Keeping economic inequality in check is an uphill battle, though countries differ. General drivers seem mediated, moderated, accelerated or perhaps even replaced by demographic, institutions or policy-making changes. Growing inequality is not found robustly linked to worsening social outcomes (health, deprivation, housing, social cohesion, etc.), though better longitudinal data may change this; Social stratification is manifest. Political impacts (e.g. legitimacy) seem stronger, underpinning deep concerns about political influence of the rich, feeding into policies increasing inequality. People on low incomes face effects on health, living conditions, social ties, child development. Redistributing income is imperative so as to alleviate poverty and promote equality of opportunities. Prevention policies cannot replace direct redistribution. The best performing countries have a large welfare state that invests in people, stimulating them to be active and adequately protecting them when everything else fails. This continues to offer the best prospect for rich countries pursuing growth with equality.