As mentioned in my last blog, I’m sharing two nutrition-related predictions for National Nutrition Month. The first focused on the systemic nature of our nutrition problem, and how lasting improvement to America’s health requires systemic reform.
In part 2, the prediction focuses on the most effective tools leaders can leverage to spur effective change. This prediction is grounded in the Tools of Cooperation.
Tools of Cooperation: A primer on leading effective change
In brief, the Tools of Cooperation theory states that in order to guide effective change, leaders must understand where their stakeholders fall on two dimensions: organizational or societal goals and how outcomes are achieved (i.e., what inputs lead to what outputs). These two dimensions are plotted on the Agreement Matrix, shown below. 
Once leaders identify their stakeholders’ consensus on goals and the pathways to achieve outcomes, leaders can leverage the most effective tools for the situation. While the boundaries aren’t rigid, they’re directional, and help leaders match the change management tool they apply to the situation their stakeholders are within.
Prediction 2: To spur collective health improvement, leaders will learn to lever Leadership and Culture Tools instead of Power Tools
An analysis of the current state
In the US today, policymakers are in a polarized position on many fronts, resulting in little consensus on goals and how to achieve desired outcomes. For example, there is little agreement across the aisle on topics such as governmental power, climate change, and K-12 education. This mass disagreement puts policymakers in the Power Tools quadrant, which the Executive Branch has leveraged to its advantage, using fiats and threats to reduce the size of the federal workforce, reduce health research funding, attempt to close federal agencies, and much, much more.
However, the problem with the Executive Branch’s tool selection when applied to health is that it forgets the first step of effective change management: identifying where their stakeholders fall on the Agreement Matrix.
Where the leaders fall on the matrix is different than where the stakeholders fall. Our elected leaders’ actions demonstrate that they’ve failed to recognize this critical difference in change management.
If they’d followed best practices and realized that the American people agree quite a bit on improving our national health, they would have instead leveraged Culture Tools or Leadership Tools. Which quadrant they focused on would depend on the level of agreement on cause-and-effect. Regardless of which of those quadrants the American people land in, we are decisively not in the lower left quadrant when it comes to either our goal of improving our collective health or on the pathway to do it.
Taking the goal of eating healthier, for example, a December 2024 consumer survey highlights that across age ranges, “eating healthier” was the top resolution for consumers in 2025. And perhaps despite great agreement on the goal, the question of how to achieve it is ever-present in people’s minds, given that the high cost of healthy food is perceived as a key barrier.
Additionally, a recent Gallup survey highlighted that Americans ranked reducing chronic disease as a top public health priority for government leaders. And this isn’t new. Back in 2021, 80% of adults reported that reducing chronic diseases such as cancer, diabetes, and heart disease should be a key responsibility of public health agencies.
However, there’s not necessarily a large amount of consensus, or even clear understanding, on where constituents fall on pathways to achieve the goal of preventing chronic disease.
Diving into the statistics around consensus on what we do know about cause-and-effect, a recent Research!America survey found that ~90% of Americans—across the political spectrum—believe it’s important for the current administration to fund both chronic and infectious disease research. This would be considered high consensus on cause-and-effect. And recent executive orders to cut that funding clearly don’t align with where stakeholders fall.
So, we have a mismatch between the tools leaders use (Power Tools) and the ones that can successfully improve America’s health, given where stakeholders fall on health-related goals and cause-and-effect (Leadership and Culture Tools).
How the current state can lead to future improvement
As the Tools of Cooperation lays out, when leaders seek to use tools that don’t match the situation their stakeholders are in, they waste time, energy, resources, and credibility. And their change management efforts fall flat.
One thing I’ve observed about the current administration is that they don’t like to lose. But the more they wield Power Tools, the more their approval ratings fall.
Perhaps a quick lesson in the Tools of Cooperation could help them achieve both Americans’ goal of improving health outcomes and their goal of American approval.
Instead of using Power Tools like threats and executive orders, they’d be more successful using Leadership Tools, such as providing a vision for what better looks like, and then leveraging a Culture Tool like policy change once enough stakeholders are aligned on what inputs will lead to the desired outcome of improved health.
The trick will be to help this administration both learn this critical difference and do the work entailed in understanding their stakeholders’ agreement. If you, the reader, happen to have their ear, would you be willing to share it with them?
Unfortunately, if they don’t change their tactics, making America healthy again will remain a pipedream, never becoming our reality. And for our collective health and well-being, we’d all likely prefer they learn to use the right tools.
That’s not to say improving health is an impossible goal if they continue their approach of leveraging fiats and threats. The prediction can still come true. And that’s because “leaders” doesn’t just mean “federally elected leaders.”
So, perhaps the prediction is more about the belief that collectively we can leverage our broad agreement around the goal of improved health to use the leadership tools at our disposal. Leaders aren’t just elected individuals. Leadership is earned. When you speak with clarity amidst chaos, people follow you.
As a public health and/or health care leader, the power is also in your hands. With stakeholders aligned around improving America’s health outcomes, you can leverage our democratic tradition to spur change from the ground up. All hope isn’t lost. In our democracy, you still have the power to lead change. Even if not from a federal office.
