The articles in this issue (30:4), Current Topics in Family and Community Health, are varied, with topics ranging from ethics to oral health, and represent a wide range of disciplines and disorders, from caregiving to family functioning. However, all seek to address the same broad issues of improving health and healthcare.

As I sit and write today, it has been difficult to weave these articles together in a concise and thematic manner. They probably do not fit together, and that is OK, for they each contribute in their own way to the overall picture of health and healthcare. As I have searched for these answers, I am very aware of yesterday's (April 16, 2007) tragedy at Virginia Tech and the unnecessary loss of life. As I have watched the media coverage unfold, I have seen the country's desperate search for answers and the offering of solutions to prevent this sort of tragedy from happening again.

I am also mindful of what else happened yesterday. In this country, approximately 1,800 people died from heart disease, 1,500 died from cancer, 411 died from stroke, and 200 died from diabetes. Unfortunately, there was no media coverage of these deaths. Maybe Joseph Stalin was correct when he indicated that while deaths of individuals are a tragedy, deaths of millions are merely a statistic.

I know that we must all die of something and that many of these deaths would not be considered "premature." But maybe some of them could have been prevented. If we extrapolated from information provided by the Institute of Medicine report, approximately 50 people died yesterday as a result of not having health insurance. Because of a lack of health insurance, they were unable to get preventive services, a timely diagnosis, or appropriate care. Being uninsured magnifies the risk of death and disability for the chronically sick, for those who are mentally ill, for those who are poor, and for minorities, who disproportionately lack access to medical care. Other notable comparisons between the uninsured and the insured show that:

* Uninsured people with colon or breast cancer face a 50% higher risk of death.

* Uninsured trauma victims are less likely to be admitted to the hospital, to receive the full range of needed services, and are 37% more likely to die of their injuries.

* About 25% of adult patients with diabetes without insurance for a year or more went without a medical checkup for 2 years, thus increasing their risk of death, blindness, and amputations.

While it is unlikely that the circumstances at Virginia Tech will be repeated today, the deaths previously mentioned, and many more, will continue to occur today, and tomorrow, and the next day, and the next unless [horizontal ellipsis]

To paraphrase one commentator who spoke about the Virginia Tech tragedy: "I don't know that we can prevent this type of attack. When you have one determined individual who has no regard for his own life, nor any regard for the lives of others, tragedy ensues." But we do know what happens when people do not have health insurance. In addition to the morbidity and mortality mentioned previously, the cost of healthcare provided to those without insurance that is not paid out-of-pocket by the uninsured themselves will continue to rise, from the current $43 billion annually to an estimated $60 billion by 2010. Access to healthcare is a moral and an economic issue and it is in everyone's best interest to advocate for a system of healthcare for all. My thoughts go out to all of those who lost loved ones yesterday.

John C. Higginbotham, PhD, MPH

Leslie Zganjar

Issue Editor, Associate Dean for Research and Health Policy Director, Rural Health Institute for Clinical and Translational Science, The University of Alabama School of Medicine Tuscaloosa Campus (Higginbotham)

Issue Editor, Assistant Director for Editorial Services Rural Health Institute for Clinical and Translational Science, The University of Alabama School of Medicine Tuscaloosa Campus (Zganjar)