In February 2015, several technical staff sat together to review the results from a jointly conducted study on malaria control. Some of the scientists were from Zambia’s National Malaria Control Centre (NMCC) and others worked at a non-governmental organization, PATH, through its Malaria Control and Elimination Partnership in Africa (MACEPA). Everyone at the table agreed: these data were remarkable. The more the scientists discussed the results, the more excited they became. This study had major implications for malaria in Zambia—and elsewhere.

Beginning in 2013, Humana Inc., headquartered in Louisville, Kentucky, pursued a major organizational transformation, from being an insurance company focused on paying claims to becoming a health and well-being company focused on improving the health of its beneficiaries. The company set a “Bold Goal” of improving the health of the communities it served by 20% by 2020. To achieve this new goal, Humana undertook a multiyear redesign and investment of people, processes, and products in order to gain the trust of consumers and providers, and to partner with communities to improve health. The case focuses on community initiatives, where Humana was developing its new role as “convener of conversations,” providing leadership infrastructure and partial funding to spark community planning with a wide range of stakeholders and to design and monitor interventions that were tailored to local health improvement. At the same time, Humana remained a publicly-held corporation accountable to its shareholders for revenue growth and financial return. The case protagonist, Andrew Renda, MD, MPH, Director, Bold Goal Measurement, must design and implement a business plan, including leading and lagging performance metrics, that would measure Humana’s progress toward its Bold Goal in ways that supported continued investment in community health improvement in Humana’s local markets, while satisfying its traditional business constituents.

In July 2016, Jennifer Brown, a graduate student at Southwest State School of Public Health, had been asked to staff an Ethics Advisory Group (EAG) meeting at Mountain Health Insurance Company, a large, regional nonprofit health insurance company where she was employed as a summer intern. The mission of Mountain Health was “to improve the health of the people we serve and the health of society.” Jennifer had been working with the ethics program director, Robert Jones, to review and update the program’s ethical guidelines to reflect emerging ethical challenges in the financing and delivery of health care. This meeting was the first time that Jennifer had been given the responsibility of identifying the ethical issues that EAG should consider and what values should be applied in determining how Mountain Health should address them.

Since the flood of child migrants from Central America burst upon the southern United States in the summer of 2014—a vast rise in arrivals dubbed “the Surge”—Kids in Need of Defense (KIND) had been facing overwhelming demand for its legal services. Wendy Young, KIND’s president, explained that the organization’s primary mission was to ensure that no child appears alone in immigration court, but KIND also wanted to provide leadership, research, and advocacy to protect these “children on the move” from laws and practices that threatened their fundamental human rights. Ms. Young was facing a critical juncture in the organizational life of KIND: where and how should it focus its resources for greatest effectiveness in protecting child migrants? What limits must the organization set on its activities when facing an almost unlimited need for legal, social, health, and educational support of these vulnerable children?