05.06.2020 in Book Report
Book Appraisal The Great Escape: Health, Wealth, and the Origins of Inequality

The Great Escape: Health, Wealth, and the Origins of Inequality by Angus Deaton is both a historical and analytical narrative that addresses the historical and present contexts of the world in terms of health, wealth and the issue of inequality. In his attempt to address health, wealth and inequality dynamics, Deaton elucidated a number of controversial issues with regard to establishing both the origins and the impact of inequality as it is known in the world today, while providing numerous examples presented for one’s reflection within the text. In the author’s view, inequality is regarded by some as a norm that exists by default in the world where capitalism is heavily adored. In other words, in most cases, inequality is a creation of man through a system that allows the rich to continue accumulating wealth, while the poor are retained in the manacles of poverty and continue to degenerate into abject poverty. In any capitalized society, the wealthy may not hold power directly, but they wield immense influence over the ruling class and are able to control the present and the future. While the book tackles a microcosm of issues relating to health, wealth and inequality, the inconsistencies in most of the arguments canvased by the author cast doubt on the validity of this book and render the author’s opinions flimsy.


The Past and the Present in the Context of Human Health

Generally, Deaton argues that the health status of the global population has improved despite the fact that there are some nations that still register very high mortality rates and low life expectancy. The striking examples include the life expectancy of a girl born in the United States who can is believed to live up to a hundred years, while her great grandparents in the early 20th century could only live to 54 years, and their grandparents later in the mid-1990s reached the age of 66. In the 21st century, the American female is likely to live for an entire century, representing a significant improvement in the health status. There is also a mention of the discrepancy in life expectancy in other parts of the world, with the indication that while other countries may not have a life expectancy of 100 years, the citizens are likely to live longer than they would have if they were born in the previous centuries. Therefore, no matter how bad things may be in any part of the world, one can agree that it was worse a number of years ago.

This argument resonates well with the present situation in many ways. First, there were a lot of reasons for people to die early in the past. The medical science has significantly developed over the past few decades, starting from the currently preventable diseases against which children and adults are immunized to the information on prevention through avoiding and eliminating germs. It is now obvious that where people applied short-term disease management leading to eventual death, there have been a number of simple solutions that provided relief. For example, there was a time when malaria was considered one of the greatest threats to children under the age of five in sub-Saharan Africa and the rest of the tropics. At that time, the medication for malaria was moistly inaccessible and in some cases even ineffective owing to the dynamic nature of the pathogen in question. With time, the world joined hands and started waging war on this destructive ailment with the supply of mosquito nets, research on the disease and distribution of the new effective malaria medication in public hospitals. Therefore, all these efforts contributed significantly to the reduction of a number of deaths associated with malaria, thereby saving a lot of children from early death.

Another observable difference that correlates with the argument of health-related improvements is the fact that the global population has significantly increased over the past few years. It is believed that in the absence of science and medicine, the world’s population was maintained at a low level due to the high number of deaths that occurred regularly, with most people even dying before they could build families. Currently, most people reach an advanced age simply because they are no longer threatened by the common ailments that would have killed them in the past. Common cold, typhoid, measles, polio and tuberculosis are some of the diseases that are no longer a challenge in most parts of the world now, even though in the past, they could claim thousands of lives on a regular basis. It, thus, follows that the world can appreciate the improvement in the health sector, leading to the increased overall life expectancy.

The Post-World War II Era and Its Successes for Human Health

The book argues that after the World War II, there were positive prospects for the world in terms of health, but it took over a century to reach the developing nations in the other side of the world. The author reiterates that while people were no longer dying of measles in England, thousands of Africans were succumbing to the disease in their homeland. The difference in economic, educational and social status manifested itself in the health sector of the countries in question. Currently, however, the space between nations has been significantly reduced with the technological inventions in the communications area. Apparently, this means that people no longer have to travel for months across the ocean in order to deliver a cure or pass a message on how to prevent a virus from spreading and causing an epidemic. In the modern world, an innovation invented in the morning in a Chinese biomedical lab could reach Canada within a few minutes through the internet. The scientific community has generally grown closer so that scientific solutions no longer have to benefit only one part of the world, while leaving others languish in death and disease.

After the Second World War, one may argue that science came alive, especially for the Third-World countries that had previously had limited exposure to matters of civilization and exposure to modern solutions. For example, most of the colonial Africans first encountered any form of medicine and health care through their colonial masters. Before that, they were mainly dependent on herbs and roots of traditional plants, most of which cannot be proven to have been effective. Health care developments were delivered to the rest of the world from the western countries at a very slow pace even after the Second World War. The author simply appreciates the fact that at least there was some consideration for the Third-World countries after the war, with the stable ones being able to procure what became known as ‘western medicine’ for the treatment of their illnesses.

Since the Second World War, there has been much innovation that helped to boost communication across the globe. The Third-World nations also underwent some development and started manufacturing their own medicines as well, with the pharmaceutical companies being grounded on research from abroad to produce generic medication for the local populations. With these possibilities, health would have to improve dramatically in the Third-World countries as well, and people no longer had to die from simple ailments that could be treated with a simple prescription. The Third World may not yet have attained the level of health care efficacy that some of the wealthy nations enjoy, but so far, the situation is much better than it was before the Second World War. While most people would argue that there may be much more health challenges in the current times compared to the past, it is important to appreciate that currently, a lot of people are living with and effectively managing lifestyle diseases, while in the past, they could easily die of a headache.

Wealth Distribution

The book considers the material wealth of the human species, with a focus on the United States mainly due to the readily available data for comparison over the years. The author notes that the US economy has steadily grown and became more stable over the years such that even during the most recent recession, there are people in the country who were not at all affected in terms of their standards of living. Apparently, this means that so far, the total wealth in the country has been on the increase. However, it can be noted on the opposite end of the spectrum that there are by far too many people living below the poverty line mainly because the distribution of wealth is not as fair as it should be. The problem is that some people are too rich, and they continue to accumulate more wealth at the expense of those who have no money to save. Therefore, this means that while the US may have considerable material wealth, the nation cannot generally be considered as wealthy since there are by far too many people who are unable to pay for their own meals, let alone housing, clothing and education.

It must be noted that the Gini coefficient in the US is much higher than that in most European countries that have been working towards a more acceptable discrepancy in income distribution amongst the citizens. The US is an individualistic society within which people are more interested in their personal achievements rather than the collective welfare of the society. Within the US, an individual would willingly advocate for increased interest rates at the banks, provided it gave them a chance to make more money out of it. The impact on the rest of the society is not considered by those who have the power to make critical decisions. Within such society, the rich will continue to become richer as the poor are forced into debt and despair within their own nation.

Discrepancies in wealth distribution can be considered as a result of multiple historical factors. Most people who are currently wealthy were born into wealthy families where parents and grandparents were at some point in history placed at an advantage to acquire that wealth. For example, this could be through education, employment or innovation at the right time in the nation’s history. Regardless of the context that led to the discrepancy, it can be noted that the current systems and policies do not favor a reversal of this discrepancy. The society may proclaim the American Dream so that everyone could have an equal opportunity to flourish; however, in reality, those in the right position have an advantage over the proverbial underdogs of the society. People who attend right schools and are from right families often hold positions in the corner office, while those who are trying to achieve the American Dream are left to struggle as hustlers on the streets for a long time. Nevertheless, others are lucky to penetrate into successful businesses that in the end propel them into the nation’s 1% category.

The Negative Impact of Foreign Aid to Developing Countries

In the book, the author argues that the concept of aid was a noble idea conceived by those in developed countries with the aim of helping people, especially in poor countries. Deaton seems to believe that aid from donors is always misappropriated and that the situation could be different if aid resources could be spent wisely. However, this is not a true scenario since a number of countries have experienced significant improvement since they started receiving foreign aid, especially in the HIV/AIDS front. Most countries could not afford to provide medication for their infected citizens, while others could also not support mass education on the issue of prevention and management of the disease. By contrast, in an effort to combat HIV and AIDS, most humanitarian organizations that have so far been working to provide foreign aid have been effective and can report positive results. The same can, however, not be reported relating to poverty eradication programs that seem to be focused on benefiting the countries that are providing help. If companies seeking to empower people in the Third-World countries actually operated in a way that would have a positive impact on these societies, it could be expected that there would be positive changes in the respective economies of the said nations. However, with the employees earning minimum wage and the profits being repatriated back home, the Third-World countries are simply being used for their resources and economies of scale; in the end, they are left as broke as they were before the foreign investors decided to provide their help.

To remedy this situation, the rich in the society need to care a little bit more about the welfare of the poor. A business organization in the US may be structured to only focus on making profits, but if a group of wealthy individuals were to come together and provide foreign aid for a country, they would be more effective since they are not likely to channel the profits to their nations. On the contrary, they will completely benefit the people of the nation that they seek to help. A good example is the Toms Shoes Company which provides shoes for children in poor nations across the world. If Toms had been a business organization to begin with, chances are that they may have wanted to sell the shoes to the poor nations at a cheap price, thereby making shoes that are of very poor quality. The fact that the company was particularly formed to provide these free shoes makes it easier for them to make a real difference in the lives of the children.

How Developing Countries Should Be Helped to Tackle Their Current Destitution

From the book, one of the most impressive recommendations in regard to helping to reduce poverty is in the impact of small actions of those in a position to help. However, this assessment is not correct since, ironically, most people look at poverty from an external perspective. As a result, poverty in poor countries is essentially a foreign narrative. In essence, wealth can be stored in different forms and be defined differently. Therefore, poverty is a difficult concept to tackle. The first solution should be to close the gap between the rich and the poor, and in this case, it is crucial to create awareness amongst the rich so that they can appreciate their position in the world and understand how they can help to reduce poverty. Most of the foreign aid is guided by the interests of the giver rather than the needs of the recipient. The role of the individual rich people in this case would be to answer to the needs of the poor rather than imposing their own desires and assumptions on them.

It is also agreeable that the developed nations would be of more help to the developing nations if they provided the technical and intellectual assistance with regard to governance. Rather than providing loans for governments, the World Bank in this case could be more effective if it provided the technical insight into creation of policies that are likely to lead to economic growth and empowerment of the nations in question. In fact, this often involves ensuring that regardless of the regime in power, the policies that are put in place are generally meant to create opportunities for financial freedom. Hereby, these developing nations are only likely to grow if they have the right trade agreements and monetary policies within their governments and if the financial sector supports the growth and development of the small scale businesses that are locally owned. Without this groundwork, there is a very limited chance of economic growth, regardless of the size of a loan that a country gets. At this point, it must be noted that the fate of the nation in terms of eradication of poverty is not dependent on what the foreign nations do but rather what the local government does, and the best way to ensure that local governments do the right thing is to show them what exactly to do without encroaching on their sovereignty. Consultation in this case is a better and more effective alternative when helping the Third-World nations.


The Great Escape: Health, Wealth, and the Origins of Inequality by Angus Deaton is not only a simple and well-thought-out book on the state of the world with regard to wealth and health but also a very insightful and factual compilation of information that would help one to understand and fully appreciate such aspects of the current world as poverty, health and foreign aid. The book provides strong arguments that are effectively supported by adequate research and the latest figures. However, the inconsistencies in some of the arguments compromise the validity of the author’s findings. From the book, it is obvious that some of the main arguments are convincing, whereas the others cannot be weighed against recent findings. For instance, the issues of donor aid should be debunked. In order to help the country tackle poverty, a better option is to provide the technical guidance that will enable it to utilize its natural resources rather than getting them to be dependent on foreign donations and loans that they are not likely to easily repay. Technical support is, thus, by far the most valuable option that these countries should get from the developed nations and organizations such as the World Bank.

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