average income and longevity and happiness show that once average income gets above about $10,000 a year, there is very little increases in either longevity or happiness. Once people’s basic material needs are met, more affluence does them little good on either of these scores.
Second, in both international comparisons and studies of the 50 American states, greater economic inequality is significantly and substantially related to higher rates of health and social problems. The findings stand up using a variety of measures of inequality and health and social problems. Wilkinson and Pickett created an index of health and social problems that included: life expectancy, level of trust, mental illness, obesity, children’s educational performance, teenage births, homicides, imprisonment rates, and social mobility (which were equally weighted). Developed countries vary in economic inequality quite substantially, with Japan and Scandinavian countries being the most equal (the richest 20% earn about four times the bottom 20%), while the U.S. and Singapore are at the other end. In the U.S. the top 20% earn 9 times what the bottom 20% earn. Wilkinson and Pickett present a graph of the relationship between inequality and their index of wellbeing. The countries are tightly clustered around the regression line, with more unequal countries having much higher levels of these problems; the U.S. has the highest score on health and social problems.
So… We’re number one!
The Supreme Court’s decision will ensure that we maintain our superiority. It will no longer be necessary for corporations to lobby legislators and give the limited amounts of money that they can give directly to candidates under campaign spending limitations. Now a corporation—or more likely an industry can own the legislator; they can simply do their own campaigns for—and against—candidates. How credible is the threat to a legislator that “Your career is over if you cross us,” when the legislator knows that the corporation can spend any amount of money they please?
Think about the tobacco industry. I have studied thousands of pages of tobacco company documents and have testified in federal court about how the companies spent millions of dollars of to lobby against restriction on their advertising that was recruiting the new young smokers who are vital any brands performance. But in many cases their efforts had to be circuitous. For example, they introduced a bogus campaign ostensibly to discourage young people from smoking. Tobacco Institute documents showed that at the same time that the companies were spending millions on advertising targeting adolescents, they were telling opinion leaders and legislators that their “Responsible Living Program” would keep young people from smoking. As I indicated in my testimony, the companies carefully tracked the value of this effort to discourage legislators from restricting advertising to young people, but at no point did they check to see if the campaign reached any parents or youth. There was no evidence that it did.
Now the tobacco industry will simply be able to select its favored candidates and the ones it wants to get rid of and spend millions getting the result they want. And as industry documents show, the companies have huge amounts of money to spend protecting their interests.
As I have written elsewhere, it is less useful to view this as a matter of the perniciousness of the people in this industry than to view it simply as a natural process of organizations working to protect their interests. Any organization that has survived for very long has done so because it evolved practices that discern threats to its future wellbeing and opportunities that can increase the flow of funds needed to survive and prosper.
Two other prominent examples of industries that will use this new opportunity to protect their wellbeing are the alcohol industry, which risks restrictions on its extensive and effective advertising to youth and the food industry, sectors of which are making and marketing many foods that contribute to obesity, diabetes, and cardiovascular disease. These industries will also use their substantial resources to ensure that legislatures and the Congress have the “right” people in it.
What industry would not do this? On every major issue of public wellbeing there are industries that stand to lose from changes in public policy that may benefit the common good, but will curtail a profitable activity. They would be fools to not use this new tool to influence public policy in their favor.
How will this affect inequality? Businesses will naturally oppose any policies that stand to reduce their profits. The economists Alesina and Glaser have documented how American social policy is already far less redistributionist than that in Europe. These are precisely the policies that affect inequality—social “safety net,” higher taxes on the wealthy, paid leave for parents of newborns, high quality daycare for young children, etc. These are all policies that have proven benefits in ensuring young people’s successful development, which ensures a productive work force and fewer people who are a drag on the economy. Without such policies, we spiral further toward an economically unequal society, as poorer citizens are unable to develop the skills they need, their behavior becomes more problematic and easier to stigmatize, and public support for “those people” is further eroded.
What to do about this excruciating situation? For me, after disgust and depression, comes the only path that seem available, namely to figure out what steps can be taken to move our society in a better direction. The only difference from before this happened is that I am less optimistic, more distressed, and find us starting from an even deeper hole. But it still comes down to what we value and how we can make our lives about working for what we value.
I have two thoughts. The first is about the importance of the public health framework. Discussion of the policies that we have and the ones we don’t have in this country is typically framed in terms of conservative economics, political freedom, the inefficacy of government, etc. Public wellbeing is seldom prominent and empirical evidence is seldom mentioned.
Public health provides both a conceptual framework and a significant infrastructure for addressing all of these issues. Public health practices evolved out of efforts to deal with epidemic disease, then extended to any disease, and then to any risk factor for any disease. In essence, the public health perspective targets the reduction in the prevalence of any process that harms a significant number of human beings.
It is from this perspective that we need to examine the harm to public wellbeing of this Supreme Court decision can do. We will need empirical work not only on the effects of specific policies on outcomes such as youth development, but also research on the harm that is done to the economy when young people’s development is harmed by impecunious public policy. In short, we need to make policies that affect economic inequality matters of public health. The public health infrastructure is large and growing. There are about 20,000 members of the American Public Health Association. Given that public policy is firmly committed to reducing disease, the contribution of economic inequality to disease becomes a matter of public policy.
Many of the people reading this know far more about public health than I. But there are also significant areas of the behavioral sciences that aren’t well linked to the public health system. The work on Acceptance and Commitment Therapy as well as work on the evolution of prosociality would both strengthen the public health movement and benefit from conceptualizing prosociality and psychological flexibility in terms of behaviors whose increasing prevalence would benefit public health.
In particular, if corporations have now been given a new freedom to pursue their interest, perhaps our best hope is to change what they see as their interests. Conservative economists have often argued that the U.S. has generally had a higher rate of economic growth than Europe because we have superior social policies. Paul Krugman recently documented the inaccuracies in this argument. But one of the things to consider is that European nations have simply chosen to forgo some of their economic growth in favor of ensuring the wellbeing of all of its citizens. This is a value choice.
Whether businesses support or oppose policies such as paid leave for parents of newborns is partly a matter of their calculation of whether it will benefit or hurt them financially. But it is also a matter of values. Is it possible that we can extend the scientific understanding of benefit of prosocial values and learn how to foster them even among the leadership of our major corporations? That may seem like a tall order, especially because growing inequality itself fosters a focus on status and materialism that will make it very hard to move people in the opposite direction. But from this vantage point, I see no other options.