Forget the ‘fat cats’. Big executive salaries can make you (not them) fat.
By Dr Garry Egger 
New findings show how big CEO payouts and runaway executive salaries can cause obesity – and other health problems – but not to those who get them.
At first glance, the opposition to mammoth payouts to the likes of Jeff Dixon and Sol Trujillo, and executive wage levels into the stratosphere, smacks of sour grapes. But a new look at health and income disparities in the wealthiest countries in the world now justifies more concern than that just generated by avarice.
Figures put together by English researchers show that just about all health and social problems in a country, from mental health to obesity, and from teen pregnancy to violence in the streets, are made worse by an increased gap between the top and bottom 20% of income earners. Those countries where the gap is widest (ie. the US, UK and even Australia) don’t fare nearly as well as those where the gap is narrower (Japan, Sweden, Norway).
Remarkably, this could also provide an answer to the question of what’s driving the modern obesity epidemic.
Dr Richard Wilkinson is an epidemiologist with an upper class Oxford accent. Like other epidemiologists he studies the causes of disease. But unlike most of his professional peers, Wilkinson is not from a medical background. Instead, he studied economic history – a unique background for considering the real causes of modern lifestyle-related chronic disease.
At a recent International Conference on Obesity in Amsterdam, Wilkinson quietly surprised the world’s best obesity researchers by humbly apologising for not being a doctor. He then went on to explain that the answer that he and his colleagues had found for what causes obesity is not just sloth and gluttony, but how we fare against our neighbour.
For over two decades, Wilkinson and his colleagues, who include the venerated Australian epidemiologist Dr Michael Marmot, who has been knighted for his contributions, have been collecting data on health and social class. Marmot made his reputation on the finding that the lower one is on the social totem pole, the worse one’s health – independently of income, education and other factors that define social class.
Wilkinson expanded this by showing that it’s not an individual’s absolute income that matters, or even the per capita income of a country, but the relative difference between income levels within that country. In the US, where the highest 20% of income earners average more than 9 times that of the lowest 20%, scores are worse on all indices of heath and social welfare studied than in countries like Sweden, Japan and Norway, where the income differential is only around three.
The indices collected in a new book entitled ‘The Spirit Level’, with health researcher Dr Kate Pickett, include: physical health, mental health, drug abuse, education, imprisonment, obesity, social mobility, trust and community life, violence, teenage births, and child well-being outcomes. In Japan, Norway and Sweden, although average income is lower than the US, all health indices are significantly better. There’s also a clear gradient between the world’s 20 richest countries on all indices, correlating to the size of the income differential. Australia is towards the US end of this gradient.
The big question of course is why should this be so?
Wilkinson presents data from a complex of surveys going back to the 1950s to show that anxiety levels have been rising in countries like the US over that time. From 1952 to 1993 the average college student was more anxious than 85% of the population at the beginning of it. And this is not just confined to college students. Studies in children have found that by the late 1980s, the average American child was more anxious than child psychiatric patients in the 1950s. There has also been an increase in a range of related factors, from the general feeling of threat (from crime, war, disease etc), to breakdown of social connectedness, with increased anxiety levels. All this appears to be less in more equal societies.
Anyone born before 1960 would empathise with this; from a time when houses didn’t need to be locked; when kids played in the streets without fear of ‘stranger danger’; when a verbal disagreement with a stranger didn’t climax in a crime scene.
But how can lack of trust, and the increased anxiety coming from this account for obesity? Wider gaps in income lead to wider waists according to Wilkinson because of the competition to ‘keep up’ by working harder, leading to less time for physical activity and more need for fatty convenience foods. Eating for comfort in times of anxiety is also a known cause of weight gain.
And if you don’t believe the difference between countries, the same effect is shown when states within the US are graded on income differentials. Texas and Lousiana are fattest and have 2-3 times the income difference of New Hampshire and Utah, which are the leanest US states, with the lowest income differentials.
According to Wilkinson, these figures confirm what should now be obvious: economic growth has ‘done its job’ in developing wealth in advanced countries. Now the job is to distribute that wealth more equally – both within and between countries. Studies have shown over and over that human well-being doesn’t improve beyond a set level of wealth. The current findings show that things gets worse, not just amongst the poor, but in all levels of society, where income is more unequal. Obesity is up to three times higher at all levels of society in the US compared to Japan or Norway for example, and not just amongst the poor.
It’s also no coincidence that when a measure other than Gross Domestic Product (GDP), the purely monetary measure of economic throughput that we use as our measure of progress is used, countries re-align themselves on the world well-being table. The US, with the number 1 per capita income drops to number 148 on a ‘happiness index’ (HI) measuring longevity, income and a subjective measure of well-being. Honduras, in the Caribbean, and Vanuatu in the Pacific leap to numbers 1 and 2 on the happiest places to live, from relative obscurity on a wealth table.
Of course these findings put health scientists into the dangerous territory of political policy. Limiting executive salaries according to Wilkinson, is a health, not an economic priority. Reducing the influence of multi-national corporations by introducing public funding of political campaigns, thus eliminating corporate lobbying, is a relatively easy structural change to make. Different countries on the good health end of the income differential scale also have different ways of ensuring greater equity: Japan for example has less of an income gap at payment; Norway and Sweden tax higher income levels more. Putting a cap on the amount people can borrow would also slow down the runaway debt bubble and reduce the increasing status gap.
There’s no way of going back to the past. And we’ve no doubt overshot the glory days of economic growth, where the marginal benefits of increasing investment exceeded the marginal costs. Climate change and the GFC has taught us that. But who is going to tell Jeff and Sole that their greed has caused my weight problem? Try explaining that to your GP.
Dr Garry Egger is Professor of Lifestyle Medicine at Southern Cross University and an Advisor to the World Health Organisation and Governments in lifestyle and chronic disease.
Dr Garry Egger is Professor of Lifestyle Medicine at Southern Cross University and an Advisor to the World Health Organisation and Governments in lifestyle and chronic disease.
12
To take a grass roots look at the issue, primary care practitioners & allied health professionals working at a clinical level, that have work clinically at both ends of the “social ladder“, would certainly agree.
Yet the questions still remain: why and what do we do about it? From a subjective perspective Garry hit’s the nail on the head. Take the workplace for example –an executive “knows this stuff”, understands “its about choices”, and accepts that their barriers “lack evidence”. At the other end those barriers become real, you hear “What choices”. It appears people (typically) get fractured and inaccurate information thus lack evidence based lifestyle strategies. Health literacy appears to reduce as the degree of social “squashedness” increases.
Why? As Garry mentions the “fear” or “lack of trust” becomes greater because, potentially there is more at stake. You begin to hear the “diatribe of the oppressed”. The barriers are real to the person, whatever they may be, because of the threat they pose to their already dicey predicament.
As we are seeing at Copenhagen with developing countries the biggest challenge may not be convincing the Jeff’s and Sole’s (& the magpies flocking to fill their place) of their impact on their fellow human. It may be convincing those climbing the socioeconomic ladder that what was ok for those above them will just “squash” those a few rungs below.