Glaude, jr. Good evening and welcome to knights live online author event with greenlight bookstore. I am chelsea from green light and we are thrilled to host to knights event with perri klass presenting her new book a good time to be born how science and Public Health gave children a future. She will be talking with andrew solomon, so youre in for an excellent time. Before we start i just want to say a huge thanks to barry, andrew, and the team at norton for making this happen, and to all of you for showing up. So were not able to events in our store spaces, our community, authors and readers is still here. We are grateful for your support and for the chance to make the space for conversation and connection. Now just a couple of housekeeping things. In our zoom webinar tonight you can see and hear the speakers but they cannot see or hear you. They can see you are here though and you can see an account of your fellow attendees at the top of your zune screen. Theres a couple of functions we will be using throughout the event you can find at the bottom of your zoom window. One is an icon labeled chat with one speech bubble. Youre welcome to post your comments and thoughts in the chat. Thats a great way to show your appreciation for the author and to interact with your fellow attendees. If you have a specific question you would like to have answered it by the author, please post that in the q a module. You can find by clicking on the icon labeled q a that looks like two speech bubbles. We will be polling questions only from the q a to be answered in the later part of the program. We are recording to knights event so for video or audio versions on her social channel later on. And importantly, to knights featured book, a good time to be born, is available for sale from greenlight bookstore. Were excited to offer actual shopping at our bookstore location noon to 7 p. M. Every day of the week, and you can purchase this book and many others onsite or order online at greenlightbookstore. 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 in the ongoing existence of independent bookstores, to knights signed featured book is a great way to show support for our interview tonight is andrew solomon. He is a writer and lecturer on politics, culture, and 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, an awardwinning film far from the tree. His books received National Book critics circle award for nonfiction as well as 25 other national and international awards. He is also the author of far and away, the National Book award winner and Pulitzer Prize finalist. The ironing tower and a novel, an activist and lgbtq to Rights Community health, education in the arts, andrew is a a foundef the solvent Research Fellowship in lgbtq status until universe answers on the board of the national Lgbtq Task Force university of michigan depression center, metropolitan museum of arts, the New York Public Library and many others. Andrew will be speaking with our featured author perri klass. She is a professor of journalism and pediatrics at new york university, codirector of nyu florence, National Medical director of reach out and read. She writes the check up for the new york times. Our new book, a good time to be born, is about the fight against Child Mortality the transformed parenting, doctrine and the way we live. Into leaving her own experience is as a medical student and doctor, she pays tribute to groundbreaking women doctors like rebecca crumpler, mary putnam and josephine baker, after the nurses, of the killed advocates and scientists who brought new approaches and scientific ideas about sanitation and vaccination to families. She is going to start us 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. It was an unpredictable risk that went along with being a parent. Now we expect children not to die. We are the like his parents in history. We who are part of this wave over the past 75 years or so, because we are the first parents ever been able to enter into parenthood in hopeful expectation of seeing all our children survive and thrive. And were also the luckiest children in history, born into an era when we expect you to gp along with all our sisters and brothers. Driving down Child Mortality in the late 19th and early 20s century was in no way a single project that he can be seen as a unified human accomplishment, maybe even our greatest human accomplishment, at least for pediatricians and parents. The entire world has we learned with some shock and great sorrow how vulnerable are precious human bodies are to the microorganisms that find hue city defense of how we live, what we eat, how we travel. Parents have taken some comfort in knowing for the most part children have been less severely affected by covid19 but all through Human History babies and children have been a particularly fundable group and parents have lived with 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 weak, because he were born with congenital anomalies, because he got infections. Older infants and oneyearold died of summer diarrhea often caused by microbes in the water or in the cows milk they had started drinking after they had been weaned. Threeyearolds and fouryearolds and five and six and seven and eightyearold died of scarlet fever in diphtheria and pneumonia and measles, a skin infection that turned into sepsis or influenza that turned into pneumonia. As recent as the late 19th and early 20th centuries, almost every family in every ethnic group in every country, rich or poor, was touched in some way by the death of children. Child of death was always there in the shadows at the edge of the family landscape, and prayers and religious ceremonies, and the memorial portraits hanging on the wall, a popular sentimental poems and stories and dramas and paintings because they figured so consistently and childhood and family life. Child death also figured in the art and literature of songs and stories of child 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. W. D. From brooklyn in 1917. I am married 11 years last july and would have six children and were about to become mother again which are almost here i have now with two letter 161. 9 years and one of security. Two died several years ago. She didnt say how. But within a year she had two babies ended up losing both them. I gave birth to a Beautiful Boy and lived but three days. The doctor told her the baby had a leaking heart. Three months later she was pregnant again and the sunlit to be your old and she awoke one morning and found him dead alongside of me. Now pregnant again she werent constantly both about the terrible long labor shows likely to endure and about what would become of the baby. I try and live a good honest life and my home is my heaven and babies are my idol. I love them but im afraid something will happen to this one again. She was writing this letter to the United States government, to the childrens here established in 1912. This new federal Office Published pamphlets prenatal care and infant care in 1913 and 1914. It was popular. First distributed free of charge and provided by politicians to their constituents later available for purchase. By 1929 the government estimated the writings attached pairs of half the babies born in the United States. You can think how i feel, mrs. W. D. Wrote to the author of the pamphlet. I cried night and day because my big fat baby taken from me like that. Mrs. W. D. Was not living in the middle ages or even in the Victorian Era pictures living in 1917, when my grandmother lived at the new york city where my grandmother lived ten years before my own parents were born. At that time in 1917 when mrs. W. D. Broker letter, nearly a quarter of the children were not a life in the United States died before the fifth birthday. Those mothers wrote in the early decades of the 20th century with a certain hope from medical solutions comfort vice that my protect the next baby, even with the desire to extend the protection to all babies and children to join in the larger project the Childrens Bureau and its patents represented. I wish i could take up the work of promoting baby welfare wrote the woman had lost her child in illinois. Some of the letters were from women who struggled with written language and spelling others educated and privilege. There was no segment of society in which childrens lives were secure nor has there ever been. Though the statistical evidence is incomplete, infant mortality both american europe was extreme high with a third of all children were in some cases even 40 or more dying for the outcome of childhood. In the first decade of the 20th century when my grandmother was growing up, out of every 1000 live births in the United States more than 100 babies did not live to the first birthday and mortality rates were even higher among the rural poor, immigrants and africans americans. By comparison to the mortality rate for the United States in 2017 was 5. 8 deaths per thousand live births, the majority with the first birthday actually occurred in the first months of life and most are due either to congenital anomalies come serious birth defects or two prematurity. A good time to be born tells the story of one of our greatest human achievements, remarkable fusion of science and Public Health of medicine, that transform our families, our emotional landscape and even our souls. All through Human History many babies died at birth and many children died in infancy and childhood. This was true to the middle ages and the renaissance, true in Middle America and in between england and is still true in the early 20th century. Infant and Child Mortality was a fact of life for almost every family, rich or poor. John d rockefeller, the richest man in the world that is a Rockefeller Institute when his grandson died of scarlet fever. The mortality was higher among 19 century disadvantaged population including enslaved children and urban immigrant poor. I will stop there. Thank you for that lovely reading. Let me begin this conversation by saying that this is really quite a remarkable book. It has a rave review in the times. It was written in an engaging and even enthralling style. It takes a long with what you just heard how fluid and you bring together the amounts of relative abstract information. Likewise it details anecdotes and stories like the story that of mrs. W. D. , but many other stories. Those of the people who lost children, ranging across the entireocial spectrum, and the peop who figured out how to save childrenit by bit and overtime. Its a very sobering studyand a parent as will as a parent as well i was struck over and over what mustve been like to have two befor the more conditional attack mode. I thought it looke forward to many of the questions helicopr parenting and so on that our current at the moment. I wanted to ask you, harry, what is your sense of how people reonded psychologically and emotionall to these losses . Do you think bause they were, people were better protected against them or do you think the quality ofheir despair was the same as the quality of despair in someoneoses a child, for example, to sids which you write about in the book today . I think the quality of despair was the sam but in a strange way they were less isolated. Because it was so common because it was discussed because it was an experience everyone had had, i dont think i think we do read the accounts that parents write you can see they love the children just as much in the same way street you can see they remembered then pick you can see the evil over and over the question of, could i have, if we had moved to the city, if i hadnt done this, if you hadnt done that. They did all of that but they did it sort of in company. One of the things which struck me is that when i talked to people who have lost children in recent years because of course the world is not a perfectly safe place and tragedies happen, many of those parents talk about how isolated they feel, that you cannot bring up casually or not so casually in coersation nowadays, we have three children but only two of the are living. That stops the conversation. Thats not something that is easily discu. In the past thereere ways because it was so common that you could at least acknowledge the child and acknowledge the grief. Talk a little bit in that context about some o the losses where the emotion clearly cuts a deep and with that part accusation cuts so deep. Im thinking particularly of Eugene Oneills mother and the story you tell about the death of what would eventually his older brother. Ou know, i was actually writing about measles and i was looking for examples in art and literature of measles. Measles w was a disease that evy single child got before the was a vaccine because it was an incribly infectious disease, and is a fairly miserable disease. Children have high fevers, they feel terrible but most of them recover. But it is a disease which hits every single child when there are relatively rare complications, its a relatively rare cplication times all the children in the world. So you lose a fair number of children. Even so, when i looked for asles references, many of them, younow, a disease we get big spots, and most children recover. And then i was watching the performance of long days journey Eugene Oneills play which is so strongly autobiographical which we think of a play abo addiction. The mother is addicted to opiates and the father and the sons drink too much. At the center of the play is this tragedy of the by lost to measles. Aother who went away to be on the road with her actor husband, and she leaves with her own mother her sixyearold son and r baby. The sixyearold gets measles or, the older child gets measles and he goes into the room with the baby and the baby gets measles. The child recovers. The baby died and the mother never forget the self or having left the children, and she never forgives the sun to win into the ro and infected his younger brother, she thinks he did it 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. It was Eugene Oneills mother was, the child would, he is the sort of reconciliation baby born later to more or less 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 extraordinary difference in the lives of children. But the Public Health story is less well known. How was the information that only about getting vaccines but also of the measures that were helpful to children, how was it disseminated and who were the visionaries who really let that process . Ieel a little guilty. Im going to be able to do Public Health that i feel there 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 certnly to the 19th century inking about building come sewer systems and cleaning up their water. Thatsremendously important. But then when you get one of the things happening in the 19th century is people are figuring out the importance of microbes, the importance of bacteria. You have experiment and later developing this technique pasteurization which can make milk safe, all that is to important, but just as you say, it has to get to the individual household. Parents have to understand the dangers of letting milk spoil, using water that you dont know whether it is pure. One of the reason that is important, that have something called cholera in hand with. Call the road that diarrhea. It killed thousands of babies every month in the summer. Theres not a full understanding either on the part of parents were on the part of the medical people where that comes from. Is it feeding babies the wrong food . Is it the heat . It bad spells . Is a poor ventilation . What it is is it a whole range of microbes that causes children to get stomach upset andhen its the fact that babies are so vulnerable to dehydration. Its still true. If you ever brought a sick baby with a stomach bug in, your pediatrician probably told you the infection is not going to do any harm, its the dehydration. You have to go out anduy rehydration solution, you have to buy popsicles,eep putting the fluids back in. Yes, absolutely. And then talk about a subject i think hasnt received perhaps to the extent i should have, what was the rationship between the people who develop vaccines and help t control or at least address some of the problems, d the early stirring of Eugenics Movement and the notion that somehow were the children lived and it was unworthy children who were dying in such large numbers. So thats a really interestg question, because righ around the beginning of the 19 century beginning of the 20th century, people start counting dead babies. The truth is if you go back much further than that, early infant mortality, children who dont make it out of the delivery room, stillborn babies, babies who dont breathe, are such a common fact life the nobody even necessarily really counts. At the beginning of the 20th century, 1906, six, a british doctor publishes a book called infant mortality, a social problem, in which he basically says we should not be losinall of these children under a year of age in the united kingdom. Were losing a regiment of small beings. But he says, some children are just going to be born weak and theres nothing we can do about that. That is to say, he thinks that probably one out of every ten may just lose because theyre sort of the unfit. Whats interesting, one of the things that was interesting about the movement against infant mortality is that the people who are trying to bring wn infant mortality especially newborn mortality are regularly being asked, if y save all of the weak babies, whats going to happen . Arent they meant to die . Are they really able to live . Theres 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 your saving babies, you also have to discoura certain people from marrying or reproducing because they are very worried about people with epilepsy, for example, some of them. Or whatever people on the list. And it isnt true of everybody who is involved in bringing down infantortality but its a question which keeps being addressed. Will we actually weaken our population if we save these babies . On the other hand, its also very cle 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 simultaneity of their losing a child at the same time as Jefferson Davis did. So you have, the lincolns have four sons. They lose one as a child, probably to diphtheria long before there was a white house. By the time they get to the white house they had to back relatively small boys were in the white house children. One of the things which is interesting is the press the source interest in white house children. They are always good Human Interest stories so that tonight voice in the white house and an older boy robert was already i think in college. The two boys in the white house get sick. This is during the civil war. They get typhoid and it probably get typhoid because washington is full of soldiers and their camps and the Sanitation Systems of the time are overwhelmed and to be honest they probably get sick because theres sewage is in the potomac and they are drinking the water in the white house. One of them dies and dies and one of the reasons i like talking about residential children is because its a shorthand way of saying with the best medical attention that anyone could provide at the time. So the child who died in the white house, both of his parents mourn him, but Mary Todd Lincoln is always felt to mourn unquote excessively, to be unbalanced, inconsolable, and often when you say that about a woman in that era, what you mean is that she is not able to accept this, something which has been determined, something which has been sent by god. And 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 his relics, she doesnt want to save his little garments. And eventually of course, she has a very tragic life. Her husband is assassinated because he sits next to her and then she has four sons, one died as a baby, one died in the white house. The other little white house boy died probably of tuberculosis not that long after his father. So she buries three of the four children, and the parallel youre talking about is that the confederate white house, Jefferson Davis, she also outlives all four of her sons. Shes got one daughter who outlives her and one who dies as the development this almost, i dont want to call it routinely 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. It was also interesting because 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. Lets move a little bit for word in a way. We are obviously in the midst of a global pandemic, and the sense of mortality particularly for adults but also to some measure perhaps for children is confronting us in a way it hasnt in many generations, in a very shocking and overwhelming fashion. And yet we find ourselves in a country where according to many people a quarter of the people who are interviewed would not be vaccinated if a vaccine were developed. Tell me about the Politics Around vaccine and how they grew up, and how what was viewed as the great miracle of modernity to a large part of the citizenship. I make to tell you the truth, i dont think you traditions understand this very well. We as a group love vaccines and we believe in vaccines, and its in someays true we havent always collectively de the best job of responding to people who are weary of vaccines because we do love them so and we do belie in them so. I think one of the things i was looking at writing this book is actually the way that you forget the diseases that you dont live with, the ways that the disease like diphtheria, which was such a terrifying word, or a disease like polio, how quickly they kind of slip from our collective memory. It helped me understand a little why people are not more frightened of the diseases and, therefore, why they are sometimes susceptible t 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 i mean, vaccines are this incredibly clever thing. They turn on your immun system. I give you a dose of something thats not smallpox but that is close enough to smallpox that it tricks your by into defend itself against smallpox. You end up as if you h had smallpox here from the very beginning for some people that was clever. Isnt your body amazing . Isnt site smart . And for some people it translates as you are getting an infection, right . You were putting something into my body. The sort of biological brilliance of vaccination sometimes also feels frightening because you were turning on this system in your body. Vaccines for children when you look at the diseases that i am writing about, and you think about diphtheria, when you think about polio, when to think about what this was when fitness was around, when youhink about what being called, theres no question that the terrorists that parents, that my grandmother livedith not that long ago. My parents grew up in new york city and there were polio epidemics every summer. They grew up with that form of social distancing in which parents were trying to keep their children away from other children because there was a terrifyingirus after that could cripple y or kill you. Its hard to remember that when you havent lived with. I think its very hard to remember it. One of the things that is, distinguish this book is its really vivid portrait of the people who helped. I feel as though our conversation has been about dying children, which is kind of a downbeat topic, chairman of knowledge to be, and the book is in many ways really about the lives of children and the lives that made the survival of children possible. I want to switch to a somewhat more upbeat piece of the conversation and i would start by asking by giving a little description of the life and activities of the woman i know think of as your josephi baker, not to be confused with the entertainer, who did such extraordinary things and who looked really quite astonishingly masculine in the photos you provide. Tell us about who she was and what you did and about what was involved really for a woman of her era in becoming a doctor and what shes able to accomplish in part because of being a woman as a dtor. I have to say, i found myself identifying or at least aspiring to identify with some of these remarkable women and with their stories. Josephine baker wrote a wonderful autobiography in 1939 called fighting for life, and you just hear her voice s clearly as she sort of desibes what life was like. She trained as a doctor. She was from a very good uppermiddleclass family. She didnt plan to have a career but these things happen. Her father died. She nded a job and she went to one of the womens medical colleges and she went out practice medicine. Sheas clearly a very determined, very determine but very smart but a but a certaint shes a lovely idea of Public Health. She started working for the City Department of health and she was going house to house purchase interest in working in the schools. She became interested in the question of preventing diseases. Because you couldnt treat when the children got diarrhea,hen the children got diphtheria. There really wasnt anythingou could do, and i was looking for an example of the way that she wrote about it. She said that she realized 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 do breastfeed babies, that you could keep the children from getting sick. She wrote about doing an experiment one summer in proving she said he did notecessarily kill babies. She was one of the first people heat. Help get nurse into the Public Schools because they were in a strange situation on the Lower East Side were children were sent home if at any kind of infection including Skin Infections or head lice or any of the very, very common things in the classroom for empty because you sent doctors in, they inspected the children sent themome. She writes about how strange it was your all these immigrant families and you have one City Department sending the Children Home because have infections and then you have the true offices coming around and yelling at the parents that the children are not in school. So you have one City Departments and the Children Home and another City Department turned around to blame the parents because the children are at home. The answer, she said, was to put nurses in the schools to deal with the infections to help parents on how to handle it. One of the things that she wrote about mothers was she sai it wasnt that they were callous when the babies died, they cried like mothers. A which is horribly fatalistic about it while it was going on. Babies always died in the summer and is no point in trying to do anything about it. It depressed me so. And then when she actually found ways to send nurses going into the homes try and help people prepare, then people are thrilled, excited, the messages go on. The messages go aund and babies live, the babies live n the summer. Ey even start doing better in some of the poor neighborhoods and in the tenements and in some of the wealthy families. This is before antibiotics. This is before most vaccines. Its hygiene, its education, what we would now call empowering parents. Its nurses going house to house and weighing babies and encouraging parents. It is milk stations where your milk is made avaable to families, one of the oers of macys, his cause is milk stations and milk stations become fairly clinics where the children can be examined. Its sort of this very hands on Public Health, you can takeare of your baby and keep her baby safe, which is back before antibiotics, which goe back before most vaccines. Do y think if the message of empowerment that ultimately caused the change to come about, i mn, its interesting think about sources you have go back a long way that are advocating fr breastfeeding, for exale. Maybe the early 19th century its all about thehe importancef breastfeeding there was a lot of attention to what women wer to bring up children but also a great deal of fatalism and in a way its that fatalism that was significantly disappear from our contemporary experience of parenthood a we more and more believed not only that our children will survive but that our children deserve to survive and thate do deserve to have survivg children. What h that shift been like and how, aside from just to think it was achieved . One of the reasons i wrote this book was by the time i trained in pediatrics in the 1980s. So when i am talking about my my grandmother and talk but having her children in the 1920s. About a little more than half a century later by the 1980s when im training pediatrics theres no such thing as predictable routine unquote acceptable deaths for children and infants. Pretty much every death represents either a failure, we havent made the world safe enough, sudden infant death syndrome were just taking out about sleep position and other risk factors. Either we have made the world safe enough. Our seats, we need better protection for children in cars. We need to prevent accidents, or if some medical conundrum we havent solved yet. They are going to one after another and that is largely true, congenital anomalies, the cardiac anomalies, diseases. So yes, sometimes you come across one of the ones which has been solved yet but theres medically theres no sense of fatalism. Okay, this is one of the ones we still have to solve. What that translates to the parents, 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. You are putting your heart on the line in so many ways. But there is a sort of underlying assumption that in the last one of the terrible tragedies happens, your child is going to live to grow up. I do think that what that does to parents is it does place a tremendous responsibility on that 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 the car seat and putting the baby down in the safest possible sleep position, if you do all of these things right, you can keep your baby safe. But theres a certain emphasis on the word you, certain emphasis on the fact that at every moment you are doing the right, safe thing. I would say to you that i dont think my grandmother lay awake nights worrying that 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 she certainly did whatever the doctor said, but i think she knew on some very profound level that there was no guarantee of safe. I mentioned john d. Rockefeller, the first billionaire in history, partly because that might be what my ran by the witness said. Even if you are john d. Rockefeller himself. Right . Theres not any real safety. One of the things that does to us nowadays as parents, need 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 anxious as we are as parents win by any objective standard theres enough food, you know, i could give you an 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, are you anxious . He would still be just as anxious or more. Right. Let meove on now to some of the questions that been coming in from participants i this conversation. Let me say with some very good questions but anyone else was a question that is a q a function as nki at the beginning. Feel freeo type in a question and we will attempt to get to them all. Betty writes, in connection with something to do address inhe book him she says although this book seems to be about contagious deases 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 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 the upper class thinking about how to elevate this issue . I do try to talk about that and i think the issue of gun violence but also the issue of other kinds of trauma of the kinds of death, those have been really important pediatric issues in the 20th 20th centur, and now on into the 21st. 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 copies to think of it as a problem that Needs Research on what other risk factors, what are the most effective strategy 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 come as something which could not be stated and which is now being studied better. The question of how you update e the risk, how you actually, when you think about trying to abate that kind of risk as we to think about trying to abate the risk of, say, dying in a car accident. You can think about technological fixes. Are there 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 all those different ways. 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 the smallpox epidemic, but in great numbers and again needless, unnecessary tragic deaths. Yes as i say its in the bk and write about it movingly and you write about themportance of taking action. The excerpt you read speaks to the profound advances d reduced infant mortality, how this addresses the infant mortalitrate versus other countries and how women of color are of particular risk in the us of death in childbirth and infant mortality . Guest absolutely. Let me try to take those kind of in order. First of all, mortality rate, we measure infant mortality as the number of children who dont make it to their first birthday. That is something we have only been doing since the beginning of the Twentieth Century. The reason is so hard to get comparative numbers because people were not using the same denominator, people were not necessarily counting things in a menacing way but we are trying to get below 5. It out of every thousand live births. 5. 8 is a very low number compared to numbers i was citing earlier, but 5. 8 is three times as high as countries with below that infant mortality rates so countries like singapore, finland and japan, iceland 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 been pointed out that our numbers are not the best and you may have noticed a country with a National Health system, prevented universal primary care that is probably most to the point in trying to make sure all women get care not only during pregnancy but before. Second part, the question i come back to again and again is the issue of the disparity, the fact that infant mortality rate is twice as high in africanamerican children as white children and Maternal Mortality rate is much higher in africanamerican men and women. The thing that is interesting and tragic about that is the mortality rate among africanamerican children has come down very dramatically over the same period of time since the beginning of the nineteenth century. It is astronomically high at the end of the nineteenth century. There has been tremendous victory in terms of lives saved, hundreds of thousands of lives saved. Even as it has come down and it looked like a dramatic improvement, the disparities have remained so when you are losing 100 extra for every thousand it comes down, now you are only losing five extra but you still have the disparities and it does not certainly the mortality rate among africanamerican women is higher even in women who are educated, well to do, have good access to medical care and theres a lot of thought and conversation and research about what goes into those disparities and why they are so persistent but there is a tremendous subject of concern and a tremendous subjective research. Host i have one other question from the audience, martha says do you think adults will take common sense covid19 precautions like mask wearing more seriously if the virus were more dangerous for Young Children . The question of covid19 and childhood is an interesting question, the way people respond to covid19, how much they tried to come of the myth that this doesnt affect children at all or the Accurate Information that it doesnt affect children as severely . Guest i dont know. I think and i think every one who takes care of children thinks about what it would mean if this virus were more severe to children and many respiratory viruses have been, a pediatric lesson the children are more vulnerable because they have tiny airways just as they are more vulnerable to diarrhea and dehydration because they have smaller blood volume and more surface area in relation to their bodies which is immunological truth. Influenza has often been really hard on babies and Young Children. How different with this pandemic look to us if this disease was more dangerous to our children . I dont know. Is it easier to imagine people being vigilant, being careful out in public if you are you are coming to close and will hurt my child . I dont know. I think it is possible that we would be more vigilant and that vigilant 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 children, so worried for their children in so many ways but not absolutely sure how to calculate the risk given that this is virus which has been harder on the hold. Host that is a powful statement of the situationthe book feels particularly urgent coming out of me that seems to me and so many other people such a bizre divide between the people who believe in taking safety precautions because a deadly panmic is ravaging the world and people who argue those precaions are merely a political move and have nothing to do with the illness that is not so severe or so dangerous, given the death rates from covid19, in some ways it parallels the diseases that you write about and talk about, persistence and magical thinking bieve somehow People Like Us in this time in history in this country in these circumstances are not subject the wiles of nature and we saw a version of that with hiv, you wrote about sars and ebola inhe course of our lifetime and the hiv one was mostly affecting gay people in the general population didnt feel highly motivated necessarily what you told me earlier in the early days of hiv, and object lesson for these days of covid19, the days we are living in. I hope many people will be reading more books. Guest i think they will. It is a book about using science and Public Health and fellowship to defeat the invisible microbes, it is not necessarily a Simple Campaign or a simple process but it is a book about the fact that science and Public Health and advocacy, working with nurses and doctors and scientists can make life better. A story that Harvard Medical School in 1982, somewhat infamous truth that we were told Infectious Diseases were over. Our job, our generation of doctors would solve the chronic diseases of civilized living, heart disease, diseases of living long, eating well in a civilized world, the infections that have essentially been defeated and that was in 1982, when hiv was not identified, shaped medical information during our years and i remember some of the extreme, before people understood how that disease was transmitted, extremes of fear, kind of the rush to judgment that it is too dangerous for this child to be in this school which when you look back on it made no sense at all which came out of that fear and anxiety, the arrogance of this idea that we have outsmarted the invisible world of viruses or bacteria is around us which we dont have but we have to keep working on the science and Public Health. Host a couple questions, i believe people are going to go at 7 30. Dana said what fraction in the Life Expectancy gains in t last century is due to improvements in infant mortality. Guest i cant give you a singleumber but most othe Life Expectancy improvement you see in the first half of the Twentieth Century comes from decrease in infant mortality, such a dramatic increase with infant mortality. One of the reasons is before the Twentieth Century as i say you dont have that denominator of 1000 life birds but people counting numbers, this percentage of all the deaths in new york city are infants. That is shameful. We have to bringown the percentage about what that really refles is how many adults are dying, a really overwhelmingly dramatic increase in Life Expectancy in the first half of the twentieth centy is from bringing down the infant mortality, it is not so much the results, because babies arent dying. Host lets hope the average keeps getting better. We turn the floor over to chelsea for a green light to wrap up but once again it is an extraordinary book. You have questions you will be able to send on to perri class as you wish to do. Thank you for taking the time. Guest thank you so much. Thank you for tonights vital, our conversation tonight, a reminder you dont have your hands on the book, greenlight bookstore, you can stop by the store every day of the week noon to 7 00 pm or shop online, greenlight, bookstore. Com. A Curbside Pickup shipped to you, if it were anywhere but the us and a reminder, to indulge in a rewatch, friends and family who missed out, the event has emerged on our youtube, thanks so much and have a wonderful rest of your evening. Weeknight we are featuring booktv programs as a preview of what is available on cspan2. A look at business and economics, the university of virginia business professor in freeman discusses responsibly and ethics that he says unite influential businesses. Financial innovation from 18881930 and its effect on us capitalism. The first and only bank by black women. Looking at how the leaders of the 15thcentury scientific revolution applied new ideas to people, money and markets and as a result, finance at 8 00 pm eastern enjoyed booktv and every weekend on cspan2. Top nonfiction books and doctors every weekend, coming up saturday at 9 00 pm eastern former president barack obama flicked on his life and political career in his newly released memoir a promised land, sunday at 9 00 pm eastern on afterwords, open markets Institute Director Sally Hubbard and her book monopoly sucks, 7 ways big corporations ruin your life and how to take back control. And david mclaughlin. At 10 00 former appellate judge in George Mason University law professor Douglas Ginsburg and his book voices of our republic examines the constitution through the eyes of judges, legal scholars and historians. Watch booktv on cspan2 this weekend and watch in depth live sunday december 6th at noon eastern
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