How are You Going to Pivot? - Part II

In 20th-century America, private‐sector physicians were paid for treating disease—through surgery and drugs—rather than preventing it. As a result, health promotion and disease prevention became the realm of public health. Private wellness services existed, but at spa-level prices few could afford.

Now, the 2nd Trump administration is shifting health-care governance toward Federalism, consumer choice, free markets—and away from federal public-health funding.(1) This upheaval will upend the health-promotion marketplace, creating openings for whole health providers—but only if they adopt new business models. I discussed pivoting to these changes in Part I of this blog. Here in Part II, I’ll contend that the key to pivoting successfully is to “go local.”

Why Whole Health Matters

People who eat well, stay active, sleep sufficiently, manage stress, nurture social ties, and avoid substance misuse are far more likely to enjoy good health, low chronic-disease burden, and extended lifespans—often into their 80s, 90s, and beyond. In many cases, lifestyle changes alone can reverse chronic conditions, eliminating the need for ongoing medications.

Yet only a minority embrace the logic and make drastic changes—quitting smoking, adopting plant-based diets, carving out exercise time, and so on. Most struggle, in part because their social environments don’t support change. Effective whole health adoption usually requires substantial guidance and encouragement.

The Tech-First Temptation

Investors and “technocrats” naturally gravitate toward internet-based solutions: synchronous and asynchronous online coaching, wearables and IoT data, remote staffing, machine learning–driven personalization and vast data warehouses. But is technology itself the best path to healthy living, or merely a way for investors to maximize profits?

Reviews give mixed feedback on digital wellness platforms.(2,3,4,5,6) Users appreciate convenience but often criticize one-size-fits-all programs, under-qualified coaches, billing hassles and clunky interfaces. While younger users embrace high-tech, the question remains: does a virtual approach truly help people flourish?

Social Connectedness Is Key

Research—including the Global Flourishing Study—confirms that social ties are crucial for thriving.(7) Whole-health practitioners should capitalize on this human need by forming locally based coalitions of employers, practitioners, community organizations and municipal bodies. These stakeholders share a vested interest in boosting their citizens’ health and well-being.

The “Go Local” Strategy

Here’s why locally grounded whole-health services outperform distant, tech-only models:

Health Happens in the Moment, Locally
Every lifestyle choice—what we eat, how we move, whether we relax or stress-out—is made in real time, in our immediate environment. A community culture that promotes healthy norms creates constant, real-world cues and support.

Face-to-Face Encounters Amplify the Sense of Caring
Behavior change is driven more by emotion and connection than by knowledge of facts. A single in-person meeting with a trusted coach or peer in an interest group can ignite motivation in ways a screen can’t replicate. Change is scary; human connection and community support make it feel achievable.

Blended Delivery Meets Diverse Needs
While in-person contact is powerful, telephonic and asynchronous options offer convenience and lower cost. A local team can provide all three: face-to-face when needed, phone check-ins for ongoing support and self-paced digital materials for independent learners.

Stronger Physician Collaboration
Local whole-health staff can coordinate seamlessly with patients’ primary-care physicians. Physicians lend moral authority and clinical insight, even if their responsibilities force them to delegate most lifestyle coaching. Wellness programs that ignore the doctor–patient relationship miss a vital source of encouragement.

Deep Community Insight
Coaches and providers who live in—and know intimately—their community’s built environment, culture and resources can nudge clients in ways outsiders can’t. They know the best walking routes, affordable farmers’ markets, local support groups and can provide friendly face-to-face handoffs to other services. AI and remote vendors can’t match that nuance.

Economic Reinforcement
Hiring local talent keeps dollars circulating within the community, creating jobs and retaining young people who might otherwise move away. In contrast, every dollar spent on distant vendors is wealth that gets permanently extracted from the local economy. Nearly every town—except the most isolated—can assemble a competent whole-health coalition with, in part, an eye on their community’s economic stability. 

Maximize Flourishing Through Social Capital
The ultimate goal of whole-health services is to help individuals flourish. Strong social bonds—rooted in shared local identity and mutual support—are the single best engine for lasting behavior change and well-being.

Conclusion

The current policy shake-up and marketplace disruption aren’t just challenges—they’re opportunities to redesign health care around real human needs. A “go local” strategy leverages proximity, personal connection, physician support and economic reinvestment to foster thriving communities. Health truly happens where people live their lives. There has never been a better time to invest in locally anchored whole health services.(8)

If you’ve liked this viewpoint, contact us. TrueNorth is pointing the way.

Geoffrey E. Moore, MD FACSM

Citations

1) Hunzinger G, et al. President Donald J. Trump’s healthcare agenda: flexibility and choice, fiscal conservatism, public health reform and deregulation. PwC’s Health Policy and Intelligence Institute. February, 2025. https://www.pwc.com/us/en/industries/health-industries/library/election-2024-trump-health-agenda.html

2) Chew HSJ, et al. Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes. J Med Internet Res 2022;24(9):e40141.  doi: 10.2196/40141

3) Better Business Bureau. Business profile of Noom, Inc. https://www.bbb.org/us/ny/new-york/profile/health-and-wellness/noom-inc-0121-150555/complaints

4) Sassos S. What is the Noom diet? What to know about Noom Weight, plus its cost. Good Housekeeping, Nov. 30, 2022. https://www.goodhousekeeping.com/health/diet-nutrition/a26023584/noom-diet-plan-review/

5) Rash W. Best weight loss apps in 2025, tested by our editors. CNN Underscored, Jan. 8, 2025. https://www.cnn.com/cnn-underscored/reviews/best-weight-loss-apps

6) Wolters C. 7 best weight loss apps, according to experts. US News & World Report, Jan. 17, 2024. https://health.usnews.com/wellness/articles/best-weight-loss-apps

7) Global Flourishing Study. What contributes to a life well-lived? Gallup, Washington, D.C., 2025. https://globalflourishingstudy.com/

8) Cordina J, et al. Engaging the evolving US healthcare consumer and improving business performance. McKinsey & Co., published online, March, 2025. https://www.mckinsey.com/industries/healthcare/our-insights/engaging-the-evolving-us-healthcare-consumer-and-improving-business-performance

All sites accessed 05/04/25