The great escape Health, wealth, and the origins of inequality

Development economist Deaton (Princeton Univ.) draws on his lifelong interest in and considerable knowledge of economic development to tell the story of modernization and the rise from worldwide poverty. Chapters illustrating demographic and economic trends utilize well-crafted charts and graphs to depict the rising paths that countries, first the US and western Europe and more recently China and India, have taken as their populations improve their health, education, and income-making abilities. Deaton documents the substantial improvements in world health as reflected in declining mortality and rising life expectancy rates over time, even as there remain large gaps in well-being between countries. He also points out that even as billions have escaped extreme poverty, many still die of diseases that were eradicated decades ago in wealthier areas of the world. The final chapter makes the case for why foreign aid hurts rather than helps developing countries (basically because it undermines the process of developing noncorrupt and democratic public sectors in those countries). This is the most forceful chapter in the book in its willingness to take a strong policy (or anti-policy) stance, even though it does not follow clearly from the preceding chapters, with their empirical focus on the story of human progress. Summing Up: Recommended. General readers and undergraduate students. J. P. Jacobsen Wesleyan University

ECONOMIC NOSTALGIA can have a strong appeal, especially following more than five years of a financial crisis and its aftermath. In the United States, people talk longingly of the mid-20th century, when the middle class was growing and upward mobility was the norm. In Europe and Japan, many hark back to the 1980s, before the euro was born and the Japanese bubble burst. Even in China and India, two of the world's more dynamic economies, some like to celebrate a time when life did not revolve around breakneck growth. The biggest accomplishment of Angus Deaton's "Great Escape" is to bring perspective to all this wistfulness. Deaton, a respected professor of economics at Princeton, does not stint on describing the world's problems, be they income inequality in rich countries, health problems in China and the United States or H.I.V. in Africa. Large sections of the book revolve around such troubles and potential solutions. Yet Deaton's central message is deeply positive, almost gloriously so. By the most meaningful measures - how long we live, how healthy and happy we are, how much we know - life has never been better. Just as important, it is continuing to improve. Deaton is surely aware that many readers will view these claims with skepticism, especially coming from someone whose discipline often seems to elevate money over basic human needs. He addresses this skepticism with both sweeping and granular descriptions of how life has improved. Life expectancy has risen a stunning 50 percent since 1900 and is still rising. Despite the resulting population explosion, the average quality of life has surged. The share of people living on less than $1 a day (in inflation-adjusted terms) has dropped to 14 percent, from 42 percent as recently as 1981. Even as inequality has surged within many countries, global inequality has very likely fallen, thanks largely to the rise of Asia. "Things are getting better," he writes, "and hugely so." Much of the most rapid change, of course, occurred long ago or - for Deaton's readers in the United States and Europe - is happening far away. In the industrialized world, it can be easy to focus on bad news (like slow-growing wages and rising obesity) and dismiss the latest innovations (say, the newest iPhone) as materialist distractions. But this, too, would be a mistake. The pace of progress may have slowed in the West. For selected groups, on selected measures, progress may even have stalled. For most people, however, it has not stopped. The digital revolution has allowed people to remain in touch with friends and family who once would have grown distant. The democratization of air travel, for all its indignities, has helped, too. The greatest progress against cancer and heart disease has come in the last 20 to 30 years. And although Deaton does not emphasize it, nearly every form of discrimination has become less common. When people talk gauzily of life in postwar America, they presumably are not referring to the lives of women, African-Americans, gays, lesbians, Catholics, Jews, Mormons, Latinos, Asian-Americans or the disabled. Most of us can find miniature versions of this tale in our families. Deaton's grandfather returned from World War I to a Scottish mine and rose to become a supervisor. Deaton's father, despite not graduating from high school, became a civil engineer and lived twice as long as his own father. My own grandfather escaped the Nazis, to New York, but succumbed to cancer as a fairly young man in 1950. Had modern medicine advanced only a few decades more rapidly, my father may well have grown up with a father. In the starkest terms, most of us today have at least one family member or friend who would not be alive absent the innovations of the last several decades. Perhaps most impressive - and, at the same time, most worrisome - is that progress is by no means inevitable. Humanity has spent most of its history not making progress, with neither life spans nor incomes rising. "For thousands of years," Deaton writes, "those who were lucky enough to escape death in childhood faced years of grinding poverty." "THE GREAT ESCAPE" of Deaton's title refers to the process that began during the Enlightenment and made progress the norm. Scientists, doctors, businessmen and government officials began to seek truth, rather than obediently accept dogma, and they began to experiment. In Immanuel Kant's definition of the Enlightenment: "Dare to know! Have the courage to use your own understanding!" The germ theory of disease, public sanitation, the Industrial Revolution and modern democracy soon followed. Deaton's writing is unfailingly accessible to the lay reader. At times, he repeats himself (he is definitely not a fan of foreign aid) or delves into technical subjects that will not interest everyone, like the calculation of exchange rates. But readers looking to learn some economics without picking up a textbook may enjoy these tangents. All in all, "The Great Escape" joins "Getting Better" - a 2011 book by Charles Kenny that concentrated on poor countries (and was more positive about foreign aid) - as one of the most succinct guides to conditions in today's world. The great, unanswered question is how rapidly the progress will continue. Deaton pronounces himself cautiously optimistic. But he also acknowledges rising threats, global warming being the most obvious of them. Beyond climate change, economic growth has slowed and inequality has risen in most rich countries, leaving the middle class and poor with only modest gains. The skew is so severe in the United States that a vast majority of Americans - the bottom 99 percent, he calculates - have done worse than a vast majority of French in recent decades, despite our reputation for economic dynamism. In China, meanwhile, a growth slowdown may just be beginning, and it could bring true political tumult, including war. From a historical perspective, the most worrisome development may be the tendency not to heed the central lesson of the Enlightenment and, by extension, of Deaton's Great Escape: Facts matter, especially when they conflict with dogma and preconceived notions. Pretending otherwise has consequences. Knowledge - which is to say education - is humanity's most important engine of improvement. Deaton concludes, based on the data, that rising education is the most powerful cause of the recent longevity boom in most poor countries, even more powerful than high incomes. A typical resident of India is only as rich as a typical Briton in 1860, for example, but has a life expectancy more typical of a European in the mid-20th century. The spread of knowledge, about public health, medicine and diet, explains the difference. Unfortunately, knowledge and facts are often on the defensive today. Fundamentalists of various stripes keep many countries from completing their own great escape. In the West, science still sometimes yields to dogma, on climate change, on evolution and on economic policy. Elites on both the right and left question the value of education for the masses and oppose attempts to improve schools even as they spend countless hours and dollars pursuing the finest possible education for their own children. It is true that many of today's biggest problems, including economic growth, education and climate, defy easy solutions. But the same was true, and much more so, about escaping centuries of poverty and early death. It was hard, and it involved a lot of failure along the way. The story Deaton tells - the most inspiring human story of all - should give all of us reason for optimism, so long as we are willing to listen to its moral. DAVID LEONHARDT, a former economics columnist and Washington bureau chief for The New York Times, is leading a new project for the paper that will focus on politics and policy.