for individuals to exploit ownership and acquire rental income which, as Thomas Piketty has shown, is the main driver of extreme inequality, especially when allied to the possibility of inherited wealth.22
The impossibility of inheriting significant wealth in the Soviet Union meant that this was one of the few places on earth where, in a strictly economic sense at least, ‘the living were worth more than the dead’, to use Piketty’s phrase.23 This has hardly ever been the case in Western countries, apart from the 30-year post-War period known in France as ‘Les Trente Glorieuses’, during which ‘for the first time in history… wealth accumulated in the lifetime of the living constituted the majority of all wealth: nearly 60 per cent.’24
In the Soviet Union, with rent and inheritance removed from the equation, people could put effort into welfare initiatives in a fairly direct way, bureaucracy permitting. Technology and science could sometimes explore important paths that were barred to Western firms by the logic of profit. In the West, for example, antibiotics became the standard treatment for bacterial infections (generating the profits necessary to the pharmaceutical companies that produced them, and which inevitably used their financial power to shape the course of research in directions that would ensure further profit). Soviet research flowed instead into the use of ‘phage viruses’ (viruses that invade and destroy bacteria). Phage viruses are not a consistent product that can be mass manufactured, stored and sold in bulk, or even patented – they are mainly found in soils, and need to be searched for and cultivated continuously to counter constant mutations in the target bacteria – so they are not attractive candidates for development within capitalist firms.25
Immediately private ownership of major assets became possible, in 1990, the hierarchies were there, ready to take advantage of the situation, unleashing the chaos that took conventional economists by surprise. Till the last, the Soviet Union had survived on the hope that egalitarianism would in the end prevail. The final crushing of that hope undoubtedly helps explain the scale of damage that followed katastroika.
A similar story unfolded, but a little differently, in China. In the 1970s (the period just after the Cultural Revolution and before Deng Xiaoping’s marketizing reforms) wage differentials between party officials of different grades were already well above those in the Soviet Union. However, overall inequality was relatively modest (about the same as in Britain at the time, and enormously less than it had been before the Revolution), and China was deemed a ‘high achiever’ in terms of public health. Birth-rates, for example, were well on the way to stabilization before the brutal one-child policy was introduced in 1979.
After 1980, with the state-managed transition to a market economy (but retaining state ownership of land), inequality soared and health gains stagnated – despite a 12-fold increase in GDP. Health indicators are still rising for most people, but much more slowly than in the past, and rural, female and older populations have suffered particularly wretched reverses.26
AUTONOMY AND SOLIDARITY: THE ESSENTIAL NUTRIENTS
Before Richard Wilkinson’s and then Douglas Black’s reports in the 1970s, nobody had imagined there could be serious differences in health in populations, like those of the US and western Europe, where almost everyone enjoys what look like excellent standards of living in comparison to those of a century or even 50 years ago. How can this happen?
Much of the new health inequality turns out to derive from psycho-social factors, which are now known to be far more powerful than anyone had previously suspected.
Two famous studies (known as the Whitehall Studies) carried out over a number of years by epidemiologist Michael Marmot and his colleagues found that civil servants’ job status was an extremely accurate predictor of their age at death. Those in lower grades did not live as long after retirement as their superiors did. In particular, subordinates had up to four times the death rates from coronary heart disease that their bosses did. This was found to be linked to higher levels of the blood protein fibrinogen, which is associated with the ‘flight or fight’ response in vertebrates: it helps blood-clotting and is released in situations where the animal feels threatened (and might suffer a wound leading to blood loss). Evolution did not anticipate the kinds of ‘pecking orders’ that are found in offices; as far as the body is concerned, a threat is a threat, and fibrinogen is released, even if the source of threat is a summons from a superior, or the thought of one.27
Whatever the cause of death or illness, the most significant factor was found to be lack of autonomy. Kate Pickett and Richard Wilkinson say: ‘of all the factors that the Whitehall researchers have studied over the years, job stress and people’s sense of control over their work seem to make the most difference’.28
Low status can be mitigated by group solidarity. In his 2005 book The Impact of Inequality, Richard Wilkinson tells the story of a village of poor, southern Italian immigrants who settled in the town of Roseto, near the US city of Philadelphia.29 They remained far healthier than equally poor Americans who lived nearby, despite very poor diet and very high cigarette consumption, because they insulated themselves within their language and culture, maintaining their old sociability and egalitarianism, which included general disapproval of competitive displays of status (which they called ‘putting on the dog’). But when a new generation grew up, speaking English, seeing themselves as Americans and comparing their own lives to the ones shown on TV, their health collapsed; they became normal poor Americans.
The downside of this protective, ‘huddling’ strategy is that an unequal society develops a class structure or caste system. People from lower-status groups become stigmatized. They are no longer seen as individuals but as examples of a disparaged sector of society. Members of higher-status groups become capable of almost any degree of cruelty towards them, while remaining in other respects decent, caring folk. This is the ‘group inequality’ phenomenon described by Heidi Ravven (Chapter 1), and which two other researchers, Mark Sidanius and Felicia Pratto, placed at the heart of the problems of unequal societies. Their book Social Dominance concludes that the multifarious forms of structural and physical violence that come with inequality are driven by:
a single, simple heuristic: group inequality. Like a fractal pattern observable from micro- to macro-levels of organization, group inequality is seen in psychological biases, in the effects of social contexts, in the biases of institutional discrimination, and, ultimately, in general social structure.30 [emphasis in the original]
All oppressive societies, they argued, are built ultimately upon ‘gender and age sets’: in plain terms, the first groups to be denied full human status when inequality appears are women and children.31
INEQUALITY MAKES PEOPLE SHORTER
The effects of inequality on human beings are impressive, even to the naked eye. For one thing, the poor are always, on average, smaller than the rich. But culture is extraordinarily good at hiding the evidence in plain sight. The idea that the poor are tougher than the rich is so powerful that it can completely obliterate what stares you in the face: that most of them are in much worse shape physically.
Sir William Hayter, who became Britain’s ambassador to Moscow in the 1950s, has described the occasion in the early 1930s when the scales fell from his own eyes. He was no sportsman, hated athletics, and his university friends were of the same persuasion. Nonetheless, the father of one of them, Sir Robert Witt, arranged for them to take part in a tug-of-war against the locals one public holiday.
We were all of us more or less unathletic, and the opposing teams, mainly young men from Brighton, had been practising all day. We expected to be ignominiously defeated. On the contrary, hardly had we touched the rope than our opponents practically
