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IMPORTANCE Recent discussion has focused on questions related to the repeal and replacement of portions of the Affordable Care Act (ACA). However, issues central to the future of health and health care in the United States transcend the ACA provisions receiving the greatest attention. Initiatives directed to certain strategic and infrastructure priorities are vital to achieve better health at lower cost.OBJECTIVES To review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation's health and fiscal integrity.EVIDENCE REVIEW Qualitative synthesis of 19 National Academy of Medicine-commissioned white papers, with supplemental review and analysis of publicly available data and published research findings. FINDINGSThe US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation's health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities-pay for value, empower people, activate communities, and connect care-recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient-and community-focused health system. The essential infrastructure needs-measure what matters most, modernize skills, accelerate real-world evidence, and advance science-were the most commonly cited foundational elements to ensure progress. CONCLUSIONS AND RELEVANCEThe action priorities and essential infrastructure needs represent major opportunities to improve health outcomes and increase efficiency and value in the health system. As the new US administration and Congress chart the future of health and health care for the United States, and as health leaders across the country contemplate future directions for their programs and initiatives, their leadership and strategic investment in these priorities will be essential for achieving significant progress.

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A 6-month retrospective self-administered questionnaire study of 482 doctors and 380 midwives in two NHS Trusts was undertaken. The response rate was 384 (80%) and 293 (77%) respectively. The study revealed that only nine per cent of doctors and 46% of midwives had reported the contamination incidents they had received. The doctors' main reason for non-reporting was 'too time consuming' and midwives' was 'did not consider anything could be done', although their awareness of the active management of contamination incidents by occupational health departments was good. Seventy-seven per cent of doctors and 69% of midwives underestimated the risk of contracting hepatitis B virus from a needlestick injury, whilst 52% of doctors and 36% of midwives underestimated the risks of acquiring infection with HIV (human immunodeficiency virus) infection following such an injury. Strategies for improving the knowledge of the potential risks of contamination incidents and methods for facilitating ease of reporting are discussed.