The Israel Healthcare Highlights Podcast
Want to learn about one of the world's most innovative and equitable health care systems?
If so, then tune in to The Israel Healthcare Highlights Podcast!
Israeli healthcare is a world leader in digital health, clinical AI, emergency preparedness, and much more. It also has universal health insurance, is a model for Arab-Jewish coexistence within Israel, and invests heavily in ensuring that all Israelis - whether rich or poor - have good access to quality health care. Israeli Healthcare Highlights showcases key features of Israeli healthcare through interviews of leading Israeli healthcare experts.
Interviewees will include the government's top physician, the president of a leading medical center, the director of innovation at a large health plan, and the CEO of a start-up that brings together Israel's strengths in AI and fertility care.
The podcast is hosted by Professor Bruce Rosen of "Together in Health" and the Hebrew University of Jerusalem, Israel.
Episodes
Friday Feb 06, 2026
Friday Feb 06, 2026
This episode introduces "conflict psychology," showing how people cope when danger is a constant and denial becomes a functional strategy to preserve daily life.It discusses why many struggled to prepare early in the recent war—not from apathy, but because acknowledging the threat was emotionally costly—and warns against framing preparedness solely through fear.The episode concludes that preparedness should be treated like a health behavior: messages must be empowering, manageable, and supported, because psychological sustainability is as important as physical readiness.
Monday Jan 05, 2026
Monday Jan 05, 2026
This episode explores how Terem, a nationwide urgent care chain, operates in both peacetime and wartime through the perspective of Hannan Kranc, director of Terem’s southern region.
Hannan describes Terem’s role in easing hospital crowding, the network of clinics across Israel, and the rapid adaptations made during the recent war—extending hours, opening temporary clinics, protecting staff and patients, and serving diverse communities.
Monday Jan 05, 2026
Monday Jan 05, 2026
Kalaniyot is a faculty-led initiative that strengthens academic ties between leading U.S. universities and Israeli researchers while building a supportive campus community for Jewish and Israeli staff.
Professor Mark Perzansky of Harvard Medical School discusses creating funded postdoctoral fellowships, and community support to counter isolation and promote scientific collaboration.
Monday Jan 05, 2026
Monday Jan 05, 2026
Avner Halperin, CEO of Shiba Impact, explains how Sheba Medical Center’s ARC Global Innovation Network trains clinicians to innovate, spins ideas into startups, and has grown an ecosystem of 120 companies worth $6 billion and employing 3,500 people.He shares concrete examples — a mitral valve replacement startup acquired by Edwards and an AI-based PTSD diagnostic built with Microsoft — and describes how hospitals worldwide can partner through ARC summits, training, and co-development.
Monday Jan 05, 2026
Monday Jan 05, 2026
In this episode Dr. David Levine explains the "home hospital" model: delivering hospital-level care in patients' homes as a substitute for traditional inpatient stays. He outlines appropriate conditions, limitations, and evidence supporting better outcomes and cost savings.
Dr. Levine also discusses his work in Boston, collaborations with Israeli programs, and the role of technology and policy in expanding home hospital care.
Monday Jan 05, 2026
Monday Jan 05, 2026
This episode examines how Israel’s health system adapted after the October 7 attack, revealing both immense vulnerability and remarkable resilience. It traces three concentric responses: immediate life-saving care at hospitals like Soroka, rapid community-level adaptations such as Terem’s hotel clinics and the CoLab volunteer networks, and the long-term psychological echo with sharply increased PTSD and depression rates.The episode highlights rapid innovation — mass EMDR training, digital peer platforms, and a national mental-health infrastructure — and shows how civic volunteering and cross-border public health efforts (including a polio vaccination campaign) became vital. It closes by noting a key long-term risk: dependence on aging, foreign-trained medical staff and the need for strategic workforce planning to sustain resilience.
Sunday Jan 04, 2026
Sunday Jan 04, 2026
Explore how Israels high-performing national health system delivers excellent outcomes but faces an urgent workforce crisis. This episode breaks down the systems structure, the 2019 policy shock that disrupted foreign-trained doctors, and the rapid reforms underway—new medical schools, expanded domestic training, advanced nursing roles, and novel leadership and mental health strategies.Learn how policy agility, digital health, and role redefinition aim to avert a demographic cliff while tackling ongoing equity and financial protection challenges.
Sunday Jan 04, 2026
Sunday Jan 04, 2026
This episode explores how Israel combines universal health data, clinical validation sites, and targeted capital to accelerate health-tech innovation—from IVF AI to hospital‑embedded predictive care and AI mental‑health tools.Through seven expert interviews, we unpack the ecosystem’s structure, key examples (Sheba, CloudLit, Ferility), and lessons other countries can adapt to create proactive, data-driven healthcare.
Sunday Jan 04, 2026
Sunday Jan 04, 2026
Welcome to the Deep Dive summarizing a YouTube playlist from Israel Healthcare Highlights that spotlights five interviews about Israel's global health contributions. We cover the explosive growth of Israeli health tech driven by 30 years of centralized health records, a precision medicine breakthrough tracing a genetic cause of kidney failure disparities, and scalable models for training global health leaders.Also featured are a low-cost geriatric care program using portable ultrasound in Ethiopia and a coordinated polio vaccination campaign during active conflict in Gaza. Together these cases show how data, affordable technology, and training are exported to improve health equity worldwide.The episode highlights three unifying themes: leveraging unique Israeli assets, prioritizing cost-effective knowledge transfer, and placing public health above political conflict to protect vulnerable populations.
Sunday Jan 04, 2026
Sunday Jan 04, 2026
A concise deep dive into Israel Healthcare Highlights (IHH): short, focused interviews with top clinicians, policymakers and innovators that show how Israel leverages centralized health data, precision medicine and rapid translational pipelines to accelerate treatments, AI tools and scalable care models.Highlights include a genetic discovery linked to kidney disease disparities, the creation of national health equity indicators, practical low-cost training projects, a thriving health-tech startup ecosystem built on decades of electronic medical records, and rapid, tech-enabled responses to crisis-driven mental health and system resilience needs.
Tuesday Sep 09, 2025
Tuesday Sep 09, 2025
In this compelling episode of Israel Healthcare Highlights, host Bruce Rosen sits down with Dr. Zimmerman - Maternal, Child, and Adolescent Health Department Head, at the Ministry of Health - to explore the remarkable legacy and future-forward advancements of Israel’s preventive healthcare services for women and children.
Dr. Zimmerman shares the rich history of Tipat Halav clinics—Israel’s maternal and child health centers—with roots tracing back to 1913, even before the founding of the State. From historical milk depots to today's nationwide standardized care for all children under age six, the evolution is both inspiring and impactful.
The conversation spotlights an extraordinary achievement: Israel’s creation of the world’s first validated, evidence-based developmental milestone database—drawn from over 4 million pediatric visits. This data revolution not only enhances individual care but also allows for early detection of developmental challenges and more targeted support across demographics.
Bruce and Deena discuss how this data-driven approach helps bridge healthcare gaps between populations, including initiatives focused on Israel's Arab community and underserved regions.
Whether you're a public health enthusiast or just curious about how thoughtful innovation can transform healthcare, this episode is packed with insights you won’t want to miss. Tune in and discover how Israel's legacy of care continues to shape its healthy future.
Sunday Aug 24, 2025
Sunday Aug 24, 2025
Join us for an inspiring conversation with Professor Naim Shehadeh of Bar-Ilan University, director of the Russell Berrie Galilee Diabetes SPHERE program, and president of the Israel Diabetes Association.
In this interview, Professor Shehadeh shares the groundbreaking work being done to combat diabetes disparities in Israel’s Galilee region, where rates of diabetes and poor metabolic control are significantly higher than the national average.
Discover how the SPHERE initiative—Social, Precision Medicine, Health Equity, Research—takes a city-based approach to intervention, building unique ecosystems of collaboration among community-based healthcare providers, government ministries, hospitals, and academia. Learn how socioeconomic status, genetics, and environment contribute to the region’s health challenges, and how targeted education and lifestyle changes are helping reduce the conversion rate from prediabetes to diabetes by an impressive 50%. Professor Shehadeh also discusses international interest in the program, with partnerships forming in Denmark, Canada, and the Gulf region.
This episode is a must for anyone passionate about public health, medical innovation, and community-driven solutions.
#diabetescare #PublicHealth #GalileeSPHERE #HealthEquity #MedicalInnovation #IsraelHealth
Wednesday Aug 20, 2025
Wednesday Aug 20, 2025
The Israeli health care system achieves outstanding health outcomes at low cost.
The seven vital ingredients of this success story are:
1. A combination of centralized government financing and non-governmental delivery
2. A combination of competition and regulation
3. A leading in the effective use of health IT
4. A strong system of primary care
5. An ability to set strategic goals and mobilize accordingly
6. Alignment of incentives
7. An ability to adapt innovations from other countries
This overview was presented at the Innovative Technology in China & Israel , IoT and Digital Health Conference, June 6-7 2016, Hangzhou, China. China, a country of over a billion people, wanted to learn from Israel - a country of fewer than ten million people. The Chinese sensed they could learn valuable lessons from Israel, despite the vast differences between the countries in size, cultural, history and political systems.
The numbers presented in China nine years ago have changed somewhat. The same is true regarding some of the organizational details presented then and there. But the overall messages about what makes the Israeli health system efficient are still valid.
Just as the Israeli system has valuable lessons for China, it also has valuable lessons for the Untied States, the United Kingdom, Japan, and other countries throughout the world.
Wednesday Aug 20, 2025
Wednesday Aug 20, 2025
One of the greatest strengths of Israeli healthcare is its ability to identify relevant innovations in other countries and adapt them to Israel.
Drawing on over 30 years of experience, Professor Bruce Rosen shares insights into how Israeli health leaders—from government policymakers to hospital CEOs—actively seek out international solutions and tailor them to meet local needs. Based on 20 compelling stories, he uncovers how adaptations in areas like national financing, care delivery, workforce development, and population health have shaped the evolution of Israeli health care.
Key Themes: - Adaptation is widespread and essential - Innovations are often discovered through informal global exchanges - Local adaptation is driven by both system limitations and strengths - Success requires humility, creativity, and courage
This video is a must-watch for anyone interested in health policy, innovation, and the power of cross-border collaboration. Have your own story of adaptation in health care? Share it with us!
Wednesday Aug 20, 2025
Wednesday Aug 20, 2025
This six minute podcast highlights the strong representation of Israeli Arabs in key health professions (medicine, dentistry, nursing, and pharmacy) and explores the factors that have contributed to this important accomplishment. It is based on a study that was carried out by Bruce Rosen of the Myers-JDC-Brookdale Institute and the Hebrew University of Jerusalem along with Sami Miaari of Tel Aviv University and Yale University. Bruce is also the founding editor of the Israel Journal of Health Policy Research. Sami is also the founder of Israel's Arab Economic Forum. The study was published in the Israel Journal of Health Policy Research and can be found here: https://ijhpr.biomedcentral.com/articles/10.1186/s13584-024-00663-3
The abstract of that article reads as follows:
Background
Israel is a multiethnic society with a population of 9.8 million at the end of 2023. Israeli Arabs (i.e., Arab Palestinian citizens of Israel) account for 21% of the Israel’s overall population, 22% of its working age population and 16% of the employed population.
This study has several objectives: (1) To provide an overview of the current representation of Israeli Arabs in four key health care professions (medicine, nursing, dentistry, and pharmacy) in terms of employment, licensure, and professional studies; (2) To document changes in those parameters over the past decade, subject to limitations of data availability; (3) To provide a broader context on the employment of Israeli Arabs; (4) To explore the policy implications of the key findings.
Methods
Estimates of employment levels are based on the Labor Force Survey (LFS) of the Central Bureau of Statistics (CBS). Data on licensure (i.e., professional qualification) and place of professional studies were extracted from the Ministry of Health report series entitled “The Health Care Professions”. Data on enrollment in degree programs in Israel was provided by the Council of Higher Education. Important background information was elicited from relevant policy documents and policy experts.
Results
In 2023, among employed Israelis up to age 67, Arabs constituted approximately one-quarter of Israel’s physicians (25%), nurses (27%), and dentists (27%), and half of Israel’s pharmacists (49%). These percentages are substantially higher than they were in 2010, with the increase being particularly marked in the case of physicians (25% versus 8%).
The number of new licenses granted annually increased significantly between 2010 and 2022 for both Arabs and Jews in each of the professions covered. The percentage of newly licensed professionals who are Arab increased substantially among physicians and nurses, while remaining stable among dentists and pharmacists. In medicine, dentistry, and pharmacy, many of the licensed Arab health professionals had studied outside of Israel; this phenomenon also exists for nursing but is less widespread there.
In the 2022/3 academic year, the percentage of first-degree students in Israeli colleges and universities who were Arab was 70% in pharmacy, 33% in nursing, 23% in dentistry, and 9% in medicine. Between 2012/3 and 2022/3 the percentage of first-degree students who are Arab increased substantially for pharmacy, declined slightly for nursing, and declined substantially for medicine and dentistry.
Conclusions
Arab professionals play a substantial and recently increased role in the provision of health care services in Israel. It is important to recognize, appreciate, and maintain this substantial role. Moreover, its potential as a model for sectors other than health care should be explored. To build on achievements to date, and to promote continued progress, policymakers should expand access to health professional education within Israel, upgrade the skills of graduates of non-Israeli universities, promote diversity in leadership positions and key specialties, and expand specialty care services in Arab localities.
The podcast makes several additional points, including:
1. The representation of minorities in medicine is much higher in Israel than in the United States.
2. Within Israel, the representation of Arabs is substantially higher in the health professions than in other professions, such as law.
The authors would greatly appreciate comments from viewers and are available to meet with interested viewers via Zoom.
Monday Aug 18, 2025
Monday Aug 18, 2025
In this episode of Israel Healthcare Highlights, Bruce Rosen sits down with Professor Nachman Ash, Chair of the Executive Committee of Israel’s National Institute for Health Policy Research. With a distinguished career which includes serving as Director General of the Ministry of Health and Surgeon General of the IDF, Prof. Ash offers a deep dive into the Institute’s pivotal role in shaping Israeli healthcare.
Learn how the Institute, founded alongside Israel’s National Health Insurance Law, has spent over 30 years funding impactful health policy research. Prof. Ash shares timely examples, including mental health initiatives during the COVID-19 pandemic and the ongoing war, and how research has influenced national policy.
Discover the Institute’s three pillars: funding research, convening policy forums, and publishing the Israel Journal of Health Policy Research. From the prestigious Dead Sea Conference to international collaborations, the Institute fosters dialogue across sectors—government, academia, providers, and patients.
Prof. Ash also discusses future directions, including expanding funding sources, embracing AI in health research, and increasing data accessibility for global collaboration.
Monday Aug 18, 2025
Monday Aug 18, 2025
Promoting health care equity is both important and challenging. Clearly, to promote equity and to monitor progress, there is a vital need for good measures of equity.
In this powerful episode of Israel Healthcare Highlights, Bruce Rosen speaks about equity measurement with Professor Rachel Wilf-Miron of Tel Aviv University and the Gertner Institute. Professor Wilf-Miron is a pediatrician, public health expert, and one of Israel’s foremost champions of health equity.
With decades of experience in healthcare leadership, Prof. Wilf-Miron shares her groundbreaking work to reduce disparities in access, quality, and outcomes across Israel’s diverse population. From her early efforts at Maccabi Healthcare Services to her national leadership on wait time measurement and equity indicators, Prof. Wilf-Miron has helped transform how Israel measures and addresses inequality in healthcare. She discusses the stark gaps in services—such as mammography rates among Arab women and long wait times in peripheral regions—and how data-driven strategies are being used to close them.
She also unveils Israel’s first national set of health equity indicators, developed through a rigorous, inclusive process involving experts and public representatives. These indicators—ranging from infant mortality to access to psychotherapy—are now being used by the Ministry of Health to guide policy and resource allocation.
Whether you're a health professional, policymaker, or advocate for social justice, this conversation offers deep insights into how a health system can strive toward fairness and inclusion.
Monday Aug 18, 2025
Monday Aug 18, 2025
What happens when nutrition meets policy, and businesses shape the food landscape?
In this eye-opening episode, Bruce Rosen sits down with Professor Ronit Endevelt—renowned nutritionist, University of Haifa professor, and former head of Israel’s Ministry of Health Nutrition Department—for a deep dive into the forces shaping public health.
Drawing from her decades of experience, Endevelt shares how behavioral change in nutrition is not just about personal willpower, but is deeply intertwined with environment, socioeconomics, and marketing. She breaks down the concepts of nutritional swamps and deserts, explains how urban planning and availability affect health choices, and reveals how front-of-pack labelling policies have led to dramatic reductions in sugar and salt consumption in Israel.
Discover the challenges of confronting powerful commercial interests, the role of media influence, and the need to combine government responsibility and individual resilience. From product reformulation to regulatory battles, this conversation lays bare the complexity of promoting health in a profit-driven world.
Whether you’re a policymaker, health professional, or curious citizen, this conversation will shift how you think about the food you eat and the systems that shape it.
Monday Aug 18, 2025
Monday Aug 18, 2025
Soroka Medical Center is on the frontlines of crisis and care. In this compelling interview, Bruce Rosen speaks with Dr. Shlomi Codish, Director General of Soroka Medical Center, about the hospital’s extraordinary role during Israel’s recent crises. From treating thousands of casualties after the October 7th terror attacks to surviving a direct missile strike from Iran, Soroka has remained a lifeline for over one million residents in southern Israel.
Dr. Codish shares a gripping firsthand account of managing the threat of a potential mass casualty event from a bomb shelter, the destruction of a key hospital building, and the emotional toll on medical staff. With over 50% of bed capacity and 40% of operating rooms lost, Soroka continues to operate under immense pressure—driven by duty, resilience, and the unwavering commitment of its staff.
The conversation also explores the psychological impact on healthcare workers, the urgent need for hospital fortification, and the long-term rebuilding efforts already underway. Dr. Codish calls for national and global support to ensure Soroka can continue its mission in times of peace and war.
To support Soroka, visit its website and/or connect with The American Friends of Soroka.
Monday Aug 18, 2025
Monday Aug 18, 2025
In this episode, Bruce Rosen welcomes Professor Benjamin Dekel, a global leader in regenerative medicine, from Sheba Medical Center and Tel Aviv University. As Chair of Pediatric Nephrology and Director of the Pediatric Stem Cell Research Institute, Professor Dekel shares groundbreaking insights into kidney regeneration and the future of medical science.
Learn how his team became the first to isolate kidney stem cells that grow the organ in utero, paving the way for revolutionary treatments. Discover the two major approaches to regenerative medicine: transplanting engineered tissues and triggering the body’s own regenerative programs through drugs and biological cues.
Professor Dekel also reflects on the unique strengths and challenges of conducting cutting-edge research in Israel. Despite limited funding, Israel’s collaborative scientific community fosters innovation through close-knit partnerships and a “neighborhood” mentality that accelerates discovery.
With extensive international experience and deep local engagement, Professor Dekel exemplifies the spirit of scientific progress and cooperation.
Don’t miss this inspiring conversation about the future of healing and the power of regeneration.
Monday Aug 18, 2025
Monday Aug 18, 2025
In this inspiring episode, Bruce Rosen from Hebrew University sits down with Dr. Maurit Beeri, Director General of ALYN Hospital—Israel’s premier pediatric rehabilitation center. Discover Dr. Beeri’s heartfelt journey from pediatrician to hospital CEO, sparked by a powerful moment that changed her career path forever. Nearly a century after its founding, ALYN Hospital continues to lead groundbreaking approaches in rehabilitative care for children with complex medical conditions, from neurological injuries to trauma recovery.
Dr. Beeri shares how ALYN combines cutting-edge technology with compassionate, holistic care—helping young patients reintegrate into society, schools, and everyday life. Learn how their commitment to “participation” over mere physical milestones has transformed Israel’s educational and medical landscapes. Whether it’s integrating children on ventilators into mainstream classrooms or empowering them with the tools to communicate and thrive, this conversation is full of insight, hope, and innovation.
Tune in to explore the powerful connection between healthcare, education, and community—and how institutions like ALYN Hospital are helping children not just survive, but truly belong. ALYN Hospital has also become a haven of inclusivity and mutual respect in a deeply diverse and often divided society. As Dr. Beeri explains, ALYN serves children from every segment of Israeli society—secular and ultra-Orthodox Jews, Israeli Arabs. Especially during times of national stress and conflict, ALYN remains a space where families and staff are united by the shared mission of rehabilitation. Whether it's curating peaceful environments free from political tension, offering multilingual communication, or providing inclusive spaces for prayer and reflection, the hospital fosters understanding and trust across communities.
In a society struggling with polarization, ALYN stands out not only as a center of medical excellence but as a model for coexistence—reminding us that empathy and collaboration are as vital to healing as any clinical treatment.
Monday Aug 18, 2025
Monday Aug 18, 2025
In this episode of Israel Healthcare Highlights, host Bruce Rosen speaks with Professor Bruria Adini, head of the Emergency and Disaster Management Department at Tel Aviv University, about the evolving concept of resilience in Israeli society.
Prof. Adini discusses her team’s groundbreaking research that tracks resilience across multiple crises—from COVID-19 and political unrest to the ongoing war post-October 7. With seven resilience assessments conducted during wartime alone, her findings challenge common assumptions. Notably, distress and resilience are not mutually exclusive—both can coexist. The key driver? Hope. Those who maintain a hopeful outlook tend to demonstrate greater personal and societal resilience.
The study also revealed wide gaps in attitudes based on the level of support of the government. For example, those that support the government feel to a very high extent that the government is making all efforts to release the hostages, while those who oppose the government feel that this is not done.
The conversation touches on global comparisons—including Ukraine—and reveals that communities under existential threat often display the highest resilience. Prof. Adini also emphasizes the dynamic nature of resilience and the vital role government and civil society must play in nurturing it through transparency, inclusive communication, and trust-building.
A powerful and timely exploration of how a nation’s resilience can be understood, cultivated, and sustained—even in the face of profound adversity.
Monday Aug 18, 2025
Monday Aug 18, 2025
Join Bruce Rosen as he sits down with Professor Shlomo Vinker, a leading expert in family medicine, for an engaging discussion on primary care in Israel.
As a board-certified family physician, the chief medical officer at Leumit Health Services, and chair of the European Association of Family Doctors (WONCA), Professor Vinker shares his unique insights on the structure of primary care, the rise of family medicine, and the challenges faced by practitioners today.
In this conversation, Bruce and Shlomo explore:
• The role of family doctors in Israel’s healthcare system
• Why family medicine is growing in popularity among medical residents
• How the national health law ensures universal coverage
• The impact of competition between healthcare organizations
• Changes in medical training and work-life balance for new doctors
• How the war has affected primary care services, including:
o Providing medical care for displaced communities in temporary shelters
o Addressing increased psychological and psychiatric stress among patients
o Expanding telemedicine and remote consultations due to evolving needs
Looking ahead, Professor Vinker discusses key challenges in family medicine, including:
• Managing high workload and growing patient needs • Balancing face-to-face and remote care
• Addressing geographic disparities in physician distribution
Learn how Israeli primary care stands out from other countries and how family doctors are adapting to modern healthcare demands.
Monday Aug 18, 2025
Monday Aug 18, 2025
In this episode, Bruce Rosen is joined by Professor Clarfield, of Ben- Gurion University of the Negev and McGill University, for a compelling conversation about global aging and Israel’s unique role in improving geriatric care in low-income countries.
With decades of experience in the care of older persons and global health education, Prof. Clarfield shares his firsthand observations from Ethiopia, where he has collaborated with local universities to train medical staff and implement low-cost, high-impact interventions.
Drawing from moving personal stories—including a preventable stroke case in an older woman in a northern Ethiopia and a vibrant 85-year-old woman defying stereotypes—Clarfield illustrates both the challenges and resilience of older adults in sub-Saharan Africa. He explains how Israeli-led initiatives cooperating with McGill University and funded by the Royal College of Physicians and Surgeons of Canada, in partnership with Ethiopian institutions, are empowering healthcare professionals with practical tools, such as portable ultrasound devices, to improve medical care.
The conversation also explores how Israel’s own journey from a developing country not that many decades ago to a leader in medical innovation positions it as a valued and trusted partner in Africa. Through humility, cross-border cooperation, and a deep respect for local needs, Clarfield offers a blueprint for meaningful global health engagement.
Tune in for a heartening and thoughtful exploration of aging, equity, and international solidarity in healthcare.
Monday Aug 18, 2025
Monday Aug 18, 2025
In this important episode, Bruce Rosen interviews Adv. Malke Borow, the Director of the Division of Law and Policy at the Israel Medical Association.
In an era of growing antisemitism abroad and an impending physician shortage in Israel, more and more physicians are making aliya (i.e. immigrating to Israel).
Find out how the Israeli Medical Association works before, during and after this process to ease the transition, minimize bureaucracy and maximize the physician's success in his or her new surroundings.


