Can you name the three biggest health care issues we face today? I don't mean the purely operational ones springing from the Affordable Care Act and other reform efforts, although no doubt those are keeping hospital executives up at night. Rather, the three issues I'm thinking of are more clinical in nature, with potentially dire implications for the health of vast numbers of individual Americans, as well as the financial well-being of the nation.

The thing is, these days, hospital CEOs have to pay more attention to the clinical side of things; it's no longer a domain they can leave entirely to their physician and nurse leaders. To keep their organizations relevant — and, yes, financially viable — executives have to really understand the health challenges of their communities and meet those challenges in the most efficient and effective ways possible. Population health management and partnering across the care continuum are priorities, particularly as hospitals and health systems take on more of the financial risk of providing patient care. It's become something of a mantra in the field that today's hospitals must be both health care providers and health promoters.

Not everybody will agree that the issues I list below are the three most urgent, and I invite you to tell me what you think pose even bigger challenges. Email me your responses at Here goes:

Obesity: This one may be a no-brainer, but the fact remains that too many Americans are too darn heavy, and it's making a lot of us sick. Kids are now getting certain types of diabetes that past generations of young Americans weren't even at risk for. Heart disease is climbing. So are stroke, orthopedic problems and any number of weight-related conditions. The cost of treating these obesity-triggered diseases was estimated at $109 billion in 2005, and it's been climbing ever since. So's the bill hospitals, EMT services and others are spending to retrofit facilities and equipment, and to hire more people to lift these patients. Yes, there has been good news recently about a drop in obesity rates among very young kids, but nobody knows if that will be sustained as they get older. In the meantime, the rate of extreme obesity among older generations keeps climbing.

Antibiotic resistance: OK, I may have written once too often about this particular problem, but, honestly, it scares the heck out of me. More signs that we are losing the war against drug-resistant bacteria seem to pop up all the time. Just last week, researchers at Rush University Medical Center here in Chicago reported that the rate of childhood infections caused by bacteria that produce the enzyme extended-spectrum beta-lactamase have increased over the last 10 years. Although the rate is still small, it's another indication that certain bacteria can develop resistance to antibiotics more quickly than pharmaceutical manufacturers can improve those drugs or come up with new ones. We must invest in more research, and in his budget proposal earlier this month, President Obama earmarked $30 million a year over the next five years to detect and prevent so-called “superbug” infections. We must also cut the amount of antibiotics we feed livestock and avoid eating and serving patients foods produced using antibiotics unnecessarily. Most importantly, providers must stop the overuse and misuse of antibiotics in treating children and other patients.

Dementia: Need I point out that as baby boomers move into senior citizenhood, Alzheimer's disease and other forms of dementia will exact an ever-greater toll? The toll is already high. A recently published study states that more than half a million Americans died of Alzheimer's in 2010, a huge jump from the approximately 84,000 deaths reported by the Centers for Disease Control and Prevention, which acknowledges its number is far too low. Altogether, about 5 million people in this country suffer from Alzheimer's. The direct costs of caring for people with Alzheimer's and other dementias was $109 billion in 2010. A March 19 editorial in the L.A. Times contends that “we can't afford not to spend more on Alzheimer's research,” and I agree. The editorial points out that 2010 health care costs were $102 billion for people with heart disease and $77 billion for those with cancer. But while federal funds allocated for cancer research total about $5.4 billion this year and $1.2 billion for heart disease, research on Alzheimer's and other dementias will receive only about $666 million in federal funding. True, President Obama signed off in 2011 on the National Alzheimer's Act to find new treatments, and OK'd $100 million in additional federal funding for research on Alzheimer's and related dementias. But, as the Times advocates, more money is needed not only to search for effective treatments, but also to find ways to actually prevent dementia in people at risk.