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April 2, 2010

Note: This is an edited conversation.

BILL MOYERS: The other day, I came across a report in the October issue of a medical journal, THE JOURNAL OF PEDIATRIC SURGERY. It's a study done by Boston's Children's Hospital and the Harvard Medical School which found that uninsured children were over three times more likely to die from their trauma-related injuries than children who were commercially insured. In other words, it could be a matter of life and death, whether a child lives or dies depends on whether the family is rich or poor. The report is just one indication of a rapidly accelerating gap that cuts right to the core of democracy. And that's why I wanted to speak with two British researchers who are pioneers studying the impact of inequality on human beings. Richard Wilkinson and Kate Pickett are epidemiologists whose book THE SPIRIT LEVEL: WHY GREATER EQUALITY MAKES SOCIETIES STRONGER — with an introduction by our friend Robert Reich — has been described by THE SUNDAY TIMES of London as "a book with a big idea, big enough to change political thinking."

THE INDEPENDENT called it "compelling and shocking. All free marketeers should be made to memorise it from cover to cover." Richard Wilkinson, professor emeritus at the University of Nottingham, is a leader in international research of inequality. His work has been published in ten languages. Kate Pickett is a scientist with Britain's National Institute for Health Research and a professor of epidemiology at the University of York.

BILL MOYERS: You're both trained as epidemiologists, right?



RICHARD WILKINSON: That's how we got together.

BILL MOYERS: What, in laymen's terms, does an epidemiologist do?

KATE PICKETT: We study the distribution and determinants of disease in populations. So rather than looking at the cause of disease in an individual, we look at the causes of different levels of disease or states of health in different populations. So we might ask the question, "Why is one group healthier than another?" And try to understand the determinants of that. Or we look at a particular disease and try and understand the kinds of things that have happened to people to cause those differences across populations.

BILL MOYERS: And that's how you came to pursue the subject of inequality?

RICHARD WILKINSON: Yes, for a long time I have been trying to understand the big differences in life expectancy between the rich and poor or the well-educated and less well-educated in this society, how sensitive health is to social and economic conditions, even amongst rich populations. And it really came out of that. It isn't that health is worse in the poorest areas of our societies, but it's worse in societies with bigger income differences between rich and poor.

BILL MOYERS: So, you're not surprised that a child in a trauma unit is more likely to survive if that family is covered by insurance than one that's not?

KATE PICKETT: No, not at all. I think we've known for quite a long time now about the social distribution of health and that health is worse in our poorest communities. It's worse among those with less education, less income, fewer resources, in the poorest neighborhoods.

BILL MOYERS: That seems pretty obvious from the last number of years. What's fresh about your insight as you express it in this book?

RICHARD WILKINSON: Well, what we've discovered is health is just one of many issues which are worse in more unequal societies, including violence or teenage births and all sorts of other problems. These are not just a little bit worse in more unequal societies, but are much worse.

You find three times the amount of mental illness, or six or eight times the homicide rate or eight times the differences in teenage birth rates; all sorts of huge differences and on almost any of these kinds of measures, more unequal countries do worse.

BILL MOYERS: Define what you mean by inequality?

KATE PICKETT: We are talking about the gap between the rich and the poor; the income gap. In our book, we look at the scale of income differences across 21 to 23 different rich, developed market democracies. And we look at the income of the richest 20 percent, the top fifth, compared to the income of the bottom 20 percent, the bottom fifth. And we compare health and social outcomes to that scale of income inequality.

RICHARD WILKINSON: But, of course, this also goes with all the sort of social differentiation, feelings of superiority or inferiority and all the ways we express differences in social status. I think the income differences are the sort of foundation and income is so important because we've used it to express our social status.

KATE PICKETT: And let me tell you about the scale of those differences. We have countries at the more equal end like Japan, Sweden, Norway, where the income of the top fifth of the population is about three and a half to for times those at the bottom. But in the U.K., in the USA, in Portugal, Australia, it's more like seven to eight and a half times. So, in the U.K., USA, Australia, Portugal, we're about twice as unequal as the 'more equal' of the rich market democracies.

BILL MOYERS: And what's the impact on the two societies, say, the U.K. and the United States compared with Japan?

KATE PICKETT: Well, it's profound.

RICHARD WILKINSON: As I said, almost everything gets worse: homicide rates, how kids get on at school, math and literacy scores, teenage birth rates, obesity. Mental illness is worse, how much people feel they can trust others, the size of prison populations, what proportion of the population are locked up, measures of social cohesion, how much people are involved in community life. Everything seems to get worse.

BILL MOYERS: Levels of trust among people are affected by the distribution of income?

KATE PICKETT: That's right. And we can see that internationally, and across the 50 U.S. states.

BILL MOYERS: How did that play out?

RICHARD WILKINSON: I think it's something that people have had an intuition about for centuries. They have often regarded inequality as divisive and socially corrosive. And our data shows that this intuition is much truer than any of us ever realized. We choose our friends from amongst our equals. People don't feel so at ease with people who are much better off.

BILL MOYERS: Inequality makes strangers of us?

KATE PICKETT: That's right. At one point, we wanted to call our book, "Inequality: The Enemy Between Us" because in a more unequal society, the social distances get stretched out between us. As the hierarchy gets steeper, social distances are greater, and it's harder to trust.

RICHARD WILKINSON: Also, as these differences in status get bigger, status competition seems to increase, and people judge each other more by status. You know, "You're somebody I should pay attention to, or are you someone I can ignore completely?"

BILL MOYERS: And you think that depends on income?

RICHARD WILKINSON: I think that we judge each other by that.

BILL MOYERS: Take an extreme case. Let's say that I love baseball. And I love the New York Yankees. And I make $20,000 a year. It doesn't really matter to me that the star slugger on the New York Yankees makes $20 million a year. I still admire his talent, his skill, and his success without feeling either envious of him or disparaging of him.

KATE PICKETT: This isn't about envy. And it's not about what you might think about a particular person whose talent you admire. It's about what those social distances and those income differences do to society as a whole. This is not about whether you trust a particular individual but rather, do you trust people you meet on the street?

RICHARD WILKINSON: The data is very clear. And we've not only looked at these rich, developed countries to see what these relationships like are there. We also looked at the 50 American states as a separate test bed and ask the same question "Do the more unequal American states do less well than the more equal ones?" And, the picture is very, very similar on all these things, particularly trust and the differences in trust. And this is fairly politically sensitive stuff.

KATE PICKETT: Just as people in more equal countries trust each other more, so do people in the more equal states of the U.S.

BILL MOYERS: Give me an example.

KATE PICKETT: In more equal countries, about two-thirds of the population trusts others, and in the more unequal countries, it's less than a fifth. And it is the same in the more equal U.S. states such as Vermont, New Hampshire, Iowa, Wisconsin. North Dakota's up there.

BILL MOYERS: Where the gap between the richest and the poorest is smaller?

KATE PICKETT: In the more equal states, two thirds of the population feel they can trust other people. And down in your most unequal U.S. states, and I'm afraid New York comes at the absolute bottom — but so do some of the southern states — only about a third trust each other.

BILL MOYERS: Kate, you've lived in this country studying and teaching sixteen years?

KATE PICKETT: Sixteen years, yes.

BILL MOYERS: We have a difficult time in this country talking about inequality. We like to proclaim from our declaration all men, women, are created equal. But when you get to discussing inequality it is a very inflamed subject. And we just don't like to go there.

KATE PICKETT: Well, a couple of points. One is that things can change. And two, we had the same situation in the U.K. until fairly recently. Nobody wanted to talk about inequality. It was off the political agenda. In fact, a few years ago, when I went up to Scotland -- I was in Edinburgh presenting our work and a member of the Scottish Parliament came up to me and said he thought it was very important, and he approved of it. And he followed Richard's work for many years.

So, I said, "What are you going to do about it?" And he said, "Oh, nothing. It's inequality, we can't talk about that. We can only talk about poverty." And that's really changed with the economic crisis. And suddenly a space has opened up. And we can discuss inequality in Europe, in the U.K. And in fact, all political parties in England have been very interested in the implications of our work.

But I think here in the U.S., there is still this idea that inequality isn't something you want to talk about, or that it's an entrenched problem. I think you're forgetting your more recent past where you were a much more equal country than you are now, among the most equal of the Western developed countries.

BILL MOYERS: When was that?

KATE PICKETT: The '40s through the '70s.

BILL MOYERS: The '70s is when the wage gap began to open.

RICHARD WILKINSON: And you were very unequal in the 1920s. But from about the 1930 onwards, you've been becoming steadily more equal, until you get to sometime in the late 1970s. And then the inequality rises again. And, of course, in relation to Europe, one of the American values, what America stood for was not having this sort of feudal class system. But you're recreating it.

KATE PICKETT: What's really interesting about America is the idea that talking about inequality is anti-American. It's disproved by your recent past as a very egalitarian country. But also what we show in our work is that social mobility is very low in the USA and in the U.K.


KATE PICKETT: It's harder to get ahead.

BILL MOYERS: Well, that's really slowed down in this country.

RICHARD WILKINSON: People have looked to see whether rich fathers have rich sons and poor fathers have poor sons. And where father's income is not a good predictor of a son's income, you've got high social mobility. And that, again, it's best in the more equal countries.

BILL MOYERS: And what's your explanation for that social mobility, the ability to start at the bottom rung and rise to the top, in terms of your study?

RICHARD WILKINSON: I think that as the differences between us get bigger there is probably more sort of downward prejudice, snobbishness, and more class differentiators. It's as if the steps on the social ladder, the rungs on the ladder, were further apart. And it becomes harder to get up and down.

KATE PICKETT: We also show that educational achievement is worse in more unequal countries. Kids do less well on international math and literacy scores. Kids in more unequal states score less well on those, and are more likely to drop out of high school. So, that's feeding into this inability to move upward socially in a more unequal country.

BILL MOYERS: Let me come back to the basic life and death issue, you know? That life expectancy, as you point out repeatedly in here, correlates strongly with inequality, the more unequal the society the shorter the lifespan of the people in it. Now, give me the cause and effect there. What the connection?

RICHARD WILKINSON: We know a lot about this. Stress continuing over long periods creates effects rather like more rapid aging. And it weakens the immune system. It has damaging cardiovascular effects. And gradually we've understood this partly through studies of human populations, but also doing experiments with nonhumans and nonhuman primates — monkeys of different kinds.

And interestingly with them, you can keep them all in the same material conditions, in the same compounds, give them the same diet, and then manipulate status by putting animals in different groups so some of the high status become low status and things like that. And you see many of the same effects of low social status as we see in big studies of civil servants working in London offices.

BILL MOYERS: And what do you find there?

KATE PICKETT: Well, the higher ranking civil servants live longer and are a lot less likely to have coronary heart disease and heart attacks than the lower ranked civil servants even though they're all employed and they're all pretty middle class.

RICHARD WILKINSON: So, we're not simply talking about how inequality affects the poor. These effects seem to affect the vast majority of the population.

BILL MOYERS: In what sense?

RICHARD WILKINSON: Well, the effects of inequality are biggest amongst the poor. But even amongst the top there are effects of living in an unequal society. Your children would probably do better educationally in a more equal country. They would be less likely to get involved in drugs or violence or any of these kinds of things. You would be likely to live a bit longer. And, the average population life expectancy is about four and a half years shorter in the USA for everyone than in Japan, which is the most equal of our rich, developed countries.

BILL MOYERS: And how do you tell the extent to which, for example, diet, let's say eating more fish in Japan means you live longer without heart disease?

KATE PICKETT: Well, there are lots of competing explanations. But we haven't yet come across one that explains the pattern of findings that we show. For instance, Portugal is very unequal, has poor health, low life expectancy, they eat quite a lot of fish. So, each competing explanation is sort of disproved by the pattern of the data.

So, we have Sweden and Japan, countries that are about as different as you can imagine in terms of culture and all sorts of other ways. But because they're more equal, their health and social problems are better.

RICHARD WILKINSON: But, when the U.S. was one of the more equal countries, its health was amongst the better, not quite at the top, but in the top few. And yet now it comes behind all the other developed countries. Japan was one of the more unequal countries, and had bad health and yet, through the '50s, '60s, '70s, and '80s, and when they became more equal, their health outstripped every other country in the world. Their crime rates went down. But the USA has slipped all through that period. And it swapped places with Japan.

BILL MOYERS: I can see the moral dilemma of a society that allows a teenager of a deprived family in the inner city to live four and a half years less, to die four and a half years earlier than some young person from the suburbs.

KATE PICKETT: Actually, within the U.K., we have eight to nine year life expectancy differences between the most affluent and the poorest areas. And I think they're even larger for U.S. neighborhoods.

BILL MOYERS: You have a chapter here on imprisonment and punishment. And you point out that prison populations have been increasing steadily in this country since the early 1970s. And that this contrasts sharply with what has been happening in some other rich countries. What are we to make of that?

KATE PICKETT: I think what surprised us is that while there's clearly a much higher rate of imprisonment in the more unequal countries, and it's not particularly closely related to crime rates. I think that's the most interesting thing.

BILL MOYERS: What do you mean?

KATE PICKETT: Criminologists here in the USA have estimated that for your changing state levels of imprisonment, only about a third of that can be explained by change in crime rates. The rest is due to a harsher judicial system.

RICHARD WILKINSON: Punitive sentences.

KATE PICKETT: People are more likely to be sent to prison for a particular crime or sent to prison for longer. And certainly internationally, we see other countries taking a very different approach to justice. I mean, some people have said that the easiest and surest route to creating a violent criminal is to send them to prison. And other countries take a much more-- a less harsh approach. They're much more interested in rehabilitation, alternatives to incarceration, job training when people are in prison, and psychological health.

RICHARD WILKINSON: But this punitive sentencing in more unequal countries is part of a wider picture of how the quality of the social fabric in a society can deteriorate. It's not only the harsher sentencing or more punitive sentencing, it's that the levels of trust go right down, community life weakens, and we have less to do with each other. We become more competitive with each other. And we value less the idea of a sort of shared reciprocity and common interests, or interest in the general well-being, and that kind of thing.

BILL MOYERS: In the forward to your book, Robert Reich, the former Secretary of Labor in this country, reminds us of the great gap that's open between CEO's and workers in this country since the '40s and '50s and now. "In the 1950s and '60s, CEOs of major American countries took home about 25 to 30 times the wages of the typical worker... by 1980, the big-company CEO took home roughly 40 times; by 1990, it was 100 times. By 2007 ...CEO packages had ballooned to about 350 times what the typical worker earned." And even after the great financial collapse of '08, that trend seems to be accelerating while wages for working people are stagnating. What does that much income inequality say to you?

KATE PICKETT: Well, this is exactly why we're seeing such a high level of health and social problems. Those runaway incomes at the top are really what we're talking about — this growing gap in some countries. And, of course, not all countries have followed that pattern.

KATE PICKETT: And bonus culture in the financial sector has had a spillover effect, as well. So, we see bigger gaps even within the public sector. Again, creating that climate where status matters, income matters. So, even in the public sector top earning CEOs want to sort of keep up as well. So, that whole culture runs away. And there's just a lack of democratic constraint on it.

BILL MOYERS: How does that play out in the terms you're discussing in the book?

RICHARD WILKINSON: Inequality is damaging to the social quality of life of all of us. We can isolate ourselves from it and, you know, stay at home and try to strive to get the next electronic gadget or whatever. But this is not what human beings really need. We're intensely social creatures and that's why inequality affects us so much.

BILL MOYERS: What does being a social creature mean?

KATE PICKETT: It means being sensitive to social relationships.

RICHARD WILKINSON: More equality seems to switch social relationships from being about status competition, where we think of where we are in relation to each other to how much we see each other as cooperative and mutual and with reciprocity and empathy being important.

KATE PICKETT: And that's why that top ten percent matter. Because, in a sense, they create a climate of striving and competitiveness and being aware of your position in society, your ranking. And that is fundamentally important to your sense of yourself and your position in society. And how you feel affects your biology and your physiology.

BILL MOYERS: You said that inequality creates a sense of trying to keep up, the rat race. But as a journalist traveling the country, I find it's the result of what's happened to our ability to earn a living in this country. That irrespective of trying to keep up with the Jones's, as we have always said in this country, regular people just have to work harder and harder to make ends meet.

RICHARD WILKINSON: Well, that's interesting. That and I think because of the increased status competition and trying to keep up. Americans work much longer hours. There's a relationship between the hours a country works and how unequal it is. So, in the most unequal countries, people work perhaps nine weeks more a year than in the more equal countries. And I think that's because income matters even more. It's what speaks for you. It's what represents you to others. You know, whether I'm a significant person or not.

BILL MOYERS: Well, and it also puts food on the table, shoes on your kids feet. I mean, there's an essential survival-quotient here.

KATE PICKETT: There is. But, you know, we are talking about the rich market democracies.

BILL MOYERS: What did it say to the two of you that in this country right now six million Americans receive no income other than food stamps? That's the only source of their daily bread. And now something like 30 million need food stamps on a kind of consistent basis, because of high unemployment and food costs. The numbers have surged since the financial crisis. How does that translate into your perception of a country?

RICHARD WILKINSON: It really is the scale of differences. How far behind the rest of us they are that are the real determinants. As countries get richer, it doesn't seem to help children at all anymore.

BILL MOYERS: So, what's your conclusion then? What's the therefore?

KATE PICKETT: The most important pressing need is to close that income gap, to reduce inequality in society.

RICHARD WILKINSON: And although for hundreds of years the best way of raising human quality of life has been to raise material living standards, it looks as if we've got to the end of that process. It no longer drives improvements in life expectancy.

KATE PICKETT: Or happiness.

RICHARD WILKINSON: Or even measures of well-being.

BILL MOYERS: You make a point in here that if you have one loaf of bread a day, that's really all you need. If you happen to have two or three, a lot of bread will mildew, with diminishing returns.

RICHARD WILKINSON: We were told by someone the other day that some interviewer asked a CEO about his wealth: "But surely you can't spend it? You know, you get so much you can't possibly spend it all?" And the CEO said, "No, but it tells me I'm better than the other CEO in another company." And so it is about those ranking systems.

BILL MOYERS: I brought a story with me from THE GUARDIAN, a newspaper, and here is a quote: "'One of London's leading bankers has suggested that the inequality created by the huge salaries of bankers is a price worth paying for greater prosperity.' Lord Griffiths, vice-chairman of Goldman Sachs International and a former advisor to Margaret Thatcher said, 'Banks should not be ashamed of rewarding their staff.' He said in Saint Paul's Cathedral, right there in the heart of the city, 'The British public should tolerate the inequality as a way to achieve greater prosperity for all.'"

This is a man who spent his childhood in a mining town in Wales. Both of his grandfathers were miners who had to retire from work, because they were injured. And he is making a case that you will hear in this country that these high earners are creating the prosperity on which everybody else ultimately depends.

KATE PICKETT: Well, we've seen that those high earners actually have managed partly to create an economic crisis and a credit crunch that is having a hugely damaging effect on all of us. There was an idea in the past that top earners deserved those incomes. That economic growth was very important. Because it would trickle down and benefit all of us. And I think what we're showing with our data is that that myth is not true. The pulling away of those top incomes at the top creates an inequality and a social dysfunction that affects all of us.

RICHARD WILKINSON: But the banker, I think, was right talking about his childhood. At that time, you know, in the 1930s-- growth did matter. It really did improve the real quality of life for human beings. But, from about the '60s on, that stopped happening.

KATE PICKETT: But let's dispel another myth about inequality which ties in with what that banker is saying. And that's that we need inequality to drive creativity and innovation and aspirations. The less you have that hierarchy, people won't struggle to get ahead. And, of course, there always are a fortunate few, like the banker whose father and grandfather were miners in Wales, who do manage to get ahead. But the vast majority of people won't get ahead in a more unequal society. Their aspirations will come to nothing. And we find actually that innovation seems to be lower in more unequal societies, not higher.

BILL MOYERS: Well, that goes to the heart of what Libertarians in this country, in particular, but conservatives generally say, that the more you try to end inequality, the more you subdue innovation, that if you try too hard to cure inequality, you will kill innovation.

KATE PICKETT: And I think what we just described proves that that isn't true.

BILL MOYERS: You touch in the book upon politics. We have seen here in America that as the financial sector, Wall Street, and the banking community have increased the gap between them and everybody else they've concentrated this new wealth into political muscle, political clout. And that political clout enables them to more effectively seduce the government, so to speak, thereby actually increasing the inequality at the same time.

KATE PICKETT: And one of the things we're trying to do is provide an evidence-base to counteract that to show the damage that that inequality does. So that instead of politicians using stories or pointing to someone who's managed to get ahead against all odds and achieve great things, the vast majority of the data show quite strongly that that's not the case. And people need facts. They need to understand what's going on.

RICHARD WILKINSON: They somehow imagine this sort of thing might be true. But they regard it as a sort of private hunch. And so, actually showing that that's what the crude data lays out helps people understand that it all pans out in the way it does when you look at the statistics.

BILL MOYERS: Well, I've done documentaries on our Constitution, on our founding fathers. And what I've learned is that people know cognitively that all men are not created equal. But intuitively, they want to believe it. What does that say to you?

KATE PICKETT: Well, I think we were very surprised to come across a survey of Americans, asking them about their values. And it turns out most Americans sort of feel that something's gone wrong with society. And that we've come to value materialism too much. The society has become too consumerist, too individualistic, too material. Everybody's striving to get ahead. And as Richard said, they think that's sort of a private view. And it's only when they're brought into focus groups to discuss these matters with other people that they discover that other people think like them.

RICHARD WILKINSON: And that intuition that actually we sacrifice more important values, like friendship and community and family from, you know, working longer hours. So, we don't have time for each other.

BILL MOYERS: The opening chapter of your book is about the impact of inequality on the social contract. You believe there's an invisible social contract. What we talk about in the preamble of the Constitution "We the People."

RICHARD WILKINSON: Throughout human development we've always had the potential to be very cooperative with each other. Or, we have had the potential to be each other's worst rivals. We've lived in everything from the most egalitarian societies to the most awful tyrannies. But we have become highly sensitized to social status and to friendship, because we need to know which game to play. Do I have to fight you for everything I can get? Or do we share? And the anthropologists say a gift makes friends and friends make gifts. Because it symbolizes that you and I don't compete for access to basic necessities. And, of course, that symbolism and not fighting over access to basic necessities goes with the fact that, you know, families eat together. You invite friends to eat together. And even in religious services, the communion is symbolic of not fighting over access to basic necessities. And what inequality does is shift us a bit more towards the competition with each other and a bit further away from cooperative reciprocity and mutuality.

BILL MOYERS: I can see my anthropology professor at the University of Texas, Gilbert McAllister, striding up and down as he reflected on his five years of research among the Apaches in West Texas. And he said that human beings over the long course of our evolution have succeeded in doing more through collaboration than through competition. And I hadn't thought about that very often. But you drive that point home in here.

KATE PICKETT: That's right. I think anthropologists estimate that we've spent about 80 percent of our time as anatomically modern human beings in quite egalitarian cooperative societies. Hunter-gatherers are very egalitarian. They need to keep the peace between each other. They share. So, we're clearly capable of living in very egalitarian settings. But human history shows that we're also quite capable of living in very tyrannical hierarchies as well. And we clearly have the capacity to do both. And that capacity is our sensitivity to social life, to social relationships.

BILL MOYERS: So, why have you spent so much of your lives on this? Why the passion?

RICHARD WILKINSON: I started off looking at these health inequalities within our society. And how long people live in the poorer areas compared to the richer areas and whether it's a five-year difference in some countries or 15-year difference. That's one of the most basic denials of human rights. You know, for people to be deprived of at least ten percent of life, it's like if we lock them up without trial. It is a basic human right that's at stake. And so, unraveling this problem, I've always felt was very important. I started off thinking our job in research was to find out what aspect of the differences in material living standards it was. Was it the housing? Was it diet or whatever that gave people more heart disease or less cancer or whatever it was?

I never thought that these psychological and social factors around human relationships were more important. But actually, the big story that's come out of all this research is, for instance, that friendship is very protective of health. The quality of your early childhood is very important. And issues to do with social hierarchy are very important.

KATE PICKETT: I suppose our current passion comes from not only understanding this, but understanding the breadth of the health and social problems that are affected by inequality. We tend to wake up listening to news on the radio. And often, these kinds of problems are being discussed: Violence, drug use, kids dropping out of school. And we would listen to, often, academics brought on to discuss them.

And they always discuss them as if they're a completely separate problem from any other health and social problems. Different academics study violence from those who study health or study education. Different government departments deal with each of those problems. And there was just a lack of understanding of inequality as a common cause of all of those things.

RICHARD WILKINSON: Although we know that those problems are all more common lower down in the social ladder.

KATE PICKETT: So, our passion at the moment also comes from feeling that there's a quite simple policy or political implication here: that if inequalities can be reduced, the benefits will not only be for the vast majority of the population, but they'll be across a whole range of problems that are currently dealt with, very expensively and pretty ineffectively.

BILL MOYERS: If you were a politician in government instead of an epidemiologist studying the issue, what are some of the practical steps that you would suggest that might win the support of the great middle of the country?

KATE PICKETT: The most important thing that a politician could do would be to actually give us a vision of how much better society could be if we're more equal. I mean, we can rely on people with policy expertise to tell us whether it's more effective to do something about taxes at the top or minimum wages at the bottom, or what combination of policies might work.

But I think what we're really lacking, certainly at home in the U.K. and perhaps here as well, are politicians willing to take a hard look at the evidence and then use that to give us a clear vision of how much better society could be for us all if differences were smaller and the quality of social life were better. And as we think that politics is probably going to be dominated for the next couple of decades by the need to cope with climate change and develop more sustainable economy and then thinking about what our societies are going to look like, and creating an optimistic vision for what those could be like rather than one in which we all just have to tighten our belts and do without. That would be the most valuable thing a politician could do. I just hope that people will look at the evidence, read it carefully, and understand that what we're talking about is very simple. It probably fits with the intuitions they've had all along. But we can now demonstrate these powerful influences on our well-being. And that gives us a handle on what we can do about it.

RICHARD WILKINSON: All we're saying is all those problems get worse if you stretch out the differences. And they get worse for all of us.

BILL MOYERS: John Carey of THE SUNDAY TIMES, in one of the first reviews I read online of your book, says this is a book with a "big idea, big enough to change political thinking." What's the big idea?

KATE PICKETT: The big idea is that inequality has a profound impact on a range of health and social problems. And that it affects all of us in society.

RICHARD WILKINSON: It's the key to the real improvement to the quality of life for all of us now.

>>More on inequality in America.

Note: This is an edited conversation.
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