Commission on Investment Imperatives for a Healthy Nation

Executive Summary

The activities of US health system organizations, including those operating in the health care sector, public health, and biomedical research, too often fail to align with the health goals and priorities of individuals and communities. In addition, these sectors do not effectively collaborate with each other or with other crucial sectors that influence health to strengthen alignment. Instead of being treated as active partners, individuals and communities are frequently viewed as passive recipients of health care, research, and public services, which neglects their expertise, experiences, and perspectives. Especially in the context of the revolutionary changes in personal health knowledge and control that artificial intelligence may enable, there is a clear need for new processes, structures, and cultures that support deliberative and democratic decision making. This moment presents an opportunity to better align all actions across the health sectors with the goals and priorities of the individuals and communities these sectors are meant to serve. To help inform a path forward, including the work of the Commission on Investment Imperatives for a Healthy Nation, the National Academy of Medicine (NAM) convened an expert working group to outline a shared vision and potential actions for ensuring that the goals and priorities of individuals and communities are the orienting reference points for every health sector decision and action. This critical reorientation has the potential to build trust throughout the health system.

To start, this discussion paper presents background on recent trends and the current state of individual and community engagement across US health sectors (health care, public health, and biomedical research), including engagement shortfalls and driving factors hindering progress. These interconnected drivers (see Figure 1) include the need for inclusive structures and metrics to promote meaningful engagement; a holistic definition of health that goes beyond physical disease; multidirectional trust between health sector organizations, individuals, and communities; a financial ecosystem that aligns with individual and community health goals; a well-equipped and accountable health sector workforce; and the effective use of data and evidence to inform decision making. To underscore the imperative for action, the authors share the societal costs of maintaining existing practices, including significant impacts for individual and community health and well-being, professional domains, and the broader economy.

In accordance with the working group’s charge, the authors outlined a menu of solutions and levers to guide health sectors toward authentic engagement of and accountability to individual and community health goals and priorities. The solutions described, along with the possible gains and outcomes at the individual, community, and societal levels from enacting them, include establishing a holistic perspective of health, promoting collaboration and shared decision making, investing in individual- and community driven research, and investing in a person- and community-centered workforce. These solutions are grounded in the need to adopt radical empathy through bidirectional learning and listening. Such a foundation will help promote deep understanding of the complex interplay between individual and community-level factors, cultivating a culture of accountability rooted in caring, mutual relationships while honoring any necessary procedures.

Potential stakeholders who could advance these solutions by activating these levers include the US health sectors mentioned; corresponding governing bodies; philanthropic groups that fund these sectors; and governmental, institutional, and community leaders and advocates in sectors critical to establishing vital conditions that enable individuals and communities to live healthfully. Important to consider when identifying the best solutions and levers to prioritize, adapt, and apply are the national, state, and local contexts, which will continue to evolve and shape health and well-being over time. To conclude, the authors emphasize that building the momentum for meaningful change will likely require sharing accountability structures, promoting collective action, and advancing strategic approaches to capability development. These momentum builders include a “bottom-up” approach, where local actors work together to develop solutions tailored to their unique contexts. In that regard, each individual and community member would bring their experiences, expertise, and other assets that can be leveraged in these relationships and activities to drive real-world change over time. Concurrently, momentum can also be accelerated through “top-down” policies and structural changes that enable these shifts and provide needed funding.