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Precisely. I grew up in an odd town on Lake Erie. On the coast there were the Cleveland Clinic millionaire surgeons, NFL, MLB, and NBA players. On the west side of town a Ford plant and some low income housing, same income and housing on the east side. Middle bit was mostly solid middle class with a couple small higher income enclaves (CEO of a Berkshire Hathaway division, for instance).

So it was truly, truly all income levels interacting in our public schools (which are pretty highly rated).

I graduated in 2009. Close to 10% of my graduating class (~400), all income levels, died of opioid overdoses or suicide. The shame of talking about our town's problem and wanting keep up appearances killed scores of people.

BBC did a documentary on our town, called Smack in Suburbia, focussed on my age group. 30 minute watch, but, it really drives this point home https://www.youtube.com/watch?v=j7ynJ5S9c58

All of this tragedy was the direct consequence of shame as public health policy.



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