Clayton Green was a master mechanic who sometimes worked on Nicholas Kristof’s family farm in Yamhill, Oregon. He died in January 2019 at the age of 57, and Kristof called his friend a “casualty of America’s social great depression.” Green had been expelled from school in the ninth grade, and he found it hard to find good jobs as factories closed. He struggled with addiction and obesity.

These Americans were left behind. But for many, there’s still hope

Photographs by Lynsey Addario
Story by Kyle Almond, CNN

Clayton Green was a master mechanic who sometimes worked on Nicholas Kristof’s family farm in Yamhill, Oregon. He died in January 2019 at the age of 57, and Kristof called his friend a “casualty of America’s social great depression.” Green had been expelled from school in the ninth grade, and he found it hard to find good jobs as factories closed. He struggled with addiction and obesity.

For years, journalist Nicholas Kristof has been documenting humanitarian issues abroad, speaking up for forgotten people around the world.

Then he realized there was another crisis unfolding right in his hometown.

About a quarter of the kids he rode the school bus with in tiny Yamhill, Oregon, are now dead, mostly because of substance abuse, suicide and reckless accidents. Some succumbed to treatable health issues such as obesity and diabetes.

“At first, we couldn't process it. Why are so many people dying?” Kristof said. “And then we saw nationwide statistics and realized that this isn't a problem of one small town. This is a problem that is striking much of the country, and it's devastating lives.”

Dee Knapp visits the grave site of four of her five children in Luther, Oklahoma. They grew up near Kristof in Oregon and rode the same school bus he did. Farlan died of liver failure from alcohol and drugs. Rogena died from hepatitis linked to drug use. Zealan burned to death in a house fire while passed out drunk. Nathan burned to death when the meth he was making exploded.

A child plays on a trampoline near the No. 6 school bus route that Kristof used to take when he was growing up in Oregon. Many of the people who rode the bus with Kristof are now dead, and he wanted to find out why.

Yamhill, Kristof says, is a microcosm of the dysfunction facing poor, working-class communities across the United States. More Americans die every two weeks from drugs, alcohol and suicide than in 19 years of war in Afghanistan and Iraq. Half a million Americans are homeless.

And it can often be traced to a lack of jobs.

“The driver was that good jobs left, and drugs arrived just as people were seeking to self-medicate, and the US, for 50 years, adopted policies that were incredibly damaging to working men and women,” said Kristof, a New York Times columnist and best-selling author.

He argues there is a collective responsibility to help — and that we as a society can and should be doing more.

“It is absolutely true that people make bad choices that compound their misery. There's no doubt that personal responsibility is a part of this,” he said. “But when you can predict, on the basis of a ZIP code that an infant is born in, a likelihood of dying early or ending up in prison or dropping out of high school, that's not because that infant is making bad choices. It's because society is making bad choices.”

Lauren Berg, principal of Yamhill Carlton Elementary School, meets with some of her students. “The way to help kids in communities like this is to get them in the school system, to keep them in, to give them a good education and partly to compensate some for really troubled home situations,” Kristof said.

Inmates watch television inside the jail in Tulsa, Oklahoma. When Kristof visited, he found 23 people who were there only because they failed to pay government fines and fees. And the long-term effects from that can be devastating. “When we lock them up, that means they just lose their jobs. They become unable to make their car payment, so they lose their cars. Their kids may be taken away from them. It has all these spiraling effects,” Kristof said. “And they certainly can't earn money to pay back their fees when they're in prison.”

Kristof and his wife, Sheryl WuDunn, investigate these problems — and offer solutions — in their new book, “Tightrope: Americans Reaching for Hope.” They traveled to all 50 states and found stories of despair and misfortune, but also selflessness and perseverance.

They teamed up with Lynsey Addario, an award-winning photojournalist, to help put a face on the issue.

“We were thinking about past explorations of those left behind in America, and we were drawn to the way Franklin Roosevelt had tried to win support for the New Deal by humanizing these issues and setting up photographers,” Kristof said.

Roosevelt knew back then that arguments alone would not be enough to win people over, Kristof said. Powerful images, however, could help persuade skeptics and get them to come around on new policies.

Daniel McDowell, an Army veteran who served in Afghanistan, is now in a different kind of fight. He’s enrolled at the Baltimore Station, a residential program to help former troops who have struggled with addiction and homelessness. “We have this big problem with homelessness, but we were able to reduce veteran homelessness by half in America because this became a priority,” Kristof said.

Mike Stepp, a homeless man in McMinnville, Oregon, was Kristof’s closest neighbor growing up. “His dad was a war hero who had a job in a mill,” Kristof said. “It wasn't that Mike is less smart or less accomplished or less social than his dad was. The difference is that good jobs just went away, and the kind of jobs that his dad had were no longer available. So Mike self-medicated with meth and alcohol, and he was injecting drugs. His wife kicked him out, so he's been homeless since.”

Addario has spent the past two decades photographing crises around the world. She was shocked by the conditions she saw in the United States, and she called this project “a tough education.”

“What sticks with me is how much work we need to do in the United States,” said Addario, an American based in London. “I think there's an incredible disparity between the rich and the poor, the incredibly rich and people who are not as privileged.”

Addario has worked in many war zones and documented countries recovering from conflict. In those places, she said, there’s often no infrastructure or basic services.

“The difference in America is that those services exist, but you need a fair amount of money or contacts to access them,” she said.

Annette Dove, right, started an after-school program to help low-income teenagers in Pine Bluff, Arkansas. She wants to keep them in school and out of trouble.

Baltimore Police Lt. Steve Olson used to arrest people with drug problems. But now he and the department are taking a different approach. “He's very eloquent that we can't arrest our way out of this — we have to provide treatment,” Kristof said. Olson also has a personal connection to the problem. His brother Mark struggled with addiction and died in his 30s.

Fortunately, there are people and programs out there helping to pick up the slack — and setting an example in their communities.

Like Annette Dove. She started an after-school program that Kristof says has been a lifesaver for low-income kids in Pine Bluff, Arkansas, putting them on a pipeline to college and good jobs.

There’s Lt. Steve Olson of the Baltimore Police Department. He lost his brother to drugs, and now he is putting a personal touch on the department’s program that tries to steer drug users into treatment instead of jails.

And Remote Area Medical has been holding health fairs in poor communities across the nation, providing people with free dental care and eye exams.

Someone receives an eye exam at a Remote Area Medical clinic in Gray, Tennessee. The company, headquartered in Tennessee, was providing services in South America and Africa when they got a call from the next town over: “Could you provide services here?” They found huge needs in the United States and now offer health fairs in communities across the nation.

Fifteen teeth lie on a dental tray at a Remote Area Medical clinic in Tennessee. They were all pulled from the same person’s mouth. Kristof recalled one man being thrilled to get 18 teeth pulled because he was in constant pain. He hadn’t been to a dentist in 20 years.

Addario has been inspired by many of the people she met that have been able to turn their lives around.

Rebecca Hale graduated from Women in Recovery, an intense drug rehabilitation program in Tulsa, Oklahoma. Daniel McDowell, an Army veteran, moved to the Baltimore Station, a two-year residential program for former troops who have struggled with addiction and homelessness.

“There are so many people who have sort of come out the other side and have really been able to sort of get through very difficult times,” Addario said. “They give me hope and I would presume they would give the reader hope as well, because it's hard to get yourself out of those circumstances.”

Rebecca Hale graduated from Women in Recovery, a drug-treatment program in Tulsa, and now she has a better relationship with her teenage daughter. “Only 4% of (graduates) end up back on drugs three years later, which is just incredibly successful,” Kristof said. “And it has saved Oklahoma $70 million because it's a lot cheaper to support these people than to imprison them forever.”

Geneva Cooley waves goodbye to fellow inmates in Alabama after she was released from her life sentence in Alabama at the age of 72. Nearly 20 years ago, Cooley was sentenced to life without parole after she was caught carrying a sock full of heroin. A team of lawyers from the University of Alabama fought to get her released based on what her sentence would be if she were convicted today. “It registered in the system as 999 years in prison for a purely nonviolent offense. … It struck us as a failure of the war on drugs and just the brutality of the policies,” Kristof said.

When it comes to solutions, Kristof said, drug treatment is a “no-brainer” and it’s cheaper than incarceration in the long run.

“Too often we still lock up drug users instead of providing treatment, even though treatment pays for itself up to 12 times over,” he said. “And yet only one in 10 Americans who has a substance-abuse problem actually gets treatment. That's just unconscionable.”

Also high at the top of Kristof’s list of solutions: better job-training programs and job incentives, and an emphasis on early childhood intervention. A national pre-kindergarten program, he said, would benefit disadvantaged children and also make it easier for their parents to hold jobs.

Drew Goff is joined by his baby boy, Ashtyn, as he gets another tattoo. Goff has a long history of drug use, but Kristof said he’s been able to turn his life around with the help of a nonprofit drug-treatment program called Provoking Hope.

Keylan Knapp, the lone survivor of Dee Knapp’s five children, rides a horse on a ranch in Luther, Oklahoma.

These problems are not insurmountable, Kristof stresses.

Drew Goff, a Yamhill resident, started using drugs when he was 12 or 13, and he had a long criminal record. His son Ashtyn was born with drugs in his system, Kristof said, and the family’s future looked bleak.

Then Goff got into a drug-treatment program called Provoking Hope.

He’s now been drug-free for two years, he’s a manager at a moving company and he’s taken parenting classes. Kristof called him “just the best dad ever.”

“It's a reminder these are not hopeless problems,” he said. “With the right support, people can absolutely turn their lives around and give kids a really different future.”

Nicholas Kristof is a New York Times columnist and best-selling author. His latest book is “Tightrope: Americans Reaching for Hope,” which he co-authored with his wife, Sheryl WuDunn. You can follow him on Instagram, Facebook and Twitter.

Lynsey Addario is an award-winning photojournalist and author of the best-selling memoir “It’s What I Do.” You can follow her on Instagram, Facebook and Twitter.

Photo editor: Brett Roegiers