The Health of Nations: Why Inequality is Harmful to Your Health [Hardcover]

Ichiro Kawachi (Author), Bruce P. Kennedy (Author)

Book Description

Publication Date: September 2002

A powerful demonstration of how global economic inequality is undermining our nation's health and our quality of life. Applying to the United States the kind of scrutiny that Nobel-prize winning economist Amartya Sen has devoted to developing countries, The Health of Nations demonstrates that growing inequality is undermining health, welfare, and community life in America. Harvard professors Ichiro Kawachi and Bruce P. Kennedy review the social costs of inequality, revealing that the United States and other wealthy countries with high levels of social inequality have lower general health than do more equitable societies, rich or poor. , The Health of Nations makes an urgent argument for social justice as the necessary vehicle for the betterment of society, including improving the health of our bodies and our body politic. Synthesizing years of groundbreaking research on the connections between social structures and health and welfare, Kawachi and Kennedy show that the cost of inequality is greater than we realize. They dramatically demonstrate that growing inequalities, far from being a benign by-product of capitalism, threaten the very freedoms that economic development is thought to bring about: freedom from want, freedom from ill health, freedom to exercise democratic choice, and freedom to pursue leisure and happiness. In the vein of Robert D. Putnam's Bowling Alone, The Health of Nations is a major new work of social science with dramatic implications for public policy.

Editorial Reviews

From Publishers Weekly

Following up on studies like The Loss of Happiness in Market Democracies, The Health of Nations: Why Inequality Is Harmful to Your Health is a timely summation of recent economic research that shows how extreme prosperity always comes at the expense of others' poverty and perhaps of one's own well-being. Ichiro Kawachi, director of the Harvard Center for Society and Health, and Harvard School of Public Health professor Bruce P. Kennedy focus on how (as any Buddhist will tell you) "merely wishing for more money seems to lead to unhappiness" and, looking internationally, ask "are we happier and healthier [as Americans] as a result of all our consumption and accumulation?" Their counterintuitive answer is a resounding "no..-- as a result of all our consumption and accumulation?" Their counterintuitive answer is a resounding "no."
Copyright 2002 Reed Business Information, Inc.

From The New England Journal of Medicine

The Health of Nations presents evidence from many disciplines that political policies that widen inequalities in income may harm a nation's health. Kawachi, an internist turned social epidemiologist, and Kennedy, an educational psychologist, examine a number of indicators of health, such as mortality rates (with respect to which the United States performs miserably in comparison with all the other rich countries), and present arguments to show that one's relative position in society is more important than absolute wealth or income, not only when it comes to general well-being, but in terms of mortality as well. The authors contend that our "consumption cancer" has left us with huge consumer debt, limited savings, and an inequality that is posited to be the root cause of our poor health. We work longer and harder, and we have less time for our families. These factors lead our country, they argue, to higher rates of violent crime and incarceration, to the establishment of gated communities with security guards, and to the outsourcing of the care of children. With the weakening of social bonds comes a dramatic increase in the incidence of depression. Paradoxically, they suggest, if the government were to launch an effort to redistribute the wealth from the rich to the poor, the poor might not even support it: although the likelihood of upward economic mobility by the poor in the United States is lower than that in other rich countries, poorer people in this country continue to dream of being among the lucky few who win the big one. Goods that were once considered luxuries in the United States, such as automobiles, telephones, television sets, and videocassette recorders, are now near-necessities, and most people have them. Kawachi and Kennedy point out that despite rising living standards, we have not become "deliriously happy," as economists had predicted. There is little correlation between increasing income and the level of happiness in industrialized countries. We end up not "getting what we want" but "wanting what they get." According to the authors, "A notable trend during the past two decades has been the contrasting difference between massive intensification of consumption wants for material goods, but the stagnation (or even decline) of expressed needs for spiritual goods, such as a fulfilling job or happy marriage." The authors also address common misperceptions of the purported benefit of inequality: that it produces increased economic growth and productivity is unquestioningly accepted as good. In a counterexample drawn from major-league baseball, the authors show that teams are more successful when players' salaries are more equitably distributed. We work harder and longer just to keep up with our 1973 standard of living. This additional work translates into 5 to 10 more weeks of work each year for members of the American labor force than for their European counterparts. Politicians preach about "family values," but how can families prosper without time for maintenance? As a result of the orientation toward individual rather than family needs, some people see children as obstacles to individual growth. The authors point out that higher rates of crime occur when the high cultural value placed on competitive achievement clashes with widespread disparities in actual living standards within a society. Inequality is harmful, and we pay the ultimate price for it with premature deaths. Why should this book be important for clinicians and biomedical researchers? To improve health in the United States or elsewhere in the world, we must address factors that affect the health of populations but have only indirect relevance for patient care. The chapter "Politics and Health" points out that, in contrast to people from healthier European countries or Japan, Americans are less inclined to expect their government to work for the common good, as indicated by the fact that the largest "political party" in this country consists of the nonvoters. The erosion of social capital -- resulting in distrust in neighbors and unwillingness to help others -- is more prevalent where income gaps are greater. In parts of the United States where there is a greater divide, voter turnout is significantly lower. Not surprisingly, mortality rates are higher in such places as well. Clearly, the political arena is the place where doctors concerned with the health of the population must work. Stephen Bezruchka, M.D., M.P.H.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Product Details

• Hardcover: 256 pages
• Publisher: New Press, The (September 2002)
• Language: English
• ISBN-10: 156584582X
• ISBN-13: 978-1565845824
• Product Dimensions: 8.5 x 6.4 x 1 inches
• Shipping Weight: 15.4 ounces
• Average Customer Review: 5.0 out of 5 stars  See all reviews (3 customer reviews)
• Amazon Best Sellers Rank: #202,454 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

6 of 6 people found the following review helpful:

5.0 out of 5 stars If you vote, you should read this book., December 3, 2006

By 

Ann Morris (Iowa City, IA USA) - See all my reviews
(REAL NAME)   

This review is from: The Health of Nations: Why Inequality Is Harmful to Your Health (Paperback)

For the most part, I'm one of those people who enjoy 95% of what they read and yet are largely quiet about it. I read, and then I move on. This book is one of the few exceptions to this rule. I read the hardbook version of this book during my college "Sociology of Medicine" class three years ago, and it completely changed the way I thought about the delivery of healthcare in the United States and the world. Written by two researchers in public health, Health of Nations is well-written, well-researched and fully cited. Using clear facts and analogies, it drives home the point that healthcare in the United States is a far cry from perfect. Just the fact that I read this book makes me cringe every time that I hear a politician claim that medicine in the United States is the best in the world. Every American who votes on the current state of healthcare should read this book. Soapbox aside, I'm now a third year medical student, and I still refer to this book in conversation. I have also cited it as a reference in at least three academic papers, both in college and in medical school. I'm not sure I could give such high praise to any other book I have read for school. All in all, this a well-crafted nonfiction book that will leave a lasting impression.

7 of 9 people found the following review helpful:

5.0 out of 5 stars Important contribution., February 29, 2004

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alainviet "alainviet" (Indianapolis, IN United States) - See all my reviews

This review is from: The Health of Nations: Why Inequality is Harmful to Your Health (Hardcover)

Chasing the American Dream could be dangerous to your health. People with extrinsic goal orientation (i.e. chasing fame, fortune, recognition, and good looks) were more likely to be depressed than the rest of the population.

The richest citizens on earth (Americans) had a higher infant mortality and lower life expectancy than 25 other economically developed nations. A high infant mortality and low life expectancy correlate with an inequality in income distribution.

Americans also took less vacation time and worked five to ten weeks more per year than people of other countries. This correlates with a high incidence of depression and other medical conditions including obesity and diabetes.

The authors concluded that economic inequality, relentless competition, escalating consumption threatened the health of the people and the nation.

2 of 2 people found the following review helpful:

5.0 out of 5 stars A Book Every American Should Read (but probably few will), July 26, 2009

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Blusuede (NYC, NY USA) - See all my reviews

This review is from: The Health of Nations: Why Inequality Is Harmful to Your Health (Paperback)

At this point in American history, as we are debating health care "reform" this book is a crucial tool we can use to educate ourselves about the overall context of our health care system. The authors persuasively argue that extreme income inequality in and of itself can negatively affect a nation's health.

This means that apart from talking about doctors and nurses and hospitals, we should be (but aren't) talking about inequality in this country. Of course, that is such a hugely taboo topic that a chorus of "class warfare" shouts will be raised if one even mentions the idea that our tax system is far from progressive and that extreme disparities in wealth are not just unseemly but unhealthy.

Don't be put off by the few graphs in the text. There is little wonkishness in these pages; the authors do a commendable job summarizing research in the field and making positive suggestions on what implications their research has for our struggling medical system.