Quality: We must redefine what “quality health care” means to Americans. All too often, the term “quality” defaults to simplistic notions of more-is-better, get-it-when-you-want-it, and having-the-latest-and- best-amenities. People almost never define quality care as timely, efficient, cost-effective or patient-centered. When I think back to that night in the emergency room with my daughter, what we wanted was timely care, not fancy waiting rooms or the newest, most expensive antibiotics. Current thinking seems to have locked providers into a permanent growth cycle, adding new services, new wings, whole new specialty hospitals. Inevitably costs go up. But challenge administrators on the quality of these new services, and you learn that they perceive quality initiatives as an expensive “add-on.” My fervent wish is that 10 years from now people will understand we can’t afford anything other than quality care. It’s the only kind of care that we should accept, that should be delivered, and that should be reimbursed. And what does quality care look like? It’s centered on the patient and family, based on the best clinical evidence, cost-effective and systems-minded—meaning that all disciplines and institutions work cooperatively. This paradigm is almost infuriatingly logical, but it requires nothing short of a revolutionary change in mind-set, which we hope to help bring about.

Childhood Obesity: America’s social and cultural environment should make it easier for kids to eat right and be active. In our programming, we will focus on children because, in terms of this problem, they are the most vulnerable group in our society—the least autonomous, yet the target of a continuous barrage of unhealthy temptations. Recently, the New York Times reported that if the present trajectory in kids’ eating habits holds, their generation is destined to have a shorter life span than adults have today. Such a regression is unconscionable.

Even people who believe that addressing children’s obesity is primarily their parents’ responsibility acknowledge how hard a job that is in the current environment. I look back and realize how fortunate I was in raising my son and daughter. I was blessed with financial resources that many parents don’t have, and my children attended a school that emphasized healthy foods and physical activity as a regular part of the day. How unusual that is becoming! Exposed to high-calorie non-nutritious foods, television, video games and neighborhoods that are not walkable, our children’s bodies are like strangers in a strange land. The world has changed but their physiology has not. The challenge for the Foundation is to help communities create environments that are healthier for kids and to help parents encourage the right choices.

Vulnerable Populations: Too many people fall through the cracks of today’s health care system. Sometimes because of age. Sometimes the problem is poverty. Sometimes it’s culture or ethnicity. Sometimes it’s race. “Vulnerable populations” cannot be simply defined. But what links vulnerable people together is the difficulty they have in navigating our nation’s health care system or in protecting their own health. Typically, they need services from a number of providers and, because these component parts of our “system” often are uncoordinated, the likelihood of both redundant services and overlooked needs is high. A key challenge here for the Foundation is to locate the gaps in care, and develop new service delivery models—something we have considerable experience in doing. We need to find effective models that can be adapted to work at the community level, rather than waiting for a probably less effective, less flexible one-size-fits-all national solution.

Disparities: Various racial and ethnic groups experience the United States health care system differently, regardless of income, education levels, or location, as my opening tale helps illustrate. We can define and approach this problem in several ways. One that I believe will be particularly effective is to support efforts to develop evidence-based protocols for specific procedures, recognizing that care will never be completely uniform because it has to account for individual differences and preferences. Quick progress may be possible in some specific disease areas—cardiovascular conditions, for example—because the evidence of poor outcomes due to disparities in care is compelling.