In response to the devastating impact of COVID-19 on the American health system, the National Academy of Medicine (NAM) convened experts in nine sectors of health, health care, and biomedical research to review how each sector was impacted by COVID-19, identify challenges encountered in combating the pandemic, and outline what opportunities exist to reinforce, revitalize, and transform the health system. These insights are being released as nine NAM Perspectives discussion papers between April and June of 2021, and then bundled as a NAM Special Publication, Emerging Stronger after COVID-19: Priorities for Health System Transformation, scheduled to be released in Fall 2021. The NAM Special Publication will include all nine previously published papers and a new concluding chapter that reviews cross-cutting themes and opportunities from the individual papers.

The first two papers in this series, focused on public health and care delivery, are being released today, April 7, 2021. Public Health COVID-19 Impact Assessment: Lessons Learned and Compelling Needs focuses on how state and local public health departments responded to COVID-19, viewed through the lens of their “essential” and “foundational” services. One of the co-authors, Georges Benjamin, Executive Director of the American Public Health Association, observed that the publication is being released during National Public Health Week, particularly appropriate given that while the essential and foundational services of public health seem straightforward in theory, in practice, public health is hampered by a series of structural challenges and barriers that have persisted for years.

“Public health is foundational to the health and well-being of our country and its citizens,” said Karen DeSalvo, adjunct Professor of Medicine and Population Health, Dell Medical School, The University of Texas at Austin and former Acting Assistant Secretary for Health and National Coordinator for Health Information Technology, one of the paper’s co-leads, “but public health has been chronically underfunded and under-resourced. Although public health professionals have known this for years, the nation experienced it first-hand as public health struggled to respond to the pandemic. COVID-19 presents a bittersweet opportunity to really focus on, appropriately fund, appropriately staff, and shore up public health leadership, workforce, and infrastructure, not only to be ready when the next epidemic arises, but to be able to effectively carry out the day-to-day services on which the nation’s health depends.”

The paper reviews both the challenges that public health experienced and the creativity and commitment displayed by the public health workforce in protecting and caring for people and communities as the pandemic progressed. These successes, innovations, and challenges have laid bare what reforms are necessary to support public health, which the authors of this paper categorize under six major headers.

Bob Hughes, President and CEO, Missouri Foundation for Health and one of the paper’s co-leads, noted “The public health sector must not only be reinforced and appropriately staffed so that it can respond to the next epidemic – it must be reinvigorated so that it can respond to threats we cannot imagine. The priority areas of funding, affirming its mandate, promoting structural alignment, investing in leadership and workforce, modernizing data and IT capabilities, and supporting community engagement are critical to ensuring a robust, modern, and flexible public health infrastructure for now and in the future.”


Care Systems COVID-19 Impact Assessment: Lessons Learned and Compelling Needs, the second paper in the series, focused on care systems: the hospitals and health care providers who shouldered the dramatic and unanticipated treatment responsibilities imposed by the pandemic. Beyond clinical care, these care systems also supported scientific research and served as large employers in many states and communities, compounding the complexity and importance of their response to the pandemic.

“Care systems have operated at the literal front lines of the pandemic,” noted Jeff Balser, President and CEO, Vanderbilt University Medical Center, and one of the paper’s co-leads. “Beyond caring for patients, looking out for the well-being of our employees, and functioning as an anchor institution in many locations, care systems also assisted, to the degree possible, in backing up our public health colleagues by supporting testing and contact tracing and caring for the most vulnerable in our communities. These two papers, released together, really reinforce the importance of looking at the health system as just that – a system. We are only strong if all of our sectors are strong, and there’s a huge opportunity for reinvention and reinvestment after COVID-19.”

Care Systems COVID-19 Impact Assessment details how care systems responded during the pandemic, including addressing acute care needs, adapting care delivery, redeploying the workforce, and addressing health inequities. The paper also provides priority actions and policy considerations for supporting and improving care delivery moving forward, noting that many challenges the sector experienced are deeply rooted and precede COVID-19.

“These challenges are not new, but they became impossible to ignore during COVID-19, and there is no better time to address them than now,” said Jaewon Ryu, President and CEO, Geisinger, and one of the paper’s co-leads. “Many of the critical needs have been talked about for years, including ensuring financial resiliency, reinforcing the medical supply chain, and rethinking capacity building. However, some of the most compelling opportunities will not only change care systems, but are also our moral responsibility, like investing in eliminating health disparities, reinvesting in rural health and safety net institutions, and supporting our public health colleagues. These changes, if enacted, will not only fundamentally improve care delivery, but will also positively impact patients across the country.”

The two Sector Impact Assessment papers published today, and all future releases, will be available at The next seven papers in the series will focus on quality and safety, health care payers, clinicians, biomedical research, digital health, health product manufacturers, and patients, families, and communities. These papers will be released in the coming weeks.

The NAM Special Publication, Emerging Stronger After COVID-19: Priorities for Health System Transformation, will be released in Fall 2021 and will be available at

Transforming Health Initiative papers and background can be found at

Please contact with any questions or requests.

Join Our Community

Sign up for NAM email updates