From sick care to
human flourishing.
Insights from the Health Systems We Build Together Signal Salon at the IMF-World Bank Spring Meetings in Washington, DC.
On April 15, 2026, Diplomatic Courier, through its Global Embassy, convened the Health Systems We Build Together Signal Salon in Washington, D.C. Co-hosted
with APCO on the occasion of the IMF and World Bank Spring Meetings, this gathering moved beyond theory to diagnose flaws in our health systems through the lens of lived human experience—not as they are designed.
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Under that examination, it becomes apparent that our health systems are in many cases actively working against the outcomes they were meant to produce. The evidence is structural: funding flows toward treatment instead of prevention, measurement rewards activity instead of outcomes, institutions preserve legacy systems rather than transform them.
These structural flaws mean that innovations developed within those constraints will tend to produce more of the same. Yet innovations in health tech are moving at pace and so are investments in projects seated within this flawed environment.
The danger these structural flaws will become entrenched is real.
The Diagnosis
Our health systems are often very good at reacting to health emergencies and treating illness. They are less adept at preventing illness and supporting wellbeing. A systemic misalignment of incentives makes a pivot difficult.
Today, non-communicable diseases now represent the largest burden on health systems globally, with around 80% of those being preventable. As one participant said, more than a statistic this is an indictment of how our health systems operate.
Rethinking the social contract for health and wellbeing
The Health Systems We Build Together Signal Salon brought together pioneering private-sector partners, multilateral institutions, and health ecosystem leaders to examine design and alignment of health systems to deliver on a new social contract.
Here, we present key concepts and takeaways from the salon.
What we must help depart well:
Reactive sick-care.
Today’s systems are optimized for crisis. Someone arrives with a problem, the system scrambles. That logic produces high costs, bottlenecks, and a workforce stretched past capacity. New tools make a preventive system technically feasible. The remaining barrier is institutional.
Output-driven metrics.
Health is currently measured as the absence of illness. Even the concept of prevention defines health by what we avoid. Programs are funded against problems and counted by interventions delivered. That frame misses what people want from their health: flourishing and agency.
Top-down, inside-out change.
Government and multilateral institutions have authority to shape health systems but lack agility. Bureaucratic systems preserve this legacy. One alternative approach is the U.S. Department of Defense’s “team of teams” model—pushing decision authority to the front lines, accepting that local context produces different right answers.
Transactional partnerships.
The pattern of writing a check, building a program, and moving on must be broken. Rather than importing solutions that worked elsewhere assuming they will work in a local context, partnerships must be relationship-oriented. External partners must meet local partners and patients in the middle, treating them as experts in their lived experience.
Misaligned incentives.
Payers (often insurance companies), patients, and healthcare providers have different incentives for how they interact with healthcare systems. Payers want to minimize costs and maximize returns. Patients want to be healthy, affordably. Healthcare providers want to provide great care. What helps or incentivizes one group may dissuade another.
What we must help arrive well:
Life-course wellness.
A reframe surfaced in the room: think in terms wellness across an entire life with measurement and capital aligned to flourishing. This includes a reorientation toward the sectors traditional health metrics ignore: education, recreation, transportation, and nutrition. This frame unlocks cross-sector engagement that “prevention” alone has not.
Outcomes-aligned capital.
The first health outcomes-driven bond is being structured with the World Bank, focused on maternal health in Sub-Saharan Africa. Outcomes bonds align incentives with results and create a new asset class that brings institutional investors into global health.
Self-care as core infrastructure.
The WHO now builds self-care into its universal health coverage guidance. Simple lifestyle and hygiene changes can combat the proliferation of non-communicable disease. Partnerships between consumer health companies, civic organizations, and foundations create credibility to advocate for behavior change without being read as product marketing.
Community-based, individual-centered systems.
The future health system is community-based, prevention-focused, tech-enabled, and built around the individual. While there is an instinct to build comprehensive, universal systems, growing evidence suggests that specific, local, and often simple systems work best. We need data-driven community models, anchored in cultural specificity.
The “meso” layer.
Between macro vision and micro programs sits the layer almost no one funds: coordination, translation, partnership infrastructure, and the relational work that lets sectors actually meet. The room returned to this gap repeatedly. Filling it is more durable than another round of grants.
Shared data with sovereignty.
As wearables and AI tools proliferate, ownership and consent must be designed from the start, with civil-society input on digital health rights. To win trust, systems must make the patient the center of gravity. Data must flow back to the person it describes. Simple, accessible tools should be privileged over highly-engineered platforms when simple will work.
The 3 P’s: prevention, partnership, people.
The systems may be broken but they are not what will save us. Individuals are. The work is to find each other across sector lines, build uncommon collaborations—city-based partnerships on non-communicable diseases, capital mobilization for global health gaps,
the self-care movement at the WHO—and run.
Signal Discernment
These are some of the specific insights and takeaways that stayed with attendees in the weeks following.
On acknowledging when systems are broken
Mass unemployment is a very dangerous thing to bring into the civic space. We have to solve the mass unemployment issue. Otherwise, it’s a tinderbox. Opening up civic engagement to a mass of educated people who are unemployed and dispossessed who don’t have a purpose in life has never worked out well for any society.
On humanity within the system.
We keep expecting the systems to change, the systems to save us, the systems to tackle these things. The systems are broken. That doesn’t mean we abandon them. It is individuals and it is people who will innovate and pull us through.
On institutions' transformation blind spot.
The change will not come from within government, the institutions are designed to preserve the legacy system. If we can partner creatively, demonstrate with action and delivery, it changes the conversation.
On data sharing as bottleneck.
It wasn’t that the data didn’t exist. It’s that we weren’t sharing it and collecting it in the right way. There is a lag. The work is in making sense of it and getting it to where it can change a decision.
On the over-engineering of siloes.
We have been over-engineering siloes for two decades. We talk about the macro—global health, the common good. We talk about the micro—the programs, the initiatives. We do not talk about the meso, the in-between. How do we get there? Six degrees of separation is wrong. In this work, it is one or two.
On the underinvestment in preventative care.
We are only investing 3% in prevention today, and we know what the high-value interventions are. Self-care today saves the system $120 billion annually, and that’s only in a handful of countries we can measure.
On the makeup of health systems of the future.
The health system for the future, irrespective of where it is, is community based, prevention focused, AI- or tech-enabled, and built around an individual not the existing systems in place.
An indictment of our failure to act on NCDs.
Eighty percent of non-communicable diseases are preventable. That is not a statistic. It is an indictment.
Note: The Health Systems We Build Together Signal Salon convened under the Chatham House Rule. Participants included: Abdul Wahab Al Halabi, Adebiyi Adesina, Ana C. Rold, Catherine Connor, Daniella Foster, Esha Gupta, Franciscka Lucien, George Zarkadakis, Gerhardus Heerink, Gregor Grassie, Jenny Yu, Judit Arenas, Kristen Honey, Malcom Quigley, Margery Kraus, Mathew Shearman, Melissa Bohne, Nicole Monge, Nii Simmonds, Pam Kelley Lauder, Rodrigo Aguilar Benignos, Ryan Ong, Sarah Howard, Sean Slade, Shamsheer Vayalil.
Quotes are unattributed as per the Chatham House Rule.
Some quotes have been lightly edited to protect speaker anonymity and for readability.