The United States spends more per capita on health care than any other country, but is far from first in healthy outcomes. In fact, according to the World Health Organization, the U.S. health system is ranked 37th after most European countries, Singapore, Japan, Colombia, Saudi Arabia, Morocco and Costa Rica, among others, and just ahead of Slovenia and Cuba.

We’re not getting our money’s worth and our population is not as healthy as it ought to be. There are many reasons for this, far too many to discuss in one column.

What about Virginia? When ranked among the states, Virginia comes in the third quartile, at 29th, according to a state scorecard on health system performance published by the Commonwealth Fund Commission. Indicators include specifics related to access, quality, preventive care, percentage of covered children, avoidable hospitalizations and so on. Certainly it’s not as good a rating as we would like.

Virginia, like other states, has a major stake in health care spending and health outcomes. Medicaid is a large item in our state budget and we need to do more to get value for our investment.

Last week I attended a health care conference sponsored by the National Conference of State Legislatures for health care chairs. I was invited in my capacity as the chair of the health care subcommittee of Senate Education and Health.

The most important lesson is that more attention must be given to chronic disease. We learned that chronic diseases ( heart disease, cancer, stroke, COPD, and diabetes) are the #1 cause of death and disability in the U.S. and patients with chronic diseases account for 75% of the nation’s health care spending.

The vast majority of cases of chronic disease could be better prevented or managed. For example, the doubling of obesity in the last two decades accounts for nearly 30% of the rise in health care spending.

The lesson is clear: living a healthy life means a higher quality of life, less illness and lower costs. The World Health Organization estimates that at least 80% of all heart disease, stroke and type 2 diabetes and more than 40% of cancer would be prevented if only Americans were to do three things: stop smoking; start eating healthy; and get in shape. All things we know we should do!

What can we do to promote wellness? Multiple examples from many states were offered. Such simple design changes as making stairs as prominent and accessible as elevators, and not hidden in back halls, can encourage physical activity. Community design that includes mixed-use development, more sidewalks, safe bicycle lanes and bike racks can really help. The idea is to make the healthy choice the easy choice.

The current epidemic of obesity is serious! We saw colored maps that changed from year-to year that show how much it has increased. Farm-to-school programs that provide locally-grown fruits and vegetables for school lunches; healthy snacks, juices and water in vending machines; nutrition classes in the community; menu labeling; and more were suggested.

And we can each do our part.