Last March, I met Oswald “Oz” Hutton. Oz, a Marine Corps veteran, was one of 250 veterans participating in the new health initiative through the VA Salt Lake City Health Care System. The program, called Food is Medicine (FIM), is an attempt to revolutionize the way our health care system treats diet-related diseases, like the hypertension Oz had struggled with for years. For Oz, his hypertension was more than just a health threat — it also constantly strained his body and his bank account. Food is Medicine promised to be an answer to both those problems.
The main idea is straightforward: Rather than alleviating patients’ symptoms with medication, FIM aims to address chronic illnesses like hypertension, diabetes, obesity and heart failure at their root cause — diet. What makes the idea novel is that Food is Medicine goes beyond just telling people how to eat better. It makes eating better more affordable and accessible by treating food access as a medical intervention, integrated into the health care system itself. Through nutrition support like produce prescriptions, medically tailored meals and healthy grocery programs, FIM aims to make health more accessible and affordable to more people than ever.
For Oz, the program was a way to take back control of his health, his life and his future. “By eating better, I have energy,” the Salt Lake City resident told me. “Now, when I go outdoors, I want to stay outside and do things.” The program provided practical support — a monthly $100 debit card that Oz could use on fresh produce at his local grocery store — but the financial benefits extended far beyond groceries. After six emergency room visits in 2024, Oz told me the program had helped him stay out of the ER for the past three months.
Oz’s story is remarkable, but it is not unique. A growing number of people across the United States are finding a new pathway to health through FIM, and models based on current research show that if FIM services were scaled to all eligible Americans, it could save an estimated $23 billion in health care spending per year. That’s why, in 2024, The Rockefeller Foundation, which I lead, made a $100 million commitment to help expand Food is Medicine across the nation — and in particular help veterans like Oz — as part of a broader $220 million investment in expanding access to good food.
FIM has the potential to turn the tide on the country’s diet-related disease crisis. It could empower health providers with a concrete tool to help patients take control of their health. It may change how people talk and think about health in the United States, what is making us sick and what we can do about it. It’s a chance to solve a challenge by reimagining what is possible.
It’s what I call a “Big Bet.”
Escaping the aspiration trap
Too often, people end up feeling so helpless in the face of big, tough challenges that, rather than setting out to address root causes, they look for answers to only a small part of the problem. Some people even give up altogether. This is what I call the “aspiration trap.” It’s why, instead of going big enough, would-be world-changers settle for doing good enough. It’s also the reason so many have grown cynical, detached or apathetic toward the idea of progress.
Big bets offer us a way to escape that trap. Because they require setting profound, seemingly unachievable goals and believing they are achievable, they often reveal new ways of thinking or doing that were previously unimaginable. They also stir others to act alongside you. People are looking for a reason to be optimistic, to believe in a future where their children will have more access to health, wealth and opportunity than they had. The bigger your goals, the more likely you are to gather allies and supporters, and the more likely you are to succeed.
Regardless of the scale of the issue, the principles of making any big bet are the same: They require finding a new way of thinking or doing things — often inspired by a technological advance or a novel method. They require developing broad alliances, often among unlikely partners, that can summon sufficient resources and diverse capabilities to break through the barriers that so often limit social progress. And they require taking a data-driven, businesslike approach by focusing on measurable outcomes and finding the most efficient, effective pathways forward.
Those three elements — innovation, partnership and persistence — have been at the heart of every successful initiative I’ve encountered over my 30-year career in government, the private sector and philanthropy. They are what set apart those who have improved life for countless millions of people from those who fizzled out.
The big-bets approach to philanthropy isn’t something I came up with — it’s an idea built into the DNA of The Rockefeller Foundation by John D. Rockefeller when he founded our institution in 1913. Back then, he had a different name for it: “scientific philanthropy.” This idea was novel, even revolutionary, at a time when both “science” and “philanthropy” were unproven paths to progress, let alone as a combined concept.
John D. Rockefeller’s philanthropy didn’t seek to better a few lives with charity. He saw the potential for science to create change on a vast scale, from ending hunger to wiping out disease, and he and his successors have sought to follow through on that vision. Even though those challenges still exist today, I would argue that the change they achieved was far more sweeping because they set out to solve problems rather than settle for incremental improvements.
Too often, people end up feeling so helpless in the face of big, tough challenges that, rather than setting out to address root causes, they look for answers to only a small part of the problem.
One of The Rockefeller Foundation’s earliest initiatives — combating hookworm disease in the American South — demonstrated the power of this new approach. What started as a targeted health intervention became the foundation of the United States’ entire public health system, proving that, by thinking big enough, it’s possible to reshape society for generations.
To set the scene: Between 1865 and 1910, an estimated 40 percent of the population in the American South suffered from hookworm disease, a parasitic infection that stunted growth, caused extreme fatigue and made victims more prone to other infections. The disease was so widespread and debilitating that some claimed the sluggishness it caused was a factor in the South’s defeat in the Civil War. But for decades, most people were either entirely unaware of hookworm or simply accepted it as a fact of life, even as it took its toll on economic development, reinforced poverty and reduced educational performance for generations of children.
For John D. Rockefeller and his adviser, Frederick Gates, hookworm was an opportunity to put scientific philanthropy to the test. As Gates put it, “disease is the supreme ill in human life.” If they could take an innovative approach to solving a disease like hookworm, they could prove their theory while also helping current and future generations of Americans. Their proposed solution was unprecedented: a coordinated campaign to treat hookworm patients, educate communities on methods of prevention and build health infrastructure to prevent reinfection.
Their approach may seem familiar today, but at the time it was a revolutionary, innovative approach to a long-standing problem. The foundation built partnerships to establish new health agencies in the region and made data-informed decisions on where, when and how to act. Before The Rockefeller Foundation’s hookworm work, concepts like community-level health agencies, data mapping and targeted health education campaigns were not widely developed or institutionalized anywhere. And even though hookworm remained problematic in the American South for years to come, that first big bet pioneered something that would eventually eliminate it and countless other ailments worldwide. Today, we call that something “public health.”
Ultimately, the foundation’s work provided an early model for health systems that have been vital in fighting everything from yellow fever to Ebola to Covid-19. It set the stage for the United States’ county-based health system and even influenced the establishment of early predecessors to the Centers for Disease Control and Prevention.
That’s the magic of a big bet. When you show others what’s possible and give them a reason to be optimistic for the future, they’ll be inspired to follow in your footsteps. That’s how the seed of an idea grows into something tangible, lasting and transformative.
Today’s biggest health threat
More than a century later, Americans face another health crisis that demands the same kind of thinking that Rockefeller and Gates used to take on hookworm. But the most significant health threat facing us today isn’t any parasite, virus or bacteria — it’s our diet.
Diet-driven diseases like diabetes, obesity and heart disease affect an estimated 133 million Americans and contribute to 500,000 deaths every year, with veterans like Oz being impacted at an even higher rate than the general population. And even though Americans spend more per capita on health care than any other developed country, we still fall far below average in terms of health outcomes. The result is a national $1.1 trillion health care bill for diet-related diseases — an amount equal to the money Americans spend annually on food.
Just as the hookworm campaign reimagined health as a community challenge rather than an individual one, our big bet on Food is Medicine demands we think beyond treating individual symptoms to addressing the barriers that prevent people from eating well.
That work is paying off and still building momentum: FIM has now expanded to 14 states and reached over 100,000 patients to date. At the same time, we are continuing to support the American Heart Association’s vital research into the benefits of FIM interventions, and, in partnership with the United States Department of Veterans Affairs, we’ve helped launch five veteran-focused FIM pilots — including the one Oz joined in Salt Lake City. Veterans face particularly acute health challenges: 75 percent of Afghanistan and Iraq war veterans were overweight or obese at their first Veteran Health Administration visit, and diabetes affects nearly 25 percent of veterans compared to 20 percent of the general population. Those pilots were a way to both put FIM to the test and to reach a population disproportionately affected by diet-related illness.
Regardless of the scale of the issue, the principles of making any big bet are the same: They require finding a new way of thinking or doing things.
The results show promise: Participating veterans have reported improved physical and mental health, as well as a greater appreciation for nutritious food. Some have even started gardens to grow their own produce (“Who knew that I would learn to love beets?” one of them joked). That enthusiasm isn’t unique to veterans. Our data show that nearly 90 percent of Americans would prefer to rely on healthy eating, rather than medications, to manage their health, and almost 4 in 5 thought FIM interventions should be covered by both public and private insurance.
The demand is clear, but scaling our big bet on FIM will require us to continue broadening our research base and building bigger partnerships. Pilot programs are the first step, and we are still working to bring employers, insurers and state and federal governments on board, too. That will take time and effort, but the long-term value is worth overcoming short-term difficulties.
Americans will lead happier, healthier, longer lives. Employers and governments will save money. Even insurance companies should see the light: After all, paying for broccoli is cheaper than paying for a heart bypass operation.
Why big bets matter
The hookworm and Food is Medicine campaigns are just two examples of how approaching a problem through the lens of big bets — with innovation, partnerships and data — can solve problems. But the reason I’m telling you about them isn’t to suggest that you need to launch your own hundred-million-dollar initiative. After all, there is practically no one in history with access to the resources of John D. Rockefeller. I’m sharing them with you to show you a fresh, optimistic perspective on what’s possible when we refuse to accept problems as permanent. What matters isn’t the money — what matters is your ambition and belief that large-scale change is possible.
Looking at the world, there is no shortage of problems that need big bets and big bettors like you. Anyone from an intern to a president in any organization — banks, government agencies, universities or community groups — can benefit from the big bet mindset. In fact, you have unprecedented power to do so.
We are living in one of the most innovative moments in history. Every day, we hear of breakthroughs in science, technology and social understanding, to name just a few. Since the Industrial Revolution, innovations have created incredible opportunities for so many people, even as far too many are left behind. Big bets are the way to ensure that modern advancements benefit all, not just the lucky few. As we embrace those revolutions, it’s up to each of us to ask ourselves: Will we allow them to widen or shrink the gaps in human opportunity?
Our challenges and problems persist not for a lack of answers or the capacity to generate them; they persist because we too often fail to try. Just as Oz discovered that changing his thinking toward food could transform his entire life, you might find that thinking bigger about our world’s challenges opens possibilities you never imagined.
Rajiv Shah is president of The Rockefeller Foundation, a global institution with a mission to promote the well-being of humanity around the world.
This story appears in the October 2025 issue of Deseret Magazine. Learn more about how to subscribe.