Transcript Public Health 2030: - Institute for Alternative Futures

Public Health 2030:
Scenarios for the Cuyahoga
County Board of Health
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The Public Health 2030 Scenario Effort
Conducted by the Institute for Alternative Futures.
Funded by the Robert Wood Johnson Foundation
and the Kresge Foundation to:
• Explore key forces shaping public health
• Consider the future of public health functions,
financing & sustainability
• Build expectable, challenging & visionary scenarios
that facilitate preparation, imagination & aspiration
• Provide & widely distribute the scenarios as a tool
for public health agencies, organizations & schools
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Scenario Zones
Visionary/Surprisingly Successful
Expectable
Challenging
Public Health 2030: Scenarios for the
Cuyahoga County Board of Health
Scenario 1
Some Health Gains, But Disparities Persist
Scenario 2
Big Challenges, Public Health Constrained
Scenario 3
Common Sense Returns, Public Health Wins
Scenario 4
My Code is Your Code
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SCENARIO 1:
SOME HEALTH GAINS, BUT
DISPARITIES PERSIST
 HIGHLIGHTS
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Scenario 1: Some Health Gains, But Disparities Persist
• Slow economic growth between 2013 and 2030,
financial constraints and instability lead to fluctuations
in public health funding
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Scenario 1: Some Health Gains, But Disparities Persist
• Climate change provokes wetter Falls & Springs,
periodic flooding, and summer droughts with
increasingly frequent heat waves
• HIP-C remained a community force, with priorities
including resilience and sustainability
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Scenario 1: Some Health Gains, But Disparities Persist
• EPH focuses its activities on
resilience, adaptation, and
mitigation
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Scenario 1: Some Health Gains, But Disparities Persist
• EPH promotes activity and
healthier food in schools,
including farm-to-school food
initiatives
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Scenario 1: Some Health Gains, But Disparities Persist
• ESI expands its work in emergency
preparedness and response,
disease outbreaks, and disease
tracking, and analyzes larger
amounts of data
• Food safety challenges persisted
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Scenario 1: Some Health Gains, But Disparities Persist
• P&W’s efforts to improve
population health are subject
to political polarization
• P&W staff numbers have
decreased
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Scenario 1: Some Health Gains, But Disparities Persist
• P&W uses new data tools and
sources to improve mental
health and reduce violence,
particularly sexual violence
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Scenario 1: Some Health Gains, But Disparities Persist
• Health gains;
but health
disparities
persist (though
in some cases
they have been
reduced)
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SCENARIO 2:
BIG CHALLENGES, PUBLIC HEALTH
CONSTRAINED
 HIGHLIGHTS
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Scenario 2: Big Challenges, Public Health Constrained
• Economic disparities and
a cycle of recessions and
slow recoveries constrain
state and local financing
as jobs are lost
• CCBH staff has been
reduced to half its 2013
numbers
Recurrent severe
recessions
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Scenario 2: Big Challenges, Public Health Constrained
• Health care reform is largely
halted by 2016
• CCBH cannot keep up with
technological advances, which
primarily benefit the affluent
Many more
uninsured
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Scenario 2: Big Challenges, Public Health Constrained
• Climate change overwhelms
the nation and Cuyahoga
County
– 100-year floods a few times
each decade
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Scenario 2: Big Challenges, Public Health Constrained
• Scorching summer
droughts and extreme
weather events
• Cuyahoga County beaches
became unusable
• New diseases and
antibiotic resistant
bacteria; Cyclospora
outbreaks; increases in
asthma and nosocomial
infections.
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Scenario 2: Big Challenges, Public Health Constrained
• Harsh spending cuts and public dissatisfaction with
government severely limit CCBH activities in prevention,
emergency preparedness, HIP-C, policy, advocacy, and
data collection
• CCBH loses accreditation
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Scenario 2: Big Challenges, Public Health Constrained
• Health outcomes and
disparities worsen
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SCENARIO 3:
COMMON SENSE RETURNS,
PUBLIC HEALTH WINS
 HIGHLIGHTS
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Scenario 3: Common Sense Returns, Public Health Wins
• “Common sense” policies of community prevention,
injury prevention, “living wages,” and environmental
protection are established and broadly supported
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Scenario 3: Common Sense Returns, Public Health Wins
• Partisanship around
climate change policy
decreased and public
policy includes
earnest commitments
to mitigate climate
change
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Scenario 3: Common Sense Returns, Public Health Wins
• Redeveloped & mixed
use neighborhoods;
“complete streets;”
health in all policies;
and local food systems
encouraged
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Scenario 3: Common Sense Returns, Public Health Wins
• Technology and digital divides are reduced, as
environmental sensing, biomonitoring, and smart
phone use become ubiquitous and inexpensive
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Scenario 3: Common Sense Returns, Public Health Wins
• Culture of greater
equity, collaborative
consumption, reuse,
and crowdsourcing
encourage inter- and
intra-community
improvement,
resilience, and
cooperation
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Scenario 3: Common Sense Returns, Public Health Wins
• Health care reform succeeds, health care is personalized,
and health care systems (Accountable Care Organizations
and Community Centered Health Homes) promote
population health
Community
Centered
Health Home
Triple Aim
Personal health record
Wellness & disease mgmt. apps
Digital coach (“avatar”)
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Facilitated Disease Network
Scenario 3: Common Sense Returns, Public Health Wins
• CCBH serves as chief health strategist for the
community
– Facilitating HIP-C;
– Using mapping, monitoring, social media, gaming,
health in all policies
– More financially stable; smaller staff
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SCENARIO 4:
MY CODE IS YOUR CODE
 HIGHLIGHTS
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Scenario 4: My Code is Your Code
• Major recession in 2017 increases visibility of disparities,
and engaging advocacy leads to the My Code is Your Code
Movement
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Scenario 4: My Code is Your Code
• My Code is Your Code uses
technology, citizen science, and
netizen advocacy to conduct
“social coding” and “social
programming” to reflect a code of
fairness, and to eliminate
disparities and marginalization that
result from inherent differences in
genetic codes or zip codes
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Scenario 4: My Code is Your Code
• “Alternative
economics” activities
and technologies are
adapted and improve
community health,
resilience, and
solidarity
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Scenario 4: My Code is Your Code
• Health care reform continued, and ACOs evolved into
Accountable Care Communities (ACCs)
Accountable
Care
Communities
Triple Aim
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Scenario 4: My Code is Your Code
• CCBH is a strong ally and leader in climate and health
goals and initiatives, including environmental mitigation,
renewable energy
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Scenario 4: My Code is Your Code
• CCBH’s strong partnerships and collaborations with My
Code is Your Code, citizen scientists, Groupnets, ACCs,
government agencies, and businesses improve
community sustainability, health, and health equity
• CCBH has a smaller, but highly skilled and enthusiastic
work force
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See the scenario matrix for a side-by-side comparison
of the scenarios across multiple dimensions
Scenario 1
Scenario 2
Scenario 3
Scenario 4
MACRO AND OPERATING ENVIRONMENTS
Economy
Technology
Health and health care
Citizen science and engagement
Climate Change effects and mitigation
CUYAHOGA COUNTY BOARD OF HEALTH
Funding
IT and informatics
Workforce
Surveillance and epidemiology
Health education and promotion
Chronic disease prevention and control
Infectious disease prevention and control
Violence prevention
Etc.
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Rate the Likelihood & Preferability of Each
Scenario
Likelihood
Preferability
(0% to 100%)
(0 to 100)
Scenario 1: Some Health Gains,
But Disparities Persist
?
?
Scenario 2: Big Challenges,
Public Health Constrained
?
?
Scenario 3: Common Sense
Returns, Public Health Wins
?
?
Scenario 4: My Code is Your
Code
?
?
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Feedback, please!
Scenario Process
• What did you learn from the scenario process?
• Where there any new or surprising insights?
• In what ways might it affect:
–
–
–
–
How you monitor your organization’s environment
The strategies or tactics organization pursues
Your communications, relationships with partners?
What other learning or outcomes would you identify?
Scenario Workshop
• What worked, or was successful about the
Scenario Workshop?
• What would you change?
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