Proceedings will boost his ratings in the polls police n. Jersey City are still investigating the apparent hate crime that claimed the lives of 3 people at a Jewish grocery store this week the attackers also shot and killed a police officer N.P.R.'s Quil Lawrence has more he says local schools have reopened. School kids were back at the Sacred Heart School next to their stone Catholic Church the children never cease to amaze us they were remarkable Rosemary Siegel has worked here for decades it took us a miniature realize that what was happening was right outside the 2nd grade class window here and the children immediately were told to crawl across the hall which they did in the water the kids waited out the 3 hour gun battle in the church Priory one little child said I was scared but only teachers made me feel safe the church will hang a banner to support the grieving Jewish community the banner will also cover some of the bullet holes in the wall and windows. Lawrence n.p.r. News Jersey City the Commerce Department says retail sales rose in a modest pace last month the government numbers showing holiday shopping off to a slow start with retail sales up by just 2 tenths of a percent where there was some good news October sales were revised upwards on Wall Street stocks ended the week modestly higher the Dow gained 3 points 228135 the Nasdaq was up 17 points today you're listening to n.p.r. . But his businesses have been waiting for a long time for some certainty when it comes to Britain's plan to exit the e.u. Over with u.k. Election results now in favoring Conservative Party had Boris Johnson It seems Bracks it is much more certain that's after multiple delays still not entirely clear how Johnson would steer the British economy be on the scheduled pulled out January 31st actor Danny Aiello has died he passed away after a brief illness N.P.R.'s Neda Ulaby reports Iowa specialized in playing rough edged it's high in American characters and some of the most memorable films of his era in do the right thing from 1909 Danny Aiello played the racist owner of a person pizza joint who rudely rejects a customer's request for pictures of famous black people on the restaurant wall along with the tally in America it's you can put your brothers and uncles and nieces and nephews just that. One scene but this is my history American the time it's on the wall I'm getting Aiello got an Oscar nomination for the role he has who appeared in The Godfather Moonstruck The Purple Rose of Cairo and he played Madonna's father in the music video for Papa Don't Preach Danny Aiello is a 2nd generation New Yorker who brought his city's rhythms the hardest charm to the screen he was 86 years old now n.p.r. News automaker General Motors now says it will invest a 1000000000 and a half dollars in a suburban St Louis plant that makes trucks and vans Missouri governor Mike parson in a statement today saying the automakers vowed to keep $4000.00 jobs in the once felt assembly and stamping plant close to $4300.00 salaried an hourly workers are currently employed at that facility outside St Louis I'm Jack Speer n.p.r. News in Washington support for n.p.r. Comes from n.p.r. Stations other contributors include the n.p.r. Shop where visitors can browse Public Radio nerd and n.p.r. Gear at n.p.r. Shop dot org and the Arcus Foundation dedicated to the idea that people can live in harmony with one another and the natural world. Living on Earth a Hollywood star and her famous and not so famous friends go to jail to fight climate change there's a crisis looming and we only have a decade Jane Fonda with a hit series behind her the least I can do is role model which is. I'm Steve Kerr with Jane Fonda and her fire drill Friday climate protest at the Capitol next time I'm living on Earth from n.p.r. Every Sunday morning at 60. It's the Ted Radio Hour from n.p.r. I'm Guy Raz. And today we're going to start in Liberia 30 years ago and I remember being in the 4th grade and it was in February of that year and being pulled out of school in broccoli This is Raj jobby and Raj grew up in Monrovia there were hundreds of people coming into the city from the rural countryside fleeing war some of them battered others with gunshot wounds seeking care of course at the time Raj didn't exactly know what was going on he was just 9 years old and 3 days later they the rebels captured the only international airport and so at that point there was a panic My father then being Indian citizens had been helping the Indian embassy to evacuate people that's what end up happening is that we my father and my mother made a plan one night that we would we would try to get evacuated and she said pack the things you need for a month and I packed a bunch of action figures. And we were put into a white van and then rushed to the center of town where an airfield had been come in and it was a cargo in 1960 sort of Russian military cargo plane that had been brought in vacuum people as I just remember sitting there sweating and it was hot and looking out the have. Seeing right in front of us there were hundreds of others people it looked like my classmates you know than in 4th grade who held Liberian passports that were restrained from jumping into that onto the plane with us and ultimately we left those people behind and we took off and ended up here in the United States and we ended up in North Carolina. Dad opened a clothing store and Raj would eventually graduate from college and then go on to medical school but in Liberia to back to back civil wars left the country brutalized and had been 15 years since a skate that airfield but it did not escape my mind it was a medical student in my mid twenty's and I wanted to go back to see if I could serve the people we'd left behind rise tells a story on the stage when I got back what I found was utter destruction the war had left us with just 51 doctors to serve a country of 4000000 people would be like the city of San Francisco having just 10 doctors. So if you got sick in the city where those few doctors remained You might stand a chance but if you got sick in the remote rural communities where you could be days from the nearest clinic I was seeing my patients die from conditions that no one should. Because they were getting to me too late imagine you have a 2 year old who wakes up one morning with a fever and you realise that she could have malaria and you know that the only way to get her the medicine she needs would be to take her to the river. To the other side and then walk for up to 2 days through the forest to reach the nearest clinic . 1000000000 people live in the world's most remote communities and despite the. Modern medicine and technology our innovations are not reaching the last mile communities have been left behind because they've been taught to hard to reach. This universal access to care. And realizing this is case. Actually came from within. The communities themselves. Where most girls have not had a chance to finish primary school. At the age of 18 she completed high school and she came back to her community she saw that none of the children were getting treatment for the diseases that they need a treatment for like deadly diseases like malaria and the Monia So she signed up to be a volunteer now there are millions of volunteers like Musudan rural parts around our world and we got to thinking community members like could actually help us solve a puzzle so we started asking some questions what if we could reorganize the medical care system what if we could have community members like moose to be a part or even be the center of our medical team but if you could help us bring health care from clinics and cities to doorsteps of her neighbors who is 48 when I met her and despite her amazing talent and grit she hadn't had a paying job in 30 years so what if technology could support her what if we could invest in her with real training equipped with real medicine it's however have a real job. Well in 2007 I was trying to answer these questions and my wife and I were getting married that year we asked our. Relatives to forgo the wedding registry gifts and instead donate some money so we could have some start up money to launch a nonprofit. A lot more romantic than that. Ended up raising $6000.00 teamed up with some Liberians Americans and launched a nonprofit called Last Mile health and our goal is to bring health worker within reach of everyone everywhere we designed a 3 step process train paid to invest. In volunteers to become paraprofessionals to become community health workers. And the concept of community health workers not new I mean this is been around for a long time that's right that's right you know I had a chance to go to Alaska where they've had a program for 50 years and have trained village based community health aides to do everything from diabetes care to care for patients with potential heart attack screening them so I had seen the power of that when you combine a focus on what we call radical task sharing you know the sharing of medical tasks with others rather than doctors and we wanted to apply that in Liberia and so that that's what you know gave rise to last mile health and how do you train people to do this. With a communal for can name Ruth and Ruth as an adult she couldn't find work up until about 3 years ago in 2016 when our team hired her as a community health worker What does that mean so over a few weeks a nurse trained Ruth equipped her with medicines and supplies taking advantage of this revolution in biotechnology we gave her a $1.00 handheld test for area which is the biggest killer of children in Liberia and about extra treat pneumonia injectable contraceptives to provide to women in the community who were wanting long term contraception and she was also equipped with a smartphone with with video lessons on topics lie. Assessing a child from malnutrition and Ruth now is able to serve the daily health needs of her neighbors door to door and she can do over 30 different medical skills and of course they don't do neurosurgery they also don't just pretend like they can care for a complex medical condition they are connected to a network of nurses outreach nurses who come and visit them and coach them every month and those outreach no nurses connect the patients who need higher levels of care to a network of clinics and hospitals. In December 2013 something happened in the rain forest across the border from us and Guinea a toddler named a meal fell sick with vomiting fever and diarrhea he lived in an area where the roads were sparse and there have been massive shortages of health workers. And male died and a few weeks later his sister died and few weeks later his mother died and this disease would spread from one community to another and it wasn't until 3 months later that the world recognized this as Ebola when every minute counted we had already lost months and by then the virus that spread like wildfire all across West Africa and eventually to other parts of the world businesses shut down airlines started canceling routes at the height of the crisis when we were told that 1400000 people could be infected when we were told that most of them would die when we had nearly lost all hope. I remember standing with a group of health workers in the rain forest where now break it just happened we were helping train and equip them to put on the mass the gloves and the gallons that they needed to keep themselves safe from the virus while they were serving their patients when Ebola threatened to bring humanity to its knees Liberia's community health workers didn't surrender to fear. They did what they had always done they answered the call to serve their neighbors community members across Liberia learnt the symptoms of Ebola teamed up with nurses and doctors to go door to door to find the sick and get them into care they tracked thousands of people who'd been exposed to the virus and helped break the chain of transmission some 10000 community health workers risked their own lives to help hunt down this virus and stop it in its tracks. So I mean are you I don't know I mean are you encouraged it does it does it I salute I'm so reluctant to use that word because it's a pretty radical but based on what you have seen so far with with community workers and the last challenge yeah I mean what do you think what are the are the signs and encouraging. I'm glad you're critical of the word solution as as I am and I think it's a part of the solution I mean let's make no mistake you know there there needs to be more hospitals there need to be more advances in cancer therapy in personalized gene therapy but you know Liberia has now launched a national program to get a worker like Ruth in every last community in rural areas and they have a program of about 3500 community health workers and nurses that then support them and they've done extraordinary things I mean 2 and a half 1000000 visits 900000 kids have been treated for malaria or tested for malnutrition they've they've improved vaccination coverage they've improved the skill birth attendance medical care is up by 50 percent for for children it turns out this makes economic sense as well right for every dollar there was a study done for every dollar invested in professionalizing a community health worker and in other words supervising them paying them training them as a as a paraprofessionals a real part of the health care team there's $10.00 of return to the society because jobs get created where there's. Employment is high health care leads to healthier productive life years and then sometimes in the case of Ebola as we found in Liberia you can avert catastrophic epidemics now if every country especially in lower middle income countries rural poor parts and equip those workers and train them with even just 30 medical schools I think there should be a lot more but even the most the ones we know work it turns out the world could save an additional $3000000.00 lives every single year and that's what stuff we already have in our formulary you know the medicines we already have the testing kits we already have so so yes I think the potentials use it's a big part of the solution and it's in. The non profit last mile health you can fight this talk. I'm sure today ideas about access better health Stay with us I'm Guy Raz In listening to the Ted Radio Hour from n.p.r. . But the case. Of to Rector's starting a. Brief reports from committee chairs and staff. Members are invited to attend and the public is welcome after the meeting join us for a community. Please bring a dish to share for 6 to 8 people serving utensils and you. Will be for sale at discounted prices as well as books C.D.'s and this is an opportunity to mix with the. Community celebrate the station's 30th anniversary to. Saturday December 14th to. Support for the Ted radio. The hour comes from the Union of Concerned Scientists putting rigorous independent science to work for a healthy planet and a safer world more at u.c. S. USA dot org from Warner Brothers presenting the new motion picture Richard Jewel based on the true story of the 1906 Atlanta bombing a Clint Eastwood film now playing only in theaters and from the Arcus Foundation dedicated to the idea that people can live in harmony with one another and to the natural world. It's the Ted Radio Hour from n.p.r. I'm Guy Raz And on the show today ideas about access to better health. Do you think that access to being healthy in the developing world and even in the u.s. Is. Privilege rather than a right I'm afraid I mean you should know that I feel. Being healthy is not only a matter of having access to individual health care services. Having access to a life that protects your health this is Mary back. From 2014 to 2018 she was New York City's health commissioner I used to be. At city hall they say there's nothing that she doesn't think is related to health. I think doesn't have. Worked on issues around social justice and she says she began to approach health care through this lens 30 years ago. From the. 1985 so. At the core of Zimbabwe's national health policy the new government emerged from a long war of independence. Health care service primary education became essentially free. Comradery was palpable I felt connected not only to an African independence movement but to. Progressive public health movement. But we had no idea. First. 985. 1990 told hundreds of people in the prime of life that they were. Friends my students hospital patients. Response. Clinic we did research we counseled the partners. About how to protect themselves we worked hard at the time I believed that I was doing my best providing excellent treatment such as. Getting infected was not a moral failure but instead related to a culture of male superiority. Colonialism. But I was not talking about. Your technical skills as a medical professional and you did what you should which was to work to educate people but as you say your tools that were at your disposal pitifully weak that actually there was a much bigger problem that you didn't feel comfortable talking about what was that . Well one of the things is how we're trained as medical doctors that we think of the patient once they walk through the door and we limit our interactions with them to that encounter and in that sense I think I was doing my job but I would argue that the role of medical doctors is broader than that that we have to think about the world from which patients come when they enter our universe and seek health care. For example economy was founded on migrant labor so. Men migrated from their homes in the rural areas in a bid to earn money for their families but in result was separations of men from their wives was a way of life and that created a risk. But we now know was a risk. So that structural things not just access to medical care create high risk situations for poor house. Medical anthropologist such as Paul Farmer. In Haiti called this structural violence structural because in equities are bad. Political and economic organization of our social world often in ways that are. To those with privilege and power and violence because its impact premature death suffering illness is violence. We do little for our patients if we fail to recognize these social injustices sounding the alarm. The 1st step towards doing public health right and that's how we may support. To break through and create real change together. So these days I'm speaking out about a lot of things even when it makes listeners uncomfortable. When it makes me uncomfortable. As you are talking this experience that you had. Had a profound effect on the way you think about access and about who gets care and who doesn't get care she gets New York and what do you see when City is one of the wealthiest cities in the United States and probably in the world but it also has many poor people nearly half the population lives in official poverty and it's also one of the most highly segregated cities in the United States and the patterns of health that we see in New York City mirror the residential segregation so that some neighborhoods in New York have life expectancies that are over 25 years shorter than other neighborhoods in New York City that's how big the life expectancy gap is and it often is a racial gap meaning that the black white different life expectancy is the largest. And that's why we have to talk about racism. In New York City premature mortality that death before the age of 65 is 50 percent higher for black man than white ones black woman in 2012 face more than 10 times the risk of dying related childbirth as a white woman. 3 times the risk of death. Compared to a white baby. Exceptional. Are parallel by. Found across the United States. And a lot of this is about racial disparities and institutionalized racism things that we're not supposed to have in this country anymore certainly not in the practice of medicine or public health but we have them and we pay for them in lives cut short. I mean as the statistics make clear not only institutional racism but day to day exposure to. A pretty profound effect. Yes there are institutional factors there are personal factors and they all move in the same direction so that person who's classified as bloc in the United States is less likely to have access to high quality health care is more likely to be subjected to unequal treatment by their physician and is more likely to live in a neighborhood where they have other obstacles to their health like finding good food or living in a neighborhood where you feel safe going out to exercise or having good public transport that enables you to neighborhood and seek services that may not be available there so all of those things make a difference as the hash tag matter movement unfolds I felt frustrated and angry that the medical community has been reluctant to even use the word racism in our research and. The medical community has largely stood by passively as ongoing discrimination continues to affect the disease profile and mortality and I worry that the trend towards personalized. Looking for biological targets to tailor treatment. Is the big picture. Context. That most importantly determines. For too many of. Our role as health professionals. It's not just to treat our pace but to sound the alarm and advocate for change. Rightfully are not our societal position our voice credibility and we shouldn't. So with any problem the 1st obviously is to address it and to talk about it even if it's provocative Yeah and as you mention Newtok I mean some people are uncomfortable with or racism but you felt that was important to continue to talk about this and to shine a light on it. How do we begin to think about. Fixing this well the 1st step is to taken a racial equity lens and apply it to all the work that we do. That's what we mean when we talk about structural right it's not just one institution it's not just the hospital. That doesn't include doctors doing their job seeing their patients it's much bigger than that extends outside of the house sector whether we have housing jobs education transport recreation. It's not just institutions across institutions it's the culture everything. We have to look at the context that makes it harder for people to have healthy lives. And that's how you start fighting racism. That's what I think. Is a physician and the director of the ethics be Center for Health and Human Rights at Harvard University you can see her entire talk at Ted that come. On the show today ideas about accessing better health 'd and for many people who live in towns in Appalachia being sick is the norm 'd Well I remember being in some callers in West Virginia and people could look down the street around the small community where they lived and point to one house next to another. Person here died of 'd stomach cancer in the person they were dying of brain cancer I ran across those kinds of stories. Just commenting about the degree of illness RINGBACK surrounded in a moment RINGBACK READY. This is Michael Hendricks he's a professor of public health and Michael spent several years and best to get in the health impact of a process called mountaintop removal RINGBACK type of mining takes place. In Central Appalachia which is stapling and also heavily forested So the 1st step is actually to clear cut the forests and they will use explosives and heavy machinery to remove up to $800.00 or more feet of mountain elevation. And they extract the coal this way like players of a cake working their way down the mountain this is literally destroyed in the effort to reach the coal seams and in the water. You know the streams at the base of those valleys are just buried in debris from. From from the from the blast that's right and there is still water that comes out from beneath these buried fills and that water is contaminated and it remains contaminated for decades to come. Back in 2006. And he was hearing so many stories about cancer and disease in mining communities so he wondered if there was a connection between people getting sick and mountaintop removal but when he searched the scientific literature in the u.s. He found nothing almost nothing had been published so Michael began to look into it himself we started with some approaches that were fairly quick and easy and less expensive we analyzed existing data and we did some air quality studies in these areas and found among other things that the levels of silica were very high in these communities Silica is a known lung carcinogen and we found that people who live close to where mountaintop removal occurs have higher death rates for chronic forms of lung disease and heart disease kidney disease some types of cancer most notably lung cancer we started to look at some birth outcomes and we saw higher rates of babies born at low birth weight and higher rates of birth defects for mothers who lived in these mining areas during the time that they were pregnant we started asking people about the health of their family members and found that people were more likely to report that someone in their household died of cancer in the last 5 years. Or that some other member of their household had a serious illness within the last year. I mean I'm sure once you started to publish your findings. What what was the response I mean but what I mean you're in West Virginia Coal is a powerful force in that state and in that region what what what started to happen . While the coal industry didn't care for our work I think that's putting it mildly . I became subject to a couple of. Extreme for you requests Freedom of Information Act Freedom of Information Act right as you work for a public university so they they said we want to see all your e-mails and all this exactly and it was an extreme request I'm all for the Freedom of Information Act but it was a really extreme and harassing request in the attorneys at West Virginia University fought it to their credit eventually it went all the way to the West Virginia Supreme Court which ruled in our favor that what they wanted to do was a violation of academic freedom there was a major effort at one point where the coal industry invested millions of dollars to support a counter movement partially in response to my work and also others that were examining the harms of this type of money. To try to conduct industry sponsored research to try to show that that it wasn't harmful for. Members of government in West Virginia. By and large are supportive of the coal industry even today and they were not RINGBACK happy for the work that we were doing. And would either try to to deny that it was important or pretend they hadn't heard about it in would continue to support the industry RINGBACK 'd Here's Michael RINGBACK the Ted stage I've published over 30 papers on this topic so far along with my co-authors other researchers have added to the evidence. Government doesn't want to listen in the industry says it's only. Lifestyle issues never occurred to us to control for smoking. Insurance. For all of those and more it may seem strange that there is any controversy over the health effects of mountaintop removal mining but somehow this subject has wound up in Support for the Ted Radio Hour comes from c. 3 dot a i c 3 dot AI's software enables organizations to use artificial intelligence at enterprise scale solving previously unsolvable business problems learn more it see 3 Ai from the Corporation for Public Broadcasting and from the group or family foundation supporting N.P.R.'s efforts to promote deeper thinking broader perspectives and trusted fact based information always with the goal of creating a more informed public. It's the Ted Radio Hour from n.p.r. I'm Guy Raz on the show today ideas for accessing better health and before the break we were hearing from Michael Hendricks about the research he's done that's shown a clear connection between mountaintop removal and its environmental and health consequences communities living nearby but despite the scientific evidence he's gathered despite higher rates of cancer and lung disease in these communities the industry even some government agencies have attacked Michael's work. Someone like you is an expert and we're living at a time when there is mistrust and dismissal of an expert opinion because that is somehow more authentic or more true to popular will. But the consequences of that are death like the consequence is that our people will die because. We're being manipulated by hugely powerful forces that don't want us to know the truth about things like public health. Or is that ever true these days and I think about mountaintop removal is one example of that but I think about problems that are going to affect everybody not just people that live in Central Appalachia climate change is maybe a great example and it's just so frustrating but you know there's. A saying I won't be able to remember exactly that it's hard to convince people to believe one thing when their livelihood depends on them believing another yeah and I think people can rationalize and come up with excuses I wonder how how to what extent some of these folks that try to argue it and deny it how much they even know that it's true but they they would rather continue doing what they're doing because that's what they depend on. I mean. If if the people affected by by this wealthy. You know if mountaintop removal was happening over Manhattan or San Francisco do you think of that it would be allowed to happen now it would not be allowed the people that live in these communities do not have a lot of economic or political power same is true for people that face other types of environmental threats we tend to put. Toxic dump sites and power plants and other polluting sources in poorer areas yeah in areas that are populated more likely with by people of color. Rich neighborhoods are not going to have these they won't stand for them they have more pull over their elected officials so no I don't believe for a 2nd that mountaintop removal would occur if the cold been buried under the mountains outside wealthy communities. And if I've talked to lots of people in West Virginia who recognize that coal is dirty that it's harmful it may not really be an ideal choice but it's what they have and they feel like it's the only option they have for good paying jobs there's not a lot of other opportunity and so people see that it's harmful it's dirty but it's what we have and we have to try to support it it's a very common mindset. So what do you think we can deal to. To mitigate this problem and it is is the only option from your perspective to continue to research and to publish research even if nothing changes. Well it has to go beyond research of course there has to be a public. Awareness of public willingness to change and there has to be some authority behind that from people in positions to do things there needs to be an explicit investment in the development of sustainable healthy economies Yeah I try to look at a few bright spots that have occurred there was one for example that comes to mind where the e.p.a. Under the Obama administration had successfully denied a permit to a new large mountaintop removal site in West Virginia and cited among other things cited our research as one of the motivations for that. So it was good to see something like that the Democratic national platform before the 2016 election had a plank that explosively called for the end of mountaintop removal money because of its public health effects I was really encouraged to see that. They lost the election so we don't have that kind of movement that's taking place now but perhaps it's not too late perhaps things can change I think people respond better to crisis rather than to an impending problem that they don't experience personally. So when the impacts start to hit us in the face more then I think we'll see a bigger response and I'm still trying to be optimistic that we will gets things done and we're going to face some hard times but we're going to make change and get through it. That's Michael Hendricks he's a professor of Public Health at Indiana University you can buy just talk at ted dot com. So far on the show we've explored how extreme factors can impact our a definition of addiction would be a choice that somebody makes as your description of what addiction is. I think addiction is a normal human response to pain and a certain internal state and at its extreme manifestations when it comes to things like substances it becomes even less voluntary because what happens is as a result of the physiological effects of certain highly addictive substances be it alcohol or opioids or amphetamines and the way that they activate the reward system the brain wiring itself changes and that makes it even harder to interrupt a particular behavior but I think that humans in gaijin substance use to try and feel a little Ok when they're feeling restless or irritable or uncomfortable on some sometimes very subtle level but we soothe ourselves some of us suit ourselves by distracting ourselves with our phones or some people do it was food but you continue to do a behavior despite it having negative effects on your social relationships your family relationships your employment your job your ability to function those criteria 10 really apply to a much broader set of behaviors than just injecting heroin or smoking methamphetamine or taking pills or drinking. Picks up the idea from the. My experiments. Miswiring in the strike relates to compulsive behaviors meaning behaviors that are cold worst by uncomfortable urges. You can't consciously resist so the stride in which for sure is involved in compulsive spectrum disorders is also involved in human social connection and our ability to connect as it turns out the social neurochemistry in the stray atom is linked to things you've probably already heard of like oxytocin which is that hormone that makes cuddling feel all warm and fuzzy but it also implicates signaling at opioid receptors there are naturally occurring opioids in your brain that are directly linked to social processes. The strike and opioid signaling it has been deeply linked with loneliness when we don't have enough signal at opioid receptors we can feel alone in a room full of people we care about and love who love us loneliness is very dangerous and it predisposes people to entire spectrum of physical and mental illnesses. Think of it like this loneliness creates a hunger in the brain and our brains signal deep dissatisfaction. We become restless irritable and impulsive. If we don't have the ability to connect socially we're so ravenous for our social neurochemistry to be rebalanced we're likely to seek relief from anywhere and if that anywhere is opioid painkillers or heroin it is going to be a heat seeking missile for our social reward system. Is it any wonder people in today's world are becoming addicted so easily BUSY BUSY BUSY BUSY. This is not really something that we 'd think of as a public health crisis but I mean as you point out in your talk it seems like there's growing evidence to link. This to all kinds of psychological breakdowns that. Having you know little or no social interaction. Can really affect somebody who might ordinarily exhibit normal behavior. Right so loneliness affects multiple systems in the brain. And I think that being much more widely recognized as potentially the biggest public health crisis that we have right now and I really also want to differentiate between. And the concept of just not being around other people because the thing about loneliness. As that you can be surrounded by other people and still feel intensely lonely there's a dimension of loneliness and social isolation that exists independently of how many people you are interacting with on a daily basis so there's something to about the nature and the quality of our interactions and something about our internal experience and the way that those interactions are perceived that contribute to a crisis of loneliness. I mean there are people who you know get injured and then get prescribed opioids and don't become addicted and then there are people who do become addicted right what explains I mean why does one kind of person become addicted and then another kind of person doesn't is I mean is loneliness part of that equation that's such a good question and this is where the reward system actually plays into it their reward systems maybe hyper sensitised and social isolation is hyper sensitizing people's reward systems so you give it something that's rewarding you give it something that's an aesthetic and it's like eating after fasting that food no matter what it is is going to taste that much more amazing and so while there are definitely biological predispositions to addiction that some people have those factors more than others are really reasonable hypothesis is that with our culture and a lot of connection and our changing lifestyles being the way they are. Brain circuits in more people. Classically that have been identified as associated with addiction are in a state where they are sort of hungry and if you give them relief by way of rewarding substance. That much more likely to become something that is. Part of a. Particular. Symptomatic of a lack of connection in literally. People's lives are painful. Feels like such a creative way to think about addiction right because we addiction is not a new human phenomenon humans have been addicted to things since we've probably existed as a species and the times it was punished at times people were probably killed and obviously. In the modern era but to me it seems like the idea of creating more social interactions is really encouraging inspiring and but at the same time really hard because. Many people don't have a natural community I mean it's and this is now a feature of modern life that. Communities just don't exist in quite the same way they did 203-040-5100 extension 000 years ago yes and that creates a human condition where there is a low level amount of pain that I think has been so common for so many centuries that we don't even recognize it and I think that we tend to think that a lot of behaviors that humans are more likely to do with that background experience we think of them as human nature but really they're artifacts of the way that we live and the kinds of communities we do or we don't have we evolved to be not just in a connected social circle for instrumental aims you know we need help gathering food and things like that that's usually how people think of it but it goes deeper than that there is a certain kind of nourishment on a biochemical physiological level. That happens through social interventions and what we really need to consider is that that puts brain circuits in a particular state but like you said we're not raised in a culture that knows how to connect we're raised in a culture that has a lot of shame and what shame does shame keeps us isolated shame makes us afraid to be vulnerable with one another shame is the sense that we are not enough and shame makes it very difficult for people to allow other people to see them so how do you address that so we've created a system where we can teach just ordinary people from all walks of life how to communicate with one another in ways that minimize shame and normalize the experience of being slightly anxious an awkward we just make that normal and so we create an environment that is radically free of judgement and in an environment where people are radically free of judgement they feel more comfortable revealing themselves and then they start to experience this connection where they can just be exist with a person in whatever they're going through and. The person knows that they are right there with. A magical. Getting chills just talking about it it's a really really powerful experience and frankly it feels like an addictive drug. That's Rachael no scientist and co-founder. And addiction treatment. Talk. Better help this week if you want to find out more about who's on it go to Ted. Ted dot com. Our production staff at N.P.R.'s. The Howard k. D. Model Leone and Maria posit Gutierrez with help from Daniel should get our intern is Kiera Brown our partners a Ted Chris Anderson called Helms and feel and. I'm Guy Raz And you've been listening to ideas worth spreading right here on the Ted Radio Hour from n.p.r. 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Climate summit in the Dritte Spain this is democracy now but with. A huge tension. It is. The irrefutable irresistible. Decision. Victory for the conservatives in the United Kingdom where Prime Minister Boris Johnson says it is now irrefutable Labor leader germ a corpse is stepping down we'll speak with journalist George Monbiot. Insurgents empire and colonial resistance and British descent then about $25.00. Deadly droughts flooding. Wildfires rage outside the u.n. Climate summit worldwide the rich countries most responsible for the Climate Emergency have spent dialing back again and blocking progress that's what activists scientists indigenous and grassroots climate leaders are charging in these last days of this year's climate conference also look at how global heating is already displacing millions of people. What we're witnessing around the world is that the climate crisis isn't just changing ecosystems isn't just raising sea levels it's forcing people to leave their homes. 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