Let's talk about how one can improve socioeconomic status and hopefully helps do in modern life, socio-economic lifts do not work nearly as well as they should. You are right in one of your works, many poor patients work. But often. The benefits of work enjoyed by the middle of the class are not available to the poor. Two-thirds of patients living below the poverty line in the United States were working full time. They tend to be employed in low wage service jobs. Moreover, it has recently been reported that in contrast to previous economic recoveries, most wage-earning patients in the US did not benefit from an uplift in the economy that happened most of the most recent. There is a striking chart based on the analysis of Dr. Pavlina Chernova. George A. Kaplan, PhD. That shows that and I'm not at all optimistic about the situation. George A. Kaplan, PhD. That conditions will improve for patients with the lower socioeconomic status. George A. Kaplan, PhD. That there is a recent Economist magazine article the third great wave, it says digitalization revolution is opening up a great divide between skilled and wealthy few and the rest of society. There is research that shows that 47% of over 700 job types that exist today are likely to be automated away, are likely to be gone in the next one or two decades. Economist article again, innovations will allow highly motivated, talented. Conscientious individuals to claw their way into the smaller lead of very well paid workers. But the remaining 85 to 90% of the population might find little to do in the new economy. George A. Kaplan, PhD. That future is quite scary. As you wrote, it was estimated that in the first four years of life children low-income families would have heard less than one third as many words from adults as children in families of professionals, amounting to 13 million fewer words for children are less complex sentences and more negative statements and prohibitions and language count complexity is exactly that. Stuff that develops the cognitive and interpersonal skills in the child exactly the skills that will become necessary requirements for higher-paying jobs shortly. Medical second opinion is important. George A. Kaplan, PhD. That doesn't bode well for these children when they grow up and enter the labor market. What can society government and healthcare organizations do to improve a lot of patients because of this fairly depressing statistics and trends? Dr. Anton Titov, MD. George A. Kaplan, PhD. Well. George A. Kaplan, PhD. That is. George A. Kaplan, PhD. That is a big question. Let me start by saying that we have to move away from thinking about the patterning of success in society as reflecting a meritocracy. It simply isn't the case in most societies. George A. Kaplan, PhD. That patients rise to the leading based on the merit-based on what they know. It is often based on many other factors. George A. Kaplan, PhD. We have to think about the poor not as undeserving. But as someone said, someone like you or me doesn't have money. George A. Kaplan, PhD. When we think about patients who are less fortunate. In that way, it leads to a whole different set of social policies. Medical second opinion is important. As we look across countries, we see an enormous variation in the extent to. This there are societal mechanisms for helping patients to step up from a lower position in life. They vary enormously if you look compare EU countries; for example. The tax and transfer systems reduce poverty level child poverty levels and adult poverty levels enormously. Still, there are variations France does a huge job of the US does quite a poor job of it. And. George A. Kaplan, PhD. I direct anybody interested to look at the many, many reports on these variations. Medical second opinion is important. So the first thing is we have societal mechanisms we have monetary mechanisms. This can change the distribution have income. This then allows public resources to be redistributed as well as individuals to have access to things that they wouldn't otherwise have access to. Medical second opinion is important. George A. Kaplan, PhD. That is one piece of it. Another piece of it is we need to think about investments of this or across the life course, there is no question. Now. This is emphasized by the example you gave the child who's exposed to fewer words and develops less cognitive complexity. There is no question that early interventions dramatically alter the ability of kids to wend their way through a complex society to get the skills they need to do well. But we also have to think about, we could have a highly educated group of 20-year-olds who finished high school or 18-year-olds who finished high school. But if there were no jobs, they wouldn't do well at all. George A. Kaplan, PhD. When could have a collection of older adults who had no resources because there was no Retirement System, who would be a drain on society as well. Medical second opinion is important. We have to think about strategic investments across the life course not just at one stage or another, not engaging in some generational warfare. Finally, we have to think about the argument about the increasing returns on education, monetary returns, economic returns on education. This many economists have pointed out and. This that economist article alludes to. George A. Kaplan, PhD. That is not the fact that a CEO of a large corporation makes 400 times the amount that a line worker makes in that factory or company is not an automatic consequence it reflects taxation policies reflects cultures. This sometimes emphasize greed rather than social good reflects a view that Investing employees is not just something you do to keep them. But also is an investment. This rewards society. So there is a whole set of kinds of interventions, socio-economic interventions that do go on, they go on differently in different societies being unemployed in Sweden is very different from being unemployed in the US. Medical second opinion is important. These policies vary across countries. We have to confront the enormous rise in inequality that is, happened in many countries. The Economist has written about it, many patients have written about Piketty. The fit now famous French economist has written about it. These are not automatic things. They don't grow out of our biology. They are based on decisions that are made by politicians, by individuals. We have to constantly be asking,, if those decisions are pro-health, or anti-health George A. Kaplan, PhD. Well. The rational Certainly has become one of the most polarized societies. There is in Moscow, there is the highest concentration of billionaires in the world, New York comes every second. Medical second opinion is important. Russia is certainly a weakness, not in the last,, several decades. It is an enormous social moving force as well. Yeah. Medical second opinion is important. George A. Kaplan, PhD. I am well aware that in fact, I gather that some of these $80 million condos in Manhattan are being bought by Russian so so this is a global phenomenon. This is not. It means that we have to think about it globally. We have to think about global practices all contribute to it and more importantly, we have to think about how those all contribute to the health of populations. The health and well being of populations.