‘The Great Escape’In “The Great Escape: Health, Wealth and the Origins of Inequality,” Angus Deaton sets out to tell a familiar story - that of the long arc of global economic advance - in a fresh way. The author is an economics professor at Princeton University, a renowned development economist and an exceptionally gifted teacher. Even those familiar with his accomplishments might be surprised by how brilliantly his book succeeds.
The world, he emphasizes, is a vastly better place than it was, and he shows that the usual preoccupation with growth in measured output understates this astounding transformation. Unusually, “The Great Escape” gives the same weight to progress in health as it does to other measures of material well-being. Health is where the changes wrought by economic progress (especially in rich countries, but by no means confined to them) have been most startling.
Consider this: In the U.K., until about 1900, adult life expectancy - the number of additional years a 15-year-old person could expect to live - was greater than life expectancy at birth. Despite having already lived 15 years, young adults could look forward to a longer future than they could on the day they were born. It’s a measure of how extraordinarily dangerous it was to be young. A century later, a Briton’s chance of dying in childhood is tiny, and the gap between life expectancy at birth and adult life expectancy is almost the full 15 years it would be if every child grew up to be an adult.
“The Great Escape” also deals at length with the countries that haven’t yet made the transition. “Almost a billion people still live in material destitution, millions of children still die through the accident of where they are born, and wasting and stunting still disfigure the bodies of nearly half of India’s children,” Deaton writes. Global inequality - the consequence of the West’s acceleration - is a call to action. People in the rich West, Deaton argues, are under a moral imperative to do what they can to help.
Yet Deaton is a foreign-aid skeptic, and he explains why. The essential point was crisply stated more than 40 years ago by Peter Bauer: “If all conditions for development other than capital are present, capital will soon be generated locally, or will be available to the government or to private businesses on commercial terms from abroad, the capital to be serviced out of higher tax revenues or from the profits of the enterprise. If, however, the conditions for development are not present, then aid - which in these circumstances will be the only source of external capital - will be necessarily unproductive and therefore ineffective.”
Deaton brings an unsurpassed yet lightly carried expertise in statistical methodology to his discussion of the effectiveness of aid. He traces the history of the controversy, looking at the various arguments and changes in approach that have been adopted from time to time. He’s for better aid evaluation but isn’t much impressed by the grandiose claims made by proponents of the current leading development fad, which calls for randomized controlled trials of specific aid projects.
The randomistas, as they’re called, model their approach on drug testing. They compare the results of an aid intervention in one village or group of villages with a control group of otherwise similar villages where the policy isn’t adopted. It’s all the rage in development circles, but Deaton demurs. This method may tell you whether the particular project in question succeeded, he says, yet reveal little about whether the policy would succeed in general, which is what you want to know. The experimental and control groups are often too small; moreover, without a good understanding of the other supporting factors, there’s no reason to think that what succeeds in one place will work anywhere else.
If rich countries are morally obliged to help, as Deaton says, what should they do? He looks much more favorably on aid directed at improving health, because that can address specific failures of market provision. Aid in the form of knowledge rather than money is valuable, too. Rich countries’ investment in research whose benefits would flow principally to poor countries can be particularly effective, he argues.
Diseases such as malaria and tuberculosis are a case in point. Their rarity in rich countries means there’s little profit to be made in researching treatments or methods of eradication. Advance market commitments (where governments and aid-givers agree to buy drugs that are yet to be invented) and other devices to bring rich countries’ purchasing power to poor countries’ priorities are a fine idea.
Above all, Deaton argues, rich countries should stop putting obstacles in the path of the development of poor countries. Rich-country trade restrictions and farm subsidies put poor countries at a disadvantage. Rules on intellectual property rights need to be reformed so that they don’t unfairly discriminate against the poor.
Freer immigration may be the best aid policy of all. Migrants from poor to rich countries are better off than before, and their remittances make their families back home better off as well. These flows, which are almost three times bigger than flows of aid, “can empower recipients to demand more from their government, improving governance rather than undermining it.”
“The Great Escape” combines, to a rare degree, technical sophistication, moral urgency, the wisdom of experience, and an engaging and accessible style. It will deepen both your appreciation of the miracle of modern economic growth and your conviction that the benefits can and should be much more widely enjoyed.
*The author is Bloomberg View columnist.
By Clive Crook