Public health has endured severe federal and state funding cuts over the last several years, creating major fiscal pressures on the public health system. Given the multiple uncertainties facing public health, four potential eventualities (scenarios) are presented below.
Overview of Four Possible Scenarios
Using the Aspirational Futures approach and supportive research, the Institute for Alternative Futures (IAF) developed four alternative scenarios describing where public health may go over the years to 2030.
- Scenario 1: One Step Forward, Half a Step Back – Scenario 1 imagines a future with continued fiscal constraints where public health agencies and health care are only able to slowly advance their capabilities. Many try to use automation and advanced analytics to improve services and community and population health. However, there is great variations in technological capabilities, funding, and approaches to prevention – along with a continuous rise in health care costs – significantly limiting public health gains.
- Scenario 2: Overwhelmed, Under-Resourced – Scenario 2 imagines a future with continued funding cuts and a hostile political context that undermines the role of public health agencies; thus, public health crises grow worse and more frequent. With a shifted focus from public to private sector initiatives, significant innovations for health and wellness occur; but, these primarily benefit the middle-class and affluent groups. Therefore, technological, economic, educational, and health disparities grow, and the institutions of public health have little capacity for doing anything about them.
- Scenario 3: Sea Change for Health Equity – Scenario 3 imagines a better future where national and local economies gradually grow, and changes in values and demographics lead to “common sense” policies and support for health equity. Public health agencies develop into health development agencies that use advanced analytics, gamification, and diverse partnerships to identify problems and opportunities, and catalyze and incentivize action to improve community health. It is imagined that this approach would decrease disparities persist, and provide greater opportunity for good health through quality improvements in housing, economic opportunity, education, and other social determinants of health.
- Scenario 4: Community-Driven Health and Equity – Scenario 4 imagines a re-invention of public health where public health agencies, partners, and local health improvement initiatives coalesce via technology and social media into a national web of community health enhancing networks. These networks will help communities exchange their innovations and best practices, and leverage the expertise of public health agencies and others. It imagines a shift to equity via new community economic models that help households sustain themselves and improve health and wellbeing. In this scenario, public health sheds many of its traditional functions and facilitates community and systemic movements to improved health.
Learn more at: Public Health 2030 Report.
Lake Cumberland District Health Department utilizes elements of both scenarios three and four, Sea Change for Health Equity; and, Community-Driven Health and Equity. We aspire to utilize data to help us truly become our communities’ “chief health strategists” while facilitating Community Health Improvement Plans. For more information on these efforts, visit LCDHD: Health Assessments, Analyses and Statistics.