Tightrope: Americans Reaching For Hope (Alfred A. Knopf, 2020) is a nonfiction book written by the journalists Nicholas Kristof and Sheryl WuDunn, who are also married. The book chronicles the individual impact of the American approach to poverty and offers prescriptions for how the United States can adopt a more human approach to those who are struggling with deprivation, addiction, and despair. Upon its release, the book was a New York Times best seller.

Plot Summary

The book opens in the 1970s in the community of Yamhill, Oregon, with a description of a working-class woman named Dee Knapp fleeing her home out of fear of her abusive husband. At the time of this incident, the Knapp family had reasons to be optimistic that are no longer shared by many working-class people. With almost no education and few resources, the Knapps had managed to buy a home and attain relative economic stability; their kids, meanwhile, who rode the school bus with Kristof when he was growing up in Yamhill, were more educated and comfortable than their parents had been as children.

However, as the authors explore in Chapter 2, that optimism did not bear fruit—not for those children, many of whom would struggle with addiction and die prematurely, and not for the many working-class Americans facing declining life expectancy, shrinking job prospects, and higher rates of poverty, addiction, and violence. In fact, despite many Americans’ perceptions of American exceptionalism—and despite a surging US economy—the country has slipped in many rankings, including children’s math scores on standardized tests and in access to internet and clean drinking water.

In subsequent chapters, the authors explore how these forces play out in the lives of Americans in Yamhill and elsewhere, using a narrative structure founded on the desire to counter the perception of those living in poverty as being responsible for their own struggles; as the authors note, the problems of poverty are compounded by individual decisions but are created by choices at the societal level. One example of these choices is the loss of jobs due to globalization and automation; these forces have also weakened unions, resulting in wages that have failed to keep pace with inflation. As the authors explore, this trend has consequences not only for people’s material well-being, but also for their sense of self-confidence. For people like Kristof’s childhood friend Kevin Green, the inability to find decently paying work lead to loneliness and poor health (with the latter exacerbated by a lack of access to health care). Like many working-class men, Green died prematurely, in 2015.

In Chapter 6, the authors explore another part of the struggle for many working-class Americans: the battle with addiction. Much of this comes from an opioid epidemic sparked by Purdue Pharma and other pharmaceutical companies that recklessly marketed opioids as a nonaddictive treatment for chronic pain. For people like Daniel MacDowell, who was prescribed opioids by military doctors for an injury incurred while serving in Afghanistan, prescription drugs can lead the way to abuse of heroin. While McDowell found his way to a treatment program that emphasized his personal responsibility for his actions, the authors look to the structural factors that have resulted in so many Americans struggling with drug addiction, from lax government oversight of pharmaceutical companies to a criminal justice system focused on punishment rather than treatment. While the judicial response to drugs—specifically, the war on drugs—has helped fuel an epidemic of mass incarceration, it has done little to address rates of addiction of reduce overdose deaths. Meanwhile, many of the executives responsible for helping to create the opioid epidemic have faced fines that pale in comparison to profits, and no jail time.

In the final chapters of Tightrope, the authors look at how the impacts of poverty carry through generations and impact children through a combination of early childhood trauma, genetic and epigenetic factors that increase the risk of addiction, and the impact of broken families on children’s graduation rates and upward mobility. The authors conclude that such problems cannot be treated as the problems of individuals—in part because they create costs for the whole of society, and in part because they are not the fault of children but reflect the deprivation of their circumstances—and offer prescriptions for policies the United States could adopt to create a more humane society, from universal health care and high school graduation to a monthly child allowance and measures to prevent unwanted pregnancies.