This conversation was led by Adrian Jaeggi, Assistant Professor and Head of the Human Ecology Group at the University of Zurich Institute of Evolutionary Medicine, and Aaron Blackwell, Associate Professor of Anthropology at Washington State University. In high-income countries, relative wealth and inequality may affect health by causing psychosocial stress. We test this hypothesis in a small-scale subsistence society, the Tsimane. We associated relative household wealth and community-level wealth inequality with a range of psychosocial and health outcomes (depressive symptoms, social conflicts, non-social problems, social support, cortisol, BMI, blood pressure, self-rated health, morbidities) controlling for community mean wealth, age, sex, community size, distance to town and relevant random effects. Wealth inequality was associated with respiratory disease, the leading cause of mortality in the Tsimane. Both inequality and wealth were associated with blood pressure. However, psychosocial stress did not mediate these associations. These findings suggest effects of socio-economic hierarchies on health in any society, but that some effects are exacerbated in high-income countries.