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The hoped-for “just recovery” from the COVID-19 pandemic has not occurred. This chapter examines socioeconomic disparities laid bare by the pandemic in the United States. They have left a marked impression, suggesting that the concept of “American exceptionalism” has negative as well as positive connotations especially when compared with other high-income countries. Strikingly, democracy is not delivering for many Americans, and yet that is not a new situation, as much scholarship shows. These findings challenge received wisdom about how this country is in the aggregate labeled “developed” when many Americans live in conditions similar to or worse than those the World Bank categorizes as “developing.” Against this background, the chapter assesses experiential learning models for engaging students on the SDGs to assess these disparities. While researching social justice gaps in Pittsburgh and Atlanta with Carnegie Mellon students, however, the lack of disaggregated data emerged as a human rights issue and major barrier to fulfilling the SDG principle to “leave no one behind” (LNOB). These findings suggest a paradigm shift is needed, using the SDGs to advance human rights, elevating socioeconomic rights, localizing issues, generating disaggregated data to drive policy recommendations, and scaling up the community of practice that is engaged in this paradigm shift. Field building these aspects of sustainable development has the possibility to positively shape policies, outcomes, and help this democracy actually deliver for all, not just for some. For the United States to lead and bolster human rights and democracy around the world, inequalities at home must be addressed.

The paper seeks to assist public sector leaders to take a balanced and impactful approach to transformation programmes which aim to deliver integrated healthcare. The paper highlights the balance of attention paid in these programmes across elements of leadership, strategy, structure and people, and aims to highlight where this balance can sit to encourage more successful and sustainable transformations, with an increased focus on interpersonal and inter-professional engagement and interaction across workforce and service users.

The project involved a literature review which identified themes that were in turn used to inform an approach to a desk review of journal articles written about past integration programmes in healthcare. A coding framework was developed to assess the articles in the desk review to identify where the focus of attention lay in the approaches to integration.

There is a spread of activity across all four themes (leadership, strategy, structure and people) in the assessed cases, but the emphasis tends to be towards static, short-term approaches, with a noticeable lack of focus on the aspects required to deliver long-term sustained transformation. There is a need for improved balance between structural and relational approaches to transformation.

The paper focuses on nine examples of transformation programmes and would benefit from further development and use of the coding framework.

The framework that emerges from this project can contribute to the development of a proactive model to assist transformation leads and decision makers bring a more balanced, thoughtful and impactful approach to integrating health and care services. In particular, the findings point to an overuse of structural approaches to change and transformation, which could include project management methods, for example, which become the product of the initiatives, rather than enablers of leaders’ visions and people’s interpersonal and interprofessional engagement and interactions.

Building on existing research, this paper makes a valuable contribution to the discourse on how to deliver the required health and care integration agenda in a more accessible way and sustainably, moving away from short-term, quick-fix approaches and considers how to accommodate the role of interpersonal interaction as the vehicle for change.