With perri klass presenting her new book a good time to be born and their talking with Andrew Solomon and before we start i just want to say a huge thanks to parry, andrew and the team at norton for making this happen and to all of you for showing up. We are not able to host this event in our store space in our community as authors and readers is still here and 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 and they can seat you are here though and you can see account of your fellow attendees at the top of your zumba screen. And there are a couple of functions we will be using throughout the event you can find at the bottom of your resume window and one is an icon labeled chat with ones Speech Bubble and youre welcome to post your comments and thoughts in the chat and thats a great way to show your appreciation for the author and interact with your fellow attendees. If you have a specific question you would like to have answered by the author please post that in the q a module and you can find it by clicking on the icon labeled q and eight which looks like two Speech Bubbles. We will be pulling questions only from the q a to be answered in the later part of the program. We are recording tonights event so i look for video or audio versions on our special channels later on and importantly tonights features book a good time to be born is available for sale from Greenlight Bookstore and we are excited to offer actual shopping at our bookstore locations noon until 7 00 p. M. Every day of the week and you can purchase perris book and many others on site or online at relied bookstore. Com for a quick pick up at the store or for shipping anywhere in the u. S. If you care about supporting careers of authors and the ongoing existence of independent bookstores find tonights future book is a great way to show your support. And now to introduce tonight speakers, are interviewer tonight is Andrew Solomon. He is a writer and lecturer on politics, culture and psychology and professor of Clinical Psychology at Columbia University Medical Center and the former president of penn america. Most recently he made an audio series called new family values and awardwinning film called far from the tree. It received a National Book critics circle award for nonfiction and along with 20 international and Non International awards but hes also the author of far and away the National Award winner and Pulitzer Prize finalist. Hes an activist and lgbtq rights education in the arts and andrew is the founder of the Solomon Research Fellowship for lgbt studies at Yale University and serves on the board of the national Lgbtq Task Force university of Michigan Center the metropolitan museum of art the New York Public Library and many others. Andrew will be speaking with our featured author. Klass. She is professor of journalism in pediatrics at new york university, codirector of nyu florence and National Medical director of reach out and read. She writes the weeks collin the checkup for the New York Times and her new book, a good time to be born, is about the fight against Child Mortality that transforms parenting from a doctoring the way we live. She weaves her own experience as a medical student doctor, she pays tribute to groundbreaking women doctors like rebecca crumpler, mary putnam and Josephine Baker. About sanitation and vaccination of families. Pair he will start us off with a reading from the book and then she will be talking with andrew and with all of you. Perri, please take it away. Thank you. Our grandparents and greatgrandparents and all the parents before throughout history expected that children would die. It was a known and protectable risk that went along with being a parent. Now we expect children not to die. We are the luckiest parents in history, we who are part of this wave over the past 75 years or so because we are the first parents 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 born into an era when we can 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 compliment and even though our greatest human account was meant at least four pediatricians. The entire world has relearned with some shock and great sorrow how vulnerable our precious human bodies are with microorganisms that find ways to take advantage of how we live, how we eat, how we travel and parents have taken some comfort in knowing that for the most part parents 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 with the fear of contagion, infection and death. Children used to die regularly and unsurprisingly and babies died to birth or soon after because they were premature or just weak because they were born with congenital anomalies and because they got infections, older infants and one years old died of diarrhea caused by microbes in the water or from the cows milk they started drinking after they had been weaned and three yearolds and four yearolds and five, six, seven, eight yearold died of scarlet fever and diphtheria, and ammonia and measles and Skin Infections are turned into sepsis or influenza that turned into pneumonia and as recently as late 19th and 20 century almost every family in every ethnic group and every country, rich or poor, was touched in some way by the death of children and childhood deaths were always there in the shadows at the edge of the family gates, and prayers and religious ceremonies and in the memorial portrait hanging on the wall and popular sentimental poems and traumas and stories and paintings because they figured so consistently in childhood and family life and child deaths figured in the art of literature and songs and stories of childhood and family life and from a century though as they had all through Human History and i am a lover of babies and i cant to have them wrote missus wd from brooklyn in 1917 and i married 11 years last july and would have six children and im about to become a mother again which i almost fear i am now but two out of 61 boys nine years and one six years. Two of apparently died seven years ago and she did not say how but then within a year she had two babies and thats lost both of them. I gave birth to a beautiful fat boy and it lived for three days the doctor told her the baby had of weak hearts. Two month later she was pregnant again and this son lived to be a year old and then she woke one morning and found him dead along side of me now pregnant again she worries constantly both about the terrible long labor she was going to endure and about what we would become of the baby and i tried to live a good, honest life but my home and babies are my idol and i love them but i am afraid something will happen to this one again. She was writing this letter to United States government into the Childrens Bureau established in 1912 in this new federal law published pamphlets prenatal care to infant care in 1913 and in 1914 and immediately it was popular and at first it was just riveted free of charge and provided by politicians to their constituents and later available for purchase and by 1929 the government estimated these writings had touched half the babies born in the United States and he can think how i feel missus wd wrote of the pamphlets and i cried night and day for my big fat baby taken from eat like that and missus wd was not living in the middle ages but living in the Victorian Era and living in 1917 when my grandmother lived and in new york city where my grandmother lived in ten years before my own parents were born and at that time in 1917 when missus wd wrote her letter nearly a quarter of the children werent alive in the United States and those mothers wrote in the early decades of the 20th century with a certain hope for medical solutions for advice that might protect the next baby, even with a desire to extend that protection to all babies and to all children and to joins in the larger project and what it represented and i wish i could take up the work wrote a woman who lost her child in illinois. Some of the letters were from women struggling with written language and spelling and others educated in the privileged and there was no segment of society where childrens lives were secure nor has there ever been and the statistical evidence had been complete infant and Child Mortality in both europe and america was extremely high through the 17th and early 18th century with a third of all children or in some cases, even 40 or more dying before they outgrew childhood. In the first decade of the 20th century when my grandmother was going up out of every thousand lives in the United States almost one hunter babies do not live to their first birthdays and mortality rates were even higher among the poor, immigrants and african americans. In the event which at a rate for United States in 2017 was 5. 8 deaths per thousand live births and the majority of these deaths before the first birthday occurred in the first month 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 and remarkable fusion of science and Public Health of medicines and that transformed our families, emotional landscape and even our souls. All through Human History many babies died at birth and many children died before seen it childhood and this was true to the middle ages and renaissance and colonial america and victorian england and still true in the early 20th century. If you went around any table pretty much everyone wouldve lost a sibling in childhood or lost a friend to death at a young age or lost a child. Infant and Child Mortality where the facts of life or almost every family, rich or poor. John d rockefellers richest man in the world founded the Rockefeller Institute with his grandson died of scarlet fever and the mortality was higher among 19th century this included children in the urban immigrant poor. Thank you for that. That was a lovely reang. Let me begin thi conversation by sayg that its quite a Remarkable Book and it does have a rave review in the tes and its wrien in an engaging and even enthralling the style and it ticks along what you just heard is how fent pair he is bringing together enormous amounts of relatively abstract informatn but likewise it details, anecdotes and stories like the story that missus wd but many other stories in both of the peoe who lost children, ranging across the entire social spectrum and theeople who figured out how to save children bit by bit and over time. Its a very sobering study as a parent mht well, i was very struck over and over again by what it mustve been like to have to form a more conditional attachment to your children and i thought it looked forward to many of the questions helicopter parenting and so on that are current at the moment but i wanted to ask you. , what is your sen of how people rponded psychologically and emotionally to these lses . To think that because they were comm people were better protected ainst them or do you think the quality of their despair was t same as equality of despair and someone who loses a child, f example, to sids which you 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 common and because it was an experience everyone had had, i dont think or i think that when you read the accounts that parents write you can see they loved the children just as much and in the same ways you can see they were remembered and you can even see they went over and over at the question of good i have, if we hadnt moved to the city, if i hadnt done this, if i hadnt done that and they did all of that but they did it for the company and one of the things that struck me is that when i talk to people who have lost children in recent years because of course its not a perfectly safe place and tragedies happen many of those parents to talk about how isolated they feel and that is to say you cannot bring up casually or not so casually in conversation nowadays and we have three children but only two of them are with it and that stops the conversation and that is not something that can easily be discussed and i think there were ways because it was so common that you could at least acknowledge thehild and acknowledged the hurt. Talk a littl bit in that context about somef the where it clearly cuts deep over the quality of accusations have cut soeep and in particularl of [inaudible]s mother and the story you tell about the death of his that would have been his older brother. Yeah, you know, i was writing about and i was looking for examples in art and literature of measles and measles is a disease that every single child got before there was a vaccine because it was an incredibly Infectious Disease and its a fairly miserable disease so if you have high [inaudible] but most recover but in the disease which hits every single child when there are relatively rare convocations is a relatively rare complication times all the children in the world so you lose a fair number of children and even so when i looked for peoples records in art and literature many were common and this disease were you get [inaudible] but in most children recover and then i was watching a performance of a long days journey into night and its strongly autobiographical and which we think of as a play about addiction and the mother is addicted to opiates and the father and the sons drink too much and at the center of the play is this tragedy of of baby lost to measles and a mother who went away to be on the road with her husband and she leaves with her own mother and her six yearold son and her baby in the six yearold gets measles or you know if the older child gets measles and he is allowed to go into the room were the baby is and the baby gets measles and the child recovers but the baby dies. The mother never forgive herself for having left her children and never forgives the son who went into the room and expected his younger brother and she thanks he did it on purpose because he was jealous of the baby and that is common childhood disease basically comes in to this family and devastates the fami family. Right. And its all true. The mother was the child who would have been butes the reconciliation baby born later to more or less take the place of the other boy who died. Talk a little bit and i think all of us know that there was enormous medical progress and that the development of vaccines has made an extraordinary difference to the lives of children but the Public Health story is less well known. How was the information, not only about getting vaccines but also about other measures that were hopeful to children and how would this disseminated and were the visionaries really lead that process . I feel a little guilty. I feel there are probably heroic things in sanitation that i probably dont know because im looking but would start by going back certainly to the 19th century thinking about the citys building sewer systems and cleaning up their water and that is tremendously important but then when you dash one of the things thats happening in the 19th century where people are figured out the importance of microbes and the importance of bacteria and you have hester doing his experiments and later developing the pasteurization which can make milk safe and all of that is tremendous and important and just as you say it hast to get to the individual households. Parents have to understand the dangers of letting milk spoil or using water you dont know whether it is pure and one of the reasons important is because especially in summers, especially in the cities around the turnofthecentury there is this understanding that in the summer come something they call cholera and fantasy, its not cholera but just upset stomach, diarrhea and it kills thousands of babies every month in the summer and there is 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 or is it the heat or is it, you know, poor ventilation or what it is is its all that whole range of microbes that causes children to get stomachs upsets and then babies are so vulnerable to dehydration and it is still true if youve ever brought a sick baby to a stomach bug and your pediatrician probably told you the infection will not do any harm but if the dehydration and you got to go out and buy rehydration solution and by obstacles and keep putting the fluids back in. Yes, absolutely. Talk about because a subject i think happened received what was the relationship between the people who developed vaccines and help to control or at least address so many of these problems and the early starting of the Eugenics Movement and the notion that where these childrens lived and these unworthy children dying. So, thats a really interesting question because right around the beginning of the 19th century or beginning of the 20th century people start counting dead babies. I think the truth is you go back much further than that early infant mentality, children who dont make it out of the delivery room, stillborn babies, babies who dont are such a common fact of life that nobody necessarily counts and then at the beginning of the 20th century 1906 british doctor publishes a book called infant mentality and the social problem in which he basically says we should not be losing all these children under the year age but were losing a regimen of small but he says some children are just going to be born weaker and theres nothing we can do about that and that is to say he thanks that probably one out of every ten you may just lose because there is the unfit and what is interesting, one of the things thats really interesting about the movement against and in infant mortality is that the people who are trying to bring down infant mortality, especially newborn mortality, are regularly being asked but if you save all the week babies what will happen and arent to be or arent they meant to die or are they really able to live and there are quite a few say these founders of american pediatrics doctor abraham jacoby was a very weak and sickly baby himself when he was born in germany and he repeatedly references the fact that just because somebody is somewhat weakened and sickly baby doesnt predict who that person is going to grow up to be but there are other people and overlap with the Eugenics Movement in which you have people slating very seriously that at the same time as you 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. Or whatever people are on their list. Its simply true of everybody involved in bringing down infant mortality but it is a question which keeps being addressed and will we actually weaken our population if we save these babies. On the other hand is also very clear to everybody that even the common you know, 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 of them losing the same time Jefferson Davis. The lincolns hav four sons and they lose one as a child probably to diphtheria long before the was a white house bu by the time toet to the white hse they had two relatively small boys and one of ththings tts interesting is the press i interested in white house children and they are always good Human Interest stories so they have twooys in the white house an older boy robert who is already in college and the two boys in the white houseet sick and this is during the civil war and they get typhoid a they probably get typhoid because washington is full of soldiers and the systems of the time are overwhelmed and to be honest they probably get sic because there sewage in the potomac and one of them dies and dies and one of them one of the reasons i like talking abo president ial chdren is because its a shorthand way of saying wit the best medical intention that anyone could provide athe time and so the child who dies in the white house, both of his parents warned him but mar todd lincoln is always felto mourn quote unquote excessive and to be unbalalanced, inconsolable as often we say that about a woman in that era what you mean is that shes not able to accept this is something which has been determin, something which has been sent by god and although both parents are deepl deeply affected by losing the son there is something aut the way that she mourns which affects peop and she doesnt cherish and she doesnt want to ever go into the room where he died again and the eventually of course, she has a very tragic life and her husband is assassinated as he sit next to her and she has four sons, one ed as a baby and one diesn white house and thether little white house boy dies probably of tuberculosis andot that long after his father so she is buried three of herour children and the parallels that are talking about is that the confederate white hse Jefferson Davis she also outlives all four of her sons and shes gotne daughter who outlives her and one who dies as an adult but this is almost i dont want to call it routinely but this kind of tragic parental history which even when you are powerful even when you a privileged there is ts kind of theme of recurring tragedy and was also interesting because this is all happening athe time when parents are all over the country are moving especially, sons going into the army. Right. Lets move a little bit forwa anyway and we are obviously in the midst of alobal pandemic and the sense of mortality, particularly [inaudibl but also some measure perhaps for children is confounding us in a way it hnt in many generations in a very shocking and overwhelming passion and yet we find ourselves in a country wher according to many polls, a quarter of the people who are interviewed wou not be vaccinated and give if a vaccine were developed. Tell us about the kd of Politics Around vaccines and how they grew up and what was viewed as the greatiracle of a dharna [inaudible] i meant to tell you i dont think pediatricians understand this very well. As a group we love vaccines and we believe in vaccines and i think in some ways it is true that we havent always collectively done the best job of responding to people who are wearing vaccines because we do love them so we do believe in them so. I think that 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 through. The ways a disease like diphtheria which was such a terrifying word or a disease like polio and how quickly they slipped from our collective memory and so it helped me understand a little white people are more frightened of the diseases and therefore why they are sometimes susceptible to worrying about the vaccine and i mean, there is certainly a long history of anxiety with vaccines going back all the way to the no question scientific miracle of small pox vaccines but people worried about it and people understood that i mean, vaccines are a clever thing and they turn on your immune system. I give you a dose of something that is not smallpox but close enough to smallpox that it tricks your body into defending itself against smallpox and you end up as if you had had smallpox and i think that from the very beginning for some people that was clever and isnt your body amazing and isnt science a smart and for some people it translates as your giving me an infection. You are putting something into my body and i think that the sort of dialogical brilliance of vaccination sometimes also feels frightening because you are turning on the system in your body. I mean, taxis vaccines for children when you look at the diseases are right about what we this diphtheria or think about polio or when you think of what tetanus was when tetanus was around when you think about whooping cough and i mean there is no question that the terrors that my grandmother was not that long ago and i remember my parents grew up in new york city and there were polio epidemics every summer and, you know, they grew up with that form of social distancing in which parents were trying to take their children away from other children because there was a terrifying virus out there that could cripple you or kill you. I think it is hard to remember that when you had to live wh it. I think its very hard to remember it. One of the things that so distinguishes this book is its really vivid portrait of the people who helped and i feel as though our conversation has really been about dying children which is kind of a downbeat topic gerally acknowledged to be i the book is in many ways really about t lives of children in the lives that made the rvival of children possible so i want t switch to a somewhat more upbeat piece of the conversation and i thought it would start by aing you to give little description of the conductivity of the woman i now think of as [inaudible] not to be confused as the entertainer but who is did such extraordinary things a would look so quite astonishingly masculine and the photos you provide but tell u about who she was and what she did an about what was involved for a woman of her era and becoming a doctor and what she was able to accomplish in part because of her being a woman. 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 [inaudible] and you just here in her voice so clearly as she sort of describes what life was like and trained as a doctor and was from a very good uppermiddleclass family from poughkeepsie and she planned to have a career but, you know, these things happen and are fathered died in family lost all the money and she needed a job and she went to one of the womans medical colleges and she went out to Practice Medicine and was clearly a very determined, very smart but at a certain point she fell in love with the idea of Public Health and she started working for the city deferment of health and she was going house to house and working in school and she was or she became interested in the question of preventing diseases. You couldnt treat them when the children got diarrhea or when the children got diphtheria and there really wasnt anything you could do and she, i was looking for a example of the way that she wrote about it and she said that she realized that the way to prevent or deal with people being sick was to keep them well and was to prevent them from getting illnesses and that if you could teach parents coming back to what we were talking about before how to provide clean milk and how to keep the monks safe and how to boil water and how to breastfeed babies that you could keep the children from getting sick and she wrote about that doing an x permit improving she did not necessarily kill babies and she was one of the first people to help get nurses into Public Schools because they were the strange situation on the Lower East Side where children were sent home if they had any infection, including Skin Infections or head lice or any of the very, very common things in classrooms were empty because you sent doctors then and they inspected the children and send them home and she writes about strange it was in these tenements with immigrant families and he got City Department sending the Children Home with infections but then it got the truant officers coming around yelling at the parents that the children are not in school so you got one City Department sending you Children Home in another City Department coming around to blame the parents that the children are home and the answers she said was to put nurses in the schools to deal with the infections and to help the parents learn how to handle it. One of the things that she wrote about mothers was she said it wasnt that they were calloused when their babies died but then they cried like mothers but they were just horribly fatalistic about it while it was going on. Babies always died in summer and there was no point to try to do anything about it and it depressed me so. Then when she actually found ways whether nurses going into the homes and trying to help people then people are thrilled and excited and the messages go on and the messages go round and babies live. The babies live in the summer and they even start doing better in some of the poor neighborhoods then they were doing some of the wealthy families and this is before antibiotics and this is before most vaccines and hygiene and education and what we would now call nurses going house to house and weighing babies and encouraging parents and its look stations where pure is made available to families and one of the owners of macys that was his cause is milk stations and they become early clinics where the children can be examined and you know, its sort of this very handson Public Health you can take care of your baby and keep your baby safe which goes back before antibiotics image goes back before most vaccines. To think that message of empowerment that ultimately called the chains to come about . I mean, its interesting to look at sources that you go back a long way that are advocating for breastfeeding and a note may be the early 19 all about the importance of breastfeeding but there was a lot of attention to what led to good and right and natural ways but as you said there was also a great deal of fatalism and in a way fatal is him that was significantly disappeared from contemporary experience as we more and more believe not only 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 do think it w achieved . One of the reasons i wrote this book was to say by the te i trained in pediatrics inhe 1980s so, you kw, im talking about my grandmother and talking about having her children in the920s. About a little more than half a century later by the 1980s when imraining in pediatrics there were no sh thing as predictablroutines quote unquote acceptable deaths for children and infants. Pretty much every death represents either a failure and we havent made the world safe enough and sudden infant death syndrome which is figurin out about sleep position and other risk factors and either weve not made the world safe enough and we have car seats and need better protections for children in cars we need to prevent the acdents or some medical conundrum we havent solved yet. They are going down one after the other and thats largely true with theongenital anomalies and cardiac anomali and genetic diseases and sometimes that comes across one of thehings that has not been solved yet but medically there is no sense of fatalism and this is one of the ones we still have to solve and i think that what that translates to two parents and is is a great and glorious thing is certain promise and i talk about a promise of safety and that you go into parenthood nowadays and parenthood is, as you know aays terrifying and never erin any guarantees and always putting your heart on the line in some anyways but there is a sort of underlying assumption that unless one of the terrible tragedies happens your child will live to grow up. I do think that what that does to parents is it does place of tremendous responsibilit and that is to say if i say to you arent you lucky ifou make the right decision and take the right ecautions starting with king that baby home from the hospital in a car seat and puttg that baby down into the safest possible sleep posions and if you do all these things you can keep your baby safe but there is certain emphasis on the un a certain emphasis on the ct that every moment you are doing the right safe thing and i would say to you that i dont think my grandmother lay awake nights wrying that she had perhaps made the wrong decision. I think tt she knew the world was a dangerous place and probably tried to cast the right spls and didhatever the ctor said but i think she knew on some very profound level as there was no guarantees and i mentioned John D Rockefeller the first billionaire and history and partly that might b because of what my grandmother said, even if you are john the rockefeller himself, right, theres not any real safety. I thinkne of the things that does to us nowadays as parents and nutritions its not that we would trade it for the uncertainty or the danger but we do feel responsible and we do feelnxious and one of the things i wondered about is why are we as anxious as we are as parents and when, by any objective standard, tre is enough food, 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 are you anxious and you would still be just as anxious or more. Right. Well, let me move on now questions coming in from participants in the conversation and then we have some very good questions but anyone else was a question and theres a q a function and feel free to type in a question and we will tend to get to them all. Betty writes, in connection with something you do address 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 and gun violence has been identified as the Public Health problem not just as a Public Safety matter but in some communities it is not a good time to be bor with many families dealing wit the loss of one or more chiren from gun violence what is our thinking about how to elevate this issue . I do try to talk about that and the issue of gun violence and also the issue of other kinds of trauma and other kinds of death those have been really important pediatric iues in the 20th century and now on into the 21st. In fact, i believe and think that pediatricia believe that the way to think about gun violence is, in fact, to think of it as a Public Health proem and to tnk of it as a problem that Needs Research on what are the risk ftors and what are the most effective strategies to protect cldren and as a person asking the questions probably knows that research was blocked funding for that research was blocked by the gun lobby as something that cannot be studied and which is now being studied betterut the question of how you make the rk and how you actually, can you when you think about trying to make that kind of risk as when you think about trying to bake the risk of say, dying in a car accident and you can think about fixes on the things that you can build and which protect children and are the laws that you could pass in their education you could do and the answer is usually yes, yes, yes. Weve seen it in all those different ways but a perso who has to ask, are they absolutely right, there is one of the things you see one especially these Infectious Diseases abate you have toee what else is hurting chiren and maybe not in the numbers of the smallpox epidemic but in great numbers and again need this, unnessary tragic deaths. Yes, as i say in the book and you write about the importance of taking action it ties in with these large questions with rockefeller and Abraham Lincoln this abandons people more and in connection with the excerpt you read speaks to the profound advances and 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 at particular risk in the risk of death inhildbirth and infant mortality. Absolutely. Let me try to take those both but inrder but first of all i cited the risk of the invert mentality rate and we measure infant mortality as the number of children from every thousands lives who dont make it to the firstirthday. And that is something weve really only been doing andne of the reasons its so hard to get comparative numbers because people were not necessarily using the same denominator and people were not necessarily counting things in anyways but so now we are trying to get down below 5 out of every thousand lives andhose 5. 8 is a very low number compared to the numbers i was fighting earlier with hundred, 200 but 5. 8 is threepoint eight times as high as the countrys lowest infant mortality rate so countries like singapore or finland, japan and iceland they are closer down to o deaths per thousand live births. The United States does not, by any means, lead the world in this way and in fact has strategically been repeatedly pointed o that her numbers are not the best and people, we are all live know the country without a national heah system and the kind of preventive universal primary care that is probably most to the point all women get this care and not only during an second part in the second part that i come back into theook is disparities in the fact that the infant mortality rate iswice as high as africanamerican chiren in this country as white children and the mortality rate is even much higher in africanamerican women. The thing that is interesng and tragic about that is that the mortality rates ang africanamerican children has actual come down very dramatically sends it was astronomally hard a the end of t 19th century and theres been a tremendous amount of victory in terms of lives saved, hundreds and thousands of lives saved and eve as its come down and the gss would look like a dramatic improment for disrities have remained in so that wn we are looping 100 extra for every thousand it comes down and now you are only losing five extra but you still have the disparities in it doesnt reflect poverty because certainly the Maternal Mortality te among africanamerican women is higher even i women who are educated welltodo and have good access to medical care and there is a lot of thought of conversation and research about what goes into those disparities and why they are so persistent but there are aremendous subject of research. I have one other question from the audience do you think adults would take commonsense covert precautions like mask wearing re seriously if this virus was more dangerous or for Young Children. Covidnd childhood is an interesting question in the ways we respond to covid and how much they are tied to the sort of myth that it does effect childr at all or the accurate infoation that doesnt seem to affect children as severely. I dont kno i think everyone who takes care of chiren thanks about what it would mean ifhis virus were more severe in children and as many respiratory viruses have been and lesson that children are more vulnerableo respiratory diseases because they have tiny airways just as they are more vulnerable to diarrhea and dehydration because they have smaller blood volumes and surface area ration to their physiological truths. Influenzaas often been really hard on babies and Young Children and how different would this pandemic look to us is this disease was absolutely more dangerous to our children, i dont know. Is it easier to imagi people being vigilant a being curious out in public if they are worried that you know youre coming too close to me and going to hurt my child i dont know. I think its possible that we woulbe more vigilant and thats vigilance would be the police more strictlyf we thought it was a question of keeping childn safe. But, i dont know. It feels like sometng which parents are already frightened for their children so in so many ways but not absolutely sure how to calculate the risk given that this is a virus which has been more harder on the old. I think thats a powerful statement situation in the book feels particularly urgent coming at a time when there what seems to me and so many other people that a bizarre divide between people who believe in safety precautions because a deadly pandemic is ravaging the world and the people who argue those precautions are merely a political move and have nothing to do with the illness that in any case is not supposed to be or be so dangerous but even the death rates from covid in some ways it parallels the diseases that you write about and talk about being with people persistent and often magic believe that somehow people like in this time in history in these countries and in these circumstances are not subject to the wild nature and we saw a version of that for hiv and sars and ebola and the other illnesses that have cropped up in the parts of our lifetime and the hiv one was mostly affecting ebola and the general population but terribly and not be highly motivated sincerely to address so why do we close in the story you told me earlier about the lecturer at harvard at the early days of hiv and its a good idea to bear in mind because of the days we are living in and t days i hope many people will be reading your boo. Thank you, i hope they will because i think it is a book about using science and Public Health but also will in fellowship to defeat the invisible microbes which bring tragedy and not necessarily a Simple Campaign or a simple process but a book about the fact that science and Public Health and advocacy and parents working with nurses and doctors and can make life better. A story that we have tald about is that when i started medical school in982 we heard a somewhat infamous truth which was we were told were Infectious Diseases were over in our generation of doctors would be solve the chronic diseases of civilized leaving and Heart Disease and the diseases of living long and eating well in over civiliz world because of the infectious had been essentially defeated and that would be in 1982 when hiv was not yet identified and was not yet understood it would be the diseasehich shape the medical education duringur years and i remember their extreme before people understood how that disease would transmit or what it was in the extreme fear prevents the kindf rush to judgment of okay, its too dangerous or thi child to be in the school or you know, stuff whic when you look back on it made no sense at all and came out of that kind of fear and what i w remembering was the arrogance of i idea that we have been outsmarted the invisible world by viruses and bacteria which of course we dt outsmart but we do have to keep thinking about and keep working on the science and the Public Health. There have been a couple other questions and i leave people will need to go at 7 30. Let me read one of them and then we can call it. Dana says, what fraction and the Life Expectancy gains in the last century have been due to improvements to infant mortality . So, i cant give you a single number but i think that most of the Life Expectancy improvement that you see in the first half of the 20th century comes from the decrease in infant mortality because you have such a dramatic increase in infant mortality and one of the reasons and i will get a little geeky but one of the reasons it is hard to figure out is before the 20th century dont have that denominator of a thousand births but instead people are counting numbers like this of all deaths in new york city are infants and that is shameful. We have to bring down the percentage but what reflects is how many adults are dying but i think the answer is that an overwhelmingly dramatic part of the increase in Life Expectancy in at least the first half of the 20th century is bringing down the infant mortality because its not so much what we are doing for the adults but babies arent dying so the average is getting better. Let us hope the average keeps on getting better. I will turn the chelsea floor over to chelsea for her to wrap up but once again i would just emphasize it was an extraordinary book and im sure for others of you hav questions that may be you will be able to send them on to perri as you wish to do. Thank you, perri for taking the ti and sharing your books with everyone. Thank you, andrew. Thank you so much. To 7 p. M. Or you can shop online at greenlight bookste. Com and find the link directly to the book by page in the chat and arrange Curbside Pickup or get the book shipped to you if you are anywhere within the u. S. Also a reminder in case you missed any part o tonights event and want to indulge in a really watch or share with friends and family that missed out, tonights event has been recorded and will be on the yoube channel in the next couple of days. Thank you so much again, everyone and have a wonderful rest of your evening. Now on cspan2 booktv more ce television for serious readers welcome to another biography event. I hop