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

• Author: Keech, William R.
• Position: Book review

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

By Angus Deaton

Princeton, N.J.: Princeton University Press, 2013.

Pp. xvii, 360. $29.95 hardcover.

Angus Deaton's The Great Escape: Health, Wealth, and the Origins of Inequality is a positive and optimistic assessment of worldwide well-being. Yet it is also a sobering book because it identifies problems and vulnerabilities. It brings together two important elements of well-being: health and prosperity. It is about "the endless dance between progress and inequality, about how progress creates inequality, and how inequality can sometimes be helpful ... and sometimes unhelpful" to progress (p. xiii).

The book's perspective is global, though several chapters focus on the United States. It is organized into three parts: "Life and Death," "Money," and "Help." The first two are self-explanatory; part 3 is mainly an argument that most foreign aid is doing more harm than good.

In spite of the fact that "the world is hugely unequal," "life is better now than at almost any time in history" (p. 1), and the book is about the interplay between progress and inequality. The global inequality of today is largely the creation of modern economic growth. Health progress creates inequality in health just as economic progress creates economic inequality.

Chapter 1 is a descriptive treatment of well-being in the world. Health and wealth are strongly, though not perfectly, correlated among the world's countries. The relationship between income and life expectancy at birth is positive but nonlinear. Life expectancy rises very steeply with income up to about $10,000 gross domestic product (GDP) per capita (in price-adjusted 2005 U.S. dollars) and then flattens. This is the epidemiological transition point at which the causes of most deaths shift from infectious to chronic diseases.

Deaton is largely agnostic on the causality of income and health other than to say that for nutrition people need money, and for sanitation governments need money. He reports that proportional increases in income are associated with constant increases in longevity. There is improvement over time in both health and income, but with some catastrophic interruptions such as the Great Leap Forward in China from 1958 to 1961, which caused some 35 million deaths, and the HIV/AIDS epidemic.

The improvements in health are due to both income and practical knowledge, and Deaton argues that knowledge is central and that income is a...