GINI DP 78: Who Feels Inferior? A Test of the Status Anxiety Hypothesis of Social Inequalities in Health

The empirical association between income inequality, population health and other social problems is now well established and the research literature suggests that the relationship is not artefactual. Debate is still ongoing as to the cause of this association. Richard Wilkinson, Michael Marmot and colleagues have argued for some time that the relationship stems from the psycho-social effects of status comparisons on health, trust and relationships. Here, income inequality is a marker of a wider status hierarchy that provokes an emotional stress response in individuals that is harmful to health and well-being as well as being damaging to relationships and social organisation. We label this the ‘status anxiety hypothesis’. If true, the hypothesis would imply a structured relationship between income inequality at the societal level, income and concerns with or anxiety around social status. The paper presents three predictions for the structure of ‘status anxiety’ at the individual level given different levels of national income inequality and varying individual income and then tests these predictions using data from a cross-national survey of over 34,000 individuals carried out in 2007 in 31 European countries. Respondents from low inequality countries reported less status anxiety than respondents in higher inequality countries at all points on the income rank curve. This is consistent with the hypothesis that the latter could account for the relationship between the former and health outcomes.. However, the impact of income rank position within country was not shown to vary by level of income inequality. As a consequence research is clearly necessary to establish the processes underlying the association between income inequality and status anxiety.