Good evening and welcome to the live author event. Iam from greenlight and we are thrilled to host tonights event with perri klass and the new book a good time to be born. And before we start i want to say a huge thanks to the team at norton for making this happen. And with the theaters are still here. We are grateful for your support and thank you for your connection. Now just a couple of housekeeping things you can see and hear the speakers but they cannot see or hear you. And those at the bottom of your window. And youre welcome to post your comments in the chat. And then to interact with fellow attendees. Please post that on the module and with the q a. And we are recording tonights event and it will be on the channel later on. And then we encourage you to shop at the actual location new and through 7 00 oclock p. M. And many others onsite. And the green light bookstore. Com or for shipping anywhere in the us. If you care about supporting authors and independent bookstores tonights featured book is a great way to show your support. And now to introduce to your speaker Andrew Solomon is our interviewer a writer and lecture on politics and culture and psychology at Columbia UniversityMedical Center and former president of an america. Most recently an audio series far from the tree would be the National Book credit circle award for nonfiction along with 25 other national and International Awards also the author of a National Book award winner and Pulitzer Prize finalist. And activist education and the arts and the founder of solomon Research Studies at Yale University and serves on the board of the national lgbtq Depression Center and metropolitan the New York Public Library and many others. And speaking with our future on our future author a professor of pediatrics the National Medical director and rates the weeks, and the new york times. And her book a good time to be born is about Child Mortality transforming parenting and the way we live and leading her own experience that pays tribute to other authors and the National Scientist who brought new approaches and scientific ideas about vaccination to families. And perri klass will start us off with a reading from the boo book. Please take it away. Thank you. To grandparents and great grandparents and all the parents before who expect to their children would die. Is a noticeable risk and now we expect children not to die. We are the luckiest parents in history over the past 75 years or so because were the first parents ever to enter into parenthood with those awful expectations to see children survive and thrive. And then expect to go all of her sisters and brothers. Driving down Child Mortality in the 20th century was a single project but it can be seen as unified accomplishment the greatest human accomplishment. The entire world has learned was shock and sorrow how vulnerable the precious human bodies are to the microorganisms take advantage of how we live or eat or travel and to take some comfort to know for the most part to be affected through covid19 but then a particular group with a fear of contagion and death. Children used to dive regularly and unsurprisingly because they were premature or born with a congenital anomaly one died of diarrhea and then started drinking. Three and four yearolds and five and seven and eight yearolds the word dive from fever and Skin Infections or influenza turning into pneumonia. As recently as the early 20th century almost every family with every ethnic group which sure was touched in some way by the death of children childhood death was at the edge of the family landscape impairs in religious ceremonies hanging on the wall because it is so consistently in childhood and family life all in the art and literature as they all have through human history. I want babies but i cannot seem to have them. Married 11 years last july and six children and about to become a mother again now two out of six to the died some years ago within one year she had two babies. I gave birth to a beautiful fat boy that lived for three days. The doctor said he had a leaking heart three months later she was pregnant again and it looked to be one year old and then found him dead. Now pregnant again she worries constantly of the terrible long labor she wouldnt do her and what would become of the baby. I try to live a good honest life and babies of my idols. But im afraid something will happen to this one again. She was ready mr. United States Government to the Childrens Bureau established 1912 to publish the pamphlets prenatal care and infant care in 1914. They were first distributed free of charge and provided by politicians and then available for purchase. By 1929 the government estimated half the babies born of the United States you can think of how i felt. I cried night and day for my big fat baby taken for me like that. She was out living in the middle ages or the Victorian Era but 1917 when my grandmother lived and in new york city where my grandmother lived ten years with my own parents were born. At that time when she wrote this letter nearly one quarter of the children born to live in the United States died before the birthday. And then with a certain hope for a medical solution or advice to protect the next baby even with the desire to extend that to all babies and children to join in the larger Childrens Bureau. I only wish i could take up the work of promoting baby welfare who lost her child in illinois summer from women in those to be educated in the privileged nor had there ever been from a statistical evidence concerning Child Mortality what was extremely high and a third of all children died before the hour grew childhood. My grandmother was growing up and with a live birth in the United States and then mortality rates were even higher. The mortality rate was five. Eight for every 1000 live births actually it occurred with those congenital anomalies and serious defects. And with the greatest human achievement with Public Health to transform our families that emotional landscape that many babies died in birth this is true to the middle ages through colonial america and true in the early 20th century pretty much everyone would have infant and Child Mortality for everyone rich or poor and John D Rockefeller founded the rockefeller institute. Mortality was higher among 19th century including enslaved children. I will stop there. Thank you for that lovely reading. Let me begin the conversation by saying thats a Remarkable Book it is written in and engaging style and what you just heard to bring togetr abstract information. But like why is anecdotes but many other stories those who losthildren and across the entire spectrum and those who tried to save children over time and it is a sobering study and as a parent myself over and over agaithinking what it must of felt like and i lo forward to many of the questions that are current at theoment but what is your consensus how people responded psychologically and emionally . Becaus better one people are better protected . Or someone who loses a child . I think quality was but in a strange way they were less isolated. Because it was discussed. I dont think so i think when you read the accounts they love their children just as much. They remember them and you can see they even went over the question of if we had moved to the city. If i havent done that or you didnt do that it was all of that but one of the things that struck me is when i talk to people who lost children in recent years and tragedies happen many talk about how isolated they to come up so casually we have three children but only two of them are living. That stops the conversation that is not something that can easily be discussed or at least to acknowledge the child and acknowledge the grief. So in that context where it can cut so deep that quality of accusatn and particularly with the mother and the story that you tell of what would have been his older brother. I was actually writing about measles and looking for an example and it is a disease every single child got. Incredibly infectious. It is a fairly miserable diseas disease. They feel terrible that most of them recover but doesnt hit every single child when there are complications for all the children in the world. Even so looking for these references and most children recover but in watching a performance that is strongly autobiographical that what we think of and then to be addicted to opiates and at the center the tragedy of a baby lost to measles and mother who leaves with her own mother and her sexual son and her baby in the sexual gets measles and then goes into the room with the baby and the baby gets measles the child recovers in the baby dies and she never forgives herself for leaving the children and never forgives the son who went into the room and infected the younger brother and things he did on purpose because he was jealous of the baby. That common childhood disease basically comes into this family and devastates the family. He is the reconciliation baby born later more or less to take the place of the one who died. And there was enormous medical progress to make an extraordinary difference in the lives of children. How is that information to helpful to children and he will the visionaries who led that process of dissemination . But then there are probably heroic things that i probably dont know. And those to clean up the water and one of the things that is happening that people are figuring out and all that tremendous importance. And then you have to understand the dangers if you dont know if the water is pure. That in the summer calm something colorado its really just upset stomach and diarrhea but it kills thousands of babies every month in the summer there is not a full understanding and where that comes from. Is at the heat or poor ventilation . The whole range of microbes that causes children with then the babies are so vulnerable to dehydration. If you ever have a baby with a stomach bug the pediatrician told you infection will not do harm its the dehydration. By the solution and keep putting the fluids back in. Absolutely. So what was the relationship between the people who develop vaccines and to help to control these problems and the notion they have were the children who were dying in such large number numbers . Thats a really interesting question because around the beginning of the 19th or the 20h century people start counting dead babies and the truth is early infant mortality is such a common fact of life and then at the beginning of the 20th century to publish a book called infant mortality in which he basically says we should not be losing all of these children and the united kingdom. We are losing a record amount. And then to say one out of every ten may just lose because they are the unfit. That the people that are trying to bring down infant mortality and are regularly being asked about saving the week babies what will happen . Arent today meant to diet . Are they able to live . There are quite of few, the founder of the american pediatrics was a very weak and sickly baby himself when he was born in germany and he repeated the references the fact that just because it doesnt predict who that person will grow up to be but there are other people with the Eugenics Movement in which people are explaining seriously at the same time that you have to discourage certain people from marrying or reproducing because they are very worried about people with epilepsy for example or whatever people are on their list. Everybody who is involved bringing down infant mortality but a question that keeps being addressed. Will we actually weaken our population . On the other hand its also very clear to everybody, even the people at the top of the social pyramid andosing babies frequently. Talk about abraham and mary todd linln and the loss of their baby and that extraordary way they responded the spontaneity of losing a child like jefferson davis. The lincolns had four sons and they lose one as a child. By theime they get to the white house they have two relatively small boys and one of the things that is interesting there are always a good Human Interest story to have two boys in the white house. Robert is already in college. And they get sick during the civil war. They get typhoid probably because washington with the soldiers in the camps inhe sanitation is overwhelmed. And there is sewage in the potomac and a drink the water in the white house. One of them dies. And one of the reasons i like talking about president ial children its a shorthand way to say with the bestedical attention anyone could provide at the time. And then the child who dies in the white house but Mary Todd Lincoln is to war excessively inconsolable and in that era shes not able to accept it for something that has been determined. Although both parents are deeply deeply affected by losing their son, theres something about the way she mourns. She doesnt want to save or ever go into the room where he died again. And then eventlly, she did have a tragic life and her husband is assassinated. She had four sons the third white house boy died probably of tubercusis not that long after his father so she buries three of her four children and the parallelwe were talking about is the Confederate White House with jefferson davis. She also outlived all four of her sons. She got one daughter who outlived her and as an adult. But this tragic history it is a recurring trage. This all happens when parts all over the country are moving, especially sons going into the army. And move forward in a way obviously in the midst oa Global Pandemic and the sense of mortality and was some measure that it hasnt in many generations in a shockg and overwhelming fashion. But yet we find ourselves in a country according to where one quarter of the people interviewed word not be vaccinated if the vaccine were developed. Tell me about the politics and how they grew up. The we this which was such a terrifying word, or a disease like polio and how quickly they ripped from our collective memory and so it helped me understand a little why people are not more frightened of the diseases and therefore why they are sometimes susceptible to worrying about the vaccine. I mean, theres certainly a long history of anxiety going back all the way to the no questionquestion scientific mirf smallpox vaccines, but people worried about it and understood vaccines are this clever thing. They turn on your immune system. I give you a dose of something that isnt smallpox but something close enough that it triggers your body into defending itself against smallpox. For some people that was clever. Isnt Science Smart and for some people it translates as you are giving me an infection. That you are putting something into my body. And i think that is sort of a biological brilliance sometimes also it feels frightening. When you look at the diseases and when you think about polio and what tetanus was when it was around. Theres no question. My parents who grew up in new york city and there were polio epidemics every summer and they grew up with the best form of social distancing and which parents were trying to keep their children away from others because there was a virus out there that could cripple you or kill you. And i think that its hard to remember that if youavent lived with it. I think it is very hd to remember it. One of thehings that is so distinguished in this book is th its a vivid portrait of the people that helped. D i feel that there are convsations so far that have been about cldren, which is kind of a downbeat topic. And the book is in many ways about the lives of children and the lives that made the survival of children possible. Im going to switch to a more upbeat pce of the conversation and i thought i would start by asking you to give a description of the life and activity of the woman i think of now as your josephine baker, not to be confed, who is so extrrdinary and looks masculinand th in the theory thu ovide but tell us about what was involved for a womanf her era in becoming a dtor and what she was able to accomplish in part being a woman is a doctor. I found myself identified at least aspiring to identify with some of these remarkable women and with their stories, josephine wrote a wonderful autobiography called fighting for life and you hear her voice so clearly as she describes she was from a good middleclass family and wanted to have a career but these things happen. She needed a job and went to one of the womens medical colleges and practiced medicine and was a very determined, very confident, but at a certain point she fell in love with the idea of Public Health and started working for the department of health and she was going to house to house and was working in the school. She became interested in the question of preventing diseases, because you couldnt treat the children. There really wasnt anything you could do, and she told me when we were looking for the example of the way she wrote about it. The way to deal with people being sick. And then if you could teach parents coming back to what we were talking about before, how to provide and keep the milk safe and boil water and breastfeed babies, that you could keep the children from getting sick. She wrote about in experiment one the summer proving that he didnt necessarily kill. She was one of the first people to help get nurses into the Public Schools and any of these common things in the classrooms. They were empty because they inspected the children and sent them home. You have won a City Department sending the Children Home because they have an infection, then youve got to the troops coming around and yelling because the children are not in school. So the one City Department sending them home and another department coming around to blame the parents because they are home. So they were dealing with the infections and teaching the parents how to handle it. One of the things that she wrote about mothers is that they were not callous but when they died they were horribly fatalistic about it. Babies will die in the summer and there was no point trying to do anything about it. It depressed me so. When she actually found ways and these are from the nurses and the settlements, going into the homes to help people, then people were thrilled and excited. The messages go on and go around and babies lived. They started doing better in some of the poor neighborhoods than they were doing and some of the wealthy families. This is before antibiotics. This is before most vaccines. Its hygiene education and what we would now call empowering parents and nurses going house to house weighing babies and encouraging parents. One of the owners of macys, his cause was milk stations where the children could be examined. Its this handson Public Health you can take care of your babies and keep them safe, which goes back before antibiotics and before most vaccines. Do you think that message of empowerment ultimately caused the change to come about . Is interesting to look at sources you had to go back a long way advocating for breastfeeding. For a century its all about the importance and there was an amount of attention. But there was also a great deal [inaudible] in a way that fatalism that has disappeared from the contemporary experience as more and more we believe not only that our children will survive, but that our children deserve to survive and so what has that shift been like and how was it achieved . One of the reasons irote this book i trained in pediatrics in the 1980s and so when im talking about my grandmother, im talking about having her children in the 1920s. About a little more than a half a century later by the 1980s, there is no such thing as predictable routine, quote on quote, acceptable death of children or infants. Pretty muchvery death presents either a failure, we havent made the world safe enough to just figuring out about sleep positions and other risk factors, we havent made the world safe enough for car seats, better protection for children in cars. We need to preventhe accidents, or some medical conundrum we havent solved yet. They are going down one after another and that is true with the genetic diseases. Yes sometimes you come across one of the ones that hasnt been solved yet but medically there is no sense of fatalism. Theres a sort of okay this is one of the ones that we still have to solve. And i think what that translates to two parents, and this is a great and glorious thing is a certainromise. I talked about a promise of safety and that you go into parenthood nowadays and we know its always terrifying, theres never any guarantees. You are putting your heart on the line in so many ways. But there is a sort of underlining assumption. I do think what that does to parents his place a tremendous responsibility 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 that baby home from the hospital in a car seat and putting that baby down into the safest possible sleep position. If you do all of these things right you can keep your baby safe, but there is a certain emphasis on y. There is a certain emphasis on the fact that at every moment u are doing the right and the safe thing. I would say to you that i dont think my grandmother lay awake at night worrying she had perhaps made the wrong decision. She knew the world was a dangerous place and she probably tried to cast the right spell and certainly did whatever the doctors said, but i think that she knew on a veryrofound level that there was no guarantee of safety. I mentioned John Rockefeller, the first billionaire. Even if you are John Rockefeller himself, there isnt any real safety. One of the things it does to us nowadays as parents it isnt at we would trade it for the uncertainty or the danger. One of the things why are we as anxious as we are as parents when by any objective standard i could give you a long list of all things you dont have to be anxious about and then at the end of the lisi could say to you are you anxious and you would still be just as anxious or more. Let me move on now to some of the questions that have been coming in from participants in this conversation. Did anybody else that have a question, theres a qanda function as i mentioned at the beginning. We will attempt to get to all of them. Writing in connection with something you do enters in the book she says although this book seems to be about contagious diseases and the significant decrease from infection, 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 health matter. In some communities i is not a good te to be born with many familiesealing with the loss of one or mo children from gun violence wre they thinking about how to elevate this issue . So, i do try to talk about that and the issue of gun violence but also the issue of other kinds of trauma and death. Those have been an important pediatric issues in the 20th century and now on into the 21st. And fact, i believe, and i think most pediatricians believe that the way to think about this is as a problem that Needs Research on what are the risk factors and what are the most effective strategies to protect children. The person asking the question probably knows the research, funding for the research was blocked by the gun lobby and was something that couldnt be studied and is n being studied better. The question of how you abate the risk and absolutely can when you think about trying to abate that kind of risk and when you think about trying to, say of dying in a car accident, you can think about technological fixes. E there things you can build in, which protect children. Are there laws that you can pass and education you can do and the answer is usually yes, yes. You need to think about all of those different ways. But the pern that asked t question is absolutely right. There is, you know, one of the things you see, especially when these Infectious Diseases abate is used or to see what else is hurting children, what else is killing children. Maybe not in the numbers of a smallpox epidemic, b in great numbers, and again needless, unnecessary tragic death. Its in the book and you write about it movingly and about the importance of taking action. It ties in with these large questions of John Rockefeller and abraham lincoln, but in connection with which i will go on to terrys question. The excerpt that you read has it the profound advance in reduced infant mortality over time. Can you talk about how your research addresses the infant mortality rate in the u. S. Versus other wealthy countries, and how and why women of color are in a particular risk in the u. S. Of both death in childbirth and infant mortality . Absolutely. So, let me try to take those let me try to take those both in order. So, first of all, i cited the risk of the infant mortality rate. We measure infant mortality is the numbeasthe number of childrm every thousand live births who dont make it to their first birthday. And that is, again, something which we have only been doing since the beginning of the 20th century. Its one of the reasons it is so hard to get comparative numbers across the centues because people were t necessarily using the same denominator for birth. So, now we are trying to get out of every thousand live births. 5. 8 is a very low number compared to the numbers i was citing earlier. One hundred200. But 5. 8 is three times as high as the countries below. So, countries like singapore, finland and japan and iceland they are clor to two per thousand. So the United States doesnt by any means lead the world in this way. And its repeatedly been pointed out that our numbers are not the best. We are also the country without a National Health system and the kind of preventive universal primary care that is probably most to the point in trying to ma sure all women get this care not only during their pregnancy but also before. And then the second part i come back to again and again in the book is the issue of the disparities and the infant mortality rate is twice as high in africanamerican children in this country. And the Maternal Mortality rate is also much higher in africanamerican women. Now, the thing that is interesting and tragic about that is 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. Its saved hundreds of thousands of lives but even as it has come down and it would look like a dramatic improvement, the disparities would remain. So when you were losing 100 extra for every thousand, it comes down n you are only losingive extra but you still have the disparities. And it doesn reflect poverty because certainly the Maternal Mortality rate among africanamerican women is higher even in those that are educated, welltodo, ve good access to medical care. And theres a l of thought and conversationnd research right now about what goes into those disparities and why they are so persistent. They are a tremendous subject of concern and researchs they should be. I have one other question from the audience. This is from martha who says you think adults wld take commonsense covid precautions like wearing a mask more seriously if this virus were mo dangerous for Young Children . I thinkhe question is covid and a childhood is interesting. The way we ve responded and how much it is tied to the sor of myth that it doesnt affect children at all or even the Accurate Information but it doesnt seem to afct children as severely. I think, and i think that everyone that takes care of children thinks about what it would mean if this virus were more severe in children and as many respiratory viruses have been. As a little obvious pediatric lesson,hildren are more vulnerable to respiratory disease because they have tinier airways and just as they are more vulnerable to diarrhea and dehydration because they have smaller blood volumes and more surface area in relation to their bodies. Influenza has often been really hard on babies and Young Children. How different would this pandemic look to us if it was more dangerous to o children, i dont know is it easier to imagine people being vigilant, being furious out in public if they are worried that you are cong too close to me you are going to hurt my child . I dont know. I think it is possible that we would see more vigilance and that 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 so frightened for their childn, so worried for their children in so many ways, but not absolutely su how to calculate the risks given that this is a virus which has been harder on the old. That is a powerful statement of the situation. The book feels particularly urgent coming at a time when there is what seems to me and so many other people a bizarre divide between the people who believe in taking safety precautions because a deadly pandemic is ravaging the world and the people who argue that those precautions are merely a political move and have nothing to do with the illness. Given the death rates from covid in some ways it parallels the diseases that you write about and talk about, but the approach to it i think often theres a magical thinking believe that somehow people in this time in history in these countries and in these circumstances are not subject to. And we saw a version of that during hiv. You write also about sars and ebola and the other illnesses that have propped up in our lifetime. Its mostly they didnt feel highly motivated necessarily to address it. Since we are coming to a close why dont we go to the story that you told me earlier. I think it is a good object lesson for all of us to bear in mind which are the days that we are living in and i hope many people will be reading your book. It is a book about using science and Public Health and also to defeat the invisible microbes that bring tragedy and i think it isnt necessarily a Simple Campaign or a simple proces but its a booabout the fact that science and publi health and advocacy and paren working with rses and doctors and scientists can make life better. The story that hes talking about is when i staed medical school in 12 we heard a somewhat infamous truth which was we were told basically Infectious Diseases were over, that our job, our generation of doctors to solve the chronic diseases of civilized livin the disease of living long and eating well in an overload of civilized world because the infections that had essentially been defeated and that was 1982 when hiv wasnt yet identified or understood, but it would be the disease which shaped medical education through the years and actually some of the extremes before people understood how thathedisease was transmitted ot it was it is too dangerous for thishild to be in this school. Just the stuff when you look back on it had made no sense at all. But what i was remembering is the arrogance of the idea that we had outsmartedhe invisible world of viruses and bacterias, which of course we have to keep thinking about and keep working on the science as Public Health. There have been a couple of other questions that have come in from the audience. But i believe that people are going to need to go as a 7 30. Why dont we quickly do one of them and then we will close. What a fraction in the Life Expectancy in the last century has been viewed to the improvements in infant mortality . I cant give you a single number, but i think that most of the Life Expectancy improvements that you see in the first half of the 20th century comes from the decrease because you have such a dramatic increase. One of the reasons, and i wont stay on this too long but one of the reasons it is hard to figure out is before the 20th century as i said you do not have that denominator of the thousand live births. Instead what you have is people counting numbers like this percentage of all the deaths in new york city are infants. Thats shameful. We have to bring down the percentage. But what that really reflects is how many adults are dying. How many people are dying of this or that. But i think the answer is a really overwhelmingly dramatic part of increasing Life Expectancy in at least the first half of the 20th centurys from bringing down the infant mortality because it isnt so much what wer we are doing fore adults. Lets hope the average keeps getting better. I will turn the floor over to chelsea from green light to wrap up but once aga i would emphasize it is an extraordinary book and im sureheres others that have questions and they can send them on. Thank you so much for taking the time and sharing your work with everyone. Thank you, andrew,o much. Thank you for tonights vital conversation and thank you, everyone, who came out. A reminder if you do not already have your hands on the book you can buy it at the green light bookstore. If you are in brooklyn you can stop by the store any day of the week from noon to 7 p. M. Or shop online at greenlight bookstores. Com and find the link directly on the chat and arrange a curbside ckupr get the book shipped to you if you a anywhere in the u. S. And also, a reminder in case you missed part of tonights event and want to indulge in a rewatch or share with friends and family that missed out, tonights event has been recorded and will be on the website in the next couple of days. Thanks so much again, everyone. Have a wonderful rest of your evening. On the evolution of scientific thought and how it is applied to modern issues including covid19 and climate change. Good evening. Im the director of programming and marketing at the library. Before we get started, i should mention if you have questions tonight you can leave those in the comments or in the chat box on the youtube page and we will get to as many as we can. If youre interested in purchasing, it is available at most major retailers that we like to point people to the bookshop. Org where your purchase will support independent booksellers at the time they need your support the most. If you are a long time follower of the programming either in person or online, you know that we lean