The National Academy of Medicine (NAM) today released guidance on approaches to ensure that the U.S. health system aligns with the goals, preferences, priorities, and lived experiences of the people it serves.
Authored by a multidisciplinary expert working group, the paper calls for a fundamental shift in how health care, public health, and the health science enterprise define success—moving from a system largely focused on services, transactions and provider system priorities to one that is fundamentally grounded in the goals and expectations of individuals and communities.
The authors highlight a persistent misalignment across health sectors, in which individuals and communities are too often treated as passive recipients rather than active partners in shaping health decisions. The prevailing practices frequently overlook the capabilities and perspectives of the very people it is meant to serve. Reorienting health systems around individual and community goals is critical to achieving better health outcomes, strengthening communities, and making more efficient use of resources. The paper argues that meaningful engagement, shared decision making, and accountability to community-defined priorities are essential to improving health outcomes and advancing equity. With the advancement of generative AI and its potential application, new tools are developing to enhance the prospects of these needed shifts.
The discussion paper outlines key drivers of misalignment, including limited definitions of health, lack of trust, poorly aligned financial incentives, and insufficient workforce capacity. It also presents a set of actionable solutions and strategies, such as:
- Adopting a holistic, cross-sector definition of health that includes physical, mental, social, and environmental factors
- Strengthening shared decision making and accountability structures
- Investing in community-driven research and evidence generation
- Building and sustaining a workforce equipped to engage meaningfully with individuals and communities
- Harnessing generative artificial intelligence and emerging technologies to integrate multi-sector data and expand access to services, engagement opportunities, and health insights for individuals and communities
The paper emphasizes that momentum can be built through both bottom-up community-driven innovation and top-down policy and structural changes. Aligning action will require coordinated effort across sectors, alongside a shift toward what the authors describe as “caring accountability,” a model rooted in relationships, trust, and mutual responsibility.
In addition to identifying challenges, the paper highlights promising models and initiatives already demonstrating how health systems can better align with community priorities, offering a roadmap for scalable, sustainable change.
Read the NAM Discussion Paper: https://doi.org/10.31478/202604a
This paper is the second in a series produced by the National Academy of Medicine’s Commission on Investment Imperatives for a Healthy Nation. Established to reimagine a US health care system that puts people first, the Commission will release additional papers over the coming year outlining its vision for a new health system, the priorities that must be addressed, and the actions needed to turn that vision into reality. Authored by experts assembled under the charge of the National Academy of Medicine, the paper was completed with support from Healing Works Foundation, Doris Duke Foundation, and the Gordon and Betty Moore Foundation. The views presented are those of individual contributors and do not represent formal consensus positions of the sponsoring organizations, authors’ organizations, the National Academy of Medicine, or the National Academies of Sciences, Engineering, and Medicine.
