The Great Escape: Health, Wealth, and the Origins of Inequality

This is an important book by one of the foremost development economists in the world. It is highly readable, indeed written in an entertaining manner. Deaton paints on a vast canvas in time and space, embracing both developed and developing worlds. His theme is how in the course of history, and especially during the past three decades, hundreds of millions of people managed to escape abject poverty. He brings new insights into the sequencing and the many interwoven and often counter-intuitive linkages between growth and quality of life, especially health and longevity. His story begins when we were all hunters/gatherers and ends in 2013 in the unresolved aftermath of the financial crisis. One of Deaton's main themes is that economic growth does not necessarily produce improved quality of life, especially when income is distributed very unequally - as is the case in today's United States. So for example, in spite of lower economic growth in France than in the United States, because of a less unequal distribution of income, "all but the top 1 percent of the French population did better than all but the top 1 percent of the American population". (p. 260) In discussing the relationships between rich and poor countries, I very much like Deaton's implicit framework, which distinguishes "us" (the people of the North), "we" (the Northern governments), aid recipients ("their governments"), and "they" (the people of the South). This helps to cut through a lot of semantic and conceptual confusion, especially when discussing "development assistance". The book concludes with a chapter about how to help those left behind the "Great Escape" from poverty. While I tend to agree with his main thrust: that foreign aid works best where it is least needed, i.e., where governance is reasonably good, and works worst in poorly-governed countries where the people are most miserable. But from all I have seen, the evidence on aid effectiveness is inconclusive, largely, as Deaton notes, because the data are so bad. Deaton is very critical of aid, but illustrates his argument with selected examples, when one can almost always find counter-examples. However, one can only agree with his observation that increased flows of money don't help - quite the opposite - when recipient countries lack basic capacities and/or are poorly governed. Although he doesn't say it quite this way, Deaton implies throughout much of the book that while is quite easy for development experts to come up with lists of conditions that are necessary for successful development - including for example respect for the Rule of Law and sound macroeconomic policies - nobody has yet come up with a list of sufficient conditions.

The author puts forward ideas, based on extensive research, that challenge the way that we think about international aid as well as endeavours around international health programs. His ideas can form the basis for better programs

This book authoritatively presents what we know about the causes and pace of improvement in health across the world in the past few centuries. The argument is replete with reference to the literature that the reader can follow up. His message is that we have the technology and the will to reduce health inequalities around the world, but simple charity and aid to poor countries are part of the problem, not part of the solution. Deaton does present some important ways the rich healthy countries can help the poor, who are mostly oppressed by dictators and corrupt regimes. He shows clearly in the final, and most important chapter of this book (it appears that many of the reviewers on Amazon did not get that far) that the cost of dramatically improving the health of the poor around the world is absurdly low, but transfers from rich to poor countries go into the pockets of the criminal oligarchies that run the poor countries. This is not the first book to recognize, document, and reveal this sat situation, but it is to my mind the most authoritative. Angus Deaton is a truly remarkable scientist. I have nothing but contempt for his ignorant and superficial detractors.

Deaton does a great job of capturing a picture of human progress by looking at the world through the lenses of economics and public health. The big heroes of the story are sanitation, germ theory, and industrialization supported by the widespread prevalence of literacy. Deaton examines the problem of inequality and raises the possibility that inequality can be used to thwart human progress as well as be a signal of a dynamic economy leading to all boats rising. His critique of foreign aid is interesting and when we look at the data his case is data-based and not idiosyncratic conjecture. His analysis of what can be done to help underdeveloped countries to catch up focuses on addressing the health problems that plague underdeveloped tropical economies. Scientific research focused on treating diseases like malaria would have large dividends for these countries and require overhead that these countries cannot afford. Interventions like this are less likely to disrupt the processes essential to the emergence of the diverse economic ecologies that are at the center of healthy economies. Deaton's reflections on the moral difficulty of deciding the value of life-years are particularly pertinent to our current global health crisis. It appears his concerns about the value of the life years of the elderly have had a receptive audience in the midst of the COVID-19 crisis. Deaton's work is an optimistic assessment of the progress we have made in terms of human well-being that is not complacent about the challenges that currently confront us. He is a master at using data to make his points and his prose is as lucid as his charts.

The Great Escape is an overview of the changing nature of life expectancy and income through time. These are big subjects but the author focuses on the interplay between health and wealth as well as the spillovers of the drivers of knowledge and how they spillover into inequality. The book tackles many things but really focuses on the way that life expectancy has changed and how it is currently changing, how income affects life expectancy and how income has changed and finally how to improve the base conditions for economic growth where there remains poverty. The book is split into three major sections - Life and Death, Money, and Help. Life and death goes through the malthusian world humanity lived in for most of its history and then discusses how major breakthroughs changed life expectency through medical knowledge. Understanding of germ theory was essential in improving sanitation and decreasing child mortality. Initially the author discusses how essentially the big step in extending life expectency was not by changing conditional life expectency at age 10 but by decreasing infant mortality. The author then discusses when that benefit accrued, improving life expectency moved from infectious disease to solving chronic illness, a much slower space of incremental progress. The ideas in this chapter are pretty straightforward and understanding how the birth death dynamical process affects distribution of age and mean and median ages is well articulated. At the same time the underlying ideas are not particularly complicated and many readers will understand the lumpy benefit to curing childhood disease on expected life versus coming up with hip replacements. The author charts life expectency in time and how there is an income component which places one on the life expectency curve; one sees that time and the knowledge that is generated in time that moves us further along the understanding disease space, is the most powerful driver of extending life rather than income. The author then discusses economic growth and divergence in the world. It starts out with the historical account and discusses the great divergence. It discusses income inequality, how it has evolved over time and where we are today. It is a descriptive account rather than prescriptive. It discusses concepts like the Gini coefficient and the process of economic growth. It also discusses qualitative aspects of life though it is noted that such a concept is hard to measure. Measure's life life satisfaction are discussed and how satisfaction and income though often claimed to be separate have many other data points which show that increased income does strictly improve one's self reflection. The author discusses how it is difficult to translate GDP/capita across countries given the non-tradeable nature of the economy and how purchasing power is not an easy concept to quantify robustly. The author also discusses global growth and India and China and how their growth has lifted so many from poverty but if one averages across countries without focusing on population average poor growth rates dont necessarily lead to higher growth. The chapter gives a good overview of globla growth and inequality, how it has changed and what is happening to these variables in a local as well as global setting. In particular the author describes how locally inequality has been growing but there is data that also shows it is reducing globally, these are potentially spillovers from labour becoming more tradeable with increasing returns going to capital. Finally the author discusses aid and its costs and benefits. The author is a skeptic and largely argues that institutions are critical for growth and hence aid, dispersed through official channels, empowers regimes with poor institutions and hence perpetuates problems. This argument is very much in line with the writings of William Easterly "The Elusive Quest for Growth: Economists' Adventures and Misadventures in the Tropics". The author argues against the view of jeffrey Sachs and believes that money is ineffective in the wrong institutional setting. The logic is powerful but is also disheartening and I'm sure many readers will remain on the fence on this issue. The Great Escape covers some relatively large topics. I think it is informative for people who are unfamiliar with the subject matter. The writing is clear and certain dynamical processes in economics are made concrete through the writing in particular how information improves the life expecency/income curve. The organization i dont think is particularly great and there is a lot of coverage of subject but not a particularly well defined thesis. Things like the impact of changing youth mortality and its marginal impact on life expectency vs solutions to chronic diseases is fairly obvious though and much time is spent on concepts which are very easy to absorb. All in all i thought the book was a good read but the material can be found elsewhere and is nothing particularly revolutionary.

Angus Deaton explores with much cogent argumentation the evolution of material living standards and health in the last 250 years. Wealth and health are two key building blocks of well-being. Some countries started escaping from death and deprivation with the advent of the Industrial Revolution in the 18th century and the subsequent successes of antibiotics, pest control, vaccinations, and clean water. Others, especially in Africa, are still mired in both death and deprivation to this day. However, today's advanced economies should not take their current situation for granted. Threats such as climate change, political failures, epidemics, and wars could bring this favorable evolution to a halt or even reverse the progress that they have made in the past centuries. Economic stagnation and low growth have been the shared destiny of many rich countries for the past few years. At the same time, more and more emerging economies have pulled an increasing share of their respective populations out of both poverty and deprivation thanks to continuous economic growth. Mr. Deaton is definitely at his best in the third part of his book that is dedicated to how to better help those still left behind. The author rightly denounces the hydraulic approach to aid. Poverty does not result from a lack of resources or opportunities, but from a combination of poor institutions, poor government, and toxic politics. Furthermore, Mr. Deaton observes that the donors' inclination to give aid to countries rather than to people on top of aid fragmentation has as a consequence that aid is not effectively targeted to the poor of our planet. In addition, Mr. Deaton criticizes those who reduce aid to a collection of projects. Too many projects can distract those who are in charge of economic development in the poor countries. Finally, the author notes that large inflows of foreign aid change local politics and can undermine both democracy and economic development in the countries in need of economic growth. Too many people in the rich world are clearly not aware that aid to poor countries can be both harmful and helpful. Mr. Deaton concludes from his examination that aid is doing the most good when it is directed toward health, especially primary health care, countries with decent governments, and effective local providers who, against the odds, have not been captured or deformed by the donors. Mr. Deaton briefly examines the other roadblocks to development besides ill-targeted aid, i.e., the dealings of rich countries with regimes in poor countries that do not care at all about the well-being of their people, a lack of incentives given to pharmaceutical companies to develop new drugs for diseases that are rare or unknown in the rich world as well as the trade restrictions and politics of migration in the rich countries. In summary, Mr. Deaton invites his audience to take a fresh look at both wealth and health in order to make it possible to those still left behind to finally experience the liberating effects of economic growth.

This is a great book. It combines a beautiful writing style with amazing insights. Deaton won the 2015 Noble prize in economics but you definitely do not need to be an economist to enjoy it. It will cause thinking people on the left, right and middle to think differently (and better) about public health, equality of opportunity, and foreign aid. This is the best book I have read on equality of opportunity because it appeals strongly to both the heart and the mind. Deaton's in-depth expertise with the negative impacts of foreign aid (especially with smaller countries) is compelling. This counter-intuitive reality shows the importance of smart metrics (which was the foundation for Deaton's Noble prize). From a positive perspective, he shows that public health usually provides a huge return on investment and lays the foundation for education and equality of opportunity. I believe a focus on "equality of opportunity for everyone" could drive economic growth and reduce inequality in the U.S. and the world. The Great Escape is a book that the world's leaders need to read, understand and embrace.

Insightful book about the global rise of living standards during the industrial era. Charts a path between the political left and right on where the data supports inferences on economic growth, health and wellbeing, and inequality. Deaton also generally reflects a recognition that economics often serves best by obtaining and analyzing data to demonstrate the impact of particular policies, but that actual policy choices really often reflect considerations of norms and values that cannot be determined by the data alone. However, I agree with many other reviewers that the final section on the ineffectiveness of international aid is a mismatch from the rest of the book. It is the least data-centered of the sections and the most like a one-sided persuasive essay. I think he raises a number of valid concerns and considerations about the efficacy of international aid as it is conducted, but I fail to be convinced by his seeming conviction that efforts to reform how aid is conducted would be fruitless. He comes off as a person who has become deeply disillusioned by development aid and can no longer see the legitimacy of any arguments in its favor. However, his even-handedness and open-mindedness about other economic matters in other areas of the book does mean that I am more willing to fully consider his arguments on this issue than I might have been from someone who had not demonstrated such qualities on other issues.

In un momento storico di grande tumultuosità tra culture, The Great Escape, dati alla mano, orienta l'attenzione verso le necessità primarie che le Società occidentali hanno affrontato ed affrontano con il lavoro e una dimensione laica della politica per darsi più benessere da generazione a generazione.

Especialmente bueno para aquellos interesados en economía de la salud. Si no estudiaste finanzas o economía, puede llegar a ser una lectura un poquito pesada, pero si estás interesado en el crecimiento e iniquidad, buenísimo.

A must read if you're into development economics

I greatly enjoyed reading this book, which for me as a general reader, achieves just the right balance of readability and learning. Focusing on health and wealth around the world and over time, the author, Angus Deaton (a professor of Economics and International Affairs), provides a clear and interesting account of how the world has become healthier, with people enjoying longer life expectancy pretty much across the globe over the last 75 years, and how this continues to improve. The book shows clearly how China and India continue to contribute so much to the overall improvement in worldwide wellbeing statistics, with over 1 billion people escaping from poverty,with all that such escape brings, in recent times. Today 80% of people around the world are literate - in 1950 the literacy rate was 50%. However, over a billion people still live in abject poverty around the world, and this book explains why this situation remains and explores what might be done to adddres this. The links between health and wealth are well known, but this book is full of fascinating facts, and delivers clear explanations that greatly help in understanding the roots and consequences of various types of inequality, and of improvement in living standards in absolute as well as relative terms. Illustrated throughout with easy to follow, and clearly explained graphs, this is a very informative and entertaining book indeed. I would have struggled to believe, for example, that life expectancy in India is today higher than it was in Scotland in 1945 had I not read this book which also explains why such changes have occurred and concludes with well argued ideas about how greater equality around the world could and should be achieved. Really superb - I have strongly recommended this book to several family members and friends - although I have read so many bits out to them that they may feel they have read it already..

Excelente livro