The Great Escape: Health, Wealth, and the Origins of Inequality
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The world is a better place than it used to be. People are healthier, wealthier, and live longer. Yet the escapes from destitution by so many has left gaping inequalities between people and nations. In The Great Escape, Angus Deaton--one of the foremost experts on economic development and on poverty--tells the remarkable story of how, beginning 250 years ago, some parts of the world experienced sustained progress, opening up gaps and setting the stage for today's disproportionately unequal world. Deaton takes an in-depth look at the historical and ongoing patterns behind the health and wealth of nations, and addresses what needs to be done to help those left behind.
Deaton describes vast innovations and wrenching setbacks: the successes of antibiotics, pest control, vaccinations, and clean water on the one hand, and disastrous famines and the HIV/AIDS epidemic on the other. He examines the United States, a nation that has prospered but is today experiencing slower growth and increasing inequality. He also considers how economic growth in India and China has improved the lives of more than a billion people. Deaton argues that international aid has been ineffective and even harmful. He suggests alternative efforts--including reforming incentives to drug companies and lifting trade restrictions--that will allow the developing world to bring about its own Great Escape.
Demonstrating how changes in health and living standards have transformed our lives, The Great Escape is a powerful guide to addressing the well-being of all nations.
which they would not die had they not been born in the “wrong” places. But this is presumably an argument for more aid. And perhaps health is the story of aid as a whole? Saving a life is a clearer target, and one more easily counted than the murkier benefits of roads, dams, or bridges, let alone of structural adjustment programs to “get prices right” or repair government finances. Yet perhaps aid for those things helps just as aid for health helps, only less transparently. And perhaps the
Chapter 4, I shall return to the gaps in life expectancy between the rich countries and try to explain what might be causing them. As is the case between groups within the United States, the experience of escape has been different for different countries. As we shall see, these differences are dwarfed by the differences between rich and poor countries. To understand more about life expectancy, we need to dig deeper and look at mortality at different ages. Figure 2 shows how mortality rates vary
Lister) to develop antiseptic methods in surgery which, together with the development of anesthetics, made modern surgery possible. The work of Snow, Koch, and Pasteur not only established the germ theory but also showed how to put it into practice for the public good. Scientific advance—of which the germ theory is such a singular example—is one of the key forces leading to improvements in human wellbeing. Yet, as the gradual adoption of the germ theory demonstrates, new discoveries and new
the countries of northwestern Europe. The United States is shown as the heavy line in both graphs. In the graph for men, we see an explosion of mortality, peaking around 1990, about two to three decades after the peak in smoking, and then falling back. On the right, because women took up smoking much later, the fall is confined to only a few countries, and the graph looks like the open jaws of a crocodile. Among women, the explosion in smoking is still going on, although for a few countries,
in Asia than in Africa. Most of this increase came from the Bank changing its poverty line, but the change illustrates the general unreliability of the numbers, not to mention the undesirability of allowing the Bank to be the only source of the numbers on which its own antipoverty efforts are judged. Of course, all of these changes are statistical and not real; no one in the world is poorer or richer because the calculations have changed. But those changes can have real effects if international