In this discussion, Dr. CJ Kunnappilly, CEO of San Mateo County Health, emphasizes the critical importance of leadership clarity and strategic focus in public health. He reflects on his journey from a physician prioritizing patient care to a CEO recognizing the need to delegate operational tasks and fully embrace his role as a strategic leader. Kunnappilly highlights the balance required at all organizational levels, where operational excellence supports, but does not overshadow, the broader goal of developing forward-thinking strategies. Dr. Kunnappilly highlights the need for a long-term vision and the integration of strategy with daily operations to achieve meaningful improvements in patient care and organizational efficiency. He also discusses the shift from being a provider of last resort to focusing on equity and addressing societal barriers like food insecurity and language access.