Pulitzer Prize Winners Nicholas Kristof and Sheryl WuDunn Chronicle America’s ‘Deaths of Despair’ in Their Latest Book “Tightrope”

Nicholas Kr istof and Sheryl WuDunn

[M usic ]

Marianne O ’ Hare : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lth care of the future. This week Mark and
Margaret speak with Pulitzer P rize winning journalist and author s,
husband and wife team Nicholas Kristof and Sheryl W uDunn, co -
authors of the critically acclaimed “ Half the Sky ” and their latest book
“ Tightrope : Americans Reach ing for Hope ” an unflinching look at the
causes of the spike in so called de a ths of despair and the declining life
expectancy in America.

Lori Robertson also checks in , the Managing Editor of FactCheck .org
looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
that 's improving health a nd wellbeing in everyday lives. If you have
comments, please email us at [email protected] or find us on
Facebook or Twitter, or wherever you listen to podcast. You can also
ask Alexa to play the program Conversations on Health Care . Now stay
tuned for our interview with New York Times columnist Nicholas
Kristof and writer S heryl W uDunn here on Conversations on Health
Care .

Mark Masselli : We're speaking today with New York Times C olumnist Nicholas Kristof
and J ournalist and A uthor S heryl W uDunn, the Pulitzer Prize winning
husband and wife writing team and co - authors of several award
winning bestsellers includi ng Half the Sky, A Path Appears , and the
most recent release Tightrope : Americans Reaching for Hope , deep
dive into America's epidemic of so called de a ths of despair. S heryl and
Nicholas, welcome to Conversations on Health Care .

Nicholas Kristof : Thank you .

S heryl W uDunn: W e’re delighted to be here. Thank you.

Mark Masselli : Yeah, you know, this book Tightrope : Americans Reaching for Hope
really takes us on this just incredible journey across America , but it
starts in the small town where Nick grew up in Ya mhill , Oregon . A
rural town, maybe about 1000 people and you really frame this story
through the lives of the kids who you rode the school bus with every
day . R oughly a quarter of them have since died due to de a ths of
despair. T his book is very personal to both of you , a nd I'm wondering
if you could talk to our listeners about its genesis, and the scope of the problem y ou were seeking to illuminate in Tightrope .

Nicholas Kristof : Well, Sheryl and I would be traveling around the world, covering
various globa l issues and then we periodically go back to this beloved
hometown of mine Yamhill w h ere my mom is still on the family farm.

Nicholas Kr istof and Sheryl WuDunn

W e saw a humanitarian crisis unfolding right there. T he five kids who
got on the school bus right after me each morning were the fi ve nap
kids Farlan [PH] who was my grade, Zealand [PH] , Nathan , Kelan [PH] ,
and their sister Regina, and they were smart, talented, optimistic kids.
Then Farlan died of liver failure after he was fired and then went into
a downward spiral , abusing drugs an d alcohol. His brother Zealand
died in a house fire while he was passed out drunk. Nathan blew
him self up cooking meth, Regina died of hepatitis. T he only survivor is
Kelan , the youngest and he survived because he was spending 13
years in the state peniten tiary. I t's just heartbreaking to see that
unfold , a nd in some ways, they were outliers , but there was another
family on the bus also with five kids and four of those five are also
gone.

Margaret Flinter: Well, I was thinking if you were novelists, and you wrote this, we
would think you reached too far too extreme --

Nicholas Kristof : That’s right.

Margaret Flinter: -- and yet , it's very real. These were people who were resilient and
rambunctious, I think as you point out, but smart and full of promise
and yet they could not overcome what we think of is the adverse
childhood events or ACE s as we’ve started to call them in almost a
clinical context . W e would welcome you talk a little bit about the
research that you've conducted around the impact of adverse
ch ildhood events, and these so many other people in our country who
are suffering as a result.

S heryl W uDunn: ACEs are really critical to us understanding how people end up
growing up in a troubled way. F or instance, if you take the example of
Farlan , so, Ni ck and Farlan were in the same class, they enjoyed the
same kinds of things at high school . B ut Farlan , as we write in
Tightrope , grew up in a very abusive household. His father was very
violent, and also used to , not only beat the children , beat his wife, he
would sometimes literally shoot at her with his guns, and she would
have to run outside to hide in the dark because she was just too
petrified to come back in lest he shoot her again. Y ou can imagine kids
growing up in that kind of environment. They're surrounded by
adverse childhood experiences.

W e know that if you actually can work with kids when they're young
and they have had some ACEs , then we do have remedies . W e have
ways of using counseling and all sorts of behavioral therapies to
address th eir situations . Most of us have an ACE or two in our
childhood, but when they start to pile up four or five or six of them,
that's where it really starts to affect not only the development of the
child rearing, but later on they have determined that a lot of t hese
ACE s also have an impact on your physical health. F or instance, later
on , you’re much more likely to have heart disease, type of chronic o f

Nicholas Kr istof and Sheryl WuDunn

diseases like diabetes . I mean of course that's a terrible cost for the
individual , but it's also a cost of gro wing constitute society because
cost on the health care system at large.

Mark Masselli : Y et as you think about those four or five ACEs that you were talking
about adding up , it really sort of make clearer why we have these
de a ths of despair and you note in your book that there were 68,000
people per year who have died from drug overdose . 80,000 from
alcohol abuse , 47,000 from suicides . Y et you noted the contrast that
much of affluent America is simply shrugging this off paying little
attention to this disin tegration of entire communities across the
country. I'm wondering talk a little bit about the disintegration, the
economics and politics behind the trend and how corporations as well
as our government policies have really failed to help reverse this
Americ an tragedy ?

Nicholas Kristof : O ne of the reasons for this crisis for this great social depression was
the loss of a good working class jobs in places like Yamhill and similar
places around the country . B ut that also raised the question of why
did the Great Depression not lead to a similar en route . I n fact, life
expectancy rose quite strongly during the G reat Depression whereas
now it ’ s tumbling. W e think that the answer is that in the 1930s, there
were still a lot of institutions, strong families that buff ered the
pressures of lost jobs. T hen gradually over the decades, these had
diminished and decline and provided much less of a buffer for most
people. Also, historically, there have been alcoholism -- alcohol, you
can argue , actually increased social capit al to some degree , while
d rugs just destroyed social capital. W hen Yamhill , for example, really
the only institution , local institution that was completely protective of
its members was the Mormon Church .

Margaret Flinter: Interest ing.

Nicholas Kristof : T h e only national institution that really provided a clear escalator out
was the military. They had a pathway out.

Margaret Flinter: Yeah . I have to note I've been doing a deep dive into some of the early
research on A CE s and these adverse childhood events h ave a
profound effect on individuals who are not necessarily at the absolute
bottom of the socioeconomic line. But then we imagine how much
worse it is in the absence of jobs. You make some interesting
comparisons in Tightrope between the American experien ce and that
of other countries and use the example about the GM plant closing in
Detroit, also affecting thousands of workers on the Canadian side of
the border , and y et those workers fare so much better. Tell us how
you think that Canadians continued acce ss to health care and social
services really made a difference from the Americans who'd lost their
job s living just a few miles away.

Nicholas Kr istof and Sheryl WuDunn

Sheryl WuDunn : After the financial crisis, the US , these workers got laid off, they lost
their job, and they also lost the ir health care because the health care
came with the job. But the lack of health care was an added stressor
on the family in addition t o the loss of job and an income. Over in
Canada, in Windsor, these people they lost their jobs , b ut because
Canada has un iversal health care, they did not lose their health care
so that just removed a huge stressor on the family. In addition, the
government intervened, the local government looked around the area
to find out where were the demands for different types of job
o pportunities and they discovered that it was in nursing. T hey quickly
arranged for some nursing programs, retraining programs to take
some of these auto workers to go into the nursing field . A s a result ,
these people were integrated back into the daily wor kforce on a much
quicker pace than in the US. Also years later , they're not entangled in
self - medication , in loneliness , in depression, that we so observed here
in the US .

Mark Masselli: We're standing today with New York Times C olumnist Nicholas Kristof
a nd J ournalist and A uthor Sheryl WuDunn , the Pulitzer Prize winning
husband and wife writing team and co - authors of Half the Sky and
their most recent release Tightrope : Americans Reaching for Hope .
Nick and S heryl, I thought you really did a great service to the country
of walking through this history of America's current addiction
nightmare starting back in the 1990s, when the pharmaceutical
industries was looking for this blockbuster drug to market address
pain and which had been designated as the fifth v ital sign . Y et, you
note that no pharmaceutical executives faced criminal sanctions for
their really nefarious marketing campaigns for drugs like Oxycontin
and others. But then you tell this incredible heartfelt story about
Geneva Cooley, and what happened to her. I'm wondering if you
could just share that story really about the broader impact of the war
on drugs which has led to mass incarceration of key populati ons that
have been devastating.

Nicholas Kristof: Yeah. There is actually one update. Now the f irst pharma executive
has [crosstalk] but in contrast, Geneva Cooley, this woman who'd
wrestled with addiction all her life had had deeply traumatic past and
self - medicated, and then paid for her addiction by transporting drugs
was caught in Alabama, Afric an - American woman and sentenced to
999 years in prison with a completely non - violent history . Geneva
should not have been transporting drugs. But he was responsible for
the tiniest fraction of the addiction and the heartbreak that groups
like Purdue Pharma were responsible for. I think if you look back at
the origins of America's disproportionate problem with drugs, it's
partly that we double down on the law enforcement toolbox to deal
with addiction while some other countries like Portugal, most notably ,
f ocused on the public health toolbox. Portugal now the number of
heroin users is fallen by two thirds and it has -- [Crosstalk]

Nicholas Kr istof and Sheryl WuDunn

Sheryl Wu D unn : That’s very impressive , yeah .

Nicholas Kristof: -- and the lowest drug fatality rate in Western Europe while we lo se at
this rate 67,000 Americans a year from overdoses. The other thing
was indeed that pharma companies behaved, just extraordinarily
irresponsible in trying to concoct new big selling drugs and marketed
opioids to deal with backache, arthritis, and creat ed institutions like
the American Pain Institute to tell doctors that they were under
treating pain . T he pursuit of quarterly profits was just staggering. That
was not present in other countries . Neither of those two factors w ere
present in other countries .

Sheryl WuDunn : But also you could also argue that it was outright lying at times when
initially they were saying that these pain killers , th ey're not addicting ,
I mean that is -- and that was just outright lie to say that they are not
addicting. I t is so mething that we really ignore when it comes to
larger corporations. We think that larger corporations, they're so
smart, they have all these employees, they do their research and they
a re just trying to sell products. Well, we see what's happening with
Boe ing , i t's a great company as well , b ut they have to be regulated .
T hat's the thing with capitalism is that capitalism is the best system
we have. But at the same time, we have to set the rules and when the
rules are poor, we need to rewrite the rules , and there's nothing
wrong with rewriting the rules , these rules should no t be set in stone.

Margaret Flinter: Well, I think we like to have a note of optimism and progress in our
shows and w e are really appreciative that your book points to a way
forward . Your title suggests that Americans are reaching for hope . Y ou
see opportunity for turning the crisis around, and you're offering both
some large scale, but also some small scale personal interventions,
things that all of us can do to make a difference . W e'd li ke to give you
a invitation to talk about some of these things that can have a big
posi tive impact moving forward.

Sheryl WuDunn : I think that , first of all , what we're really excited about is that this is
sort of the age of innovation when it comes to dev eloping solutions
for social problems. Research institutions and academics all over the
country are really trying to come up with great ways to address our
social problems. A lot of private philanthropy is sort of funding the
experiments . On e of the ones t hat we think is really important, it's
kind of a model that we think can be scaled, or at least be adapted for
other cities as well is a drug treatment program . It's a diversion
program for women and it also can be for men. It's called Women in
Recovery , i t can be Men in Recovery as well, but basically what it does
is it looks at women who are destined for prison sentences. It says if
their underlying reason for the criminality is really related to an
addiction to opioids or just some sort of drug, let's ac tually divert
them from prison because in prison, they're going to sit there for

Nicholas Kr istof and Sheryl WuDunn

many, many years and incur costs, and let's actually treat them . I n 18
months , two years, let's make them productive members of society so
they can actually start con tributing to the local economy. It puts them
through a very, very intense program, psychotherapy, lots of drug
treatment depending upon what the nature of their addiction is. It
puts them through classes on normality training, and business training
skills and gives them apprenticeships and actually places them in jobs
so that by the end, they do come out as pr oductive members of
society.

Nicholas Kristof: One reason I'm optimistic is that there is just a much clearer sense of
how we address these problems and that’s partly because other
countries have addressed and partly because some parts of the US
have. Now, we now know that universal access to health care, really
important. We understand more about social determinants of health ,
a nd we also understand that public health is incredibly important i n
addition to just clinical approaches . We 've done so well with auto
safety, for example, because we've reduced auto fatality rate per
hundred mi llion miles driven by 95% since 1921 . T here was no one
thing it wasn't just se at belts , i t wasn't just airbags , i t wasn't just
padded dashboards , i t was a million things . T hen the same way we
can tackle these challenges before us but it's going to mean really
childhood education. It's going to mean child allowances, which are
founde d in almost every other [ inaudible 00:16:49] . It’s g oing to mean
drug treatment , i t's going to mean job training. W hen the United
States was shamed by veteran homelessness then Obama
A dministration undertook a serious national -- [ Crosstalk ]

Sheryl WuDunn : Absolutely yeah that’s in Connecticut.

Nicholas Kristof: Reduced it by half. If we compared it equally about child
homelessness, we could reduce that as well. It's a question of
whet her we have the political will.

Mark Masselli: You talk eloquently about this great divide that exists in the country
between the haves and have - nots . I was just thinking of our own
experience, probably about eight years ago, we run a large a not - for -
profit, we have about 1000 employees. Margaret and I made the
decision about e ight years ago to interview every single person.
H ere's what we heard. 80% of people say almost the exact thing I've
never met, let alone been interviewed by a CEO of any organization, I
work it. Can you imagine that? Just thinking about this divide that
e xist is oftentimes just simply about having conversations with people
unless people connect with other people and hear their story as you
did. You not only went once you went back, you've checked on
people, we need to figure out how those who have the reso urces and
the power can connect with t hose because we're just tone deaf. I
don't think there's a substitute for figuring out how we get this larger

Nicholas Kr istof and Sheryl WuDunn

conversation going across our cou ntry.

Sheryl WuDunn : T hose conversations are really, really important becau se they also
create greater empathy. I think that right now there's a sense of
otherness , a nd so people in the first up on deck, or they're having a
huge party on the boat, and all other people below deck are
struggling with this growing hole in the h all . U ltimately, that hole is
actually going to bring down the whole boat. I think we have to
recognize that if we aren't all , as a country , going to try and address
these problems it's going to hurt the country as a whole. It already
has a s we know with a life expectancy, life expectancy in the US has
actually declined . E ve rybody else's life expectancy among our peer
countries is rising . B ut because this segment of the population namely
the working class, their life expectancy has drastically dropping. It's
dra gging down the entire national average. Last year, we actually had
an uptick in life expectancy, b ut that's because we're saving people
from cancer . T he underlying trend of the deaths of despair related to
alcoholism, and also drug abuse and also suici des. That trend is still
there.

Margaret Flinter: We've been speaking today with Nicholas Kristof and Sheryl WuDunn
the Pulitzer Prize winning co - authors of Tightrope , Americans
reaching for hope . It is an absolute must - read for anyone working in
the field of health care, public policy, public health, or anybody that
knows either of us. You can learn more about the book and their work
by going to newyorktimes.com/Kristof or follow them on Twitter at
WuDunn and Nick Kristof. Sheryl and Nick, thank you for sharin g your
journalistic gifts for shining a light on humanity's many challenges and
opportunities for sharing some optimism and a blueprint for going
forward a nd , of course, for j oining us today on Conversations on
Health C are .

Sheryl WuDunn : Thanks very much , delighted to be here .

Nicholas Kristof: Thanks for your great conversation.

Mark Masselli: Yeah thanks so much continue success.

Margaret Flinter: Thank you so much.

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Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in US p olitics. Lori,
what have you got for us this week?

Lori Robertson: In the last Democratic Presidential Debate , Senator Amy Klobuchar

Nicholas Kr istof and Sheryl WuDunn

accused former South Bend Mayor Pete Buttigieg of flip flopping on
support for Medicare for A ll . Klobuchar cited a 2 018 tweet in which
Buttigieg said he supported it, “ i n dubitably and affirmatively ” .
Buttigieg says he supports a Medicare for A ll Who Want It plan which
he says would put the US on a “ glide path that leads to a Medicare for
A ll environment. “ As a candidate , Buttigieg has proposed a more
centrist health care proposal. He does not support the Medicare for
A ll plan proposed by Senator Bernie Sanders t hat would expand
Medicare, which now covers primarily those age 65 and older to
everyone creating a new univers al single payer health care system in
the United States.

Rather, Buttigieg is proposing an option for people to buy into
Medicare through the Affordable Care Act exchanges. Those who are
eligible would get subsidies to help pay for it, and the cost would b e
capped at 8.5% of a person's income . B ut it would not force people
into Medicare if they choose to keep the private insurance they
currently have. Buttigieg says his plan will ultimately lead to Universal
Medicare because over time, he believes people wi ll choose it.
Klobuchar , meanwhile, supports a public insurance option built on
either Medicare or Medicaid. That’s my fact check for this week I'm
Lori Robertson, M anaging Editor of FactCheck .org.

Margaret Flinter: FactCheck.org is committed to factual ac curacy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, email us at chcradio.com, we'll have FactCheck.org's Lori
Robertson chec k it out for you here on Conversations on Health Care.

[Music]

Margaret Flinter: Each week C onversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Here's a
question for you. What is the last sound tha t you would want to hear
when you die? Would it be this [Beep] Or this [Orchestra] ? That's the
question the ambien t musician and composer Yoko Sen asked after an
illness led to an extended h ospital stay. During that time Sen was
hooked up to multiple machi nes that made a cacophony of d iscordant
and disturbing sounds.

Yoko Sen: I was terrified by the sound of alarms is such dissonance . L ying on a
hospital bed I wondered, why does it have to be this way? Could it be
better ?

Margaret Flinter: She set out to co mpose hospital machine sounds that would create a
more soothing and harmonious oral environment.

Yoko Sen: What if I tune to some of these into may be th is Sen sound just
different tuning.

Nicholas Kr istof and Sheryl WuDunn

Margaret Flinter: She found ed Sen Sound, a social enterprise that's aimed at reducing
noise pollution in hospital settings and creating what she's calling the
future of hospital sound. As an artist in residence at the Johns Hopkins
Sibley Innovation Hub , Sen has design a multimedia tranquility room
to relax with soothing music moving projections, aroma therapy and
tea.

Yoko Sen: Staff members don’t really have a place they can go to relax before
the shift , after the s hift, especially nurses. I f we could help take care
of them who take care of patients , ultimately I think w e are making
everybo dy's experience better.

Margaret Flinter: Yoko Sen is driven to provide a better answer to this question.

Yoko Sen: What is the last sound you wish t o hear a t the end of your life ?

Margaret Flinter: Se n S ound. Now that's a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Marianne O ’ Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, s treaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please email us at
[email protected] , or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community Health Center.

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