This is a pocket book in a series called Darwinism Today, which is intended to increase public awareness of the relevance of Darwinism for human affairs. The theme is health in relation to evolution. The author argues throughout for fairness and equality of access to health provision, which is certainly laudable, but I was not convinced that he makes a very plausible connection with evolution.
He starts by claiming that what matters in a society is not absolute income and living standards. so much as relative income and social status. This seems intuitively likely and Wilkinson tells us that research supports the idea. (A list of references is provided at the end of the book.) He then goes on to identify two views of society: "agonic", based on power and dominance, and "hedonic", based on egalitarian cooperation. We tend to take the agonic form of society as the norm because, historically, most societies have been class societies. But, Wilkinson asserts, this is a late aberration; during our hunter-gatherer past we lived in hedonic groups.
This sounds pleasing and reassuring, but is it true? We know very little about how our remote ancestors lived. The evidence provided by Wilkinson comes from anthropological accounts of modern hunter-gatherer societies, but we can't assume that these societies are similar to those of the remote past; they may be quite different. Indeed, as Wilkinson acknowledges, the societies of our closest anthropoid relatives (chimpanzees and gorillas) are characterised by emphasis on rank order. Wilkinson's claim is that this earlier state of affairs was reversed in early human society, but we appear to have regressed in this respect. All this reads like special pleading; I don't think Wilkinson can have it both ways. It's difficult to believe that evolution made our ancestors agonic at one stage, hedonic later, and now once more agonic. Either we have inherited a predisposition to construct rank order societies or we haven't. If we have, the desire to construct a class-free society is counter-evolutionary (though not necessarily the worse for that); if we haven't, then our evolutionary heritage is irrelevant for the argument.
Wilkinson goes on to claim that class distinctions and inequalities are stress-inducers and so cause health problems, and this may be true, but some of the examples he gives for the ill effects of prolonged stress provoked by class-induced anxiety are questionable. For example, he says that the rise in blood pressure with age that is found in economically developed societies but not in pre-agricultural societies is due to social changes that cause stress, but it could equally well be due to increased intake of salt, as a number of researchers have suggested.
Not everyone is sympathetic to the idea that evolutionary factors are important in shaping human societies today; sociobiology has its critics. Personally, I find it quite persuasive, but I don't think a good case for it has been made out here. Wilkinson's hope for a more egalitarian society is surely one we can share, but I don't think that he has succeeded in demonstrating a convincing link between the desirability of achieving such a society and evolution. Political aims should be evaluated on their own merits and not because they do or don't accord with notions about our evolutionary past.