Tapu Misa: Inequality is the real evil at the heart of hardship

There is a fatigue that creeps up on people who work with those at the bottom of the social and economic heap, a sense of futility that comes from feeling that no matter how hard they try they can never keep up with the human wreckage that arrives on their doorstep.

I've noticed it with some social workers and some teachers at low-income schools. Faced with a tidal wave of social problems, and no easy solutions, they start blaming poor people for their predicament. Perhaps, some suggest, the problem is not material poverty, but a poverty of the spirit. Perhaps it's the fault of bleeding-heart liberals for giving poor people excuses to fail.

Maybe. But it's clear we have a perceptual problem with poverty.

If some of the poor can afford luxuries that were unheard of in the old days - the widescreen TVs, PlayStation consoles, and late-model cars - how can anyone claim there's poverty in this country? Some readers insist the problem would be solved if the poor had fewer children, made their own clothes, grew their own vegetables and had more gumption.

No wonder there's little support in the wider community when the Child Poverty Action Group takes the Government to court for discriminating against the children of beneficiaries in its Working for Families package.

Similarly, moves to raise the minimum wage to $12 an hour have drawn sighs of exasperation from the business sector and predictions of higher unemployment and economic doom, in contrast to the sector's outright approval for the bloated salaries of the, naturally, more deserving management at the top of the ladder.

If mum, dad and the eldest siblings are all working to make their mortgage payments - I met one Year 12 student who was working 20 hours a week after school - they should be grateful. Who cares that the family is stressed to breaking point when they have food?

But here's the thing. If we're doing so well - if, as our champions of the free market are wont to claim, the pain of the last two decades was truly worth it - why are we paying increasing amounts of money to fix up the mess?

Why do we have such wide health disparities between poor and rich? Why does CYF report ever-growing numbers of children needing its help and intervention? Why do we need more social workers in our schools? Why do we need more prisons? Why do our educational gaps show no signs of narrowing? Why do so many fall through the educational gaps that an institute like Te Wananga o Aotearoa, which managed to plug them back into the system, is overcome by adults who missed out on their first-chance education?

The right and the rich believe that the poor are victims of their own shortcomings. They're too dumb, too lazy, too lacking in moral fibre.

I prefer the analysis drawn by Richard Wilkinson, a British professor of social epidemiology, in his 2005 book Unhealthy Societies: The Afflictions of Inequality.

Wilkinson is the latest in a growing number of public-health specialists who has come to the irrefutable conclusion, based on a mountain of international data, that inequality is the real evil. The more unequal a society is, the more unhealthy and dysfunctional that society is.

Wilkinson says that once wealthy societies have gone beyond the threshold at which modern medical care and higher living standards make a difference to life expectancy, the critical factor becomes not so much material poverty, as relative poverty.

In the developed world, it's not the richest countries which have the best health, but the most egalitarian.

The United States, despite being the richest country in the developed world, is also the most unequal country with the lowest life expectancy. Greece, with half the GDP per head but a more equal distribution of income, has a higher life expectancy. People in Harlem have a shorter life expectancy than people in Bangladesh. Heart disease is two-thirds of the reason, once violence and drugs are accounted for - and that's due to stress, says Wilkinson; the stress of living at the bottom of a very steep social heap.

What counts is one's place on the social ladder, and how sharply that ladder tilts. Tests have shown, for example, that stressful social hierarchies have the same negative health effects on low-status baboons - who developed high levels of the stress hormone, cortisol, which leads to arteriosclerosis - as on low-ranking Whitehall civil servants, who were three times more likely to die in a year than their seniors. Change the pecking order, as researchers did with the baboons, and you change the health outcomes.

What about individual behavioural risk factors, such as smoking, exercise and diet? Wilkinson says these don't explain the big health differences between societies.

That's why spending millions of pounds on stop-smoking programmes for the homeless, as Britain did this year, is an exercise in futility. The stress of being homeless will kill long before the cigarettes do.

Wilkinson says the stress arising from this lack of social status and respect is far more damaging to human beings than exposure to other toxic environmental materials.

It is social cohesion, he says, that makes egalitarian countries healthier than less egalitarian ones. The most egalitarian countries have the highest levels of trust and social capital.

"They have a strong community life. The individualism and the values of the market are restrained by a social morality. People are more likely to be involved in social and voluntary activities outside the home. These societies have more of what is called 'social capital' which lubricates the workings of the whole society and economy. There are fewer signs of anti-social aggressiveness, and society appears more caring. In short, the social fabric is in better condition."

How's our social fabric looking? Not too flash. Until we understand the relationship between inequality and social cohesion, we're doomed to spend ever-increasing amounts stitching it up.