The Measure of America: American Human Development Report, 2008-2009
The Measure of America: American Human Development Report, 2008-2009

The Measure of America

Dec 19, 2008

Following the UNDP model, this report uses a Human Development Index that provides a single measure of well-being for all Americans. The disturbing results reveal huge disparities in the health, education, and living standards of different groups across the nation.


DEVIN STEWART: I'm Devin Stewart, from the Carnegie Council. Thank you very much for coming.

Today we are talking about The Measure of America: American Human Development Report 2008–2009, the very first of its kind. It's a human development report about the United States of America. We have two of the authors, Kristen Lewis to my left and Sarah Burd-Sharps to her left. We have a PowerPoint presentation to accompany the presentation.

This is a fascinating book. It's based on the United Nations Development Programme methodology for developing countries, putting a lens on ourselves to see how we measure up, using, for example, these three categories of measurement: access to knowledge, health, and livelihood.

There is this one chart that I just want to point to before we start that was really eye-catching. There are many eye-catching charts here. It's really well done.

Over the past 25 years or so, from 1980 to 2005, of the top 12 countries in the world, the United States started out as number 2, right below Switzerland, and has fallen all the way to the bottom, number 12, in 2005. It started in 1980.

I'm just giving you a flavor, but we are going to go through the whole thing right here. Both authors are directors of the project called the American Human Development Project. I'm going to turn it right over to Kristen Lewis to start out.

Thank you very much for coming.


KRISTEN LEWIS:Thanks, Devin. Thanks very much for having us.

Let me just first tell you a little bit about what we are going to tell you today. First we are going to go over a little bit about the project. We are going to discuss what this concept of "human development" is. We will do that briefly, because I think this audience understands that concept pretty well already. We will talk a little bit about what the benefits are of applying this approach—which was developed for developing countries, obviously—to the United States. We will tell you what we found. We will talk a little bit about what it might take to boost the scores on our index of different groups in different parts of the country that right now are lagging behind.

In terms of a little bit about the project, our main goal in the project was to introduce to the United States an idea, which is human development, that has been very successful around the world in broadening the way in which people understand, measure, and track people's well-being, moving from strictly economic metrics to other things, in addition to money, that expand people's choices and freedoms. We are funded by the Conrad N. Hilton Foundation, Oxfam America, the Rockefeller Foundation, the Annenberg Foundation, and we are a project of the Social Science Research Council.

Though we are using a methodology that was developed by the United Nations Development Programme (UNDP), we ourselves are an independent project and not in any way affiliated with the United Nations.

So what is this concept of "human development"? Basically, the definition we use is that it's the process of improving people's well-being and enlarging their freedoms and opportunities. The idea draws heavily on the capabilities work of Nobel Laureate Amartya Sen and uses that as its conceptual framework. The model emphasizes the everyday experience of ordinary people. It includes the economic, social, cultural, political, and so forth, processes that shape the range of options that are available to people.

So human development is about two things. It's about what people themselves can do to enhance their well-being and expand their opportunities. It's also about how institutions of society constrain or expand the choices and opportunities that people have. Basically, human development is about what ordinary people can do and become.

This is a little graphic of the human development concept. Here's a little person here. Right now his or her opportunities are constrained; interests are constrained. Those little light bulbs—they have four capabilities there. So the human-development process is basically moving up that line to this place, where you have expanded capabilities and choices.

The concept of human development is far-reaching. It includes things like political participation, personal and community security, and environmental sustainability—basically, a range of things. But the index measures just three factors. It measures education, health, and income. These three components are valued by people the world over as the building blocks of a good life and the ones that we would argue that Americans care about the most. These are the things that people are talking about around the kitchen table, that they are worried about when they are thinking of the future. They are areas where there is not too much debate around whether they are important or not. Everyone pretty much agrees that they are important.

How do we measure these things?

A long and healthy life we measure using life expectancy at birth. That is calculated from mortality statistics from the Centers for Disease Control and Prevention.

Access to knowledge is measured by two indicators. One is educational degree attainment for the population age 25 and above—so it's high school diploma, college diploma, and graduate degree—and school enrollment. School enrollment is for everyone ages 3 to 24. Are they in school or not? That gets preschool and it gets whether people are attending college or not.

A decent standard of living we measure using median personal earnings. The personal earnings figures might seem a little bit low to you. That's because I think people are accustomed to seeing household earning figures. But we really wanted to be able to disaggregate our data by gender, men and women. Since men and women are often living together in households, you can't really do that if you don't look at personal earnings that each person earns through their own labor and wages and salaries.

So those were our indicators.

Then we look at them through different lenses. We disaggregate our data by state, by congressional district, the 436 congressional districts, by gender—as I just said, men and women—and by race and ethnicity. We use the five major Census Bureau categories for doing that. Then we have these three indices. We add them together, we divide by three, and we get one number between zero and 10. Ten is high and zero is low. That's how we figure it out.

This is, of course, not from our book. This is from the global Human Development Report of UNDP. These are the rankings of countries around the world. You will see, in 1980, 1985, and 1990, the United States was second but then, in 1995, started to slip, and in 2000, we are now 12th.

Why has this happened? The United States has actually made steady progress in human-development indicators over the course of this time, but other countries have made much quicker progress, particularly in terms of health and education. They have been much more efficient than the United States in transforming income into positive health and education outcomes for their people.

What are some of the possible benefits of the new approach? Why do we think it's a good idea to apply this human-development methodology to the United States? There are a few reasons.

First of all, it's a well-honed international methodology that has a robust conceptual framework which is well-known and very effective around the world. We hoped that it could offer some new insights when applied to the United States.

The second is that right now there is a real polarized debate around a lot of important issues. There is sort of a partisan shouting match, in a lot of ways, around really important issues that Americans care about, like health and education and income. We feel that there are a lot of people in the middle of the political spectrum who really care very much about these issues, but who are alienated by this polarized debate and who feel helpless, in a sense, like there is nothing to do but throw up their hands—"It's so complicated, how can we possibly do anything about it?"

We are hoping that by offering this objective, fact-based analysis, as well as examples from other countries about what is actually working, that will give more of a sense of optimism and create a sort of common ground for people to discuss these issues.

We wanted to really emphasize that economic indicators tell only part of the story. The person who created this methodology and this conceptual framework was someone called Mahbub ul Haq. He had worked at the World Bank in the late 1970s and 1980s. He felt very frustrated with GDP as a measure of progress. He really felt that it didn't capture people's well-being. He would often use the example of Pakistan and Vietnam. At that time, they had about the same per-capita income, around $2,000 per year per person. But at the same time, people in Vietnam were twice as likely to be literate. The literacy rate was around 84 percent or so; in Pakistan, around 41 percent. People in Vietnam were also living a full eight years longer. He really felt that that was an illustrative example of how, if you just looked at GDP, you would think the countries were doing about the same, but when you looked deeper, you found that they were having very different human-development outcomes.

We also thought this would be a useful way to hold elected officials accountable for very different results that our index shows in terms of human well-being.

And we wanted to connect research to action. One thing we found when we started the research on this report was that there is just an overwhelming amount of fabulous social science research out there that could be so informative, so helpful for people to really understand what's going on in the country, but also for the formulation of policy. Unfortunately, most of it is very hard to get at. It's written in very obscure sort of scientific language. Maybe it's available in subscription-only journals. It's not really written in a way to link it to action at all. So we hoped that we would be able to bring some of that interesting and informative research to a broader audience.

We're talking a lot about this index. What did we actually find?

In addition to doing the index of today, which is sort of a snapshot of where we are today, we also did historical trends analysis from 1960 to 2005, every decade and then 2000 and 2005. What we found was that in terms of human development, there was steady progress:

  • The index score went up by about fourfold or so.

  • In terms of life expectancy, life expectancy from 1960 until now increased by eight years, which is significant.

  • Rates of high school completion—that's the population of adults 25 and older who have a high school degree at least—doubled. It was only 41 percent or so in 1960. It was surprising to us that it had been so low at that time. College completion and graduate school completion rates went up by about four times.

  • Income almost doubled, though from 2000 to 2005, it stalled.

Two things are important to emphasize about this—or three things, better said.

One is that we made progress, but other countries have been progressing more quickly. That's the first thing.

The second is that this is, of course, an aggregate. This is the overall country as a whole. But you will see that some groups, some parts of the country are lagging behind. They are maybe where the country as a whole was in 1960 or 1980 or 1990, on different indicators. So that is an important thing.

The third is that this can kind of give the impression that it's merely the passage of time that is creating these better outcomes and that we just have to wait for a few more decades and everyone will be doing better. That's not necessarily the case. Of course, this progress was fueled by policy choices, by economic growth, and by all sorts of things.

This is the map of the United States, obviously. The dark color is the highest scores; the lighter color is the lowest scores. You can see right away in looking at it that the Northeast is the region of the country that is doing the best on the index and the South is the region that is doing the worst.

Within the Northeast, does anybody have a guess what the state is with the highest index?

PARTICIPANT: Rhode Island.

PARTICIPANT: New Hampshire.

PARTICIPANT: Massachusetts.

KRISTEN LEWIS: Massachusetts is second. It's actually Connecticut that wins the prize, that has the highest index in the country. Mississippi is at the bottom of our well-being scale.

Some people look at this and maybe they are surprised that it's Connecticut versus Massachusetts. A lot of people guess Massachusetts. A lot of people guess Vermont also. But no one is really that surprised about Mississippi. Sometimes they say, where's the news here? Mississippi has been at the bottom of these well-being scales for decades. How is this newsworthy?

One way to think about it, to make it a little bit more newsworthy or to kind of reacquaint ourselves with its importance, is the idea that Connecticut, if current trends continue, is where the country as a whole is going to be in about 2020, and Mississippi is where the country as a whole was in the late 1980s. So that's about 30 years, three decades of human progress, or a generation of human progress, that separates the top-ranked state and the bottom-ranked state, in the same country. That's a pretty serious disparity.

As I mentioned earlier, we did disaggregate also by congressional district, by 436 congressional districts. You all should be feeling really full of well-being, you should feel that your opportunities are enhanced and your choices are myriad, because the east side of Manhattan has the top rank in the country. The bottom is actually around Fresno, California. A lot of people are surprised by that. They would assume that the lowest congressional district would be, say, in Appalachia or in the Mississippi Delta, but it is actually the Central Valley of California. There is a lot of agriculture there, obviously.

So that's how the map looks.

This one shows everything at once. It shows all the disparities, all the different lenses. It shows that the Northeast is at the top; Connecticut at the top; Congressional District 14 in New York, New York's east side, at the top.

Then we also disaggregated by gender and by racial and ethnic group. This makes it look as though men are much ahead of women. Actually, statistically, men and women are doing about the same. It's just the size of the bubbles there. Men are doing a bit better than women. But the way in which men and women arrive at their same overall score is very different. Men are brought there by their higher incomes; women are brought there by their higher health scores and slightly better educational scores.

Asian–Americans top the list of the major racial/ethnic groups in the United States, followed by whites. As you can see, there is quite a big difference. Actually, Asian–Americans are quite far ahead on our scale of well-being, then whites, then Latinos are next, then Native Americans and Alaska natives, with African Americans, in terms of well-being, at the bottom of this scale. Again, different things are driving this. Asian–Americans are very much pulled ahead, as you will see, by education. African–Americans are really impeded in their well-being by health scores that are comparatively poor.

When we disaggregate by gender, race, and ethnicity all together, Asian–American men are doing the best and African–American men are doing the worst. In terms of scores, there is about a 50-year gap between Asian–American men and African–American men in terms of human well-being.

Now I'm going to turn it over to my colleague Sarah, who is going to take apart the index a little bit and talk about the different components.

SARAH BURD-SHARPS: Any composite index is really only a hook for getting people interested in looking at these issues. But to really understand what's going on, you, of course, need to delve into the different pieces of the index. So I'm going to go through quickly what we found in terms of health and education and income. I'm going to also look at what we found comparing the United States to our peer nations. We use the 30 countries of the OECD.

First of all, in terms of health (again, the dark is higher levels of life expectancy), average life expectancy in the United States—these data all come from 2005—is 78. However, when you break it down by state, Hawaii is where you live longest overall, on average, and Washington, D.C., is at the bottom.

That disparity is magnified when you look at congressional districts. One thing I want to remind everybody of is that congressional districts are all about 600,000 people. It's an apples-to-apples comparison. It's not taking districts that have high-density population versus others. The way that they are districted, they are about the same size population.

If you live in Congressional District 8, which is a suburb of Washington, D.C., you can expect to live, on average, a decade longer than the same 600,000 population size in rural Kentucky. So in the same country, a newborn in this district of Virginia can expect to live a full decade longer, on average.

You can see the way the spread is there. For big groups, the East is doing well, the West is doing well, the Northwest is doing well, and the South, in life expectancy, is significantly behind.

Looking at life expectancy by race and ethnicity, there is an enormous gap in this country. There is about a two-decade difference between Asian females and African–American males. Of course, women, on average, the world over, live about five years longer—a biological advantage. So comparing men to women is not entirely fair. But if you look at the gap, for instance, between Asian females and African–American females, it's also quite surprising and a lot of concern.

Looking at this in the context of history, African Americans' overall life expectancy is a shorter lifespan than the average American did in the late 1970s. That's the context of where we stand in history.

I'm going to do a couple of global comparisons now as well. In the report, the index itself was sort of the beginning of the analysis. There is a chapter on health that really looks beneath these indicators and beneath the averages to understand what's going on and what some of the root issues are there. We also did a lot of comparing of the United States to other countries.

In terms of health care, we spend more than any country on Planet Earth, both in gross numbers and in terms of per capita. We spend three times what Japan spends on health care per person, yet they outlive us by four years. We are number 24 in terms of our peer nations in Western Europe and the Scandinavian countries, Australia, Japan, Canada, et cetera. That's our ranking. We are actually even lower, because there are a number of non-OECD countries that come in when you look at the full table.

So clearly we are not getting a very good bang for our health-care buck. Hopefully, help is on the horizon. We'll see what happens. There is certainly momentum brewing, and a recognition that we are way beyond reaching a crisis.

In the book we have a quote from President Truman in 1949, who says, "In such an affluent nation, how can it be that there are people who don't have access to affordable health care? We must without any delay get there." That was in 1949.

When I came across that, I thought, "Well, some things take a while."

The last international comparison I want to do is infant mortality. I think it's really important to recognize that the United States has one of the worst infant-mortality rates of any of our peer nations. The rate at which babies are dying before their first birthday is extremely high in this country. We calculated that if we were top-ranked in infant-mortality rate, 21,000 American babies in 2005 would have lived to celebrate their first birthday instead of dying prematurely, many times of preventable causes.

So that's a little bit of an international framework for our health indicators.

To give you a flavor of the book, we tried to look beyond just the numbers at what is really going on, really to look at life chances and how the different circumstances of people's lives affect them. This is sort of a case study of two girls, both now 8 years old, both diagnosed a few years ago with severe asthma. One, who lives in the suburbs in Westchester, has parks to play in, rarely misses school, never spends those terrifying nights in the emergency room with a severe attack, can participate in gym, has nebulizers in all her after-school programs, et cetera. Another girl lives in a project in Brooklyn, in a neighborhood that has a huge waste-transfer station, a lot of asthma in the community, because they are breathing the waste, in a house with a lot of cockroaches—cockroach droppings are a known asthma trigger—et cetera. We try to look at two children with the same condition, but how it plays out in terms of how much school they miss, what the experiences of their lives are, and how it affects their ability to reach their full potential.

Now I want to move to education. Again, we will start with the state map. At the top is Washington, D.C., and at the bottom, again, is Mississippi. This is what we call the "Washington paradox": In health, it's at the bottom. In terms of education and, you will see in a minute, as well in terms of income, it's at the top. I'm sure you all can figure out why. It has to do with mobility. People are moving to Washington, D.C. because they are attracted by well-paying jobs that require a high level of education. But they are not dying there. They are leaving and going back to places with much higher life expectancies. It's the people who are born and live most of their lives in Washington, D.C., who are the ones who figure into the very low life expectancy.

Moving to congressional districts, at the very top is around Malibu in California, where I think only five percent of adults 25 and older don't have a high school diploma or equivalency, versus the bottom, which is in Texas, around Houston, where nearly half the adults there today 25 years and older don't have a high school diploma or equivalency. There are a number of congressional districts where that is the case.

Just to remind you, the education index is not only high school; it's looking at the highest educational degree that you have attained. But for me, that's one critical measure. In our globalizing world where knowledge is at such a premium, not having that basic requirement pretty much guarantees a life of challenge to having economic security and to having choices.

This table is too little and hard to read. But there are couple of things that I want to show. In every one of the five ethnic groups that are the major categories that the Census looked at, women have more education than men, except Asian–Americans, where men are slightly above. In every one of the other categories, women have higher levels of educational attainment than men.

Moving a little bit to the international realm, just a couple of comparisons. The first one is, our upper secondary graduation rate, which in the United States translates to high school, is actually comparatively very low, as compared with our peer nations. The other thing that really surprised me a lot as we were doing this research is that we have the highest level of teenage pregnancy of any of the nations—just way off the charts. For Japan, the Netherlands, and Switzerland, it's under five per 1,000 girls, young women, ages 15 to 19. In the United States, the rate of teenage pregnancy is more than nine times greater. And teenage pregnancy is known to be the end for many girls of their high school education. I forget what the statistic is, but very few girls who become pregnant in high school go on to graduate from high school.

So that's looking at the international picture.

Moving on to the final one, which is income, median earnings are about $27,000 in the United States. By state, the range is from Washington, D.C., which is about $37,000, to Montana, which is about $22,000. Just to remind you, median earnings is both full- and part-time workers 16 years or older, individuals.

Looking at it by congressional district, the span is much broader. Where we are right now it's $51,000, and around the Central Valley, around Fresno in California, it's significantly lower than that, $17,000 a year, which basically means that 50 percent of the people in that district are barely above the poverty rate. The poverty rate in this country varies depending on the size of the family. That's not a poverty wage.

Looking at earnings by race and ethnicity, white males are at the top, but Asian males are extremely close. Latino females are at the bottom—significantly lower wages. As Kristen mentioned, despite the fact that women live longer in every ethnic group and have higher levels of educational attainment in virtually every one, men earn more. I don't need to say much more about that. You can draw your own conclusions.

Just a couple of things about income. We looked a lot at distribution of income in the United States. It's widely known that the income inequality in this country, particularly over the last eight years, has been increasing greatly. These figures never ceases to astound me. Basically, the richest fifth of households in America take home more than half the income and the rest of us, 80 percent, take home less than half. That's what this martini glass is showing you.

This is a bit about net worth. While in the index we are not able to measure wealth or net worth because the data are not available by congressional district, it doesn't mean that we don't see assets and building of assets as extremely important for human development. This chart basically shows that over time nonwhite net worth and assets have been increasing, but white net worth and assets have been increasing so much more that the gap has become a chasm. Net worth and assets are not only important for, for instance, if you lose a job, to weather a bad time or if somebody becomes sick or something, but it's also critical for investing in the next generation. An absence of assets means it's extremely hard for you to send your children to college, to help pay for their mortgage on a first home, to invest in the next generation. This gap is extremely troublesome from the perspective of the transmission of advantage or disadvantage across generations.

Child poverty: we have the highest rate of child poverty of any of our peer countries. This is looking at income poverty. The United States is at the very bottom there—a very, very high rate.

PARTICIPANT: How are you defining child poverty?

SARAH BURD-SHARPS: It's percentage of kids up to 17 years in households that have 50 percent of the median income. It's income poverty only, but it's using more of a European way of looking at it. The only way to make international comparisons in income poverty is to use 50 percent of the median. We are the only country left that doesn't use relative poverty as a measure. All European countries and Nordic countries switched over long ago to that. So the only way to make those comparisons is by switching to the way that they measure income poverty.

These data, by the way, come from UNICEF, which has done tremendous work on this. It's this scorecard that they did for child well-being in OECD countries. Some of these comparisons are very hard to make because of the way data are collected.

Just a couple more things on the international side.

One is, we did some research looking into asset building in this country. There are policies in this country to help support Americans to move into the middle class and to build their assets, to own a home, to save for retirement, to open a small business. However—and this is based on studies commissioned by the Federal Reserve itself—the lion's share of that investment that the government makes in building assets goes to the already-wealthy, helping to buy the seventh home and not the first home.

I think it's not very well-known that there is $380 billion a year in lost tax revenue and investment for asset building, for homeownership, for retirement, for small business. Much of it is going to the wealthy.

We looked at examples of how other countries are trying to battle that kind of inequality. One very successful policy that the U.K. government started just two years ago is called the Baby Bond Act. Basically, every kid, when they are born, gets a savings account. The government deposits about $500 into it. If you are lower-income, it deposits double that. When you are age seven, they deposit money in it again.

There are 30 million households in America that have no bank account whatsoever. Starting kids off with a bank account is a great way to get started.

In the book we look at best practices from other countries around the world. This was one. They tried it and they have found it to be tremendously successful. Families are allowed to contribute to it, to a finite amount, tax-free, and they are contributing. So it breaks the cycle of living day to day and month to month—it can help to break that cycle.

One other international comparison has to do with the way that the United States supports families to balance their work responsibilities with their home responsibilities. The reality in this country is that more than three out of four mothers of school-age kids are in the workforce. The notion that people are choosing to work or not to work is a little bit of a rosy picture of the situation. The new normal is two parents working in a household or a single parent working in a household. But our policies have not caught up with this new normal. We are one of only four countries in the world that has no federally mandated paid maternity leave. We, the United States, find ourselves in the company of Papua New Guinea, Swaziland, and Liberia. These are the four countries that have no federally mandated paid maternity leave.

Likewise with things that are critical for parents of children to be able to balance their responsibilities. I'm sure this resonates with all of us. There are certainly companies, and there are even a couple of states, that have stepped up and mandated this, in the absence of a federal mandate. Unfortunately, what then happens is that people who are working for good companies, with decent wages, have these benefits and then people who are in low-wage, more marginalized occupations don't have these opportunities. They are the ones who often need them more, because they can't pay for somebody to stay with their kids when they are ill, et cetera.

I'll turn it over to you now.

KRISTEN LEWIS: We did this analysis, and then the natural question is, what will it take? What do we need to do in order to boost the scores? Since it was a political season and it's an election year—we are a nonpartisan enterprise, and we were very keen to remain that way, both in reality and also in the way in which we appeared—we didn't take any kind of detailed stand on any kind of policy. So our policy recommendations are very broad. We don't say, for instance, that there should be this exact response, but we do highlight areas in which, without action, it will be impossible to progress. (Sort of a convoluted way to put it.)

But one thing I do want to show you first is how important policy is. This is just showing the poverty rate in the United States from 1958 to 2006. You see a huge drop in poverty among the elderly and poverty among children. That's because of public policy. The poverty rate for working-age adults remains pretty much the same over time—it goes up and down, but not a big change—whereas all sorts of policies to aid parents with young children who aren't working—and then also Medicaid and Medicare and supplemental security insurance among the elderly has cut elderly poverty, for instance, in half.

So the public policy is tremendously important.

So when we are talking about what needs to happen, we are talking very much about policy formation in these areas.

Here they are, the eight items. Basically, we had two in each of the areas we looked at—health, education, and income—and then we had two more that really related to vulnerable populations and vulnerable parts of the country.

In terms of health, we have promoting prevention and making health care affordable to all Americans. What we are talking about here with promoting prevention—the lion's share of life-expectancy gains in the last half of the last century were drawn from preventive things—cigarette package warnings or seatbelt laws, helmet laws for motorcycles, and all these kinds of things to prevent death. That's how the majority of our life-expectancy gains have occurred, whereas we are spending most of our money, 95 percent, on curative and end-of-life care. So we think that a greater investment in preventive health care is going to help us a lot as a country.

The second is the big, obvious one, which is making health care affordable for all Americans. Every other industrialized country in the world has managed to ensure that all of their people are covered by health insurance. It's not that hard. There is so much debate here. Yes, it's complicated. Yes, it's hard. Yes, no system will be perfect from the get-go. But everybody else in the world has managed to do it. There is really no way we can claim that it's just impossible and throw up our hands. It's an urgent thing that the United States really needs.

In terms of education, we have two recommendations there. One is to modernize K–12 education. We mean two things by that. One is to address the horrible inequalities that we all know about in the public school systems. The second is to prepare kids for a globalized world, rather than having all this emphasis on basic skills. Yes, basic skills are very important, but kids need higher-order skills in order to succeed in a globalized, knowledge-based world.

In terms of investing in at-risk kids, there is so much research showing that early intervention, intervention before kids even reach school, has the greatest economic return and that every dollar invested can yield anywhere from $4 up to $17 worth of benefits to that child and also to society at large. So that is a critical area.

In terms of income, strengthening and supporting families with policies that allow working parents to balance their work and home-life responsibilities is one, and aiding asset building, particularly among people who don't even have a bank account, who don't have savings. Negative net worth is the reality for most Americans. The average American household has $8,000 just in credit card debt alone. This is a critical area for human development.

Last but not least, one is to launch a Marshall Plan for the Gulf. These states have been at the bottom of these lists for decades. They continue to be. Our data were before Katrina, even. Things are obviously worse now than they were.

The last is to take responsibility for the most vulnerable. What we mean here are, for instance, kids in foster care or adults with persistent and severe mental illness. Right now the burden falls very much on the individual or—in the case of, for instance, mental illness—on the family to care for that person. This is a burden we should take up as a society—for that person, but also for their family and for all of us—in order to be the civilized society we think we are.

So that's it. Thanks very much for your attention.

Questions and Answers

DEVIN STEWART: Thank you very much.

I'm sure we have lots of questions.

First, do you have an assessment of why it's so bad? You have given a lot of depressing statistics. We feel really bad about ourselves here. You have given some helpful signposts for the future, some suggestions on policy platforms.

Are there a couple of key areas that have contributed, in a policy framework, to such a sorry state of affairs?

SARAH BURD-SHARPS: I would say that the major reason we fell down to 12 and those other countries surged ahead of us was an investment in people, particularly in terms of health care, affordable access to health care for everyone. It's very clear from our research that lack of health insurance—you die earlier, period. It's incontrovertible.

In terms of education, we have systematically underinvested in education of the next generation.

It's obviously much more complicated than that, but if you ask for the big-ticket items, that's what I would say.

DEVIN STEWART: That's very helpful. Thank you. Go ahead.

QUESTION: One real quick question. On the income distribution slide, I wonder if you have a historical comparison. I suspect it's gotten significantly worse in the last decade or so, the distribution from the wealthiest to the poorest.

The second—this isn't supposed to be a quibble, but in looking at the presentation, it occurred to me that almost 99 percent of the presentation was based on quantitative data. You were looking at the number of people who had gone through high school, college, and so on and so forth, and then at the end you got into it with the caring penalty for mothers, for example, as a qualitative or interpretive factor, as it were. Then the recommendations became more qualitative.

For example, living as I do in a state that is doing extremely well, New Jersey, there are pockets of places where people would say a high school diploma has been devalued incredibly over the last 30 years. So just to look at the fact that someone has a high school diploma, from parts of Newark, is simply not enough. It seems in your eight recommendations you get into that, in a way that perhaps wasn't reflected, for me at least, in the data assembly in the beginning.

KRISTEN LEWIS: In terms of income inequality, for sure. From the postwar period, the 1940s to, say, the mid-1970s, economic growth and prosperity was shared, broadly shared. So this rising tide did lift all boats, in a sense. But since the mid-1970s, the richest basically have been peeling away from the pack and the wages of middle-class and low-income workers have basically stayed the same, in terms of keeping dollar values constant. That has gotten significantly worse in the last 30 years or so.

In terms of your point about the qualitative versus quantitative, it's important to keep in mind that this kind of index is really just to start the conversation. It's an advocacy tool, in a sense. It's to draw people's attention to huge disparities. It doesn't really tell why and it doesn't tell what to do. It flags it; it waves a big flag around it.

What we tried to do in the book was to do what you suggest, which is to talk a little bit about what's behind the health numbers, the income numbers, and the education numbers. One thing we do talk about a lot is, for instance, the quality of education and the huge disparities. That doesn't show up in this. It would be nice if there were some way to bring that in.

At the same time, the disparity, even putting just quantity, is still pretty shocking. Then, if you go beyond that number, it grows more so, if you talk about quality a bit more.

QUESTION: Kudos, really. It's a fascinating and excellent job. I found it very, very interesting. Being a former UNDP person, I really value enormously what you have done.

I have two very simple questions. Sarah, you mentioned that you presented this report in Washington. I wanted to ask what the reaction was from Washington government circles—if you have had a reaction—and secondly, what UNDP's reaction here in New York has been to your study. Did they facilitate anything?

KRISTEN LEWIS: In the days before we launched, we went around and actually met with all the offices of the congressional districts that were at the bottom of the index, out of courtesy. We didn't want it to be a "gotcha" surprise exercise, where people would find out about their rankings when a reporter called or something like that. So we did that. I had the pleasure of telling the Fresno congressional district that they were at the bottom of the 436. They were not happy, but they were extraordinarily gracious and extremely kind to me. They kept saying, "We're not mad at you."

It's very upsetting. That's the problem with a rank list. Someone is always going to be at the bottom and nobody, obviously, wants to be at the bottom.

At the same time, they did point out that there had been a study a few years back which called the Central Valley the "New Appalachia." So it wasn't a surprise to them. Nonetheless, they weren't super-enthusiastic about that. But they were constructive.

Then there were many people from other low-ranking congressional districts and states that felt that it would be a useful tool in terms of arguing for greater resources or greater focus by policymakers and things like that.

So people were very receptive, very enthusiastic. Obviously, the ones at the top were really, really happy. The 8th Congressional District in Virginia, for instance—Rep. Jim Moran talked about it. He wrote an op-ed about it—

SARAH BURD-SHARPS: He continues to talk about it.

KRISTEN LEWIS: He continues to talk about the long life expectancy there. He's very happy about that.

Obviously, people's emotions related very much to their place on the index.

In terms of an official sort of response, of course, there hasn't been anything. It's an interesting idea. Internationally, this index is a very well-known thing, a very powerful tool. People working for UNDP in other countries, when it comes out, have the wrath, potentially, of the host government if they are doing poorly on the list. It's not like that here. There is no sort of official response to what we have done.

SARAH BURD-SHARPS: The day after we launched, Senator Schumer invited us to testify to the Ways and Means Committee. That was a great opportunity, particularly to talk about the middle-class squeeze, which was what was being talked about a lot in election time. Then we were also invited to submit testimony on the federal poverty line. So we have had some opportunities to bring some of this thinking to bear.

We are also working with a number of different organizations. It has been a really exciting couple of months, since we launched three or four months ago. We are working now with the United Way, which has chapters in 5,000 municipalities around the country, to look at this high school completion rate issue and to develop a campaign to make people more aware of what's going on.

As you say, to some communities, it seems like the bare minimum. But there are communities that are struggling to make it to 1 and 2.

So that has been exciting as well.

In terms of UNDP, I was working on the global human development report for a number of years and then started working with countries around the world on national reports, using the model of the global report. For those who don't know, 150 countries around the world have done this kind of report. I think it was during that time, and seeing how powerful it was, that I thought to myself it might be really interesting to turn this lens on my own country.

So I left that work to do this. UNDP was supportive. We purposely didn't take any funding from UNDP, and couldn't have anyway, because UNDP has no mandate to support things in the North. But they were supportive. We showed the statistical team the index, just to make sure we could get their seal of approval on it. I think that has been useful.

In terms of an official response, right before we launched, they were afraid and they called us to say, "Are you sure that everything's okay?" They were worried that if we said things that were extremely controversial, it could have a backlash on U.S. support for UNDP. But I think our goal was to put out—we had a peer-review process with the Social Science Research Council to make sure that every argument was credible and defensible and that we were really on strong ground. So we tried to reassure them that they had nothing to worry about.

DEVIN STEWART: To build on that question a little bit, just to bring it a little further, and maybe looking at sort of the soft reaction in Washington, thinking about how you might predict policy-makers in Washington would react to these types of findings, the Bush "ownership society" has been called the "you're on your own" society, as you probably know. I think some of your recommendations speak to that lack of government involvement in people's lives, other than the accumulation of real estate.

In my recent travels and speaking to various people—I just had lunch with a senior Japanese journalist, and John Ruggie was here recently—various people around the world are saying that the thing that they have observed in the United States is an attitude shift toward believing that government can play a positive role in people's lives.

Do you feel that's the case? If so, is there a more receptive environment in Washington for your type of finding?

SARAH BURD-SHARPS: I would say that the underlying message, which we never say overtly, of this report is that policy matters and that evidence-based policymaking is a good way to go. It's what we are trying to say. It's one of, I would say, two huge messages that we are trying to get across by putting the facts on the table.

Yes, I sense a shift, although I think it would be a little too optimistic to say it's—I don't know if it's going to translate into policy yet. We'll have to see. I sense a shift, yes, and I think it's great.

For me, I have teenagers who are learning about government and trying to think about government. The sense that they have is that the word "Washington" is a bad word, the notion that you would be involved in anything—and yet it's coming from the people who are in Washington, in many cases. It's very confusing. I think that's about to shift.

KRISTEN LEWIS: Also, there's nothing like a collapse of the entire economy, and the government basically having to illustrate the importance of government. It's a strange time in a way. On the one hand, I think people are more receptive to the idea of the importance of policy-making. We have just seen a time when government intervention was necessary to save our houses and our economy, and maybe even the world economy, in a sense. At the same time, there is a real financial crunch. So it's good and bad in terms of that. People might be more receptive to the idea of government taking a stronger role in policy, and yet we have much less money to do it, certainly at the state government level and at the federal government level.

DEVIN STEWART: Absolutely.

QUESTION: In your analysis, it appeared that the U.S. children—there was so much focus on, first, poverty, pregnancy, early death. Did you find that there was a correlation between the fact that in the middle class there is everyone working—I think you said that this was the highest percentage of families working, both the mother and the father. Did you find that similar statistic in the high-income, where maybe the two parents weren't working? Was there any correlation between that?

KRISTEN LEWIS: No. In all of our European peer countries, the same demographic shift of women in the workforce has occurred. In all the countries, the new normal is both parents in the workforce or a single parent-headed household with that person working. That has happened all over the OECD, all over the industrialized countries. But the poor child outcomes are only in the United States. That has to do with lack of health insurance and things like that, other factors affecting people who are living in poverty, primarily.

SARAH BURD-SHARPS: Just to add to that, even the fact that the way we measure poverty in this country doesn't take into consideration the need to pay for childcare. The way that we are measuring poverty has also not caught up with the new normal in this country. Childcare, added transport from two workers, a whole range of issues don't figure in there. It really disadvantages the ability to manage. That is a big part of child poverty.

QUESTION: I have a couple of questions and comments. I was surprised, and not surprised, to see the figures on Chinese men and women, that they excel in many categories, especially in income.


SARAH BURD-SHARPS: Asian, which includes Chinese. But all Asian–Americans.

QUESTIONER: I meant Asian, I'm sorry. Koreans, I know, do very well, and Japanese do well as well.

I wondered if there was a reason for that, perhaps immigration policy—in other words, our immigration policy, or lack of it, might attract uneducated people, for instance, from Mexico and Central America, et cetera—or if you have any other explanations for it.

I was also astonished to see that Alaska was not always at the bottom of the pile, since they do have a significant indigenous population, where education, for instance, is extremely difficult. Very often it amounts to homeschooling, which has its limitations.

I would like your comment on that, on specifically what policies of the state government have benefited the population in terms of some of the categories that you use.

Then I have another question. When you deal with financial matters—for instance, income—do you take into consideration, especially when you are comparing the United States with other countries, certain inflationary factors? If a country—say, Timbuktu—might have a 200 or 300 percent inflation rate, how does that enter into your calculations? Also the inflation rate in the United States—do you consider that that is an adequate and accurate reflection of the actual inflation rate in the United States? I, for one—and I'm sure this is duplicated thousands of times all over the United States—one looks at a cereal box, takes one out of one's cupboard and sees that it was $2 only a few months ago and all of a sudden it's $2.50 or $3, whatever it is.

My own feeling is that the official inflationary rate in the United States does not accurately reflect the actual inflation in this country.

I'm sorry, I asked several questions that are not necessarily related.

KRISTEN LEWIS: I'll answer two of your questions. Sarah is the expert on Alaska, so I'll knock that over to her.

In terms of immigration policy and the educational-attainment issues of Asian–Americans, for instance, versus Latino immigrants, who are at the bottom of the educational scale on our well-being, we didn't look at immigration policy per se, but one thing we did do an analysis on is that, in general, Asian–American immigrants to the United States have degree attainments higher than that of the average person in the United States, whereas the average Latino immigrant coming to the United States has a degree attainment lower than that of the average American. Both groups make progress over generations, but among the Latino immigrants, on the whole, on average—not, of course, every person—they are starting with a lower level of degree attainment. So even though the next generation might then graduate from high school or graduate from college, they are starting at a lower point than the average Asian American.

So that's the first question.

The second question, in terms of income and cost of living and inflation, in our report we are using 2005 dollars. We are taking everything and turning it all into 2005 dollars, so that we can compare from year to year. In terms of our comparisons with other countries, we are using PPP, which is purchasing power parity.

SARAH BURD-SHARPS: It's a World Bank program, just to standardize.

KRISTEN LEWIS: To standardize. So we are using constant dollars, not today's dollars versus yesterday's dollars.


SARAH BURD-SHARPS: Why am I the expert on Alaska?

KRISTEN LEWIS: You have an Alaskan aunt and I don't have an Alaskan aunt.

SARAH BURD-SHARPS: Okay. Alaska is an interesting case. They come out 17th of the 50 states. The major reason that they do as well as they do is because of oil money. Income is relatively on the high side.

Health care is below average. But it's a very young population. Most of the people who are there now are young. Many people don't die there. If you look at age at death, the statistic is quite bad. But life expectancy at birth, which takes every group, is at average or a little bit below average.

In terms of education, nine percent of adults there don't have a high school diploma. Ten percent have a graduate degree. It's better than average.

There are certainly other factors, geographic factors and factors of distance, as you mentioned, that make life in Alaska particularly challenging. But oil money has done a lot to cushion those challenges.

QUESTION: Two questions. Firstly, what are your thoughts on why it took so long for us to get to this point, to actually put these indicators together in a comprehensive piece? We are, I think, one of the last, if not the last, of OECD to do so. What are your thoughts on that? Are you the first, as far as you know, to make this attempt?

Secondly, your reasons for doing this are not just to publish a piece. Obviously, it's about exposure and awareness. What do you have in planning for exposing it further? You have expressed a little bit about what the response has been to this. But what are your plans, as responsible authors?

KRISTEN LEWIS: Why has it taken so long? This is actually the first for any OECD country. There has never been one on any of the OECD countries, including the United States. There are two reasons for that, we think.

One is that the impetus for the creation of these national reports has largely been with UNDP, the UN Development Programme, which published the global report. They have a mandate to work in developing countries, but they don't have a mandate to work in industrialized countries. The country office in developing countries often takes the lead or partners with a research institute to get this whole ball rolling in terms of doing national reports. But the UNDP can't play that kind of role in a developed country, just because of their mandate.

QUESTIONER: So OECD countries have not done this?

KRISTEN LEWIS: No, no. There has never been a human development report for an industrialized country.

That's the first one.

The second is just this idea that this is a methodology and a way of understanding progress that was created to understand progress and change over time in developing countries. So the idea of applying it to a so-called developed country, a rich country, was less natural, and it just didn't happen. We were lucky that there was still that space for us to go in.

SARAH BURD-SHARPS: So that leads to our plans. I guess one of our big plans—we just got the great news that we got funding from the Hilton Foundation to do a next report. We will bring out a next one in the spring of 2010. It will update statistics. But some of these statistics don't change that fast, so we will also be looking deeper.

Our goal with this one was to sort of set the base line on the basics. The next one, hopefully, will look deeper on one or two on a theme, on a specific theme, which is kind of the pattern that has been followed by these national human development reports around the world. So that's our big plan.

In terms of other things, we have been commissioned by the NAACP in Mississippi, as well as Oxfam America, to produce a mini-human development report for Mississippi, which we are furiously working on day and night. We have disaggregated the data down to the county level, which is alarming and fascinating, and much more useful from a policymaking perspective. At the county level, you can really get a sense of what the levers are and what's going on. So we are working on that and finding just hair-raising things, and very interesting things.

DEVIN STEWART: Like what hair-raising things? Everyone is dying to know.

SARAH BURD-SHARPS: One of the things that I have been grappling with is that about 75 percent of the kids ages 7 to 18 who get into the criminal justice system get in there because of disorderly conduct, not a violent crime, not even a nonviolent crime. I finally got the FBI to tell me what disorderly conduct means. It basically means you were spitting or you were cursing or you were playing basketball and there was no toilet, so you peed in a corner, or whatever. Thousands of kids—they have huge what they call training schools in Mississippi, which are juvenile schools, filled with kids.

So that's one thing that I have been sort of following down the train of and trying to pick apart the statistics by race and understand a little bit the dynamics of what's going on.

KRISTEN LEWIS: Another thing that is quite noteworthy in looking at Mississippi—Mississippi is at the bottom of the state ranking, but, of course, there is still a lot of variation in Mississippi. There are counties where, for instance, the white population has the same human development index as the average in Connecticut. So there are pockets where human development scores and levels are quite high, even in the state that is the lowest in the country.

DEVIN STEWART: On that note, I think it's actually a really good place to stop. Thank you all for coming. Thank you to Kristen and Sarah.

KRISTEN LEWIS: Thank you very much.

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