Image: Finn NYC, Unsplash

Will governments prioritise wellbeing or let inequality damage mental health?

We seem to be reeling from crisis to crisis these days – the global financial crisis of 2008 has been followed by the cost of living crisis, the climate crisis is inflicting drought, heatwaves, and other environmental catastrophes across the world, and we are in the midst of multiple pandemics, not just Covid-19.  One of those pandemics is mental ill health.  The World Health Organisation ranks depression as the leading cause of ill health and disability worldwide; in its latest, pre-pandemic, estimates from 2017, more than 300 million people were living with depression, and the prevalence had increased precipitously since 2005.

The burden of mental illness continues to worsen, and much of the current pressure on mental health is easy to understand. Over recent years there has been growing awareness of the wider determinants of mental health.  The Power Threat Meaning framework for explaining mental health links wider social factors such as poverty, discrimination and inequality, along with individual experiences of trauma as pathways to emotional distress and troubled behaviour. The Covid-19 pandemic increased mental health problems directly, as we all worried about our own health and the wellbeing of loved ones, and indirectly through the unintended consequences of the lockdowns and other measures that were undertaken to reduce transmission.  In the city of Bradford in the north of England, where I work with a team focused on the health and wellbeing of children and families, we saw a doubling of the prevalence of clinical levels of depression and also increases in loneliness, financial, food and housing insecurity. Families reported acute health anxieties, the strain of managing multiple responsibilities, loss of social support, and being unable to switch off from what was happening in the pandemic. Now, with eye-watering increases in the costs of fuel and energy, but also in food prices and housing costs, everyone living in poverty is facing extreme levels of anxiety and stress.

But it isn’t just the poor who will suffer the mental health consequences of what is happening in the world economy.  Even those who would previously have been financially comfortable are now worried by rising fuel bills and the impact of inflation on their mortgages. Average real incomes have declined – most of us are now having to cover more with less.

Importantly, it isn’t just poverty and lack of material resources that is driving the worldwide pandemic of mental ill health. Many mental illnesses are triggered or exacerbated by issues of superiority and inferiority.  Inequality itself, the gap between rich and poor, causes mental health problems on a significant scale. This is because, in more unequal societies, social comparisons become toxic, anxieties about social status increase and some people go under with depression and anxiety, while others respond with self-enhancing narcissism and psychosis. Inequality is linked to lower levels of happiness because of increased mistrust and more status competition in more unequal societies.  The differences in levels of mental illness between more and less equal countries are large precisely because inequality affects almost everyone and in myriad ways.

Systematic reviews of research studies covering large numbers of participants provide robust evidence that economic inequality has psychological consequences and affects mental illness and that austerity measures tended to worsen mental health and increase inequalities.  In the face of this evidence, we should be deeply shocked that, in many countries, on balance, political choices and policy responses to the cost of living crisis will actually increase economic inequality and the misery it inflicts.

Even though most governments can point to actions taken to mitigate the crisis, in general they will be insufficient to help people keep up with rising costs, and, in some cases, policies are actively increasing the gap between rich and poor. 

For example, in the UK, the government has imposed a one-year windfall tax on gas and oil firms, given all households a one-off payment as an energy discount as well as extra money to older people and those receiving social security benefits, and frozen energy bills for households for two years. More than £1billion has been given to local governments to support poorer households. But while these measures will go some way towards easing the economic burden for many, they won’t fully mitigate rising costs and inflation so the poor will get poorer. And the International Monetary Fund has warned that the UK government’s  Growth Plan for 2022 will increase inequality, making the rich richer. In the face of the evidence that inequality damages the health and wellbeing of the population, current economic strategies and choices are making it worse. Across most of the world, income and wealth inequalities within countries have risen over recent decades, including in East Asia, South Asia, North America and Europe.

Now is the time to align our understanding of the causes of population health and wellbeing, including mental health, with political, economic and social strategies.  New economic policies that centre on wellbeing are already underway in countries like Finland, Iceland, Canada and New Zealand, who are collaborating under the Wellbeing Economy Governments partnership program (WEGo) to advance wellbeing policiesthat prioritise people and the planet. While Wales and Scotland are also part of the partnership and some traction has been made, more could be done to live up to their ambitions of a wellbeing economy.

New Zealand, for example included mental health as one of their 5 priority areas for their wellbeing budget which was launched in 2019 and facilitated a $NZ 1.9 billion investment in mental health. Their 2022 budget includes a $NZ 100 million investment over four years which will support community-based crisis services, enhance existing specialist child and adolescent mental health and addiction services, as well as fund workforce development programs for service workers.

However, what is important is that the wellbeing approach is not simply about mitigating the negative outcomes of our current economic system but recognizing that all aspects of what constitutes a good life must be considered holistically, whether it’s access to health care and education or a strong sense of connection to one’s community. It is growth in wellbeing that we need, and growth in mature, evidence-based debate or what works, not growth in outmoded GDP.

Kate Pickett, patron and co-founder of the Equality Trust