Years before Harvard University Professor Howard Koh was appointed by President Barack Obama as the 14th U.S. Assistant Secretary for Health (2009-2014) for the U.S. Department of Health and Human Services (HHS), where he went on to address a vast portfolio of health challenges, he played a leading role in two highly impactful coalition-based public health campaigns focused on tobacco control and organ donation. The tobacco tax and organ donation campaigns illustrate how public health advocates can effectively build and rally coalitions of diverse groups around a results-focused health mission. They underscore the perseverance and other leadership traits that public health leaders like Koh harness to push through innovative strategies in the face of powerful entrenched groups committed to preserving the status quo. And while the campaigns also demonstrate the difficulties of sustaining public health initiatives due to changing political and economic circumstances, leaders like Koh must surmount disappointments to find new ways to continue the mission over the course of a long career.

As a veteran international development specialist, Vivian Lowery Derryck spent 35 years trying to influence governments in Africa by working with State Department and United States Agency for International Development (USAID) officials, African heads of state, and non-profit leaders across the continent. She believed the right outside pressure and expert collaboration could meaningfully shape U.S. foreign policy toward Africa and improve democracy in African governance. Derryck left her tenure as Senior Vice President and Director of Public-Private Partnerships at the former Academy for Educational Development (AED) and joined the inaugural Advanced Leadership Initiative Fellowship program at Harvard University. She thought it would be an ideal opportunity to build on a long-standing desire to start an institute to build African democracy and strengthen good governance on the continent. She launched the Bridges Institute to promote civil society as a pivotal actor in bringing about more inclusive and effective policy dialogue in Africa. This case follows her journey and raises important questions about how to achieve such large scale change.

After thirty-three years as a corporate lawyer, Marissa Wesely became a 2014 Advanced Leadership Initiative Fellow at Harvard University to pursue her passion of advancing women's rights, particularly in the developing world. She took on a leadership role with the Win-Win Coalition, which worked with women's funds and local women's organizations, advocated for the value of cross-sector partnerships and coached key players to work together and find common ground despite different vocabularies and expectations. The case covers key lessons and questions for consideration during Wesely's early stage efforts to launch the Win-Win Coalition into global prominence under a cohesive identity and strategy.

In early 2016, Stanley Litow, IBM's Vice President of Corporate Citizenship and Corporate Affairs and President of the IBM International Foundation, made his travel arrangements for still another flight from New York to discuss possibilities for application of a new model for high school called P-TECH, for Pathways in Technology Early College High School, the name of the first school in Brooklyn. In the past month alone, he had flown to Little Rock, Arkansas, to meet with Republican governor Asa Hutchinson and to Providence, Rhode Island, to meet with Democratic governor Gina Raimondo to discuss bringing a P-TECH model to their states.