I'm Kevin Fiscella. I will discuss trends in population health in the United States compared to other countries. To talk about population health, we need to first define health. The World Health Organization defines health as a state of complete physical and mental social well-being, not merely the absence of disease or infirmity. I want to emphasize the elements of this World Health Organization definition. First, health is not simply the absence of disease. Second, the definition emphasizes that health entails well-being. The definition is based on complete well-being, emphasizing the importance of mental and social well-being in addition to physical well-being. In this definition of health is the fulfillment of basic human needs. Decades of research have documented what is needed to optimize physical, mental, and social well-being. Fulfillment of physical needs such as healthy eating, stable housing, clean water, access to health care, among other factors listed here, are critical to optimizing well-being and health. Fulfillment of mental needs such as sense of worth, feeling in control of one's life, hope and purpose, among other factors listed on the slide here, are critical to optimizing mental well-being and health. Fulfillment of social needs such as feeling loved and needed, having healthy family and community relationships, having a sense of belonging and status among other factors listed here, are critical to optimizing social well-being and health. Now that we've defined health, let's move on to population health. David Kindig and Greg Stoddard, experts in population health, define the term as health outcomes of groups of individuals, including the distribution of such outcomes within the group. They emphasize equity as a key dimension of population in that allows one to consider health inequality and inequity and the distribution of health across sub-populations, as well as the ethical and value considerations underpinning these issues. In another session I will discuss disparities in population health in the United States which relates to health inequality and inequities. How do we measure population health? An IOM, currently the National Academy of Medicine reported on this. They've given us the top five life expectancy, well-being, obesity, addictive behavior, and unintended pregnancy. Let's take a look at how the United States fairs in each of these five measures of population health. Let's start with population health from birth. The US ranks poorly in terms of population health at birth. It ranks 26 among developed countries, its peer countries. First yet, the US has been steadily falling in its ranking beginning around 1980 as you can see from the slide. Up to about 1980, we were on track and after that, we have fallen off. Yeah, life expectancy in the United States is in crisis, having dropped for the past three consecutive years, again, as shown on the slide by the circle. How is the United States fairing in the next measure well-being? Similar to life expectancy, the US ranks poorly compared to its peer countries. Obesity is a key behavioral determinant of poor population health in the United States. It's the third measure on the core measures that the IOM lists. The US ranks second worst in the world. That's from all the countries in the world we are second to the bottom. Eating and physical activity are the primary causes of high rates of obesity in the United States. You've probably heard in some of the other talks about some of the other contextual factors that shape both overeating and physical inactivity. Another addictive behavior is smoking. Smoking is a relative bright spot for the United States. The US ranks among the top five developed countries and having low rates of smoking. In fact, when we look at trends and smoking over time, smoking in the US is a remarkable success story, with steady declines each year. When we move on to another addictive behavior, alcohol. We see the US is around the middle in terms of it's developed country peers, in terms of overall alcohol consumption. When we look at trends over time between men and women, we see that rates of binge drinking, that's excessive drinking at one episode have declined among men, but have rain relatively stable among women, leading to a relative convergence between men and women. Drug overdoses is another important addictive behavior. Here, the US performs very poorly. In fact, we're an outlier compared to the rest of the world in terms of drug overdose deaths. The final of the IOM measures is unintended pregnancy. Rates of unintended pregnancy in the US are worse than Northern and Western Europe and comparable to poorer regions of Europe, that's Eastern Europe and Southern Europe. In 2002, the United States had the highest rates of teen pregnancy among its peer countries. However, this is another area where the US is making progress. The steady drops in teen pregnancy rates over time, largely due to the use of long acting reversible forms of contraceptive. Deaths from drugs, alcohol, and suicide had been called deaths despair by Case and Deaton. These deaths have disproportionately affected middle aged whites. Key risk factors for these deaths include being unmarried, socially isolated, unemployed, and living in economically distressed communities in the United States. In terms of population health in the United States, our country performs poorly compared to its peers in overall population health, particularly life expectancy. Beginning in 1980, we began falling off the curve. Overeating, physical activity, and drug overdoses are important behavioral risk factors that can contribute to our poor performance compared to our peers. Deaths from despair underscore the importance of thwarted human need fulfillment, ie, despair in the decline in population health in the United States through deaths from drug overdoses, suicides, and alcohol.