Dear friends,

We are entering a historic year—the 250th anniversary of the United States’ founding—with our vision fixed on the present. The deluge of crises flowing from federal actions, from massive Medicaid and SNAP cuts to civil rights abuses to vaccine retreat, have gripped our attention and obscured our sense of orientation within history’s arc.

Yet as we enter 2026, it’s important to remember foundational themes of our nation and understand the present risks in the context of history. 

Beyond the direct material harm and suffering, one casualty of crisis is the distortion of time. In times of crisis—whether natural or manufactured—we easily forget the past and future and focus only on survival in the present. Another casualty is our sense of agency (we feel helpless), connection (we feel isolated), and imagination (we feel stuck). Leaders can forget what’s possible and retreat to a small menu of options, seeking only to mitigate or avoid risk on their own rather than collectively weather the storm or contest the policies that intentionally put vulnerable people and vital institutions in harm’s way.

Let us strive to remember instead that this present moment is part of a long, often turbulent arc. The U.S. has experienced threats throughout the last 250 years. What kept us from teetering into collapse in those moments was the continual and consistent push to repair and strengthen unwritten democratic norms against those threats, and to unyieldingly promote democratic practices. We have much to learn from the courageous leaders who came before us, including those we now revere as giants. (Watch, for example, this powerful roundtable interview from 1963, in which Rev. Dr. Martin Luther King Jr. and fellow civil rights leaders talk about coordinating responses to the major threats of their day.) We stand now on foundations they laid during previous challenges, even when we feel those foundations shaking.

When we reclaim this sense of the past, seeing ourselves as stewards of the democratic practices that underpin the health of our communities and our nation, we can meet the present with more strength. We can avoid succumbing to the casualties of crisis. 

Let us note that this year also marks the 50th anniversary of the National Academies of Sciences, Engineering, and Medicine Commission on Human Rights. The Academies created this commission in 1976 to serve “as a bridge between the human rights and scientific communities, in recognition of the importance of rights protection for scientific inquiry and the realization of human dignity worldwide.” The commission enshrines a truth that health equity advocates understand: that health and justice are inseparable. One cannot flourish without the other.

This year, you can expect to see HealthBegins draw on rich lessons from the past to meet this moment with support and solidarity for those working to connect health and justice — and connect with each other. You will see that in the form of even more useful services and tools in our three health-equity-focused practice areas: Investments, Integration, and Power Building. You will see it in the spaces we create to help our community of Upstreamists come together and learn, such as the upcoming February 19 symposium we’re hosting with the UC Berkeley School of Public Health Social Impact Team and Common Health Coalition to reimagine financing and investments for health equity. We will also soon share a timely Collaborative Action Framework to help health equity leaders develop the collective capabilities, shared infrastructure, and strategic alignment needed to navigate both immediate crises and long-term challenges. And we’ll continue to deepen our role as a field catalyst and convener, building bridges of partnership among leaders in health care, public health, social services, finance, law, and social justice.

Together, let us draw on historical wisdom to anchor us. Let’s continue to spotlight and confront the upstream conditions and choices that put people in harm’s way. And scale novel solutions to propel us forward. This is our time to strengthen the democratic practice of health equity—not just to survive this historic moment, but to radically reimagine the future that flows from it.

Best,

Rishi Manchanda, MD, MPH