What new idea or innovation is having the most significant impact on medicine?

The current focus on paying doctors with "global payments" (instead of traditional fees for service) is a step in the right direction. It aims to improve health care, reduce hospitalizations, and bring down costs.

What's something that most people just don't understand about your field?

It's hard to understand how a practicing physician can devote him- or herself to research and education on issues that seem so intangible. But it's critical for health professionals to speak out about the global impacts of public policies and private-sector practices. There's a small international network in our field, and recently the American Medical Association, the American Nurses Association, and other health professional organizations have become involved.

What's an emerging trend that you think will shake up the health world?

The health impacts of an unstable climate regime are becoming more evident. There are direct effects of warming--bugs that bite and carry disease shifting to new territory, for example. But wilder weather--including wicked winters--takes the greatest toll.

A problem that's suddenly surged is the rise in food prices, grains particularly--posing nutritional risks for those in many nations. Several factors stand out. 1. Increased demand for meat. 2. Rising fuel prices. 3. Bioethanol crops (displacing food crops in some countries). And 4. The droughts, heat waves, and floods afflicting so many parts of the globe. The wheat crop crash in Russia during that country's 2010 summer heat wave, for example, boosted bread prices and led to food riots in Mozambique (where I lived and worked some decades ago).

You'll notice that three of the four reasons listed are about climate instability and energy. The right energy policies are needed to restabilize the climate.

What's a health trend that you wish would go away?

If a wish could make it so. I wish the upward trend in cancer would abate; it is heartening that more people are surviving. Prevention involves reducing the carcinogens assaulting our defenses through approaches like "green chemistry," which uses non-toxic chemicals, and plants and algae, rather than petroleum, as the stocks for plastics and other products, keeping our water safe. European nations are moving in this direction. Agriculture without pesticides is a crucial measure and growing more food locally reduces air pollution from transport.

What's an idea you became fascinated with but that ended up taking you off track?

Rather than throwing me off track, a new idea shifted me onto new track. Three years ago I began focusing the health lens on proposed climate solutions. I first examined the problems with some solutions (e.g., more coal and nuclear energy), and then healthy solutions (electric vehicles, cleanly powered smart grids, and healthy cities programs) that could be rapidly scaled up today.