What explains why the United States is doing so badly? In short: inequality. A growing number of epidemiologists – the scientists who study the health of populations – have come to view the widening gap between our richest and the rest as the main culprit behind our disappointing health outcomes. Over the past decades, our global life expectancy has collapsed as our society has become increasingly unequal.

The most compelling argument for the surprisingly negative impact of inequalities on health can be found in two books by British epidemiologists Richard Wilkinson and Kate Pickett. In The bubble level: why greater equality makes societies stronger and The Inner Level: How More Equal Societies Reduce Stress, Restore Mental Health, and Improve Individual Well-Being, the two researchers follow the statistical trail and explore how an economic phenomenon – the poor distribution of income and wealth – can harm our physical and mental well-being.

The Equality Trust, a London-based nonprofit that Wilkinson and Pickett helped establish a dozen years ago, currently offers a broad overview online of the latest research into what makes inequality a so powerful health hazard. The “most plausible explanation” for the powerfully negative impact of inequality, sums up the Equality Trust, revolves around “status anxiety”. Inequality pushes people into steep social hierarchies which increase competition for status and generate pervasive stress that undermines our health.

“The greater the material differences between us, the more important status and money become,” Wilkinson and Pickett add. “The more unequal the society, the more anxious people are about their status and how they are seen and judged. These effects are visible in all income groups, from the poorest to the richest tenth of the population. “

Dr. Stephen Bezruchka of the University of Washington School of Public Health has worked for more than 20 years to get the same message across to Americans.

“In healthier societies, the gap between the rich and the poor is smaller than us,” he observes. “This gap causes a tremendous amount of stress in our society – road rage, air rage, stress at work, child abuse. I say stress is the tobacco of the 21st century. We have learned that inequality kills.

Bezruchka brought forward the notion of a global “Health Olympics” to help get the message “inequality kills” across. If the developed countries of the world competed on health outcomes the same way they compete in sports like sprinting and swimming, with “running” how long you live, the United States would finish dead last.

Bezruchka also likes to quote the late great epidemiologist Geoffrey Rose, author of the widely acclaimed 1992 book, The strategy of preventive medicine.

“There is no known biological reason,” Rose notes from the outset in this influential volume, “why every population shouldn’t be as healthy as the best.”

But the political and economic reasons for the differences in the health of the population do abound. And inequality tops the list, a reality that actually leaves Bezruchka with a sense of hope. After all, we don’t need to discover a fantastic new miracle cure to lengthen the lives of Americans. We just need to forge a more equal America.

“Our current raw levels of inequality are not inevitable,” as Bezruchka wrote with her health care colleague Mary Anne Mercer just before the last Summer Olympics in 2016. “Reasonable and fair economic policies can do them. change.”

Sam Pizzigati co-publishes Inequality.org. His latest books include The arguments in favor of a maximum salary and The rich don’t always win: the forgotten triumph over the plutocracy that created the American middle class, 1900-1970. Follow him on @Too_Much_Online.

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