The Great Escape: Health, Wealth, and the Origins of Inequality by Angus Deaton (Princeton University Press)

"Life is better now than at almost any time in history. More people are richer and fewer people live in dire poverty.” So begins the economist Angus Deaton’s study of changing levels of well-being. But he immediately continues: “Yet millions still experience the horrors of destitution and of premature death. The world is hugely unequal.” The aim of The Great Escape is to tell a twofold story: the “escape” of many from what we now see as premature deaths, and the persistent inequalities, both within and between nations, that prevent this happy “escape” from being a reality for many of the world’s people.

The book begins in a touching but somewhat misleading way. Deaton’s father, he tells us, “escaped” from a dismal life in a Yorkshire mining village, where he never got more than a few years of schooling. Eventually, through opportunities opened up by military service in World War II, he studied at night and became qualified as a civil engineer. Through effort and determination he then ensured that his son would get a first-class education. By now, sending his two children to Princeton, where he also teaches, Deaton himself has made sure that his children received an education that he judges to be “vastly superior in its depth, range of opportunities, and quality of teaching” to his own narrow education at Cambridge. Onward and upward!

Deaton tells us that his father’s story is “an example of what this book is about.” But it isn’t: it has nothing to say about changing health and sanitation conditions, which is what most of the book is really about. Even more important, it is a classic story of success through personal effort (with a little help from the army), and it says nothing about the role played by government services, which is where Deaton will argue that much of the responsibility for the “escape” rests. Indeed, those who achieve success through personal effort often conclude from their success that government services are a useless crutch, and that poverty is caused by laziness and stupidity. Deaton knows much better, and the whole point of his book is to insist that institutions and government action matter; so I wish he had resisted the temptation to begin with what is a charming digression. I wish he had also scrapped the all-too-catchy title, alluding to the 1963 film about the escape of Allied prisoners of war from a German POW camp during World War II. Comparing malnutrition and infectious diseases to the Third Reich suggests a grotesque exoneration of the worst in human behavior. And even though Deaton will ultimately impute causal importance to many human actions (medical discoveries, government action and inaction), it is surely not helpful to compare this complicated range of mainly well-intentioned activities to Hitler’s hideous projects.

Once we get past these initial missteps, Deaton proves an engaging and sure-footed guide to the “endless dance between progress and inequality” that is humanity’s history, particularly in recent years. Income and health have improved almost everywhere since World War II; there is not a single country where infant and child mortality is not lower than it was in 1950. And yet inequality is famously skyrocketing even within the richer countries. Even there, many people are denied “escape” from premature death, bad education, and lack of political voice. And inequality between nations is also rising. Although some very populous developing countries, particularly China and India, are making great strides, thus tilting the global average in a rosy direction, other countries appear to be falling even further behind.

To understand these problems and what can be done about them, we must begin by understanding what has already happened. But before we can do that, we must understand what we are talking about. Unfortunately, The Great Escape contains no detailed analysis of the concept of human welfare and no extensive confrontation with rival normative conceptions of welfare and development. But the reader who patiently searches for evidence of Deaton’s views will find a lot of it, together with some compelling arguments against opposing conceptions.