Renowned public health policy expert Mandy Cohen, MD, MPH, called on physicians to embrace consensus building around public trust in health care as confidence in federal agencies has fallen significantly this year — reaching a record low for the Centers for Disease Prevention and Control (CDC) in some recent polls — in delivering the 2025 Eugene A. Stead Jr. Memorial Medicine Grand Rounds Lecture, “Leading Through Crisis and Change."
“Politics isn’t a dirty word. It’s a tool,” she told the audience during a Nov. 7 fireside chat facilitated by Dr. Cameron Wolf, professor in the Division of Infectious Diseases. “Building consensus and trust is worthy work—and it’s part of solving big problems.”
Shared Lessons
Dr. Cohen, the twentieth Director of the Centers for Disease Control and Prevention and former North Carolina Secretary of Health and Human Services, shared lessons from leading the public through some of the most consequential public health events in modern history, including Medicaid expansion efforts, implementation of the Affordable Care Act, and the COVID-19 pandemic.
Reflecting on recent efforts by state governors and others to launch independent public health groups to evaluate and recommend vaccines in place of the CDC, Cohen emphasized that these actions underscore a growing need to engage thoughtfully with the political process rather than avoid it.
“Building consensus and trust is worthy work—and it’s part of solving big problems,” she said, noting that public health progress depends not only on scientific rigor but also on the ability to bring stakeholders together around shared goals.
Finding Places of Consensus
Describing her unexpected entry into North Carolina leadership in 2017 when Governor Roy Cooper appointed her to lead the state health department, Dr. Cohen recounted how she approached legislators on both sides of the aisle with no preconceived alliances to better understand their priorities and find places of consensus.
The approach led to bipartisan collaboration on the opioid crisis and, ultimately, North Carolina’s successful seven-year effort to expand Medicaid. “Advocacy is not a one-day activity,” emphasized Dr. Cohen, currently a national advisor for Manatt Health. “You wake up every day and return to your North Star.”
Reflecting on the COVID-19 pandemic, Dr. Cohen described North Carolina’s communications strategy as foundational to the state’s relative success with daily press briefings, real-time public data dashboards, and “radical transparency,” helping to maintain public trust.
“We always said: This is what we know. This is what we don’t know. We’ll be back tomorrow,” she said, adding that making people feel seen and heard is key.
Cohen, whose CDC tenure centered on modernizing data infrastructure and strengthening collaboration with private laboratories to accelerate nationwide testing capabilities, underscored that trust within institutions, between leaders, and with the public is critical in crisis response.
A Worthy Fight
“Leadership begins with explaining the why,” she said. “People are feeling a lot of economic pressure, so thinking about how we reduce health insurance costs for about 15 million people. So, that feels like a worthy fight.”
Academia has an important role to play in ensuring that people continue to be trained and good evidence is generated and analyzed, Cohen added.
“I see talent in this room and in many that I've been working with, so I know we'll be able to navigate through this but it has to be for building a future where I hope public health and health delivery are much more integrated into one unified vision of what we need for our communities to be healthy,” she said.
Responding to an audience question from a young HIV health services researcher about how junior faculty, or even academic institutions, can develop responsible partnerships with the private sector to achieve ethical, need-based public health solutions, Cohen noted that such conversations are already happening.
She cited Duke Clinical Research Institute as an excellent model of such successful partnerships.
“Those are the kinds of models that I would like to see, where you create a governing board that involves the community with needs assessments that inform priorities,” she said. “They want something, we want something. Together we can build something, but you need to go into it with the principle of saying here's how we're going to govern and allow those partnerships to have guardrails.”
Watch the Recording
See the Department of Medicine Photo Album