American health is declining and its health system is fractured. Accelerated by the COVID-19 pandemic but also due to pervasive issues such as systemic racism, structural wealth inequality and poverty, deaths of despair, and the U.S.’ crumbling-to-nonexistent social infrastructure, our health will likely continue to decline without fundamental, some would say radical, change. Though evidence and models of what works to improve health exist, society continues to invest resources and attention in approaches that do not significantly improve health and well-being.

To reverse this concerning trend, health and health care leaders, as well as other stakeholders, must recognize that the incremental steps of the past several decades have not led to significant progress. The public health system continues to be underfunded, understaffed, and fragmented. The health care system continues to grow in size and financial magnitude, but despite ever-increasing resources, it does not seem capable of making investments to improve population health. This is largely because the health care system is stuck in the status quo—an ingrained “medical care” mindset exacerbated by misaligned incentives. As it stands today, the system lacks sufficient leadership and alignment to move in a different direction without additional action.

The time for incrementalism is over. Americans must act quickly and collectively to appropriately value our health and change how we conceive of health and well-being going forward and shape the conditions that promote it. The urgency that has propelled change in responding to the climate crisis must now fuel how health and health care leaders consider our nation’s health.

We do not have much time. Disruptive change is needed in who, what, and how we finance, pay for, and ultimately value health. If the slow, incremental pace of change continues, we cannot expect significant progress toward greater equity, improved life span, or quality of life. Instead, we will continue to spend more on care that only marginally impacts health while neglecting other areas with an outsized influence on our collective well-being.

However, this does not have to be our future. While the comparatively dire state of our nation’s health is due to fragmented incentives, values, and systems prioritizing the bottom line over health, the solution lies in uniting our communities, governance structures, and businesses. This movement begins with patients, families, and communities demanding that policy makers take bold, disruptive steps to prioritize individual and collective health in all policies. As all sectors implement policies, incentives, and regulations that support a system-wide transformation toward whole person, whole population health as described in Chapter 4, they will direct action and alignment toward a rapid and voluminous creation of solutions.

The transformation spurred by these incentives and policies should manifest through large volumes of new public and private capital to invest in health-producing solutions. In Chapter 4, the Steering Group proposed a set of goals to strive for by 2030, along with opportunities for action that key stakeholders can take to reverse the current trajectory and begin a movement toward whole health in the United States. By implementing these priority actions, the right incentives and the necessary conditions would be created to prompt every sector to change how they do business. Most importantly, these solutions would center health at the forefront of every decision and policy. In every sector, leaders should set ambitious health-related goals and be held accountable for striving to meet them.

While this transformation in health may sound radical or implausible, we are witnessing an example on this scale through activism on climate change. Although more progress needs to be made, the case for climate action is approaching wide acceptance as new policy and cultural norms have been established. Today, leadership is rising from sectors including retail, transportation, financing, architecture and building construction, and farming. These partnerships and actions have emerged in different forms as more organizations realize they have important roles in mitigating climate change. The same type of broad-based activism and change leadership is needed for our nation’s health. Appendix C describes a possible cascade of change starting with action from the federal government.

An activated citizenry is the key to change. Without a mass social movement that pushes leaders, organizations, and sectors at each and every level to prioritize health in every policy; radically transforms the involvement of every stakeholder in health promotion and prevention; and promotes financing and paying for health care that promotes whole health, the authors believe that the national health crisis will continue to fester. The present approach will be the same incremental steps we have seen, which have not succeeded in substantially mitigating health disparities or stopping the decline in national health.

A multi-stakeholder approach is also needed for significant change to occur. While the federal and state governments must set bold goals and align policies and incentives with whole health, action from other organizations such as social service and anchor institutions, as well as care delivery organizations and payers, is necessary to realize the vision of this Special Publication. This transformation will only happen when the government is pushed by its citizenry to act and lead boldly.

As the conditions for change emerge, the best and boldest solutions may not come from the health care and public health sectors. Because there is little incentive for health care leaders to change the status quo, it is highly unlikely that the industry alone will lead the needed changes. Leadership will likely come from community leaders, philanthropy, business leaders, investors, and change-makers within the health care industry who see the value of investing in health. Regardless, the conditions must exist for all entities to be incentivized to invest in and advance whole person and population health. As communities begin to experience the benefit of better health, the authors hope that a positive feedback cycle will result in more entities prioritizing health and doing business in new and different ways that lead to better overall health.

Investors can see the return on investment (ROI) of financing changes that lead to healthier communities and healthy returns. Private equity and venture capital are now pouring billions of dollars into health care companies—in 2018, the valuation of private equity deals for the health care sector surpassed $100 billion (Offodile et al., 2021). Investments in health care continue to be attractive precisely because the incentives for realizing a system of health care are currently so enticing. Health care is recession-resistant, many operational and outcomes gaps require potentially profitable and innovative solutions, and an aging population could lead to higher care utilization (Offodile et al., 2021). While the impact of novel technologies or care models on overall health is still largely unknown, the rapid and deep investment signals that the private sector will continue to value these investments when financial incentives and potential ROI are aligned. Many of the priority actions outlined in this publication are intended to do just that: align incentives with health rather than health care for its own sake and establish the utility of measuring ROI based on overall long-term improvement in whole person and whole population health.

Collective action, though difficult, has the potential to produce meaningful and disruptive change that will improve American health. Working together to fix this national health crisis holds enormous potential for cost savings, capital gains, and real economic growth. If the climate crisis is worth changing how we do business for the sake of future generations, so is creating the conditions for everyone and every community to experience their most healthy state. The way is clear; what is needed now is the will to move forward.