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The United States has made historic progress in combating the epidemic of tobacco-caused illness and death since the landmark 1964 Surgeon General's Report on the health effects of cigarette smoking. Since then, adult smoking rates in the United States have been cut in half (from 42.4% in 1965 to 20.6% in 2008). More than half of all adults who have ever smoked have quit. 11 This substantial decline has been characterized as one of the 10 greatest achievements in public health in the 20th century. 12 Despite this progress, tobacco use remains the leading cause of premature and preventable death in our society. 13 Worldwide, the tobacco epidemic killed 100 million people in the 20th century and is projected to kill one billion people worldwide in the 21st century. Each year, smoking kills more than five million people around the globe. 14 In the United States, smoking kills an estimated 443,000 people each year, with secondhand smoke responsible for 50,000 of those deaths. 15 The list of diseases caused by smoking has been expanded to include abdominal aortic aneurysm, acute myeloid leukemia, cataract, cervical cancer, kidney cancer, pancreatic cancer, pneumonia, periodontitis, and stomach cancer. These are in addition to previously known diseases, including bladder, esophageal, laryngeal, lung, oral, and throat cancers; chronic lung diseases; coronary heart and cardiovascular diseases; reproductive effects; and sudden infant death syndrome (SIDS). 16 Tobacco use causes more deaths than HIV/AIDS, alcohol use, cocaine use, heroin use, homicides, suicides, motor vehicle crashes, and fires combined. 17 Secondhand smoke exposure also causes serious disease and death in adults and children, including heart disease, lung cancer, SIDS, acute respiratory infections, ear problems, and asthma attacks. 18 Approximately 8,600,000 people in the United States have chronic illnesses related to smoking. 19 Cigarette smoking also costs the nation $193 billion in health care costs and lost productivity each year. Of those costs, private and public health care expenditures for smoking-related health conditions are estimated at $96 billion. 20 While smoking among U.S. adults is down significantly from a decade ago, the decline in the adult smoking rate has now stalled, with virtually no change in prevalence since 2004. The current smoking rate of 1 in every 5 adults far exceeds the national goal set by Healthy People, which aimed to reduce adult prevalence to less than 12%. If the current trend continues, the adult smoking rate likely will remain considerably higher than this target. 21

Nearly five million uninsured children in the United States are currently eligible for Medicaid or the Children's Health Insurance Program (CHIP) but are not enrolled in these programs. A top Obama administration priority is to achieve the long-sought goal of ensuring that uninsured children are enrolled--and that they stay enrolled for as long as they are eligible. The author, who is secretary of the U.S. Department of Health and Human Services (HHS), outlines measures that HHS and other federal agencies are implementing to reach this goal. She also cites existing state efforts to enroll more children and improve children's coverage, and she describes steps that states, local governments, and the private sector can take to expand outreach efforts, increase enrollment, and keep eligible children covered.

In the past two years, the United States has made a historic investment in biomedical research. But innovative medicines often stall in the pipeline from microscope to market. To deliver the next generation of cures and treatments to help Americans live longer, healthier, and more comfortable lives, strong, strategic partnerships both within government and among government, academe, industry, and nonprofits are needed at every stage of drug development. In this article I describe actual and potential efforts on the part of the US governmentincluding the Biomarkers Consortium and National Institutes of Health Therapeutics for Rare and Neglected Diseases program-to work with other stakeholders to advance biomedical research and development.

Medicare Advantage: Issues, Insights, and Implications for the FuturePaul Cotton, Joseph P. Newhouse, PhD, Kevin G. Volpp, MD, PhD, A. Mark Fendrick, MD, Susan Lynne Oesterle, Pat Oungpasuk, Ruchi Aggarwal, Gail Wilensky, PhD, and Kathleen SebeliusEditorial   S-2D.B. Nash, and A.Y. SchwartzThe History, Impact, and Future of the Medicare Advantage Star Ratings System   S-3P. CottonMedicare Advantage and Traditional Fee-For-Service Medicare   S-4J.P. NewhouseBehavioral Economics: Key to Effective Care Management Programs for Patients, Payers, and Providers   S-5K.G. VolppValue-Based Insurance Design: A Promising Strategy for Medicare Advantage   S-6A.M. Fendrick, S.L. Oesterle, P. Oungpasuk, and R. AggarwalTwo Perspectives on the Future of Medicare Advantage   S-7G. Wilensky and K. Sebelius