The Great Escape

How did humanity escape the long shadow of poverty, disease, and short lives? In The Great Escape: Health, Wealth, and the Origins of Inequality, Angus Deaton tells a story of progress that is both thrilling and troubling. He argues that over the past 250 years, humankind has achieved an unprecedented escape from the misery that haunted every previous generation—but the escape route, like a tunnel in the film he borrows the title from, allowed some to flee ahead while others remain trapped. This is not only a tale of success; it is a reflection on why inequality often widens even as average wellbeing improves.

Escaping the prison of deprivation

Deaton opens with the story of his father, born into a Yorkshire coal-mining family in 1918, whose life exemplified the twentieth-century “escape” from hard labor and tuberculosis to education and middle-class security. The family’s upward trajectory becomes a metaphor for humanity itself. Until the eighteenth century, almost everyone lived on the edge of subsistence. The Industrial Revolution, the Enlightenment, and scientific breakthroughs unleashed a sustained rise in both income and life expectancy. Knowledge, markets, and institutions combined to expand opportunities on a scale never before seen.

Progress and inequality intertwined

Deaton insists that poverty and inequality are not opposites but twins. Escapes always create gaps. When new technologies, vaccines, or institutions appear, they first benefit a few—those with education, wealth, or political voice—and only later diffuse to the rest. Just as the germ theory or public sanitation spread slowly from cities to villages, the Internet and modern medicine follow networks of power and capacity. In this sense, inequality is the price—and sometimes the engine—of progress. Yet unbridled gaps can stall future escapes if elites suppress innovation or block political reforms that would extend opportunity (he gives examples from historical bans on printing presses and railways used to control dissent).

Two dimensions of wellbeing

To understand whether life is improving, Deaton urges you to measure both income and health. Money determines material possibilities; health determines how long and fully those possibilities are enjoyed. Gains in nutrition, sanitation, and medical technology have expanded life spans dramatically—from about 30 years in 1750 to over 70 in much of the world today. But the distribution of these gains matters as much as their average size. A child who survives in Denmark but dies in Sierra Leone at age two shows that progress is uneven not only between but within nations.

Knowledge, institutions, and luck

Every escape, Deaton observes, depends on a triad: knowledge (scientific discovery and its uses), institutions (governments and social systems that deliver and sustain progress), and luck (being born in the right place or time). Germ theory opened doors, but only effective public-health administration turned knowledge into reduced mortality. Similarly, postwar vaccines saved millions of children when administered through organized campaigns like WHO’s Expanded Programme on Immunization. Without capable states and public trust, scientific progress stalls. Success, therefore, is as much political as epistemic.

Morality of measurement

You cannot tell this story without data. Deaton helped pioneer the measurement of living standards—the use of national accounts, survey data, and subjective wellbeing instruments such as the Gallup “life ladder.” He demonstrates how life satisfaction rises roughly with the logarithm of income—a fourfold income increase matters about equally across levels of wealth. Using multiple measures reveals hidden truths: daily happiness can be high in poor countries even when life satisfaction is low, reminding you that economic and emotional wellbeing are not the same thing.

From danger to hope

The narrative ultimately moves from a celebration of progress to a warning. Inequality is not just a trailing symptom of growth; it can shape future paths. When elites bend politics to protect rents—as in the rise of U.S. top incomes or in aid-dependent autocracies—progress for the many slows. Yet Deaton’s optimism endures: humanity’s Great Escape proves that science, political movements, and moral concern can expand opportunity further. The question is whether we will use that power to open the tunnel for all or leave others behind in darkness.

Core message

Progress has freed billions from want and disease, but the freedom of some depends on structures that must evolve if all are to escape. Measuring, understanding, and correcting inequality is part of completing humanity’s Great Escape.

You can’t understand progress without first understanding how it’s measured. Deaton argues that statistics—GDP, life expectancy, and subjective wellbeing—are not just technical tools; they are moral instruments defining whose lives count. Each captures a piece of the truth but none the whole picture. The art of welfare economics lies in combining them wisely.

Income and wellbeing

GDP per capita measures production, not welfare. It says little about how income is distributed or whether growth stems from desirable activities. Yet rejecting GDP entirely would be a mistake. When adjusted for purchasing power parity (PPP)—which corrects for cheaper local goods—GDP becomes an anchor for comparing material standards across countries. Using PPP rather than market exchange rates changes narratives: at PPP, China’s economy is roughly three-quarters the size of America’s; at market rates it looks much smaller. This has huge policy implications for global poverty and power balances.

Subjective wellbeing and the income ladder

The Gallup World Poll distinguishes two forms of wellbeing: life evaluation (how satisfied you are overall) and experienced emotion (how you felt yesterday). Life evaluation correlates strongly with income, especially when plotted on a logarithmic scale; experienced emotion flattens out sooner. Equal percentage rises in income tend to yield equal boosts in life evaluation across levels, but beyond a point they bring little extra daily joy. This dual picture warns against both economic determinism and naïve dismissal of money’s value.

The Marmite problem and cross-country comparison

Translating living standards across borders involves what Deaton calls the “Marmite problem.” Do you price locally representative goods (like Marmite in Britain) or internationally standard items (like a Coca-Cola)? The choice changes relative prices and, thus, global poverty estimates. Revisions to PPP rounds have repeatedly redrawn the poverty map, sometimes making Africa appear poorer or Asia richer. The lesson: global statistics are always approximations, yet they are essential for moral understanding and policy design.

Measurement principle

Measure wellbeing with multiple lenses—income, health, and subjective life quality—and always ask how the data were collected and converted. The numbers decide who is seen and who remains invisible.

Health’s transformation is one of history’s most dramatic escapes. For millennia, average life expectancy hovered between 25 and 35 years. Deaton traces the modern rise in survival to a combination of scientific discovery and collective action: from the acceptance of germ theory in the nineteenth century to global vaccination drives in the twentieth.

Germ theory and sanitation

Urbanization initially worsened health—industrial cities like Manchester became breeding grounds for cholera and typhoid. The major turning point came when figures like John Snow, Louis Pasteur, and Robert Koch demonstrated microbial causation. Knowledge alone didn’t save lives; investment in water and sewer infrastructure did. Britain’s nineteenth‑century sanitary reforms and later municipal engineering exemplify how politics and enfranchisement converted science into public benefit (Simon Szreter’s work shows that universal male suffrage paralleled improvements in sanitation).

Postwar miracles and setbacks

After 1945, newly independent countries adopted vaccines, antibiotics, and simple health technologies at scale. UNICEF, WHO’s Expanded Programme on Immunization, and later GAVI coordinated mass campaigns that slashed child mortality. Innovations like oral rehydration therapy—a simple salt-glucose solution discovered in 1970s Bangladesh—saved tens of millions. Yet politics could destroy overnight what medicine built in decades: Mao’s Great Leap Forward famine and Africa’s AIDS epidemic reveal the fragility of human gains.

New challenges in rich countries

As infectious disease waned, chronic illnesses took center stage. From the 1950s onward, smoking became a leading cause of premature death. Behavioral change—quitting smoking—and cheap drug innovations such as antihypertensives and statins together produced major post‑1970 declines in cardiovascular mortality. Here again, progress was both technological and behavioral: knowledge helped, but choice saved lives.

Historical lesson

Health revolutions succeed when scientific understanding meets institutions capable of implementing it. Discovery without delivery changes nothing; delivery without discovery runs out of tools.

One of the most misunderstood aspects of progress is population growth. The mid‑twentieth‑century surge in global population—often framed as a “bomb”—was actually a byproduct of success: declining child mortality due to vaccines, sanitation, and improved nutrition. More children survived to adulthood, so populations rose rapidly before fertility later declined.

From explosion to transition

Deaton walks you through the demographic transition: mortality decline comes first, fertility decline later, yielding a temporary explosion followed by stabilization. When parents realize most children will live, they choose smaller families. This voluntary adjustment transformed societies, freeing women for education and work and enabling faster economic growth through the “demographic dividend.”

People as resources

While Malthus feared overpopulation, economists like Julian Simon saw opportunity—more people mean more potential innovators. Deaton aligns with the optimistic view: if institutions harness human creativity, larger populations become assets, not burdens. China’s and India’s economic booms demonstrate that demographic momentum, paired with investment in education, can accelerate growth.

Ethical lessons from population control

The book confronts the dark side of demographic policy—forced sterilizations in India, China’s one-child policy—and argues that coercion was not only wrong but unnecessary. Fertility declined sharply in places with voluntary programs emphasizing maternal education and access to contraception, such as Thailand and southern India. The durable lesson: freedom and knowledge, not compulsion, drive sustainable demographic change.

Guiding principle

Empower families with health and education, and population adjusts peacefully. Fear-led coercion erodes trust and the institutional foundations that support long-term progress.

The United States serves as Deaton’s empirical laboratory for understanding how prosperity and inequality interact within a single rich nation. The key pattern: average income has risen exponentially since 1950, but the distribution of those gains has grown increasingly uneven.

Growth and its discontents

Real GDP per capita rose from roughly $8,000 in 1929 to over $43,000 by 2012 (in 2005 dollars). But such averages hide massive variation. While the top fifth of households saw steady wage growth exceeding 1.5% per year, the bottom fifth barely moved. The official poverty line, based on Mollie Orshansky’s 1963 food budget formula, has barely evolved conceptually, treating poverty as an absolute measure adjusted only for inflation. This design obscures changing social norms and transfer benefits like food stamps, tax credits, and Medicare, which understate progress when omitted.

Technology and labor market polarization

Deaton synthesizes research by Katz, Goldin, and Acemoglu showing how technological change favors skilled workers—what Tinbergen called the “race between education and technology.” When education supply lags, inequality widens. The shift from manufacturing to service industries, automation of routine jobs, and non‑indexed minimum wages have hollowed out middle incomes. Falling unionization (from 24% in 1973 to under 7% today) compounds this, as workers lose bargaining power and political clout.

Top incomes and political capture

Tax data from Piketty and Saez reveal that the top 1% now claim nearly half of all U.S. income. Unlike early‑century rentiers, today’s elite are “working rich” in finance, technology, and corporate management, enabled by deregulation and performance pay. Deaton warns that some of these gains stem from rent-seeking rather than productivity. Lobbying, campaign financing, and regulatory capture turn inequality economic into inequality political. When democracy becomes plutocracy, public goods decay—echoing Justice Brandeis’s caution that concentrated wealth and democracy cannot coexist indefinitely.

American paradox

The world’s richest large economy demonstrates both the boundless potential of technological progress and the fragility of fairness. Growth without equitable institutions yields privilege, not shared wellbeing.

Globalization amplifies both the diffusion of knowledge and the spread of crises. Air travel and trade now carry viruses as readily as vaccines. Deaton argues that the same interconnectedness that lifts billions from poverty can also deepen vulnerability when institutions fail.

Global convergence and divergence

Post‑1950, international inequality in life expectancy has narrowed: most countries’ citizens now live longer. Yet income inequality between nations remains huge. Some—China, India, the Asian Tigers—have surged ahead through “catch‑up” growth; others remain stagnant. Colonial legacies, extractive institutions, and weak states prevent diffusion of knowledge and capital. Deaton’s “flag crowd” metaphor—some flags racing forward while others stand still—shows why global inequality persists even as extreme poverty rates fall.

The limits of foreign aid

Deaton’s most controversial argument is that conventional foreign aid often harms more than it helps. Large transfers weaken governance by disconnecting rulers from taxpayers, encouraging corruption and dependence. Examples from Zaire to Zimbabwe show aid propping up tyrants. Donor conditionality is ineffective because political and bureaucratic incentives favor continued disbursement. Meanwhile, major successes like GAVI’s vaccine financing or Advance Market Commitments demonstrate that focusing on global public goods, not on rewriting local politics, yields genuine results.

Smarter ways to help

The book advocates humility and innovation: fund research into diseases of poverty, encourage free trade and migration, remove harmful agricultural subsidies, and reward policy success through outcome-based grants. Aid should strengthen, not substitute for, local institutions. This approach transforms moral intent into sustainable empowerment. Progress, once again, depends on coupling knowledge with good governance.

Final moral insight

Generosity blind to governance can backfire. To help others escape, you must build systems that let them walk out for themselves.