Nostradamus was a would-be prophet with a knack for predicting catastrophes well beyond his lifetime, half a millennium ago. What people don’t remember is that Nostradamus also worked as an apothecary and physician’s assistant during his early adulthood, trying to protect people from the plague.

As a doctor who has devoted my life to fighting disease and spreading health, I understand why Nostradamus would want to see the future. I too want to know the causes of future suffering in time to do something about them.

Recognizing that crystal balls won’t get us there, the Robert Wood Johnson Foundation employed the art and science of scenario planning to envision the health future of America’s most vulnerable populations over the next two decades. Together with the Institute for Alternative Futures, we mapped a range of possible forecasts, based on questions such as:

  1. What if the economy as a whole recovers but high unemployment persists?
  2. What if oil shortages lead to steep rises in energy and food prices?
  3. What if urban school systems collapse, contributing to spikes in violence and crime?
  4. What if government debt or continued political polarization means that our leaders respond poorly to these challenges?
  5. Or, what if a period of hardship and division sparks a countertrend of innovation, collaboration, and compassion?

This exercise is incredibly humbling.  And we came away with important insights that help to focus our work going forward.

First, the factors that will have the biggest impact on the health of vulnerable populations will likely come from outside the health care system. In fact, when you look at county health rankings released earlier this month, health care is estimated to account for only about one-fifth of what makes a place healthy.

What will matter most are things like jobs, schools, crime, food, housing, and energy. That has huge implications for health foundations, NGOs, and government agencies, all of which typically look for solutions within, not across, sectors.

Second, social innovation will be even more critical over the next two decades. The optimal approach to take in the face of many possible futures is to develop strategies that will work under a range of scenarios. And such strategies must be firmly grounded in the communities they are to help. 

The best solutions will be innovations that help the most people—that is, cost-effective solutions that are practical to adapt and replicate in other communities. Wherever possible, we should seek policy changes that can support implementation and spread.  Even better, those solutions will address the intertwined problems—such as health, education, employment, and housing— that affect our most vulnerable at the same time.

Now that we have developed insightful forecasts, we must go beyond the predictive role of Nostradamus and prepare courses of action to build partnerships across disciplines and to help our most vulnerable communities overcome the changes that are certain to come.

We may not be able to predict the future as well as we’d like, but we do have the power to make it better.

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