From: Julie Rogers
To: Singapore Review
27 October 2004

Does Inequality Make You Sick? S'pore ministers salaries

Hi, I pondered over Catherine Lim's article "PAP and the people: A return of
disaffection?"
(see: http://www.singapore21.org.sg/art_disaffection.html#debate1)

Until recently I knew next to nothing about Singapore so it is a revelation
that my first introduction to this little speck is through various discussions
on the internet about Ministerial Salaries.

Quite frankly I am rather appalled by the fact that ministers in your country
can earn upwards of USD 1 million. Any officer of the state is a
public servant and this was a once noble and honourable calling. In the
civilised world, persons assume this office because they want personally to
contribute to the well being of the country. Self sacrifice and altruism are
essential hallmarks for a public office holder and the minister must be ready
and willing to make these personal sacrifices.

If the heart is not in this noble service, then it will be wasted effort.
Money should not be an issue at all and if it is, then your "elected leaders"
have very ill-placed priorities and are obviously in it for the wrong reasons.

Even if we were to overlook the misplaced financial motives of your ministers,
the sheer gulf in income disparity between ministerial salaries and those of
the working class will create a huge irreconcilable dichord and disenchantment
with any normal voting public. (A valid point in Catherine Lim's article)

But I am told that Singapore is a democracy with elected leaders! So I have to
assume that Singapore must have a very unique "voting public" which is able to
silently and willingly take all this in their stride. Singaporeans should take
note here that Who they vote for and who they elect is a reflection of their
own core value systems and the undeniable fact remains that Singaporeans have
elected a group of Leaders who are eminently pre-occupied with escalating their
on salaries.

I for one will never be able to accept this unequal state of affairs if ever it
was my lot. And thank goodness it isn't for I will never be able to sleep
soundly at nights knowing that the fate, future and well being of my country
are in the hands of a bunch of financially motivated hired mercenaries.

Below is a further write-up of some of the social ills that a huge income
disparity can create. There is an old saying that the most efficient form of
governance is a Monarchy, but this assumes the Monarch has the same priorities
and agenda as the people he rules. Is this the case with Singapore's Monarchy?

I repeat that who you elect is a mirror image of your own core values and
Singaporeans have to ask themselves whether their current leaders who require
million dollar salaries to be in office, have the same value systems as the
voters who elected them.

Lastly, I have also copied in Guniess World of Records to see if this unique
feature of your country will earn it a place in the world record books.

Julie Rogers

http://www.sallysatelmd.com/html/a-ws1.html

Does Inequality Make You Sick?
The dangers of the new public health crusade.
The Weekly Standard | July 16, 2001

By Sally Satel and Theodore R. Marmor

Dr. Stephen Bezruchka, a physician with the University of Washington School of
Public Health, has made the startling claim that income inequality is the major
cause of our nation's health problems. Writing in Newsweek's My Turn column, he
dismisses the role individuals can play in safeguarding their own well-being,
claiming that "research during the last decade has shown that the health of a
group is not affected substantially by individual behaviors such as smoking,
diet and exercise." Better prescriptions for a healthy society, he argues, would
include a "consumption tax."

Bezruchka is not alone in believing that improving health depends upon
transforming economic conditions. Ichiro Kawachi of the Harvard School of Public
Health, in his book Is Inequality Bad for Our Health?, declares income
inequality an "important public health problem." Indeed, for the past decade
public health experts have become increasingly eager to expand their
professional agenda beyond health into broader controversies. In academia,
combating inequities of all sorts has become a mission. According to Harvey V.
Fineberg, former dean of the Harvard School of Public Health, "a school of
public health is like a school of justice." At the National Institutes of
Health, the Centers for Disease Control and Prevention, and health
philanthropies such as the Robert Wood Johnson Foundation, research on health
disparities related to race, ethnicity, and class—and the policy implications
thereof—has expanded sharply. The American Public Health Association, too, has
taken up far-flung political causes. Campaign finance reform, affirmative
action, and the war in Nicaragua have been subjects of its policy statements. In
1996 the theme of the APHA's annual meeting was "Empowering the Disadvantaged:
Social Justice in Public Health."

To be sure, attempts to understand the ultimate non-medical sources of ill
health (e.g., education, class, deprivation) have occupied scholars for decades.
But there is a huge difference between explicating these factors and claiming
scientific authority for political remedies, as public health professionals such
as Bezruchka believe is their charge. Indeed, fixating on social transformation
as the proper role of public health professionals risks taking physicians and
epidemiologists away from their traditional mission, or trivializing it. That
mission is to develop the scientific and practical bases of disease prevention
and to devise effective ways to educate the public about health risks. Misguided
political activism is also demoralizing. Columbia University scholar Ronald
Bayer, a contributing editor of the American Journal of Public Health's Policy
and Ethics Forum, laments that so many of his colleagues believe "public health
officials can do little or nothing to change the prevailing patterns of
morbidity or mortality in the absence of social change." He dubs that mentality
"public health nihilism."

None of this is to deny that social conditions, especially poverty, affect
physical well-being and length of life. And public health practitioners do have
a responsibility to design policies that reliably prevent disease, reduce
contagion, and minimize injury. But they are sorely mistaken in thinking they
have special expertise in changing the income distribution, in defining social
justice, or in producing the instruments that can attain it.

A central premise of new public health scholarship is the "income-inequality"
hypothesis. This hypothesis has spawned a minor academic industry, which has
produced some important and carefully drawn epidemiological studies. It has also
produced a surprising volume of ideologically driven speculation that fails to
withstand critical scrutiny.

The hypothesis reached a wide audience in the early 1990s through the
publications of Richard Wilkinson of the University of Sussex in England.
Wilkinson claims the causal link between income inequality and individual health
represents "the most important limitation on the quality of life in modern
societies." From this he concludes there is "a persuasive case for the
redistribution of income." Wilkinson and others point to data purporting to show
that health and longevity are, in large part, determined by relative wealth. For
example, wealthy countries with more equal income distributions, such as Sweden
and Japan, have longer life expectancies than the United States.

Harvard's Kawachi, along with his colleague Bruce Kennedy and Norman Daniels, a
philosopher at Tufts University, expand on Wilkinson's thesis. "The health of a
population," they write, "depends not just on the size of the economic pie, but
how the pie is shared." The authors speculate on how social inequality produces
differences in health at each step on the socioeconomic ladder. "Income
inequality," they observe, "appears to affect health by undermining civil
society. . . . Lack of social cohesion leads to lower participation in political
activity (such as voting, serving in local government, volunteering for
political campaigns)." And lower participation, in turn, reduces government
spending on public goods, such as education, and social safety nets.

Other public health scholars point to the disease-producing anxiety of not being
able to keep up with the Joneses. As John W. Lynch and George A. Kaplan of the
University of Michigan write, "health may be affected through individual
appraisals of relative position in social order. Even those with good incomes
might feel relatively deprived compared to the superrich."

There is in fact intriguing evidence that a person's socioeconomic position can
affect health. Consider the landmark Whitehall studies led by Michael Marmot of
University College in London. Marmot and his colleagues examined workers in the
five grades of the British Civil Service; all had access to health care and at
least a decent income. It was no surprise to the researchers that civil servants
at the lowest grades suffered heart disease at about three times the rate of men
at the top tier. But they were puzzled to discover that even highly paid
professionals in the fourth category had twice as much heart disease as the
workers right above them. What appeared to explain this finding was the fact
that these workers had little "control of destiny"—their jobs were heavy with
responsibility, but with relatively little authority.

Marmot did not presume to lead a social movement. Yet other scholars have done
just that, using the Whitehall study as ammunition in their political crusade.
"Illness is caused by the power imbalance in a capitalist society," insists
Paula Braveman, a physician with the University of California at San Francisco.
"We must counteract the free market with social programs," she told colleagues
at an APHA meeting.

For those like Braveman who condemn capitalism, it is a small step to say that
income inequality is the issue. Yet there are fundamental problems with the
evidence upon which their arguments for the redistribution of income are based.
First, consider the very measures of inequality typically cited—indices of
income dispersion. "In practice, it is very difficult to distinguish the
potential health effects of income inequality from the strong effects that arise
from absolute need," says Harold Pollack, a policy researcher at the University
of Michigan's School of Public Health. To those at the bottom of the economic
ladder, it may be the ability to meet daily needs that matters most, not
relative status. In this reading of the evidence, money is meaningful to the
poor because of what it can buy, not because they have less of it than others.
Thus, it is not so much income dispersion itself that matters for health but the
proportion of the population that suffers true poverty-related problems, such as
under-nourishment, lack of access to timely medical care, and so on.

In the United States, for example, the poverty level is higher than in northern
Europe, where the social safety net has much finer mesh. The stunted longevity
of poorer people pulls down the average life expectancy for our country. What's
more, Pollack points out, the health impact of inequality itself is really
unknown, once one controls for closely connected characteristics like race. What
we are left with is energetic advocacy of a deeply uncertain claim about the
connection between health and the degree of income inequality.

There are also dangers in concluding from the relationship between health and
wealth that being less well-off produces disease. Indeed, the so-called healthy
worker effect suggests an opposite reading: that health may determine income.
After all, people who are healthier are more likely to hold jobs and to work
competitively, activities that help them advance both their social and economic
positions and, in turn, protect their health.

What's more, there may well be a third variable that is linked, independently,
to health and socioeconomic success. "Individuals with great self-control and
foresight may choose to acquire more education," explain Jeffrey Milyo and
Jennifer Mellor, economists at the University of Chicago and William and Mary,
respectively. "This heightened awareness of future outcomes could translate into
both better earning potential and reduced propensities to engage in unhealthful
behaviors such as smoking."

Last, there are some striking exceptions to the income-inequality schema. For
instance, in Denmark, the gap between the top and bottom of the income scale is
smaller than in the United States, yet its citizens have a lower average life
expectancy than ours. The Japanese have the longest life expectancies, but their
social hierarchy is very rigid. So much for sweeping generalizations about the
longevity-threatening effect of a socially stratified society.

Even if the link between inequality and health were clearly established, the
public health profession has no particular expertise in reducing inequality and
solving broader problems of social injustice. Expending efforts in these
directions diverts public health experts from proven strategies to better the
health of the population—and there is much to do. Climbing rates of HIV/AIDS
among minorities, epidemic levels of obesity, low rates of screening for cancer
and high blood pressure—all of these call out for attention. While the
opportunity to open a new front in the public debate over income distribution is
seductive to some, it will siphon energies and resources from the vital issues
that the public health profession has addressed so well in the past.