Inequality harms the health of all Indonesians, not just the poor

By Sudirman Nasir, Universitas Hasanuddin

When we talk about inequality, the victims that commonly come to mind are the poor. But in fact, inequality harms all parts of the society, including the middle and upper class.

Oxfam and the International NGO Forum on Indonesian Development (INFID) released early this year a report on inequality, revealing that the gap between the rich and the rest of the population in Indonesia has widened over the last two decades compared to neighbouring countries in Southeast Asia. “The four richest men in Indonesia now have more wealth than the poorest 100 million people”, the report stated.

Indonesia’s inequality, measured by the Gini index, increased from 0.30 in 2000 to 0.41 in 2015. The Gini, developed by Italian Corrado Gini in 1912, measures income distribution with a scale of zero to one. Zero means perfect equality and one means all the country’s income is earned by a single person.

The widening inequality in Indonesia will create or worsen public health problems, such as physical and mental illness, as well as increasing acts of violence that impact the whole society.

Injustice is toxic, makes us all unhappy

Inequality is divisive and corrosive for the whole society. Studies have shown various forms of health and social problems are much worse in societies with bigger income differences between rich and poor.

Worse health and social problems means we have more people with physical and mental illness, more people engaging in violence, and a lower level of trust in the community. The situation can lead to drug abuse, more people in jail, and teen pregnancies. It affects children’s well-being, with a higher likelihood of those children scoring lower in maths and literacy, thus reducing their chances of having a better life than their parents.

Recent studies have advocated reducing the gap between rich and poor to reduce such problems. They conclude inequality and injustice are toxic to our health and well-being.

According to Indonesian Health Ministry data from 2013, 6% of Indonesia’s population older than 15 years old, or about 14 million people, suffered anxiety and depression. An estimated 400,000 people have severe mental disorders and 57,000 of them are shackled or have been a victim of shackling. Fortunately, the 2014 Mental Health Law outlaws shackling, but Indonesia needs to make greater efforts beyond the law on paper.

Unfair conditions promote risky behaviour

High levels of inequality can affect how people view themselves in the society. Public health researchers Kate Pickett and Richard Wilkinson, in their seminal 2009 book on inequality, “The Spirit Level”, say greater inequality prompts “status competition” and “status insecurity” among adults and children and across all income groups.

Competition and insecurity breed individual alienation and vulnerabilities like worsening stress and frustration. They promote risk-taking behaviour such as heavy smoking, alcohol dependence and involvement in violence or even suicide.

This man lived shackled in stocks for nine years in a back room in his family’s home in Cianjur in West Java. When he was released, his legs had atrophied from disuse. Andrea Star Reese for Human Rights Watch, CC BY-NC-ND

Evidence shows surprising differences in countries’ well-being with different level of equality. The intentional homicide rate in 2011 in the United States, which has low equality, was 47 people for every million population. Compare the figure with those in more equal countries: 15 in Canada and three in Japan.

The cost of defending ourselves from such social problems is high. We need more money for police, jails and specific public services to tackle the problems, sometimes with high cost but low impact.

The middle and upper classes also suffer in situations of high inequality because of fear, threat and cost related to such problems. Take as an example the fear and anxiety related to the real threats of crimes, from petty ones to violent robbery on our streets. The economic, social and psychological impacts of these crimes are enormous because they can lead to injury, trauma, disability or even death.

Equality is good and possible

A large majority of the whole population — between 90% and 95% – benefits from greater equality, studies show. We, especially the government and the private sector, have to take the recommendations from the Oxfam-INFID report seriously.

A more equal society will benefit us all; we will have a better chance to improve our lives and have more capacity to live and work together. We will have less violence, crime, drug use and suicide in a more equal society.

Newer studies on mental health prescribe equality as part of the cure, and criticise the undue focus on individual solutions to mental illness. Individual treatments like therapies and drugs work well for many individuals, but the studies propose “social solutions” as well. We need to reduce inequality, based on the strong evidence that our mental health is highly sensitive to inequality.

Achieving equality is possible. Healthy public policies can help overcome the intergenerational cycle of inequality, by addressing its various drivers.

The Indonesian government has several options to combat inequality. One option is improving local service delivery in nutrition, sanitation, health, family planning and education, which then provides a better start for the next generation. Others are improving social protection programs such as conditional cash transfers, education subsidies and job training for young people.

We will need more funds to do this, but we can find the money if we tackle corruption and implement a fairer taxation system that forces more taxpayers to pay. The combination of these structural and individual programs can reduce inequality and promote better health and well-being.

The ConversationThe future of Indonesia’s development as a nation depends not merely on superficial economic indicators like economic growth but also on the more meaningful social measures of a more equal and just society.


By Sudirman Nasir, Lecturer and researcher at the Faculty of Public Health, Universitas Hasanuddin.

This article was originally published on The Conversation. Read the original article.