Health system organizations in the United States — across health care, public health, and biomedical research — often fail to align with the goals and priorities of the individuals and communities they serve. Rather than engaging people as active partners, these sectors frequently treat them as passive recipients, overlooking their lived expertise and perspectives.
Limited collaboration across sectors and growing complexity, including the rise of artificial intelligence, underscore the need for new systems and cultures that support more inclusive, transparent, and democratic decision making. In response, the National Academy of Medicine convened an expert working group, joined by ChangeLab Solutions CEO, Sarah de Guia, to outline a vision for reorienting health systems around individuals’ and communities’ priorities, with the goal of strengthening trust.
The paper identifies key barriers to meaningful engagement — including gaps in governance structures, insufficient trust, misaligned financial incentives, and workforce limitations — and highlights the societal costs of maintaining the status quo. It presents a set of solutions focused on advancing holistic definitions of health, fostering collaboration and shared decision making, investing in community-driven research, and building a workforce centered on people and communities. Achieving this shift will require both bottom-up and top-down efforts, shared accountability, and sustained commitment across sectors to embed equity, trust, and community voice at the center of decision making in our health system.
5/5/2026