Public Health 2030
Clem Bezold
Trevor Thompson
WFS Orlando July 13, 2014
Supported by
grants from:
Introduction
• Public Health is “what we as a society collectively do to ensure the
conditions for people to be healthy.”
...
What Public Health Does
• Prevents Epidemics
• Protects the Environment, Workplace, Housing, Food and
Water.
• Promotes He...
Essential Public Health Functions
• Assessment (Collection and analysis of information to identify
important problems)
– M...
The Public Health 2030 Project
Funded by Robert Wood Johnson & Kresge Foundations
Following Scenarios on Vulnerability 203...
Developing the Scenarios
• Considered key drivers shaping public health
• Developed expectable, challenging, and
aspiratio...
Aspirational Futures: Scenario
Zones
Visionary/Surprisingly
Successful
Expectable
Challenging
7
State & Local PH2030 Scenarios
Fargo Cass Public Health (ND)
Boston Public Health Commission (MA)
Cuyahoga County Board of...
National Public Health 2030
Scenarios
• Scenario 1: One Step Forward, Half a Step Back
Significant advances in big data an...
Scenario Likelihood and Preferability
Poll
Please use the grid below to assess the likelihood and preferability of each sc...
SCENARIO 1: ONE STEP
FORWARD, HALF A STEP BACK
Public Health 2030: A Scenario Exploration
11
Scenario 1: One Step Forward, Half a Step Back
• Public health agencies (PHAs) advance
capabilities in technology and big ...
• Public health funding varies widely; Federal funding
for health care programs reduced as access to
health care improves
...
• Emergence of Big Data
• Improved surveillance
and analysis
• PHAs provide quality
control, some “nudge”
social networks ...
• When possible, PHAs
– Automate inspections
– Enhance population health monitoring
– Improve emergency preparedness
• Som...
• More extreme
weather events
(EWEs) and vector-
borne infections
– E.g. Lyme disease and
dengue fever
• PHAs use simulati...
Triple Aim
Electronic
Health
Records
(EHRs)
• Health care reform largely
implemented
• Expansion of Accountable Care
Organ...
• Health care costs continue to rise as access
improves
• Social determinants not addressed
• No “game-changers”
• Continu...
19
SCENARIO 2: OVERWHELMED,
UNDER-RESOURCED
Public Health 2030: A Scenario Exploration
20
• Severe recessions in
2016 and 2023
• PHA funding
reduced, many
programs eliminated
Scenario 2: Overwhelmed, Under-Resour...
• PHAs blamed for lack of
preparation and
ineffective responses
• Public distrusts PHAs,
federal government in
general, an...
• Distrust grows, people refuse to
get flu shots
• Highly virulent flu strain in 2020
• Tens of thousands of people die
Sc...
• Citizen science and
technology grow but serve
affluent and reinforce
disparities.
• PHA health care services
cut while n...
• “Runaway climate
change” emerges
• Climate refugees and
migrants
• Health, violence, and
discrimination worsen
• PHAs ov...
• PHAs understaffed, overwhelmed.
• Many universities shut down public
health programs.
• Private sector innovations ignor...
27
SCENARIO 3: SEA CHANGE FOR
HEALTH EQUITY
Public Health 2030: A Scenario Exploration
28
• Changes in values and demographics.
• Funding improves for public health.
• Public health pursues advanced analytics,
ga...
• Support for “common sense” policy
• Public support for opportunity, equity, and
fairness in policies and economics
– Nat...
• Public health funding improves
• Economies gradually grow,
reduce fiscal strains and cuts
• PHAs foster additional
resou...
• PHAs become health development agencies,
chief health strategists, shift away from direct
services
• Collaborative
netwo...
• Gaming changes communities’ awareness of
and commitment to achieving health
• New tech developments are made to be
affor...
• Health care improves
• Capitated, effective, accessed
• Primary Care supports
community prevention
• Cuts in Federal $ t...
By 2030,
• Better health and health equity, less demand
for health care
• Improved community conditions, esp. for low
inco...
36
SCENARIO 4: COMMUNITY-DRIVEN
HEALTH AND EQUITY
Public Health 2030: A Scenario Exploration
37
• Health improvement initiatives coalesce via
technology and networks into a broad, national
public health infrastructure....
• Groupnets used to improve
behavioral health at the
micro-level, often through
“peer uplift”
• Community activity &
organ...
• Health records integrated with
other personal and community
data to allow advanced health
analysis and targeting
• Commu...
• Environmental Health
evolves
• PHAs work with
communities, and partners
to reduce environmental
impact and expand
renewa...
• Governments spend less and spend “smarter”
• Unemployment accelerates shift to alternative
economics/new community econo...
• Economic and social
justice movement
progressed
• “Truth and
Reconciliation”
processes spread
• New legislation
promotes...
• Public health graduates are
trained for community
engagement and advanced
analytics
• PHAs serve as effective
chief heal...
45
Scenario 1 Scenario 2 Scenario 3 Scenario 4
MACRO AND OPERATING ENVIRONMENTS
Economy
Fiscal Health
Internet & Social Media...
Scenario Likelihood and Preferability
Poll
Please use the grid below to assess the likelihood and preferability of each sc...
• Reactions, Comments, Questions about the
scenarios?
• What is your sense of the likelihood and
preferability?
Questions,...
Public Health 2030
Recommendations
from the
National Workshop
March 6 & 7, 2014
49
50
Rec 1: Transform Public Health Agencies into “Health Development
Agencies” with Dedicated, Sustainable, and Sufficient
...
Public Health 2030:
A Scenario Exploration
Supported by
grants from:
www.altfutures.org/publichealth2030
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Public Health 2030

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Presented by Clem Bezold and Trevor Thompson

Public health in each city and county in the United States works to ensure the conditions for all to be healthy. Public health investigates disease outbreaks, fosters health promotion and health equity, and assures that health care is available. And it typically focuses on the most vulnerable in the community. There are several forces changing public health—what it does and how it operates. The effects of climate change on local communities, other types of emergencies, future infectious diseases and their surveillance, optimal approaches to health promotion for communities, the role of health care providers in enhancing population health, the state of health equity or fairness—these are among the topics considered in the scenarios. The Institute for Alternative Futures, with funding from the Robert Wood Johnson Foundation and the Kresge Foundation, has developed a national project developing Public Health 2030 Scenarios. This session will present those results.

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Public Health 2030

  1. 1. Public Health 2030 Clem Bezold Trevor Thompson WFS Orlando July 13, 2014 Supported by grants from:
  2. 2. Introduction • Public Health is “what we as a society collectively do to ensure the conditions for people to be healthy.” • Public health is not medical care (though some PHA’s do that); public health has traditionally done what needed to be done that no one else was doing. • There are over 3000 State and Local Health Departments in the United States. • The Who, What, and How of public health is evolving – not always in consistent directions. Scenarios are an important tool for exploring this uncertainty. • Public Health 2030 Scenarios were developed as a foresight contribution to the field, in conjunction with NACCHO, ASTHO, APHA and other leaders in the field 2
  3. 3. What Public Health Does • Prevents Epidemics • Protects the Environment, Workplace, Housing, Food and Water. • Promotes Healthy Behavior • Monitors the Health of the Population • Mobilizes Communities for Action • Responds to Disasters • Assures that Medical Services are High Quality and Accessible • Trains Specialists in Investigating and Preventing Diseases • Develops Policies to Promote Health 3
  4. 4. Essential Public Health Functions • Assessment (Collection and analysis of information to identify important problems) – Monitor health status to identify community health problems. – Diagnose and investigate health problems and health hazards in the community. • Policy Development (Setting priorities and developing strategies based on the assessments of health) needs) – Inform, educate, and empower people about health issues. – Mobilize community partnerships to identify and solve health problems. – Develop policies and plans that support individual and community health efforts. • Assurance (Assuring that appropriate services are available and accessible to meet the needs of the population) – Enforce laws and regulations that protect health and ensure safety. – Link people to needed personal health services and assure the provision of health care when otherwise unavailable. – Assure a competent public health and personal healthcare workforce. – Evaluate effectiveness, accessibility, and quality of personal and population-based health services. – Research new insights and innovative solutions to health problems. 4
  5. 5. The Public Health 2030 Project Funded by Robert Wood Johnson & Kresge Foundations Following Scenarios on Vulnerability 2030, Primary Care 2025, and Health and Health Care in 2032 • Explore key forces shaping public health • Consider the future of public health functions, financing and sustainability • Build expectable, challenging, and visionary scenarios that facilitate preparation, imagination, aspiration • Provide and widely distribute the scenarios as a tool for public health agencies, organizations, and schools 5
  6. 6. Developing the Scenarios • Considered key drivers shaping public health • Developed expectable, challenging, and aspirational forecasts for the drivers • Interviewed experts, Project advisers • Developed and used state and local Public Health 2030 Scenarios • Developed national Public Health 2030 Scenarios 6
  7. 7. Aspirational Futures: Scenario Zones Visionary/Surprisingly Successful Expectable Challenging 7
  8. 8. State & Local PH2030 Scenarios Fargo Cass Public Health (ND) Boston Public Health Commission (MA) Cuyahoga County Board of Health (OH) Virginia Department of Health 8
  9. 9. National Public Health 2030 Scenarios • Scenario 1: One Step Forward, Half a Step Back Significant advances in big data analytics, in access to and quality of health care; yet recurring fiscal and health challenges for communities and PHAs. • Scenario 2: Overwhelmed, Under-Resourced Economic and environmental challenges, infectious diseases increase, health care reform halted, public health constrained. • Scenario 3: Sea Change for Health Equity PHAs evolve into health development agencies. Economic stability and value and policy shifts toward equity support this evolution. • Scenario 4: Community-Driven Health and Equity Innovation in communities, alternative economics, transformation is accelerated through technology and recognition of economic and social injustice. 9
  10. 10. Scenario Likelihood and Preferability Poll Please use the grid below to assess the likelihood and preferability of each scenario separately. •100% refers to highly likely or preferable. •0% means there is nothing desirable or preferable about a particular scenario. •Percentages can be from 0 to 100 in each cell. Columns or rows need not add up to 100%. For example, you may assign 60% for likelihood and 85% for preferability of a scenario. Public Health 2030 Scenarios Likelihood Preferability Scenario 1: One Step Forward, Half a Step Back 0-100 0-100 Scenario 2: Overwhelmed, Under-Resourced 0-100 0-100 Scenario 3: Sea Change for Health Equity 0-100 0-100 Scenario 4: Community-Driven Health and Equity 0-100 0-100 10
  11. 11. SCENARIO 1: ONE STEP FORWARD, HALF A STEP BACK Public Health 2030: A Scenario Exploration 11
  12. 12. Scenario 1: One Step Forward, Half a Step Back • Public health agencies (PHAs) advance capabilities in technology and big data analytics • Public health is restrained by –High costs of health care –Variations in PHAs’ technological capabilities, funding, services, and effectiveness 12
  13. 13. • Public health funding varies widely; Federal funding for health care programs reduced as access to health care improves – PHAs refocus on prevention and improving community conditions • PHAs consolidate and share services; most improve comparability and show positive returns on investment (ROI) Scenario 1: One Step Forward, Half a Step Back 13
  14. 14. • Emergence of Big Data • Improved surveillance and analysis • PHAs provide quality control, some “nudge” social networks toward better health Scenario 1: One Step Forward, Half a Step Back 14
  15. 15. • When possible, PHAs – Automate inspections – Enhance population health monitoring – Improve emergency preparedness • Some PHAs are confined to mandated services • Others are able to emphasize prevention Scenario 1: One Step Forward, Half a Step Back 15
  16. 16. • More extreme weather events (EWEs) and vector- borne infections – E.g. Lyme disease and dengue fever • PHAs use simulations and gamification to prepare communities for emergencies Scenario 1: One Step Forward, Half a Step Back 16
  17. 17. Triple Aim Electronic Health Records (EHRs) • Health care reform largely implemented • Expansion of Accountable Care Organizations (ACOs), Triple Aim, and Patient-Centered Medical Homes (PCMH) • Care improved by knowledge technologies – Doc Watson, digital health coach • PHAs focus on prevention, have varying roles with ACOs Scenario 1: One Step Forward, Half a Step Back 17
  18. 18. • Health care costs continue to rise as access improves • Social determinants not addressed • No “game-changers” • Continued disparities Scenario 1: One Step Forward, Half a Step Back 18
  19. 19. 19
  20. 20. SCENARIO 2: OVERWHELMED, UNDER-RESOURCED Public Health 2030: A Scenario Exploration 20
  21. 21. • Severe recessions in 2016 and 2023 • PHA funding reduced, many programs eliminated Scenario 2: Overwhelmed, Under-Resourced 21
  22. 22. • PHAs blamed for lack of preparation and ineffective responses • Public distrusts PHAs, federal government in general, and health care Scenario 2: Overwhelmed, Under-Resourced 22
  23. 23. • Distrust grows, people refuse to get flu shots • Highly virulent flu strain in 2020 • Tens of thousands of people die Scenario 2: Overwhelmed, Under-Resourced 23
  24. 24. • Citizen science and technology grow but serve affluent and reinforce disparities. • PHA health care services cut while need grows. • Excellent, personalized care for those who can afford it. • Innovative private sector approaches to health for those who can afford them. Scenario 2: Overwhelmed, Under-Resourced 24
  25. 25. • “Runaway climate change” emerges • Climate refugees and migrants • Health, violence, and discrimination worsen • PHAs overwhelmed, struggle to recover Scenario 2: Overwhelmed, Under-Resourced 25
  26. 26. • PHAs understaffed, overwhelmed. • Many universities shut down public health programs. • Private sector innovations ignore disparities and vulnerability. • Worsening disparities in health, quality health care access, effective prevention, and other public health services. Scenario 2: Overwhelmed, Under-Resourced 26
  27. 27. 27
  28. 28. SCENARIO 3: SEA CHANGE FOR HEALTH EQUITY Public Health 2030: A Scenario Exploration 28
  29. 29. • Changes in values and demographics. • Funding improves for public health. • Public health pursues advanced analytics, gamification, and multisectoral partnerships. • Improvements in housing, economic opportunity, education, and other social determinants of health. • Some disparities persist. • But in 2030, the vast majority of Americans have attained greater opportunity for good health. Scenario 3: Sea Change for Health Equity 29
  30. 30. • Support for “common sense” policy • Public support for opportunity, equity, and fairness in policies and economics – National minimum wage, Health in All Policies • Innovation and use of new tech for outcomes Scenario 3: Sea Change for Health Equity 30
  31. 31. • Public health funding improves • Economies gradually grow, reduce fiscal strains and cuts • PHAs foster additional resources from business, foundations, ACOs • Evaluations show positive ROI • Congress restores Prevention Fund restored to $2B level in 2020, add 2% tax in 2022 on medical services Scenario 3: Sea Change for Health Equity 31
  32. 32. • PHAs become health development agencies, chief health strategists, shift away from direct services • Collaborative networks and partnerships • Simulations, forecasts, analyses • Spread best practices • Identify most cost- effective and appropriate providers Scenario 3: Sea Change for Health Equity 32
  33. 33. • Gaming changes communities’ awareness of and commitment to achieving health • New tech developments are made to be affordable and culturally appropriate • PHAs lead coalitions, recognized by the public as chief health strategists Scenario 3: Sea Change for Health Equity 33
  34. 34. • Health care improves • Capitated, effective, accessed • Primary Care supports community prevention • Cuts in Federal $ to PH programs for screening and treatment Community Centered Health Home Scenario 3: Sea Change for Health Equity 34
  35. 35. By 2030, • Better health and health equity, less demand for health care • Improved community conditions, esp. for low income communities Scenario 3: Sea Change for Health Equity 35
  36. 36. 36
  37. 37. SCENARIO 4: COMMUNITY-DRIVEN HEALTH AND EQUITY Public Health 2030: A Scenario Exploration 37
  38. 38. • Health improvement initiatives coalesce via technology and networks into a broad, national public health infrastructure. • Value shift to equity was accelerated by another major recession and economic transformation. • The nation tries to come to terms with its racial and socioeconomic histories, and tries to create a more equitable society. • Public health sheds many functions and facilitates these movements to improve health. Scenario 4: Community-Driven Health and Equity 38
  39. 39. • Groupnets used to improve behavioral health at the micro-level, often through “peer uplift” • Community activity & organizations focused on health • PHAs lead on information quality & community facilitation Scenario 4: Community-Driven Health and Equity 39
  40. 40. • Health records integrated with other personal and community data to allow advanced health analysis and targeting • Community health learning systems enhance PHAs’ roles as facilitators and health strategists • Games and simulations improve community engagement and planning Scenario 4: Community-Driven Health and Equity 40
  41. 41. • Environmental Health evolves • PHAs work with communities, and partners to reduce environmental impact and expand renewable energy. • Highly effective pre-event resilience games and simulations for Extreme Weather Events. Scenario 4: Community-Driven Health and Equity 41
  42. 42. • Governments spend less and spend “smarter” • Unemployment accelerates shift to alternative economics/new community economic models Scenario 4: Community-Driven Health and Equity 42
  43. 43. • Economic and social justice movement progressed • “Truth and Reconciliation” processes spread • New legislation promotes social and economic fairness Scenario 4: Community-Driven Health and Equity 43
  44. 44. • Public health graduates are trained for community engagement and advanced analytics • PHAs serve as effective chief health strategists • Disparities are reduced and the nation is largely unified in seeking to eliminate them Scenario 4: Community-Driven Health and Equity 44
  45. 45. 45
  46. 46. Scenario 1 Scenario 2 Scenario 3 Scenario 4 MACRO AND OPERATING ENVIRONMENTS Economy Fiscal Health Internet & Social Media Environmental Threats & Impacts Health Care Health Equity Public Health Public Health Roles Funding for Public Health Public Health & Health Care Health Care’s Role in Population Health Surveillance and Epidemiology Emergency Preparedness Environmental Health/Safety Injury and Violence Prevention Etc. See the Public Health 2030 Scenario Matrix for a side-by-side comparison of the scenarios across multiple dimensions 46
  47. 47. Scenario Likelihood and Preferability Poll Please use the grid below to assess the likelihood and preferability of each scenario separately. •100% refers to highly likely or preferable. •0% means there is nothing desirable or preferable about a particular scenario. •Percentages can be from 0 to 100 in each cell. Columns or rows need not add up to 100%. For example, you may assign 60% for likelihood and 85% for preferability of a scenario. Public Health 2030 Scenarios Likelihood Preferability Scenario 1: One Step Forward, Half a Step Back 69 30 Scenario 2: Overwhelmed, Under-Resourced 37 6 Scenario 3: Sea Change for Health Equity 39 79 Scenario 4: Community-Driven Health and Equity 39 76 47
  48. 48. • Reactions, Comments, Questions about the scenarios? • What is your sense of the likelihood and preferability? Questions, Comments on the Public Health 2030 Scenarios? 48
  49. 49. Public Health 2030 Recommendations from the National Workshop March 6 & 7, 2014 49
  50. 50. 50 Rec 1: Transform Public Health Agencies into “Health Development Agencies” with Dedicated, Sustainable, and Sufficient Funding. 1A: Develop Dedicated, Sustainable, and Sufficient Funding 1B: Implement Policies for the Systematic Use and Development of Evidence and Best Practices 1C: Build Public Health Agencies' Role in Fostering Prevention and Health Promotion Strategies Rec 2: Partner in Health Care Transformation to Facilitate the Evolution from a Health Care System to a Health System Rec 3: Build the Capacity for Dialogue about Inclusion, Opportunity, and Equity Rec 4: Dialogue with Other Sectors to Support Innovation
  51. 51. Public Health 2030: A Scenario Exploration Supported by grants from: www.altfutures.org/publichealth2030

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