What will public health look like in 2030?

  Historical days like the 238th anniversary of American independence offer a chance to get some perspective of how far we have come in improving medical standards and access to healthcare. These articles, here and here offer some details if you want specifics. But a new report offers four potential scenarios that explore how public […]

 

Historical days like the 238th anniversary of American independence offer a chance to get some perspective of how far we have come in improving medical standards and access to healthcare. These articles, here and here offer some details if you want specifics. But a new report offers four potential scenarios that explore how public health will shake out in the next 16 years, from hugely optimistic to bitterly depressing.

Public Health 2030: A scenario explanation is part of a series produced through a collaboration between the Robert Wood Johnson Foundation, Institute for Alternative Futures and Kresge Foundation.

One issue that gets surprisingly little mention is vaccines. It’s tough to think about a history of public health or what will be its future without thinking about the impact vaccines have had in eradicating small pox, measles and polio. And yet a campaign of misinformation has dealt these achievements a significant setback. It’s a great example of a situation that would seem highly unlikely and tough to predict. It makes me wonder about other things that could undermine public health that we’ll need to confront.

In fairness, one of the more depressing scenarios did allocate one paragraph to the issue. It talked about the risk of misinformation spread about flu vaccines, particularly on social media, contributing to distrust of flu vaccine programs and leading to the death of tens of thousands of people.

The scenarios are based on working with public health officials in Boston, Cuyahoga County in Ohio, and Fargo, North Dakota. They’re designed to help public health officials plan for some of these scenarios and recommend what agencies need to do to control communicable diseases, ensure food safety, promote health, and foster emergency preparedness and response, according to the report.

In the most optimistic scenario, public health agencies have the resources to widely adopt big data analytics tools to improve population health. They create community-enhancing networks with partner organizations and local health improvement initiatives thrive. The networks make it possible for communities to exchange innovations and best practices. Racial inequality is a distant memory and economic disparity is no longer an issue.

For better and for worse,  technological advancements have meant that companies can operate with fewer people, leading to mass unemployment. But in this scenario, it’s OK because new community economic models help households sustain themselves. Hopefully, taxes and credit card debt won’t be a problem anymore either. I get it — it’s just one scenario. The problem is, it sounds more like one for a much smaller, homogeneous society in Northern Europe rather than the U.S. It seems like for these scenarios to be the most effective there should be more realism.

Here’s a summary of the worst case scenario:

Funding cuts and a hostile political context undermine the role of public health agencies. Public health crises grow worse and more frequent, largely due to climate change. Private sector initiatives produce significant innovations for health and wellness, but these primarily benefit the middle class and affluent. Technological, economic, educational, and health disparities grow, and public health institutions have little capacity to do anything about them.”

So what recommendations does the report promote?

1. Make public health agencies into health development agencies that would wield more influence with people and resources to improve population health and eliminate health disparities.

2. Shift from a culture of reacting to and treating people who get sick to a focus on preventing illness and promoting well being.

3. Initiate conversations about inclusion, opportunity and equity.

4. Work with other sectors outside of healthcare to support innovation to benefit from insights gathered from other industries.

Like most visions of the future, there is a certain amount of each of these recommendations that are already being implemented, particularly number four. For example, the hospitality industry is having an influence on the health IT tools hospitals are beginning to embrace. There’s no question that there’s a lot more that can be accomplished and the pace is inevitably frustrating. It will be interesting to see which one of the scenarios the report puts forward will adhere closest to reality.