July 25, 2016


“We Have to Walk Away From This Road Show”

These are among the words with which Pulitzer Prize-winning author Marilynne Robinson concludes her book, “Mother Country.”  It was published in 1989.  She was writing about a somewhat different challenge then.  She described it as a “decline in national self-esteem.”  But in a way, it wasn’t different.  In a way, we are facing much the same challenge today.  I describe it as a “decline in confidence in our institutions.”  

Because of this, we are witnessing a campaign by a candidate for the presidency of the United States by Donald Trump unlike any other we have witnessed in my lifetime.  A campaign that relishes in sweeping, categorical defamation of other people, such as Muslims and immigrants.  A campaign that takes delight in pushing the boundaries of outrageous pronouncements, whether that be in vilifying an entire group of people or accusing a former president of the United States of “lying.”  We are perversely taken by Trump’s authenticity, his fearlessness and his complete and utter rejection of political correctness.

Trump is feeding off a space filled with the potent mixture of boredom, frustration, hopelessness and anger and the all-too-present human attraction to witness, and indeed even revel, in the bizarre.  His impact is fueled by a media frenzy producing unending coverage and the inability of even the most seasoned, tough-minded interviewer to overcome his steamrolling, self-guided verbosity.

Without articulating any policy much beyond “building a big wall, which we’ll have Mexico pay for” and “making America great again” in ways weakly defined, he emphatically says, “Trust me.  I’m great at making deals.”  

He has the insidious talent of demeaning, indeed trashing, “others,” while making those he is addressing feel special, valued, even “loved.”  He gets away with this in no small measure because he is so obviously delivering what he says with gay abandon.  He is really enjoying himself.  

All of what I’ve written here has been easy to write.  But what is not easy and has never been easy in times of challenge of the kind we face today is to find and support the leader who can bring us together, who can offer a vision for the future and plans to support it that realistically offer an improved life for all and to find a role for our country in the world which advances as far as possible the peace we need while avoiding nuclear disaster and the threat of terrorism.

Returning to Ms. Robinson, she closes her book with words I resonate to:  “My greatest hope is that we will at last find the courage to make ourselves rational and morally autonomous adults, secure enough in the faith that life is good and to be preserved, and to recognize the greatest forms of evil and name them and confront them.”  

Paraphrasing her conclusion, we have to walk away from this road show which Donald Trump’s campaign represents.  We need to “consult with our souls, and find the courage in ourselves, to see and perceive and hear and understand.”



July 20, 2016

July 18, 2016

My reading of an outstanding “biography of cancer” titled The Emperor of all Maladies by Siddhartha Mukherjee has stimulated a line of thinking that I am finding to be very mind-opening.

Put simply, I believe we should re-frame and attack the issue of the enormous number of gun caused deaths in our nation as an issue of PUBLIC HEALTH. 
One thing guns, cancer, tobacco and automobiles have in common is their association with high rates of mortality, actual and potential.  And with their association with morbidity, automobiles, guns and tobacco have, to different degrees and at different points in time, raised the question of how “causal” the relationship is.
The struggle, or more precisely the “fight” (for indeed industry did fight) against the ever more evident and deadly linkage between cigarette and cigar smoking and cancer was brutal.  I won’t try to tell that chilling story here.  It’s done brilliantly in the aforementioned book. 
Cigarette smoking skyrocketed during the first half of the 20th century.  In 1870, the per capita consumption of cigarettes in America was less than one cigarette per year.  By 1953, the average adult American was smoking ten cigarettes every day.  (Sadly, as we went into the 1960s, I was smoking at four times that level!)  Not surprisingly, in this same period—the 1950s—a meteoric increase in lung cancer was being observed in the U.K. and the United States.  But was it being caused by the increase in cigarette smoking?  At first, that notion was greeted with more than skepticism. It was disbelief.  One evidence of this: even medical journals were routinely carrying cigarette advertisements.  At the annual conferences of the American Medical Association in the early 1950s, cigarettes were distributed free of charge to doctors who lined up outside the tobacco booths.  When I joined Procter & Gamble in 1963, there was an ashtray placed in front of every member of the Executive Committee, with no thought it was carrying a danger (though by then research was amply available to demonstrate that).  Almost everyone smoked, many nonstop. 
Ironically but profoundly, and this has great significance to the issue we face on the causal relationship of the availability of guns to increased morbidity,  as Mukherjee writes, it was the “rapid, viral ascendency of tobacco that made its medical hazards virtually invisible.”  He points out that our intuitive appreciation of statistical correlations “performs best at the margins.”  When rare events are superposed against rare events, the association between them can be striking.  That had been seen in drawing a link between scrotal cancer and chimney sweeping in the U.K. Both the profession and the disease were uncommon enough that the juxtaposition of the two stood out starkly like a lunar eclipse; two unusual occurrences in precise overlap.
However, as cigarette consumption escalated into a national addiction, and the documented incidence of cancer also sky rocketed,  it became harder to discern an association  of smoking with cancer. 
Similarly, with guns today, with their penetration growing at a rate which like cigarettes in the past can only be described as an “addiction”—over 300 million in homes in the United States, twice the level of 1968—and, sadly, with deaths involving guns also becoming more prevalent day to day, it becomes harder to make direct associations.
In time (measured in decades)  and with great difficulty, the causal relationship of cancer and smoking, was irrefutably established.  It happened only thanks to the perseverance and courage of scientists and academics.  Prospective trials were carried out among (ironically, at first doctors) matching those who smoked and those who didn’t and then documenting the prevalence of lung cancer over many years. The results were unarguable. But even then getting clear warnings on packages and banning televison advertising was resisted by the industry-- and by legislators committed to the industry, just as is the case today with guns.   It took decades to bring regulations which recognized and grew from the knowledge that cigarette smoking is a “public health issue” of the highest magnitude. And it came through the Public Health Administration, not Congress which was beholden to special interests just as  is the influence of the NRA on legislators today.  

I do not believe the type of "prospective", irrefutable research has been carried out to establish the causal relationship of guns and various forms of deaths caused by guns that would match the research which eventually underpinned the causal relationship of cigarette smoking and cancer.  It would be very hard to model that. 

But there is powerful "retrospective" and "associative" evidence to show the correlation between gun penetration and deaths caused by fire arms. The facts are staggering. Based on 2010 research reported in the Journal of American Medicine, deaths caused by fire arms are (per 100,000):

U.S. 10.2
Canada 2.3
France 2.8
Germany 1.1
UK 0.2

Gun penetration per 100 people:

U.S. 112.6
Germany 30
UK 6.6
Russia  8.9

The instant death which a gun can cause in a domestic dispute or suicide attempt (compared to other "weapons") makes it altogether more lethal just by the very fact that it is on hand. Just being there is a "public health" risk of a greater dimension than alternative implements which can cause great injury and even death.
Today, no one who can read can mistake the danger that they are embarked on in smoking.  This is not being done with the usage of guns.

So what about automobiles?  How do they come into the picture?

On a per capita basis, automobiles used to place far higher in the ranking of the causes of death (and injuries) in this country than they do today.  In this case, it was easy to establish the causal relationship.  There was no mistaking that, when a car crashed and there were no seatbelts, and the passengers flew through the windshield and died, that the cause of death was irrevocably related to the car accident.  And in time, for this and other reasons, sharp regulations have been brought to driving a car.   You need to have a license and you have to have that license renewed regularly.   You have to pass a driver’s test to show that you know what you’re doing when you drive the car.  Surely we should insist on nothing less than that when one buys a gun.  We don’t insist on that today.  I can find no logical explanation for that.
Many will raise the familiar argument that guns don’t cause death, people do. It is their choice.  Of course, that could have been said about tobacco—and it indeed was, literally, vehemently, repeatedly.  It wasn’t the tobacco that caused cancer, it was the smoker.  And it could be said about automobiles, too.  It wasn’t the car; it was the driver or the weather or the road.  Yes, but…we have identified a causal relationship of such importance that we ought to be certain that proper steps are being taken to regulate its use so that not only harm to the “owner” but harm to others who are not the owner can be constrained.  That is certainly the case with guns.  Sometimes, it is the harm to the “owner” in the case of accidentally shooting oneself and suicides, which happen all too often.  But even more, it is the danger to people who don’t “own” the gun.  To not require a license and training on how to use the gun is absolutely irresponsible. 
Which brings me to my last point where the relationship of tobacco and cancer, and of automobiles and guns, has something to teach.  It come under the heading of prevention.  It was decades before the medical community was prepared to really address the issue of “prevention” when it comes to cancer.  There were those who favored surgery; others, oncology; of course, many, both. But it was only later, and it’s still a movement underway, that the issue of “prevention” in terms of diet and living habits, especially smoking and alcohol,  as they relate to the risk of cancer was addressed.  It manifested itself especially in the focus on not smoking, and this has had a major effect in reducing lung cancer. 
“Prevention” has played a big role in the reduction of deaths through automobile accidents too.  The requirement for seatbelts, speed limits (no matter how inadequately enforced) and other safety devices, have all come into play, under the mantra of “public health”.
I don’t think we have thought deeply enough, or taken action, on what can be done to prevent needless deaths from widespread gun ownership much as we have done on smoking and driving a car.
There will be many, certainly the NRA, that retreat to the familiar citation of the “rights” conferred by the 2nd Amendment.  This argument should carry no weight when it comes to making intelligent modifications on the requirement for gun ownership dictated by learnings from history.  Certainly, the authors of the 2nd Amendment did not contemplate that it would confer the right to have semi-automatic and automatic military-style weapons in the hands of millions of people; weapons capable of killing dozens and dozens of people in a matter of seconds.  Just as with automobiles, or now with tobacco, I cannot believe the authors of this Amendment would object to there being strict rules dictated by the well documented knowledge  of the risks these guns pose to public health and life which would  require clearance and registration before they could be purchased and training before they could be used to be as sure as we could that they were going into responsible hands that are capable of resposnsible use.   
This is a short treatment of a complicated subject.  I hope it sheds a light on what it took to understand, document and then control the causal impact of cigarette smoking on cancer and the impact of automobiles on highway deaths in a way that provides insight on what we should do about the tragic loss of life from the broad and inadequately regulated penetration of guns in this country today. Put simply, I believe we need to frame and approach this as a "public health" issue, which it surely is. 


July 19, 2016

As Toni Morrison writes, this is a “profound, necessary and an absolute delight to read.  It is at once mind-opening, sobering, inspiring and, above all, truthful.”  It tells the story with great academic depth of the migration of black Americans from the south to the north during the period 1915-70.  It does so with data-based perspectives which show that contrary to much of the written history, the men and women making this journey tended to be better educated, better employed and have stronger family formations than blacks who had been born in the north. 
The story comes alive through the tracing of the journey of three individuals over a period of 50 and 60 years who traveled from Florida, Louisiana and Mississippi to New York, Chicago and Los Angeles.  Each of these stories is worthy (and indeed is represented here) by its own “book.”
The book brings to life in an unforgettable way the horrible treatment, whether in orange groves or cotton fields, that led these individuals to make the courageous decision to leave and then the discrimination they faced as the “lowest of the lowly” new immigrants in cities in the north.  Substantively, none of this is really surprising to someone who has lived as long as I have, but in the details it is brutal as it documents in the most personal way, the denigration of blacks requiring that they not associate with whites, not only in schools, use of water fountains, bathroooms, bar rooms  and theatres, but in something as trivial and mundane as betting windows at a horse track. 
Wilkerson never trivializes or idealizes the lives of these men and women.  They all made mistakes, as they themselves admitted; they all gave up something vital which, to varying degrees, was hard for them to leave behind in the south.  They had disappointments in their children; deaths in their extended families; these were lives that I only wonder: how I could have possibly managed?
The common denominator, of course, is they were all looking for Freedom.  As James Baldwin wrote in Notes of a Native Son:
 “Most of them care nothing whatever about race. 
They want only their proper place in the sun.
And the right to be left alone, like any other citizen of the republic.”
The challenges were legion.  We look at the horrors going on around us today, and “horrors” they are.  But this history reminds one that there were 58 bombings of houses that blacks moved into or were about to move into between 1917 and 1921 alone on the south shore of Chicago.  As Wilkerson writes, “No laws could make frightened white Northerners care about blacks enough to permit them full access to the system they dominated.”
The terrible harm reaped on the children of these immigrants by the drug-infested culture around them is spared no detail. 
Again, James Baldwin in Notes of a Native Son:
“I can conceive of no Negro native to this country
Who has not, by the age of puberty, been irreparably scarred
By the conditions of his life…
The wonder is not that so many are ruined
But that so many survive.”
As these immigrants from the south were the first to say, that provides no excuse to their youth but it does describe circumstances that need to be understood as one draws judgments and particularly draws conclusions on what we need to do now.
The all-pervasive presence of “Implicit Bias” is revealed again and again in this book.  For example, the “expectation that any colored woman walking in the white section of town was available to scrub floors and wash windows” continued into the 1960s.  The author’s mother had a woman call out to her in the late 1950s when she was on her way to decorate and fit slipcovers in Cleveland Park, a wealthy neighborhood in Washington, D.C.: “Say girl, could you come up here and clean my bathroom?”  “I’m looking for someone to clean mine,” my mother yelled back to the woman.
There is wonderful contemporary joy to be taken from the joy which these immigrants to the north felt as they were able to vote, as they were not in the south.  And their votes mattered Ida Mae’s (one of the three lives Wilkerson illuminates) first vote and that of her husband’s in Chicago was one of those tens of thousands of other colored migrants’ votes that helped Roosevelt carry the State of Illinois by two percentage points in the reelection of 1936.We continue to face repression of voting by African-Americans (and others) today, especially in Ohio.
Wilkerson records an amazing galaxy of African-American leaders in every field—black mayors (including Lou Stokes in Cleveland), sports stars like Bill Russell, artists like Duke Ellington—who were children of parents who fled from the south. 
This history, showing the embedded systemic impact of racism that existed both as a driver to this great migration and in the reality which those who moved to the north found themselves in has lessened today, but it is far from gone.
 And one should not forget that the children, and the grandchildren, of the men and women who made this brave journey and incurred all of the insults and discrimination they did along the way,  while feeling being of a different generation and, in many ways, wanting to distance themselves from their forefathers and mother’s generation, still inevitably carry the varying combination of fears, resentments, ambitions, and of determination that every one of us draw, knowingly or not from the road which prior members of our family traveled.


July 12, 2016


I’ve never been as struck or worried as I am today at the multiple drivers that are driving rising inequality between people of means and higher education and those without and the barriers to upward mobility which these drivers of inequality represent.  What worries me most is how these drivers build on one another. And how systemic and deeply embedded they are, especially in family conditions, racial and other biases and policy. This is tearing at our social fabric (witness the appeal of Donald Trump in this election cycle) and cramping significantly our economic growth as a Nation. 

The realities are numerous and altogether clear.  As just one example, the likelihood of an individual having been born into the bottom quintile of income now having a college degree is 6%.  The chance of a person born into the lower income quintile moving to the median income in his or her lifetime is 30%.

What are these drivers and barriers I refer to?

1.     They start with the impact of the family circumstances into which a child is born--circumstances differentiated by education, income and wealth and race.  A well-known fact:  A child born into a college-educated family (and far more than in the past, today, people are choosing partners of similar education) have a working vocabulary three times the size of a child born into a family whose parents have not gone beyond high school at the time the child enters kindergarten.  Here is another critical fact relating to family circumstances as influenced by education (and poverty). While over 40% of all babies born today are born to unwed mothers, the comparable number for college educated mothers is only 6%. It goes on...the enormous and widening gap in wealth (and, thus, what parents can afford for their children) which exists today is likely to continue widening. Why? One reason is that, as Thomas Piketty persuasively argues in his book, Capital in the 21st Century, the return on capital (accumulated wealth) is significantly greater today (at 6-8%) than the average increase in wages (at 1-2%) which barely covers inflation and is virtually the only potential  source of increased wealth for the overwhelming majority of all families. The gap in wealth in our country has greatly expanded over the past 30 years. As of 2013, the average median family wealth was $81,000 compared to $942,000 in the top 10% and $7,880,000 in the top 1%. The bottom 10% was a meager $2,050 and the bottom 1% are in debt.  And as we know, the gap in wealth is particularly significant across racial lines. The median wealth for white families is $134,000 yet only $11,000 for African-American families, again in 2013. Much lower home ownership among African Americans is a key factor. 

And it is not only the increasing gap in "wealth.”  There is the increasing gap in "earned income". This of course continues to drive this wealth gap on a compounding basis.   Over the last approximately 40 years, real income for the bottom 20% of wage earners has not increased at all, while income for the top half have increased in double digits, and particularly the top 10%, has increased by 60%. There are simply too many people, working one or two jobs, who are being paid poverty wages, grossly insufficient to allow them to bring up a family. The failure to provide a livable wage for work well done is an enormous inequity in our nation and a driver of the poverty that afflicts us. 

2.     The availability of quality parental support during the first three years. We know more than ever how important the interactions are between a parent and child in the development of the child.  A lower-income family, particularly one with the only parent or both parents needing to work (which characterizes over 70% of these families), is going to have far less time to interact with a child in his or her earliest years than those families where one of the parents, if not staying at home fulltime, can spend substantial time with the child 

Beyond that, there is the affordability (or lack of it) of quality childcare and pre-K experience.  Today, no more than 25% of children are in quality pre-K.   And again class and race make all the difference. Most families of significant means do have their children in quality pre-K, some as early as age two, let alone at the age of three and four. The cost of quality child care is as much as 25% of the average median family income, i.e., unaffordable. 

3.     The gap in the quality of educational support continues in K-12.  Not so much in the quality of teachers, but in the facilities and extra-curricular activities and the preparedness of fellow students, all of which makes a difference to every single student in the class. In light of the foregoing facts, it is hardly surprising to find that recent tests show that while overall American elementary school students fall below the median compared to the students from other developed nations in proficiency tests , those students from high-income districts (i.e. ones where less than 10% of the students are in federally subsidized lunch programs) score the highest of all the nations. In contrast, in those school districts where 75% or more of students are in federally-subsidized lunch programs, students from the United States score the lowest.

4.     Post-high school education.  As is well publicized, up to 70% of jobs in the future will require more than a high school education.  Yet, the availability of this education is far more readily available to students whose families have significant means, both in affording tuition and being able to handle the debt which remains after school. The need for post-high school education will only grow in the future. 

Thus, from pre-birth all the way through to a young person’s latter teenage years, there are these reinforcing, multiple drivers to growing inequality and greater barriers to upward mobility.  They build on one another. They are deeply rooted. And they are multi-generational in their impact.  This is wrong.  Every child deserves the chance to fully develop his or her God-given abilities. Our future as a nation and society depends on it.  Today, an estimated 25-30% of our young are entering adulthood unprepared to succeed and prosper and the consequences of this also flow to the next generation. 
We must not allow this to continue.

Beyond all the points I have made so far, there is one other. We have abundant evidence that the investment in quality childhood development programs, focused on children ages 0-5 and their parents, provides financial returns of 2 or 3:1. They are financial no brainers.

It goes way beyond this short piece to address the systemic and policy changes we need to make to confront the realities I have described above.  However, four are of fundamental importance: 

·      to provide support for parents to give their children the development experience they need and parents want for their children, cognitively, emotionally and in health, ages 0-5 during which 90% of brain development occurs. 

·      to provide holistic, community-based interventions to address the scourge of poverty, including addressing racial and income disparities in health, safety, jobs and education.

·      to implement minimum wage legislation bringing salaries over the next few years to at least $15.00 per hour or about $30,000 per year, assuming a 40 hour work week; 50 weeks per year.
t  .to provide tuition plans and student loan relief that will enable every young adult seeking post high school to obtain it.

John Pepper 



July 2, 2016


His writings and spirit will be remembered for all time.
I heard him speak on November 9, 1999. I will never forget it. Among his inspirational perspectives that night:

"The great miracle of life is not to begin..but to begin again."
"You can't let God go. It creates an insufferable vacuum". 
"We are not abstractions, we are members of the human family. "Whatever you do, remember a human being is a human being. A universe within a universe itself. When a human being is killed, something is happening to the whole human race."
"Whatever you do, never choose indifference...act on what you believe to be true"