WHY AMERICA'S VARYING GROWTH RATES AND THE CHALLENGE WE FACE IN THE FUTURE

April 6, 2016

WARNING:THESE EXTRACTS COVER SIX PAGES BUT I BELIEVE YOU WILL 
FIND THE CONTENT AND REFLECTIONS TO BE WORTH THE TIME

The Rise and Fall of American Growth
The U.S. Standard of Living since the Civil War
By Robert J. Gordon

The following extracts from Robert Gordon’s new book try to capture in a short six pages the essence of the argument he makes in a 600+ page book.  I, of course, have shorthanded it tremendously and have not tried to develop all of its themes. 

The two principle themes I have chosen to emphasize have been:

1.     The role of transformative innovation and entrepreneurship in dispersing that innovation.  This is something that we must keep in mind in every business or initiative we undertake.

2.     The reality of the “headwinds” we face in America in sustaining a rate of real growth that approximates what we had during the middle part of the 20th century.  Those headwinds include growing inequality and the challenge of sustaining the pace of the “unique” innovations that came into play during that period. 

The most compelling challenge for me is the one Gordon develops on the related issues of education and family formation.  You’ll see the shocking statistics that show the decline in births to married couples as well as the decline in the relative educational capability of the American workforce.  I come to this book with tremendous conviction in the importance of addressing these issues where we must:  at the very earliest age of a child, pre-natal through five, and also then changing the ways in which we finance elementary and secondary education to provide a more-even playing field to children and their families regardless of income.

Enough said.  I hope you enjoy these notes and that they encourage you to delve more deeply into this book.
*****
The Great Leap Forward from the 1920s to the 1970s
Our task in this chapter is to shed light on this fundamental puzzle in American economic history:  What allowed the economy, particularly in the 1950s and the 1960s, to so unambiguously to exceed what would have been expected on the basis of trends estimated from the six decades before 1928?

The traditional measure of the pace of innovation and technological change is total factor productivity (TFP)—output divided by a weighted average of labor and capital input.  Gordon documents that the annualized growth rates of total factor productivity increased about fourfold during the fifty year period 1920-1970 (1.89%/year) versus prior years and versus the rate that has persisted since then.  Wood examines what was the cause of this “Great Leap.”

The most novel aspect of this chapter is its assertion that World War II itself was perhaps the most important contributor to the Great Leap.  We will examine the beneficial aspect of the war both through the demand and supply side of the economy.  The war created household savings that after 1945 was spent on consumer gods that had been unavailable during the war, the classic case of “pent-up demand.”  A strong case can be made that World War II, however devastating in terms of deaths and casualties among the American military (albeit much less than the greater toll of deaths and wounded among other combatants), nevertheless represented an economic miracle that rescued the American economy from the secular stagnation of the late 1930s.  In fact, this chapter will argue that the case is overwhelming for the “economic rescue” interpretation of World War II along every conceivable dimension, from education and the GI Bill to the deficit-financed mountain of household saving that gave a new middle class the ability to purchase the consumer durables made possible by the Second Industrial Revolution.

The supply effects are more subtle and interesting and include a vast expansion of the nation’s capital stock as the government paid for new factories and equipment that were then operated by private firms to create aircraft, ships and weapons.

The explanation of the Great Leap then turns to the innovation of the 1920s that had not been fully exploited by 1929, as well as to the additional inventions of the 1930s and 1940s.  By some measure, the 1930s were the most productive decade in terms of the numbers of inventions and patents granted relative to the size of the economy.  Previous chapters of this book have pointed to technological progress during the 1930s, including in the quality and diffusion of electric appliances, improvements in the quality of automobiles, the arrival of commercial air transport, the arrival of network radio programs available in every farm and hamlet, the culmination of growth in motion picture quality and attendance, and continuing improvements in health with the invention of the first sulfa drugs.  Inventions in the 1930s and 1940s also occurred in other areas not explicitly treated in previous chapters of the book, especially chemicals, plastics, and oil exploration and production.

Gordon also makes the case, one which challenges my own long-term thinking, that the history of immigration and trade during this period also are important factors in this “Great Leap” forward.  Let me explain. 

Between 1870 and 1913, roughly 30 million immigrants arrived on American shores; they crowded into central cities but also populated the Midwest and the plains states.  They made possible the rapid population growth rate of 2.1 percent per year over the same interval, and the new immigrants created as much demand as supply in the sense that there was no mass unemployment caused by their arrival—and in fact the unemployment rate in 1913 was only 4.3 percent.  All those new people required structures to house them, factories to work in, and equipment inside the factories, so the new immigrants contributed to the rapid rise of capital input.

Contrast this with the shriveling up of immigration after the restrictive immigration laws of 1921 and 1924.  The ratio of annual immigrations to the U.S. population dropped from an average 1.0 percent per year during 1909-13 to 0.25 percent per year during 1925-29, and the growth rate of the population fell from 2.1 percent during 1870-1913 and 0.9 percent between 1926 and 1945.

Both the immigration legislation and the draconian regime of high tariffs (the Ford-McCumber tariff of 1922 and the Smoot-Hawky tariff of 1930) converted the U.S. into a relatively closed economy during the three decades between 1930 and 1960.  The lack of competition for jobs from recent immigrants made it easier for unions to organize the push up wages in the 1930s.  The high tariff wall allowed American manufacturing to introduce all available innovations into U.S.-based factories without the outsourcing that has become common in the last several decades.  The lack of competition from immigrants and imports boosted the wages of workers at the bottom and contributed to the remarkable “great compression” of the income distribution during the 1940s, 1950s and 1960s.”

Thus the closing of the American economy through restrictive immigration legislation and high tariffs may indirectly have contributed to the rise of real wages in the 1930s, the focus of innovative investment in the domestic economy, and the general reduction of inequality from the 1920s to the 1950s.

Can the Innovations of the 1920s and 1930s Explain the Great Leap?
The two most important inventions of the late nineteenth century were electric light and power and the internal combustion engine, and these are often described as a “General Purpose Technology” (GPT) that can lead to the creation of many subinventions.

The most important invention of all time was the discovery of how to transform mechanical power into electricity, which then could be transported by wires for long distances and then retransformed into whatever form of energy might be desired.  This passage is interested also for its perspective on how much of the modern world had already been invented at the time of its writing in 1932.

Without it not only would the street car again be horse-drawn, but the automobile and the airplane would stop.  For without electromagnetic sparking devices, how could gasoline engines function? 

Thus every source of growth can be reduced back to the role of innovation and technological change.

Few descriptions of the role of risk and chance in the process of invention are as evocative as that of D.H. Killeffer, writing in 1948:

Inventions do not spring up perfect and ready for use.  Their conception is never virginal and must be many times repeated.  One seldom knows who the real father is.  The period of gestation is long with many false pains and strange forebirths…Few of the children of the mind ever survive and those only after many operations and much plastic surgery.

William Baumol offers a related caution.  Entrepreneurs contribute to economic growth far more than the narrow word “innovation” can convey.

The 1870-1970 century was unique.  Many of these inventions could only happen once, and others reached natural limits.  The transition from carrying water in and out to piped running water and waste removal could only happen once, as could the transition for women from the scrub board and clothes lines to the automatic washing machine and dryer.  After 1970, innovation excelled in the categories of entertainment, information and communication technology:  Television made its multiple transitions to color, cable, high-definition, flat screens and streaming, and the mainframe computer was joined by the personal computer, the Internet and the World Wide Web, search engines, e-commerce and smartphones and tablets.


The Challenge Ahead of the U.S. – Strong Headwinds – Devastating Statistics
The timing of the stream of innovations before and after 1970 is the fundamental cause of the rise and fall of American growth.  In recent years, further downward pressure on the growth rate has emerged from the four headwinds that are slowly strangling the American growth engine. Rising inequality has diverted a substantial share of income growth to the top 1 percent, leaving a smaller share for the bottom 99 percent.  Educational attainment is no longer increasing as rapidly as it did during most of the 20th century, which reduces productivity growth.  Hours worked per person are decreasing with the retirement of the baby-boom generation.  A rising share of the population in retirement, a shrinking share of working age, and longer life expectancy are coming together to place the federal debt/GDP ratio after the year 2020 on an unsustainable upward trajectory.  These four headwinds are sufficiently strong to leave virtually no room for growth over the next 25 years in median disposable real income per person.

Gordon underscores the challenge which an almost unbelievable change in family structure represents.

For white high school graduates, the percentage of children born out of wedlock increased from 4 percent in 1982 to 34 percent in 2008 and from 21 percent to 42 percent for white high school dropouts.  For blacks, the equivalent percentages are a rise from 48 percent to 74 percent for high school graduates and from 76 percent to 96 percent for high school dropouts.  Not only is the rate of marriage declining, but almost half of all marriages fail.  The number of children born outside of marriage is drawing equal with the number of children born within marriage.  June Carbone and Naomi Cahn summarize the implications for the future:

The American family is changing—and the changes guarantee that inequality will be greater in the next generation.  For the first time, America’s children will almost certainly not be as well educated, healthy, or wealthy as their parents, and the result stems from the growing disconnect between the resources available to adults and those invested in children.

Much of this reflects the importance that females place on having an employed spouse, as well as that there are only sixty-five employed men for every 100 women of a given age.  Among young African Americans, there are only fifty-one employed men for every 100 women, reflecting in large part the high incarceration rates of young black males. 

Charles Murray’s most devastating statistic of all is that for mothers aged 40, the percentage of children living with both biological parents declined from 95 percent in 1960 to 34 percent in 2010.  The educational and inequality headwinds interact, leading to the prediction of a continuing slippage of the United States in the international league tables of high school and college completion rates. 

Other sources support Murray’s emphasis on social decline in the bottom third of the white population.  A recent study showed that between 1979 and 20009, the cumulative percentage of white male high school dropouts who had been in prison rose from 3.8 percent to 28.0 percent.  For blacks over the same time interval, the percentage who had been in prison rose from 14.7 percent to 68.0 percent.  That is, fully two-thirds of black male high school dropouts experience at least one spell in prison by the time they reach 40 years old.  For black graduates from high school (including those with GED certificates), the percentage in prison rose from 11.0 percent to 21.4 percent.

Any kind of criminal record, and especially time in prison, severely limits the employment opportunities available to those whose prison sentences are ending.  According to the FBI, no less than a third of all adult Americans have a criminal record of some sort, including arrests that did not lead to convictions; this stands as a major barrier to employment.

The Potential for Policy Changes to Boost Productivity and Combat the Headwinds
The potential effects of pro-growth policies are inherently limited by the nature of the underlying problems.  The fostering of innovation is not a promising avenue for government policy intervention, as the American innovation machine operates healthily on its own.  There is little room for policy to boost investment, since years of easy monetary policy and high profits have provided more investment funds than firms have chosen to use.  Instead, educational issues represent the most fruitful direction for policies to enhance productivity growth.  Moreover, overcoming aspects of the education headwind matters not only for productivity growth.  A better educational system, particularly for children at the youngest ages, can counter increasing inequality and alleviate the handicaps faced by children growing up in poverty.

Gordon goes on to document the growing inequality of our nation’s educational outcomes.

Throughout the post-war years, starting with the GI Bill, which allowed World War II veterans to obtain a college education at the government’s expense, the United States was the leader among nations in the college-completion rate of its youth.  But in the past two decades, the United States has stumbled, with its college completion rate now down to tenth or below.  College completion for households in the top quarter of the income distribution rose between 1970 and 2013 from 40% to 77%, but for those in the bottom quarter, it increased only from 6% to 9%. 

Education problems are even deeper in U.S. secondary schools, which rank in the bottom half in international reading, math and science tests administered to 15-year-olds.  We now rank 12th among developed nations in terms of the percentage of 25-34 year-old age group who have earned a BA degree from a four-year college (32%).

Most serious is the high degree of inequality in reading and vocabulary skills of the nation’s children at age 5, the normal age of entrance into kindergarten; middle class children have a spoken vocabulary as much as triple that of children brought up in poverty conditions by a single parent.

Toward Greater Equality of Opportunity – Preschool Education and the Financing of Elementary and Secondary Education
Though preschool is universal for 4-year-olds in countries such as Britain and Japan, in the United States, only 69 percent of that age group is enrolled in preschool programs, ranking U.S. participation as number 26 among OECD countries, with the poorest children least likely to be enrolled.  The Unites States is ranked 24th for the fraction of 3-year-olds participating in preschool programs, with a 50 percent enrollment parentage as compared to at least 90 percent in such countries as France and Italy.  The United States ranks poorly not just in the age at which children enter preschool but also in class sizes and per-pupil expenditures.

The benefits of preschool education apply to all students, but particularly to those growing up in low-income families.  Children of poor parents, who themselves have a limited educational attainment, enter kindergarten at age 5 suffering from a large vocabulary gap that limits their performance in elementary and secondary education and that leads to high dropout rates—and often to criminal activity.  Age 5 is too late for the educational system to intervene in the learning process, for by then, the brain has already developed rapidly to build the cognitive and character skills that are critical for future success.  Poor children lack the in-home reading, daily conversation, and frequent question/answer sessions so common in middle-class families, particularly those in which both parents have completed college.

Preschool comes first, because each level of disappointing performance in the American educational system, from poor outcomes on international PISA tests administered to 15-year-olds to remedial classes in community colleges, reflects the cascade of underachievement that children carry with them from one grade to the next.  No panacea has emerged in the form of school choice and charter schools, although there has been much experimentation—with some notable successes in which children from low-income backgrounds have earned high school diplomas and gone on to college.  An important component of the inequality and education headwinds is the U.S. system of financing elementary and secondary education by local property taxes, leading to the contrast between lavish facilities in rich suburbs which coexist with run-down, often outmoded schools in the poor areas of central cities.  A shift of school finance from local to statewide revenue sources would reduce inequality and improve educational outcomes.  Ideally, schools serving poor children should have the resources to spend more than those serving well-off children, rather than less as at present.



Book Exceprts_TheRiseandFallofAmericanGrowth

MY VIEW ON WHY THE U.S. AND RUSSIA MUST WORK TOGETHER

March 11, 2016

THIS ARTICLE FROM "THE NATION" PRESENTS THE ARGUMENTS I MADE IN A PANEL DISCUSSION ON WHY IT IS IMPERATIVE THAT THE UNITED STATES WORK WITH RUSSIA IF WE ARE TO SUCCESSFULLY CONFRONT THE ENORMOUS CHALLENGES OF FAILED STATES, TERRORISM, CIVIL WAR AND NUCLEAR PROLIFERATION.

 http://www.thenation.com/article/beyond-a-new-cold-war/

BRYAN STEVENSON--AN INSPIRATIONAL TALK TO BE READ AND READ AGAIN

March 10, 2016

YWCA'S HEART TO HEART BREAKFAST – BRYAN STEVENSON’S TALK
Bryan Stevenson is the Executive Director of the Equal Justice Initiative in Montgomery, Alabama. He is the author of the acclaimed searing indictment of our criminal justice system, "Justice Mercy".

He delivered a mesmerizing talk at the YWCA breakfast in Cincinnati, Ohio on March 8th.

Here is how I summarized what I had experienced. I am only sorry you could not experience in its entirety and in person.

*************************************

This is one of the finest talks that I can ever recall hearing.  Bryan took some time in disclosing the terrible inequalities and predicament we find ourselves in as a nation in terms of racial trauma.  He observed that statistically, one in three young black boys born today will be in jail at some point in their life, and the depressing statistics went on.  However, he quickly turned to the subject of the future and how to make change.  He built his talk around a very personalized portrayal of four principles:
1.     Proximity – Get close to the spaces where the challenge is.  Close to the people who are suffering.  How relevant this is to our recently commissioned Poverty Task Force which confronts the reality that about 40% of all children in Cincinnati are growing up poor.  Bryan found in his discussions that children 11-12 years old “don’t believe they will be free when they get to be 20.”  It takes me back to the importance of being intimate with the issues, with the consumer, with fellow employees. (at P&G).   I loved the way he tells his own history.  “There is power in proximity.”
2.     We need to change the narrative.  For example, as we deal with drugs, we have to stop dealing with it so much as a crime but as a health issue.  He made the fascinating contrast in how we treat alcoholics; we don’t criminalize them, throw them in jail.  
Our narrative today is too often rooted in fear and anger.  Everyone is vetting how tough they are on crime.  Life sentences are being given out for using marijuana or writing a bad check. 
Fear and anger lead to injustice.
We have to stop putting children in adult jails.  They are being hurt by others.
We need to recognize that “all children are children.”  The “great society is the one that deals and supports the most disadvantaged, not the most wealthy.” 
He offered the extraordinary insight that the “great evil of slavery was not as much the fact that it resulted in bonded labor as that it created the ideology of white supremacy which is continuing to live.”
Slavery didn’t end in 1865.  It just evolved.  It led to terrorism, not different than the terrorism that exists today in many ways.  KKK, lynchings, burning of blacks.  Blacks grew up amidst racial terrorism.
He made the interesting observation that blacks came up from the South not just to get jobs but to escape terror.  Of course, the North didn’t really welcome them; they were tolerated.  He feels we have been much too “celebratory” about civil rights.  We have really never faced up to the issue of the legacy of slavery.  That is certainly our task at the Freedom Center.
3.     We need to protect hopefulness.  We can’t correct injustice without hope.
His comments here again showed the importance of telling stories. 
4.     In the end, “We have to be willing to do the uncomfortable.”  Difficult things.  This certainly applies to making preschool for all happen and for confronting poverty.  We will have to do uncomfortable things.
He cited the opposite of poverty as not being wealth but “justice.”  In a later conversation with Shannon Isaacs, I loved how she described the opposite of poverty being:  “empowerment and dignity.”
*****

"WE HAVE TO WALK AWAY FROM THIS ROAD SHOW"

February 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.”
 

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THE MORAL RESPONSIBILITY OF BUSINESS--WHAT IS IT AND WHAT IS IT NOT?

February 17, 2016

The Moral Responsibility of Business

Some time ago, we were presented with a real drama in the States of Indiana and Arkansas, as legislation was adopted and then quickly reversed which proposed to give license to business organizations to refuse service based on their religious principles to gays and lesbians.  A broad array of business and business leaders objected to this, including the nine leading businesses in Indiana, WalMart, Apple, and many others.  New legislation was quickly introduced (and that in Arkansas modified) to explicitly indicate that this “religious freedom” legislation could not be used to discriminate against marriage preference. 

This is a very tricky area.  To what extent do businesses have the right and indeed the obligation to voice their position on moral or ethical grounds to sway public policy?  How does business strike the right balance between its values and abiding with an existing social policy, imbedded in law and perhaps embraced by a large percentage of the population, including its employees or customers?

Getting down to cases, as CEO in 1995, I reached the position that Procter & Gamble should provide equal benefits to individuals who are in a codified same-sex partnership.  We did this at a time when the majority of Ohioans opposed same-sex marriage.  We were not taking a position that these individuals were wrong in their belief.  We were taking the position that the same-sex partnership as it was codified made it right in the name of fairness to accord our employees in such a partnership the same benefits as a married couple.  It proved fairly controversial, but I believed it was right to do.  We were not making a moral pronouncement on same-sex marriage at this time.  We were saying that in the name of fairness there was no reason to deny individuals in this relationship same-sex benefits.

A related issue being discussed here relates to the “personhood” of a corporation.  Is a corporation a “person” or not? 

Many, perhaps most, would say, no, a corporation is not a “person.”  As one columnist said, a corporation won’t be a “person” until it is capable of being executed in the State of Texas. 

Where do I stand on this issue?  It depends on what you mean by “person.”

I would say that business has a “responsibility” as part of society to advance positions that are consistent with what as a corporate body (leaders, board of directors, best understanding of shareholders) represent correct and moral values.  I say this because I believe corporations have a major role to play in forming the cultural and value-based character of a society.  I do believe that corporations need to be humble and circumspect in taking on an issue.  They have to recognize the practical need to balance the interests of those it serves -- its consumers, employees, shareholders and the community. 

In other words, if a corporation took on a value-based position that would destroy its business, it would end up serving no one in the future.  Would there ever be occasions where it would have to go this far, to almost literally have to go out of business?  Yes, if its being in business meant threatening the life of consumers or anyone else.

When I say a corporation must be circumspect and humble, I mean that it must avoid becoming sanctimonious or in any way believing that it has a role of being a priest or prophet in its times.  It must speak judicially, though sometimes bravely, and it must avoid failing to do the good it can do at a given point in time because it cannot achieve perfection. 

Take the situation of Procter & Gamble in Saudi Arabia many years ago.  There was a social mandate that men and women could not work together in the same office.  P&G might have, given its commitment to gender equality, said that it would not do business in Saudi Arabia at all.  Or, I guess it could have taken the position it would violate the laws, though that would not have lasted long.  What did we do?  We set up separate office locations where women would work and where men would work and they would communicate between the two offices.  We did this on market research work.  We also pushed to change the social norms and the laws.  We felt that was right to do, not only morally; we knew it would be better for the business to have people working together in that way.  We felt advancing gender equality was right for the business and right morally.  We kept advancing this goal.

This raises a question:  is the test for a company taking a position on a moral or social issue whether it is relevant to the success of the business itself in the long-term?  Put differently, should businesses only weigh in on social and moral issues that bear directly on having the right (and by “right” I include being morally correct) business and working environment long-term?  I think the answer is yes, but I’d underscore the importance of taking a long-term view.  For example, I believe the commitment to achieve a sustainable environment is one that businesses should advocate, even beyond the immediate benefit of that for the business itself.   Why?  Because I believe businesses should understand that having a world in which they or any other business could operate long-term requires a sustainable environment.

I believe that a business has social and moral obligations that go beyond simply making money in any short- or medium-term measurable sense.

At the same time, I believe its judgments and pronouncements must be measured and put in the context of a business’s doing what is right and fair for its employees, its shareholders and its consumers, recognizing there will always be different points of view on what is right and fair.  While always seeking to do the “right” thing.  It must avoid being self-righteous or over-extending its role in advocating for what it sees as the common good.



THE ULTIMATE GAP STEMMING FROM INCOME INEQUALITY: "LIFE ITSELF"

The Ultimate Gap Stemming From Income Inequality:  Life Itself

The article by Sabrina Tavernise in the Saturday, February 13, edition of The New York Times, “LIFE SPANS OF THE RICH AND POOR” demonstrates in a horrifyingly compelling way yet another dimension in which income inequality impacts people’s lives—the very length of their lives.

In the early 1970s, a 60-year-old man in the top half of the earnings ladder could expect to live 1.2 years longer than a man of the same age in the bottom half.  Fast-forward to 2001 and he could expect to live 5.8 years longer than his poorer counterpart. 

New research released this month contains even more jarring data.  Looking at the extreme ends of the income spectrum, economists at the Brookings Institution found that for men born in 1920 there was a six-year difference in life expectancy between the top 10% of earners and the bottom 10%.  For men born in 1950, that difference had more than doubled to 14 years.  For women, the gap grew to 13 years from 4.7 years.

Why?  The report sees different smoking habits accounting for perhaps a third of the gap.  Some of the difference could be attributed to somewhat higher obesity.  But an enormous part is attributed to the availability of health care support in all its dimensions.

Here is another data point.  For men born in 1950, life expectancy is about 73 years, for the poorest 10%.  For the highest 10%, it is about 87 years.  Women are somewhat higher; about age 76 for the poorest 10% and about age 88 for the highest 10%.

Think of that.  A decade more of life for the highest income versus the lowest.  It makes you think about what we can do to at least provide people with the opportunity to escape poverty.  Which inevitably brings you back to education and development and health, starting from the earliest years, 0-5, including quality Pre-K.


'WHEN BREATH BECOMES AIR"

February 14, 2016


I finished reading one of the most mind-opening, emotionally moving books that I have ever read:  “When Breath Becomes Air” by Paul Kalanithi.  Kalanithi graduated from Stanford University with a B.A. and M.A. in English Literature.  He went on to earn a Master’s Degree in History and Philosophy of Science and Medicine from the University of Cambridge and graduated cum laude from the Yale School of Medicine.

He returned to Stanford to complete his residency training in neurological surgery.  At the age of 36, on the verge of completing a decade’s worth of training as a neurosurgeon, he was diagnosed with Stage IV lung cancer.

This magnificent book tells the story of his practice as a doctor treating the dying which flowed to the story of him as a patient struggling to live.  He died in March 2015 while working on this book.  His wife completed it.

I have never read a book which brings to life in anything so graphic way the incredible intricacy of operating on the human brain and the miracle that the brain represents.

There are too many phrases and thoughts in this book to try to summarize it in any way that could be satisfactory.  Yet, there were many thoughts that I resonated to so closely based on my own experiences that I cannot fail to record them for future reference.

“Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day.  It is a tired hare who now races, and even if I had the energy, I’d prefer a more tortoise-like approach.  I plot.  I ponder.  Some days, I simply persist.  Languor settles in.  There is a feeling of openness.  Now the time of day means nothing, the day of the week scarcely more.”

“Doctor and patient, in a relationship that sometimes carries a magisterial air and other times, like now, was no more and no less, than two people huddled together, as one faces the abyss.  Doctors, it turns out, need hope, too.”

Kalanithi’s memoir leaves us staring starkly into the inevitability of death but equally indeed more so that life is precious and miraculous and needs to be lived in the moment.



Kalanithi’s perspectives on faith and religion mirror my own in many ways.  Like many of us, it is clear he had moments, many of them, of deep disbelief.  Moments when, like most scientific types, “(I) came to believe in the possibility of a material conception of reality, an ultimately scientific world view that would grant a complete metaphysics, minus out-moded concepts like souls, God, and bearded white men in robes.”  He acknowledged spending a lot of his 20s working to build a frame for such an endeavor but, as he eloquently writes, “the problem eventually became evident:  to make science the arbiter of metaphysics is to banish not only God from the world but also love, hate, meaning—to consider a world that is self-evidently not the world we live in.

Scientific methodology in the end is the product of human hands and thus cannot reach some permanent truth.”  This makes “scientific knowledge inapplicable to the existential, visceral nature of human life, which is unique and subjunctive and unpredictable.”  It is unable “to grasp the most central aspects of human life:  hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.”

Like myself, Kalanithi returned to the “central values of Christianity—sacrifice, redemption, forgiveness—because I found them so compelling.”  The main message of Jesus, Kalanithi believed, as do I, is that “mercy trumps justice every time.”

Finally, I have resonated to Kalanithi’s rumination that “maybe the basic message of original sin is less an internal ‘feel guilty all the time'; maybe it is more along these lines:  ‘we all have a notion of what it means to be good and we can’t live up to it all the time.’”

So what is the aspiring metaphysician to do?, Kalanithi wonders, “give up?  Almost,” he replies.  But he goes on (we must) “struggle toward the Truth, but recognize that the task is impossible—or that if a correct answer is possible, verification certainly is impossible.  In the end, it cannot be doubted that each of us can see only part of the picture.  The doctor sees one, the patient another, the engineer a third, etc., etc.  Human knowledge is never contained in one person.  It grows from the relationships we create between each other and the world, and still is never complete.  And Truth comes somewhere above all of them where, as at the end of that Sunday’s reading, ‘the sober and reaper can rejoice together.’  For here the saying is verified that ‘one sows and another reaps.  I sent you to reap what you have not worked for; others have done the work and you are sharing the fruits of that work.’”