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At the beginning of the 21st century, multiple and diverse social entities, including the public (consumers), private and nonprofit healthcare institutions, government (public health) and other industry sectors, began to recognize the limitations of the current fragmented healthcare system paradigm. Primary stakeholders, including employers, insurance companies, and healthcare professional organizations, also voiced dissatisfaction with unacceptable health outcomes and rising costs. Grand challenges and wicked problems threatened the viability of the health sector. American health systems responded with innovations and advances in healthcare delivery frameworks that encouraged shifts from intra- and inter-sector arrangements to multi-sector, lasting relationships that emphasized patient centrality along with long-term commitments to sustainability and accountability. This pathway, leading to a population health approach, also generated the need for transformative business models. The coproduction of health framework, with its emphasis on cross-sector alignments, nontraditional partner relationships, sustainable missions, and accountability capable of yielding return on investments, has emerged as a unique strategy for facing disruptive threats and challenges from nonhealth sector corporations. This chapter presents a coproduction of health framework, goals and criteria, examples of boundary spanning network alliance models, and operational (integrator, convener, aggregator) strategies. A comparison of important organizational science theories, including institutional theory, network/network analysis theory, and resource dependency theory, provides suggestions for future research directions necessary to validate the utility of the coproduction of health framework as a precursor for paradigm change.

In this final chapter, we explore the ever-evolving 21st century landscape where ethics drive community development toward resilience and progress. Drawing inspiration from the subheadings mapping our journey, we traverse international case studies spanning Canada, Brazil, Sweden, Kenya, China, Australia, Antarctica, and India. Through these global insights, we uncover the impacts of dynamic forces on communities worldwide, navigating ethical dilemmas and opportunities. We present strategies tailored to diverse continent-specific needs, explore inclusive governance models, and highlight the transformative power of ethical engagement. This journey underscores the vital role of resilience and concludes with a global call to embrace ethical approaches for inclusive community development and a sustainable future.

The purpose of this chapter is to highlight how universities got into the predicament in which they currently find themselves in, or somewhat planned to be in, in the 2020s. The historical account outlines the purpose of higher education and who it was for throughout the last few centuries, before a more in-depth analysis of the last few decades will highlight how, and why, neoliberal and subsequently managerial aspects of leadership and performance metrics crept into universities before an analysis of the last 5–10 years, including the onset and consequences of COVID, will demonstrate that many ‘COVID recovery plans’ around staff cuts and course reforms were already in place before COVID, but it was COVID that allowed these plans in most cases to be escalated.