Fleischer: Hagel is wrong about Israel

Former Sen. Chuck Hagel was nominated by President Obama for defense secretary.

STORY HIGHLIGHTS

• In 2006, Hagel said 'the Jewish lobby intimidates a lot of people up here'


• Ari Fleischer: The support for Israel isn't because of 'intimidation,' but merit


• Polls show most Americans view Israel favorably, but don't support Iran or Palestinians


• Fleischer: Israel is a steady friend of the U.S. and a tolerant democracy

Editor's note: Ari Fleischer, a CNN contributor, was White House press secretary in the George W. Bush administration from 2001 to 2003 and is the president of Ari Fleischer Sports Communications Inc. He is a paid consultant and board member for the Republican Jewish Coalition, which opposes the Hagel nomination. Follow him on Twitter: @AriFleischer

(CNN) -- "The political reality is ... that the Jewish lobby intimidates a lot of people up here." -- Senator Chuck Hagel, 2006

As a result of those words and his voting record, former Nebraska Sen. Chuck Hagel's nomination has turned a decades-long, bipartisan confirmation process for secretary of defense into an acrimonious one.

While some leading figures such as the Anti-Defamation League's Abe Foxman and the Simon Wiesenthal Center's Rabbi Abraham Cooper say Hagel's words are borderline anti-Semitism, I'm less worried about anti-Semitism and more worried about the judgment of a potential defense secretary who thinks Israel has won support because of "intimidation," not merit.

Ari Fleischer

Israel is widely supported by the American people because Israel deserves to be supported. Israel is a lonely democratic ally and a steady friend of the United States in a dangerous and tumultuous region. Their people are like the American people -- free, independent, capitalistic and tolerant.

A Gallup poll taken last year showed 71% of the American people view Israel favorably while only 19% view the Palestinian Authority favorably and just 10% view Iran favorably.

In a Pew Research Center study last month, 50% of adults said they sympathize more with Israel in its dispute than with the Palestinians. Just 10% sympathize more with the Palestinians, while about as many (13%) volunteered that they sympathize with neither side.

Contrary to Hagel's logic, Israel doesn't enjoy widespread American support because anyone -- from any faith -- intimidated someone else; Israel earned the support of the American people because of its people's values.

Opinion: Hagel is a friend to Israel

The danger in what Hagel said is if he thinks Israel is supported on Capitol Hill because of intimidation, then it's not hard to see why Hagel is so soft in his support for our ally. He sees himself as an independent voice willing to stand up to intimidation, and he wears his anti-Israel votes as badges of honor.

But Hagel isn't independent. He's alone.

His position on Middle Eastern matters is so outside the mainstream of both parties that almost no one agrees with him.

In 2000, Hagel was one of only four senators who refused to sign a Senate letter in support of Israel.

Peter Beinart: What's behind Hagel nomination fight

The following year Hagel was one of only 11 senators who refused to sign a letter urging President George W. Bush to continue his policy of not meeting with Yasser Arafat until the Palestinian leader took steps to end the violence against Israel.

John Cornyn: Why I can't support Hagel

Contrary to America's longstanding bipartisan position, Hagel has called for direct talks with terrorist organizations Hamas and Hezbollah. In 2007, Hagel voted against labeling the Iranian Revolutionary Guard Corps, the group responsible for the death of many American servicemen in Iraq, a terrorist organization.

And in 2008, he was one of two senators on the banking committee to oppose a bill putting sanctions on Iran. One of the measure's biggest backers was an Illinois senator named Barack Obama.

I'm a New Yorker and neither of my senators -- Chuck Schumer and Kirsten Gillibrand -- supports Israel because someone muscled them into that position through intimidation. They both support Israel because the lobby that wants them to support Israel is an American lobby, made up of people from both parties and all religions and from people with no religion or political party at all.

But if Chuck Hagel believes that it's intimidation and not sound judgment that has caused his colleagues to support Israel, then Chuck Hagel should not be confirmed as our next secretary of defense.

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The opinions expressed in this commentary are solely those of Ari Fleischer.

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North Korea vows to bolster war defenses

PYONGYANG, North Korea North Korea is vowing to strengthen its war defenses amid concerns the country may conduct a third nuclear test.

Citing U.S. hostility, Pyongyang's Foreign Ministry said Monday without elaborating that the country will "continue to strengthen its deterrence against all forms of war."

A ministry memorandum carried by the Korean Central News Agency urged the U.S. to dismantle a U.N. command that oversees an armistice signed at the close of the Korean War in 1953.

North Korea claims the right to build atomic weapons to protect itself against U.S. threats. Monday's memorandum comes amid worries Pyongyang may follow a December rocket launch with a nuclear test.

Pyongyang carried out atomic tests in 2006 and 2009 weeks after being slapped with U.N. Security Council condemnation and sanctions for similar rocket launches.

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Quest: U.S. economy to dominate Davos

The United States and the sorry state of its political and budgetary process will be the center of attention at Davos, writes Quest

STORY HIGHLIGHTS

• Quest: Davos is a chance to see where the political and economic landmines are in 2013


• Quest: People will be speculating about how dysfunctional the U.S. political process has become


• Quest: Davos has been consumed by eurozone sovereign debt crises for three years

Editor's note: Watch Quest Means Business on CNN International, 1900pm GMT weekdays. Quest Means Business is presented by CNN's foremost international business correspondent Richard Quest. Follow him on Twitter.

(CNN) -- It is that time of the year, again. Come January no sooner have the Christmas trees been taken down, as the winter sales are in full vicious flood the world of business start thinking about going to the world economic forum, better known as Davos.

For the past three years Davos has been consumed by the eurozone sovereign debt crises.

As it worsened the speculation became ever more frantic.....Will Greece leave the euro? Will the eurozone even survive? Was this all just a big German trick to run Europe? More extreme, more dramatic, more nonsense.

Can China be the biggest engine of growth for the global economy. Round and round in circles we have gone on these subjects until frankly I did wonder if there was anything else to say short of it's a horrible mess!

This year there is a new bogey man. The US and in particular the sorry state of the country's political and budgetary process will, I have little doubt, be the center of attention.

Read more: More 'cliffs' to come in new Congress

Not just because Congress fluffed its big test on the fiscal cliff, but because in doing so it created many more deadlines, any one of which could be deeply unsettling to global markets... There is the $100 billion budget cutbacks postponed for two months by the recent agreement; postponed to the end of February.

At exactly the same time as the US Treasury's ability to rob Peter to pay Paul on the debt ceiling crises comes to a head.

Read more: Both Obama, GOP set for tough talks ahead

The Treasury's "debt suspension period" is an extraordinary piece of financial chicanery that if we tried it with our credit cards would get us locked up!! Then there is the expiration of the latest continuing resolution, the authority by which congress is spending money.

There is the terrifying prospect that all these budget woes will conflate into one big political fist fight as the US faces cutbacks, default or shutdown!!

I am being alarmist. Most rational people believe that the worst sting will be taken out of this tail....not before we have all been to the edge...and back. And that is what Davos will have on its mind.

People will be speculating about how dysfunctional the US political process has become and is it broken beyond repair (if they are not asking that then they should be...)

They will be pondering which is more serious for risk...the US budget and debt crises or the Eurozone sovereign debt debacle. A classic case of between the devil and the deep blue sea.

The official topic this year is Resilient Dynamism. I have absolutely no idea what this means. None whatsoever. It is another of WEF's ersatz themes dreamt up to stimulate debate in what Martin Sorrell has beautifully terms "davosian language" In short everyone interprets it as they will.

What I will enjoy, as I do every year, is the chance to hear the global players speak and the brightest and best thinkers give us their take on the global problems the atmosphere becomes febrile as the rock-stars of finance and economics give speeches, talk on panels and give insight.

Of course comes of these musings, it never does at Davos. That's not the point. This is a chance to take stock and see where the political and economic landmines are in 2013. I like to think of Davos as the equivalent of Control/Alt/Delete. It allows us to reboot.

We leave at least having an idea of where people stand on the big issues provided you can see through the panegyrics of self congratulatory back slapping that always takes place whenever you get like minded people in one place... And this year, I predict the big issue being discussed in coffee bars, salons and fondue houses will be the United States and its budgetary woes.

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China economy to rebound in 2013: survey

BEIJING: China's economy is poised finally to end a long downward trend in 2013, economists polled by AFP say, as the new communist leadership vows to retool the nation's investment-led development model and promote a "happy life" for all.

The world's second-largest economy is not expected to return to double-digit growth, but the economists' predictions are a welcome spot of good news in a financial world assailed by the eurozone debt crisis and lacklustre recovery in the United States.

After seven consecutive quarters of slowing growth, China's gross domestic product (GDP) will rise by 8.0 per cent in 2013, according to the median forecast of 15 economists surveyed by AFP. The poll also projected 7.7 per cent growth for 2012.

The figures would outpace the government's 7.5 per cent growth target for 2012 -- but are well below the 9.3 per cent recorded in 2011 and 10.4 per cent in 2010.

Maintaining growth is all-important for China's communist leaders, who derive much of their claims to legitimacy from the country's reform-led economic rise, which has lifted hundreds of millions of people out of poverty over the past three decades.

The rebound comes as China formally wraps up a once-in-a-decade leadership change in March when Xi Jinping, who was named Communist Party chief in November, takes over as president and Li Keqiang becomes premier in charge of day-to-day administration.

Xi, in his first public appearance after being chosen to lead the party, said China's citizens "want their children to have sound growth, have good jobs and lead a more enjoyable life. To meet their desire for a happy life is our mission."

China's stunning economic transformation has long been fuelled by heavy state investment in railways, airports, bridges and buildings, as well as an emphasis on manufacturing and exports.

But it is now trying to promote demand from its own increasingly well-off consumers as the economy's main driver. And the Communist Party says it recognises the need to encompass the have-nots who have failed to share in the boom as a rich-poor gap opens up.

The National Bureau of Statistics is due to announce GDP figures for the fourth quarter and the whole of 2012 on Friday.

For the final quarter of last year, the median forecast in the AFP survey was 7.8 per cent, up from official third-quarter growth of 7.4 per cent -- which was the lowest figure since early 2009.

"The new leaders themselves would like economic growth to not be slower than 2012... in their first year," Chen Xingdong, a Beijing-based economist with French bank BNP Paribas who is expecting 2013 growth of 8.3 per cent, told AFP.

Stronger monthly data during the fourth quarter, including industrial output and retail sales, has fanned optimism the worst is over, as did new single-month highs for imports and exports in December.

But the economy still faces challenges such as unresolved structural problems including overcapacity and reliance on investment-driven growth, said Yao Wei, Hong Kong-based economist with Societe Generale.

"We can't get over-optimistic over the current recovery," she said.

China's economy averaged GDP growth of 10 per cent in the decade to 2010. A slower rate of 7.0-8.0 per cent is seen by economists as part of China's natural economic evolution as spending on projects such as transport and utility networks is reined in.

But market optimism over China's prospects risks being disappointed if in 2013 "the recovery remains centred on infrastructure and real-estate investment rather than consumption", wrote Mark Williams, chief Asia economist at Capital Economics.

Some also question how serious the government is about reforming the economy, as well as other challenges it has vowed to pursue, including cracking down on corruption.

"The current difficulty we have with the policymakers is that the focus is on changing the perception and hoping that the people believe," said Andy Xie, a Shanghai-based independent economist.

"It shows that real change is very hard to do. So you shift to the propaganda department to see if they can do the job."

- AFP/ck

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Making job stress worth enduring

Defense Secretary Leon Panetta swears in reenlisting troops in Turkey. A survey found that military jobs tend to be the most stressful.

STORY HIGHLIGHTS

• Marci Alboher: Annual list of most stressful jobs drew attention


• She says the right issue is whether job rewards compensate for stress


• People who take on stressful jobs that help others report satisfaction, she says

Editor's note: Marci Alboher, is a Vice President of Encore.org, a nonprofit making it easier for people to pursue second acts for the greater good. Her latest book is, "The Encore Career Handbook: How to Make a Difference and a Living in the Second Half of Life" (Workman: January 2013).

(CNN) -- A recent study with a catchy headline about the most stressful jobs of 2013 found its way to the soft hour of news this week.

The annual study by careercast.com created some buzz in the online water cooler and I was asked to appear on the "Today" show to talk about it. Colleagues e-mailed me and posted on my Facebook page about where their chosen professions ranked. My media friends couldn't help noticing that public relations professionals, reporters and photojournalists all made it into the top 10 for stress.

The "study," referred to in quotes in some of the commentary, considered some logical criteria to come up with these rankings. Proximity to risk of death (yours or others'), travel, deadlines, working in the public eye and physical demands all racked up points on the stress scale. And there's no arguing that military personnel, firefighters and police officers -- all high-rankers on the most-stressed list -- are exposed to higher stakes than your typical seamstress (holder of the second-least stressful job slot).

Marci Alboher

The job that snagged the "least stressful" slot, according to the survey, was "university professor," a designation that caused outrage among people who actually hold that job. One commenter conceded that most academic jobs don't put you in personal danger (though you can argue that point), but anyone who's ever been around professors knows that faculty politics, difficult students and pressure to "publish or perish" can cause even the most calm character to crack.

We could debate whether these designations make any sense. And whether every police officer, firefighter and member of the military faces the same amount of stress.

But let's make sure we are having the right conversation. How many people choose a profession based on how high the stress level is? And how can you measure stress objectively? If you're prone to stress, perhaps you're just as likely to feel stressed out whether you work as a librarian, a massage therapist or a commercial airline pilot (No. 4 on the stress list).

People choose their line of work for a lot of reasons. For those who are committed to making our communities and the world safer and healthier for the rest of us, minimizing stress is probably not so high on their list of criteria. And it shouldn't be. Folks who choose helping jobs that may have a high level of stress are fueled by other motivators, like wanting their work to have meaning.

They aren't deterred by the fact that their job will likely come with stress. And some people are simply by their own nature and personalities drawn to work that may be to others, dauntingly stressful. How many FBI agents do you think would prefer a gig as an audiologist (sixth-least stressful job)?

When I talk to men and women in their 50s and 60s who've decided to take on encore careers as teachers, they tell me that the work is often exhausting and stressful. They are on their feet all day, often with inadequate resources, with kids who are themselves highly stressed; even those who come from leadership roles in other sectors say they've never worked harder. Yet they almost always tell me that doing something that matters to others -- and that puts them in touch with young people every day -- compensates for the added stress.

The same is true of those tackling some of the world's most intractable problems. When I talk to Stephen and Elizabeth Alderman, whose foundation trains health-care professionals around the world to work with victims of trauma, or Judith Broder, who founded The Soldiers Project, which works with returning veterans, they rarely talk about stress. Instead they talk about how they are compelled to do what they do, because moving the needle even a fraction is better than doing nothing.

Rather than discouraging people to take on jobs that might have a lot of stress, let's instead encourage those who are designed for those jobs to do them. And let's make sure to support our friends and family members who go down these paths.

It's hard to grab headlines in the crowded space of morning television, but a good survey with a catchy title will always do that. So let's use these kinds of surveys to have the right kinds of conversations. Like why so many jobs that keep us safe and healthy, and that care for our children and the environment rarely show up on lists of the most highly compensated jobs. Now there's a conversation I'd most like to be having.

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The opinions expressed in this commentary are solely those of Marci Alboher.

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Kaepernick delivers, 49ers beat Packers 45-31

San Francisco 49ers quarterback Colin Kaepernick (7) runs for a 56-yard touchdown against the Green Bay Packers during the third quarter of an NFC divisional playoff NFL football game in San Francisco, Saturday, Jan. 12, 2013. / AP Photo/Marcio Jose Sanchez

SAN FRANCISCO Colin Kaepernick ran for a quarterback playoff record 181 yards and two touchdowns and threw two scoring passes to Michael Crabtree in leading the San Francisco 49ers back to the NFC championship game with a 45-31 victory against the Green Bay Packers on Saturday night.

Playoff first-timer Kaepernick outshined reigning NFL MVP Aaron Rodgers, who never got in sync for the Packers (12-6) in finishing 26 of 39 for 257 yards with two touchdowns.

Kaepernick ran for scores of 20 and 56 yards on the way to topping the rushing mark of 119 yards held by Michael Vick. Crabtree caught TD passes of 12 and 20 yards in the second quarter and wound up with nine receptions and 119 yards for the Niners (12-4-1) in the NFC divisional matchup.

San Francisco had 579 total yards, 323 on the ground.

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Poisoned Lottery Winner's Kin Were Suspicious

Urooj Khan had just brought home his $425,000 lottery check when he unexpectedly died the following day. Now, certain members of Khan's family are speaking publicly about the mystery -- and his nephew told ABC News they knew something was not right.

"He was a healthy guy, you know?" said the nephew, Minhaj Khan. "He worked so hard. He was always going about his business and, the thing is: After he won the lottery and the next day later he passes away -- it's awkward. It raises some eyebrows."

The medical examiner initially ruled Urooj Khan, 46, an immigrant from India who owned dry-cleaning businesses in Chicago, died July 20, 2012, of natural causes. But after a family member demanded more tests, authorities in November found a lethal amount of cyanide in his blood, turning the case into a homicide investigation.

"When we found out there was cyanide in his blood after the extensive toxicology reports, we had to believe that ... somebody had to kill him," Minhaj Khan said. "It had to happen, because where can you get cyanide?"

In Photos: Biggest Lotto Jackpot Winners

Authorities could be one step closer to learning what happened to Urooj Khan. A judge Friday approved an order to exhume his body at Rosehill Cemetery in Chicago as early as Thursday to perform further tests.

Lottery Winner Murdered: Widow Questioned By Police Watch Video

Moments after the court hearing, Urooj Khan's sister, Meraj Khan, remembered her brother as the kind of person who would've shared his jackpot with anyone. Speaking at the Cook County Courthouse, she hoped the exhumation would help the investigation.

"It's very hard because I wanted my brother to rest in peace, but then we have to have justice served," she said, according to ABC News station WLS in Chicago. "So if that's what it takes for him to bring justice and peace, then that's what needs to be done."

Khan reportedly did not have a will. With the investigation moving forward, his family is waging a legal fight against his widow, Shabana Ansari, 32, over more than $1 million, including Urooj Khan's lottery winnings, as well as his business and real estate holdings.

Khan's brother filed a petition Wednesday to a judge asking Citibank to release information about Khan's assets to "ultimately ensure" that [Khan's] minor daughter from a prior marriage "receives her proper share."

Ansari may have tried to cash the jackpot check after Khan's death, according to court documents, which also showed Urooj Khan's family is questioning if the couple was ever even legally married.

Ansari, Urooj Khan's second wife, who still works at the couple's dry cleaning business, has insisted they were married legally.

She has told reporters the night before her husband died, she cooked a traditional Indian meal for him and their family, including Khan's daughter and Ansari's father. Not feeling well, Khan retired early, Ansari told the Chicago Sun-Times, falling asleep in a chair, waking up in agony, then collapsing in the middle of the night. She said she called 911.

"It has been an incredibly hard time," she told ABC News earlier this week. "We went from being the happiest the day we got the check. It was the best sleep I've had. And then the next day, everything was gone.

"I am cooperating with the investigation," Ansari told ABC News. "I want the truth to come out."

Ansari has not been named a suspect, but her attorney, Steven Kozicki, said investigators did question her for more than four hours.

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Saudi execution: Brutal and illegal?

STORY HIGHLIGHTS

• Saudi authorities beheaded Rizana Nafeek, a Sri Lankan woman


• She was convicted of killing a baby of the family employing her as a housemaid


• This was despite Nafeek's claims that the baby died in a choking accident


• Becker says her fate "should spotlight the precarious existence of domestic workers"

Jo Becker is the Children's Rights Advocacy Director for Human Rights Watch and author of 'Campaigning for Justice: Human Rights Advocacy in Practice.' Follow Jo Becker on Twitter.

(CNN) -- Rizana Nafeek was a child herself -- 17 years old, according to her birth certificate -- when a four-month-old baby died in her care in Saudi Arabia. She had migrated from Sri Lanka only weeks earlier to be a domestic worker for a Saudi family.

Although Rizana said the baby died in a choking accident, Saudi courts convicted her of murder and sentenced her to death. On Wednesday, the Saudi government carried out the sentence in a gruesome fashion, by beheading Rizana.

Jo Becker

Read more: Outrage over beheading of Sri Lankan woman by Saudi Arabia

Rizana's case was rife with problems from the beginning. A recruitment agency in Sri Lanka knew she was legally too young to migrate, but she had falsified papers to say she was 23. After the baby died, Rizana gave a confession that she said was made under duress -- she later retracted it. She had no lawyer to defend her until after she was sentenced to death and no competent interpreter during her trial. Her sentence violated international law, which prohibits the death penalty for crimes committed before age 18.

Rizana's fate should arouse international outrage. But it should also spotlight the precarious existence of other domestic workers. At least 1.5 million work in Saudi Arabia alone and more than 50 million -- mainly women and girls -- are employed worldwide according to the International Labour Organization (ILO).

Read more: Indonesian maid escapes execution in Saudi Arabia

Again according to the ILO, the number of domestic workers worldwide has grown by more than 50% since the mid-1990s. Many, like Rizana, seek employment in foreign countries where they may be unfamiliar with the language and legal system and have few rights.

When Rizana traveled to Saudi Arabia, for example, she may not have known that many Saudi employers confiscate domestic workers' passports and confine them inside their home, cutting them off from the outside world and sources of help.

It is unlikely that anyone ever told her about Saudi Arabia's flawed criminal justice system or that while many domestic workers find kind employers who treat them well, others are forced to work for months or even years without pay and subjected to physical or sexual abuse.

Passport photo of Rizana Nafeek

Read more: Saudi woman beheaded for 'witchcraft and sorcery'

Conditions for migrant domestic workers in Saudi Arabia are among some of the worst, but domestic workers in other countries rarely enjoy the same rights as other workers. In a new report this week, the International Labour Organization says that nearly 30% of the world's domestic workers are completely excluded from national labor laws. They typically earn only 40% of the average wage of other workers. Forty-five percent aren't even entitled by law to a weekly day off.

Last year, I interviewed young girls in Morocco who worked 12 hours a day, 7 days a week for a fraction of the minimum wage. One girl began working at age 12 and told me: "I don't mind working, but to be beaten and not to have enough food, this is the hardest part."

Many governments have finally begun to recognize the risks and exploitation domestic workers face. During 2012, dozens of countries took action to strengthen protections for domestic workers. Thailand, and Singapore approved measures to give domestic workers a weekly day off, while Venezuela and the Philippines adopted broad laws for domestic workers ensuring a minimum wage, paid holidays, and limits to their working hours. Brazil is amending its constitution to state that domestic workers have all the same rights as other workers. Bahrain codified access to mediation of labor disputes.

Read more: Convicted killer beheaded, put on display in Saudi Arabia

Perhaps most significantly, eight countries acted in 2012 to ratify -- and therefore be legally bound by -- the Domestic Workers Convention, with more poised to follow suit this year. The convention is a groundbreaking treaty adopted in 2011 to guarantee domestic workers the same protections available to other workers, including weekly days off, effective complaints procedures and protection from violence.

The Convention also has specific protections for domestic workers under the age of 18 and provisions for regulating and monitoring recruitment agencies. All governments should ratify the convention.

Many reforms are needed to prevent another tragic case like that of Rizana Nafeek. The obvious one is for Saudi Arabia to stop its use of the death penalty and end its outlier status as one of only three countries worldwide to execute people for crimes committed while a child.

Labor reforms are also critically important. They may have prevented the recruitment of a 17 year old for migration abroad in the first place. And they can protect millions of other domestic workers who labor with precariously few guarantees for their safety and rights.

Read more: Malala, others on front lines in fight for women

The opinions expressed in this commentary are solely those of Jo Becker.

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Basketball: Lakers' Bryant and wife Vanessa reconcile

LOS ANGELES: Los Angeles Lakers superstar Kobe Bryant and his wife, Vanessa, confirmed they have reconciled in posts on social media.

Vanessa Bryant, who had filed for divorce from the NBA star in December of 2011, posted a message on Instagram, and Bryant said on his Facebook page that the couple were back together.

"We are pleased to announce that we have reconciled," Vanessa Bryant wrote. "Our divorce action will be dismissed. We are looking forward to our future together. Kobe & Vanessa."

"I am happy to say that Vanessa and I are moving on with our lives together as a family," Bryant posted on Facebook. "When the show ends and the music stops, the journey is made beautiful by having that someone to share it with.

"Thank you all for your support and prayers!" Bryant added.

The Bryants married in 2000. Vanessa stood by her husband after he was charged with sexually assaulting a Colorado woman in 2003, charges that were eventually dropped.

Vanessa Bryant filed papers in Orange County Superior Court in Santa Ana, California, in December of 2011 citing "irreconcilable differences" as the reason for seeking a divorce.

However, the two continued to work together for various charitable causes and the celebrity website TMZ reported last June that they were working towards a reconciliation.

They have two daughters, nine-year-old Natalia and six-year-old Gianna.

- AFP/al

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Why death comes sooner in America

A report finds that Americans have "shorter lives and poorer health," coming in last in key areas behind 16 other rich nations

STORY HIGHLIGHTS

• Aaron Carroll: New study shows U.S. health and lifespan worst of 17 rich countries


• He says it's because of personal choices, systemic woes. Poverty high, health care uneven


• He says this particularly affects youth, plagued by sickness, violence, high mortality


• Carroll: Don't make it political. The richest country in the world must improve public health

Editor's note: Dr. Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- A just-released report from the Institute of Medicine and National Research Council is making news by clearly illustrating that Americans have "shorter lives and poorer health." This is somewhat shocking, given how much we spend on health care each year — more than any of the 16 other rich countries surveyed in the study. What's even more upsetting is that this report focused quite heavily on people who are young. In the United States, even that group fared poorly.

Aaron Carroll

Why is this?

Some of the reasons involve choices make at a personal level. We eat too much, abuse drugs too often, wear seat belts too rarely and commit violence against each other to often.

Systemic issues are also to blame. We have higher levels of poverty than comparable countries, and our safety net programs are less capable of catching people when they fall. And too many also have too much trouble accessing the health care system, resulting in inefficient, ineffective and often absent care.

It's far too easy to let these dreadful statistics become obscured in a politically charged argument. Let's avoid that. This report is so stark that it's going to take a concerted effort on the part of the government, the media, the health care system and everyday citizens to turn things around. Our personal choices are bad. Our safety nets are bad. Our health care system is bad. It's all bad. How bad?

When compared with peer countries, the United States was the absolute worst with respect to still births, infant mortality and low birth weight. Some have tried to blame this on "coding" differences. In other words, they will claim that other countries will refuse to define a premature birth as we do, resulting in artificially high numbers in the United States. But when this report recalculated the rates to exclude such births equally in all countries, we still ranked last.

Things don't get better after birth. The chance that a child in the United States will die before age 5 is higher than in any of the other 16 peer countries. Injuries are the most common cause of death, but the United States also has the highest rate of deaths caused by negligence or abuse.

And violence is decidedly an American problem. Homicide is the third most common cause of death in children age 1-4.

From age 5-19, the trend continues. Kids this age in the United States have the worst health ranking of the 17 studied countries. More than one-third of U.S. children age 5-17 are obese or overweight, the highest of any peer country. The adolescent pregnancy rate in the United States is about 3.5 times the average of others. Additionally, the rates of sexually transmitted infections, including syphilis, gonorrhea and chlamydia are the worst compared to peer countries.

Nor are these children exempt from death. Injury deaths are more common in 15- to 19-year-olds in the United States than in any other studied country. Homicide claims the second highest number of lives in 15- to -24-year-olds, and 4 in 5 of those deaths involve guns. Males between the ages of 15 and 19 are five times as likely to die from violence in the United States than in other countries.

Even as young adults, ages 25-34, mortality remains consistently upsetting and preventable. Unintentional injuries remain the No. 1 cause of death. The risk of dying by violence remains seven times higher for males in the United States ages 20-24 than in other countries.

We have to work together to make these numbers better. Some of them can be improved with public health measures. We need to help Americans be less obese, to have fewer accidents and to commit less violence. There are lots of local studies and initiatives that propose ways to fix these things, but our public health system is woefully underfunded, and translating any promising findings to meaningful societal change poses a huge challenge.

We also need to improve our safety nets to help children at the lowest end of the socioeconomic ladder do better, even before they are born. Pregnant women, babies and children suffer from hunger and malnutrition far too often in the richest country in the world. Yet we still debate the merits of the federally funded WIC (Womens, Infants and Children) program, school lunches and food assistance to needy families.

Finally, we need to find a way to improve access to the health care system. The Medicaid program covers one in every three births and one in every three children in the United States, and it's still not enough. As some states balk at expanding Medicaid to cover many of the poorest uninsured, some are still talking about reducing funding to the already stretched program. There's no question that we have the capability, the knowledge and the resources to care for people. It's just a matter of doing it better.

There will be some who deny these results. Others will try to use them for political gain. That would be a mistake. We have to accept these findings and begin to work holistically to improve them. Being last just isn't the American way.

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The opinions expressed in this commentary are solely those of Aaron Carroll.

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