The Why Axis: Hidden Motives and the Undiscovered Economics of Everyday Life (24 page)

Now that we’d identified the most-at-risk students, the next step was to pair them with mentors through a program called Youth Advocate Programs, Inc. (YAP). One of YAP’s mentors is Chris Sutton, a forty-year-old, African American, married father of two, who owns a car wash and holds a bachelor’s degree in marketing. Sutton describes his dangerous job in five short words: “I keep my clients alive.”

YAP pays Sutton between $12 and $30 per hour for each of his five clients/students, so he earns between $60 and $150 per hour in total. The pay is certainly good—yes, it “pays enough” to incentivize him—but it’s a dangerous, twenty-four-hours-a-day job, and he says that the money isn’t his chief motivator. Sutton really wants to help at-risk kids; he knows that if they were left alone on the streets, they would surely die. So he drops his young clients off at school in the morning and picks them up in the afternoon—the two times when school violence is at its peak. He takes them to work, and then to dinner and home in the evenings. He’s on call the rest of the time.

One of Sutton’s most recent ultra-high-risk clients was an impulsive young black man named Darren who pretty much fit all our criteria for shooting victimhood. Darren’s parents are addicts who’ve spent time in prison. “If you are surrounded by people who are always doing the wrong thing, you have to be ten times stronger to do the right thing,” Sutton observes. All of Darren’s friends dropped out of high school, and because Darren has so often been in trouble, he has missed a lot of school, making him older than his
peers. He was on probation for bringing a loaded gun to school. He lives with a foster parent in Englewood, a very dangerous section of Chicago where drive-by shootings are a daily occurrence. “It’s like the OK Corral over there,” says Sutton.

Darren is bright and hardworking, and he holds a city job, cleaning gutters and parks, that he procured through YAP. Unfortunately, he has a habit of gambling his paychecks away, and it’s been a struggle for him to understand that all his impulsive actions have consequences. Because Darren is highly suspicious of institutions and adults, Sutton has had to walk a fine line to earn his trust. “You have to go undercover with kids like him,” Sutton says. “You have to dress like they do, listen to the same music, and listen deeply. You collect intelligence about the really bad kids, and alert the school principals to them so we can get them into YAP, too.”

While the program indeed saves lives, mentoring is very risky work. One day, Darren and other YAP kids with Sutton happened to cross the wrong line. Darren got into an argument with another kid, and then a gang member from a rival group entered the fray. Soon the bullets were flying. Darren and another student were hit. Sutton reclined his seat in the car, called 911, and prayed.

The good news is that Darren survived the shooting. He has managed to graduate high school. To his own astonishment, he even pulled a B in music, and tells Sutton he couldn’t have done it without the help YAP provides. And Darren is still holding down a job with the city. “If kids like Darren can hang in there and get through high school, they will be prepared to hold a full-time job—provided they can secure one—after they graduate,” Sutton says. “We can’t take tests for them, but we can provide safe transportation, study help, and guidance. And eventually we can pull off the training wheels.”

The YAP program is certainly expensive—averaging $15,000 per student—but it’s nothing compared to the cost of incarceration,
and for those it helps it does seem to stick. So far, while on most of the outcomes that we measured, the YAP kids are not different from the control group kids, none of the successful YAP kids have gotten into serious trouble after graduation; most of them, including Darren, have shown a dramatic improvement in behavior.

Nevertheless, YAP can’t save all the at-risk kids in Chicago, and money is always tight, particularly for experimental programs. Even if they are lucky enough to qualify for YAP, many children, facing tremendous odds in their lives, simply give up and drop out. We need to continue to learn what works for these kids.

The Silent Killer: Obesity

Schoolkids—not just in Chicago, but all across the country—face another big threat: the danger of obesity, the rate of which has nearly tripled since 1980. According to the Centers for Disease Control and Prevention, 17 percent of children aged two to nineteen and one in seven low-income preschool-aged children are now obese. Obviously, these kids are spending too much time on the couch and not enough time exercising. And they are eating too much high-fat, processed food—not just at home, but also at school.

We call obesity the “silent killer” because most people do not understand just how deep the problem runs. A 1999 study that appeared in the
Journal of the American Medical Association
concluded that 280,000 to 325,000 US adults die each year due to obesity. That is one person every few minutes, or nearly forty deaths an hour. This rate of death exceeds many other well-known killers, such as drunk-driving fatalities and breast cancer.

Most adults barely remember—or have repressed—what the “lunch ladies” in hairnets and white smocks served them in the school cafeteria. There were “burgers” made of a quizzically brown meatlike substance pressed between white bread buns. Pigs-in-a-blanket
made mostly of bread, with a tiny hot dog hidden within. Stale French fries. Bagged lettuce, which passed for a vegetable offering, doused in ranch dressing. Instant mashed potatoes spooned over with an unidentifiable gravy, pocked with cubed giblets. The kind of stuff that you wouldn’t feed your dog, but too many American parents, or the government, pay for their kids to eat it anyway.

One night in March 2010, millions of TV watchers tuned in to watch Jamie Oliver, the famous British chef, go on a rampage in a school cafeteria in the town of Huntington, West Virginia, dubbed the unhealthiest city in America (because half the adults are obese). His goal was to improve what the town puts in its collective mouth. Oliver said he didn’t like what he was seeing. Pizza for breakfast, followed by a lunch of chicken nuggets?

The lunch ladies were, not surprisingly, defensive. Why was Oliver picking on them and not their boss? “Those things are set up on a monthly basis by a nutritional analysis on the meals,” said one lady, pointing to the label on a container of frozen chicken nuggets that Oliver had yanked from their very disappointing freezer. “The first ingredient is white meat chicken.”

But as Oliver moved down the list of ingredients it was hard to find another pronounceable name. The majority of the list was unrecognizable chemicals designed to improve the freezer-hardiness, cohesiveness, springiness, chewiness, and gumminess of the chicken-like substance, including things like sodium benzoate, tertiary butylhydroquinone, and dimethylpolysiloxane. Oliver held a nugget up. “Would you eat that?” he asked the ladies. “Yes,” one of them replied. “It’s good!”

The US School Nutrition Association took umbrage at Oliver’s charges and issued a countervailing press release, arguing that a 2009 survey of more than 1,200 school districts across the country “found that nearly every school district offers students fresh fruits and vegetables, low-fat dairy products, whole grains and salad bars
or pre-packaged salads. Most schools still bake items from scratch in their kitchens, and school districts are offering more vegetarian meals and locally sourced foods. School nutrition programs have reformulated kid favorites to make them healthy, like pizza prepared with whole wheat flour, low-fat cheese and low-sodium sauce.”
⁵

Obviously, something between the lunch ladies in Huntington, the School Nutrition Association, and Oliver got lost in translation. But to its credit, the US federal government is, in fact (slowly, painfully), trying to improve matters to the tune of around $1 billion in annual spending. In 2011, the US Department of Agriculture (USDA) overhauled its school nutritional guidelines for the first time in fifteen years. But in November of that same year, Congress pushed back on the USDA’s healthier school lunch standards by limiting some of the USDA’s aggressively pro-health policies (prompting late-night comedians to poke fun at the idea that the tomato sauce on pizza and French fries are still to be considered vegetables). In spite of this setback, a spokesperson for the School Nutrition Association says that they expect most schools to continue to follow the USDA guidelines for healthier lunches.

Despite all the good intentions, here is the big problem: most kids still prefer French fries and pizza to spinach and apples. While many schools have tried to introduce healthy options, such as fruit instead of desserts, kids tend not to choose them—and even if they do choose them, they don’t end up eating them. Some parents try very hard to instill a love for broccoli and brown rice in their kids, only to find themselves defeated by the influence of grocery store checkout lines and well-meaning but uninformed relatives, friends, and neighbors.

Aside from the fact that their taste buds have been spoiled, kids face another problem, of course: they have no long-term perspective,
as we discussed in
Chapter 4
. Popeye ate his spinach, but if you tell a child “eat your veggies because it’s good for you, and it will make you grow up big and strong,” you’ll be met with a blank stare. Children aren’t thinking about their future health (or future anything, with the possible exception of their birthdays).

In
Chapter 1
, we talked about using incentives to make people exercise more, showing that paying students to visit the gym for a month made a change in their habits. Could the same kind of incentive work here?
What does it take to get kids to choose fruit over cookies?
To find out, we worked with the Chicago Food Depository to set up a study involving 1,000 schoolchildren in the Chicago area, where we worked with after-school meal programs to see what could entice children to choose healthy food. In our experiment, we first told kids in one group, “Today we have some extra desserts. Would you like a cookie or these dried apricots?” Predictably, 90 percent of the children went for the cookies.

Next, the children received some nutritional education, in which they were taught the importance of eating healthy fruits and vegetables and got to do fun things like drawing their own colorful food pyramids. After the program, we offered the children the same choice—cookies or fruit? To our (predictable) chagrin, the nutritional program didn’t make a dent in their preferences. The kids still went for the cookies.

So we tried yet another treatment in which we told a different group of children, “You can have either a cookie or fruit. If you choose the fruit, you get a prize!” (The prizes were a small rubber ducky in fruit colors, a wristband, a pen imprinted with the words “eat strong to be strong,” or a fruit keychain.) This time, 80 percent of the kids ate the fruit, compared to just 10 percent when there was no prize offered. We were also delighted by what happened when we combined the educational program with the prizes. When
we came back a week later, 38 percent of the kids were still choosing and eating the fruit—demonstrating that some of the kids were beginning to accrue some longer-term good habits.
⁶

A slightly different approach produced an even more positive result. We moved back a few steps to think about what happens in grocery stores. “Packaging and placement is something every grocery store does,” Ron Huberman observes. “Why not apply that to institutional food?” (It’s true: if you put the healthy food in a brightly lit, attractive, easily accessible place, and put the less healthy stuff in the aisles, more people will move to the “healthy” areas.)
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We started by eliminating the bad choices and replacing them with healthier ones, but—and this is important—we didn’t stop there. One innovation was to replace the chips at the front of the lunch line with bags of sliced apples. This did the trick, Huberman thinks, because the packaged apple slices were less daunting than choosing a gigantic apple with skin that gets stuck in braces, and because we made the chips harder to get. The chips and cookies were put in a place where the kids had to ask the lunch lady to get them. Who wants to ask the grouchy lunch lady for anything? Effectively, we changed the cost of consumption. As Huberman says: “Make it hard for them to ask for the cookie and make it easy for them to grab the sliced apple.” Duh.

The net-net? Once again, it’s all about adaptation—combining nutritional education with healthy choices and making sure those choices are much more appealing than the less healthy ones will make the difference.

Nudges Versus Nuisances to Save Lives

A week before Thanksgiving in 2012, John’s father-in-law, seventy-three-year-old Gary Einerson, lay in a hospital bed in the Intensive Care Unit of the University of Wisconsin’s hospital, while the
Grim Reaper patiently waited for him to breathe his last. Once an athletic, six-foot-two-inch, 200-pound college basketball player, he was known as a no-nonsense high school principal who got things done at Deforest High School, just outside of Madison. Awaiting a liver transplant, Gary had shrunk to just 138 pounds. The doctors said that if they failed to secure a matching liver within a few days, Gary would not survive. But he was fortunate: a liver, possibly from a nineteen-year-old boy killed in a car accident near Madison, arrived just in time. The transplant was successful, and Gary went home on Thanksgiving Day. The oldest organ recipient in the hospital’s history, Gary is today gaining weight and doing well.

According to the US government website
organdonor.gov
, eighteen people die every day while waiting for an organ; a single organ donor can save up to eight lives. You have doubtlessly heard the heart-wrenching pitches about the need for organ donors. The pitches go something like this: