Looking back on 2025

Reflections on the challenging year that was.

As the calendar year wraps up, I would like to use this last essay of 2025 to reflect on the year we have just experienced. I would like to do this less to catalogue the year’s events and more to use this space, as I often try to do, to think in a systematic way about the world around us and what it means for how, and why, we do what we do. Events move quickly; the public debate often moves quicker still. Understanding what happens and why can be a challenge, one that calls for time and space to reflect, to think through the moment and its implications. The end of the year is such a time, and The Healthiest Goldfish aspires to be such a space, where we make an effort, together, to understand what is happening and the ideas that are driving the present moment.

So, what happened in 2025?

Fundamentally, 2025 saw an enormous shift in the political and institutional contexts through which those of us who are concerned with creating a healthier world operate. The year began with, and was in many ways defined by, this shift. A new federal administration in the US came to power feeling it had a mandate to rethink a range of structures that affect health. Globally, this entailed a pullback of the US from international bodies like the WHO and organizations like USAID. This was paralleled by America rethinking many of its old partnerships and strategic alliances, shaking up the global order.

Domestically, we have seen a sharp cutback of support for organizations like the CDC that have long help sustain health in the US. We have also seen challenges to policies, such as Medicaid, which help to create an environment in which health can thrive. Closer to home for those of us working in academia, there have been unprecedented challenges to the mission and work of universities. Taken together, these disruptions have created a climate of uncertainty around much that seemed fixed, settled, and have posed challenges for the future of health and the policies and institutions that support it.

In some respects, these shocks to the system seemed to come out of nowhere. But such developments rarely, if ever, come out of nowhere. The election of a new administration with a clear electoral mandate built on popular dissatisfaction with the way things were being done, it built on widening social and economic divides, it built on dissatisfaction with the handling of the most important crisis this country has faced in decades, the COVID crisis, it built on deep ideological rifts, many of which have direct bearing on the business of health, it built on lack of clarity about shared national values and too much clarity about persistent national divides.

This has brought us to a moment when the structures that support the creation of a healthier world have been challenged like never before in recent memory. In such a moment, there are perhaps three courses of action one can take. The first is paralysis. When faced with challenges that are significant and sudden, it is understandable to momentarily freeze, to be unsure of what to do, the right course to take. This is a perfectly human reaction.

Another very human response is to act as if nothing has happened, as if all is the same as it was before. This can make sense in the short-term but quickly becomes untenable as the reality of events asserts itself. Finally, we can do our best to achieve a clear-eyed understanding of the moment and ask: what is there to be learned here? How did we get to where we are, what are the forces driving what is happening, and how can we engage with them to make the world better? This course of action differs from the first two in that it is less intuitive, less in immediate alignment with human nature. It can be hard, with so much incoming, to find the perspective that lets us learn from difficulty while it is still ongoing. However, as Lincoln said, “we cannot escape history,” which is to say we cannot afford to do our thinking and learning in retrospect. We live in the here and now, and we have a responsibility to learn from it so we might improve it, and, in doing so, lay the foundations for a better future.

What, then, can we learn from this moment? There are, I think, four top-level lessons which are worth reflecting on as we approach the end of the year.

The first lesson is both simple and difficult: we need to be better listeners. By “we” I mean, really, everyone – everyone who thinks, who speaks, who makes policy, who participates in the public debate. But I particularly mean those of us who are in the business of creating a healthier world. For a movement for health to be, well, healthy, it needs a plurality of perspectives, it needs comfort with heterodoxy and a widespread embrace of the open-mindedness that keeps our thinking supple and responsive. Listening also helps us to understand the public’s discontent before it builds into political movements that cause the kind of disruption we are seeing. The frustrations that inform the MAGA and MAHA movements are longstanding and intersect with Americans’ frustration with the policies and institutions tasked with supporting health and the public’s declining trust in expertise generally and scientific expertise in particular. Had we done a better job of listening to these concerns, we might have blunted the momentum of the political forces that careened into us in 2025, or, at least, have been less surprised by them. Learning the lessons of this past year means, in part, learning to listen better, so we can better address the forces that drive popular discontent with our work.

The second lesson is that our job is to lean into science. This builds on the theme of listening. It has become somewhat commonplace in public health to hear some version of the complaint that we are seeing the rise of anti-science forces in politics, that their aim is simply a kind of policy vandalism, a senseless attack on expertise. On some level, this complaint has merit; anti-intellectualism is certainly a factor in what we are seeing, and much of the disruption of the moment has had a wanton, gratuitous feel to it, as good people doing good work lose their jobs and scientific progress faces significant setbacks for wholly unnecessary, partisan reasons. Yet it is important to consider where this movement came from, and that some of its grievances may have a measure of legitimacy. In recent years, particularly during COVID, public health took actions which were interpreted by many as placing values ahead of scientific data. An example of this was inconsistency in public health’s COVID guidance, which at times seemed motivated more by politics than science, informing the broader critique that public health is too ideological, that it has drifted from its roots as a scientific discipline. The critique of public health also intersects with the broader issue of the replication crisis and challenges to our methodologies and research directions. Taken together, this has informed a willingness by a critical mass of voters, policymakers, and influential voices in the media to cease to view much of mainstream science as particularly scientific at all, and, as such, to feel that measures which seem to be challenges to science are nothing of the kind. They are simply a sweeping away of an ideologically compromised group of overfunded partisans who are engaging in politics and advocacy under the guise of science. From this perspective, it is even possible to feel like the disruption of the moment actually supports science by clearing away deadwood to make room for better approaches that yield better outcomes in a context of global competition around core scientific and technological goals. This is bluntly put, but this is a moment for putting things bluntly, if we are to understand what is happening and respond constructively. Such a response starts with recognizing the importance of producing rigorous, high-quality science that reflects, first and foremost, a process of the utmost intellectual integrity. What we do in public health is fundamentally about generating the data that support the policies that create a healthier world. When this foundational work is sound, so is everything else we do. We should do all we can, then, to ensure the integrity of our science. It is true, of course, that science is not the only consideration in what we do – our work is also deeply informed by our values, our mission to create better health for all. And while we need to be in the business of promoting values, we need to ensure that the quality of our science is unimpeachable, that it cannot be said we are leading with values to the detriment of our science.

The third lesson is that we should indeed hold fast to our core values—centrally the values that say we cannot be healthy until we are all healthy and that we should not have health left-behinds. A healthier future is one where all forms of progress—technological, social, economic —coalescence behind better health for all. We should not lose sight of this vision, no matter what the moment brings. Perhaps this seems a contradiction of lesson number two, yet this is not the case. Public health, to borrow a phrase from Walt Whitman, “contains multitudes.” We can be proactive in the world, we can – must - advocate for what we believe while still leading with science, leading with rigor. This means continuing to engage in the policy space and with the media, continuing to do whatever we must to generate healthier outcomes at the local, global, and national level. It also means being creative in our partnerships, as we expand our vision of where public health can go and who it can bring into fold as we pursue solutions in the coming year. Our values are best served when we build new pathways to impact, new avenues for our science to inform the pragmatic work of building bridges to health for all. Our data should be everywhere—in the policy space, in industry, in the institutions that are leading the way towards progress in the 21st century. We have learned to think like activists and politicians—perhaps we have overlearned, our zeal to create positive change tipping our efforts into partisanship. Now we must learn to think like artists, to view the moment, in all its light and shade, as a canvass on which we might surprise ourselves with the connections we make, the syntheses we achieve, and the degree to which our vision might resonate with a skeptical, but persuadable public.

The fourth lesson is we need to get better at telling the story of health, including the many successes of public health over time. In the face of so many attacks, so much disruption, it is easy to second-guess ourselves, to go beyond good faith engagement with criticism to doubt the fundamentals of what we do and why. In such moments, we should remember who we are. We are a field that fights pandemics, cures diseases, works on behalf of the marginalized and dispossessed, and moves pragmatically towards a radical vision of a healthier world. People who might have sickened and died have not because of what we do. People whose poor health might be overlooked by the powerful are not ignored because we insist that they have dignity and the right to health, and because we strive to shape policy that reflects this. We have been doing what we do for hundreds of years. We have faced hard moments and gotten through them. Our goal—health for all—is perhaps the only truly universal aspiration. Health is more popular than any president or party, more popular than any institution or media figure. The story of health is inspiring, epic, and ongoing. We should tell it, tell it often, and tell it better. In telling it, we need to convey that it is a story in which everyone can participate, and, in participating, make a better world for ourselves, our children, and our children’s children. If we can do this, our field will be stronger, our world healthier, than ever.

I have emerged from this year feeling deeply hopeful about our capacity to build a healthier world in 2026. Yes, we face challenges. Political winds blow and there are threats to what we do that have not abated. But if we learn the lessons of the moment, if we listen, if we lean into science, if we stay true to our values, if we keep telling the story of health, then, despite everything, good will have come from this year—good we can continue to realize in 2026. And that will make for a happy new year indeed.

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Also this week:

In JAMA Health Forum:

Poor Mental Health and the Use of Buy Now, Pay Later Loans – with Hridika Shah, Emma Prus, Brian Castrucci, and Catherine Ettman.

Back to the Future of Primary Care – with Zirui Song

In Annual Review of Public Health:

“The Road from Science to Health: The Importance of Designing For, Measuring, and Communicating Impact in Public Health” – with Douglas Luke and Sara Malone

And in the Journal of Traumatic Stress:

Prevalence of posttraumatic stress disorder and major depression in Ohio, Pennsylvania, and West Virginia 9 months after the East Palestine train derailment - with Cameron Pugach, Aaron Reubern, Angie Moreland, Alex Rothbaum, John Boyle, Michael Scmidt, James Dayton, Rchel Kinder, Salma Abdalla, Mohammed Abba-Aji, and Dean Kilpatrick.

Thank you to all my good colleagues for your partnership on this work and throughout the years. I look forward to our work together in 2026.