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We will be polling questions only from the q a to be answered in the later part of the program. We are recording tonight event so look for video or audio versions on our social channels later on. And importantly, tonight featured book, a good time to be born, is available for sale from greenlight bookstore. We are excited build offer actual shopping our bookstore locations noon to 7 p. M. Every day of the week, and you can purchase this book and many others onsite, or order online at greenlight bookstore. Com for a quick pick up at the store or for shipping anywhere in the u. S. If you care about supporting the careers of authors and the ongoing assistance of independent bookstores, tonight featured book is a great way to show your support. And now to introduce to nights speakers. Our interview tonight is andrew solomon. He is a writer and lecturer on politics, culture and psycholog psychology. A professor of Clinical Psychology at Columbia University Medical Center and the former president of pen america. Most recently he made an audio series called new family values, and awardwinning film. His books received National Book critics circle award for nonfiction, along with 25 other national and international awards. He is also the author of and National Book award winner and Pulitzer Prize finalist. The irony tower and a novel. An activist and lgbtq writes, mental health, education and the arts, and who is a founder Solomon Research Fellowship and lgbtq studies at yale universities and serves on the board of the national Lgbtq Task Force Come University of michigan and metropolitan museum of arts come in your Public Library and many others. Andrew would be speaking with our featured author, perri klass. She is a a professor of journam and pediatrics at new york university, codirector of nyu florence and National Medical director of reach out and read. She writes a weekly column the checkup for the new york times. Her new book, a good time to be born, is about the fight against Child Mortality transform ferreting come doctrine and the way we live. In weaving her own experiences as a medical student and doctor, she pays tribute to groundbreaking women doctors like rebecca, mary putnam and josephine baker, and to the nurses Public Health advocates and scientists who brought new approaches and ideas about sanitation and vaccination to families. She is going to start off with a reading from the book and then shell be talking with andrew and with all of you. Perri, please take it away. Thank you. Our grandparents and great grandparents and all the parents before throughout history expected that children would die. Die. It was a known and predictable risk that went along with being a parent. Now we expect children not to die. We are the luckiest bears in history, we who are part of this wave coming over the past 75 yr so, because we are the first parent ever who have been able to enter into parenthood in the hopeful expectation of seeing all our children survive and thrive. And we are also the luckiest children in history, or into an era when we could expect to grow up, along with all our sisters and brothers. Driving down Child Mortality in the late 19th and early 20th century was in no way a single project, but it can be seen as a unified human accomplishment, maybe even our greatest human accomplishment, at least for pediatricians and parents. The entire world house we learned with some shock and great sorrow how vulnerable our precious human bodies are to the microorganisms that find ways to take advantage of how we live, what we eat, how we travel. Parents have taken some comfort in knowing that, for the most part, children have been less severely affected by covid19, but all through Human History, babies and children have been a particularly vulnerable group, and parents have lived the fear of contagion, infection, and death. Children used to die regularly and unsurprisingly. Babies died at birth or soon after because they were premature or just week, because they were born with congenital anomalies, because i got infections, older infants and oneyearold died this summer diarrhea often caused by microbes in the water or in the cows milk they had started drinking after they been weaned. Three year old and for your old guy dip scarlet fever and diphtheria and pneumonia and measles, of Skin Infections that turned into sepsis or influenza that turned into pneumonia. As recently as the late 19th and early 20th centuries, almost every family in every ethnic group and every country, rich or poor, was touched in some way by the deaths of children. Childhood death was always there in the shadows at the edge of the family landscape, in prayers and religious ceremonies, in the memorial portraits hanging on the wall, and popular sentimental poems and stories and dramas and paintings. Because they figured so consistently in childhood and family life, child deaths also figured in the art and literature and songs and stories of childhood and family life from a century ago, as they had all through Human History. I am a lover of babies and yet i cant seem to have been, wrote mrs. Wds from brooklyn in 1970. I married 11 years last july and would have six children and about to become a mother again which almost fear, i have now that two out of six. Two of them apparently died some years ago, she didnt say how, but then with any year she had two babies and ended up losing both of them. I gave birth to a beautiful fat boy and it lived about three days. The doctor told her that they behead a leaking heart. Three months later she was pregnant again, this son was live to be your own and then she awoke one morning and an event alongside of me. Now pregnant again, she worried constantly both about the terrible long labor is likely to endure and about what would become of the baby. I try to live a good honest life and my home is my habit and babies are my idols. I love them but im afraid something will happen to this one again. She was writing this letter to the United States government come to the Childrens Bureau established in 1912. This new federal office has published a pamphlet a needle care and infant care in 1913 and 1914, immediately and to drink with popular. They were at first distributed free of charge and provided by politicians to their constituents later available for purchase. By 1929 the government estimated these writings had touched parents of half the babies born in the United States. You can think how i feel, she wrote to the author of the pamphlets. I cried night and day for my big fat baby taken from me like that. Mrs. W. D. Is not living in the middle ages or even in the thick point here. She lived in 1917 when my grandmother lived and in your city where my grandmother lived ten years before my own parents were born. At that time in 1970 when mrs. W. D. Rotor letter, nearly a quarter of the children were not a life in the United States, died before the fifth birthdays. Those mothers wrote in the early decades of the 20th century with a certain hope for medical solutions for advice that my protect the next baby, even with a desire to extend that protection to all babies and children to join in the larger project the Childrens Bureau representative i only wish i could take up the work of promoting big welfare, wrote a woman had lost her child in illinois. Some of the letters were from women who struggle with written language and spelling, other semieducated and the privileged. There was no segment of society in which childrens lives were secure, no have there ever been. Though statistical evidence is incomplete, infant and Child Mortality in both europe and america was extremely high through the 17th and early 18th centuries with the third of all children or in some cases even 40 or more dying before the outgrew childhood. In the first decade of the 20th century when my grandmother was going up, out of every 1000 live births in the United States, more than 100 babies did not live to the first birthdays and mortality rates were even higher among the rural poor, immigrants and africanamericans. By comparison the infant mortality rate for the United States in 2017 was 5. 8 deaths per 1000 live births if the majority of these deaths before the first birthday actually occurs in first months of life and most are due either to congenital anomalies, serious birth defects, or to prematurity. A good time to be born tells the story of one of our greatest human achievements, remarkable fusion of science and Public Health and medicine, that transformed our families, i notional landscapes and even our souls. All through Human History many babies died at birth and many children died in infancy and childhood. This was true through the middle ages and the renaissance, two in colonial america and in victorian england and of still true in the early 20th centuries. If you went around any cable pretty much everyone wouldve lost the sibling in childhood, lost a friend to death at a young age or lost a child. Infant and child were told it was a fact for almost every family, rich or poor. John john d. Rockefeller, the rt man in the world, founded the Rockefeller Institute when his grandson died at scarlet fever. So mortality was higher among 19th century disadvantaged populations including enslaved children and urban immigrant poor. I will stop there. Thank you for that lovely reading. Let me begin this conversation by saying this is really quite a remarkable book. It just had a rave review in the times. It was written in an engaging and even enthralling style. It takes a long would takes a long what you just heard is how fluid period is over it in a was not so relatively aspect information likewise details, anecdotes and stories like the story that of mrs. W. D. But many other stories. Those are the people who lost children, ranging across the entire social spectrum and the people who figured out how to save children bit by bit and overtime. Its a very sobering study, and a parent as well i was struck over and over again by what mustve been like to have to perform a more conditional attack on your children. I thought it looked forward to many of the questions helicopter parenting and so on that our current at the moment. I wanted to ask you, what is your sense of how people responded psychologically and emotionally to these losses . Do you think because theyre a Common People were better protected against them or do you think the quality of their despair was a same as the quality of despair in someone who loses a child to sids which write about in the book today . I think the quality of despair was the same but in a strange way they were less isolated. Because it was so, because was discussed, because it was an experience by doing had had. I dont think i think when you read the accounts that parents right, you can see they love their children just as much and in the same ways, you can see the room members you can see the with over and over the question of could i had come if we didnt move to the city, if i hadnt done this, if you hadnt done that. They did all of that but they did sort of encompass. One of the things which struck me is that when i talked to people of lost children in recent years, because of course the world is that it perfectly safe place and tragedies happen, many of those parents talk about how isolate the field, that you cannot bring up casually or not so casually in conversation nowadays, we have three children but only two of them are living. That stops the conversation. Thats not something that can easily be discussed. And i think in the past there were ways because if so, that you could at least acknowledges the child and acknowledge the grief. Talk a little bit in that context about some of the losses where the emotion clearly cut so deep and with the quality of accusation cuts a deeper i taking particularly of Eugene Oneills oneill mother and the story you tell about the death of his will wouldve been his oldest brothe brother. I was actually writing about people and is looking for examples in our literature of measles. Measles was a disease that every single child got before there was a vexing cousin it was incredibly infectious disease, and most, its a fairly miserable disease. Children have high fevers and feel terrible but most of them recover. But in a disease which hits every single child when the relatively rare complications, if the relatively rare complication times all the children in the world so you lose a fair number of children. Even so when i looked for references, but many of them were complicated because its a disease we get expats. Most children recover. Then i was watching a performance of long days journey, a play so strongly autobiographical in which we think of as a play about addiction, the mother is addicted to opiates and the father and the sons drink too much. At the center of the plate is this tragedy of a baby lost. A mother who went away to be on the road with her actor husband and she leaves with her own mother her sixyearold son and her baby. The centuryold gets measles, you know, the older child gets measles and he goes into the room where the baby is and the baby gets measles. The child recovers. The baby died and the mother never forgive yourself for having left their children and she never forgives the son who went into the room and infected his younger brother and she thinks he did on purpose because he was jealous of the baby. That common childhood disease basically comes into this family and devastates the family. Right. And it was all true. Eugene oneills mother, the child or whatever, hes sort of reconciliation baby born later timorleste take the place of the boy who died. Talk a little bit, i think all of us know that there was enormous medical progress and that the development of vaccine has made an extremely different in the lives of children. But the Public Health story is less well known. How was the information that only by getting vaccines but also about other measures that were helpful to children, how was it disseminated and who was the visionaries led that process . I feel a little guilty here im going to be able to Public Health but if you are probably heroic names in sanitation that i probably dont know because im looking at this from the medical side. You start by going back certainly to the 19th century and thinking about the cds building sewer systems and cleaning up the water. Thats tremendously important. But when you get towards when the things happening in the 19th century people are figuring out the importance of microbes. The importance of bacteria and you have has to doing his experience and later developing this technique pasteurization which can make milk safe for all that is tremendously important but just as you say it has to get to the individual household. Parents have to understand the dangers of letting milk spoiled, using water that you dont know whether it is pure. One of the reasons thats important is because especially in somers, especially in cities around the turnofthecentury theres this understanding that in some become something they call call the roof in phantom. Its not really call her. If shes upset stomach, diarrhea. Call. It kills every babies every month in the summer. Theres not a full understanding either on the part of parents or on the part of the medical people where that comes from. Is it feeding babies of all food . Is it the heat . Is it bad smells, poor ventilation . What it is is its the whole range of microbes that cause children get stomach upset and then its the fact babies are so vulnerable to dehydration. Its still true. If youve ever brought a sick baby with a stomach bug and come your pediatrician probably told you the infectious not going to do any harm, its a dehydration. You have to go out and buy dehydration solution, popsicles, keep putting the fluids back in. Yes, absolutely. And then talk about a subject i think hasnt received perhaps to the extent should of what was relationship between the people who develop vaccines and help to control or at least address the many of these problems and early stirrings of the Eugenics Movement and the notion where these children and it was unworthy children who were dyin such large numbers. Thats a good interesting question because right around the beginning of the 19th century, beginning of the 20 century, people start counting dead babies. The truth is if you go back much further than that, early infant mortality, children dont make it out of the delivery room, stillborn babies, are such a common fact of life that nobody even necessarily really counts. At the beginning of the 20 century, 1906, a british a british doctor publishes book called infant mortality a social problem in which he basically says we should not be losing all of these children under a year of age in the united kingdom. Were losing a a regiment a sml beings. But he says some children are just going to be born week and is nothing we can do about that. That is to say, he thinks probably want out of every ten mages lose because they are sort of the unfit. Whats interesting one of the thinks its really interesting about the movement against infant mortality is the people who are trying to bring that infant mortality especially newborn mortality are regularly if if you save all the week babies, whats going to happen . Are not the meant to die . Are the able to live . There are quite a few who say the founder of american pediatrics, dr. Abraham jacobi, was a very weak and sickly baby himself when he was born in germany. He repeatedly references the fact that just because somebody is a weak and sickly baby doesnt predict who that person is going to grow up to be. But there are other people and theres overlap with Eugenics Movement in which you have people explaining very seriously that at the same time as we are saving babies you also have to discourage certain people from marrying or reproducing because, you know, they are very worried about people with epilepsy, for example, some of them. Or whatever people are on the list. It isnt true of everybody whos involved in bringing that into infant mortality but it is question that keeps being addressed. Will we actually weaken our population if we say these babies . On the other hand, its also very clear to everybody that even the people at the top of the social pyramid are losing babies, and losing babies frequently. Talk a little bit about abraham and Mary Todd Lincolns loss of their baby and the very extraordinary way that they responded and the odd using a child at the same time Jefferson Davis did. You have, the lincolns have four sons. They lose one as a child probably to diphtheria, long before they are in the white house. But by the time they get to the white house had two relatively small boys who are the white house children. One of the things which is interesting is the president was interested in white house children. They are always good Human Interest stories so they have two boys in the white house and older boy robert who is already i think in college. The two boys in the white house get sick or kisses during the civil war. They get typhoid and the probably get typhoid because washington is full of soldiers and that i cant and the sanitation assistance of the time are overwhelmed. To be honest they probably get sick because their sewage is in the potomac and their drinking the water in the white house. One of them dies, and dies one of the reasons i like talking about president ial children is because its a shorthand way of saying with the best medical attention that anyone could provide at the time. The child who died in the white house, both of his parents mourned him, but Mary Todd Lincoln has always felt to mourn unquote accessibly. To be unbalanced, inconsolable and often when you say that about a woman in that era, what you mean is that shes not able to accept this come something which is been determined, something which has been sent by god. Although both parents are deeply, deeply affected by losing their son, theres something about the way that she mourns which affects people. She doesnt cherish come she doesnt want to save his little garments. She doesnt want to ever come into the room where he died again. And then eventually of course she has a very tragic life. Her husband is a sassy as he sits next to her and she has four sons, one died as a baby, one dies in the white house. The other little white house boy dies probably of tuberculosis not that long after his father. She buries three of her four children and we parallel what you are talking about is the confederate white house, Jefferson Davis, she also outlives all four of her sons. She got one daughter who outlives her and one who dies as an adult but this almost i dont want to call routinely come but this kind of tragic parental history which even when you are powerful, even when you are privileged, there is this kind of theme of recurring tragedy. He it was also interesting becae of course this is all happening at the time of the civil war when parents all over the country are losing especially sons going into the army. Right. Lets move a little bit forward in a way. We are obviously in the midst of a global pandemic, and infant mortality particularly for adults but also to some measure perhaps for children is confronting us in in a way that hasnt in many generations, in a very shocking and overwhelming fashion. And yet we find ourselves in a country where according to many, a code of the people who are interviewed would not be vaccinated if a vaccine were developed. Tell me about the kind of Politics Around vaccines and how they grew up and how what was viewed as a great miracle of modernity to a larger part of the citizenship. I meant to tell you the truth i dont think he dictations understand this very well. As the group would love vaccines and we believe in vaccines and i think it is in some ways true we havent always collectively done the best job of responding to people who were wary of vaccines because we do love them so and we do believe in them so. One of the things that i was looking at writing this book is actually the way that you forget the diseases that you dont live with. The ways that a disease like diphtheria, which was such a terrifying word, or disease like polio, how quickly they can to slip from our collective memory. And so it helped me understand a little like people are not more frightened of the diseases and, therefore, why they are sometimes susceptible to worrying about the vaccine. Theres certainly a long history of anxiety about vaccines, going back all the way to the no question scientific miracle of smallpox vaccine but people worried about it. People understood that i mean, that seems an incredibly clever thing. They turn on your menu system. I give you a dose of something thats not smallpox but that is close enough to smallpox that it checks your body into defending itself against smallpox, and you end up as if you had had smallpox. I think from the very beginning for some people that was clever. Its interbody amazing . Isnt Science Smart . For some people translates it s you are giving me an infection, right, putting something into my body. I think the sort of dialogical brilliance of vaccination sometimes also feels frightening because you are turning on this system in your body. I mean, vaccines for children when you look at the diseases that are right about, when to think about diphtheria, would you think about polio come when you think about what that this was that this was around, when you think about whooping cough, i mean, theres no question that the terrorists that parents terrors, that my grandmother was not the longago. My parents grew up in new york city and the were polio epidems every summer. They grew up with that form of social distancing in which parents were trying to keep the children away from other children because there was a terrifying virus after that could cripple you or kill you. I think its hard to remember that when you have not lived with it. I think its very hard to remember it. One of the things that is so come distinguishes this book is its really vivid portrait of the people who helped her i feel the our conversation so far is really been about dying children, which is kind of a downbeat topic, generally acknowledged to be, and the book is in many ways really about the life of children and allies that made the survival of children possible. I went to switch to a somewhat more upbeat piece of the conversation and if i was up asking you to give a little description of life and activities of the woman i know think of as your josephine baker, not to be confused with the entertainer, who did such extraordinary things and to look really quite astonishing masculine in the folder you provide to tell us about who she was and what she did at about what was involved really for one of her era in becoming a doctor and wishes able to accomplish in part because of being a woman and a doctor. I have to say i found myself identifying or a lease aspiring to identify with some of these remarkable women and with their stories your josephine baker, she wrote a wonderful autobiography in 1939 called fighting for life, and you just hear her voice so clearly as she sort of the scribes shes trained as a doctor. She was from a very good uppermiddleclass family from just be. She didnt plan to have a career but these things happen. Her family lost all its money. She had a little sister. She needed a job and she which one of the womens ethical colleges and she went out and practiced medicine. She was clearly a very determined, very confident, vy smart as she fell in love with the idea of the celt and she started working for the City Department of health, and she was going to Houston Houston interested working in the schools. She became interested in the question of preventing diseases. Because you couldnt treat them. When the children got diarrhea come with the children got get through there really wasnt anything you could do, and i was looking for an example of the way that she wrote about it. She said that she realize that the way to deal with people being sick was to keep them well, was to prevent them from getting illnesses, and if you could teach parents, coming back to what we were talking about before, how to provide clean milk, how to keep the milk safe, how to boil water, how to breastfeed babies, that you could keep the children from geg sick. She wrote about doing xp and one summer and proving she said he did not necessarily kill babies. She was one of the first people to help get nurses into Public Schools because they were in a strange situation on the Lower East Side were children were sent home if it any kind of infection, including Skin Infections or headlights or any of the very, very common things in the classrooms are empty had lice they sent them home and she writes about how strange it was and all these immigrant families and you got one City Departments in the Children Home because they cut infection and then you have the truant officers come here and yelling au pairs that children are not in school. So youve got one City Departments and if the Children Home and another City Department coming around to blame the parents because the children are home. The answer she said was to put nurses in the schools to deal with infections, to help the parents learn how to handle it. One of the things she wrote about mothers was she said it wasnt that they were how the winter babies died, they cried like mothers. Images horribly fatalistic about it what was going on. Babies always died in summer and there was no point in trying to do anything about it. Depressed me so. And then when she actually found ways to send nurses, going to sound home side help people prepare, then people are thrilled, excited, the messages go on. The message go around and babies lived. The babies live in the summer and even start doing better in some of the poor neighborhoods and then the tenements and in some of the wealthy families. This is before antibiotics. This is before most vaccines, hygiene education, what we would now call empowering parents. Its nurses going house to house and weighing babies and encouraging parents. Its milk stations where pure milk is made available to families, one of the owners of macys, his cause, his milk stations and milk stations become fairly clinic where the children can be examined. Its sort of this very handson Public Health you can take care of your baby and keep your baby safe, which was back before antibiotics, which goes back before most vaccines. And do you think that the message of empowerment that ultimately caused the change to come about, i mean, its interesting to look at sources you have that go back a long way that are advocating for breastfeeding, for example. You have a poem from 18th century maybe the early 1960 us all about the importance of breastfeeding. A lot of attention to what women right but as you say theres also a great deal of fatalism. In a way its that fatalism that most ineffably has disappeared from our contemporary experience of parenthood as we more and more believe not only that our children will survive but that our children deserve to survive and that we deserve to have surviving children. What has that shift been like, and how aside from just what she achieved . One of the reason i wrote this book was by the time i i trained in pediatrics in the 1980s, so when i talk about my grandmother on talking to about having her children in the 1920s. So about a little more than half a century later by the 1980s when im training in pediatrics there no such thing as predictable, routine quoteunquote acceptable to death for children and infants. Pretty much every death represents either a failure, we havent made the world safe enough, sudden if a death syndrome is taken out about sleep position and other risk factors. We either we havent made the world safe enough, car seats, better protection for children in cars. We need to prevent accidents, or if some medical conundrum we havent solved yet. They are going down one after another and thats largely true come to congenital anomalies, the cardiac anomalies, the genetic diseases. So yes sometimes you come across one of the ones which hasnt been solved yet but theres no come medically theres no sense of fatalism. Medically theres like okay, this is one of the winds that we still have to solve. What that translates to parents and this is a great and glorious thing, is a certain promise. I talk about a promise of safety and that you go into parenthood nowadays and parenthood is, you know, its always terrifying. There are never any guarantees. Its always, youre putting your heart on the line in so many ways. But there is a sort of underlying assumption that unless one of the terrible tragedies happens, your child is going to live to grow. I do think that what that does to parents is it does place a tremendous responsibility on them as parents. That is to say, if i say to you arent you lucky if you make the right decisions and you take the right precautions, starting with taking the baby home from the hospital in a car seat and putting that baby down may be in the safest possible sleep position, if you do all of these things right, you can keep your baby safe but that certain emphasis on the you. Theres a certain emphasis on the fact that at every moment you are doing the right thing. I would say to you that i dont think my grandmother lay awake nights worrying she had perhaps made the wrong decision. I think that she knew the world was a dangerous place and she probably tried to cast the right spell and she certainly did whatever the doctor said but i think she knew on some very profound level that the was no guarantee of safe. I mentioned john d. Rockefeller, first billionaire in history, partly because that might be what my grandmother would it said. Even if you are john d. Rockefeller himself, right . Theres not any real safe. One of the things that does to us nowadays as parents, and it also as pediatricians, its not that we would trade it for the uncertainty or the danger, but we do feel responsible and we do feel anxious. One of the things i wondered about as a pediatrician is why are we as as we are as parents when by any objective standards theres enough food, you know, i could give you a long list of all the things that you dont have to be anxious about and then at the end of the long list i could say to you, so are you anxious . You would still be just as anxious, or more. Right. Well, let me move on now to some of the questions that have been coming in from participants in this conversation and let me say we had some very good questions but if anyone else has a question that is a q a function as mentioned at the beginning. Feel free to type in a question and we will attempt to get to them all. In connection with something you directly to address in the book, although this book seems to be about contagious diseases and the certificate decrease from infections, the death of children that continues today is from gun violence. Gun violence has been identified as a Public Health problem, not just a Public Safety matter. In some communities it is not a good time to be born with many families dealing with the loss of one or more children from gun violence. What is upper classes think about how to elevate this issue . Side to try to talk about that and i think that the issue of gun violence but also the issue of other kinds of trauma, of the kinds of death, those simple pd issues in the 20th century, now on into the 21st. In fact, i believe and i think most pediatricians believe that the way to think about gun violence is, in fact, to think of it as a Public Health problem, is to think of it as a problem that needs a research on what other risk factors, what are the most effective strategies to protect children. As the person asking the question probably knows, that was research that was blocked funding for the research was blocked by the gun lobby and something which could not be studied and which is now being studied better. The question of how you abate the risk, how you actually, when you think about trying to abate the kind of risk as when you think about trying to abate the risk of, say, died in car accidents, you can think about technological fixes. Are the things you can build in which protect children . Are there laws you can pass . Is her education you can do . The answer is usually yes, yes, yes and yes. You need to think about in all of those different ways, but the person who asked the question is absolutely right. One of the things you see especially when these Infectious Diseases abate is you start to see what else is hurting children, what else is killing children. Maybe not in the numbers of a smallpox epidemic, but in great numbers, and again, unnecessary tragic death. Yes as they say its in the book and youre right about it movingly and youre right about the importance of taking action here this ties in with these large questions. John d john d. Rockefeller and m lakin but it affects disadvantaged people more. And connect you with what i will go on to this question. The excerpt you read speaks to the profound advances it reduced infant mortality for time. Can you talk about Higher Research addresses the infant mortality rate in the u. S. Versus other wealthy countries, and how and why women of color are at her to get a risk in the u. S. Of both death in childbirth and infant mortality . Absolutely. So let me sort of try to take those let me try to take those both but kind of in order. So first of all i cited the risk of infant mortality rate we measure infant mortality as the number of children from every thousand live births who dont make it to the first birthday. Thats again something which we dont weve really been doing since the beginning of the 20th century. Its one of the reasons its hard for us to get compared numbers because people were not necessarily using the same denominator, every thousand live births. People were not counted things in any way, in the same way. So now were trying to get down below 5. 8 out of every thousand live births. 5. 8 5. 8 is a very low number compared to the numbers i was citing earlier, hundred, 200 out of every thousand live births dying. But i. 8 is three times as High Pressure by. 8 is three times as high as countries with the lowest infant mortality rate. Countries like singapore, finland and japan and iceland, they are closer down to two deaths per thousand live births. So the United States does not by any means lead the world in this way and, in fact, has repeatedly pointed out that our numbers are not the best, in people, we are also you may have noticed a country without a National Health system and the kind of preventive and universal primary care that is probably most to the point in trying to make sure that all women get infant care not only during the pregnancy but also before. Second part, and the question which i come back to again and again in the book, is this issue of the disparities. The fact that the infant mortality rate is twice as high in africanamerican children in this country as white children, and the Maternal Mortality rate is also much higher and africanamerican women. Now, the thing that is interesting and tragic about that is that the mortality rate among africanamerican children has actually come down very dramatically over the same period of time since the beginning of the 19th century. It was astronomically high at the end of the 19th century. And so theres been a tremendous amount of victory in terms of lives saved, hundreds and thousands of lives saved. But even as it is come down and the graph would look like a dramatic improvement, the disparities have remained. So that when youre losing 100 extra for every 1000, it comes down, now youre only losing five extra but you still have the disparities and it does not reflect poverty because certainly the Maternal Mortality rate among africanamerican women is higher even in women who educated, have good access to medical care. And theres a lot of thought and conversation and research right now about what goes into those disparities and why they are so persistent. But they are a tremendous subject of concern and tremendous subject of research, as they should be. I have one other question from the audience, from martha. She says, you think adults would take commonsense covid precautions like mask wearing more seriously if the spy was for more dangerous for Young Children . Dashed if this virus was more dangerous for Young Children . The ways we responded to covid and how much they are tied to the myth that it doesnt affect children at all or even the Accurate Information that it doesnt seem to affect children as severely. The obvious pediatric lesson that children are more vulnerable to respiratory old diseases because they have tiny airways justice are more vulnerable to diarrhea and dehydration because they have smaller blood volume and more surface area in relation to their body, that is truth. Influenza has often been really hard on babies and Young Children, how different would this pandemic looked to us is it was more dangerous to our children, i dont know, is it easier to imagine people being vigilant, furious sound public, is there worries that youre coming too close and going to hurt my child . I dont know. I think it is possible that we would be more vigilant and that vigilance would be policed more strictly if we thought it was a question of keeping children safe but i dont know. It feels like something which parents are already frightened for their children and worried for their children but not sure how to calculate the risk giving this is a virus that has been more harder on the old. I think thats a powerful statement with the situation, it feels particular urgent coming out of time when what seems to me into for many other people such a bizarre divide between the people whod believe in taking safety precautions because the deadly pandemic is ravishing the world and the people who argue that those precautions are merely a political move and have nothing to do with the illness that too many is not so severe and not so dangerous, given the death rate from covid, in some ways it is parallel that you write about and you talk about but the approach to it, with people persistent and i think often somehow people might end up in these countries and the circumstances that are not subject to the nature and inversion of that, hiv write about sars and ebola and the other illnesses that are propped up in our lifetime in the hiv was mostly affecting ebola and the general population but i didnt feel highly motivated necessarily to address those in the earlier days. What we close were coming to the end with the stories that you told me earlier about the early days of hiv because i think its a good object lesson for all of us to bear in mind in these days of covid which of the days were living in the days in which i hope many people will be reading your book. Thinking, i hope they will because it is a book about using science and Public Health but also fellowship to see the invisible micros in which bring tragic its not necessarily a Simple Campaign or a simple process but its a book about science and Public Health and advocacy in working with nurses and doctors and scientists to make lives better. The story that hes talking about is when i started Harvard Medical School in 1982 we heard in infamous truth which was we were told that Infectious Diseases were over that our job, our generation of doctors would solve the product diseases of civilized living, heart disease, the diseases of living long and eating well and over civilized world because the infections had essentially been defeated and that was in 1982 when hiv was not yet identified, not yet understood but it would be the disease in which shaped the medical education during our years and actually i remembered some of the extreme before people understood how that disease was transmitted or what it was, the extreme and rush to judgment, it is too dangerous for this child to be in the school, the stuff when you look back on it makes no sense at all what came out of the fear and anxiety but what i was remembering is the arrogance of our idea that we had outsmarted the invisible world of viruses and bacteria around us which of course we dont but we have to keep thinking and keep working on the science and the Public Health. Right, there have been some other questions coming in from our audience but i believe people are going to need to go, why dont we very quickly do one and then will call a close, they said what fraction and the life expected to gain in the last century has been due to improvements in infant mortality . I cant give you a single number but i think most of the Life Expectancy improvements that you are seeing in the first half of the 20th century comes from the decrease in infant mortality because you have such a dramatic decrease in infant mortality, one of the reasons, i know this is a little geeky but one of the reasons its hard to figure out is before the 20th century, you dont have the denominator of a thousand lives, you get people counting numbers like this of all the deaths in new york city are infants, that is shameful, we have to bring down the percentage, what that really reflects is how many adults are dying, how many are dying this and how many are dying there, the answer is that an overwhelmingly dramatic part is increasing Life Expectancy in at least the first half of the 20th century is from bringing down the infant mortality because it is not so much what you are doing for the adults, the babies are dying so the average is getting better. The average or getting bett better, lets turn the floor over to chelsea from green light to wrap up, once again i would emphasize im sure there are others that have questions that we will be able to send them on as you wish to do, thank you so much and sharing your book with everyone. Thank you andrew, thank you so much. Thank you for tonights vital conversation, and thank you everyone who came out and made a conversation tonight, a reminder if you dont already have your hands on the book that you can buy good times be born at greenlight goods enter bookstore if youre from brooklyn you can stop by the store any day of the week, noon 7 00 p. M. Or you can shop online at greenlight bookstore. Com, you can find the links directly to the book by page in the chat and you can arrange a Curbside Pickup or if the book shipped to you or anywhere within the u. S. I also a reminder if you missed tonights event or want to indulge in i rewatch or share with friends and family who missed out, tonights event has been recorded and will be on our Youtube Channel at the bookstore in the next couple of days. Thank you so much again, have a wonderful rest of your evening. The u. S. Senate is not in session due to the veterans day holiday but senators will meet tomorrow morning at 11 eastern to continue judicial confirmation they will be considered President Trumps District Court nominee for the Southern District of florida the senate has confirmed 222 federal judges under President Trump so far and nominee eileen cannon of florida would be the first woman to join that during the trump administration, watch live coverage on cspan2. Weeknights this month were featuring book tv programs as a preview of whats available every weekend on cspan2, this marks the 20th anniversary of book tv monthly Author Program in depth in tonight highlights from past shows including our interviews with david macola, shelby, toni morrison, tom wolf, cornell west and many others, that begins at eight eastern, enjoy book tv, this week and every weekend on cspan2. Book tv on cspan2 has top nonfiction books and authors every weekend, saturday at 1 00 p. M. Eastern from the recent virtual southern festival of books, Thomas Burton and Wayne Winkler reflect on life in appalachia and david discuss the jim crow era and the south. And at 7 45 p. M. New yorker staff writer discusses his book joe biden the life, the run and what matters now on sunday at 1 00 p. M. Eastern from the southern festival of books journalist matthew talks about deep full of justice about a civil rights case which reaffirmed the right to a trial by jury in most criminal cases. And author Stephanie Gordon offer their thoughts on Investigative Journalism in the more on democracy. At 9 00 p. M. Eastern on after words law Professor John fabian talks about his book american contagions, epidemics in the law from smallpox to covid19 he is interviewed by joy entrance georgetown law professor, watch book tv this weekend on cspan2. Welcome to the History Center virtual author talk featuring Isabel Wilkerson with john meacham to discuss her new book the origins of our discontent. And Vice President of programs and Community Engagement i am honored to be hosting this important co