Because more equal societies work better for everyone

Aren’t these relationships with inequality really a reflection of the benefits of better services in more equal countries?

No. On p. 80 of The Spirit Level we show that there is no correlation between life expectancy and total medical expenditure per head in different countries.  Although medical care is important for many aspects of the quality of life, such as hip and knee replacements, cataract and hernia operations, it looks as if the huge differences in the rates at which people get life threatening conditions such as cancer or heart disease, overshadow the differences made to survival by the quality of medical care.  The fact that the vast majority of medical expenditure on each person is spent during their last year of life suggests that its ability to extend the length of life is limited. 

OECD figures on government social expenditure as a proportion of national income are, like medical expenditure, unrelated to the extent of problems as measured by the Index of Health and Social Problems (see p.177 of The Spirit Level).  Many services may be seen as attempts to cope with problems created elsewhere in society.  In an important sense they exist to pick up the pieces but are rarely the main determinants of the scale of problems which exist in each society.  As well as being true of medical care, criminology studies suggest that differences in policing do not exert a major influence on levels of crime.  Even in education, it is well known that early experience, family life and socioeconomic circumstances exert overwhelmingly powerful influences on ‘school readiness’ and subsequent levels of educational achievement.

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