4 lessons the US learned from the COVID-19 pandemic
The long-term lessons America learns from the coronavirus pandemic will spell life or death.
19 January, 2021
- As the US commences its early stages of COVID-19 vaccinations, Michael Dowling, president and CEO of Northwell Health, argues that now is not the time to relax. "There are lessons to be learned by systems like ours based upon our experience," says Dowling, adding that "we know what these lessons are, and we're working on them."
- The four major takeaways that Dowling has identified are that the United States was unprepared and slow to react, that we need a domestic supply chain so that we aren't relying on other countries, that there needs to be more domestic and international cooperation, and that leadership roles in public health must be filled by public health experts.
- If and when another pandemic hits (in the hopefully distant future), the country—and by extension the world—will be in a much better place to deal with it.
Learn more about Northwell's pandemic response here.
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<div class="amazon-assets-widget__title" style="display: block;">Leading Through a Pandemic: The Inside Story of Humanity, Innovation, and Lessons Learned During the COVID-19 Crisis</div>
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How will we govern super-powerful AI?
The AI constitution can mean the difference between war and peace—or total extinction.
08 January, 2021
- The question of conscious artificial intelligence dominating future humanity is not the most pressing issue we face today, says Allan Dafoe of the Center for the Governance of AI at Oxford's Future of Humanity Institute. Dafoe argues that AI's power to generate wealth should make good governance our primary concern.
- With thoughtful systems and policies in place, humanity can unlock the full potential of AI with minimal negative consequences. Drafting an AI constitution will also provide the opportunity to learn from the mistakes of past structures to avoid future conflicts.
- Building a framework for governance will require us to get past sectarian differences and interests so that society as a whole can benefit from AI in ways that do the most good and the least harm.
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The social determinants of health, explained
Want to tell someone's future in the US? You don't need a crystal ball, just their zip code.
06 January, 2021
Credit: Stephanie Keith/Getty Images
- Social determinants of health, such as income and access to healthy food, affect well-being long before people may enter medical facilities.
- They're one reason neighborhoods in the same city can maintain life expectancy gaps larger than a decade.
- With growing awareness of how societal ills determine health, medical professionals and their partners are devising more holistic approaches to health.
<p>New York City is a vibrant, vivacious city. No one knows this better than the people who live on its Upper East Side. Residents of this Manhattan neighborhood enjoy easy access to Central Park, a panoply of top-tier restaurants and markets, and some of the country's most renowned museums and cultural venues. But the real perk to calling the Upper East Side home is measured in years.</p><p>Upper East Side residents maintain an average<a href="https://data.cccnewyork.org/data/map/1341/life-expectancy#1341/a/3/1573/25/102/a" target="_blank"> </a><a href="https://data.cccnewyork.org/data/map/1341/life-expectancy#1341/a/3/1573/25/102/a" target="_blank" rel="noopener noreferrer">life expectancy of 86.4 years</a>, a number on par with the most peaceful, prosperous countries in the world. For a population to enjoy so many precious years represents historic achievements in education, infrastructure, and health care. Yet these hard-won achievements have not been distributed equally. A mere 15 miles away, in the Brooklyn neighborhood of Brownsville, the average life expectancy is a full decade shorter.</p>
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Just 15 miles from Brownsville, Brooklyn, residents of the Upper East Side in Manhattan have an average life expectancy of 86.4 years.
Source: NYC DOHMH; Bureau of Vital Statistics, 2006-2015
<p>Such life-expectancy gaps are common across the United States.<a href="https://www.chicagotribune.com/business/ct-biz-chicago-has-largest-life-expectancy-gap-between-neighborhoods-20190605-story.html" target="_blank"> </a><a href="https://www.chicagotribune.com/business/ct-biz-chicago-has-largest-life-expectancy-gap-between-neighborhoods-20190605-story.html" target="_blank" rel="noopener noreferrer">Residents of Chicago's Streeterville</a> neighborhood can rest easy knowing they will live to be, on average, 90 years old. Chicago's Englewood neighborhood, however, maintains a life expectancy of around 60 years. That's ten years lower than<a href="https://data.worldbank.org/indicator/SP.DYN.LE00.IN?order=wbapi_data_value_2012+wbapi_data_value&sort=asc" target="_blank"> </a><a href="https://data.worldbank.org/indicator/SP.DYN.LE00.IN?order=wbapi_data_value_2012+wbapi_data_value&sort=asc" target="_blank" rel="noopener noreferrer">the world average</a>—in the world's most affluent country. The phenomenon is not just an urban affliction. On the whole, rural community members have lower life expectancies as<a href="https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html" target="_blank"> </a>they become more likely to die from <a href="https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html" target="_blank">these five leading causes</a> than their city-dwelling peers.</p><p>While it may be tempting to write off these life gaps as the result of lifestyle choices or bad luck, they aren't. They are the consequences of a complex intersection between social, environmental, and cultural conditions that fall under 'social determinants of health.'</p><blockquote>You can have the best treatments, the best physicians, the best facilities, but unless a patient's non-clinical needs are addressed, none of it will make a difference.</blockquote>
The 80/20 rule of health
<p>Social determinants of health are those conditions in a person's life and environment that can either aid or degrade their health. They include employment, education, food availability, living conditions, communal support, neighborhood quality, socioeconomic status, and the wider systems that surround these conditions. When such determinants aren't wholesome, they erode health long before someone enters a hospital—at which point, health professionals may have only minutes to turn the tide of years of eroded health.</p><p>As Udai Tambar, vice president for community health at Northwell Health, said, "You can't medicate for social issues, and that's, in a way, the system we have developed. We're trying to medicate for social risks and social factors. <a target="_blank"></a>You can have the best treatments, the best physicians, the best facilities, but unless a patient's non-clinical needs are addressed, none of it will make a difference."<a href="#_msocom_1" target="_blank" rel="noopener noreferrer"></a></p><p>Today, experts generally agree that 20 percent of health outcomes are derived from the care received at medical facilities, 80 percent from the non-clinical care attributed to one's lifestyle, environment, and social circumstances.</p><p>The data bear this out.<a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/#:~:text=The%20combination%20of%20long%2Dterm,7%20percent%20of%20total%20spending." target="_blank" rel="noopener noreferrer"> </a><a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/#:~:text=The%20combination%20of%20long%2Dterm,7%20percent%20of%20total%20spending." target="_blank" rel="noopener noreferrer">U.S. health-care spending</a> has nearly quadrupled since 1980, and the country has invested that bankroll heavily in hospitals, nursing facilities, prescription drug development, and medical specialist training. Each is valuable in its own right, yet as a systematic whole, this massive, decades-long investment has not netted proportionate health dividends. In addition to country-wide life gaps, the U.S. has one of the lowest life expectancies, the highest suicide rate, the highest chronic disease burden, and the highest obesity rate when<a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019" target="_blank" rel="noopener noreferrer">compared to other major OECD nations</a>.</p><p>These other OECD countries don't spend more on health than the United States. In terms of absolute dollars, the<a href="https://data.oecd.org/healthres/health-spending.htm" target="_blank" rel="noopener noreferrer"> </a><a href="https://data.oecd.org/healthres/health-spending.htm" target="_blank" rel="noopener noreferrer">U.S. handily outspends these countries</a>. Instead, these countries spend<a href="https://www.commonwealthfund.org/sites/default/files/2018-12/Multinational%20Comparisons%20of%20Health%20Systems%20Data%202018_RTikkanen_final.pdf" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.commonwealthfund.org/sites/default/files/2018-12/Multinational%20Comparisons%20of%20Health%20Systems%20Data%202018_RTikkanen_final.pdf" target="_blank" rel="noopener noreferrer">a larger portion of their GDP</a> on social services, helping to mitigate deleterious social determinants long before a hospital visit. By<a href="https://www.brookings.edu/opinions/social-spending-not-medical-spending-is-key-to-health/" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.brookings.edu/opinions/social-spending-not-medical-spending-is-key-to-health/" target="_blank" rel="noopener noreferrer">one estimate</a>, other major OECD countries allot, on average, $1.70 for social spending for every dollar on health. The U.S. system is almost the inverse, spending .56 cents on social services for every dollar on health.</p><p>"You need social equity to get health equity," Tambar added.</p>There’s no pill to cure poverty
<p>This pattern of spending is one reason for the U.S. health-wealth divide, a pernicious and destructive social determinant of health. We've seen this divide's handiwork in the life expectancy differences between the Upper East Side and Brownsville, but those are samples of a whole.<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer">According to a 2017 paper in </a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"><em>The</em></a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext" target="_blank" rel="noopener noreferrer"><em>Lancet</em></a>, the "life expectancy of the wealthiest Americans now exceeds that of the poorest by 10-15 years." And these life-gap metrics signal the end consequences of a myriad of unmet social needs.</p><p><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a>Consider the health barriers common in impoverished areas, where residents lack access to healthy, affordable food. Limited funds make it impossible to update or maintain safe housing without mold or lead-contaminated<a href="https://www.epa.gov/lead/protect-your-family-sources-lead" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.epa.gov/lead/protect-your-family-sources-lead" target="_blank" rel="noopener noreferrer">paint</a> or<a href="https://www.cdc.gov/nceh/lead/prevention/sources/water.htm#:~:text=The%20most%20common%20sources%20of,1986%20may%20also%20contain%20lead." target="_blank" rel="noopener noreferrer"> </a><a href="https://www.cdc.gov/nceh/lead/prevention/sources/water.htm#:~:text=The%20most%20common%20sources%20of,1986%20may%20also%20contain%20lead." target="_blank" rel="noopener noreferrer">water pipes</a>. Narrow or nonexistent transportation options cut off residents from employment opportunities or health-care access. And being surrounded by street crime, unsafe public spaces or no greenways generates sustained high stress, which <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">research shows</a> grinds away at our physical health as fiercely as it does our mental wellbeing.<a href="#_msocom_1" target="_blank" rel="noopener noreferrer"></a></p><p>Each of these conditions is bitter in and of itself, but these social determinants often come packaged as part of a social circuit that magnifies the effects of each.</p><p>Unfortunately, dietary fads and the U.S.'s rugged individualism have loudly espoused health to be the culmination of lifestyle choices (for some, even moral rectitude). While lifestyle and choice certainly have their role, an understanding of these social determinants shows how inextricably tied our choices are to our social conditions. As Tambar points out, a person can be well-versed in nutrition, but if their neighborhood is a food desert, their choices are constrained. Social circumstances can limit or adversely influence health in inimical ways.</p><p>As Dr. Mary Travis Bassett, Director of the FXB Center for Health and Human Rights at Harvard University,<a href="https://bigthink.com/videos/mary-bassett-on-new-york-city-health-disparities" target="_self"> </a><a href="https://bigthink.com/videos/mary-bassett-on-new-york-city-health-disparities" target="_self">told </a><a href="https://bigthink.com/videos/mary-bassett-on-new-york-city-health-disparities" target="_self"><em>Big Think</em></a>: "Nobody picks a substandard building to live in with terrible issues of rodent infestation and indoor allergens that trigger asthma. That's not a lifestyle choice. […] It's not about choice; it's about the fact that people don't have enough choice."</p>Going to the source
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<p>Negative social determinants of health provide a massive challenge to the health-care community, but experts and medical professionals aren't powerless to meet it. As Michael Dowling, CEO of Northwell Health, writes in his book <a href="https://healthcare-reboot.com/" target="_blank">"Health Care Reboot"</a>:</p><p style="margin-left: 20px;">This trend toward greater awareness of the social determinants of health is one of the most encouraging developments in health care, for it creates greater awareness among providers of the whole patient, including all of the various elements—most of them outside what might be considered strictly medical issues—that affect an individual's overall health and wellbeing.</p><p>An outgrowth of this growing trend goes by the name "<a href="https://bigthink.com/Northwell-Health/health-care-2634148633" target="_self">upstreamism</a>." Upstreamist practitioners don't only focus on the patient's downstream symptoms; instead, they also turn their attention upstream to incorporate the patient's social determinants of health in their diagnosis. Dowling illustrates this paradigm with an example of a patient with chronic, life-interrupting headaches. Her upstreamist doctor provided her the usual medication but added the unusual prescription of a visit by a community health worker. The health worker found the patient's apartment walls to be infested with high levels of mold. The doctor and health worker told the patient to have her landlord fix the problem and provided the number for a public-interest attorney should the landlord fail to comply.</p><p>Dowling's story shows the holistic approach of upstreamism: to take into account all the determinants of health, not only those found within hospital walls. Sometimes, Dowling notes, that will require medical professionals to take the lead. But other times, when there are extra-symptomatic drivers of health, it will mean <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank">partnering with</a> or supporting social service workers, law enforcement, or legal minds to secure a combination of services to heal the whole person.</p><p>It's for these reasons that many health-care organizations are spearheading initiatives and outreach programs to directly target social determinants of health <em>before </em>they become medical issues. Examples include<a href="https://www.northwell.edu/center-for-gun-violence-prevention/news/the-latest/northwell-receives-1-4m-nih-grant-to-establish-gun-violence-prevention-screening" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.northwell.edu/center-for-gun-violence-prevention/news/the-latest/northwell-receives-1-4m-nih-grant-to-establish-gun-violence-prevention-screening" target="_blank" rel="noopener noreferrer">Northwell's first-of-its-kind gun-violence screening program</a> and<a href="https://pediatrics.aappublications.org/content/early/2015/10/20/peds.2015-3301" target="_blank" rel="noopener noreferrer"> the American Academy of Pediatrics'</a> fight for food security for U.S. children.</p><p>As Tambar points out, this holistic outlook means changing our approach to more than just medicine. It will require many aspects of our society to adopt a multi-lens approach, one that adds an interdisciplinary depth to social problems beyond a solitary profession's expertise. He concluded, "What people are realizing is to holistically serve someone, it's not about you doing it all. It's about partnering with the best person who can do something you can't do."</p>
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The neoliberal era is ending. What comes next?
The next era in American history can look entirely different. It's up to us to choose.
30 November, 2020
- The timeline of America post-WWII can be divided into two eras, according to author and law professor Ganesh Sitaraman: the liberal era which ran through the 1970s, and the current neoliberal era which began in the early 1980s. The latter promised a "more free society," but what we got instead was more inequality, less opportunity, and greater market consolidation.
- "We've lived through a neoliberal era for the last 40 years, and that era is coming to an end," Sitaraman says, adding that the ideas and policies that defined the period are being challenged on various levels.
- What comes next depends on if we take a proactive and democratic approach to shaping the economy, or if we simply react to and "deal with" market outcomes.
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Oregon decriminalizes drugs: Here are 3 metrics other states will track
It's "the biggest blow to the war on drugs to date," said Kassandra Frederique, executive director of the Drug Policy Alliance.
06 November, 2020
Credit: pxfuel.com
- Oregon voted to decriminalize possession of small amounts of all drugs, including heroin, cocaine and methamphetamine.
- The state also legalized the therapeutic use and sale of psilocybin mushrooms.
- As the laws go into effect, other U.S. states will be watching to see how the experiment plays out, influencing future votes across the country.
<p>Amid the uncertainty of the unfolding U.S. 2020 presidential election, Americans decided one thing on November 3 with refreshing clarity and unity: It's time to move away from the war on drugs.</p><p>In the nine states where ballots featured legalization or decriminalization measures, all passed. That includes recreational and medicinal marijuana in South Dakota, medical marijuana in Mississippi, and recreational marijuana in Arizona, Montana and New Jersey.</p><p>But Oregon passed the most sweeping and historic reforms, voting to partially decriminalize all drugs—even heroin, cocaine and methamphetamine. Oregon's measure 109 also legalized the therapeutic sale and use of psilocybin mushrooms, which, as a <a href="https://bigthink.com/mind-brain/psychedelics-depression" target="_self">new era of psychedelic research continues to show</a>, have proven remarkably effective at treating conditions like depression, anxiety and post-traumatic stress disorder. </p><p>Of course, drug decriminalization isn't legalization. Oregonians caught in possession of small amounts of hard drugs will be fined $100, whereas they would've been fined up to $6,250 and sentenced up to a year in jail under the previous law. The initiative, called the Addiction Treatment and Recovery Act, also allows people caught with drugs to avoid paying the fine if they undergo a health assessment at an addiction recovery center.</p><p style="margin-left: 20px;">"Today's victory is a landmark declaration that the time has come to stop criminalizing people for drug use," <a href="https://apnews.com/article/oregon-first-decriminalizing-hard-drugs-01edca37c776c9ea8bfd4afdd7a7a33e" target="_blank">said</a> Kassandra Frederique, executive director of the Drug Policy Alliance, which was behind the measure. "Measure 110 is arguably the biggest blow to the war on drugs to date."</p>
<div id="49425" class="rm-shortcode" data-rm-shortcode-id="c5811192ec0f155d42d5c9410cb009f1"><blockquote class="twitter-tweet twitter-custom-tweet" data-twitter-tweet-id="1323839290246389760" data-partner="rebelmouse"><div style="margin:1em 0">Oregon made history tonight by becoming the first state to decriminalize drug possession! Our c4 @DrugPolicyAct led… https://t.co/s9pNxUn4HI</div> — Drug Policy Alliance (@Drug Policy Alliance)<a href="https://twitter.com/DrugPolicyOrg/statuses/1323839290246389760">1604462857.0</a></blockquote></div><p>The new laws aim to reframe drug use as a public health issue.</p><p style="margin-left: 20px;">"People suffering from addiction are more effectively treated with health care services than with criminal punishments," Oregon's initiative says. "A health care approach includes a health assessment to figure out the needs of people who are suffering from addiction, and it includes connecting them to the services they need."</p><p>Marijuana and hard drugs remain illegal on the federal level. But as Americans generally continue to shift toward favoring drug reforms, citizens and policymakers will be watching Oregon to see how the experiment plays out, and the outcomes will likely influence voters in other states. Here are a few things to keep an eye on.</p>
Arrest and incarceration rates
<p>Reduced arrest and incarceration rates for drug possession are likely to be the most obvious changes. The Oregon Criminal Justice Commission <a href="https://www.opb.org/pdf/IP44%20-%20REI%20Statement%20Supplement_1602708982790.pdf" target="_blank">estimates</a> that the new laws will reduce convictions for drug possession by about 90 percent, from 4,057 convictions in 2019, to a projected 378 in 2021.<br></p><p>The commission's report also estimates that drug convictions among Black and Indigenous Oregonians may drop by 94 percent, and that racial disparities in drug arrests could drop by the same amount.</p><p>If more Oregonians stay out of the criminal justice system, it could help more people find employment, housing, addiction services and student loans, all of which can be harder to access with a drug conviction on your record. </p><p>It's also conceivable that the new initiative will reduce contentious interactions between Oregonians and law enforcement, which, potentially, could lead to lower arrest rates for other infractions, and create fewer opportunities for police interactions to turn violent.</p><p>Alternatively, if the initiative frees up time and resources for Oregon law enforcement, the state could see arrests rise for other types of crimes. That may include arresting more dealers and traffickers, considering the new laws only apply to users carrying small amounts. If police focus on the suppliers, it will likely change the dynamics of Oregon's illegal drug trade.</p>Drug use rates
<p>How will removing the threat of jail and steep fines change drug use and overdose rates? It's hard to say for sure, but Portugal's 2001 decision to decriminalize drugs provides some clues. In the years following decriminalization, the nation's drug overdose deaths and <a href="https://www.scientificamerican.com/article/portugal-drug-decriminalization/" target="_blank">HIV infection rates dropped significantly</a>, while <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1464837" target="_blank">drug usage either stayed constant or decreased</a>.<br></p><p>That drug use remained constant or decreased may be because Portugal only decriminalized drugs, meaning drugs weren't legally available for purchase at something like a marijuana dispensary. But it's also worth noting that Portugal invested money in addiction treatment services, as Oregon <a href="https://ballotpedia.org/Oregon_Measure_110,_Drug_Decriminalization_and_Addiction_Treatment_Initiative_(2020)#How_is_the_drug_addiction_treatment_and_recovery_program_funded.3F" target="_blank">plans to do with tax revenues from marijuana sales and savings on correctional services</a>.</p><p style="margin-left: 20px;">"Most accounts of the Portugal experiment have focused on decriminalization, but decriminalization was part of a broader effort intended to encourage treatment," <a href="https://www.cambridge.org/core/journals/law-and-social-inquiry/article/uses-and-abuses-of-drug-decriminalization-in-portugal/1F68DA5A8F0369F3FBA6B2B04E454BBE" target="_blank" rel="noopener noreferrer">Hannah Laqueur</a>, an assistant professor in the Department of Emergency Medicine at the University of California, Davis, <a href="https://www.nytimes.com/2020/10/05/upshot/portugal-drug-legalization-treatment.html" target="_blank" rel="noopener noreferrer">told</a> <em>The New York Times</em>.</p><p>Oregon will be a particularly interesting case study for decriminalization's effects on drug usage, considering the state ranks among the worst for <a href="https://www.wweek.com/news/state/2019/10/02/nobody-can-beat-oregon-for-drug-use-and-abuse/" target="_blank" rel="noopener noreferrer">rates of addiction, use, and overdose</a>.</p>Treatment rates
<p>Although Oregon plans to expand investments in treatment programs for drug users, some are worried the new initiative will discourage people from seeking help.<br></p><p>John Kitzhaber, a former E.R. physician in Oregon, called for Oregonions to reject the measure, writing on his <a href="https://blog.johnkitzhaber.com/vote-no-on-measure-110/" target="_blank">blog</a>:</p><p style="margin-left: 20px;">"Measure 110 would eliminate this invaluable tool by reducing the possession of highly addictive drugs like heroin, cocaine, methamphetamine and oxycodone to a "violation," which means the court will no longer have the ability to offer people the choice to pursue treatment. It also means that a teenager caught in possession of heroin or meth will only receive a ticket, which in many counties means that parents won't be informed of their child's drug use."</p><p>Still, even if Oregon's measure reduces the number of people who get treatment, that wouldn't necessarily be an indictment of decriminalization writ large, but rather the specific way the state is allocating funds. Kitzhaber concluded his post with a sentiment shared by both drug reform advocates and some of the measure's opponents: "Incarcerating people who suffer from addiction should not be tolerated."</p><span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="1f7bc5a3d5d9b078bad4b151ae3da84f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/VIpqZmdBgvw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>Drug prevention advice for parents Watch the newest video from Big Think: https://bigth.ink/NewVideo Join Big Think Edge for exclusive videos: https://bigth....
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