In The New York Times bestseller The Boy, the Mole, the Fox and the Horse, Charlie Mackesy’s characters remind us that the wild is a bit like life—noting that although life is sometimes frightening, it is also beautiful; that silence can hide pain; and that strength is often found in gentleness. As I navigate today’s public health challenges, I find myself returning to these pearls—simple truths that can guide us in complex times.

Sometimes just getting up and carrying on is brave and magnificent. –The Horse¹

A Reckoning in Health Care

Health care in America is in the midst of a deep and difficult period of confronting past failures, injustices, and systemic problems, such as racial disparities and unsustainable administrative burdens. Driving significant change toward greater equity, efficiency, and trustworthiness in our system requires acknowledging harm, understanding its historical roots, and taking concrete steps to establish accountability and seek lasting solutions.

Historically, the United States has served as a leader in global public health, yet today our institutions are strained. The best example, the CDC, faces significant budget cuts and mass layoffs, shifting philosophies and leadership turmoil, and even violence against its workforce. Nevertheless, at public health institutions across the country, people are still working tirelessly to prevent disease and improve public health. This work is groundbreaking, lifesaving, and essential to improving the health of our nation and beyond. For decades, US global health agencies and institutes have addressed global health disparities. Recently, however, leading medical organizations have warned that erosion of trust and resources leaves us vulnerable to future crises across the globe. It is thus vital to rebuild trust and deliver new resources. “Trust helps assuage doubt,” wrote a surgeon and public health adviser in a CBS News interview last Sunday, while cautioning that chaos and uncertainty dissolve it.²

Still, progress is undeniable. From curing once-fatal childhood leukemias to eliminating smallpox and polio, American public health has markedly improved our survival. Mortality rates for children have fallen by more than 75% since 1950. Diseases once deemed incurable—HIV, many cancers, hepatitis C—are now manageable or curable. And although inequality, rising costs, and institutional mistrust have eroded these gains, we must remember not to “burn down the house,” but instead to repair what works—our research, prevention, regulation, and educational efforts—while addressing weaknesses with thoughtful reform.³

Everyone is a bit scared…. But we are less scared together. –The Horse¹

Key Areas of Reckoning

To regain trust, several key areas need to be addressed:

• Racial disparities and inequities: confronting inequities rooted in systemic racism
• Administrative burden: reducing inefficiencies that drain provider energy
• Moral and ethical challenges: addressing clinician moral distress
• Health care costs and affordability: making coverage sustainable and care affordable
• Communicating uncertainty: building trust by openly addressing unknowns

Process of Reckoning

A reckoning typically involves several stages⁴:

• Acknowledging harm: openly recognizing past wrongs and the harm caused
• Understanding the system: investigating the policies, structures, and historical factors that have contributed to problems
• Promoting accountability: taking responsibility and establishing mechanisms for accountability
• Implementing solutions: developing and implementing changes to prevent future harm and create more equitable systems
• Engaging in dialogue: fostering dialogue and intentional learning to drive proactive and deliberate change

When have you been at your strongest? –The Boy

When I dared to show my weakness. –The Horse¹

Medication Access: A Persistent Crisis

Redress and restitution for countless inequalities is necessary and especially urgent to address the medication access crisis in our nation. A young colleague’s recent post about patient access to guideline-directed medical therapies for heart failure ignited passionate responses on our Cardiology PRN Community platform. This was later echoed by numerous attendees at an ACCP Town Hall. Medication access remains a daily barrier, adding to pharmacist workload and limiting patient care.

This crisis will not fade—it will only deepen. I find myself asking: Am I ready for this challenge? How can I equip myself to navigate it?

I’m so small. –The Mole

Yes, but you make a huge difference. –The Boy¹

Opportunities for Education and Action

ACCP continues to lead in preparing pharmacists to meet these challenges, with offerings grounded in cultural competence, social determinants of health, and health equity. Within this framework, pharmacoequity reminds us that every patient deserves timely access to the right medications regardless of race, socioeconomic status, or geography.

Sessions addressing pharmacoequity at the 2025 ACCP Annual Meeting will include:

• Ambulatory Care PRN Focus Session—Unlocking the Future of Ambulatory Care: Innovations, Challenges, and Opportunities: Saturday, October 18, 2025, from 1:45 p.m. to 3:15 p.m.
• Whole Person Care Is Better Care: A Drive Toward Pharmacoequity: Saturday, October 18, 2025, from 3:30 p.m. to 5:00 p.m.
• BCOP Clinical Session I—Philadelphia-like Acute Lymphoblastic Leukemia: Understanding and Closing a Health Disparity: Tuesday, October 21, 2025, from 8:30 a.m. to 10:30 a.m.
• Health Equity PRN, Pulmonary PRN, and Women’s Health PRN Focus Session—Breathing for Two: Providing Equitable Care for Pulmonary Health in Birthing Parents: Tuesday, October 21, 2025, from 10:15 a.m. to 11:45 a.m.

In the past, the ACCP Academy’s Comprehensive Medication Management Implementation Certificate Program also offered training on optimizing care for medically underserved populations. Although enrollment for this program has now closed, the activity Successful Models of Medication Optimization for Medically Underserved and Disadvantaged Populations is still available as a standalone program.

These programs not only expand our skills but also affirm our collective responsibility to our patients.

Always remember you matter … you bring to this world things no one else can. –The Horse¹

Meeting the Crisis with Innovation

True change often requires letting go. When guided by clarity and love, this is not failure—it is leadership. Like wildfires that clear space for new growth, health care must release outdated systems to make room for innovation.

Everything in business—products, systems, beliefs—has a life span. Clinging to what no longer works doesn’t make you loyal. It makes you stuck. Numerous companies have led innovation, such as Netflix shedding DVDs to embrace streaming, LEGO phasing out oil-based plastics, and Ford pivoting to electric vehicles. These are not acts of chaos but of courage.⁵

The Art of Blowing Things Up—Lovingly

Before making drastic changes, it is critical to ask, “Am I doing this from a place of wisdom or frustration?” Healthy reform comes from love and clarity, not ego or impatience, and sparks innovation when handled thoughtfully. The key is to destroy what no longer serves you—and trust in what can arise in its place. The 5 steps to “blowing things up”⁵:

1. Identify what is draining you. Identify outdated beliefs, processes, or products that limit progress.
2. Destroy it with intention. Express gratitude and then let go purposefully.
3. Savor the empty space. Appreciate gaps in time and space and their creative potential.
4. Create a better replacement. Choose a new belief, system, or practice that better reflects you and your organization.
5. Set a new norm and empower it. Integrate healthy destruction and encourage feedback and collaboration.

In health care, we too must ask, “What no longer serves?” What outdated practices can we let go of to create space for more equitable, patient-centered systems?

One of our greatest freedoms is how we react to things. –The Mole¹

An Invitation

Consider yourself invited to join me at the ACCP Annual Meeting in Minneapolis to continue to support ACCP’s many efforts to address this crisis. Let’s create opportunity amid the chaos and embrace this cycle of reckoning and renewal. May we have the wisdom, courage, and compassion to destroy what no longer serves us, create space for innovation, and walk together—one step at a time—toward a better health care system that delivers on its promise.

We have such a long way to go. –The Boy

Yes, but look how far we’ve come. –The Horse¹

References

1. Mackesy C. The Boy, the Mole, the Fox and the Horse. Ebury Publishing; 2019.
2. Costa R, Morgan D. Former CDC physicians speak out against new vaccine policies. CBS News. September 7, 2025. Accessed September 8, 2025. https://www.cbsnews.com/news/former-cdc-physicians-speak-out-against-new-vaccine-policies/
3. Carroll AE. American health care gets a lot wrong. Here’s what it gets right. The New York Times. September 7, 2025:SR5.
4. HealthBegins.org. Why health care systems can’t advance health equity without first reckoning with their past. HealthBegins. November 30, 2022. Accessed September 8, 2025. https://healthbegins.org/why-health-care-systems-cant-advance-health-equity-without-first-reckoning-with-their-past/
5. Engelberg M. Why leaders need to destroy the old to create the new. Inc.com. July 19, 2025. Accessed September 8, 2025. https://www.inc.com/moshe-engelberg/why-destruction-in-business-is-critical-to-innovation-and-growth/91210286