This open discussion session examined how misaligned incentives across academia, industry, government, and philanthropy undermine progress in health equity research. While research has recently shifted toward addressing structural inequities, systemic issues like academic tenure systems, profit-driven pharmaceutical practices, and lack of community-driven funding persist. Panelists emphasized the importance of power-sharing, increasing clinical trial diversity, and creating equitable funding mechanisms. There was a collective call to realign incentives to support innovation led by and for communities.

Speakers presented innovative health interventions—such as ChiFresh Kitchen, the Comprehensive Care Program, and the Urban Health Initiative—that demonstrate how addressing food access, social needs, and community-hospital linkages can improve health outcomes. Emphasis was placed on sustainability, community ownership, and building scalable models of whole-person care like NowPow, LLC (acquired by Unite Us).

This session explored funding strategies that prioritize long-term, trust-based research collaborations. Presenters highlighted the need for infrastructure investment, use of economic framing (e.g., return on investment – ROI), and strategic messaging that adapts to political climates. Models like social impact investing and social annuities were discussed as ways to align financial and health equity goals, with a broader shift in language toward cost savings and scalable solutions.

Panelists reflected on worsening life expectancy trends and the complex structural causes behind them, including economic deprivation, residential and economic mobility, and capital extraction from neighborhoods. The discussion emphasized the need to elevate uncomfortable truths without triggering resistance, and to invest in local infrastructure that fosters health and economic stability. Health systems must fill gaps in training and access through storytelling and relationship-building between academics, funders, and communities. Root causes such as poverty and systemic inequity were identified as essential targets for health equity work, despite institutional resistance. Key Questions Posed:

• How do we elevate critical truths about structural injustice while minimizing emotional backlash or defensiveness from stakeholders?
• What makes a community healthy—and what undermines it?

 The final session focused on developing community-driven, upstream solutions to health inequities as opposed to fragmented, disease-specific approaches. Implementation science was identified as key to moving from knowledge to action, with trust and sustained collaboration between academics and communities at the center. Value-of-information and implementation (VOI) analysis and other research tools were discussed as promising ways to inform funders and shape effective, long-term interventions. Panelists underscored that only coordinated, longitudinal efforts will meaningfully reduce disparities.