I have been laid off and looking to pivot industries. I don't want to hurt my chances of getting a job, but would I be less likely to love forward in an interview if I'm honest and say I'm actually looking for X? Want to pivot out of health and into CSR/environment/impact

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I believe this would be based on the nature of the position you are interviewing for. If you are interviewing for another health-based position with an organization that does not also have the type of opportunities that you would like to grow into, you would likely send them the message that the position would just be a short-term placeholder for you until you find what you are really looking for. No one wants to invest in avoidable turnover. On the other hand, if you are in the situation where you are interviewing for something related to your future goals, be prepared to explain (positively) why you are driven towards those industries and how your past experiences, knowledge and personal strengths have prepared you for success in the new arenas. Industry specifics can be taught. Sales methodology can be taught. Passion and drive are the gold standard in a good company representative, and a good leader will see the value in your foundational skills if you have the kind of drive that they can’t teach. Best wishes to you in your pursuits.

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With strong references, an agency may be willing to take a chance and train you into a new capability

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