What role do futurists play in the world of health care and health policy? From the term itself, one might expect futurism to be about extrapolating from the present to predict the future. This type of futurism certainly exists. Writers and artists use it to capture our imaginations about where technology or humankind is headed, whether it is a Star Trekkian utopia or the dystopian aftermath of unchecked climate change or nuclear war. In health care and other sectors, artificial intelligence is both lauded as wonderous development with significant benefits and painted darkly as unsafe or causing economic displacement.
But this is a limited and not very useful application for futurism. A different approach is actually providing important, practical insights to leaders working to shape productive organizations and policies. At a recent conference in Barcelona hosted by the Commonwealth Fund and supported by the Financial Times to celebrate the 100th anniversary of the Harkness Fellowships in Health Care Policy and Practice, Canadian health futurist Zayna Khayat led a session exploring “strategic foresight” and its implications for health policy, public health, and health care delivery. In the midst of dramatic, disruptive change for health and science in the United States, could strategic foresight help health policy and health research leaders manage uncertainty and proactively work toward a different future? AcademyHealth's participation in this conference reflects the organization's recognition that learning from international contexts and diverse global perspectives is essential for improving the U.S. health care system.
What is Strategic Foresight?
With historical roots in military planning, strategic foresight can be applied to whole systems like health care or specific organizations such as a school of public health. It uses a variety of inputs and tools to identify less obvious signals and potential disruptive changes that could lead to various potential futures—a range referred to as the “cone of plausibility.” Strategic foresight distinguishes among (1) possible futures, which are speculations of what may happen based on some early indicators; (2) probable futures that could come about in approximately ten years based on current knowledge and precedents; and (3) preferred futures that reflect the values and agendas we seek to bring about. Strategic forecasting is about gathering the data needed to articulate these multiple potential futures and the opportunities and challenges they may create. The ultimate goal is to help policymakers and organizational leaders adopt policies and mobilize joint action now that prepares for and helps create a preferred future of values-based aspirations.
In a recent report, Vinnova, a government agency in Sweden that supports innovation and sustainable growth, identified three key components of strategic forecasting:
Using “horizon scanning,” “scenario planning,” and other methodologies to better understand and prepare for potential futures. While horizon scanning is a process of continuously collecting and analyzing data to identify large trends, “weak signals,” and unexpected events, scenario planning uses that data to create specific, plausible, and possible futures.
Creating a more widespread capacity to do this work through training, dedicated organizational units like Vinnova, and other investments. Sometimes referred to as “futures literacy,” this capacity includes an embrace of uncertainty and comfort with acting under such conditions, the ability to creatively imagine what might be, a mindset that considers the interconnected components of whole systems rather than individual phenomena, and an understanding that small and seemingly insignificant ideas and trends today could quickly grow to have major impacts.
Ensuring the full participation and collaboration of the broadest spectrum of stakeholders to achieve legitimacy and bring together the multiple perspectives needed to identify and implement effective strategies.
Strategic Foresight and Health Care Research, Policy and Practice
The Commonwealth Fund’s Harkness Fellowship draws talent and perspectives from many countries, and this diverse pool of international perspectives made the discussions in Barcelona both lively and productive. Harkness provides health policy professionals opportunities to learn in the United States and take those experiences back to their home countries. For the Americans in the audience in Barcelona, however, the conference highlighted some of the ways we too can learn from our peers abroad. The strategic foresight session demonstrated that such learning shouldn’t be expansive, including not only the outcomes of policies and programs, but also the tools and frameworks used to develop them. While strategic foresight is currently used by a variety of public and private organizations in the United States, other countries have made this approach routine and prominent in developing health policy and public health initiatives. For example:
For many years, the Netherlands has used strategic foresight to inform its national policies around health and prevention.
The Australian Parliament is currently considering legislation that would institutionalize the use of strategic foresight in developing policies that promote the well-being of future generations.
Strategic foresight has recently been used by stakeholder groups to promote forward-looking public health, prevention, and health equity policies within the European Union.
The European Union itself has used strategic foresight through its Centre for Disease Prevention and Control to prepare for future public health challenges.
Over the last year, the pace of change in U.S. federal health and science policy has been dizzying and disruptive, creating a need for health policymakers and health services researchers to understand the here and now. But this departure from the status quo will ultimately present an opportunity to work toward a new future, including one in which research is relevant, valued, equitable, and used in health care policy and practice. Strategic foresight could provide a systematic approach to working through the complexity of this challenge and the large number of unknowns. It also provides a way to think about the future now, rather than when it is upon us. Better understanding the application of this tool in other countries could provide a good place for would-be American health policy futurists to start.