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Book Review: The Future of Us

Donna Miele

The Future of Us: What the Dreams of Children Mean for Twenty-First-Century America
Irwin Redlener
Columbia University Press, 2017

As an urban-born Jewish kid relocated to rural Pennsylvania, Irwin Redlener’s sense of being different planted the seeds of his lifelong empathy for the most vulnerable in American society. A brush with his own personal “Nurse Ratched” during a childhood illness seemed to call him to children’s healthcare in particular:

“Sit up!” she would snarl. “Look at this mess you’ve made with these rumpled sheets and your pillow on the floor.”

…I never forgot how unnecessarily agonizing the experience was for me. On the clinical rotations in pediatrics as a medical student in Miami, as a resident in training, as the director of a pediatric intensive care unit, as the pediatrician in the dregs and despair of Lee County, Alabama, as a visitor to the children’s wards of hospitals in rural Honduras and famine-stricken Ethiopia, and as a doctor for thousands of New York’s homeless children, I never forgot what it felt like to be a nine-year-old boy hospitalized in Coatesville, Pennsylvania.

Dr. Redlener has since become well-known in New York City for his charismatic outspokenness and his unabashed reliance on celebrity partnerships to further his cause. His most prominent effort has been the founding and operation of the Children’s Health Fund with the singer Paul Simon, advocating nationwide for family health care in disadvantaged communities. 

In The Future of Us, Redlener tries both to describe his unique journey and to deflect attention from himself, laying out the robust social benefits of strong public health policies. His discussion is earnest, sometimes strained. But the book’s punch is in Redlener’s powerful position: a society that ignores the basic health care needs of its children “reflects a moral failure to value and respect the aspirations of children and families. It also suggests a terrible misunderstanding of what it takes for any nation to remain economically viable and internationally influential.” 

Redlener begins with portraits of typical patients. They are pre-adolescent urban kids, often presenting with “asthma… diagnosed in 8.6 percent of all children, and found in an astounding 33 percent of homeless children in New York City.” Increasingly, his patients are homeless. “[I]n the late 1980s, some 10,000 children lived in New York City shelters on any given night, and by 2016 that count had more than doubled to nearly 24,000 children.” In a less stressed community, well-established protocols would serve these children. But these families are dispossessed by our society, and follow-up is difficult. Dr. Redlener created a mobile medical service, traveling around the city in distinctive blue vans that were fully functional pediatric clinics. Even these heroic efforts, though, are mere Band-Aids for a relentless human catastrophe. “[W]hen the possibilities for these children are constricted,” Redlener writes, “the inevitable outcome is another generation of unforgiving adversity and unfulfilled dreams.”

In getting to know patients, Redlener goes “for the big question, the ultimate cliché to which almost all kids respond: ‘So, what do you want to be when you grow up?’” He encounters a wealth of youthful aspirations—along with social histories that contrast sharply with those of kids whose families routinely provide enrichment and are able to get them to school in safety and good health every day. In the section entitled, “Raymond, Graphic Designer,” Redlener depicts an avid young artist who’d lived all his life in New York City and had never once visited a museum.

Redlener’s personal profile, for which his most fervent supporters must be thirsting, takes up the bulk of the book, peppered with research-based musings and supporting data. He has an instinct, probably based on practiced telling and re-telling, for which stories will resonate: a grade-school teacher asking to “feel his little [Jewish] horns”; a house call in rural Alabama to resuscitate a farmer’s prize pig; dinner with Fidel Castro while visiting Cuba; the difficulty of balancing public health activism against celebrity muscle during the USA for Africa campaign. 

The reader might occasionally wince against seemingly pointless celebrity appearances, or at too-neat sets of fact and dialogue, crafted by an academic to prove a clear point. But when we read Redlener’s account of homeless families lining up outside a New York City shelter for his mobile clinic, we witness the result of his powerful call to action, one that negates writerly craft concerns. 

One after another, children climbed on board with their parents. We treated ear infections, asthma, impetigo, lice, intestinal infections, and gave needed immunizations. We assessed children—and their parents—who seemed depressed and anxious, traumatized by the experience of homelessness, with no way to escape the ugliness and chaos.

Redlener points, at times graphically, to how economic disadvantage affects basic healthcare for children. As we look ahead to continued Congressional healthcare-bashing, Dr. Redlener’s simple, earnest plea is profoundly well-crafted: “…[F]ighting for children is anything but a lost cause. And nothing could be more important.”