Inequality harms mental health
The Jakarta Post
Though we have experienced sustained economic growth in the last 15 years that contributed to the reduction of poverty and a growing middle-income bracket, we have also been facing widening inequality. A recent World Bank report said that our economic growth had primarily benefited the richest 20 percent and left behind the remaining 80 percent of the population ' more than 205 million people.
The report also illustrated that between 2003 and 2010, consumption per person for the richest 10 percent of Indonesians grew over 6 percent per year after adjusting for inflation, in sharp contrast to the consumption of the poorest 40 percent, which only grew by less than 2 percent per year.
Furthermore, the report warned that the level of inequality was now alarmingly high and climbing faster than most of our neighbors in Southeast and East Asia.
Our inequality is also confirmed through the Gini Index over the past 15 years, which increased from 30 in 2000 to 41 in 2013.
An increasing body of knowledge addresses the negative impacts of widening inequality on health, mental health in particular. There is strong evidence that inequality is associated with increased stress and exacerbates the stress of coping with material deprivation.
The adverse consequences of stress are worsening in societies where greater inequality is found and where numerous people feel worse off than others.
Health and social problems include physical and mental illness, higher engagement in violence, drug abuse and imprisonment, teenage pregnancies, poor wellbeing among children, lower levels of trust and weaker community life, low math and literacy scores and lower upward mobility.
Therefore, more studies advocate reducing the gap between the rich and the poor to reduce such problems. These newer studies conclude that inequality and injustice are highly toxic to our health and wellbeing.
Health Ministry data from 2013, for example, said that 6 percent of the population suffered from anxiety and depression, or approximately 16 million people. Additionally, the number of people suffering from severe mental disorders (such as psychosis) in the archipelago was estimated at 400,000, or 1,72 people per 1,000 of the population; with 57,000 of them reportedly shackled or having at least once been a victim of shackling. Fortunately, the Mental Health Law was passed in 2014, aiming for the humane treatment of people with mental disorders and intellectual disabilities, including outlawing the shackling of sufferers. However, more efforts beyond the law on paper are required.
Why widening inequality is bad for mental health is of course an important question. Studies have revealed that high levels of inequality can have a severe impact on how people within a society view themselves, and how this manifests itself in their overall mental health.
Kate Pickett and Richard Wilkinson, prominent public health researchers in their seminal 2009 book on inequality, The Spirit Level, Why More Equal Societies Almost Always Do Better, maintained that greater inequality heightened 'status competition' and 'status insecurity' among both adults and children, and across all income groups.
These facilitate individual alienation and vulnerabilities, for example worsening stress and frustration as well as promoting risk-taking behavior such as heavy smoking, drinking, and involvement in violence or even suicide.
On account of the link between greater inequality and mental health, the newer studies criticize undue focus on individual solutions to mental health difficulties such as depression and advocate a 'social solution'.
While individual psychological and biomedical treatment such cognitive behavioral therapy and pharmacological therapies work well for many individuals, we also need to reduce the important social determinants of health, including the widening inequality, owing to strong evidence that our mental health is highly sensitive to inequalities.
It is also important to note that high inequality is not inevitable. Healthy public policies can contribute to overcome the intergenerational cycle of inequality, by addressing its various drivers.
There are several options for the government to combat inequality, such as improving local service delivery in nutrition, sanitation, health, family planning and education services that play a pivotal role in providing a better start for the next generation. In addition, improving social protection programs such as conditional cash transfers and education subsidies, as well as implementing skills training for young people to enable them to attain decent jobs, are required.
To support the above programs, more funds should be secured by reducing corruption, the implementation of a fairer taxation system and increasing adherence in personal income tax collection.
The combination of these structural and individual programs may reduce inequality and promote better health and wellbeing.
The writer is a lecturer and researcher at the School of Public Health, Hasanuddin University, Makassar.
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