What is next for health in 2025, part 1 of 2

On the trends and ideas that will shape health in the coming year.

This is the first Healthiest Goldfish essay of 2025. I hope all the readers of this newsletter had a happy, restorative holiday season with family and friends. For my part, I spent much of the season moving with my family from Boston to St. Louis, to join the new School of Public Health at Washington University. It is an exciting time, one of transition, of engaging with the possibilities of the moment and looking ahead to the future. Thank you to the many who have participated in this process—those at WashU, those in the wider world of public health, and you, the reader of The Healthiest Goldfish. It takes the proverbial village to build a healthier world, and, in this time of change, it is just such a village that we are building around the ideas that generate better health for all.

The start of a new year is a time for looking ahead, for thinking about the challenges and opportunities of the moment and how they might shape the next twelve months and beyond. In today’s essay, I would like to reflect a bit on what is next for health in 2025. What are the key trends that will likely define the pursuit of healthier populations in the coming year? What should our priorities be as we aspire to do the most good in this moment? We are in a time of social and political churn, with a range of influential forces shaping the present and, potentially, the future. However, it seems to me that the following four trends will be of special salience to health in the coming year, reflecting the ongoing work of shaping a forward-looking vision for health and suggesting our engagement with these forces should be at the heart of our collective priorities.

First is the need for new ideas in health. This need is in large part a legacy of COVID, when we saw many established ideas that had long supported the work of public health fall short under the pressure of the moment. I have often said that the pandemic was, in many ways, public health’s finest hour. Together, we worked to support health in a difficult moment, providing data to inform policy, and working to lend clarity to a difficult, evolving situation. Yet we also made mistakes. We did not always do a good job of balancing tradeoffs in our policy approach. We were swayed by biases, which caused us to sometimes overlook the harm our favored policies could do to populations that were less able to weather extended lockdowns. We were often unwilling to engage with good faith criticism of what many in the field were doing. These mistakes were, in part, a reflection of the moment itself, as we did our best, as fallible humans, to address an unprecedented, historic challenge. But to the extent that they represent ways in which we may indeed have fallen short by drifting away from our liberal roots and embracing approaches that did not always reflect our better angels, we should be willing to reckon with where we went wrong, towards correcting course. New ideas, new methodologies, and a renewed focus on addressing the inequities that drive health gaps can help us to revitalize our pursuit of health in the new year.

Second is the rise of new approaches in how we engage with health and the forces that shape it. Centrally, this means coming to grips with changes in technology and the ongoing rise of data in many aspects of life and our pursuit of health. 2022 saw the launch of ChatGPT, a generative artificial intelligence chatbot. Its arrival announced that AI had progressed to a point where its presence would become increasingly part of our daily lives. Since then, AI has indeed become more central to how we live and work and how we think about the future of technology. At the same time, we have seen the evolution of older, but still comparatively new, technologies like the internet and social media, and we have continued to reckon with their implications for how we live and work. Podcasts and independent platforms like Substack have disrupted traditional media and reshaped how news and information are consumed. Digital education has become increasingly central to how students learn. Telehealth has, in the years since the pandemic, become an even more important part of care delivery. These changes are happening quickly, and seem to be accelerating, with the potential to do much that is good and much that could be destabilizing. Our work in 2025 will be, in part, the work of leveraging tech towards approaches that are good for health. As technology evolves in new and unpredictable ways, it is on us to channel these currents into better health policy, better health curricula, better communication around health, and a future-oriented vision that embraces new technology while mitigating some of the challenges it can present.

This includes continuing to update and refine our engagement with data. New technologies have made it possible to generate vast quantities of information. We now know more about more than ever before. Where it was once possible, for example, for an online store to know how often we visit its website, it now can guess from a visitor’s shopping habits everything from her tastes to whether she may be pregnant. The rise of AI, the consolidation of online services within large companies like Google, the digitization of health records, the data-collection of social media apps, and public health’s increased engagement with population-level data of all kinds has made data a powerful force in this moment, and has made questions of how to use data ethically and in support of the public good of central concern. I have been privileged to engage with these questions with colleagues at the 3-D Commission, which has looked at how we can use data to deepen our understanding of the social determinants of health. Such questions will only grow more salient in 2025, as we continue to reckon with the role of data in our pursuit of health and in our world more broadly.

Third is the creation of new systems that generate health. Public health has long depended on certain key institutions, organizations, systems, and bureaucracies which have done, and continue to do, much essential work in pursuit of a healthier world. However, in recent years we have seen how these systems and institutions can stumble in moments of crisis, sometimes falling short of the nimbleness necessary to generate data to advise policymakers in contexts of uncertainty and to modify recommendations accordingly when the data change. This reflects the need for creating new pathways to impact, where we can generate knowledge quickly and accurately and then translate that knowledge into actionable advice for policymakers. We have also seen how the reputations of public health institutions can be fragile and how, when they lose trust, public health as a whole can suffer. This suggests the importance of exploring new modes of public health organization which can work both outside of and in concert with the institutions that have long led our field. It is worth asking: Is there room for more state and community-based interventions that would put us closer to the populations with whom we engage? Have we come to over-rely on top-down approaches which concentrate energy and resources within entrenched institutions and bureaucracies? Are there ways we can restructure how some of these institutions operate, towards creating new models of public health functioning that are fully responsive to the needs of the moment? Engaging with these questions can help ensure public health remains robust as we move into 2025.

Fourth is the work of improving public health’s relevance and supporting its engagement with the moment. This means improving how we communicate with the public to rebuild the trust lost during the pandemic. In recent years, the public’s trust in science significantly declined. We have felt the effects of this in public health. We went into the pandemic broadly trusted as a nonpartisan, data-based enterprise, listened to by people on many sides of the political spectrum. We emerged from the pandemic with many on the right side of the political divide tuning us out, to the detriment of our work. The reasons for this are many—they include some of the policies for which we advocated as well as the words and tone we used in some of our public statements. I have written before about how moral clarity in our communications can tip into moral grandstanding, and how we should avoid messaging that leans too heavily on a spirit of “thou shalt not.” We have also seen, most recently in the 2024 election, how the language of progressive movements can, in an effort to be inclusive, have the effect of actually alienating much of the public. By embracing this language, we have been able to change much about progressive political and social movements, but the words and symbols we have used have, perhaps paradoxically, limited our ability to change the world, threatening our wider relevance. This challenge will not go away in 2025, and we need to fully reckon with our failures to communicate if we are to create a movement that is capable of building a healthier future for all.

It is worth noting perhaps, at this time of presidential transition in the US, that I have not mentioned the incoming Trump administration in this essay. This is not because I do not think the next administration will have enormous implications for health—I do. But the trends I have mentioned predated the election result and represent real shifts that are happening in health which will likely continue long after a given president leaves office. It is important to attend to the urgencies of the moment, and the next administration will likely supply many. But it is also important to keep an eye, always, on the long-term, structural forces that are shaping our field, as I have tried to do in this essay and as I will always try to do in The Healthiest Goldfish. Towards this aim, in next week’s essay I will suggest some ways we can challenge ourselves to do better in 2025, towards embracing strategies that can help us fully meet the needs of the moment.