Lifestyle is Medicine

By Garry Egger

Living in a rich country but being poorer than your neighbour, could be the cause of that gut.

Obesity is now bigger than Eddie McGuire’s Christmas list. But do we know why? Whilst not (yet) a Nobel Laureate, I can tell you that it’s largely down to what we eat (not necessarily how much) and how we move (not necessarily how much we exercise), with a little bit of family background thrown in.

Still, this is like saying ‘life is a sexually transmitted disease.’ It doesn’t stop it from happening. For more years than I can care to remember, I’ve been pushing the notion of an ‘obesogenic environment’ as the driving force behind why people eat the wrong foods and move too little. Now it seems, a new and less obvious social cause may also play a part. Equality and health.

In a new book called The Spirit Level British Epidemiologists Dr Richard Wilkinson and Dr Kate Pickett have shown that just about all health problems in a country are associated with the size of the income differential within that country.

Countries such as the US, the UK, and even Australia, where there is a big gap between the incomes of those in the top 20% of income earners, compared to those of the bottom 20%, do worse on all aspects of health, including obesity. Where the income differential is small, such as in Norway, Sweden or Japan, health and social problems – including personal happiness, are much better.

This is unrelated to the total income level of the country. The US for example, has the highest per capita income in the world. Yet it is last on every index of health in the richest 20 countries. It’s the wealth distribution within, rather than between countries, that seems to shape the health, happiness and well-being of the individual.

This is verified when the differences are looked at between states within the US. New England and Vermont have the best health and least income diferentials. Arkansas and Alabama have the worst of both. Why should this be so?

According to Wilkinson and Pickett, countries where there is a big income gap have higher levels of anxiety, lack of trust, and break down of social structures than those where people have to try less to keep up. And it’s not just the bottom of the scale that suffer. Obesity and ill-health for example are higher at all levels of social status in the unequal countries.

Obesity at every level in the US for example is up to twice and sometimes three times that in Sweden or Japan. But whilst it’s easiest in theory for an individual to eat differently and move more, how can one change social inequality to make the country less fat?

Surprisingly, agitation to limit excessive executive wages, a policy that is agreed to by 80% of the population, could go part way to having such an effect. Limiting corporate power, played out through political donations, could also have a health benefit. In those countries with good health status, there are different ways to achieve equality.

The Japanese for example have much less disparity of income. Japanese executives earn nothing like the 500 times the basic worker level of income that is paid in the US or Australia.

In Sweden and Norway on the other hand, excessive incomes are allowed but these are taxed accordingly to balance the system.

So next time, you’re poked in the belly and chided by some no-all drunk for being a glutton or sloth, come back with the line that it’s ex-Qantas chief Jeff Dixon’s huge executive payout, or Sol Trejillo’s golden hand-shake or bankers payroll exuberance that’s causing your corpulence. Then set out to get the bastards!