From Unmet Basic Needs to Mental Distress: Rethinking Inequality, Poverty, Employment, and Mental Health
“The biggest disease today is not leprosy or tuberculosis, but rather the feeling of being unwanted, uncared for, and deserted by everybody.”
— Mother Teresa, A Simple Path (1995)
Introduction
A recent study published in Nature caught my attention as it urges researchers and policymakers to reconsider assumptions about economic inequality as a direct determinant of psychological health (Sommet et al., 2026).
For more than a decade, as highlighted in the study, influential research across social epidemiology, economics, sociology, and psychology has suggested that people living in more unequal societies tend to report lower subjective wellbeing and exhibit higher rates of mental health disorders such as depression and anxiety (Wilkinson and Pickett 2009; Oishi et al. 2011; Kondo et al. 2009; Pickett and Wilkinson 2015; Patel et al. 2018). The prevailing explanation has been that inequality heightens awareness of social hierarchies and fosters competitive social environments, intensifying status anxiety and weakening social cohesion—dynamics that ultimately undermine psychological wellbeing (Layte and Whelan 2014; Buttrick and Oishi 2017). Because of these interrelated mechanisms, reducing economic inequality has frequently been proposed as a powerful lever for improving population-level mental health (Marmot 2015; WHO Commission on Social Determinants of Health 2008).
Against this backdrop, Sommet and colleagues (2026) conducted for the Nature study a comprehensive meta-analysis of 168 multilevel studies involving more than 11 million individuals to examine whether income inequality is systematically associated with subjective wellbeing and mental health outcomes. Subjective wellbeing, in this context, refers to how individuals evaluate and experience their lives, including life satisfaction and the balance between positive and negative emotions (OECD 2013; OECD 2020).
Across countries, the authors found no consistent overall association between income inequality and subjective wellbeing once methodological biases and heterogeneous modeling approaches were addressed. Adverse effects were largely confined to low-income and economically unstable contexts (Sommet et al., 2026). In other words, the mere presence of large income differences within a society does not automatically translate into worse mental health outcomes.
Although these findings are striking at first reading, they do not diminish the broader importance of economic inequality. Rather, they suggest that inequality may operate less as an independent causal determinant and more as a contextual catalyst—shaping health outcomes through intermediary factors such as poverty, economic insecurity, institutional capacity, and social protection. Importantly, the authors acknowledge that alternative conceptualizations and measurements of inequality may still reveal effects under specific social and economic conditions.
In this post I summarize a broader literature review that I conducted to better understand this complex relationship.
Source: Picture taken by author of Wilfredo Lam’s Untitled painting, 1958, at Retrospective “When I Don’t Sleep, I Dream”, The Museum of Modern Art, New York, February 28, 2026.
Understanding Economic Inequality
Economic inequality is defined as the uneven distribution of income and wealth in a population. The Gini coefficient is a widely used indicator of income inequality that ranges from 0 (perfect equality) to 1 (perfect inequality); for example, Sweden has relatively low inequality (around 0.28), while the United States shows higher inequality (around 0.41) and Brazil exhibits even higher inequality (around 0.53) (World Bank 2024a). While income inequality refers to how unevenly income is distributed, wealth inequality captures disparities in asset ownership such as housing, savings, land, and financial investments.
Global disparities remain substantial, and that helps explain why inequality receives significant attention in public debate (OECD 2015a). The richest 10% of the global population receive 52% of total global income and own 76% of global wealth, while the poorest half earn just 8.5% of income and hold 2% of wealth (Alvaredo et al., 2022).
Branko Milanović’s work (2016) has showed that while globalization reduced inequality between countries, it increased inequality within many advanced economies. His “elephant curve” illustrates that technological change and globalization benefited emerging middle classes and top earners, while segments of lower-middle classes in advanced economies experienced stagnation.
Inequality measures primarily capture dispersion—the numerical distance between higher and lower incomes, but they do not tell us whether individuals can meet basic needs, feel economically secure, or perceive mobility pathways.
This distinction matters as the psychological implications are important. While income gaps may shape perceptions of fairness and social comparison, psychological distress appears more directly linked to economic stagnation, insecurity, and blocked mobility than to inequality per se (Rohde et al. 2016; Case and Deaton 2020). Dispersion alone does not automatically generate mental distress, deprivation and instability do (Adjaye-Gbewonyo et al. 2016).
Poverty and Economic Insecurity
Unlike inequality measures, which show dispersion, poverty directly captures whether individuals lack sufficient resources for survival and basic functioning (World Bank 2024b).
In June 2025, the World Bank updated the international extreme poverty line from USD 2.15 (2017 PPP) to USD 3.00 per day (2021 PPP) to reflect updated price data and cost-of-basic-needs estimates (World Bank 2025a; Baah et al. 2025). Under this revised threshold, approximately 808 million people—about 9.9% of the global population—were living in extreme poverty in 2025 (Baah et al., 2025; United Nations, 2025). Extreme poverty is heavily concentrated in Sub-Saharan Africa, where nearly half the population lives below the extreme poverty line and where roughly two-thirds of the world’s extreme poor reside. Fragile and conflict-affected states also account for a disproportionate share of global poverty (World Bank 2024; United Nations 2025). These numbers underscore that hundreds of millions of people remain unable to secure the most basic consumption needs necessary for physical and psychological wellbeing.
Beyond deprivation lies economic insecurity—exposure to shocks such as job loss, illness, income volatility, or inflation, combined with limited capacity to absorb them (OECD 2015b; World Bank 2022). It captures vulnerability and instability, not just income level. Even households above poverty thresholds can experience high insecurity if they lack savings, stable work, or social protection.
This matters for mental health and wellbeing. Ridley et al. (2020) show that poverty and economic shocks increase depression and anxiety risk, while mental illness reduces earnings and labor participation, creating a reinforcing cycle. Across OECD countries, for example, people in the lowest income groups are several times more likely to experience depressive symptoms than those in higher-income groups, highlighting the strong socioeconomic gradient in mental health outcomes (Vargas et al., 2025). Life satisfaction varies systematically by income security and employment status (OECD, 2024).
These gradients reflect material deprivation and economic instability rather than income dispersion alone. Individuals facing persistent financial strain experience higher levels of stress and insecurity, which increase cognitive load, bias decision-making toward short-term concerns, and reduce psychological resilience (Shah, Mullainathan, and Shafir 2012; Mani et al. 2013). At the same time, chronic exposure to economic uncertainty activates sustained stress responses that accumulate as physiological strain on the body and brain (McEwen and Stellar 1993).
Mental health outcomes, therefore, appear more closely associated with whether individuals can reliably secure essential goods and services—and whether they live under conditions of chronic economic uncertainty—than with the mere dispersion of incomes across society (OECD 2024; Vargas Lopes and Llena-Nozal 2025).
The Experience of Vulnerability
In her recent book, The Invisible Illness: A History, from Hysteria to Long Covid (2026), Emily Mendenhall adds an important dimension to understanding vulnerability beyond economic insecurity. She shows how health conditions that lack clear biological markers are often misunderstood, dismissed, or psychologized, resulting in stigma, disbelief, and fragmented care.
By tracing conditions from historical diagnoses like hysteria to contemporary long COVID, Mendenhall illustrates how chronic suffering is often intensified when institutions fail to provide recognition and coordinated support. The parallel with economic insecurity is striking. In both cases, distress is amplified when individuals face sustained uncertainty without reliable institutional buffering, whether in healthcare or economic policy (Mendenhall, 2026).
Mendenhall’s analysis reinforces the idea that vulnerability—whether medical or economic—cannot be reduced to simple averages or statistical gaps, and that structural support matters deeply for psychological wellbeing.
Source: Picture taken by author of Wilfredo Lam’s painting “La Rumeur de la terre (Rumblings of the Earth)”, 1950, at Retrospective “When I Don’t Sleep, I Dream”, The Museum of Modern Art, New York, February 28, 2026.
Employment: A Critical Transmission Channel
Employment is where economic conditions and mental wellbeing intersect. Jobs provides income, but also structure, identity, social connection, and a sense of purpose. Stable employment can buffer insecurity; unemployment and precarious work amplify it.
OECD research shows that mental health conditions are associated with higher unemployment and lower labor participation, costing economies up to 4% of GDP in medical care expenditures, lost productivity, and reduced employment (OECD, 2023). At the same time, unemployment itself increases psychological distress (Ridley et al., 2020).
The above dynamics are especially visible among Generation Z, generally defined as those born between 1997 and 2012 (Pew Research Center, 2019). Many members of this cohort are entering adulthood amid elevated inflation and labor market volatility. In several economies, youth face record highs on the ‘Misery Index.’ This index measures economic distress as the sum of the unemployment rate and the inflation rate, reflecting the idea that both joblessness and rising prices impose tangible costs on households and society (Okun 1970; Cato Institute 2009; Federal Reserve Bank of St. Louis, n.d.). High unemployment reduces opportunities; high inflation erodes purchasing power. Combined, these forces intensify economic insecurity.
For young adults at the start of their working lives, prolonged unemployment or unstable employment can have lasting effects. Early labor market instability leaves durable economic and psychological scars. Individuals entering the workforce during economic downturns face persistent reduction in wages and career progression that can last a decade or more (Kahn 2010; Oreopoulos, von Wachter, and Heisz 2012).
Research has also showed that there are long-term mental health scarring effects of exposure to youth unemployment and multiple exposure to unemployment during the life course (Strandh et al. 2014). These conditions are associated with heightened long-term vulnerability to anxiety and depressive symptoms (Strandh et al. 2014; Paul and Moser 2009).
More specifically, chronic economic insecurity imposes both cognitive and physiological burdens. Conditions of scarcity reduce the mental bandwidth available for processing information, planning ahead, regulating emotions, and making decisions, as individuals must constantly devote attention to meeting immediate needs. In turn, these constraints increase short-term decision bias and heighten stress reactivity, contributing to the cumulative physiological strain placed on the body and brain through prolonged exposure to chronic stress (Shah, Mullainathan, and Shafir 2012; Mani et al. 2013; McEwen and Stellar 1993).
The mental health consequences of instability therefore extend beyond financial limitations. They operate through disrupted expectations, constrained agency, and prolonged stress exposure (see related discussion on Marquez 2026).
Artificial Intelligence and Labor Market Disruption
Nowadays, the rapid development and adoption of artificial intelligence (AI) tools across industries add another layer of uncertainty. In a recent interview, Jamie Dimon, CEO of JPMorgan Chase, has acknowledged that AI may reduce employment in certain sectors while increasing productivity. He has urged proactive retraining and redeployment strategies to avoid large-scale displacement shocks (World Bank Group, 2025; Fortune, 2026).
The social implications are clear. The challenge that we face is not technological disruption per se, but how transitions are managed. If institutions fail to provide credible pathways for redeployment, insecurity increases—even if overall inequality measures remain stable. Hence, unmanaged technological disruption becomes another source of economic instability (Marquez 2026).
From this perspective, the emphasis placed by Ajay Banga, President of the World Bank Group, on job creation acquires particular importance. As he has emphasized, “The job is not done without jobs. Work is never just about wages, it is about dignity, stability, and the bridge between growth and belonging” (Martin 2025). Hence, employment should be understood as not merely an economic statistic, but as a source of psychological stability, human capital formation, and community belonging.
The Intergenerational Effects of Economic Insecurity on Health
The relationship between economic insecurity and physical and mental health unfolds not only within individuals but also across generations (Zhang et al. 2022; Chauhan and Potdar 2022). Economic hardship, social instability, and limited support systems shape the environments in which children are conceived, born, and raised. These conditions influence parental wellbeing and caregiving capacity, thereby affecting the early developmental foundations of human capital.
Maternal depression illustrates one of the clearest pathways through which adverse economic and social conditions influence child development (Chauhan and Potdar 2022). Often associated with poverty, gender inequality, exposure to violence, and weak social support networks, maternal depression reflects the psychological toll that economic and social stressors can impose on caregivers (World Bank 2012; Rahman et al. 2004; Walker et al. 2011; Stein et al. 2014; Black et al. 2017).
When mothers experience persistent psychological distress during pregnancy or early childhood, their capacity to provide consistent care, emotional responsiveness, and adequate nutrition may be affected, with consequences that may manifest across the life course, shaping children’s physical growth, cognitive development, emotional regulation, and educational attainment (Goeglein and Yatchmink 2020; Marquez and Dutta 2018).
Maternal depression has been linked to less responsive parenting, shorter durations of breastfeeding, and reduced attention to infant feeding and health practices (Stewart 2007). As a result, children of depressed mothers face higher risks of undernutrition and stunting—defined as impaired growth and development measured by low height-for-age (Wemakor and Akohene Mensah 2016; Lara et al. 2015; Marquez and Dutta 2018). While deficiencies of vitamin A and zinc are associated with increased child mortality, deficiencies of iodine and iron, together with stunting, can impair cognitive development and prevent children from reaching their full developmental potential. At the same time, childhood overweight is emerging as a growing concern. It generally arises from an energy imbalance between calories consumed and calories expended, shaped by the interaction of behavioral, environmental, and biological factors. Increasingly, childhood overweight contributes to the rising burden of adult obesity, diabetes, and other non-communicable diseases (Black et al. 2013). Many of these nutritional challenges originate during pregnancy and early childhood, a period when physical growth and brain development are particularly sensitive to environmental influences.
A large body of scientific evidence shows that adequate nutrition, care, and stimulation during pregnancy and the first years of life, often referred to as the “first 1,000 days”, are essential for healthy brain development and the acquisition of cognitive and socioemotional skills later in life (Black et al. 2013). When early childhood environments are compromised, the developmental consequences can be long-lasting.
Chronic stress during early life can disrupt brain development and alter stress-response systems, affecting cognitive development, emotional regulation, and later educational outcomes (Shonkoff et al. 2012; Goeglein and Yatchmink 2020). Empirical evidence illustrates the magnitude of these risks: children exposed to maternal depression before age five face a 17% higher likelihood of developmental vulnerability at school entry, with particularly strong impacts on social competence, physical health and well-being, and emotional maturity (Wall-Wieler, Roos, and Gotlib 2020).
The global scale of this challenge is considerable. Mental health conditions affect at least 10% of the world’s population, and approximately 20% of children and adolescents experience some form of mental disorder (WHO 2022). At the same time, an estimated 23% of the world’s 667 million children under age five are stunted, and nearly 45% of deaths among young children are linked to malnutrition (UNICEF, WHO, and World Bank 2023). Together, these statistics highlight the deep interconnections between economic insecurity, mental health, nutrition, and early childhood development.
Implications for Human Capital Development
Recent evidence from the World Bank’s 2026 report Building Human Capital Where It Matters: Homes, Neighborhoods, and Workplaces place these findings within a broader framework for development policy (Holla, Schady, and Silva 2026). The report emphasizes that human capital—the health, knowledge, and skills people accumulate throughout life—is shaped not only by schools and health systems but also by the environments in which people live and work, particularly the home, the neighborhood, and the workplace (Holla, Schady, and Silva 2026).
This perspective helps explain why maternal wellbeing and early childhood conditions play such a critical role in development outcomes. In the home, family resources and caregiving practices influence nutrition, early learning, and emotional development, factors that shape children’s physical growth, cognitive abilities, and socioemotional skills. These early-life conditions form the foundation of human capital and influence educational attainment, productivity, and earnings later in life.
The report further highlights that human capital formation is also shaped by neighborhood environments, including access to quality schools, health services, safe public spaces, and economic opportunities. Finally, workplaces serve as key arenas where skills are reinforced and expanded through experience, training, and on-the-job learning.
Viewed through this broader lens, poverty and economic insecurity, physical and mental health, and human capital development are deeply interconnected. Breaking intergenerational cycles of poverty, instability, and ill health therefore requires an integrated, cross-sectoral approach, one that strengthens families, communities, and labor markets simultaneously. Early disadvantages in nutrition, caregiving, and psychological wellbeing can accumulate across the life course, weakening the development of human capital and ultimately affecting productivity, labor market participation, and economic growth.
Conclusion: From Puzzlement to Clarity
When I first read the Nature meta-analysis questioning the link between inequality and mental distress, I felt somewhat puzzled, and it prompted me to look more closely at the broader literature to gain clarity. What emerged, consistent with the Nature meta-analysis findings, was not a dismissal of inequality as unimportant, but a clearer understanding of where the strongest evidence lies. Income gaps alone do not consistently predict psychological harm. What does, repeatedly and across contexts, is the lived experience of deprivation, instability, and economic insecurity—especially when reflected in unstable employment and limited opportunity for younger generations.
If we are serious about strengthening the physical and mental wellbeing of people and long-term economic resilience, our focus of attention and action must center in ensuring that people can meet basic needs, participate meaningfully in the labor market, and live with a realistic sense of stability and dignity.
It is precisely here that perhaps a compelling justification emerges for the jobs agenda now prioritized by the World Bank Group (2025b). In an era of rapid technological transition and persistent economic insecurity, World Bank President Ajay Banga’s emphasis on employment carries renewed urgency (Martin 2025a). Addressing poverty, generating and stabilizing employment, and strengthening institutional buffers are not peripheral to the mental health and wellbeing of a population, they are foundational to it.
Employment is not merely an economic statistic. It provides income, structure, social connection, dignity, and a sense of purpose. In doing so, it serves as a critical anchor of psychological stability and an essential channel through which individuals accumulate skills and build human capital.
Against the backdrop of technological disruption, demographic change, and ongoing economic uncertainty, economic opportunity and mental wellbeing should be understood as mutually reinforcing objectives. Policies that reduce poverty, support families, promote stable employment, and invest in health, early childhood development, and education do more than stimulate economic growth—they strengthen the human capital and social resilience upon which thriving societies ultimately depend.
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