At the June 2007, Central City Medical Group (CCMG) board meeting, Deb Moore, Executive Director, reported that there were mounting tensions caused by the implementation of an electronic health record (EHR). Physician morale and productivity were spiraling downward. The present challenge was the growing gap between the patient workload and physician capacity, as physicians remained well below historic productivity levels while learning to use the new EHR. The medical director had resigned her post and other senior physicians were threatening to retire. Ms. Moore had a pressing question for the board: should CCMG stop accepting new patients until they returned to full productivity?

In October 2008, Dr. Richard Mgaga, Head of the Malaria Control Programme in Uganda reviewed the monthly malaria statistics report for the district of Apac, which in April of 2008 had undergone a pilot indoor residual spraying (IRS) program using DDT in a campaign to prevent mosquitoes from biting and spreading malaria. The campaign was halted by a court injunction requested by organic farmers, exporters and environmentalists in May 2008, and the injunction was upheld by the High Court in June. In early August, the Uganda Health Ministry began spraying a pyrethroid insecticide in place of DDT. Meanwhile the Ugandan Attorney General was challenging the High Court’s decision.  Dr. Mugaga was under pressure by the Presidential Malaria Initiative (PMI) to undertake a full program of IRS in 300,000 households in the northern districts of Uganda, including Apac. However, he was unsure whether to proceed, given the opposition and apparent problems that surfaced when the Apac pilot was implemented.

“Suffolk County is experiencing elevated cardiovascular disease mortality relative to New York State,” explained Dr. Humayun Chaudhry, Commissioner for the Department of Health Services of Suffolk County. Given the general affluence of the area, he finds the CVD mortality rates "a paradoxical situation. We need to determine strategies to address this high priority health issue for our county."