This nine-chapter book addresses the primary questions of how and why inequality negatively affects individuals and populations. Chapters 2 through 4 describe the patterns of association between inequality and health and social outcomes, underscoring that "differences in inequality as small as those found between different market democracies or different U.S. states produce very substantial social and health effects." Chapter 2 reviews evidence supporting the idea that the quality of social relations is associated with income disparities, and Chapter 3 outlines psychosocial factors that contribute to ill health and premature death, including low social status, poor social affiliations, and negative childhood experiences, all of which can be linked to inequality. The data presented in Chapter 4 build upon previous chapters and strongly indicate that the more unequal a society is, the worse its health: "The pathway runs from inequality, through its effects on social relations and the problems of low social status and family functioning, to its impact on stress and health."
The remaining chapters explain the causal processes responsible for these relationships. In Chapter 5, the author uses violence as an example of a strong correlate of inequality and discusses the contributions of low social status and self-worth. Chapter 6 moves the theme forward and describes the social processes responsible for social distances and distinctions, including discrimination. In Chapter 7, race and gender inequality are examined, revealing among other things an interesting paradox: men appear to be more harmed by male domination than women are. Chapter 8 examines the pathway from the form of social organization (degree of inequality) through stress and coping mechanisms to physiological factors (e.g., cardiovascular, immune) that shape health status. Finally, in Chapter 9, the author frames the problem of inequality and health in terms of ideology and political objectives, revisiting the traditional democratic values: liberty, equality, and fraternity.