Posts Tagged ‘obesity’

Just How Fat Are We?

Tuesday, July 24th, 2012

In the race to create the most addictive app (or maybe it’s a next-generation Angry Birds game) the BBC has launched an online Biomass Meter that tells you where the percentile where you fall in terms of corpulence worldwide and, most compellingly, lets you see where in the world you’d fit in given your waistline (I’d be at home Brazil, Iran or South Africa). This calculator is based on research data pulled together by a team of researchers at the London School of Hygiene and Tropical Medicine, using UN data on population size in 177 countries, together with estimates of global weight from the WHO and mean height from national health examination surveys.

Interesting timing given that (according the New York Times) last month, researchers affiliated with the World Health Organization and the London School of Hygiene and Tropical Medicine reported that, worldwide, people’s waistlines are expanding, with the total combined weight of human beings on Earth now exceeding 287 million tons. About 3.5 million tons of that global human biomass is due to obesity, a third of which exists in North America, although we account for only 6 percent of the world’s population.

The biggest culprit ? Voluntary inactivity, according to a study in the Lancet. Led by Pedro C. Hallal, a professor at the Federal University of Pelotas in Brazil, the study finds that 31.1 percent of the world’s adults, or about 1.5 billion people, are almost completely sedentary, meaning that they do not meet the minimum recommendation of 150 minutes of walking or other moderate activity per week, or about 20 minutes a day.

But surely we can look to our teenagers as models of physical vitality, correct? Not quite. Teenagers do worse. More than 80 percent of young people ages 13 to 15 worldwide are not getting the hour a day of vigorous exercise recommended for their age group. North America leads (or wheezingly lags) the world in not exercising, with 43.3 percent of Americans not doing the bare minimum. But, it’s spreading: more than 30 percent of Russians and 27 percent of Africans are sedentary. And what’s the most sedentary nation on Earth? Malta, population 419,000, 72 percent of whom won’t be appearing on The Biggest Loser.

According to the Lancet study, the effect of being a couch potato is comparable to smoking. “Smoking and physical inactivity are the two major risk factors for non-communicable diseases around the globe. Of the 36 million deaths each year from non- communicable diseases, physical inactivity and smoking each contribute about 5 million deaths each.”

New York Controversy Emerges Over Food Portion Size Campaign

Monday, February 20th, 2012

The New York City Department of Health recently launched a campaign to get New Yorkers to make their waistlines smaller by controlling their portion sizes when ordering food and beverages. “Consuming too many calories can lead to weight gain,” said city Health Commissioner Thomas Farley.  “If New Yorkers cut their portions, they can cut their risk.”  The “Cut your portions. Cut your risk” campaign is billed as “hard-hitting” and has the purpose of making certain that people understand that large meals cause obesity.  Even worse, obesity can cause diseases like diabetes.  In one city poster, a man whose leg has been amputated because of Type 2 diabetes sits behind a graphic showing how soft drink portions have grown over the years.

Over the last 40 years, according to the Health Department, serving sizes for sugary soft drinks have grown four times, and the amount of French fries in a single order has tripled.  As a result, “a single meal could balloon to contain many more calories than the amount an adult needs for an entire day” – roughly 2,000.

Writing on the friendseat.com blog, Spence Cooper takes a more cynical attitude. “The number of New Yorkers motivated to make healthier choices and forgo that next order of large fries because of ad nauseam public service ads is equal to the number of New York smokers who pay attention to the warnings on cigarette packs. You can count them on one hand.”

The new posters, available in both English and Spanish, bear the message “Cut your portions. Cut your risk,” providing New Yorkers with a clear strategy for preventing obesity and its health penalties.  While the City has made strides in combating the nationwide trend of growing obesity, the majority of adult New Yorkers (nearly 57 percent) and two out of every five New York City elementary school children remain overweight or obese and the health consequences are dire, ranging from hypertension to type 2 diabetes.  Nearly 10 percent of New Yorkers have been told they have type 2 diabetes, which can lead to blindness, kidney failure and amputations. In 2006, nearly 3,000 New Yorkers with diabetes were hospitalized for amputations. Obese children and adolescents also are more likely to become obese adults. Even while young, they are more likely to develop obesity-related conditions such as high cholesterol, high blood pressure, and type 2 diabetes.”

Not all are in agreement with Farley’s campaign. The New York ads create an “inaccurate picture” of the impact of soft drinks, argues Stefan Friedman, a spokesman for the American Beverage Association.  “Portion control is indeed an important piece of the solution to obesity,” he said. “Instead of utilizing scare tactics, the beverage industry is offering real solutions like smaller portioned containers and new calorie labels that show the number of calories in the full container, right up front, to help people chose products and sizes that are right for them and their families,” he said.

The posters are appearing on subway stops around the city for the next three months. Mayor Bloomberg dismissed his critics who claim that the ads were too graphic and disturbing:  “What do you want to do? Do you want to have people lose their legs or do you want to show them what happens so that they won’t lose their legs? Take your poison. Which do you want?” said Bloomberg.

Many healthcare experts agree with Bloomberg. “Obesity rates in adults rose to 35.7 percent from 30.5 percent between 1999 and 2010, compared with rates that nearly doubled in the two previous decades, the Centers for Disease Control and Prevention (CDC) reported . The rate among boys climbed 29 percent, surpassing girls for the first time, according to the CDC.

More than 78 million American adults — as much as  one third of the population, and about 12.5 million children were considered obese in 2009- 2010, according to a series of studies reported in the Journal of the American Medical Association. The studies are part of a continuing CDC effort to track obesity rates with new numbers every two years.

Americans Spend More on Healthcare Than Comparable Nations

Tuesday, December 13th, 2011

The United States spends far more on healthcare than other countries, although Americans visit the doctor and are hospitalized less often than most of the other 34 member countries of the Organization for Economic Co-operation and Development OECD).  In its Health at a Glance 2011 report, the OECD shows that the United States spent about $7,960 per person on healthcare in 2009 – approximately 2.5 times the average of the countries studied.  It also determined that health spending in the U.S. has grown faster than in all other high-income OECD countries since 1970, even accounting for population growth.

“Why?” asks Julie Appleby in Kaiser Health News.  “Generally, prices for medical care are higher in the U.S. – and some services are performed more often.  Hospital prices are 60 percent higher than the average of 12 selected OECD countries, and the U.S. also generally pays more for each appendectomy, birth, joint replacement or cardiac procedure.  Americans have more imaging tests, such as CT scans and MRIs, than residents of other countries and are far more likely to have knee replacements, coronary angioplasty or surgery to remove their tonsils.  Even with all that, compared with most of the other developed countries, the U.S. has fewer practicing physicians per person, fewer hospital beds, and patients don’t stay as long in the hospital.  Administrative costs in the U.S. are also high, the report notes, accounting for about seven percent of total spending.  That is roughly comparable to what is spent in France and Germany, which have universal health coverage.  In Canada — another country with national healthcare – administrative costs are about four percent of health spending.”

“The U.S. is just this astonishing outlier compared to everyone else,” said Mark Pearson, the head of the OECD’s social policy division. A significant part of the difference relates to pricing.  American patients don’t spend more time in the hospital or visit more doctors than patients in other OECD countries; they pay more for everything.  Physician fees are more than twice the average cost, for example, while drugs and hospital care cost 60 percent more.  In terms of results, however, the U.S. does not come out on top.  Life expectancy in 2009 was 78.2 years, below the OECD average of 79.5.  That puts the nation closer to the Czech Republic and Chile, “not countries you would usually expect the U.S. to be compared to,” Pearson said.

The U.S. also has one of the poorest records in terms of premature mortality in general and mortality from heart disease in particular.  Americans have the highest obesity rate — with more than one-third of the population considered obese.  They also have one of the highest rates of hospital admission for illnesses that are optimally managed by primary-care physicians, including asthma, chronic obstructive pulmonary disease (including emphysema), and diabetes.

The news isn’t all bad.  The OECD report notes that the U.S. does an excellent job of cancer care, with very high survival rates and low mortality rates.  Stroke deaths are well below average in the United States.

Americans spend approximately 17.4 percent of its gross domestic product on healthcare; other OECD nations spend an average of 9.6 percent of their GDPs on healthcare.  According to OECD, the U.S. has an “underdeveloped” primary-care system that physician shortages only intensify.  There are 2.4 physicians for every 1,000 Americans, compared with an average of 3.1 in other countries.  Additionally, there are 3.1 hospital beds per 1,000 Americans, compared with 4.9 per 1,000 in other countries.

The Washington Post’s Ezra Klein thinks that Americans spend too much on healthcare. According to Klein, “There are a lot of complicated explanations for why American healthcare costs so much, but there are also some simple ones.  Chief among them is ‘we pay too much.’  And I don’t mean in general.  I mean specifically.  Mountains of research show that for every piece of care you might name — a drug, a doctor visit, a diagnostic — you’ll pay far more in the United States than in other countries.  That’s why seniors head to Canada to buy drugs made in the United States.  In Canada, the government negotiates one low price.  In America, insurers with much less bargaining power negotiate many higher prices.”

According to Ezekiel Emanuel, a bioethicist and fellow at the nonprofit bioethics research institute The Hastings Center, “Unfortunately, few people really understand how much we spend on healthcare, how much we need to spend to provide quality care, and the difference between the two.  Do we spend too much?  Let’s begin with the costs.  In 2010, the United States spent $2.6 trillion on healthcare, over $8,000 per American. This is such an enormous amount of money, it’s difficult to grasp.

“Consider this: France has the fifth largest economy in the world, with a gross domestic product of nearly $2.6 trillion.  The United States spends on healthcare alone what the 65 million people of France spend on everything: education, defense, the environment, scientific research, vacations, food, housing, cars, clothes and healthcare.  In other words, our health care spending is the fifth largest economy in the world.

“The fact is that when it comes to healthcare, the United States is on another planet.  The United States spends around 50 percent more per person than the next highest-spending countries, Switzerland and Norway.”

Poor Education Can Lead to Alzheimer’s

Monday, August 8th, 2011

As many as 50 percent of Alzheimer’s cases worldwide could be avoided if risk factors such as depression, obesity and smoking were eliminated, either with lifestyle changes or treatment of underlying conditions.  Even modest cuts in the level of risk factors could prevent millions of cases of the memory-robbing illness, the researchers said.  As an example, a 25 percent cut in seven common risk factors – such as poor education, obesity and smoking — could prevent as many as three million Alzheimer’s cases around the world and up to half a million in the United States alone.  The new research is being presented at the Alzheimer’s Association International Conference (AAIC) and published online in The Lancet Neurology.

“The idea here is to get a better bead on exactly how we can start untangling what the risk factors are, so that we can not only treat and modify Alzheimer’s but also start talking about prevention of Alzheimer’s,” said Mark Mapstone, associate professor of neurology at the University of Rochester Medical Center.  “The field is working very hard (to figure out) what these risk factors are so we can start heading this disease off before it starts.”

Led by Deborah Barnes of the University of California San Francisco (UCSF), the researchers revisited earlier epidemiological studies on links between Alzheimer’s and seven vital risk factors: poor education, smoking, low physical activity, depression, hypertension during mid-life, obesity and diabetes.  They estimated that these risk factors account for 17 million cases of Alzheimer’s worldwide (approximately half of the estimated 34 million cases of dementia globally) and three million of the 5.3 million estimated cases in the United States.  Some factors appeared to have a greater impact on Alzheimer’s risk than others.  The UCSF team estimated that worldwide, 19 percent of Alzheimer’s cases can be attributed to low education; 14 percent to smoking; 13 percent to physical inactivity; 10 percent to depression; five percent to mid-life hypertension; 2.4 percent to diabetes; and two percent to obesity.  In the United States, more than 20 percent of cases can be traced to low physical activity; 15 percent to depression; 11 percent to smoking; eight percent to mid-life hypertension; seven percent to mid-life obesity; seven percent to low education and three percent to diabetes.

Dr. Ronald Petersen of the Mayo Clinic said the findings have important public-health implications and will help raise awareness of the need for prevention.  The study offers “an uplifting message for aging and cognition,” he said, insofar as it suggests that lifestyle factors can be modified to alter Alzheimer’s risk, at least at the societal level.  But, with the exception of increasing physical activity, there is scant evidence that interventions are successful in altering an individual’s chances of developing Alzheimer’s.

Other studies have shown that increasing physical activity is effective.  But whether taking up crossword puzzles or losing weight impacts the path of Alzheimer’s — the pathology of which seems to begin years before symptoms appear — remains unknown.  Last year, a National Institutes of Health panel concluded – with some controversy — that the scientific evidence on lifestyle factors was negligible and said that intervention is helpful.  Petersen said that, while depression is clearly associated with Alzheimer’s, the causal direction could go either way, especially when the depression comes late in life.  “Is that really a risk factor for, or a function of, the disease?” he asked.  The question is, for the most part, irrelevant from a clinical perspective because depression should be treated anyway, Petersen said.

“Education, even at a young age, starts to build your neural networks,” so being deprived of it means poorer brain development, Barnes said.

“It gives us a little bit of hope about things we could do now about the epidemic that is coming our way.”  Alzheimer’s cases are expected to triple by 2050, to approximately 106 million globally.  “What’s exciting is that this suggests that some very simple lifestyle changes, such as increasing physical activity and quitting smoking, could have a tremendous impact on preventing Alzheimer’s and other dementias in the United States and worldwide,” Dr Barnes said.

The study could be good news for people – usually family members – who are caregivers for individuals with Alzheimer’s. “Throughout the progression, I felt quite helpless…without any cure for (Alzheimer’s disease) yet, I could only watch,” said Rick Lauber, who acted as caregiver to his father, John, who developed the disease in his 60s and died at age 76.  As his father’s caregiver, Lauber had to take on unexpected responsibilities, such as moving him three times, taking him to doctor’s appointments, paying bills and becoming his father’s Joint Guardian and Alternate Trustee.  “As an adult child and a family caregiver, caring for Dad had to one of the hardest things imaginable,” Rick Lauber said.  “Watching him decline from a healthy, active, respected academic to a shell of a man was very challenging.  Dad was changing before my eyes and I could not do anything about this.”

According to the 2011 annual Facts and Figures release from the Alzheimer’s Association, nearly 15 million Americans provide 17 billion hours of unpaid care worth $202 billion every year.

This blog is dedicated to the memory of William A. Alter, the founder of our company who passed away August 8, 2008 of complications of Alzheimer’s disease.  To read about Bill Alter’s amazing career, please click here.

New Study Ranks Healthiness in the Nation’s 3,016 Counties

Tuesday, April 19th, 2011

A study led by the Robert Wood Johnson Foundation has ranked the level of healthiness in the more than 3,000 counties that comprise the United States. Conducted with the assistance of the University of Wisconsin’s Population Health Institute, the study entitled “County Health Rankings: Mobilizing Action Toward Community Health,” provides a snapshot of where America’s healthiest people live.

“This is a complicated story about what makes a community healthy and another not so healthy,” said report author Pat Remington, the associate dean for public health at the University of Wisconsin.  For example, researchers point to cities reputed for their top-quality medical centers – most notably Baltimore and Philadelphia — that ranked close to the bottom in their respective states.  “Social, economic and health habits may be at play there,” said James Marks, senior vice president and director of the foundation’s health group.

The researchers examined federal and state health-related data on 3,016 counties, according to Remington.  The information was analyzed by researchers who had created similar reports for the state of Wisconsin over the past six years.  Remington said   his group wanted to “bring it down to the ground level” by learning where strengths and weaknesses lie within individual counties.

Each county is examined in two ways:  “Health Outcomes” and “Health Factors.”  “Health Outcomes” look at a county’s disease and death rates.  The “Health Factors” rating is more complicated and examines such factors as obesity rates, smoking and alcohol use.  Socio-economic factors, such as unemployment, income and safety, also are considered in addition to access to healthcare and the local environmental.  “The ‘Health Outcomes’ rank is about current healthiness factors.  The ‘Health Factors’ rank is about where they are going — predictors of health,” Marks said.

Some of the results are eye-opening. The healthiest of Illinois’s 102 counties is Kendall, which is located next to LaSalle County, which ranked 65th.  LaSalle County, whose smoking rate is twice the national average, is home to twice as many people who can be considered to be in fair to poor health.  The divide between suburban and rural also comes into play here.  Kendall County is close enough to Chicago be almost be considered part of the metropolitan area, while LaSalle County is rural and home to many farms.  According to Dr. Remington, “Affluent suburbs tend to have higher-paying jobs, often in the cities, whereas rural communities often are dealing with loss of business.”  Rural populations also are in decline as younger and healthier people move away from places like LaSalle County to the cities where employment opportunities are more varied.  To improve the health of its citizens, LaSalle County health department officials are giving nicotine patches to smokers and educating school officials about obesity and diabetes.

“It’s hard to lead a healthy life if you don’t live in a healthy community,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.  “The County Health Rankings are an annual check-up for communities to know how healthy they are and where they can improve.  We hope that policymakers, businesses, educators, public health departments and community residents will use the Rankings to develop solutions to help people live healthier lives.”

New Medical School Bases Its Curriculum on Community Care

Thursday, January 20th, 2011

To combat the nation’s severe doctor shortage, five new medical schools have opened since 2009 and an additional 10 are in the process of receiving accreditation.  In addition to producing badly needed new physicians, these medical schools are also working to reshape how doctors are educated.  A case in point is Miami-based Florida International University’s (FIU) College of Medicine, which bases its teaching on a community-based medical curriculum.

Medical students at FIU are assigned a family who lives in a targeted Miami neighborhood.  Dr. John Rock, the medical school’s founding dean, believes the mission is to improve the chosen family’s health and improve the neighborhood’s quality of life.  “We’ve adopted those neighborhoods, and we never leave.  Clearly, we have a commitment to those neighborhoods to be there and to work with households and the community to address the socio-determinants of healthcare,” Rock says.  Rock, whose past experience includes stints at Johns Hopkins and as chancellor of Louisiana State University’s Health Sciences Center, says his primary goal at FIU is to graduate primary-care physicians.  At the same time, he believes the deep commitment to community care will enhance the careers of those physicians who ultimately practice in a specialty field.

FIU’s unique curriculum was created by Dr. Joe Greer, a gastroenterologist who directs Camillus Health Concern,  a free clinic that serves Miami’s poor and homeless.  Dr. Greer, who has advised two presidents and received a prestigious MacArthur Fellows award, says “What we’ve become is a nation of interventionalists.  If you’re dying, I’ll save you.  But, it’s sort of like in America, we won’t let you die, but we’ll let you suffer.  So how do we get beyond that?”

Although other medical schools are committed to community-based medicine, Dr. Greer believes that FIU has a distinct advantage because of its newness.  “Changing a curriculum in a medical school is like turning a battleship in a pool.  Luckily, all we had was a raft.  Now our job is to make sure that raft is pointed in the right direction, so that when it becomes a battleship, it has the ability to turn when the turns are needed to adjust to society,” according to Greer.

New Study Cites Setbacks in Women’s Health Issues

Tuesday, December 28th, 2010

More American women are binge drinking and not being screened for potentially deadly diseases such as cervical cancer, according to a new study  by the National Women’s Law Center and the Oregon Health and Science University.   Additionally, greater numbers of women are obese, diabetic and hypertensive than just a few years ago; even more alarming is the fact that more women are testing positive for Chlamydia, a sexually transmitted disease (STD) that can cause infertility.

The report presents a grim picture and gave the United States an “Unsatisfactory” grade and numerous Fs on specific goals created by the federal government’s Healthy People 2010 initiative. “The takeaway message is that we’re really not where we should be,” said Dr. Michelle Berlin, an associate professor of obstetrics and gynecology at the Oregon Health and Science University School of Medicine and associate director of the Center for Women’s Health.  http://www.ohsu.edu/xd/health/services/women/ “We’ve had 10 years of doing this report card, and you would hope the needle would have moved more than it has.”

Although screening rates for colorectal cancer and high cholesterol have improved since the 2007 report card, just 78 percent of women aged 18 to 64 are being tested for cervical cancer, a drop from the 84.8 percent reported in 2007.  The Healthy People 2010 objective is 90 percent.  Another growing problem is obesity, which impacts 24 percent of women.  According to Dr. Berlin, 25 percent of women are sedentary and participate in very limited physical activity; a majority do not eat the recommended five daily fruits and vegetables.

The amount of binge drinking was especially surprising to the researchers, with more than 10 percent of women saying they had five or more drinks on at least one occasion in the previous month.  “This is very concerning, especially when we think about what other things can happen when people engage in binge drinking:  there are more sexual-assault problems, they’re more likely to acquire an STD, and more likely to have accidents while driving,” Dr. Berlin said.

CDC Sets Six “Winnable Battles” for Americans’ Health

Tuesday, October 12th, 2010

 CDC sets six health priorities as "winnable battles". The Centers for Disease Control and Prevention (CDC) has identified six priorities to keep the nation healthy – or what its director, Dr. Thomas Frieden, calls “winnable battles”.  The six are smoking, AIDS, obesity/nutrition, teen pregnancy, auto injuries and healthcare infections. Although some healthcare experts consider this a bold move on Frieden’s part, others are angry that the six take priority over certain deadly diseases.

Bruce Burkett, past president of the National Hepatitis C Advocacy Council, believes that hepatitis B and C are “badly neglected” by the CDC.  “I was very disappointed that it wasn’t on there.  This is gong to affect millions by not being on there.”  Jeff Levi, who heads the research group Trust for America’s Health, also expressed concern, saying “I think everyone is going to be cautious in how the focus on winnable battles is balanced against other areas” that are considered crucial and may not be as easy to treat.

Frieden disagrees, noting that proven programs can save lives and reduce the risk of these health problems.  “In each of these areas, we know what to do to make a difference and we need to do it to a much greater extent,” Frieden said.  Additionally, the CDC has no intention of ignoring its other public health mission.  For one thing, it’s impossible, given that Congress directs the agency’s funding to certain causes.  Less than one-tenth of one percent of CDC’s $6.6 billion annual budget is discretionary and can be invested in the winnable battles initiative.

State health authorities are in agreement with Frieden’s priorities and will be happy to receive grant money from the CDC.  “We’re in the position of focusing pretty much on what we can get federal funds for,” said Will Humble, director of the Arizona Department of Health Services.  Humble believes that Frieden’s six winnable priorities are long overdue and welcomes the opportunity to better sell health improvement to Arizonans.  “You can’t market if your message is too diffuse.  If we’re all on the same page and working in the same direction, we can get a lot more momentum,” Humble said.

HHS Awards $100 Million to Public Health Initiatives

Monday, October 11th, 2010

Affordable Care Act sends $100 million to public health agencies.Thanks to the Patient Protection and Affordable Care Act, the Department of Health and Human Services is awarding nearly $100 million in grants to support locally based public health and prevention services. The money will support several public health initiatives, including substance abuse; mental health; stop-smoking hotlines; HIV testing and prevention; and obesity treatment and prevention.  According to Department of Health and Human Services Secretary Kathleen Sebelius, some of the funding also will be spent on health information technology.

“From providing tools to help people stop smoking to new HIV testing and prevention programs to a critical investment in mental health, these Affordable Care Act prevention grants will help people get what they need to stay healthy and live longer,” Sebelius said.  The Centers for Disease Control and Prevention http://www.cdc.gov/ will receive $75 million of the funding for its state and local public health programs.  Approximately $26 million of the CDC money will fund epidemiology, lab and health information systems in the health departments of all 50 states, two territories and the nation’s six biggest cities.

The funding is intended to help public health departments participate in “meaningful use” of electronic health records by implementing high-tech reporting.  Another $21.7 million in CDC funds will promote HIV testing and prevention.

Medicare, Medicaid Head Rallies Insurance Companies

Thursday, September 30th, 2010

Controversial CMS chief wants insurers to work with healthcare providers to make reform work.CMS administrator Donald Berwick has asked the insurance industry to work in good faith to implement healthcare reform in a timely manner. Dr. Berwick made his plea at a Medicare conference sponsored by America’s Health Insurance Plans, the health insurance industry’s trade group.

“We need your help, our nation needs your help,” Dr. Berwick said, noting that companies, CEOs, healthcare professionals and managers all play a role in achieving the objective, yet the insurance industry “can be among the keys of our success, the central part in navigating the success of healthcare reform.  We have a job to do, we need to make care better for America.”  Berwick told the audience that he plans to work with others at CMS to build relationships and partnerships to assure that the Patient Protection and Affordable Care Act works as intended.  “If we steadily work together to make care what it can become, trust will resurface and the rest will follow,’ he said.

Dr. Berwick, who President Barack Obama named to his post in a recess appointment that bypassed the Senate confirmation process, is not well liked by Republicans because he once wrote an article that praised Britain’s National Health Service, raising concern that he will introduce healthcare rationing.  He tried to allay those fears by saying “I urge lower costs without harming a hair on any patient’s head.  It’s a clear, stark reality.  Our healthcare system, in its current form, is not up to that job.  We cannot, with our current system of care, give Americans the care that they need and want and deserve.”

The most pressing issue is improving patient safety and cutting deaths that result from unnecessary medical errors, a specialty that Dr. Berwick developed when he headed the Institute for Healthcare Improvement.  He also called for improved prevention and treatment of diseases like obesity and depression.