I find myself in the midst of two public discussions. The first is the question of whether Oregon Research Institute should be allowed to build a building in the research park; I am a Senior Scientist at ORI. A second is the question of what Lane County should do to improve public safety; I am a member of the Citizens Advocates for Public Safety, chaired by Jean Tate and David Frohnmayer.

As I awoke this morning, I found myself thinking warmly about all of the people involved in these discussions—whatever “side” or facet they are on. Consider their basic humanity. They care enough about what happens in our community that they are speaking up, risking criticism, and trying to make a difference. And they are all trying to create a community that sees to the wellbeing of everyone—our safety, enjoyment, and ability to thrive. Even when some advocates for public safety demand more punishment for offenders, I have no doubt that their advocacy stems from the belief that doing so would lead to more people being safe.

The same is true of the Research Park controversy. I have met many of the students who are leading efforts to prevent ORI from constructing its building according to its current plan. Clearly they are motivated—as are ORI’s people–by their vision of a city that will do a better job of caring for the environment, while at the same time, creating a community where people can meet, recreate, work, and enjoy each other. While the details of people’s strategies for getting there differ, I have no doubt that everyone wants to create a city that thrives, cares, and sees to the wellbeing of all of its citizens—and all of the other species that inhabit our community.
This may seem like some new-age psychobabble, but there is hard science behind it. Conflict is stressful to all concerned. Communities that lack social cohesion—trust and social support among their residents–have greater crime, stress, and disease. That’s why our Promise Neighborhood Research Consortium is trying to help high poverty neighborhoods improve the prospects for their young people by encouraging people to listen to, respect, and care for one another.
Public discussion throughout the nation is hampered by the tendency of people on all sides of issues to criticize and attack those with whom they disagree. Frequently, they are egged on by their supporters. We can break free from this national disease by noticing and celebrating the things that people in other “camps” do that contribute to Lane County. This will require that our leaders boldly reach across ideological lines to publicly recognize what others are doing. And their supporters will need to thank them for doing so. Let us have a race to the top, where the first leader to publicly recognize the good efforts of traditional opponents gets credit for breaking the log jam of ideology and starting us on a new era of pragmatism.
Americans are a pragmatic people. In fact, we invented the formal philosophy of pragmatism. The essence of pragmatism is evaluating our ideas, in terms of how well they help us solve practical problems, rather than in terms of their consistency with an ideology or the number of people who agree with us. Recent research in psychology shows enormous benefits for people who learn to hold their opinions lightly and evaluate them in terms of how well they help achieve valued outcomes.
When people adopt this stance, they become more open to others’ opinions and more caring toward others. It is this way of thinking that makes me think that I have some good ideas about what we should do to improve our community, but that others may have good ideas and that all desire a community of safety, warmth, and wellbeing.
My half-awake vision of our future this morning was that people on different sides of these issues would meet in the community of the future—a future we are so vigorously debating–and be able to warmly greet and interact with each other; proud of the community we have created and pleased that all of us are able to live in such a kind and caring place.
It would be ironic if the very process of trying to create a better community made life more stressful for all us. So when someone with a different view speaks, notice their basic humanity. See if you can find the values that you share. Don’t they also desire a safe, thriving community where people like and respect each other? Perhaps we can foster the kind of community we want by first caring for each other in the very process of debating strategies for moving forward.

When I read Milton and Rose Friedman’s “Free to Choose” sometime in the eighties, I became convinced that free markets have an important function for society in that they evolve efficient and innovative products and services; better products and services get selected by buyers who are trying to maximize their own benefit and sellers who are motivated to maximize their economic gain.  Over time new and more efficient products and services evolve. Societies which have adopted free market principles have seen considerable improvements in their economic wellbeing.

There are, however, externalities—the costs to third parties of transactions. While the transaction may be mutually beneficial to buyer and seller, others may be harmed by the transaction. For example, a power plant may produce electricity and sell it to satisfied consumers, but may emit mercury that harms those living near the plant.

But that is another story. Here, I want to enumerate things that government does that free markets have typically not done (though there have been innovations such as cap and trade that have improved ways that markets can solve problems that were traditionally thought to require governments “heavy hand.”)

Here is a place to start that might surprise you—the redistribution of wealth. Wilkinson and Pickett’s recent book, The Spirit Level, documents the relationship between economic inequality and human wellbeing. I detailed this in an earlier post. In both international comparisons and studies of the 50 American states, greater economic inequality is significantly and substantially related to higher rates of health and social problems.  The findings stand up using a variety of measures of inequality and health and social problems, including  life expectancy, level of trust, mental illness, obesity, children’s educational performance, teenage births, homicides, imprisonment rates, and social mobility.

Developed countries vary in economic inequality quite substantially, with Japan and Scandinavian countries being the most equal (the richest 20% earn about four times the bottom 20%), while the U.S. and Singapore are at the other end.  In the U.S. the top 20% earn 9 times what the bottom 20% earn.  Wilkinson and Pickett present a graph of the relationship between inequality and their index of wellbeing. The countries are tightly clustered around the regression line, with more unequal countries having much higher levels of these problems; the U.S. has the highest score on health and social problems.

The Scandinavian countries achieve greater equality through taxation.  Japan does not.  It has a culture that never evolved toward great inequality even as its corporations became very successful internationally. So government tax policies are not the only way to get to greater economic equality, but such redistribution does appear to be one way.

Wilkinson and Pickett present considerable evidence that the underlying mechanism involved in this relationship is the stress produced by living in an unequal society.  Sapolsky’s entertaining book on stress gives the details of how chronic arousal produced by unpleasant interactions, the threats associated with loss of one’s material goods, and unfavorable social comparisons contribute to heart disease, depression, and many other problems.  Simply knowing that you don’t have as much as another person seems to be stressful and in more unequal societies, there are many more opportunities to be stressed.

But there is more.  Even the wealthiest people in a society are worse off if the society is unequal. For example, among working age males, life expectancy is lower for the wealthiest slice of people in unequal England and Wales than it is in more equal Sweden.

Then of course there are all the things that tend to not get mentioned when the efficacy of government is discussed.  Fire protection, police, road building, bridges, etc.  Some may argue that even these functions should be privatized.  And there has been a movement to privatize some of them, in particular education. Thus, far the empirical evidence does not show that privatizing schools produces superior results, though, as we say in my business, more research is needed.

One reason that practice may not measure up to theory is that, while a market place is an arena that selects efficient products and services, the actors within that arena are simply trying to maximize their gains.  They can do that by lobbying government to pay them handsomely for whatever they can get government to fund. And so we see KBR winning no bid contracts and electrocuting soldiers through shoddy wiring. Government is not inherently more corrupt or inefficient. It is always a matter of the contingencies you set up.

But I am particularly concerned about the role that government can play in ending the cycles of poverty that so many American’s are mired in.   Despite one of the most free market economies in the world, we have not reduced the proportion of citizens living in poverty (other than those over 65, who, thanks to social security and Medicare, are no longer the poorest age group in society.)

(And speaking of Medicare, its administrative costs are way below those of private insurance companies. This is an example of where the market does not outperform government. Health insurance companies have to have profits and pay more to executives.)

Children who are raised in poverty have much poorer outcomes–health, learning, behavior problems, and psychological problems.  For example, poor families and families that experience economic reversals have more conflict which directly contributes to their children engaging in drug use and failing academically. And, reducing poverty reduces family stress and improves outcomes for young people. For example, Jane Costello and her colleagues at Duke University found that psychological and behavioral problems declined among Native Americans after their tribe opened a casino that significantly increased families’ incomes.

The Institute of Medicine Report on prevention documents evidence-based preventive interventions for every phase of development–from the prenatal period through adolescence–that can prevent multiple problems.  Here is a list of examples (asterisks indicate that the programs that have been shown to save more than they cost):

• *The Nurse Family Partnership. Nurses contact at-risk pregnant mothers and work with them through the pregnancy and the child’s first two years of life. In three randomized trials done over 25 years, the program has been shown to significantly reduce mothers’ welfare dependency, increase the time to her second pregnancy, reduce child abuse, and even reduce the child’s likelihood of arrest in adolescence.
• The Family Check-up for parents of young children. This program has been provided through the Women, Infants, and Children’s program (a federally funded program that also has clear benefits for at-risk parents). In three brief contacts with parents, the check-up reinforces the parents’ strengths and gives them additional advice on parenting. It improves children’s social and cognitive competence—two factors that are essential to further successful development.
• *High Quality Preschool Education.  High quality preschool prevents the development of the entire range of psychological, behavioral, and academic problems. James Heckman, the Nobel Laureate in economics, has concluded that investing in early childhood education has the best return on investment of any preventive interventions.
• *Behavioral Parenting Skills Training for children and adolescence. There are numerous interventions that improve parenting and prevent antisocial behavior, drug use, and academic failure.  There are more than fifty randomized trials of the efficacy of these interventions.
• *Multidimensional Treatment Foster Care takes young children in foster care or adjudicated delinquents and provides them intensive support and training to the foster parents. The program reduces recidivism among adolescents and significantly improves young children’s functioning.

The one problem with the cost-benefit analyses is that the costs are incurred by government, but many of the benefits go to others—those whose houses weren’t broken into, the health care system that didn’t need to treat people for drug addiction, alcoholism, cardiovascular disease, or cancer.  A society that chooses to reduce its psychological, behavioral, and health problems will incur greater governments cost for a long time to come.

When Milton and Rose Friedman wrote their book, much of what they said was theoretical. In theory, free markets would lead to economic growth and greater wellbeing because they would motivate those in the market to provide increasingly better products and services. Events since then have proven their theory to be remarkably prescient.   Some of the examples of the success of free markets, include the collapse of communism, as country after country embraced free markets, the economic development in these countries that followed their switch to capitalism, and the technological development of the past century.

But that is not the same as saying that free markets and limited government are going to produce the best outcome in every case. That is an empirical matter and the evidence provided above points to a number of ways in which government activities benefit people more than sole reliance on the free market.

The implicit assumption in discussions of these issues is that a given economic and political system should be preferred because it improves human wellbeing. Certainly Milton and Rose Friedman were arguing for free markets, not because they would benefit a small proportion of the populace, but because they would benefit all to a greater extent than systems that depended on governmental control.

As support for a free market approach to policy grew in the U.S. over the past thirty years, I think we have not always heeded the evidence and have lost sight of our ultimate goal.  Yes, deregulation and reductions in government programs contributed to economic growth in this country.  But unquestioning belief in small government and little regulation have also produced policies that are harming many people.  I include under this heading the very substantial increase in economic inequality in the U.S. and the corruption involved in business such as KBR fighting regulation, while making vast sums of money from government contracts that received little oversight.

Ultimately we have a choice. Should the ultimate goal of social policy be to increase the wellbeing of all of the members of a society?  If this is your goal, then you need to evaluate each policy in terms of its contribution to this goal. Above I point to evidence that an economic system that allows great disparities in wealth harms many people. This implies to me that we should be pursuing policies to rectify these disparities.

This is not to say that we should abandon accountability. The evidence-based programs and policies that I advocate are likely to improve human wellbeing.  But when government (or the private sector) implement them, there must be monitoring to ensure that they are being implemented carefully and that they are achieving the outcomes that they are expected to produce.

One last thought. The National Institutes of Health has funded the vast majority of medical and public health related research in the world for the past forty years.  I could tell you many problems with the system. Yet it has unquestionably contributed to human wellbeing.

So let me amend my last post.  Taxes, Yes!  Accountability Too!

I was looking through the policy briefs that Kelli Komro and her team of policy experts have compiled for our Promise Neighborhood Consortium.  Here are some of the things that empirical evidence shows will benefit the population: After school programs that include academic supports; Reduced classroom size in grades k through 3; Provision of nutritious food by schools; High quality childcare and preschools for young children; and Living wage ordinances.  Every one of these things, plus numerous programs and practices, would improve child and adolescent development, reduce crime, substance abuse, and depression; increase academic performance; and improve the productivity of the workforce.  All of them are lacking because there is no money to pay for them.

Higher taxes spent on these things would be of benefit not only to the direct beneficiaries of these policies and programs, but to entire communities. There would be fewer people breaking into our houses, more well-trained and conscientious employees to work in our companies, and fewer sick people.

As Wilkinson and Pickett’s book The Spirit Level documents, other nations which tax more heavily and spend the money on programs and policies of this sort have longer life expectancy, less crime, and less stress-related disease.

For the past forty years, a network of wealthy individuals and organizations has been promoting this anti-government, anti-tax philosophy and thanks to their domination of the media and public discussion, we have had low taxes and a deteriorating nation.  The most amazing thing about their advocacy is that they have millions of people who directly benefit from government and get no benefit out of our low-tax practices taking to the streets to support the very wealthy having fewer taxes.

So here I am in this little blog on a Friday afternoon, wishing that voices would be raised to tell the truth about how we need more taxes on those who have so much more that most.  (And I am one of them and happy to pay.)

So if you have read this, copy the URL and send it to other people.  Not just true believers, but your Aunt in Missouri who watches nothing but Fox.  If enough voices are raised, we could influence the direction of the country.

More taxes for those who have so much!

I was surprised that anyone would put something like that on their car.

If I had been able to, I wanted to ask the driver (almost certainly a guy), how he thought “Fat Chicks” might feel about his sign.

But I am confident that if I had asked him, he would have laughed and dismissed my question with some sort of derision.

His proclamation is just another example of the ways that people do things that hurt others.  It poses a real problem for anyone who wants to foster nurturing in every corner of life.  What do we do with such behavior?

Typically we try to punish it.  I am sure that more than one person has angrily accosted this guy about his sign. I am equally sure that such attacks are highly reinforcing for the guy.  But even if our criticism of him were aversive to him, I doubt that it would bring about the kind of change in his behavior that we would love to see–more caring and respectful toward all women, sorry about the hurt he had caused to women who might feel sensitive about their weight.

I have to believe that for this guy,  “No Fat Chicks” was a statement about how he was superior to at least someone on this planet.  He was so “cool” that he could reject “fat chicks.”

I am convinced that underneath virtually every hostile act toward another, there is fear.  Fear that we aren’t good enough.  The function of this guy’s sign was to proclaim that he was better than someone.

The problem we have is that if we want more and more people to become nurturing, we have to be nurturing enough to them that they can let go of their fear, feel cared for, and in that context, make contact with the pain and needs of others.

The ACT work suggests a way out of this problem.  It shows that getting people to look at their thoughts and feelings as thoughts and feelings–not as facts and helping them get clear about their values helps people to become more caring.  If we could get close to that guy–or if he came to us for help because, say, another woman had left him, we might be able to get him to notice his fears about not being good enough, defuse from them, such that they became less powerful for him. In the context of becoming more caring toward himself, he might begin to feel more empathy for others.

But of course, we aren’t likely to have access to him.  And, since beginning this piece I searched the internet and discovered there is a website called NoFatchicks.

There appears to be a network of folks who are getting their social support by banding together around this theme.

This is guaranteed to get them the kind of mutual support from other members of the club, and constant anger from those who are offended by it.

Here is another place where ACT seems relevant.  Suppose, instead of attacking this guy OR getting angry about his statement, we simply defuse from the thoughts and feelings we have about it. Notice how angry it makes you.  If  you are a “fat chick” notice the hurt the phrase evokes. Can we make room for the hurt, anger, frustration, or depression we feel when we see something like this and do what will work to move people in a more caring direction?

The hard part is that attacking people is unlikely to work.  We hesitate, of course to do anything that might remotely be seen as accepting such talk.  In fact, in writing this, I hesitated to use the term “Fat Chicks” because I feared that people would say I shouldn’t even use the term.  It is like the “N word.”

But does it work to give words such power?  Does it reduce their power to have words be so powerful that we can’t even say them?  Over time do they become less powerful?  I don’t think so.

My history professor at the University of Rochester went down to Alabama to witness the marches in Selma. He reported that civil rights workers had started to call Martin Luther King, “The Nigger’s Jesus.”  It was nonviolence in action. They did it because they knew that embracing this derision took the power out of it.

What would Gandhi do?

So if we want someone like the young man with the “No Fat Chicks” sign to become more nurturing, we have to deflate the power of hostile or hurtful words by recognizing that they are words.

What would happen to this guy if every time he stopped anywhere an overweight woman came up to him and smiled and showed genuine interest in him?

I don’t want anyone reading this to think that I feel callous toward women who are overweight. It was my own feelings of hurt for anyone who would feel hurt in reading this that made me write this post.   (And feel free to comment, especially if you have other views of it.)

There is a recent ACT study, by the way, that found that helping people to simply defuse from negative thoughts about their weight (that is, got so they noticed the thoughts, but just accepted that they were thoughts and didn’t get caught up in them).  Not only did these negative views become less hurtful to them, they lost some weight as well (though weight loss was not the purpose of the program).

This issue goes well beyond “fat chicks” (don’t you just love ‘em!).  Every controversy is fed by two warring factions shouting epithets at each other from secure bastions of their own.  Fox vs. MSNBC, Republicans vs. Democrats, Conservationists vs. Resource Extraction Industries.

We have been trying to shout the other side down ever since this great experiment in free speech began in America.  It hasn’t worked.

Maybe the only way we will ever come together is for some group of us to start a movement that is about defusing from all the “loaded words.”  We might call it “The [blank] word! Movement.”   It would start with chanting all of the words that are used to revile and arouse people.

Comments?

In the first couple of chapters Wilkinson and Pickett provide an overview of the relationship between economic inequality and various measures of health and wellbeing. There were two key findings.  First, International studies of the relationship between average income and longevity and happiness show that once average income gets above about $10,000 a year, there is very little increases in either longevity or happiness.  Once people’s basic material needs are met, more affluence does them little good on either of these scores.

Second, in both international comparisons and studies of the 50 American states, greater economic inequality is significantly and substantially related to higher rates of health and social problems.  The findings stand up using a variety of measures of inequality and health and social problems. Wilkinson and Pickett created an index of health and social problems that included: life expectancy, level of trust, mental illness, obesity, children’s educational performance, teenage births, homicides, imprisonment rates, and social mobility (which were equally weighted).  Developed countries vary in economic inequality quite substantially, with Japan and Scandinavian countries being the most equal (the richest 20% earn about four times the bottom 20%), while the U.S. and Singapore are at the other end.  In the U.S. the top 20% earn 9 times what the bottom 20% earn.  Wilkinson and Pickett present a graph of the relationship between inequality and their index of wellbeing. The countries are tightly clustered around the regression line, with more unequal countries having much higher levels of these problems; the U.S. has the highest score on health and social problems.

So… We’re number one!

The Supreme Court’s decision will ensure that we maintain our superiority.  It will no longer be necessary for corporations to lobby legislators and give the limited amounts of money that they can give directly to candidates under campaign spending limitations.  Now a corporation—or more likely an industry can own the legislator; they can simply do their own campaigns for—and against—candidates.  How credible is the threat to a legislator that “Your career is over if you cross us,” when the legislator knows that the corporation can spend any amount of money they please?

Think about the tobacco industry. I have studied thousands of pages of tobacco company documents and have testified in federal court about how the companies spent millions of dollars of to lobby against restriction on their advertising that was recruiting the new young smokers who are vital any brands performance. But in many cases their efforts had to be circuitous. For example, they introduced a bogus campaign ostensibly to discourage young people from smoking.  Tobacco Institute documents showed that at the same time that the companies were spending millions on advertising targeting adolescents, they were telling opinion leaders and legislators that their “Responsible Living Program” would keep young people from smoking. As I indicated in my testimony, the companies carefully tracked the value of this effort to discourage legislators from restricting advertising to young people, but at no point did they check to see if the campaign reached any parents or youth. There was no evidence that it did.

Now the tobacco industry will simply be able to select its favored candidates and the ones it wants to get rid of and spend millions getting the result they want. And as industry documents show, the companies have huge amounts of money to spend protecting their interests.

As I have written elsewhere, it is less useful to view this as a matter of the perniciousness of the people in this industry than to view it simply as a natural process of organizations working to protect their interests. Any organization that has survived for very long has done so because it evolved practices that discern threats to its future wellbeing and opportunities that can increase the flow of funds needed to survive and prosper.

Two other prominent examples of industries that will use this new opportunity to protect their wellbeing are the alcohol industry, which risks restrictions on its extensive and effective advertising to youth and the food industry, sectors of which are making and marketing many foods that contribute to obesity, diabetes, and cardiovascular disease.  These industries will also use their substantial resources to ensure that legislatures and the Congress have the “right” people in it.

What industry would not do this? On every major issue of public wellbeing there are industries that stand to lose from changes in public policy that may benefit the common good, but will curtail a profitable activity.  They would be fools to not use this new tool to influence public policy in their favor.

How will this affect inequality?  Businesses will naturally oppose any policies that stand to reduce their profits.  The economists Alesina and Glaser have documented how American social policy is already far less redistributionist than that in Europe. These are precisely the policies that affect inequality—social “safety net,” higher taxes on the wealthy, paid leave for parents of newborns, high quality daycare for young children, etc. These are all policies that have proven benefits in ensuring young people’s successful development, which ensures a productive work force and fewer people who are a drag on the economy.  Without such policies, we spiral further toward an economically unequal society, as poorer citizens are unable to develop the skills they need, their behavior becomes more problematic and easier to stigmatize, and  public support for “those people” is further eroded.

What to do about this excruciating situation? For me, after disgust and depression, comes the only path that seem available, namely to figure out what steps can be taken to move our society in a better direction.  The only difference from before this happened is that I am less optimistic, more distressed, and find us starting from an even deeper hole.  But it still comes down to what we value and how we can make our lives about working for what we value.

I have two thoughts. The first is about the importance of the public health framework. Discussion of the policies that we have and the ones we don’t have in this country is typically framed in terms of conservative economics, political freedom, the inefficacy of government, etc.  Public wellbeing is seldom prominent and empirical evidence is seldom mentioned.

Public health provides both a conceptual framework and a significant infrastructure for addressing all of these issues. Public health practices evolved out of efforts to deal with epidemic disease, then extended to any disease, and then to any risk factor for any disease. In essence, the public health perspective targets the reduction in the prevalence of any process that harms a significant number of human beings.

It is from this perspective that we need to examine the harm to public wellbeing of this Supreme Court decision can do.  We will need empirical work not only on the effects of specific policies on outcomes such as youth development, but also research on the harm that is done to the economy when young people’s development is harmed by impecunious public policy.  In short, we need to make policies that affect economic inequality matters of public health.  The public health infrastructure is large and growing. There are about 20,000 members of the American Public Health Association.  Given that public policy is firmly committed to reducing disease, the contribution of economic inequality to disease becomes a matter of public policy.

Many of the people reading this know far more about public health than I.  But there are also significant areas of the behavioral sciences that aren’t well linked to the public health system.  The work on Acceptance and Commitment Therapy as well as work on the evolution of prosociality would both strengthen the public health movement and benefit from conceptualizing prosociality and psychological flexibility in terms of behaviors whose increasing prevalence would benefit public health.

In particular, if corporations have now been given a new freedom to pursue their interest, perhaps our best hope is to change what they see as their interests.  Conservative economists have often argued that the U.S. has generally had a higher rate of economic growth than Europe because we have superior social policies. Paul Krugman recently documented the inaccuracies in this argument.  But one of the things to consider is that European nations have simply chosen to forgo some of their economic growth in favor of ensuring the wellbeing of all of its citizens. This is a value choice.

Whether businesses support or oppose policies such as paid leave for parents of newborns is partly a matter of their calculation of whether it will benefit or hurt them financially. But it is also a matter of values.  Is it possible that we can extend the scientific understanding of benefit of prosocial values and learn how to foster them even among the leadership of our major corporations?  That may seem like a tall order, especially because growing  inequality itself fosters a focus on status and materialism that will make it very hard to move people in the opposite direction. But from this vantage point, I see no other options.

This is an exciting time in America. We are witnessing the first significant effort to comprehensively address concentrated poverty in a generation and numerous efforts to ensure that all young people develop successfully. Examples of these efforts include the Obama Administration’s Promise Neighborhood initiative (inspired by the success of the Harlem Children’s Zone), the Department of Education’s Race to the Top, and a National Prevention System that a federal interagency task force has been discussing.

There is solid evidence that these ambitious efforts can succeed. The recently released Institute of Medicine report on prevention identifies numerous evidence-based programs, policies, and practices that can ensure young people’s successful development.  All of the proposed efforts will draw on this knowledge.

But these efforts could fail if they do not use the scientific tools that got us this far.

Traditionally, once a program’s value has been shown by one or two rigorous experimental evaluations, it is widely implemented without further evaluation. But such a practice is risky for at least three reasons.

First, it is well-documented that a program’s benefit cannot be replicated unless the program is implemented with fidelity. If we do not measure fidelity and verify that benefits are being achieved, the quality and thereby the impact of our interventions will deteriorate.

Second, we cannot be sure that an intervention that worked for one population will work when it is tried in a different, and perhaps more challenging environment.  This is especially true when we first begin to implement evidence-based interventions in high poverty neighborhoods where they have not been tried before.

Third and most important, if good science does not accompany these important efforts, we simply won’t know if they are working. Two things are paramount: good measures and good experimental evaluations.

Measure Outcomes

We must abandon the traditional model of doing sporadic evaluations of social programs and replace it with a public health system for ensuring young people’s successful development. In this system, communities will routinely monitor youth wellbeing and will evaluate the impact of their policies, programs, and practices on outcomes for children and adolescents at each stage of development.

We now have the measures to know whether infants are thriving, young children are ready for elementary school, elementary school students are progressing at grade level, and whether adolescents are learning and developing the prosocial behaviors that will protect them from the major threats to adolescent wellbeing such as substance abuse, delinquency, depression, and risky sexual behavior. With these measures it is possible for every community to know how well their young people are doing, and to take steps to ensure their wellbeing when measurement shows that some are failing or falling behind.

This innovation would be no different than the system for management of the economy that was developed in the 1940’s or the one for managing infectious diseases that evolved over the last four hundred years of struggle to control epidemics.

Why shouldn’t we devote as much energy to assessing young people’s wellbeing as we do to measuring the health of the economy or the course of epidemics? The costs of our failures in childrearing are just as great as those involved in failures to manage the economy or control epidemics. For example, the economist Ted Miller estimated that adolescents who develop multiple problems cost this country more than $400 billion each year.

Experiment

But even if we build an infrastructure for permanent measurement of young people’s wellbeing, our success will be limited if we don’t also use the experimental tools that have created the mountain of evidence that shows that young people need nurturing environments in order to develop the skills, interests, and health habits needed to live productive and caring lives.  We can achieve reductions in social and environmental risks and toxins, as well as promoting safe, nurturing, and health-enhancing environments.

Randomized trials are the “gold standard” for knowing whether an intervention has benefits.  Every prescription medication that is approved by the FDA has gone through at least two randomized trials.  By randomly assigning people (or schools, workplaces, or communities) to get or not get the intervention, we can be confident that any differences in outcomes for the two groups are due to the intervention.  This is why we can be so confident that behavioral parenting skills programs help parents replace harsh and inconsistent discipline with patient and reinforcing nurturance of their children’s skill; this type of intervention has been tested in more than fifty randomized trials around the world—with all ages of children and every level of income.

Interventions must target specific developmental stages and contextual conditions to produce desirable effects. Rigorous repeated evaluations can then be conducted of each intervention approach.

Policymakers may blanch at the thought of doing randomized trials to test community interventions. But David Hawkins tells us that when the State of Washington lacked funds for prevention work in all of the communities that applied, they randomly chose the communities to be funded and, as a result, created a randomized trial of the impact of the intervention. Why shouldn’t we do something similar at the federal level?

If we do, we will know with some confidence whether the intervention is working. If it is not, it will prompt further research that will incrementally improve the quality of our interventions. If we don’t do this, then, when the political winds change, claims will be made that once again we fought the war on poverty and poverty won.

Randomized trials are not the only rigorous way of testing the effects of what we do. If communities have a good system for measuring the outcomes and processes you are trying to affect in multiple neighborhoods or communities, you can intervene in one and see if the things you targeted change there and not in the places where you didn’t intervene.  If it looks like you are getting an effect, you can move on to the next community or neighborhood.   This is called a Multiple Baseline Design (MBD).

The monitoring or surveillance needed for MBD’s are also good for management of program implementation and quality control. Implementing comprehensive preventive interventions in whole communities is a complex and arduous process. You would be crazy to think it will go smoothly in every case or even that we know how to ensure implementation when we begin.  But, if you accept that, and recognize that in the initial intervention you will need to learn from your mistakes and get better as you go, then you will have the makings of a multiple baseline design.  Once you have some success in the first community you can go onto others. You can use the first community to train people for work in subsequent communities. And you can use evidence from the results in the first one to garner support for more efforts.

Careful experimental evaluation of social interventions is something new under the sun. Through all of human history we have tried to improve the human condition through guesswork and ideology, uninformed by empirical evidence. It is as though we have been climbing the sheer rock face of El Capitan in Yosemite Park with our bare hands—rising high occasionally, but inevitably slipping back.

But as the Institute of Medicine report documents, a growing number of careful experiments have allowed us to steadily—and at an accelerating pace—identify the programs, policies, and practices that can ensure that every young person develops successfully.

There is much work left to be done. If all the agencies of the federal government work together, we can have a new round of experimental evaluations that identify the most effective strategies for getting tested programs, policies, and practices widely disseminated and that refine our interventions so that they are even more effective. To do otherwise would be like climbing half way up El Capitan with our new scientific tools and then throwing them to the ground for the rest of our climb.

          (I don’t say any of this to say this is what we must do. Don’t forget I am planning to cut back in two years and retire in five.  And I don’t want our dreams to become our burden.)

What We Could Accomplish in the Next Two Years

          We have gotten fifty neighborhoods at various levels of involvement with the PNRC.  All of them have registered and get information from our website about evidence-based practices.  Twenty or so have implemented one or more of our recommended measures and are using our website to collect data and to display it to their residents, policymakers, and organizations funding them. Thanks to materials we produce from their data, they are able to effectively publicize to residents and policymakers the importance of the outcomes that our measures document and, increasingly, public attention and practice is shaped by evidence and discussion about the outcomes and processes that our measures assess.

          At least twenty neighborhoods, are implementing programs that we have specified and informed them about. We have partnered with them in securing funding for these programs. Solid designs (interrupted time series designs?) are in place to detect the impact of these programs. The measures that these neighborhoods are collecting are just the ones needed to detect effects of these programs.

          Many more neighborhoods have residents and neighborhood organization leaders who are using kernels to influence prosocial behavior.  In many cases, good experimental designs are being used evaluate the use of the kernels.  (Our success with the kernels followed our working out the nettlesome issues of conflict of interest and ownership. J )

          Our work on policy, which has been distilled down to one page fact sheets, as well as high quality reviews of the empirical evidence is influencing policy making and advocacy in twenty to thirty of our communities and our repository of policies has become the place that local, state, and national policy makers look to guidance about the most useful policies.

          Many more unregistered users of the website are getting information from it about evidence-based prevention.

          Our online journal has been started. Just as scientific publications went from Latin in the time of Newton to English in the time of Priestly, we have evolved new and more effective ways of communicating scientific knowledge through an online journal that makes use of all of the possibilities of the internet and makes the knowledge simultaneously accessible to both scientists and nonscientists. As a result, science is once again an integral part of public discussion, as it was in Priestley’s and Franklin’s day.

          Through partnerships with neighborhoods and communities, we have helped many neighborhoods get funding to implement effective interventions to reduce poverty and improve outcomes for children and youth. And we have become a key resource for evaluating these initiatives.

          Geoffrey Canada likes us!

          The White House has a ceremony celebrating the Promise Neighborhoods and we are invited.  (Don’t forget to take a souvenir napkin.)

          We have succeeded in getting additional funding.  Some of the funding is for an NIH funded center on prevention in high poverty neighborhoods. The rest is for specific groups of investigators who are conducting various trials in multiple sets of neighborhoods; they are all part of the Center.

          What else?

Five Years

          Published papers are beginning to accumulate that show the benefits of a variety of interventions in high poverty neighborhoods.  One of those papers reports on the impact of massive diffusion of kernels in a series of neighborhoods.

Thanks to the use of kernels and programs like positive action that increase positive reinforcement (caring, support, warmth, appreciation, love, and forgiveness) the levels of violence are found to be declining in neighborhoods where we have succeeded in disseminating these programs and practices.

          The Center for the Promise Neighborhood Consortium has continued to articulate and disseminate programs, policies, and practices that are making a difference in the lives of now millions of people. All around the world people come to our website for the most useful information about what works, how to implement it, and how to evaluate.

          Our Center has succeeded in creating a “marketplace” in which neighborhood and community leaders, neighborhood residents, policymakers, and early career and established scientists can connect with each other exchange information, support each other’s efforts, and form new teams.

Ten Years

          Histories have begun to be written about the eight years of the Obama administration. One of the most impressive accomplishments that is widely noted is that concentrated poverty has begun to decline and there has been a marked increase the proportion of children living in poverty who are succeeding in school and in their social relations. Violence in poverty neighborhoods has declined.  Thanks to the adoption of new policies the proportion of families living in poverty is declining across America.  At the same time, there is an increased sense across the nation that we are all one people and that it is in everyone’s interest to support the successful development of children—even when they are different from us in race, ethnicity, or economic situation. The vision of one nation that Obama articulated in his first campaign has begun to be achieved.

          In many of the accounts of this progress, mention is made of the Promise Neighborhood Research Consortium, which brought the knowledge and tools of the behavioral science community to bear on the problem of neighborhood poverty and contributed to the increased use of data to guide the evolution of more nurturing family, school, workplace, and neighborhood environments.

Looking back over this, I can think of one reason, why we have not generally done this.  It can turn into a burden of expectations.  That is where the ACT stuff comes in handy.  We can have such fears and still work to try and make the world a little bit more like what we can envision and a little bit less like the one we now have.

After a little more waiting I went to the United counter to give them my claim check.  (Believe me I know the routine.)  The Dad and his two sons were there ahead of me. The youngest son–maybe four–was holding his stuffed owl and crying quietly. It had been damaged–not too badly to my adult eye–but I suspect that to him–his dear friend had been hurt.

His Dad told him in an angry tone  to be quiet.  I felt so bad.  Without thinking I tapped him on the back and said in a soft voice, “It’s fine.”  I then went over to the boy and talked to him about his owl and how it got hurt.  It seemed to help a little.

I felt bad for the Dad too. The bag was apparently new and he was frustrated. 

I guess I said, “It’s fine,” because I always think that the first discomfort of parents in public situations is that their crying child is embarassing to them. And I bet that boy has at times cried at much higher volume.  I bet Dad was afraid of that.

I hope I didn’t add to Dad’s frustration and embarassment–both for his sake and for his sons. 

So what should we do when we see a parent getting angry and frustrated with their kid?  How do we calm and support the parent and help them be more nurturing to their child?  Mostly stay out of it I suppose,. But maybe we could come up with some cultural practices that were well recognized signs that we support parents being patient and caring and get it that that can be hard.

Walk down a hall where a young child is oblivous to whose way they get into and parents will inevitably chastise the child.  I always say in a friendly way that is just fine. That is one opportunity.

In the case of health care reform, it is as though America has decided to move its rescuers half way to the spot where people are falling in. For example, the Senate Committee on Health, Education, Labor and Pensions’ proposes to fund “basic preventive services such as screenings, for diabetes, depression, and colorectal and other forms of cancer, tobacco cessation, and nutrition counseling.” Such screening will prevent many people from developing life-threatening illnesses.  But the Congressional Budget Office argues that the cost savings would be minimal.

We would do better to go all the way up stream to the source of these problems. We need to prevent children and adolescents from developing the psychological and behavioral problems that contribute to serious illness.

Young Americans who develop depression, antisocial behavior, tobacco, alcohol, and other drug use, academic failure, or obesity will become the sickest Americans. Each of these problems contributes very substantially to physical illness. For example, boys who are aggressive as children and adolescents are at greater risk for heart disease.  Aggressive children are also more likely to fail in school, take up cigarette smoking, become addicted to drugs, and become depressed—all of which are risk factors for physical illness.  Similarly, depression increases the risk of heart disease, strokes, and diabetes. Waiting until people develop these problems and then treating them in order to prevent cancer and heart disease will be much more expensive than preventing them in the first place.

Fortunately, there is substantial evidence that these problems can be addressed through behavioral interventions.  A just-released report of National Research Council and Institute of Medicine enumerates interventions that prevent the development of multiple problems. Interventions for poor, stressed young women that support them during their pregnancy and the first two years of their child’s life can prevent child abuse, welfare dependency, and even the children’s delinquency in adolescence. There are numerous carefully evaluated family interventions that can prevent the development of aggressive behavior and all of the problems that result from it. There are programs that can prevent depression. There are nurturing school interventions that can produce extraordinary results. For example, Sheppard Kellam and his colleagues showed that a simple game, played in first grade, which rewards children for cooperation and doing their school work, can prevent the development of substance use, suicidal behavior, and antisocial behavior when the children are adults!

Many of these interventions are cost-effective. They save more in criminal justice, health care, and education costs than they cost—sometime by substantial margins.

The NRC-IOM report urges that the logical next step is to widely disseminate these proven preventive interventions. That will require further research to develop and test strategies for making these valuable interventions widely and effectively available. Their call is in keeping with President Obama’s proposal to fund “Promise Neighborhoods” that would be modeled after the Harlem Children’s Zone and provide comprehensive supports to families and schools to ensure every child’s successful development.

Unfortunately, these efforts are not receiving the support they deserve. As the IOM report documents, prevention research receives only a tiny portion of the funding from the National Institutes of Health. And although the NIH has been trying to inspire ground breaking innovations in research through their Roadmap initiative and the “Grand Opportunity” initiative, the emphasis on these initiatives is almost entirely on neuroscience, medical, and biological research. For example, the review committee for a recent proposal we submitted for research in high poverty communities was reviewed by a panel that had only one behavioral scientist.  Not surprisingly, it did not fare well.

The IOM report calls for the White House to take the leadership on this problem. Currently, we have myriad agencies of the federal and state government charged with addressing one or a few of these problems—despite the fact that the problems co-occur and stem from the same set of environmental conditions—poverty, harsh parenting, stress. Moreover, like the town by the river of drowning people, most of our resources are going to treating problems, rather than preventing them. With White House leadership it would be possible to develop a coordinated, comprehensive strategy to gets preventive interventions widely and effectively deployed. Doing so would reduce health care costs as well as all of the increasingly burdensome criminal justice costs.

University of Oregon running back LaGarette Blount punched a Boise State player after the their game on Thursday night after the player apparently taunted Blount about his pre-game statement that Boise State needed an “ass whoopin.”  So far no nurturing in this.

But University of Oregon coach Chip Kelly acted in a way that strikes me as a model of nurturing. He suspended Blount for the rest of the season saying that such behavior cannot be tolerated.  But in doing so, he said with considerable emotion, “I love LeGarrette Blount. … LeGarrette Blount needs this football program, he needs structure. He understands that he made a mistake, and that he needs to pay for that mistake. But we’re not going to throw LeGarrette Blount out on the street.”  Kelly said that Blount would not lose his scholarship, would continue to practice with the team, and would continue to attend classes. Blount indicated that he accepted the consequences of his behavior and apologized for what he did.

This strikes me as an example of what we need to be doing whenever people make mistakes. At the same time that there need to be negative consequences for aggressive behavior, we need to recognize that people will go on living. When we fail to provide for their moving forward successfully in life, we make further trouble likely—for them and for those around them.

I have always admired the way that Oregon’s football and basketball coaches showing caring and respect for their players. 

Many people who read this blog may not be interested in sports.  Some may feel that football is too violent and not a good model for society. But I think we need to pragmatically look at every facet of society and see how we can move it toward more nurturance.

So I salute Kelly for the course that he chose.