If you could wave a magic wand and increase Irish life expectancy, wouldn't you do so? Imagine if that same spell could reduce violence, road accidents, drug and alcohol abuse and many of the stresses and insecurities of life in post-boomtime Ireland.
There are those who argue that this spell not only exists but is within the competence of any democratic government. A body of reputable social scientists now argues that the greatest determinant of ill health in any society is not the quality of its health services nor the level of its wealth. They suggest instead that what determines the length of life in a society is its level of income inequality. To improve life expectancy and reduce any number of social evils, the simple remedy - the magic spell - is therefore to reduce income inequality.
One of the foremost proponents of the view is Prof Richard Wilkinson, author of Unhealthy Societies - The Afflictions of Inequality, is speaking in Dublin tomorrow. He has pointed out how more egalitarian societies such as Sweden and Japan have higher average life expectancies than less egalitarian societies such as the US.
Britain just after the second World War was remarkably egalitarian by today's standards, with only 8 per cent of the population living on incomes below half the average (the definition of "relative poverty"). When, in the 1980s under Thatcher, that proportion in relative poverty had tripled, Britain experienced growing violence, suicide and drug abuse and growing disparities in life expectancy between different social groups. "In the developed world, it is not the richest countries which have the best health but the most egalitarian," he writes.
If Wilkinson is right about the links between income inequality and ill health, this is bad news for Ireland. According to the UN's 2002 World Development Report, the level of income inequality in Ireland is second only to the US among OECD countries. The proportion of the population living on incomes below half the average grew from 16-17 per cent in 1994 to 21-22 per cent in 2000, according to the ESRI.
Even before the growing inequality of the boom years, Ireland's richest 20 per cent had nearly six times the share of national income of the poorest 20 per cent. Meanwhile, the gap between Irish and average European life expectancy has been growing. What if Wilkinson is right?
Wilkinson's theories have certainly been contested. In an interview this week, he related how the left criticised him for insufficiently emphasising the importance of material deprivation, while the right simply sought to disprove his data. Yet other researchers have weighed in to support his thesis. He cited a Canadian analysis of 500 cities in five countries, due for imminent publication, which will show quite close relationships between income inequality and mortality.
Wilkinson's analysis is highly relevant to the debate in Ireland about how poverty should be measured. The National Anti-Poverty Strategy targets consistent poverty, through a complex formula which measures the proportion of people who lack for certain basic necessities like heating. Relative poverty, on the other hand, is a measure of income inequality and therefore of social exclusion, which Wilkinson considers critical to health and ill health in modern societies.
Deaths caused by alcohol, violence or accidents tend to be strongly related to income distribution and reflect the effects of social disintegration, in his view. "If Irish income differences have widened dramatically, I would expect a rise in violence," he commented this week. Road accidents are higher in countries with wider income differences, he has suggested, because "perhaps nothing is so indicative of the standards of people's behaviour towards unknown others in a society than aspects of the way people drive."
Wilkinson attributes much experience of illness to what he terms "psychosocial stress", the stresses of living in society. Chronic stress affects the endocrine and immune systems and leads to a greater vulnerability to illness. Social exclusion and low social status are major sources of stress.
He describes how researchers attempted to discover why it was that one small town in Pennsylvania had consistently lower death rates than all its neighbours. Having discounted all the obvious reasons like diet, they were forced to the conclusion that it was because the Italian community which had emigrated to Roseto was so close-knit, so egalitarian and so inclusive.
Wilkinson's closely argued analysis leads to an appeal for communitarian values, for the kind of valuing of social engagement championed by Robert Putnam, author of Bowling Alone, the book which was latterly reported to be the Taoiseach's bedside reading.
Wilkinson's belief in the corrosive effect of inequality on the quality and duration of life speaks directly to the concerns of our society, in which rapidly rising wealth and inequality have been accompanied by spiralling violence, alcohol and drug abuse and disregard for human life on our roads. He might just be right.
Prof Wilkinson will speak to the Adelaide Hospital Society's conference at Tallaght Hospital tomorrow.