The time to build is always

Meeting the moment in the new year.

As we all return from hopefully a restful holiday season, I start 2026 with a nod to the seasonal. In A Christmas Carol, three spirits visit Ebeneezer Scrooge. The Ghosts of Christmas Past and Present are quite loquacious. But the third spirit—the Ghost of Christmas Future—says nothing. It shows Scrooge possibilities, a vision of his fate if he does not change his miserly ways, but it keeps its own counsel about what will ultimately be. Scrooge asks, “Are these the shadows of the things that Will be, or are they shadows of things that May be, only?” The ghost says nothing.

It is the start of a new year, and we face the same unknowability. We look to the future, wondering what 2026 holds. We try making predictions, as some years seems possible. In January 2024, for example, we could reasonably expect the year to be dominated by the American presidential election, and it was. Other years, however, events are a right hook coming out of nowhere. We thought we had some sense of the future in January 2020, then a pandemic came and knocked us off our feet. We spent the years since getting, sometimes unsteadily, back up. We learned much from the COVID moment; nothing more so, perhaps, than that the future always reserves the right to defy augury. We might do well to remember this.

I do not know what will happen in 2026. None of us does. We make educated guesses, we hope, we plan. But we cannot know. The discombobulation of the past decade, the wild swings of history, are reminders that our view is always incomplete. The Ghost of Christmas Future keeps mum.

The past, however, is a different story. It speaks to us. Last year taught us much. We learned about changing political winds; how they can blow away what seems firmly fixed in place, how they can expose vulnerabilities in movements and institutions. We learned not to take for granted the public’s trust in what we do, that trust should be tended like a garden, that when it is not, it can wither. We learned that when the public no longer listens to us they will turn to other voices which may not have the best interests of health at heart.

We learned something else, too. We learned that even in hard times, we can still build. For all the challenges this moment has posed, never in the past quarter century has our field seen more ideas, more new energy, more efforts to improve and innovate in pursuit of our mission. In 2025, many members of our public health and academic communities were concerned, at times shaken, by the disruptions of the moment. But more than that, they were busy. Busy shaping new approaches, new foundations for what we do. From the graduate student thinking about how to improve mental health in urban environments, to the community health worker partnering with local businesses to address food insecurity, to the biostatistician using AI to generate the data that inform good policy, green shoots are sprouting all around us in public health, even in the current distressed landscape. The field is full of people looking around asking, “What can I do? How can I help?” And our community of public health thinkers and doers is, bit by bit, building the future of public health.

All this happened during a year of unprecedented challenge, when it was not obvious that we—that anyone—could build in the context of so much being torn down. It is daunting to lay foundations for something new when the ground is shifting beneath our feet. We might prefer to do such work when times are stabler. There is something to be said for building what the world needs us to build when the sun is shining and the storm has not yet struck. But a lesson of the moment—perhaps the key lesson—is that such conditions are not necessary to create something great. We can lay the foundations for a healthier future now, and these foundations can be stronger for having been tested, at the outset, by adversity.

About two years ago, on a visit to Japan, I was introduced to Kintsugi, the art of repairing cracked pottery with gold lacquer. When pottery breaks—a teakettle, say—it is not discarded. Its fragments are rejoined with lacquer that makes the flaw luminous. In Kintsugi, a shattering is not the end of an object, it is the basis for its recreation into something lovelier and more interesting for bearing the marks of history. The pottery is arguably better for having broken; the breaking showed where it might have been stronger, the gold lacquer seals the lesson.

This lesson might guide all we do in 2026. Much about public health has been shattered, many weaknesses exposed. But Kintsugi teaches that this need not be the end of the story. Imperfections addressed and challenges met can be the basis for work that is stronger than ever. We can do such work in 2026. We can do this now because we did it then. Last year brought disruption. But we looked to ourselves, to our values, to what we could do. And we built. The new year is a chance to keep meeting the moment, keep delivering on a radical vision for a healthier world. Speaking for myself, I hope—in my thinking, my writing, my engaging in multiple media—to apply to 2026 the lessons of 2025, lessons I wrote about in my last essay. I would like to be better at listening and engaging with heterodox opinions, at leaning into the science that is the cornerstone of all we do, at holding fast to the core values of our field, at telling the story of health. This is what I can do—what we all can do—no matter what happens in the year ahead.

The time to build is not only when the stars align and everything seems to go our way. The time to build is always. It is right now. Thank you to all who are building a healthier world in 2026.

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Of note this week

On the latest episode of the Complicating the Narrative podcast, Dr. Salma Abdalla speaks with Professor Sabiha Essack about a One Health approach to antimicrobial resistance

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