The dual-degree clinician-scientist, often termed a physician-scientist, represents a distinct and critical professional in the biomedical ecosystem, uniquely positioned at the confluence of direct patient care and rigorous scientific inquiry. These individuals traditionally earn both a clinical doctorate, such as a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO), and a research doctorate, typically a Doctor of Philosophy (PhD). While the MD/PhD and DO/PhD are archetypal, the concept and the associated training pathways have broadened to encompass other clinical disciplines. The National Institutes of Health (NIH) in the United States, for instance, recognizes and supports dual-degree training for dentists (DDS/PhD), pharmacists (PharmD/PhD), and veterinarians (DVM/PhD) who pursue careers as clinician-scientists.

This global concept of a clinical professional deeply embedded in research manifests with some regional variations in terminology. While "physician-scientist" is common in North America, "clinician-scientist" or "clinician-researcher" are frequently used in British and Australian English. Regardless of the specific term, the defining characteristic is a substantial commitment to scientific research, with professional effort often divided in ratios ranging from 50% research/50% clinical to as high as 80% research/20% clinical. Indeed, for formally trained physician-investigators, the expectation is often that at least 75% of their professional time will be dedicated to research endeavors. This significant investment in research distinguishes them from clinicians who may engage in research more peripherally or episodically. The formalization of dual-degree programs, such as the NIH-supported Medical Scientist Training Programs (MSTPs) in the US or the MD-PhD program at the Institut Pasteur in France , underscores the international recognition of the need for structured pathways to cultivate these specialized professionals. While the fundamental value of this role is universally acknowledged, the specific pipeline structures and support systems may differ across national contexts, suggesting that strategies to bolster this workforce may require adaptation to local conditions, even as the overarching goals remain consistent.

The United States healthcare system stands as a complex, multifaceted entity, distinguished by its mixed-payer structure and exceptionally high levels of expenditure.

Despite this significant financial investment, the system often yields suboptimal and inequitable health outcomes when compared to other high-income nations. This report provides a detailed description of the U.S. healthcare system, encompassing its structure, financing mechanisms, key stakeholders, and major coverage programs. It critically evaluates the system's performance, highlighting pervasive challenges such as persistent barriers to access and affordability, considerable administrative inefficiencies that contribute to waste, and profound health disparities linked to socioeconomic status, race, ethnicity, and geography.

The analysis reveals that these challenges are deeply interconnected, stemming from structural features including inherent conflicts of interest within a market-driven framework, significant fragmentation, and an ongoing societal debate regarding the government's role in healthcare. The report underscores the unsustainable trajectory of cost growth, the paradox of high out-of-pocket spending despite widespread insurance coverage, and the impact of payment systems that often incentivize service volume over value. Furthermore, the profound influence of social determinants of health (SDOH) is examined as a critical factor shaping health outcomes and exacerbating inequities.

In response to these multifaceted issues, this report outlines pathways toward a higher-performing healthcare system. These pathways are guided by foundational principles of universal coverage, affordability, equity, quality, and efficiency. Key recommendations include strengthening existing coverage mechanisms like the Affordable Care Act (ACA), exploring innovative models such as public insurance options, and implementing robust cost-control measures. These measures involve promoting value-based care, enabling drug price negotiation, and significantly reducing administrative burdens. Crucially, the report emphasizes the necessity of improving care quality through investments in primary and preventive care, optimizing health information technology, and enhancing care coordination. Advancing health equity requires targeted interventions for underserved populations, a concerted effort to address SDOH through cross-sectoral collaboration, and the promotion of culturally competent care and health literacy. Finally, strengthening the public health infrastructure is identified as essential for population health improvement and preparedness. The report concludes with a call for sustained, courageous, and evidence-informed reforms from all stakeholders to transform the U.S. healthcare system into one that is affordable, accessible, equitable, and delivers high-quality care for all Americans.

Cardiovascular disease (CVD) persists as the foremost cause of mortality globally, underscoring the critical need for effective prevention and management strategies. The American Heart Association (AHA) has a long-standing commitment to mitigating the burden of CVD, with historical efforts contributing significantly to reducing mortality rates from these conditions. However, the evolving landscape of health and disease necessitates a continuous refinement of public health approaches.

Recognizing this, there has been a significant evolution in strategy, moving beyond a primary focus on treating established disease towards a more encompassing model of positive health promotion and preservation throughout an individual's life. This represents a paradigm shift towards "primordial prevention"—the prevention of risk factors themselves—aiming to foster a foundation of cardiovascular health (CVH) from an early age and maintain it across the lifespan. This proactive stance acknowledges that optimal CVH is not merely the absence of disease but a positive state that can be actively cultivated and maintained. The low prevalence of ideal CVH, even among adolescents, highlights the urgency of instilling healthy habits early.

The AHA's "Healthy for Good" platform serves as a public-facing initiative designed to make healthy living accessible, understandable, and sustainable for all individuals, supporting this broader vision of lifelong well-being.

In 2010, the AHA introduced "Life's Simple 7" (LS7), a set of seven key modifiable lifestyle factors and health metrics aimed at improving cardiovascular health and reducing CVD mortality. This framework provided a clear, actionable guide for both individuals and healthcare providers. Building upon a decade of research and practical application, the AHA unveiled "Life's Essential 8" (LE8) in 2022. This update was not merely an addition but a comprehensive enhancement, driven by extensive evidence gathered since 2010, which offered new insights into the strengths and limitations of the original LS7 construct and identified emerging areas critical to cardiovascular health.