America's Health: Our Top Doctor's 2006 Report Card

In your view, what is the No. 1 health crisis in America today?

Health literacy. We have a lot of science and a lot of information, and we can talk all about prevention and medications, but if people don't understand what health pros are trying to do, all is for naught. And it's not just the people we serve, but also on the part of health professionals.

Health professionals often talk "doctorese." Sometimes people don't fully understand what we are trying to advise them to do. I don't want to demonize doctors. We are all trying to do the right thing. What we need to remember is communication is not a one-way street. We may think we have made a point, but have not. And we may think patients have understood, but they don't. Communication is not one-size-fits-all. It is modified and modulated by culture, gender, language -- all these things are important as we communicate. The Institute of Medicine reports that low health literacy adds $50 billion to health care costs. Ninety million Americans can't adequately understand basic health information. Can you imagine what we could do if we could get even half of these Americans to understand health better?

Are Americans getting smarter about smoking?

We are. In 1964, when the first Surgeon General report on smoking came out, the majority of American men and women smoked. Most don't now. We are getting smarter. When the report came out a few years ago, we are very heartened to learn that people are understanding [the risk] and taking it to heart. We were able to communicate the message in such a way that people hear it, understand it, and put it into action. What about teens? The number of teens taking up smoking continues to go down compared to the late '90s. It's the lowest ever since 1991. The not-so-good news is that the rate of decline is beginning to stall. We can't be complacent. We need to communicate to teens in ways they can hear the message, embrace it, and put it into action. And we need to appreciate that our young adults are educated people who can learn to make the right choices for themselves.

Why is organ donation such an important issue to you?

Organ donation is a professional and personal issue. As a physician, I have always been a proponent of organ and tissue donation. I have seen the life-giving benefits it provides to other individuals. It became personal to me when my wife was killed in an auto accident. Because she and I talked about it, we had the privilege of donating her organs. Four people received solid organs and had a longer life because of her. Four years later, my 22-year-old daughter was struck by a car while crossing the street. Because of her gift, another five people had a renewed life. Today, 93,000 people are on a waiting list for a transplant. If we could only find enough donors, people who are generous enough. When we are faced with the sudden death of a loved one, we are in the depths of grief. But in our grief, we see that good can come of it, helping us to remember our loved ones and what they were able to do as organ and tissue donors.

When you put a human face in front of the issue, that makes a difference. That is why I feel so passionate both professionally and personally about this issue.