Challenging health in 2025, part 2 of 2

On seizing opportunities to shape a healthier world in the new year.

In last week’s essay, I suggested four trends that likely will play an outsized role in health in the coming year: the need for new ideas in health, the rise of new approaches in how we engage with health and the forces that shape it, the creation of new systems that generate health, and the work of improving public health’s relevance. In that essay, I stressed that these trends and ideas long predated this moment, representing major shifts in our engagement with health. They are structural factors in what we do, currents that already are playing a significant role in health and how we work, collectively, to support it. The essay was, in a sense, countercultural to this moment in that it did not engage with the upcoming presidential transition. Certainly, the incoming Trump administration matters for health, but had Vice President Harris won the election, I still likely would have written much the same essay, in an effort to address these longstanding trends and issues in health. This aligns with the aspiration of these essays to, at times, pull back from the daily developments of politics and culture, the current events that shape the news cycle, to engage with what is driving events at the most fundamental level.

Having identified trends in last week’s essay, I would like today to discuss how we can tackle these trends in 2025. How do we challenge ourselves to intersect with emerging trends in the pursuit of a healthier world? It can feel, at times, like large-scale trends just happen to us, with little we can do to meaningfully affect them. However, I would like to suggest that we challenge ourselves to do more, that we can engage with trends to build a healthier world in 2025 and beyond. Toward this aspiration, I would like to suggest four challenges to health in this moment, inspired by four strategies that have guided our efforts at WashU as we have begun the work of building a great school of public health in St. Louis.

First, we will be well served if we listen to a diverse range of voices, with the understanding that good ideas can come from unexpected places. I contend that we can all do this in our environments. At WashU we are working to build a community of exceptional faculty and staff who bring to the table many perspectives, opinions, and forms of expertise, toward shaping an academic community that can generate the ideas that support a healthy world in this moment. Creating such a world aligns with the need for new ideas in health that I discussed in last week’s essay. This means engaging with ideas with which we agree and ideas with which we may not agree. In this polarized time, there is a temptation to surround ourselves with people who think like we do, to avoid the discomfort and occasional conflict that can come with reaching out to those with whom we disagree. But just as an academic community is ill-served by a culture of intellectual homogeneity, a movement for health also needs many ideas and perspectives for it to remain vital and capable of making an impact. It is also important to maintain a critical posture toward all ideas, even when they are embraced by those on our “side,” with the understanding that bad ideas can come from those with whom we agree, just as good ideas can come from those with whom we disagree. We should be able to listen to ideas from a diverse range of voices, to engage without fear or favor, stepping outside the bubble of groupthink to make up our own minds. Such engagement is at the core of excellence in the academic tradition, and it is core to a healthy life of the mind for our field, which we will need to maintain in what is likely to be a complex, next several years.

Second, we need to keep the mission of health front and center in our work, to ensure that all we do will have a meaningful impact. Aiming to walk the walk, in my current environment we are pursuing this goal by building a community that nurtures outstanding teachers and students through scholarship and teaching grounded in the fundamental principles of public health. Health is a product of the world around us. Politics, culture, technology, the economy, the environment — such forces are at the heart of whether we are able to live healthy lives in the 21^st century. Just as public health thinking and teaching should reflect a central concern with these forces, the broader work of public health should keep them front and center. In 2025, there will be much to distract us from what matters most for health. This makes it all the more important that we keep the mission of health at the core of all we do, to ensure that every step we take will make a meaningful difference. At the same time, as we remain grounded in these fundamentals, we also should be working with an eye toward new approaches to our engagement with the mission of health, including the challenges and opportunities presented by the rise of tech and data, as discussed last week. In academia, this requires us to continually improve how we transmit knowledge to students, to broaden the accessibility of our educational offerings through digital learning, and to update our curriculum to ensure it is both rooted in fundamentals and responsive to the changes of the moment, so that the next generation of health professionals has the tools they need to advance the mission of public health.

Third, can we finally move beyond the narrow view of health as an end in itself to see health as a means to an end? As I have written many times in The Healthiest Goldfish, health is a means to the end of living a rich, full life. It is important that in all we do in health — from our teaching, to our activism, to our engagement with the media — we keep in view what matters most, what health is for. Within public health, we are sometimes liable to “miss the forest for the trees,” to pursue a vision of health for its own sake, shaking a disapproving finger at what some people choose to do with the freedom health provides. We need to become better at accepting that the freedom afforded by health includes the freedom to make, at times, unhealthy choices. A healthy person can engage in many activities, from skydiving, to taking unpopular political positions, to enjoying the occasional glass of wine. We need to learn to be OK with this, and we still have a good deal of learning to do. 2025 presents a wide canvas of opportunity to embrace this vision of health. The first step is recognizing that the process of creating health should be just as inclusive as the range of activities that health enables. We build a healthier world by working across sectors, leveraging partnerships in government, academia, health care, tech, and the broader corporate world toward our common goal of a healthier future for ourselves, our children, and our children’s children. At WashU, we are pursuing this vision of interdisciplinarity through what we are calling Public Health Plus, a commitment to building partnerships across schools and academic fields toward our shared goal of excellence in all we do. Such an approach reflects a vision of health that includes everything that goes into health and everything that health enables — an expansive vision of health for this moment. This vision also includes the creation of new systems for health. As I discussed in last week’s essay, established public health institutions have, at times, stumbled in their engagement with the challenges of the moment. As we work to shore up these institutions, we also should be working to develop new models for public health action, building pipelines to generate knowledge and apply that knowledge to the world of policymaking, as a means of addressing health at all levels and in all moments.

Fourth, can we marry the role of health care and the work of health, accepting that the whole world around us matters for health while recognizing the immense contributions of health care? Core to the work of health is our commitment to making a local and global impact, and health care and medicine have played a key role in doing so. Vaccines, better treatments, more efficient health systems, these are central to the progress we have made on health. But health is about more than health care. It is about building a world that generates health at the local, global, and national level. This starts in our own backyards, in the work of making our neighborhoods, towns, and cities healthier. It means engaging with the national debate to ensure we are focused on the issues that are fundamentally driving health in the 21^st century. And it means working with an eye toward global trends like climate change, urbanization, and population aging so we can advance health in a world where these realities play an increasing role in the lives of billions. If we can do this, we can shape a healthier world indeed. At WashU, we are aiming to engage with this work by building a community that is focused on local and global impact, both in our city of St. Louis and in the wider world. In the coming months, we will be hosting a series of conversations where we will welcome speakers to discuss ideas of consequence for health and pathways to impact. Recognizing that the world around us matters for health means opening our arms to the world, learning from everyone, taking the best ideas and running with them, toward our goal of better health for all.

These are modest suggestions about how we can challenge ourselves to engage with the trends we are seeing, to create a healthier future in 2025. Thank you to all who are helping to build this future, toward channeling the currents of the moment into the makings of a healthier world. I look forward to continuing the conversation about how we can do so in the weeks and months to come.