For more than 30 years, Dr. Joan Reede worked to increase the diversity of voices and viewpoints heard at Harvard Medical School (HMS) and at its affiliate teaching hospitals and institutes. Reede, HMS's inaugural dean for Diversity and Community Partnership, as well as a professor and physician, conceived and launched more than 20 programs to improve the recruitment, retention, and promotion of individuals from racial and ethnic groups historically underrepresented in medicine (UiMs). These efforts have substantially diversified physician faculty at HMS and built pipelines for UiM talent into academic medicine and biosciences. Reede helped embed the promotion of diversity, equity, and inclusion (DEI) not only into Harvard Medical School's mission and community values, but also into the DEI agenda in academic medicine nationally. To do so, she found allies and formed enduring coalitions based on shared ownership. She bootstrapped and hustled for resources when few readily existed. And she persuaded skeptics by building programs using data-driven approaches. She also overcame discriminatory behaviors and other obstacles synonymous with being Black and female in American society. Strong core values and sense of purpose were keys to her resilience, as well as to her leadership in the ongoing effort to give historically marginalized groups greater voice in medicine and science.

Three months into her job as secretary of health for Washington State in 1999-a position which had been vacant for nearly a year following the previous secretary's resignation-Mary Selecky read a newspaper story that the state's largest and most influential health jurisdiction, Public Health Seattle King County, reported three unconnected people in the county had been infected with salmonella, a common foodborne bacteria that makes people sick and can lead to severe illness and even death in some instances if untreated. While Department of Health epidemiologists had already serotyped the bacteria, which they traced to fruit smoothies from a Seattle chain, this was the first time that Selecky had heard anything about the outbreak. Clearly, she mused, no one in the state working on the matter thought the state secretary of health needed to know about it. Selecky, who had previously run a poorly resourced, rural county health district in Washington State, did not yet understand how state-level public health laboratories and other resources interacted with Public Health Seattle King County, health labs in other states, or federal agencies and resources. She was not even sure of her role vis à vis the State Department of Health's own epidemiology team when it came to routine foodborne outbreaks. However, Selecky did know that foodborne pathogens could sicken and kill, and had no respect for man-made borders. What if anything should Selecky do? What does she need to know? What is her role in what staff consider routine communicable disease investigations. How should she go about discovering it? How does one decide what is and what is not routine?

The 8.9 magnitude earthquake that struck Japan on March 11, 2011, unleashed a 30-foot tsunami along Japan's Pacific Coast that damaged nuclear reactors at the Fukushima Daiichi Nuclear complex. The crippled reactors leaked radiation into the sea and atmosphere, contaminating the local environment and sending a radioactive plume across the Pacific Ocean toward North America some 5,000 miles away. Washington State Governor Christine Gregoire soon asked State Secretary of Health Mary Selecky for the State Department of Health's action plan for the crisis, directing the seasoned health officer to "handle it!" Although the health risks posed to west coast communities by the incoming radiation was low, the public's anxiety about possible health consequences was high. Round-the-clock news coverage of the Fukushima nuclear disaster and its fallout inadvertently stoked what Selecky described as "an epidemic of fear" as residents sought to protect themselves from potential radiation contamination in water, shellfish, and dairy products. Nearly three weeks into the crisis, Selecky received an unexpected phone call from Governor Gregoire, whom New York Times reporters had just contacted for comment on radiation found in a Washington State milk sample. "What milk sample?" Selecky replied, hearing the news for the first time. What should Selecky do? How should she and her staff respond to the March 11 disaster? How should she proceed following revelations of radiation in a Washington State milk sample? How should she and her department handle the public's concerns about contaminated debris washing up on Washington's shores and other disaster-related issues in months and years to come?

As administrator for the U.S. Environmental Protection Agency (2013-2017), Gina McCarthy faced a daunting challenge: to write a technically airtight and legally defensible regulation, the Clean Power Plan, to reduce carbon pollution from existing power plants. The task required deep understanding of current trends in the electric power sector and how regional markets operate to ensure that EPA actions to curb carbon pollution would not threaten energy reliability or affordability. The initiative, officially launched in 2013, was key to U.S. action and leadership on climate change during the Obama administration's second term. McCarthy could count on industry and other players to resist proposed changes. Extensive and thoughtful stakeholder outreach and communication were hallmarks of EPA's approach under McCarthy. The strategies used provide a prominent example for leaders mandated to craft complex regulations in a contentious environment.

A deep sense of foreboding filled Dr. Jim O'Connell and his team at Boston Health Care for the Homeless Program (BHCHP) in October 2014. The Boston mayor's office had just announced the closure of the 64-year-old bridge that provided the only passage to the island in Boston Harbor housing the city's largest homeless shelter. It did not have a long-term contingency shelter plan in place and the city's other shelters were full. With winter fast approaching, O'Connell, who at the time had been providing health care to Boston's homeless population for over a quarter century, feared some of the city's dispossessed would die on the streets from cold. BHCHP would be hard pressed to provide them the medical care they needed. To implement his solution-reopening the Boston Night Center-O'Connell had to overcome the disinterest of BHCHP's traditional allies in the homeless service provider community, who for a number of years had been channeling their energies away from sheltering toward permanent housing solutions. The Boston Night Center's reopening helped achieve an unprecedented feat for the City of Boston: Not a single homeless person died from the elements that winter, the harshest in the city's recorded history. How did O'Connell work with stakeholders to accomplish his goal? What could he do to maintain support for the Boston Night Center and the reestablishment of homeless services on the island?

Dr. Jonathan Woodson faced more formidable challenges than most in his storied medical, public health, and military career, starting with multiple rotations in combat zones around the world. He subsequently took on ever more complicated assignments, including reforming the country's bloated Military Health System (MHS) in his role as assistant secretary of defense for health affairs at the U.S. Department of Defense from 2010 to 2016. As the director of Boston University's Institute for Health System Innovation and Policy starting in 2016, he devised a National Digital Health Strategy (NDHS) to harness the myriad disparate health care innovations taking place around the country, with the goal of making the U.S. health care system more efficient, patient-centered, safe, and equitable for all Americans. How did Woodson-who was also a major general in the U.S. Army Reserves and a skilled vascular surgeon-approach such complicated problems? In-depth research and analysis, careful stakeholder review, strategic coalition building, and clear, insightful communication were some of the critical leadership skills Woodson employed to achieve his missions.

Center for Health Communication at the Harvard T.H. Chan School of Public Health Director Jay Winsten spearheaded a national mass media campaign, the Harvard Alcohol Project, also known as the Designated Driver Campaign, to rapidly diffuse the "designated driver" into the American lexicon and culture. The campaign broke new ground in the process, most notably by harnessing on an unprecedented scale the Hollywood entertainment community's power to disseminate messages and facilitate social learning. Writers incorporated the campaign's designated driver message into the scripts of more than 160 prime-time television episodes during four television seasons. The campaign persuaded large numbers of Americans to adopt the practice of choosing a designated driver-i.e., a member of a social group who agrees to stay sober in order to safely drive others in the group who have been drinking alcohol. The campaign provided a model for a generation of advocates seeking to mobilize the power of Hollywood to advance social causes, and convinced funding organizations that media advocacy campaigns were worth supporting.

The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." For many Americans, the World Health Organization's definition of true health seems unattainable, given the multitude of complex problems plaguing the U.S. health system. The United States over the last 50 years has focused most of its health resources on providing medical care for individuals after they fall ill. It has placed far less emphasis on the non-medical determinants of health and the prevention of disease for the lives of its citizens. The result: an infamously expensive "sick care system" that does not perform as well as other wealthy countries across key measures. Americans of all socioeconomic stripes experience poorer health outcomes than their rich country peers. Such trends undermine U.S. international competitiveness. This background note digs deeper into these trends and their origins, the barriers hindering change, and past and current reforms, including the 2010 Affordable Care Act. If fully implemented, the controversial act will help the United States push beyond its myopic sick care focus towards the WHO's true health vision by creating a health system that integrates medical care with public health and prevention for all Americans.

"Dr. Benjamin Hooks and Children's Health Forum" charts the many different career paths of Hooks, a civil right activist and pioneer. Hooks' positions ranged from lawyer, judge, preacher, entrepreneur to the first African American commissioner of the Federal Communications Commission (FCC) and to the head of the National Association for the Advancement of Colored People (NAACP) to the co-founder of the non-profit Children's Health Forum (CHF). CHF's mission was to eradicate lead poisoning in children in the United States. The case provides an overview of lead poisoning in the U.S., including how it is measured, its causes, and legislation enacted to prevent it. The case asks students to reflect on Hooks' leadership choices and his decision to launch CHF. How would they assess Hooks as a leader? What made him a strong leader? Given Hooks' past experiences, do they think that Hooks made the right decision to focus on lead poisoning after leaving the NAACP? Is this an area where he could have the most impact?