Book Reviews

Aiding and Abetting

Angus Deaton

The Great Escape

Health, Wealth, and the Origins of Inequality

Princeton University Press, Princeton, New Jersey, 2013, 360 pp., $29.95 (cloth).

Princeton University economist Angus Deaton has written an elegant, wide-ranging, and fascinating book on the history of U.S. and global progress in health and material well-being from prehistory to modern times.

The Great Escape of the title is the escape from poverty and ill health that some of the world’s population has already largely achieved, most of the world is undergoing, and an unfortunate few have yet to begin. The book is an accessible and enjoyable journey narrated by a world authority on global health and income data, and the discussion of the assumptions, biases, and flaws of such statistics makes for a wonderful read. Much of the book amounts to a warning: there are unavoidable uncertainties and compromises in all economic and health data, so don’t believe any of it too much.

With that caveat, Deaton concisely outlines the history and extent of global progress, as well as its major causes. Not least, he argues that the escape from high mortality was only weakly connected to the escape from poverty. In the West, it was not primarily greater private wealth that led to improved health. Instead, better public services such as water and sanitation were the proximate causes. In developing economies over the past 50 years, the answer to the question “Do faster-growing countries have faster rates of decline in infant mortality?” is clearly “No.” Perhaps the book should have been titled The Great Escapes.

Along the way to progress, Deaton points out, unnecessary evils were committed in the name of international population control. This highlights yet another great escape: all countries have exited the Malthusian trap of the preindustrial era, when population growth was routinely associated with lower incomes and worse health.

Returning to Deaton’s focus on the limits to our understanding, those looking for simple policy pointers on promoting income growth in countries at the wrong end of global divergence or on sustaining worldwide health progress will be disappointed. Writing of the foolishness of searching for a “key to growth”—or indeed, a key to stagnation—Deaton suggests that such efforts attempt to “make fatuous generalizations based on coincidence. Etruscan and Roman haruspices did the same with entrails of chickens.” Still, Deaton does argue that institutions tailored to the elite are “inimical to growth”—one reason for the book’s focus on inequality.

The Great Escape does elaborate on one policy recommendation for helping the world’s poorest: cut aid budgets. Aid, Deaton suggests, doesn’t promote growth. Copious aid is in fact âa roadblock to developmentâ that can corrode institutions—allowing rulers to rule without consent because they do not need to tax their citizens. He does support some aid and ways of providing it: financing the development of new technologies, including drugs, for...