Getting Better

Getting Better Plot Summary

Introduction

In a small rural village in Niger, West Africa, a child wakes up to a new day. What might seem unremarkable to outsiders represents something extraordinary in human history: this child is more likely to survive to adulthood, receive basic education, and live a longer life than at any previous point in history. This reality exists despite Niger being one of the poorest countries in the world, with minimal economic growth over recent decades. How can a nation with stagnant income metrics experience such dramatic improvements in quality of life? This paradox sits at the heart of global development's surprising journey. Contrary to popular belief, development isn't simply about economic growth—it's about the spread of life-enhancing technologies and ideas that have dramatically improved human existence even in places where GDP hasn't risen significantly. Throughout history, we've witnessed dramatic divergence in incomes between rich and poor nations, yet simultaneously seen remarkable convergence in health outcomes, education levels, and even political rights. By understanding this fuller picture of progress, we gain a more nuanced view of what development truly means and how we might better support it in the future. This exploration is valuable for policy makers, development practitioners, and anyone interested in how human wellbeing has evolved across time and geography.

Chapter 1: The Malthusian Trap: Early Beliefs and Historical Constraints

For most of human history, populations across the globe lived under what economists now call the "Malthusian trap"—named after Thomas Malthus, an English clergyman who in 1798 published his influential "Essay on the Principle of Population." Malthus proposed a sobering view of humanity's future: populations would inevitably grow until they outstripped available resources, particularly food, at which point famine, disease, and conflict would reduce numbers until a precarious equilibrium was restored. This wasn't mere theory—historical evidence strongly supported this view. From 1200 to 1650, Britain's economy showed almost complete stagnation in production technology. Any increase in output was matched by population growth, keeping per capita income virtually constant. When the Black Death swept through Europe in the 14th century, killing perhaps a third of the population, wages rose dramatically due to labor scarcity—only to fall again as populations recovered. This cyclical pattern seemed inescapable. In Malthus's view, any temporary improvement in living standards would be quickly erased by population growth. He wrote chillingly of nature's method for maintaining balance: "The vices of mankind are active and able ministers of depopulation... But should they fail in this war of extermination, sickly seasons, epidemics, pestilence, and plague, advance in terrific array, and sweep off their thousands and tens of thousands." This bleak vision suggested that most humans were destined to live at bare subsistence levels, with only brief periods of relative prosperity possible. For centuries, this trap appeared universal. In 1820, the richest countries had average incomes only about 4.5 times higher than the poorest. Most people everywhere lived short lives of hardship. Malthus himself was skeptical that even the "best-directed efforts of human industry" could significantly increase food production in places like China and Japan. His views profoundly influenced economic and social thought, with echoes persisting through modern neo-Malthusian concerns about environmental limits to growth. Yet something remarkable happened: beginning with the Industrial Revolution and accelerating in the 20th century, humanity began escaping the Malthusian trap globally. Between 1950 and 2000, among 102 countries examined, only the Democratic Republic of Congo experienced negative GDP growth. Even Africa, often cited as development's greatest failure, saw impressive 3.5% annual GDP growth during this period. Rather than hitting absolute resource limits, human innovation continually pushed productivity higher, allowing populations to grow while living standards improved. Perhaps most remarkably, this economic expansion occurred alongside dramatic population growth—the global population more than doubled in the second half of the 20th century, yet food supplies per capita increased by around 25%. This historical transformation represents one of humanity's greatest achievements, though it remains incomplete in some regions. The world has moved decisively beyond Malthus's nightmare scenario, demonstrating the power of technology and innovation to overcome seemingly fixed natural constraints.

Chapter 2: Income Divergence: The Growing Gap Between Nations (1800-2000)

When we examine the economic trajectory of nations since 1800, a striking pattern emerges: while overall global income has risen dramatically, the gap between rich and poor countries has widened into a chasm. In 1850, the Netherlands, then the world's wealthiest country, had an income per capita of $2,371—approximately 4.5 times higher than India's. By 2008, the Netherlands' per capita income had soared to $24,695, while the Democratic Republic of Congo reported just $249, creating a gulf nearly 100 times wider. This divergence accelerated during the post-World War II era. In 1950, the poorest documented country (Guinea Bissau) had an income of $289, while the United States topped the chart at $9,561—a ratio of about 33:1. By 2008, this gap had expanded to 127:1 between the richest and poorest nations. Today's global economic landscape reflects extreme inequality, with the bottom 10% of the world's population sharing just 0.6% of global income (averaging $291 per year), while the richest 10% control over half, enjoying average annual incomes of $30,081. Sub-Saharan Africa exemplifies this divergence most dramatically. Many African countries today have per capita incomes lower than Britain had during the Roman occupation or in the Dark Ages. Between 1960 and 1999, GDP per capita in sub-Saharan Africa inched up from $477 to just $561, while high-income countries saw their averages jump from $13,000 to $31,000. Africa's relative income position actually deteriorated, falling from 4.8% to 1.9% of wealthy nations' averages. What makes this divergence particularly puzzling is how persistent it's been despite seemingly small initial differences. In 1820, the gap between the richest and poorest countries was only $1,441—an amount that took just two years of growth for the United States to add to its income between 1997 and 1999. Yet these small initial differences have produced enormous long-term divides. Countries that were relatively wealthy in 1820 tend to remain wealthy today, while poor countries largely remain poor. This "stickiness" of economic position extends to individuals as well as nations. In the United States, more than half of children born to parents in the bottom 10% of incomes remain in the bottom 20% as adults. The chance of moving from the very bottom to the very top is approximately one in seventy-seven. Even famous self-made billionaires like Bill Gates typically started from positions of relative privilege—Gates was born into America's top 1% of household incomes, with a prominent lawyer father and a mother on the board of a major bank system. There have been notable exceptions to this pattern of divergence. Several East Asian countries—particularly South Korea and Singapore—achieved remarkable convergence with rich nations. More recently, China and India have experienced rapid growth, helping to reduce global poverty. However, these success stories remain relatively rare in the broader picture of persistent and growing international inequality. For most of the world's poor nations, catching up to wealthy economies has proven frustratingly elusive, raising profound questions about the nature of economic development and growth.

Chapter 3: The Technology Paradox: Why Growth Models Failed

For decades, economists and development experts have sought the formula for economic growth—the policy prescription that would allow poor countries to catch up with rich ones. Yet despite thousands of academic papers, billions in aid, and countless reform packages, a sobering conclusion has emerged: there is no single formula that reliably produces growth. The search for universal growth models has largely failed. In 1949, the first World Bank mission to a developing country went to Colombia, confidently reporting that "only through a generalized attack through the whole economy on education, health, housing, food and productivity can the vicious circle of poverty... be decisively broken." This optimistic tone reflected early development economics, which believed in clear, technocratic paths to prosperity. The Harrod-Domar model of the 1940s proposed a straightforward relationship: invest more in factories, roads, or housing, and growth rates would rise predictably. Later, Nobel laureate Robert Solow suggested technology diffusion was the key, with poor countries naturally catching up as knowledge flowed across borders. When reality failed to match these theoretical predictions, new theories emerged. The Washington Consensus of the 1980s emphasized market-friendly policies: privatization, deregulation, and fiscal discipline. When these reforms delivered mixed results, institutional theories gained prominence, suggesting that property rights, market systems, and governance structures were fundamental. Yet each new theory, despite Nobel Prizes and billions in aid, failed to provide reliable guidance for generating economic convergence. The empirical evidence reveals why: economic growth is stubbornly context-dependent. Policies that succeed brilliantly in one country often fail in another. East Asian countries achieved remarkable growth with activist industrial policies—but so did many African and Latin American countries that saw dismal growth rates. Even dramatic "policy shocks" seem to have limited long-term effects. Studies show that civil wars and bombing campaigns (like those in Vietnam) don't significantly alter long-term growth trajectories. Communist Eastern Europe outperformed many market-oriented economies during the Cold War, while rapid transition to capitalism produced economic collapse in Russia but prosperity in Poland and the Czech Republic. Cross-country statistical studies further highlight this complexity. Investment—perhaps the factor most consistently associated with growth—sometimes produces high returns and sometimes almost none. Zambia maintained reasonably high investment rates from 1960 to 1994, but instead of the predicted $20,000 per capita income, achieved only $600. Similarly, education shows a weak or even negative relationship with growth rates across countries, despite its theoretical importance. The reasons for these failures are profound. Francisco Rodríguez of Wesleyan University concluded that there simply aren't enough data points in history to test the complex, context-dependent models needed to predict economic growth. Historical factors appear to exert tremendous influence—from colonial settlement patterns to disease environments to whether a society was affected by the slave trade. As MIT economist Daron Acemoglu noted regarding the divergent paths of North and South Korea: we know institutions matter greatly, but we can't determine precisely which institutional factors were most important. This reality explains why development economists—despite their confidence—have struggled to help countries like Ghana, which saw virtually identical growth rates (around 0.2-0.3% annually) under both state-led dirigisme in the 1960s-70s and market-oriented reforms in the 1980s-90s. The search continues, but we now understand that economic growth represents a complex, context-specific process that resists universal prescriptions.

Chapter 4: The Great Convergence: Health and Education Improve Worldwide

While income disparities between countries have widened dramatically over the past two centuries, something remarkable and underappreciated has occurred: a great convergence in health, education, and other quality-of-life indicators. This convergence tells a fundamentally different story about global development than the pessimistic narrative focused solely on economic growth. Consider health outcomes. In 1900, global average life expectancy was around thirty-one years; by 2000, it had more than doubled to sixty-six. This improvement has been nearly universal, affecting even the poorest countries. In 1950, the life expectancy gap between the bottom 20% and top 20% of countries was enormous—people in the healthiest countries lived twice as long as those in the least healthy. By 1999, this gap had shrunk considerably, with the poorest performers achieving two-thirds the life expectancy of the strongest performers. Infant mortality tells a similar story. In the late nineteenth century, about one in five infants died before their first birthday worldwide. By 2002, this had fallen to one in twenty—a 75% reduction. Even more remarkably, the worst-performing country in 2000 (Sierra Leone) had an infant mortality rate similar to the average for Europe a century earlier. Meanwhile, forty-six countries achieved rates below 1%—ten times better than the global leaders in 1900. Africa, despite economic challenges and the devastating impact of HIV/AIDS, has shared in this health progress. Life expectancy in sub-Saharan Africa increased by thirteen years since 1960—a greater absolute increase than in high-income countries. Child survival rates improved from 75% to 88%, representing millions fewer tragedies for African families. Even in desperately poor Niger, about eight hundred children now survive each week who would have died at 1960 mortality rates. Education shows equally impressive convergence. In 1870, primary school enrollment was already 50-75% in advanced Western nations but just 2% in India and barely measurable in most of Africa. By 2002, global enrollment had reached 87%, with nearly half the world's countries achieving universal primary education. Adult literacy increased from one-quarter of the global population in 1870 to four-fifths by 2000. The gap between leaders and laggards narrowed dramatically—the bottom fifth of countries increased their average schooling nineteen times over the century, moving from one-fortieth to one-quarter of leader countries' education levels. Political and civil rights have also spread globally, though unevenly. The Polity database, which measures democratic governance on a scale from -10 to +10, shows remarkable progress. In 1820, the global average score was -6.7, with 37% of countries scoring the worst possible -10. By 2000, the average had risen to +2.9, with only 1% scoring -10, while 21% achieved the perfect score of +10. Even violence has declined in recent decades, with battle deaths in interstate wars falling from over 65,000 annually in the 1950s to fewer than 2,000 in the current decade. These improvements have occurred not just in economically successful countries but across the board—even in nations with stagnant or declining incomes. Haiti, for example, saw its income fall from $1,051 to $752 between 1950 and 2002, yet infant mortality more than halved and adult literacy increased from 11% to 50%. This pattern appears across multiple measures and regions, suggesting that quality of life can improve substantially even without economic growth. While significant challenges remain, including slowing progress in some areas, the overall picture reflects a profound and historically unprecedented improvement in human wellbeing worldwide.

Chapter 5: Prosperity Beyond Income: The Cheapening of Quality of Life

One of this century's most remarkable yet underappreciated developments is how the cost of achieving a decent quality of life has plummeted. Countries today can provide their citizens with good health, education, and security at much lower income levels than was possible in the past—a phenomenon that helps explain how quality of life has improved even in economically stagnant regions. Vietnam offers a striking illustration. With a 2003 GDP per capita of just $2,147—placing it firmly in the low-income category—Vietnam achieved an average life expectancy of nearly seventy years, infant mortality of about 2%, and literacy above 90%. These figures are dramatically better than those of the United Kingdom when it had similar income in the early 1800s, when life expectancy was forty-one years and literacy just 69%. In fact, Vietnam's child mortality rate was one-quarter of what the wealthiest British experienced in the early nineteenth century. Similar patterns appear across the developing world. Nigeria in 1995 had approximately the same GDP per capita as Finland in 1870 ($1,100), yet Nigeria's life expectancy of fifty-one years exceeded any European country's in 1870—including the UK, which had three times Nigeria's income level. This is particularly impressive given Africa's tropical climate, which fosters higher communicable disease rates than Europe's temperate environment. Samuel Preston of the University of Pennsylvania first documented this phenomenon in the 1970s, noting that life expectancy at any given income level rose rapidly over time. His research showed that a country with $1,000 per capita income in 1900 typically had infant mortality of twenty per hundred births; by 2000, countries with the same income had infant mortality of just seven per hundred. This suggests that a nation experiencing no economic growth whatsoever over the twentieth century would still have seen a two-thirds decline in infant mortality. The pattern extends beyond health. Primary school enrollment shows virtually no relationship with income at levels above $1,000 per capita in recent decades. Countries as poor as Togo, Malawi, and Bangladesh have achieved near-universal enrollment levels despite minimal economic growth. Similarly, measures of civil and political rights show a weakening relationship with income over time. A GDP per capita of $1,000 was associated with highly autocratic governance (Polity score -2.2) in 1900, but near-neutral governance (score -0.1) by 2000. This "cheapening" of quality of life explains why improvements have continued even in places experiencing economic setbacks. A study of twelve countries where income per capita was lower in 2005 than in 1960 found that life expectancy still increased by an average of ten years, literacy nearly doubled, and political rights improved in most cases. Bill Easterly's comprehensive study of sixty-nine quality-of-life indicators found that income growth showed a statistically significant positive relationship with only eight of them—and a strong relationship with just three (calorie intake, protein intake, and fixed-line telephones). What explains this remarkable decoupling? The spread of affordable technologies and knowledge has been crucial. Vaccines, antibiotics, oral rehydration therapy, hand-washing practices, and basic sanitation approaches have dramatically reduced the cost of saving lives. The smallpox eradication program cost approximately 32 cents per person in infected countries—about the same as producing five Hollywood blockbusters or one-tenth the cost of Boston's "Big Dig" road project. Similarly, education has become more affordable and accessible, with ideas about its importance spreading globally. This cheapening of quality of life has profound implications. It means that even without achieving rich-country income levels, developing nations can provide their citizens with decent, dignified lives. It also suggests that sustainability is more achievable—high quality of life needn't require the resource-intensive consumption patterns of wealthy countries. The good life, it turns out, is increasingly within reach at modest income levels.

Chapter 6: The Diffusion of Ideas: How Knowledge Transformed Societies

The dramatic global improvements in health, education, and rights cannot be explained by income growth alone. Instead, they reflect the powerful role of ideas and technologies spreading across borders—often irrespective of wealth. This diffusion process has transformed societies worldwide, including those with stagnant economies. The remarkable similarities in quality-of-life improvements across different countries provide compelling evidence for this diffusion model. Six-sevenths of the average change in infant mortality across sixty-eight countries between 1950 and 2000 can be attributed to global patterns rather than country-specific factors. Similarly, about 90% of the variation in primary school enrollment rates follows a common s-shaped curve of transition, where countries move from very low to near-universal enrollment in predictable stages. This pattern holds regardless of economic performance or even many policy differences. Ideas about health have spread with particular impact. The germ theory of disease, which overturned earlier "miasma" theories in the nineteenth century, gradually transformed sanitation practices worldwide. John Snow's groundbreaking work on cholera transmission in 1850s London eventually led to improved water systems, and knowledge of disease prevention continued spreading globally. Even in places where expensive sewage systems remain unavailable, simple practices like hand-washing, oral rehydration therapy, and bed net use have dramatically reduced mortality. The most effective health interventions proved remarkably affordable. A study by the Bellagio Child Survival Study Group concluded that fully one-third of the 10 million annual child deaths in developing countries could be prevented through just three interventions: oral rehydration therapy (sugar and salt in water), breast feeding, and insecticide-treated bed nets. Between 1974 and 2000, global immunization rates for six major diseases increased from 5% to 80% of newborns, preventing millions of deaths annually. The spread of knowledge, rather than merely the provision of services, often drives these improvements. In Ghana, individuals who understand that sanitation-related illness comes from germs rather than heat, smell, or dirt are more likely to adopt preventive practices. A study across forty-five developing countries found that parental knowledge about treating childhood illnesses was the strongest predictor of child survival—more important than disease prevalence or even household income. Educated mothers in particular are more likely to use health services and adopt life-saving practices. Education has followed a similar pattern of idea diffusion. While school construction matters, demand for education has proven more crucial in explaining enrollment patterns. Studies suggest that building schools closer to rural households increases enrollment by only about 3 percentage points. Instead, changing parental and community attitudes about the value of education, especially for girls, has been the primary driver of educational expansion. Cultural and social factors shape this demand—in some communities, educating girls is seen as making them less attractive marriage prospects or even morally dangerous. Democratic ideas have likewise spread through global diffusion. Support for statements like "democracy may have its problems, but it's better than any other form of government" reaches 80-90% in surveys across diverse regions. The concepts of civil and political rights, once limited to a few societies, have become ubiquitous in legal frameworks and popular discourse worldwide. When democratic transitions occur in one country, they often inspire similar movements in neighboring states—as seen in Eastern Europe's post-communist transitions or Asia's "people power" movements. This diffusion process has been accelerated by urbanization and expanded communications. Television ownership has spread rapidly—reaching 60% of households within seven years of electrification in rural Indonesia, where average incomes were around $2 daily. Studies show television exposure significantly influences social attitudes, with cable TV access in rural India associated with improved female autonomy, higher girls' school enrollment, and lower fertility rates. Similarly, Brazil's popular soap operas, featuring women with small families, coincided with declining birth rates in areas receiving the broadcasts. These patterns suggest that while income remains important, the spread of ideas and technologies has been the primary driver of global quality-of-life improvements. As ideas about health practices, education value, and human rights continue diffusing worldwide, we can expect further progress—even in places where economic growth remains elusive.

Chapter 7: Policy Lessons: National Approaches to Sustaining Progress

Given our understanding of development as more than just economic growth, how should governments and international organizations approach the challenge of improving quality of life? This question demands nuanced answers that reflect both the remarkable progress already achieved and the significant challenges that remain. First, economic growth remains important—particularly for the poorest countries—but should not come at the expense of other quality-of-life dimensions. The evidence suggests a "Do no harm" principle should guide economic policymaking. Reforms that sacrifice education, health services, or civil liberties in pursuit of hypothetical future growth rarely deliver sustainable improvements. This is especially true given our limited understanding of reliable growth recipes. As we've seen, cross-country studies have failed to identify universal policy prescriptions that consistently deliver economic expansion. Instead, focusing directly on quality-of-life improvements offers more reliable returns. Governments should prioritize affordable, high-impact interventions in health and education, which can be sustained even without significant economic growth. For example, a basic package of primary health services typically costs between $3-6 per person annually in developing countries—less than 1% of GDP even in very poor nations. The challenge is often not finding additional resources but directing existing funds effectively. In Chad, the health ministry budget amounts to $6.50 per person annually—sufficient for basic care if distributed properly—but only 20% reaches front-line health centers, with just 6 cents per person spent on essential supplies. Creating demand for quality-of-life improvements has proven particularly effective. Just as private companies use marketing to sell products, governments and civil society organizations can promote life-enhancing behaviors. Social marketing campaigns have successfully increased the use of oral rehydration therapy, promoted breast feeding over formula, and encouraged hand washing. In Egypt, such programs increased the percentage of mothers correctly using oral rehydration solution from 25% to 60% within a year. Community-led approaches to sanitation in Bangladesh have eliminated open defecation in thousands of villages without subsidies, dramatically reducing diarrhea. Conditional cash transfers represent another powerful demand-side tool. Mexico's PROGRESA program, which provides cash to mothers when their children attend school and health clinics, increased girls' secondary enrollment by 15% and boys' by 7%. Children in participating families were 40% less likely to be reported ill and grew taller than non-participants. Similar programs have succeeded in Bangladesh, Colombia, Pakistan, Nicaragua, Kenya, Honduras, Brazil, and Cambodia. These payments can be particularly effective when they help establish new social norms that persist after the payments end. Improving service quality requires attention to accountability mechanisms. Citizen report cards, which survey users about government services, have proven effective in many contexts. In Uganda, implementing primary health care report cards led to higher utilization and lower child mortality despite unchanged funding. Bangalore's Citizen Report Card increased overall satisfaction with public services from 9% to 34% over five years. School management decentralization combined with standardized testing has improved educational outcomes in several countries by increasing parental involvement and oversight. Protecting civil and political rights requires both removing legal impediments to freedom and strengthening institutional safeguards. In many countries, excessive regulations create opportunities for corruption and abuse. Land regulations that make most urban housing technically illegal, for example, give officials power to extract bribes from residents under threat of eviction. Reforming such regulations and strengthening civil society oversight of police and courts can reduce rights violations. Finally, governments should recognize the interconnected nature of quality-of-life improvements. Better health increases educational attendance, education provides better access to health information, democracy reduces conflict risk, and so on. This "virtuous cycle" means that progress in one area often spills over into others, creating momentum for broader development. While change won't happen overnight—cultural and institutional factors limit the speed of progress—historical evidence suggests that sustained, incremental improvements can produce remarkable results over time. By focusing on affordable, proven approaches to enhancing quality of life rather than chasing elusive economic silver bullets, governments can build on the significant progress already achieved worldwide.

Summary

The surprising journey of global development reveals a profound paradox: while income gaps between rich and poor nations have widened dramatically over the past two centuries, nearly every other measure of human wellbeing has shown remarkable convergence. Life expectancy, education, civil rights, and access to basic services have improved almost everywhere—often with similar trajectories regardless of economic performance. This pattern contradicts the pessimistic narrative that focuses solely on GDP growth and African "failure." Instead, it reveals development as a multidimensional process driven largely by the spread of affordable technologies and powerful ideas. This fuller understanding of development carries important implications for our approach to global challenges. Rather than obsessing over economic growth formulas that have proven elusive and context-dependent, we should focus more attention on the proven mechanisms that improve quality of life directly: affordable health interventions, education access, civil society strengthening, and information diffusion. The remarkable cheapening of basic wellbeing means that even modestly resourced countries can achieve substantial improvements in their citizens' lives. By supporting both the creation of new life-enhancing technologies and the spread of knowledge about their use, we can accelerate the virtuous cycles of development that have already transformed so many lives. The world faces significant challenges in sustainability, inequality, and conflict, but the historical record of progress gives us good reason for realistic optimism—and a stronger moral case for action to extend that progress to those still left behind.

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Charles Kenny

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