12/07/2005 12:35 am ET Updated May 25, 2011

A New Way to Talk About Inequality

Progressives need a new way to talk about inequality. We tend to assume everyone agrees that a nation should not have executives who make 420 times more than factory workers. Or an education system in which your access to top schools has more to do with who your parents are than with your merits.

Some conservatives agree. But what do we do with people who don't share those beliefs? How do you convince someone who says, well, these differences are the result of having an open, dynamic society in which people are free to exercise their abilities? Who says, sure, people at the bottom of the heap should get decent schools and medical care, but let's not mess with success. Where the best always do well, there will be people who have not succeeded yet; and others who don't have what it takes.

These may not be congenial beliefs to many of us, but people who think along these lines appear to be running every branch of government at the moment, so a lot of Americans must agree with this philosophy.

On the horizon, I think, is a different way to talk about inequality, which entirely avoids this unresolvable clash of values. It comes from the scientific literature on stress and mortality.

Take a look, for instance, at Robert Sapolsky's article in the current Scientific American. It's a tour around the mountain of evidence that the stress of low status translates into heart attacks, diabetes, over-reactivity to trouble, and other health problems.

Or look at this summary of important new work, announced last month, by Nancy Adler of UC-San Francisco and her colleagues.

Adler studies how people's health is affected by their perceptions of their place in society. Fascinatingly, her work shows that the predictor of ill effects is NOT entirely a person's objectively measured income, education and job. Rather, it's a person's perception of her place in society.

Take two high school graduates who earn $18k a year. The one who thinks "I'm just a clerk in a cardboard factory, didn't amount to much" will have worse health indicators (for instance, levels of cholesterol and stress hormones) than the one who thinks "I'm a church deacon and vice-president of the PTA, so I am somebody."

That's key to the connection between status and health: It's not a matter of objective, material assets. That's why Americans, though richer than Greeks, don't live as long. It's also why charity -- be it from government or from the faith-based groups that conservatives like -- won't solve the problem. I may get excellent medical care at the Church of the Redeemer clinic, but if I perceive that other Americans count for much more than I do in this world than I do, then that knowledge will still be bad for my health.

We don't know why inequality is associated with illness and death. Some think it is because low status means a stressful lack of control over your life, at work and at home. Others think it's the perception of inequality itself, working on the highly-tuned sense of status that we share with other primates. Some have argued that high-inequality societies have low levels of trust, and not trusting people is quite bad for your physical health. However that debate gets resolved, the key point for Democrats is this:

Inequality is a public health issue. People who live in societies with a lot of inequality get sick sooner, and die younger. This is not a matter of values. It's a medical fact.

Sapolsky quotes the 19th century neuroscientist Rudolph Virchow: "Physicians are the natural attorneys of the poor." So: Rather than arguing about opportunity versus social justice with Dr. Bill Frist, Democrats should be asking him to oppose policies that make Americans sick.

Repealing the estate tax. Nibbling away at affirmative action. Throwing people onto the mercy of indifferent HMO's. These are toxic policies, because they foster inequality, and inequality is a public-health issue. How about it, Dr. Dean?