Skip to main content

The Last Mile

Introducing the May/June 2013 issue of Pacific Standard.


You’ve probably heard about the so-called last-mile problem, an affliction bedeviling everyone from telecommunications companies to humanitarian aid agencies. As behavioral economist Sendhil Mullainathan explained in a popular TED talk a few years back, the last mile is the surprisingly hard-to-bridge distance between a problem’s solution and its actual delivery to millions of people on the ground.

Mullainathan’s main example is a powerful one: It involves the vexing difficulty of delivering the cure for one of the world’s biggest killers to the people who need it most. The killer is diarrhea, and the cure is water.

The problem isn’t that the killer is poorly understood by experts. And it’s not that the cure is expensive. It’s that millions of people carry in their heads a very intuitive mental model of how the body works. According to that model, a body with diarrhea is a leaky bucket. And you don’t put water in a leaky bucket.

We know there is a coming housing crisis for the elderly, that kids with stressful childhoods are at higher risk for disease, and that gun violence is a public-health problem.

In this issue, we’re delivering to you a number of stories with variations on the last-mile theme. We know an awful lot about some big problems: We know that there is a coming housing crisis for the elderly, that kids with stressful childhoods are at higher risk for disease, and that gun violence is a public-health problem. We may even know how to design fixes for these big problems—but implementing them is another matter.

As Lisa Margonelli writes in “The Trailer Park at the End of the World,” every day 10,000 American baby boomers retire. By 2030, people older than 65 will make up 18 percent of the population—and housing them will be a huge challenge. Margonelli says a solution is “staring us right in the face. But we look away.” Why? Largely because of a simple two-word phrase: trailer trash.

In the late 1970s, Margonelli babysat for a family that lived in a trailer. “It had a sunken living room and recessed amber lighting; it was sort of groovy. In the winter the whole thing shook and rattled in the wind—spookily—and we had to leave the tap running to keep the pipes from freezing.” In 1976, new regulations from the Department of Housing and Urban Development basically removed a lot of the tinny-ness from the mobile home, and pushed the structures on their way to becoming what is now called “manufactured housing.” These modern mobile homes are inexpensive, conducive to healthy living, and have light environmental footprints. Some of them are pretty stylish, too. But the stigma attached to them, and lingering problems with their legal status, make us blind to this solution.

For our story “What Does It Take for Traumatized Kids to Thrive?,” Laura Tillman traveled to Washington State, which has done more than any other state to inform its citizens about research on how early-childhood adversity affects kids’ brains. Here’s a case where scientists are still figuring out exactly how stress and trauma affect the brain, and how those effects can be mitigated. But Washington got a head start on the last-mile problem by promoting a new mental model—one that depicts a stressful childhood not only as a private matter, but as a major risk factor for disease and other social problems—to families across the state. (For another take on the current fascination with stress and neuroscience, check out Tom Jacobs’ book review, “Brainism.”)

In our Prospector section, Vince Beiser writes about a unique program aimed at reducing gun violence in California. Government agents are knocking on doors, asking people who have lost the right to own guns because of violence or mental illness to hand over their weapons—an approach that originally had the NRA’s support. The program is based on the idea that gun violence should be treated as a public-health issue. Despite signs of success, Beiser points out, few states could emulate the program, because California is essentially the only one that collects the records showing who should and shouldn’t own a gun. The last mile is blocked by a huge lack of data.

But if this all sounds disheartening, look to Dorothy Fortenberry’s story about country superstar Brad Paisley, titled “It Gets Better, Y’all.”