The COVID-19 pandemic shocked the health care system globally and shone a harsh light on inequities, but also spurred rapid developments in public health and policy. Among the achievements: the fastest development of a vaccine on record, thanks to decades of foundational research and international collaboration in 2020, and a sharp (albeit temporary) decline in child poverty in the U.S.
While the pandemic emergency enabled rapid public policy change previously unimaginable, in many cases policies have reverted back to their pre-pandemic status, and some gains have been lost. Public trust in public institutions and the government to make their lives better is waning worldwide. Thoughtfully designed public policy is essential for improving population health and well-being, especially for historically underserved groups. But how do we catalyze progress in a way that is sustainable? For the health services research community, this question is particularly critical as we consider how to design, evaluate, and sustain policies that address health inequities and improve health care outcomes.
At a fall 2025 conference in Barcelona celebrating the 100th anniversary of the Harkness Fellowship, hosted by the Commonwealth Fund and supported by the Financial Times, Bola Owolabi, Vice President of the Royal Society for Public Health, and Dave A. Chokshi, the Sternberg Family Professor of Leadership, City College of New York, shared their perspectives from the UK and U.S. experience, respectively, in a “lightning talk” format.
The COVID-19 Pandemic Served as a Burning Platform for Public Policy Change
Professor Bola Owolabi CBE was appointed the Director of Healthcare Inequalities for NHS England in December 2020, at the height of the pandemic when disparities in COVID-related outcomes were in the spotlight. This gave her burning platform that enabled a strategic approach to addressing healthcare inequalities, which resulted in the Core20PLUS5 initiative, which aimed to reduce health inequalities in England by focusing on specific populations (the most deprived 20 percent of the national population per a national index, and population groups identified at the local level) and clinical priorities (e.g., maternity, severe mental illness, chronic respiratory disease).
While some questioned the role of the NHS in addressing issues beyond the doctor’s office, the pandemic created an opening for demonstrating the responsibility of the health care system—the largest recipient of the U.K. GDP and an institution with critical societal influence—to address such upstream social drivers.
Meanwhile in the U.S., Dr. Dave Chokshi brought his combination of primary care and public health expertise to his role leading New York City’s response to the COVID-19 pandemic, including the vaccination of six million people in a little over a year. His years working with people experiencing homelessness instilled an understanding of a core element of a clinician’s role: building a trusted connection with patients so that they return to the health care system again.
Dr. Chokshi’s charge to the health and public policy community now: reimagining our systems of care. The health services research community is well-positioned to rise to the challenge, as a field already accustomed to designing and evaluating new approaches to health care delivery and policy.
From Burning Platforms to Burning Ambition
Professor Owolabi CBE described the current climate, now that the emergency of the pandemic has passed, as a time to pivot from burning platform to “burning ambition” to power further progress. As opposed to a burning platform, which has high potential for rapid impact but is energy-intensive, burning ambitions are energy-enabling and necessitate time and intentionality to bring more people along.
Thanks in part to acute lessons learned during the pandemic in the UK, the National Institute for Health and Care Research (NIHR) now requires inclusion in research, in recognition that research designed and conducted inclusively benefits all. The commitment to inclusion spans the institute’s workforce, advisory bodies, the research workforce, research participants, and other public contributors. Professor Owolabi credited the work of NIHR and the National Institute for Health and Care Excellence (NICE) in helping the UK become the first country in the world to make available a novel gene-editing treatment for sickle cell disease, which disproportionately affects people of African ancestry.
The rapid evolution of the applications of AI in health care is one example highlighted by Professor Owolabi of a burning ambition around which leaders can rally people today. While the potential for positive impact is high, AI models are being trained using non-representative populations, baking in inequities that have historically existed. Partnerships, such as that of the NIHR and NICE in the U.K., and advocacy by key actors in the health care and research ecosystem are essential for calling out the resulting inequities and identifying what needs to be done.
Dr. Chokshi highlighted multiple issues where leaders in the U.S. have an opportunity to reshape the discourse and enable public policy change that prioritizes the most vulnerable. First is the “zero-sum” story—the idea that one group can only get ahead at the expense of another. As an alternative, leaders can spread a story of solidarity by applying principles of targeted universalism—rejecting an “either-or” mindset and instead designing tailored interventions that address the needs of particular groups, all in pursuit of established, universal goals. Dr. Chokshi drew on a key insight from a 2023 study tour to New Zealand, where the saying, “What’s good for Māori is good for all,” emphasizes that addressing racial disparities (i.e., prioritizing health system improvements that center the marginalized groups, like the Indigenous population in New Zealand) benefits all.
The societal tendency toward total faith in the free market and lack of faith in the U.S. government can also be countered by telling the story of the impact of the muscular government approach to respond to the pandemic. While recognizing and grappling with real mistakes made during the pandemic is a necessary step to rebuild trust, leaders can also highlight the achievements that were uniquely possible through government action, such as the record-setting pace of design and delivery of the COVID vaccine and decreases in child poverty and homelessness.
As Professor Owolabi and Dr. Chokshi both demonstrate, reconnecting with one’s purpose is necessary to take on the challenges that emerge. These reflections reinforce the role of nonpartisan independent evidence in informing policy and practice, in alignment with the aims of AcademyHealth and the field of health services research. With perseverance, a burning ambition to catalyze change, and narratives that can shift the architecture of our culture, the public health and policy leaders can reimagine and create a more just and resilient health care system.