A laska Native (AN) people experience higher incidence of, and mortality from, gastric cancer compared to other US populations. 1,2 Compared to the general U.S. population, gastric cancer in AN people occurs at a younger age, is diagnosed at later stages, is more evenly distributed between the sexes, and more frequently shows signet-ring or diffuse histology. 3 It is known that the prevalence of Helicobacter pylori infection, a risk factor for gastric cancer, is high in AN people 4 ; however, high antimicrobial resistance combined with high reinfection rates in Alaska make treatment at the population level complex. 5 In addition, health issues in AN people are uniquely challenging because of the extremely remote locations of many residents. A multiagency workgroup hosted a symposium in Anchorage, Alaska, that brought internationally recognized experts and local leaders together to evaluate issues around gastric cancer in the AN population. The overall goal of this symposium was to identify the best strategies to combat gastric cancer in the AN population through prevention and early diagnosis. Symposium Framework To identify goals and actions that were scientifically sound, logistically realistic, and culturally acceptable, a symposium was hosted in Anchorage, Alaska, in July 2019. This symposium brought together voices from many viewpoints, included gastric cancer and H pylori experts, Alaskan health providers, AN community and tribal leaders, public health officials, and representatives from other North American indigenous populations. Overall, 57 people attended and contributed to this symposium. The symposium aimed to identify concrete actions and was designed to maximize discussion. Scientific presentations were kept to a minimum. Presenters were encouraged to present well-established conclusions and information that could be used to address gastric cancer in AN people. After the scientific presentations, the symposium was divided into small groups, and participants were asked to identify the main questions or challenges related to gastric cancer in AN people. On the second day, the group was divided into 2 sections; 1 focused on scientific data and investigations, and 1 focused on community priorities and cultural acceptability. The symposium ended with the 2 groups coming together to summarize findings. The overall goal of this symposium was not to create guidance but to evaluate existing data, identify knowledge gaps, and summarize actions that could improve gastric cancer diagnosis and survival.

Our unhealthy nationCOVID-19 has unveiled some uncomfortable truths for the UK. The Global Burden of Diseases, Injuries, and Risk Factors Study found that Britain had the worst healthy life expectancy in Europe. 1 This finding was driven by obesity, hypertension, chronic respiratory conditions, excess alcohol use, and inactivity, compounded in some areas by poor physical, economic, and social environments.Our national health is worse than we thought: the analysis by Outcomes-Based Healthcare using objective National Health Service (NHS) clinical data found that on average, women in England get their first major health condition when they are aged only 55 years, and in the poorest areas when they are aged only 47 years. 2 Moreover, people in low-income areas live with ill-health for nearly 20 years longer than those in the highest-income areas. We have known this fact for many years but have not done enough to change it. Now is the time to do so.This state of poor health has meant that Britain was inadequately prepared for a virus that is most severe for the least healthy in our society. More people have died in Britain from COVID-19 pro rata than most other countries. 3 This is in part the result of our poor national health. We have the highest obesity rates in Europe and people who are obese (body-mass index ≥30 kg/m²) have a 40% greater risk of dying from COVID-19. 4 People with chronic respiratory problems, diabetes, or coronary heart disease are also all at greater risk. 3•9 million people in Britain have diabetes, 5 and an estimated 4•0 million people have untreated hypertension. 6 These risks and chronic conditions are more prevalent in people on low incomes and in poor communities, so more poor people die from COVID-19 than people on high incomes from wealthy areas.COVID-19 has exposed the lack of action on prevention and population health improvement over many years. It would be a mistake to think that the solution to future infections lies only in better vaccines and more hospitals. We need to prevent illnesses, both contagious and chronic ones.The British Prime Minister Boris Johnson in the Conservative government manifesto declared that his government would work "for everyone to have five extra years of healthy independent life by 2035 and

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