Transformation Does Not Come From Comfort—It Comes From the Courage to Disrupt

Dr. Carmen Capo-Lugo PT, PhD was one of the ignite speakers at the 2024 Education Leadership Conference and received a standing ovation for her talk. We invited Dr. Capo-Lugo to write the guest editorial for the March issue of the Journal of Physical Therapy Education and share her insight with our readers—Dr. Keshrie Naidoo. I want to start by acknowledging Oakland—historically, a hub for health activism. This city has been the backdrop for passionate activism that ignited radical change for decades.1 The spirit of Oakland is about more than just movements; it is about disrupting comfort zones to dismantle inequality. And that ties directly into our discussion today on health system science. As I prepared for my talk here today, I realized something troubling: while our profession has engaged with health system science components, we have done so only at the surface level. We talk about it, but we have not truly embraced it. And that is dangerous. If we continue our path, we will continue to perpetuate disparities in care and limit our ability to truly transform society. To embrace health system science,2 we need to look deeper—not just at the components or strategies but at 3 implicit forces: context, culture, and community. And I want us to acknowledge something hard: We are not all in the same boat. We are not all in the same storm. In fact, some of us are not even in a storm at all. Some are coasting in still waters, while others are drowning. Let that sink in. If we do not address this, we will keep making decisions that work for some and devastate others. Let us talk about context. Do you have a deep enough understanding of your own context to create real transformation? Let me share mine—I am a neuroscientist, a health services researcher turned department chair in Puerto Rico. I went back home because I knew transformation was not just needed—it was overdue. Puerto Rico is resilient, yes, but it is also struggling. If Puerto Rico were a state, it would be among the poorest in the United States.3 There is no direct access for physical therapy services, autonomy is a pipe dream, and we take the National Physical Therapy Examination in English, although our practice is primarily in Spanish. We talk about equity through health system science, but this… this is inequity baked into the system. So, I ask you: How does your context shape the change you are pushing for? Because if we do not confront the hard realities of our own environments, we are just spinning wheels. We cannot implement a curriculum that embraces health system science if we are afraid to engage with the systemic injustices staring us in the face. Now let us talk about culture. Are we nurturing cultures that truly embrace change? Real change—not the comfortable kind, but the radical, disruptive kind. The kind that makes people uneasy. I knew we could not build a transformative program in Puerto Rico without first shifting the culture. We hired faculty and staff who understood our context. We prioritized adaptability and innovation over academic experience. We needed people who could be agents of radical change, including our students. But let us be honest—most academic institutions are not built for that. They are built to maintain the status quo. And maintaining the status quo means maintaining inequities. It means some of us will always have more power, more privilege, more voice than others. So, what about your culture? Is it truly open to new ideas? Is it really willing to challenge the status quo? Or is it just paying lip service to innovation while preserving comfort for a select few? And finally, community. Are we building truly inclusive communities? Or are we just recreating silos of privilege? Community is about reaching beyond our university walls and engaging populations that do not look like us, do not sound like us, and do not have access to the opportunities we do. It is about bringing in voices that are not traditionally heard—the ones who will challenge us the most. I am here today because of a community that refused to accept the status quo. Our fully bilingual DPT program in Puerto Rico is a direct result of partnerships that challenged conventions and conspire for something better. We are developing students and faculty who will not just thrive within the current system; they will reshape it. But this does not happen without discomfort. Without acknowledging the deep inequities that run through our profession. Without actively creating spaces for those who have been marginalized to step in and lead. Closing As I mentioned earlier, Oakland holds a special place in the fight for justice. Fifty-eight years ago, the Black Panther Party was founded here, boldly declaring health as a right, not a privilege.4,5 That fight still goes on. Health system science is part of that fight, but it will not solve the problem unless we confront the deeper, systemic forces that shape our journeys. We are not all in the same boat, nor the same storm. But we are all striving for the same destination—a transformed society. Let us remember: Transformation does not come from comfort. It comes from the courage to disrupt.