How can we reimagine our health systems to enhance social justice in health and wellbeing? What could completely reimagined health systems look like by 2030 or 2040? What seeds of transformation can we spot today in the trends and emerging changes arising all over the world?
These are the questions that HSG’s Reimagine Health Systems initiative has been posing since it was launched at Phase One of the Sixth Global Symposium on Health Systems Research (HSR2020). Since November, HSG members, HSR2020 participants, and other colleagues around the world working in research, policy and practice have shared their insights and ideas on emerging changes that may shape health systems, health and wellbeing in the future. Those changes present both opportunities for innovation and challenges to be addressed on the way to reimagining what health systems might be in the future.
As you were sharing research, ideas, and discussions with colleagues during HSR2020, Reimagine Health Systems was collecting data about trends and emerging changes that could impact health, health systems, and social justice. We captured that change data from three sources:
- existing research on health futures and trends in health, wellbeing, and social justice;
- HSR2020 presentations describing trends, changes, and innovations;
- And via three Futurescaper crowdsourcing surveys you told us what trends and emerging changes you think might be most transformative over the next decade.
We are currently analysing and summarizing the change data from those three sources.
Futurescaper can visualize response data graphically. System maps show the interconnections among changes, challenges, and impacts. The graphic below shows the 50 top ‘causes’ – changes that drive other impacts and changes – across all three themes, as specified by respondents and visualized as a system map. Larger nodes in warmer colours are those mentioned most often and with the highest number of outgoing causal links.
Description automatically generatedWhile we are still compiling the complete Change Analysis report, we can offer some additional highlights to provoke your reimagining.
Our review of existing research on possible futures for health and social justice is illuminating a range of changes and challenges for our futures. Here are nine transformative issues that could end ‘business as usual’ over the next few decades:
- Increased authoritarianism, nationalism, populism, and tribalism, accompanied by regression on issues of social justice
- The rise of self-organized communities and movements – political decentralization and distribution of activism aided by technology – able to challenge nation-states and even supplant them
- The amplified struggle for identity, truth, and culture, as the global economic and cultural centre of gravity shifts from the West and North
- Increasing controversy and conflict over privacy, data, and the ‘right to self’ – controlling access to your own actions and preferences – in a context of increasing economic and political surveillance
- The evolution of post-scarcity economics and post-capitalist societies – digital fabrication, the consumer as producer, the sharing economy, and potential redefinition of core economic concepts like capital and property rights
- Accelerating environmental breakdown – the climate crisis that will increase heat stress, water stress, extreme weather events, flooding, wildfires, and habitat destruction – as well as increased species extinctions and pervasive pollutant contamination, all of which will render food chains fragile and marginalized populations more vulnerable to disease
- The built environment as an adaptive machine ecosystem – as the ‘internet of things’ increasingly interconnects our appliances, energy and transport infrastructure, computing devices and wearable technology, it could increasingly sense and respond to our needs and augment our capabilities
- Digital fabrication – our increasing capacity to use machines at all scales to design and build individually tailored goods precisely, efficiently, and quickly – resulting in flexible, customizable, and dramatically decentralized manufacturing, as well as the dematerialization of trade
- Beyond the digital era to the age of biology – the push for vaccines and pharmaceuticals to address a global pandemic has only amplified the accelerating advances in biological manipulation and engineering; humans are refining their capacity to engineer useful synthetic organisms in order to produce biofuels – or create programmable organic microbots.
Some of the nine trends present challenges, others provide levers to create solutions and drive change, and many do both. These trends are the dynamic context against which health concerns will play out as we move forward into whatever future emerges. While more detailed, they echo several of the ‘hot spots’ in the respondents’ map of causes displayed above.
The Futurescaper crowdsourcer initiative also provides a conceptual map of respondents’ health concerns. The graphic below visualizes Futurescaper’s computation of the six most important issues and their impact cascades across the data from all three thematic crowdsourcers. This set of impact chains highlights key goals for equitable and just healthcare, innovations or new models of practice that may help meet those goals, and some significant challenges constraining progress. The causal links between the changes and impacts emerged as a result of the pattern of participants’ answers.
In some cases, the causal relationships are obvious – better health system responsiveness offers better health outcomes and contributes to the possibility of ‘Health4All’; better accountability would also contribute to Health4All; or a fragile peace might fracture communities, increase health inequalities and service access inequalities. In other examples, the connections require a bit of interpretation, e.g., AI diagnostics would certainly lead to faster and cheaper diagnostic systems – and might help to *address* the failure of welfare systems and its negative impacts. In considering this initial map of health concerns in the context of change, think about these questions:
- How might the nine transformational changes help address these concerns?
- How might the changes make things worse?
- What futures might result?
The Change Analysis report, currently being prepared, will summarize patterns of key changes drawn from the desk-based trends research, the change data in the Symposium presentations, and crowdsourcer responses. These changes will be the building blocks of our scenarios of possible health system futures. Scenarios are not predictions; they are designed to let us explore different potential future situations, and so help us manage uncertainty by rehearsing how we might respond to futures that are beyond business as usual.
That’s where our second crowdsourcer will assist: Sensemaker invites people to share stories. We want you to share what futures you think might emerge from the changes identified during the first stage. The Sensemaker crowdsourcer will open on 18 February and run until 26 February. We invite you to please share your stories of what the future could be like – whether good or bad, transformational, or disruptive. Sensemaker will identifying patterns and themes in your stories that describe possible future scenarios.
In two workshops at the beginning of March, groups of policymakers, practitioners, researchers and other actors will refine those collected stories into a set of formal scenarios that reimagine health systems.
The outcome of this process – a set of future health systems scenarios – will seek to inform how health systems might be reimagined and the implications for actors engaged in the development and management of health systems across the world.