Academic journal article Agenda: A Journal of Policy Analysis and Reform

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

Academic journal article Agenda: A Journal of Policy Analysis and Reform

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

Article excerpt

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

(Princeton University Press, Princeton, 2013)

Professor Deaton's qualification for tackling this ambitious subject is acknowledged by his award of the 2015 Nobel Prize in Economics. There is perhaps no better authority to bring together the wide branches of health, wealth and inequality, which he does so masterfully in this book. It bespeaks a writer who says it all as he sees it; and not from the vantage of a Princeton ivory tower, but as someone who has spent a career thinking about how to measure and improve the lot of the world's worst off. In closing its pages, there is the sense that there is not much more left to say. It is the story of some of humanity's great escape from deprivation beside the inevitable remaining gaps in global wellbeing.

This is, overall, an optimistic and uplifting read. The past 250 years have witnessed the most spectacular increase in human wellbeing in history. The economies of China and India, accounting for one-third of the world's population, have seen growth rates that are unparalleled in any country or time in history, supporting recent expansions in global living standards. Life expectancy in most parts of the world has soared on the back of achievements in child mortality (for example, a child born in sub-Saharan Africa today is more likely to live to the age of five than a child born in the UK just a century ago). However, it is a dual story of the 'dance between progress and inequality' where almost a billion people still live in destitution and countless children still die from the same diseases that killed European children in the 17th and 18th centuries.

There are many books that tell separate stories of wealth and health inequality but in this book both stories are told at once. Wealth and health, it is argued, are each central parts of the story of human wellbeing. The merit of the book lies not in the telling of each story but in its attempt at weaving health and wealth as a self-reinforcing whole. Gaps in income, both between and within countries, correspond to gaps in health. The intriguing part of the story is the claim that income explains less about health than we would think ,which Deaton attributes (p. 97) to advancing knowledge and technology, human capital accumulation, and government capacity and institutional quality across countries:

Turning the germ theory into safe water and sanitation takes time and requires both money and state capacity; these were not always available a century ago, and in many parts of the world they are not available today.

While written by a self-professed economist, The Great Escape explores an impressive collection of writings on the subject, from demography, public health, anthropology and history. The book is written for a general audience in a style that is far from that of his earlier works such as An Analysis of Household Surveys. To ease digestion the core contents of the book are summarised in the first two chapters or 60 pages of the book. For the time-pressed reader it may be tempting to end there but I urge you to continue to the pieces of gold that lie in the details of measurement and the author's first-hand experience and anecdotes, such as in the development of World Bank's one-dollar-a-day poverty line. Thereafter the book is divided into three sections on health, money, and how to help those left behind.

Perhaps the real value of the book lies in the last section and Professor Deaton's roadmap of how to close gaps in global inequality. His views on foreign aid are the most controversial. He provides an overview of the aid-effectiveness literature and concludes that aid's past record shows no evidence of an overall beneficial effect. …

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