>> Reilly: I'M ADAM REILLY, IN FOR JIM BRAUDE.

TONIGHT ON "GREATER BOSTON," CHANGES ARE COMING TO MCAS SCORING REQUIREMENTS FOR STUDENTS.

NEW RULES NOW REQUIRE HIGH SCHOOLERS TO SCORE EVEN HIGHER ON THE TEST IN ORDER TO GRADUATE.

A MEMBER OF THE STATE EDUCATION BOARD, WHO SUPPORTED THE CHANGE, AND THE EXECUTIVE DIRECTOR AT "CITIZENS FOR PUBLIC SCHOOLS," JOIN ME.

THEN, AS THE WAR IN UKRAINE RAGES ON, TWO LOCAL HEALTH EXPERTS ARE SHINING A LIGHT ON THE DEVESTATING HEALTH IMPACTS OF THE WAR.

>> Reilly: HIGH SCHOOL STUDENTS ACROSS THE STATE WILL SOON HAVE TO SCORE HIGHER THAN BEFORE ON THE STANDARDIZED MCAS TESTS IN ORDER TO GRADUATE, AFTER OFFICIALS APPROVED A CONTROVERSIAL NEW PLAN YESTERDAY.

THE STATE EDUCATION BOARD VOTED 8-3 IN FAVOR OF ELEMENTARY AND SECONDARY EDUCATION COMMISSIONER JEFFREY RILEY'S PROPOSAL, WHICH WILL KICK IN STARTING WITH THE CLASS OF 2026, DESPITE OVERWHELMING OPPOSITION TO THE PLAN FROM MEMBERS OF THE PUBLIC WHO SUBMITTED COMMENT THIS SPRING.

STUDENTS HAVE HAD TO SCORE A CERTAIN LEVEL ON BOTH ENGLISH AND MATH IN THE MCAS-- OR MASSACHUSETTS COMPREHENSIVE ASSESSMENT SYSTEM-- IN ORDER TO GRADUATE SINCE 2003.

BUT UNDER THE NEW PLAN, THE BAR WILL BE RAISED FROM 472 TO 486 ON THE ENGLISH EXAM, AND THEN AGAIN TO 500 FOR BOTH ENGLISH AND MATH BEGINNING WITH THE CLASS OF 2031.

ALL OF THIS COMES AT A DIFFICULT TIME FOR STUDENTS, WHICH PEOPLE ON BOTH SIDES OF THE ISSUE ACKNOWLEDGE: AMID THE NEW STRESSES OF THE PANDEMIC, MCAS SCORES LAST SEPTEMBER DROPPED BY HUGE MARGINS ACROSS THE STATE.

AND THEN THERE ARE LONGSTANDING EQUITY CONCERNS SURROUNDING THE MCAS AND A WIDE VARIETY OF MARGINALIZED STUDENT GROUPS, AS WELL AS A FIERCE AND ONGOING DEBATE ABOUT WHETHER STANDARDIZED TESTING MAKES THINGS WORSE OR HELPS PUSH LOW-PERFORMING SCHOOLS TO BE BETTER.

I'M JOINED NOW BY EDUCATION BOARD MEMBER MARTIN WEST, WHO PROPOSED THE ADOPTED AMENDMENT TO THE COMMISSIONER'S PLAN THAT FURTHER RAISED THE GRADUATION REQUIREMENT TO A SCORE OF 500 IN FUTURE YEARS.

HE IS ALSO THE ACADEMIC DEAN AT THE HARVARD GRADUATE SCHOOL OF EDUCATION.

AND BY LISA GUISBOND, EXECUTIVE DIRECTOR AT "CITIZENS FOR PUBLIC SCHOOLS."

THANK YOU BOTH FOR BEING HERE.

MARTIN, LET ME START WITH YOU.

WHY WAS THIS THE RIGHT MOMENT TO MAKE STANDARDS TOUGHER, RATHER THAN KEEP THEM AS THEY WERE?

>> WELL, THIS DECISION THAT WE TOOK YESTERDAY IS THE PRODUCT OF A YEARS-LONG PROCESS.

SO BACK IN 2019, THE STATE ADOPTED WHAT IS KNOWN AS "THE NEXT GENERATION MCAS" FOR TENTH GRADERS, AND THIS WAS A NEW ASSESSMENT, AN IMPROVED ASSESSMENT.

AND WHEN WE ADOPTED THAT, WE ENGAGED IN A STEP OF SETTING INTERIM STANDARDS THAT WOULD APPLY TO THE FIRST TWO CLASSES TO TAKE THAT NEW ASSESSMENT, THE CLASSES OF '21 AND '22.

EARLY IN 2020, WE BEGAN THE PROCESS AS A DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION, BY FORMING AN ADVISORY COMMITTEE TO OFFER ADVICE TO THE COMMISSION AND THE BOARD ON WHAT THE STANDARDS ON THE NEW TEST SHOULD BE.

THAT PROCESS WAS INTERRUPTED BY THE PANDEMIC, AS WAS THE ADMINISTRATION OF MCAS.

SO WE'VE BEEN IN INTERIM STATUS FOR A NUMBER OF YEARS NOW.

SO WE FELT, AS WE TURNED TO THE CLASS OF '26, THE GROUP OF FRESHMEN THAT WILL BE ENTERING SCHOOL THIS FALL, THAT THERE WAS FINALLY TIME TO RESTART THIS PROCESS, TO CONTINUE A PROCESS THAT HAD ALWAYS INTENDED TO SET AN INTERSIM AND HAVE THAT BECOME A PERMANENT STANDARD.

SO EARLIER THIS YEAR, WE FORMED AN ADVISORY COMMITTEE AGAIN, REPRESENTING DIVERSE STAKEHOLDERS ACROSS THE STATE, EDUCATORS WERE A BIG PART OF THAT.

AND THEIR RECOMMENDATION TO US AS A BOARD WAS, YES, WE SHOULD MOVE FORWARD WITH RAISING THE STANDARD.

I CAN TALK A LITTLE BIT ABOUT THE EVIDENCE THAT WENT INTO THAT.

BUT THAT WAS THE CLEAR RECOMMENDATION FROM THE ADVISORY COMMITTEE THAT WE FORMED.

AND THAT INFORMED THE ACTION THAT WE TOOK TODAY.

>> Reilly: LET ME JUMP TO LISA NOW.

I WANT TO GET YOU IN HERE.

WE'VE HEARD FROM MARTIN WHY HE BELIEVES IT WAS THE RIGHT MOMENT TO RAISE STANDARDS, PART OF A PROCESS THAT'S BEEN IN PLAY FOR A WHILE.

LISA, WHY DO YOU THINK THIS IS THE WRONG MOMENT TO BE DOING WHAT WE'RE DOING?

>> I THINK IT'S A TERRIBLE MOMENT TO DO THIS BECAUSE OF ALL THE DISRUPTIONS THAT OUR STUDENTS AND TEACHERS AND FAMILIES HAVE BEEN THROUGH DURING THE PANDEMIC THAT HAVE AFFECTED THEIR LIVES IN MANY WAYS.

BUT I ALSO THINK IT'S A STEP BACKWARD IN GENERAL, REGARDLESS OF THE MOMENT BECAUSE YOU MAY KNOW THAT MASSACHUSETTS IS AN OUTLIER IN CONTINUING TO USE A GRADUATION TEST.

WE'RE ONE OF ONLY 11 STATES THAT STILL DO THAT.

AND MANY OTHER-- MOST OTHER STATES IN THE NATION HAVE MOVED AWAY.

-- I BELIEVE IT WAS A HIGH OF 27 STATES AT ONE POINT DOWN TO ABOUT 11-- BECAUSE OF ALL THE CONCERNS THAT MANY PEOPLE RAISED, I BELIEVE, IN THE PUBLIC COMMENT, YOU KNOW, 98% OPPOSITION IN PUBLIC COMMENT TO THIS MOVE BECAUSE OF THE IMPACT ON.

SO MANY STUDENT GROUPS, INCLUDING STUDENTS WITH DISABILITIES, ENGLISH LEARNERS, STUDENTS FROM LOW-INCOME HOUSEHOLDS, BLACK AND BROWN STUDENTS.

SO A TERRIBLE MOMENT AND A BACKWARDS STEP INSTEAD OF A POSITIVE STEP.

>> Reilly: TELL ME IF I'VE GOT THIS RIGHT-- PUT SIMPLY, THE CONCERN PEOPLE HAVE WHEN IT COMES TO THOSE GROUPS THAT YOU MENTIONED THAT THEY'RE NOW GOING TO BE LESS LIKELY TO GRADUATE, AND THEN MEMBERS OF THOSE GROUPS WILL HAVE A BLACK MARK WORKING AGAINST THEM AS THEY ENTER ADULTHOOD.

IS THAT A FAIR SYNOPSIS?

>> YES, THAT AND ALSO THE IMPACT ON THE EDUCATION THAT THEY HAVE WHEN THEY'RE IN SCHOOL.

THERE WAS PUBLIC COMMENT FROM REPRESENTATIVE JIM HAWKINS WHO USED TO BE A TEACHER, A TENTH GRADE MATH TEACHER, AND HE DESCRIBED WHAT HAPPENS WHEN KIDS FAIL, AND THE FOCUS OF THEIR EDUCATION BECOMES EVEN MORE NARROW, GEARED TOWARD PASSING TEST, AND THEY IS LACK ACCESS TO A LOT OF THE THINGS THAT MAKES SCHOOL ENGAGING AND WORTHWHILE AND EXCITING IN HIGH SCHOOL.

>> Reilly: GOT IT.

MARTIN, I WANT TO GO TO THE POINT OF PUBLIC FEEDBACK THAT LISA MENTIONED.

WE MENTIONED IT IN THE INTRODUCTION OF THE SECMENT.

HOW DID YOU AND YOUR FELLOW BOARD MEMBERS INCORPORATE THAT OVERWHELMINGLY NEGATIVE FEEDBACK ABOUT THE PROSPECT OF ENHANCED OR TOUGHER GRADUATION REQUIREMENTS, IF YOU INCORPORATED IT AT ALL?

HOW DID YOU THINK THROUGH WHAT YOU HEARD FROM PEOPLE?

>> AS I SAID, THE COMMISSIONER'S PROPOSAL TO THE BOARD WAS DEEPLY INFORMED BY A ROBUST PROCESS OF ENGAGING THE PUBLIC IN THIS DECISION-MAKING PROCESS.

SO IT IS TRUE, LISA IS CORRECT, WE DID NOT MAKE ANY SPECIFIC CHANGES TO THE PROPOSAL THAT THE COMMISSIONER HAD PUT OUT AS A DRAFT FOR PUBLIC COMMENT IN RESPONSE TO THE COMMENTS THAT WE RECEIVED FOR THAT PROCESS.

BUT I THINK IT'S WRONG TO SAY THAT THE PUBLIC WAS NOT ENGAGED IN IT.

OF COURSE, THE PEOPLE THAT YOU MAY HEAR FROM IN A FORMAL PUBLIC COMMENT PROCESS MAY NOT BE REPRESENTATIVE OF THE STATE AS A WHOLE, AND I THINK THAT'S CLEARLY WHAT HAPPENED IN THIS INSTANCE.

THE OTHER THING I WOULD SAY IS THAT A LOT OF THE PUBLIC COMMENT WAS URGING US TO ABANDON MCAS AS A GRADUATION REQUIREMENT AT ALL, AND THAT'S SOMETHING, FRANKLY, THAT'S NOT WITHIN OUR MANDATE TO DO.

THE EDUCATION REFORM ACT OF 1993 SAYS WE AS A BOARD ARE CHARGED WITH ARTICULATING THE LEVEL OF EXPECTATION THAT STUDENTS NEED TO MEET ON A CRITERION REFERENCE TEST TIED TO THE STATE'S ACADEMIC CONTENT STANDARDS.

SO THAT'S OUR RESPONSIBILITY.

WE COULDN'T RESPOND TO MOST OF THE COMMENTS THAT WE RECEIVED WITHOUT VIOLATING THAT STATUTE.

AND THE LAST THING I WOULD SAY IS WHILE WE DID NOT MAKE SPECIFIC CHANGES TO THE PROPOSAL THAT WE ADOPTED YESTERDAY IN RESPONSE TO THE COMMENT, THE COMMENTS THAT WE RECEIVED WILL, IN MANY WAYS, INFORM THE DEPARTMENT'S IMPLEMENTATION OF THIS NEW REQUIREMENT.

SO A LOT OF ATTENTION WAS PAID BY THE COMMENTERS TO THE NEED TO MAKE SURE THAT ALTERNATIVE PATHWAYS TO A DIPLOMEDDA FOR THOSE STUDENTS WHO FIRST FAIL THE TEST ARE AVAILABLE, THAT THEY'RE WIDELY DISSEMINATED, THAT THEY ARE IMPLEMENTED IN AN EFFECTIVE WAY.

AND THAT YOU CAN EXPECT WILL INFLUENCE WHAT THE DEPARTMENT DOES IN THAT AREA GOING FORWARD.

>> Reilly: I WANT TO ACTUALLY BACK UP EVEN A LITTLE MORE AND MAKE SURE THAT WE'RE REALLY CLEAR HERE.

IT'S INFORMATION THAT I NEED, MYSELF, TO BE EDUCATED AS I THINK THIS THROUGH.

I QUOTED SOME SCORE INCREASE, OR SCORE INCREASED THRESHOLDS AT THE BEGINNING, FROM% 400-SOMETHING TO 400-SOMETHING.

BUT I DON'T KNOW WHAT THAT MEANS.

AND I'M GUESSING A LOT OF PEOPLE WATCHING AT HOME MAY NOT KNOW WHAT THAT MEANS.

HOW MANY MORE QUESTIONS ARE WE TALKING ABOUT KIDS STROG GET CORRECT IN ORDER TO PASS THE MCAS AND GO ON AND GRADUATE?

EITHER ONE OF YOU CAN HOP IN AND TELL ME.

IS IT ONE MORE QUESTION ON ENGLISH OUT OF A 50-QUESTION TEST?

IS IT SOMETHING ELSE?

WHAT ARE WE TALKING ABOUT CONCRETELY?

( BOTH TALKING AT ONCE ) >> I CAN'T ANSWER THE SPECIFIC NUMBER OF QUESTIONS.

>> Reilly: OKAY.

>> HERE'S WHAT I CAN SAY.

TO CONFUSE THINGS EVEN MORE, THERE ARE TWO DIFFERENT STANDARDS THAT THE BOARD WAS SETTING YESTERDAY.

ONE IS THE LEVEL OF PERFORMANCE THAT STUDENTS NEED TO MEET IN ORDER TO BE ABLE TO RECEIVE A DIPLOMA, ALONG WITH COMPLETING WHAT WE CALL AN EDUCATION PROFICIENCY PLAN.

AND SO THAT IS THE LOWER OF THE TWO STANDARDS.

>> Reilly: RIGHT, RIGHT.

>> THERE'S A HIGHER STANDARD WHICH SAYS IF YOU MEET THAT, YOU DON'T NEED TO GO THROUGH THIS EDUCATION PROFICIENCY PLAN PROCESS.

AND SO WE MADE CHANGES TO BOTH OF THOSE.

WHAT YOU SEE ON THE SLIDE HERE IS THE LEVEL OF EXPECTATION FOR AVOIDING THE EDUCATION PROFICIENCY PLAN PROCESS.

WELL, WHAT IS AN EDUCATION PROFICIENCY PLAN?

IT IS A NOTIFICATION OF PARENTS ON AN ANNUAL BASIS OF THE ADDITIONAL SUMENTZ THE STUDENT WILL RECEIVE IN ORDER TO RAISE THEIR COMPETENCY IN MATH AND ENGLISH LANGUAGE ARTS, AND THERE ARE SOME OTHER COMPONENTS THAT GO ALONG WITH IT.

BUT IT'S INTENDED TO PROVIDE ADDITIONAL SUPPORTS TO STUDENTS WHO NEED TO RAISE THEIR ACHIEVEMENT IN ORDER TO MEET THE BOARD'S EXPECTATIONS.

THE MORE BINDING STANDARD IS THE ONE BELOW WHICH STUDENTS CAN'T RECEIVE A DIPLOMA, EVEN WITH THE EDUCATION PROFICIENCY PLAN.

AND THERE THE CHANGE, THE CURRENT SCORE REQUIRED IS 455 IN ENGLISH LANGUAGE ARTS, AND THAT IS GOING UP TO 470.

AND FROM 469 TO 470 IN MATH.

SO ONLY A SINGLE POINT INCREASE.

>> Reilly: THAT DOESN'T SOUND LIKE A LOT IT ME.

I'D LOVE TO KNOW, AGAIN, CONCRETELY, EXACTLY WHAT WHATSAPP IT MEANS.

LISA, YOU SAID YOU WANTED MARTIN TO TACKLE THAT, THAT YOU DON'T EVEN IT'S ONE MORE QUESTION CORRECT, TWO MORE QUESTIONS CORRECT?

>> I JUST THINK IT'S INTERESTING THAT YOU ASK THAT QUESTION AND THE ANSWER IS TOW COMPLICATED AND IT DOESN'T REALLY GET AT EXPLAINING TO ME OR OTHER PARENTS OR STUDENTS, LIKE, HOW DOES THIS ALL REALLY MEASURE WHETHER SOMEONE IS READY TO MOVE ON TO PURSUE THE GOALS THEY HAVE IN THEIR LIVES, AND I WOULD ARGUE THAT IT DOESN'T.

IT'S LIKE A BLACK BOX.

IT'S THIS VERY MECHANICAL SORT OF BUSINESS-MINDED WAY OF LOOKING AT HUMAN BEINGS THAT YOU CAN SORT OF SET THE GOAL-- YOU KNOW, THE SALES GOAL HIGHER AND EVERYONE WORK HARDER TO ACHIEVE THE GOALS.

BUT THAT'S NOT HOW EDUCATION WORKS, LEAST ACCORDING TO ALL THE EDUCATOR THEY SAY RESPECT.

>> Reilly: YOU MENTIONED-- I ACTUALLY WANTED TO ASK YOU ABOUT SOMETHING YOU MENTIONED, LISA.

YOU SAID YOU SAW THIS AS DOUBLING DOWN ON A FUNDAMENTALLY FLAWED APPROACH.

YOU'RE OPPOSED TO THE MCAS IN PRINCIPLE.

IT'S NOT JUST THE INCREASED STANDARDS.

YOU DON'T WANT THE TEST TO EXIST.

>> I'M OPPOSED, DEFINITELY, TO USING THE MCAS TO DECIDE WHO GETS A HIGH SCHOOL DIPLOMA.

MOST OF THE REST OF THE COUNTRY HAS REJECTED.

>> Reilly: THANK YOU FOR THE CLARIFICATION.

IT'S AN IMPORTANT ONE.

I HEARD THE NEW PRESIDENT OF THE MASS TEACHERS ASSOCIATION ON OUR RADIO AIRWAVES TODAY SAYING WE'RE GOING TO BE BACK WHEN THE BAKER ADMINISTRATION'S GONE, AND WE'RE GOING TO BE PUSHING TO MOVE IN THE OPPOSITE DIRECTION.

BUT TELL ME, MAYBE I'M MISSING SOMETHING, BUT I'M NOT AWARE OF ANY GROUNDSWELL WHEN IT COMES TO ELIMINATING THE MCAS AS A GRADUATION REQUIREMENT.

I HAVEN'T HEARD MAURA HEALEY TALK ABOUT IT.

I DON'T THINK I'VE HEARD GEOFF DIEHL TALK ABOUT IT IN THE GOVERNOR'S RACE.

MAYBE I'M WRONG.

IS THERE A PUSH THAT YOU THINK COULD LEAD TO THE MCAS BEING JETTISONED ENTIRELY DOWN THE ROAD AS A GRADUATION REQUIREMENT?

>> I THINK IT'S PRETTY INCREASINGLY UNPOPULAR, ESPECIALLY THE GRADUATION REQUIREMENT.

AND HUNDREDS-- HALF THE LEGISLATURE SIGNED A LETTER TO THE BOARD OF EDUCATION OPPOSING THIS POLICY OF INCREASING THE PASSING SCORE AND A LETTER THAT THEY SENT, JUST REALLY OUTLINED A LOT OF THE PROBLEMS WITH HIGH-STAKES TESTING IN GENERAL.

SO I DO THINK, YOU KNOW, THE WAY THE LEGISLATURE WORKS, EVERYTHING HAS TO GO THROUGH THESE COMMITTEES WITH THE COMMITTEE CHAIRS HAVING A LOT OF POWER ABOUT WHETHER ANYTHING EVER GETS OUT OF COMMITTEE.

BUT IT WAS VERY INTERESTING TO ME WHEN YOU SORT OF PUT THIS LETTER OUT THERE THAT WAS SIGNED BY HALF THE LEGISLATORS, AND, YOU KNOW, THEY REPRESENT VOTERS.

THEY HAVE CONSTITUENTS.

THEY'RE ELECTED, NOT APPOINTED.

>> Reilly: AGAIN, JUST TO DRIVE HOME, THEY WERE TALKING ABOUT THE INCREASE AS OPPOSED TO THE CONTINUED USE OF THE TEST AS A GRADUATION REQUIREMENT, PERIOD.

>> YEAH.

THE SPECIFIC FOCUS WAS THE INCREASE.

BUT AS I SAID, I READ THE LETTER, AND MANY OF THE POINTS IN THE LETTER APPLY MORE BROADLY TO USING THE TEST TO DETERMINE WHO GRADUATES FROM HIGH SCHOOL.

>> Reilly: MARTIN, I WANT TO GIVE YOU LAST WORD HERE.

I KNOW YOU WERE TRYING TO GET IN AND I MADE A POINT OF ASKING LEASE A QUESTION.

YOU WORK AT THE HARVARD SCHOOL OF EDUCATION, WHICH I THINK IS A MACRO WHEN IT COMES TO A PROGRESSIVE APPROACH OF EDUCATION.

FROM YOUR VANTAGE POINT THERE AND YOUR VANTAGE UPON POINT AS A BOARD MEMBER, WHAT ARE PEOPLE MISSING WHEN THEY TALK ABOUT MAYBE GETTING RILD OF THE TEST ENTIRELY AS A GRADUATION REQUIREMENT.

WHY WOULD THAT BE A BAD IDEA?

>> I KEEP MENTIONING THIS ADVISORY COMMITTEE, WHICH HAD THE CHANCE TO LOOK CLOSELY AT THE EVIDENCE WE'VE ACCUMULATED OVER TIME ABOUT HOW THE STUDENTS' PERFORMANCE ON THE MCAS TEST IS RELATED TO THEIR LONG-TERM OUTCOMES.

AND WE JUST-- WHEN WE LOOK AT POST-SECONDARY OUTCOMES IN THE STATE, WE LOOK AT EARNINGS OF STUDENTS IN THE LABOR MARKET, WE FIND THIS ROBUST RELATIONSHIP, EVEN WHEN WE COMPARE STUDENTS FROM SIMILAR DEMOGRAPHIC BACKGROUNDS, EVEN FROM THE SAME HIGH SCHOOL.

AND THIS REALLY TELLS US THAT THE MCAS IS CAPTURING SKILLS THAT MATTER FOR STUDENTS' SUCCESS.

AND SO IT SEEMS TO ME THAT WE'RE MISSING THE FACT THAT THESE TESTS DO TELL US SOMETHING ABOUT WHAT STUDENTS NEED TO SUCCEED.

THEY DON'T TELL US BY ANY MEANS EVERYTHING ABOUT WHAT THEY NEED TO SUCCEED.

AND SCHOOL DISTRICTS HAVE LOTS OF ROOM TO OFFER A MUCH-BROADER DEFINITION OF STUDENT SUCCESS.

BUT OUR ROLES IS THE BOARD OF ELEMENTARY AND SECONDARY EDUCATION, UNDER THE EDUCATION REFORM ACT, IS TO ARTICULATE STANDARDS IN THIS DOMAIN, AND THAT'S WHAT WE'VE SOUGHT TO DO.

JUST TO GIVE YOU CONNECTICUT CRETE WAY TO THINK ABOUT-- >> Reilly: VERY QUICKLY, BECAUSE WE'RE ALMOST OUT OF TIME.

MAKE IT SPEEDY.

>> ROUGHLY 3,300 STUDENTS, WE ESTIMATE, WOULD NOT PASS THE ELEVATED STANDARD, RELATIVE TO WHO WOULD HAVE PASSED HAD WE LEFT THE STANDARD UNCHANGED.

NOW, WHAT DOES THAT MEAN FOR THEM?

HOPEFULLY, THEY'LL RAISE THEIR EXPECTATIONS AND MEET THE STANDARD.

THAT HAS BEEN THE STATE'S HISTORY.

GRADUATION RATES HAVE INCREASED, AS WE'VE HAD THIS REQUIREMENT IN PLACE.

BUT IF NOT, THEY WILL HAVE TO PURSUE ONE OF THOSE ALTERNATIVE PATHWAYS.

>> Reilly: GOT IT.

>> WE DON'T SEE THIS AS SOMETHING THAT WILL INCREASE DROPOUT RATES.

WE THINK IT IS SOMETHING THAT WILL HELP STUDENTS SUCCEED.

>> Reilly: WE HAVE TO LEAVE IT THERE.

MARTIN WEST, LISA GUISBOND THANK YOU BOTH.

NEXT UP, IT'S BEEN NEARLY SIX MONTHS SINCE RUSSIA LAUNCHED ITS BRUTAL ASSAULT ON UKRAINE.

AND WHILE THE FIGHTING HAS MADE IT IMPOSSIBLE TO GET AN ACCURATE COUNT, MOST ESTIMATES PUT THE UKRANIAN DEATH TOLL IN THE TENS OF THOUSANDS OF SOLDIERS AND CIVILIANS, INCLUDING CHILDREN.

THE KREMLIN IS NOW UNDER INVESTIGATION FOR WAR CRIMES IN THE INTERNATIONAL CRIMINAL COURT FOR ITS MANY ATTACKS TARGETING HOMES, SCHOOLS, HOSPITALS AND EVACUATION ROUTES.

AND MUCH OF THE WORLD HAS RALLIED AROUND UKRAINE WITH MILITARY AID AND HUMANITARIAN SUPPLIES, THOUGH OFFICIALS THERE SAY THEY STILL NEED MORE ASSISTANCE TO BEAT BACK RUSSIAN TROOPS.

BUT AS THE BATTLES CONTINUE, TWO LOCAL DOCTORS ARE ALSO WORRIED ABOUT OTHER DEVASTATING HEALTH EFFECTS, FROM THE SPREAD OF DISEASE AND MALNUTRITION TO WORSENING PRE-EXISTING CONDITIONS, P.T.S.D., AND OTHER MENTAL HEALTH PROBLEMS.

THEY RECENTLY WROTE IN THE "NEW ENGLAND JOURNAL OF MEDICINE," "HEALTH PROFESSIONALS HAVE RESPONSIBILITIES NOT ONLY TO RESPOND TO THE NEEDS OF CURRENT VICTIMS BUT ALSO TO ENGAGE IN PREVENTING THE DEVASTATING, LONG-LASTING, INTERGENERATIONAL EFFECTS OF WAR ON HUMAN HEALTH AND LIFE."

DR. BARRY LEVY IS A PHYSICIAN, EPIDEMIOLOGIST, AND AN ASSOCIATE PROFESSOR OF PUBLIC HEALTH AND COMMUNITY MEDICINE AT TUFTS SCHOOL OF MEDICINE.

DR. JENNIFER LEANING IS AN ASSOCIATE PROFESSOR OF MEDICINE AT HARVARD MEDICAL SCHOOL AND SENIOR FELLOW AT THE UNIVERSITY'S FXB CENTER FOR HEALTH AND HUMAN RIGHTS.

THANK YOU BOTH FOR BEING HERE.

DR.

LEANING, WHY IS IT IMPORTANT FOR THOSE OF US IN THE PUBLIC AT LARGE TO THINK ABOUT THIS CONFLICT, NOT ONLY IN TERMS OF POLITICS AND POLITICAL VIOLENCE, BUT IN TERMS OF PUBLIC HEALTH?

>> IT'S ONE OF THE FIRST MAJOR INTRASTATE WARS, THAT IS A WAR THAT IS INTERNATIONAL, WE HAVE REALLY LOOKED CLOSELY AT FOR THE LAST 20 YEARS.

I MEAN, IT IS AN ASTONISHING WAR IN THE SENSE OF ITS CAPACITY TO KILL BROADLY AND TO LEAVE LONG-LASTING EFFECTS BECAUSE OF THE HEAVY ARMAMENTS THAT ARE USED INDISCRIMINATELY.

SO WHEN WE'RE THINKING THINKING ABOUT PUBLIC HEALTH, WHICH IS THE HEALTH OF POPULATIONS, THIS WAR IS CREATING ENORMOUS EFFECTS ON HOW PEOPLE CAN THINK ABOUT THEIR FUTURE, HOW THEY CAN THINK ABOUT THE HARVEST NEXT YEAR, WHERE THEIR CHILDREN MIGHT HAVE TO FLEE TO.

THEIR FAMILIES ARE NOW SCATTERED THROUGHOUT EUROPE.

SO YOU HAVE A DISRUPTION OF HUMAN LIFE AND HUMAN FUTURE.

IT IS QUITE EXTRAORDINARY, ALL IN A RELATIVELY SMALL PLACE TO 40 MILLION PEOPLE.

>> Reilly: I WANT TO MAKE SURE THEY UNDERSTAND THIS AS CLEARLY AS I CAN.

ARE THE EFFECTS THAT YOU'RE TALKING ABOUT EFFECTS THAT HAVE EXISTED IN OTHER CONFLICTS, BUT THAT WE HAVEN'T HAD THE TOOLS TO FULLY SCRUTINIZE AND ANALYZE?

OR ARE THE EFFECTS DIFFERENT HERE BECAUSE OF THE POWER OF THE DESTRUCTIVE TECHNOLOGIES AT PLAY?

OR BECAUSE OF SOMETHING ELSE INVOLVING THE NATURE OF UKRAINE, THE NATURE OF ITS RELATIONSHIP WITH RUSSIA, SOCIOCULTURAL ISSUE, ON TOP OF OTHER ISSUES?

SO WHICH IS IT?

>> IT'S BOTH.

>> Reilly: IT'S BOTH?

>> EXCELLENT QUESTION.

PART OF IT IS THAT THESE EXPLOSIVE EFFECTS OF WAR-- THAT IS THE KINETIC EFFECTS OF THE USE OF BOMBS AND KILLING PEOPLE AND FORCING THOM FLEE-- IS A FEATURE OF ALL WARS.

BUT IT'S PARTICULARLY INTENSE IN A RELATIVELY SMALL AREA.

IT'S RATHER ONE-SIDED IN TERMS OF RUSSIA HAS COMMAND OF THE AIR, AND WHAT YOU HAVE IS A WAR OF ATTRITION WHERE THE UKRAINIANS ARE TRYING TO HOLD ON, OUT-MATCHED IN TERMS OF POPULATION AND IN TERMS OF ARMAMENTS, BY A COUNTRY THAT IS MUCH MORE POPULATED AND ALSO MORE SOPHISTICATED IN THE USE OF WEAPONS.

WHAT WE'RE SEEING IS THE WAR ENTIRELY ON THE COUNTRYSIDE OF UKRAINE, RUSSIA IS LOBBING THINGS OR AIMING THINGS INTO THE COUNTRY.

SO IT'S A PUNISHING WAR, WHERE, STRANGELY ENOUGH, IT'S AT A CLOSE STANDSTILL BECAUSE OF THE VERY, VERY EFFECT OF RESPONSE OF THE UKRAINIAN GOVERNMENT AND MILITARY.

>> Reilly: LET ME GET DR. LEVY IN HERE.

YOU TWO MENTIONED IN YOUR "NEW ENGLAND JOURNAL" PIECE, THAT IT'S DIFFICULT TO SAY EXACTLY HOW MANY PEOPLE HAVE DIED, HOW MANY PEOPLE HAVE BEEN INJURED.

I TEND TO THINK OF WARS AS HAVING EASILY TABULATED MORBIDITY AND MORTALITY COUNTS.

I GUESS I'LL ASK ANOTHER VERSION OF THE QUESTION THEY JUST POSED TO DR.

LEANING: IS THERE SOMETHING ABOUT THIS CONFLICT THAT MAKES IT ESPECIALLY HARD TO GET A HANDLE ON THE HUMAN TOLL?

OR HAVE WE PRETENDED TO HAVE CLARITY IN PREVIOUS CONFLICTS WHEN MAYBE WE DIDN'T?

>> YEAH, I WOULD AGREE WITH WHAT JENNIFER SAID SO FAR.

AND I WOULD SAY THAT THE SAME KINDS OF ISSUES THAT ARE OPERATING IN MANY, MANY OTHER WARS-- THERE ARE ABOUT 40 OTHER WARS GOING ON IN THE WORLD-- BUT THIS ONE IS, YOU KNOW, UP FRONT AND, YOU KNOW, 24/7 NEWS COVERAGE.

SO WE'RE SEEING ON A BIGGER SCALE A LOT OF WHAT HAS GONE ON IN MAINLY INTRASTATE WARS, MAINLY CIVIL WARS, AND MAINLY LOW- AND MIDDLE-INCOME COUNTRIES FOR MANY, MANY YEARS.

AND SOME OF THESE SAME ISSUES WITH REGARD TO TRYING TO QAWNTITATE HOW MANY DEATHS, HOW MANY SERGS INJURIES, THOSE ARE THINGS THAT OPERATE IN ALMOST ALL CONFLICTS.

THE DATA SYSTEMS ARE DOWN.

THERE'S THE FOG OF WAR.

EACH SIDE HAS REASON NOT TO ACCURATELY REPORT MILITARY OR CIVILIAN CASUALTIES.

AND, IMPORTANTLY, MANY OF THE DEATHS AND INJURIES TO CIVILIANS OCCUR NOT ONLY DUE TO BOMBS AND BULLETS, BUT IN FACT, PROBABLY ON A MUCH LARGER SCALE, MORE PEOPLE DYING AND BECOMING ILL AND SERIOUSLY INJURED AS A RESULT OF DESTRUCTION OF THE INFRASTRUCTURE-- WE'RE TALKING ABOUT FOOD AND WATER SYSTEMS, HEALTHCARE FACILITIES AND SO FORTH-- AS WELL AS DISPLACEMENT.

SO THOSE INDIRECT EFFECTS OF WAR CAUSING PEOPLE TO BE DISPLACED.

THERE ARE ABOUT 12 MILLION PEOPLE DISPLACED FROM UKRAINE, ROUGHLY HALF-- A LITTLE MORE THAN HALF WITHIN THE COUNTRY, A LITTLE LESS THAN HALF OUTSIDE THE COUNTRY, 12 MILLION ALL TOGETHER.

AND THAT, PLUS THE TARGETING OF CIVILIAN INFRASTRUCTURE IS REALLY CAUSING A LOT OF THE CASUALTIES THAT MAY NEVER BE QUANTIFIED.

>> Reilly: INCLUDING HEALTHCARE INFRASTRUCTURE.

JUST TO HIGHLIGHT THAT, RIGHT?

>> YES, AND THERE'S ALREADY BEEN RECORDED ALMOST 500 ATTACKS, TARGETED ATTACKS ON HOSPITALS AND CLINICS, MANY HEALTHCARE WORKERS HAVE BEEN KILLED OR INJURED.

MANY PATIENTS HAVE BEEN KILLED OR INJURED.

AND EQUALLY IMPORTANTLY, THERE'S NO LONGER THE HEALTHCARE THERE TO PROVIDE ONGOINGLY TO THE LOCAL POPULATION.

SO IT'S A HORRENDOUS PROBLEM, AND IT'S A WAR CRIME.

>> Reilly: DR.

LEANING, I HOPE YOU CAN GET JUST A LITTLE MORE GRANULAR, WHEN WE TALK ABOUT THE CONSEQUENCES OF CARE NOT BEING PROVIDED, WHAT THAT MEAN IN PRACTICE.

I THINK OF UKRAINE AS A COUNTRY THAT HAS A PRETTY SUBSTANTIAL H.I.V.

INFECTION RATE.

MY ASSUMPTION WOULD BE PEOPLE LIVING WITH H.I.V.

IN UKRAINE MAY HAVE THE TROUBLE GETTING THE TREATMENT THAT KEEPS THEM HEALTHY, KEEPS THEM ALIVE.

MAYBE I'M WRONG ABOUT THAT.

BUT YOU CAN EXPAND A LITTLE BIT ON WHAT DR. LEVY JUST SAID?

>> LET'S TALK ABOUT THE DIRECT WAR WOUNDS, DIRECT WAR INJURIES.

>> Reilly: OKAY.

>> FIRST.

OKAY?

BECAUSE UKRAINE IS A QUITE SOPHISTICATED COUNTRY.

WHICH, AGAIN, IS DIFFERENT FROM SOME OF THE OTHER PLACE WHERE'S WE HAVE SEEN WARS TAKING PLACE.

AND THE-- THE DESTRUCTION OF HOSPITALS, MATERNITY WARDS, AND OPERATING ROOMS HAS MEANT THAT THE TREATMENT OF THESE SEVERE WAR CASUALTIES HAS BEEN MARKEDLY IMPAIRED.

SO PEOPLE ARE DYING OF WOUNDS WHO EVEN IN UKRAINE, IN ORDINARY TIMES, WOULD HAVE REALLY SURVIVED, IF IT WASN'T HAPPENING IN SUCH WIDE AREA AND EXTENT, AND IF THE FACILITIES HADN'T BEEN DESTROYED.

SO ONE THING IS THAT THE WAR INJURIES ARE NOT BEING TREATED IN WAYS THAT RESULT FROM THE INTENSITY OF THIS WAR.

>> Reilly: OKAY.

>> THE SECOND IS THAT YOU HAVE A LOT OF PEOPLE WHO ARE UNABLE TO GET ACCESS TO GOOD FOOD OR GOOD WATER.

AND THIS IS SOMETHING BARRY MAY WANT TO EXPAND UPON.

BUT THERE'S AN INCREASE IN THE INDIRECT EFFECTS OF WAR ON THESE MAJOR HEALTH ISSUES.

AND THE THIRD THING, BEFORE I LEAVE, IS THAT THERE IS NO PLACE TO HIDE, OKAY, IN UKRAINE.

BECAUSE THIS-- IT'S IN A FISH BOWL.

RUSSIA HAS COMMANDED THE AIR.

HAS EXCELLENT, YOU KNOW, SATELLITE CAPACITIES, GOOD DRONE CAPACITIES.

IT KNOWS WHERE PEOPLE ARE, AND IT IS JUST CHOOSING WHERE IT WANTS TO LOB A MAJOR EXPLOSIVE DEVICE.

SO THIS IS THE FISH BOWL ASPECT OF IT IS THAT YOU ARE CAUGHT IN THE SENSE OF BEING TRAPPED AND ALWAYS IN JEOPARDY IS A VERY, VERY BURDENSOME ASPECT OF THIS WAR.

>> Reilly: GO AHEAD, SORRY.

>> BARRY, YOU MIGHT WANT TO EXPAND UPON THE INDIRECT EFFECTS, IF YOU WOULDN'T-- >> Reilly: DO YOU WANT TO TAKE A CRACK AT THAT, DR. LEVY?

>> SURE.

SO WHAT WE'RE TALKING ABOUT, FOR EXAMPLE, IS COMMUNICABLE DISEASES.

BECAUSE OF THE FACT THAT MANY PEOPLE ARE NOT DRINKING SAFE WATER, WATER TREATMENT PLANTS AND PIPELINES AND SO FORTH HAVE BEEN DESTROYED.

PEOPLE ARE GETTING GASTROINTESTINAL, DIARRHEAL DISEASE, CHILDREN ARE DYING AS A RESULT.

RESPIRATORY DISEASES, INCLUDING COVID, BECAUSE PEOPLE ARE CLOSELY CROWDED TOGETHER IN, YOU KNOW, SUBWAYS AND REFUGEE CAMPS AND SO FORTH.

TUBERCULOSIS, WHICH ALREADY IS A HIGH PREVALENCE IN UKRAINE, IS LIKELY SPREADING MORE FREQUENTLY.

THERE IS MORE MALNUTRITION.

PEOPLE WHO HAVE CHRONIC DISEASE-- HEART AND LUNG DISEASE, DIABETES-- ARE NOT ABLE TO GET REGULAR MEDICATIONS.

WOMEN ARE NOT ABLE TO GET GOOD PRENATAL CARE OR CARE DURING LABOR AND DELIVERY AND NEWBORNS ARE NOT GETTING ADEQUATE CARE.

AND INDEED, MENTAL HEALTH PROBLEMS ARE PROFOUND.

SO ALL OF THESE ARE ARGUABLY INDIRECT EFFECTS.

THEY'RE NOT DEATHS DUE TO BOMBS OR BULLET, BUT THEY'RE EQUALLY AS IMPORTANT, IF NOT OCCURRING EVEN MORE FREQUENTLY THAN THE BOMBS AND BULLET INJURIES.

>> Reilly: DR.

LEANING, I WANT TO GIVE YOU THE LAST QUESTION, AND YOU ONLY HAVE ABOUT 30 SECONDS AND IT'S A BIG QUESTION.

YOU TWO CALL IN YOUR PIECE FOR PROACTIVE APPROACH ON THE PART OF PHYSICIANS TO GET A HANDLE ON THE LONG-TERM EFFECTS.

WHAT WOULD THAT MEAN IN PRACTICE?

>> WE ACTUALLY SAY PHYSICIANS NEED TO PAY-- AND NURSES AND OTHER HEALTHCARE PERSONNEL-- NEED TO PAY ATTENTION TO THE ENORMOUS RECONSTRUCTION NEEDS AND CURRENT NEEDS THAT ARE GOING ON IN UKRAINE, AS LONG AS THIS WAR CONTINUES, ANDS FOR DECADES THEREAFTER.

SO WE SHOULD BE PREPARED TO BE PART OF THE ENTRY TEAMS THERE TO HELP PROVIDE HEALTH CARE ON THE BORDERS AND IN THE-- MANY OF THE REFUGEES.

AND WE ALSO NEED TO BE AWARE OF THE ENORMOUS NEED THAT WILL COME OUT OF THIS COUNTRY-- WHEN THE WAR BEGINS TO DIE DOWN.

>> Reilly: I APOLOGIZE FOR INTERRUPTING.

WE ARE OUT OF TIME.

DR. BARRY LEVY, DR. JENNIFER LEANING, THANKS.

THANK YOU BOTH.

>> THANK YOU VERY MUCH.

>> THANK YOU VERY MUCH.

>> Reilly: THAT'S IT FOR TONIGHT.

THANK YOU FOR WATCHING.