What is the future of health? Those of us who created this project consider ourselves to be cutting-edge health philanthropists and, honestly, we’re not sure. What we do know is that while we and others are constantly talking about how to secure a better future, our system for health is spiraling out of control. Analysts project runaway health care costs, inadequate health outcomes, and persistent health disparities for decades to come. Finding a way out of this has been a scary and chaotic endeavor, likely because we’ve all been focused on solving the problems of a system that no longer serves us well rather than challenging ourselves to articulate the kind of system we really need. Therefore, we have taken it upon ourselves to organize an initiative that can produce a shared idea of a radically equitable future where all people are thriving, and a solid understanding of what it would take to establish it. We need a strong start at breaking the country from our entrenched reliance on short-sighted norms and practices.

Enter FORESIGHT, a three-year project that builds a shared understanding of our interconnected past, present, and futures as the basis for equitably envisioning and bringing about a new future for health and well-being in the United States. In this future, the health and well-being of all people in America is valued and well supported. FORESIGHT sets this future in motion by creating inventive, inclusive spaces for all to share historical experiences alongside their aspirations as they engage in the work of health transformation. The initiative was established by philanthropic partners who, facing the reality that our current system has not (and cannot) put our nation on a trajectory toward a healthier future, see an urgent need to collectively explore alternatives.

FORESIGHT is designed to provide a unique opportunity for all of us who are working to advance regional health to step outside our current thinking and behaviors and open new vantage points for ourselves. Together, we’ll use powerful and proven futures planning techniques, combined with the voices and insights of regional residents, to build a shared body of knowledge about how demographic, technological, social, and environmental influences have already shaped—and have the potential to shape—the future of health in dramatic ways. Then, we’ll use that shared knowledge to determine the future we aspire to achieve. Later, we’ll develop and take the steps we need for regions to effectively transition to a new system for health and well-being—a system that is designed to bring about the new future we envision.

Most importantly, we’ll take this on in partnership with one another, as national and regional leaders—including residents—influencing diverse people and organizations in many regions and sectors. We will work together from our own places of knowledge and influence, each contributing to the process and taking responsibility for the new system’s long-term success.

GO TO > Process
a future where all people are thriving

The world is changing fast.
It’s time we design a future for health together.
Our work begins with FORESIGHT.

The Process

The process of gaining foresight is disciplined but rewarding; it’s an emergent practice that allows us to unleash our imaginations, question assumptions, and envision what is possible. To make room for this practice, FORESIGHT will span two phases over three years or more.

In Phase 1, we will equitably explore and envision a new future for health and well-being. We have designed a highly inclusive process that will use futures planning techniques (such as Futures Scanning and Scenario Planning), in powerful combination with listening to regional residents about their experiences and aspirations, to develop a shared understanding of what forces will substantially impact our system for health—for better or worse. We will synthesize all of this into an aspirational vision for the future, and share it widely to catalyze new conversations, mindsets, and actions around what it will take to bring about health and well-being.

In Phase 2, we will take this new understanding for a spin. Our current thinking is that we will work directly with a handful of regions committed to developing transition plans that allow leaders to simultaneously shape the future while meeting today’s responsibilities. And we will widely share what we learn so the insights generated are positioned to influence the mindsets and actions of decision makers and thought leaders around the country.

What is an emergent process?

FORESIGHT is unlike many initiatives where the design of the process precedes the collective work. While doing things this way takes some getting used to, FORESIGHT’s process must constantly emerge from what is discovered through preceding parts of the initiative so that it reflects diverse interests and perspectives, including those of underserved populations, and so that we all have the opportunity to learn from one another.
GO TO > Outcomes

FORESIGHT’s Emergent ProcessClick on the icons below to learn more about each step. Information will show below the graphic.

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Futures Scanning

Building Blocks of New Vantage Point

Past, Present, and Futures

There’s only one past and present, but there’s an infinite number of possible futures. Futurists use what we know now to forecast the most likely ones.

The initial Futures Scan was completed in August 2019. >>> Click here to learn more.

We may not be able to see the future, but we can look at what’s happening right now and try to forecast where that might lead. The present contains four sets of building blocks that we can use later in the FORESIGHT process when imagining different futures (what we call “alternative futures scenarios”):

  1. Which forces have we seen drive change in the past that may be at work again today?

    The answer to this first question will need to be based on an examination of what has driven change in our chosen area—health and well-being—in the past (we call these “historical drivers”).

  2. What new sources of change do we think we are detecting?

    There are two subcategories of new sources of change: trends and emerging issues. We’ll get back to those in a moment.

For decades, health care businesses have been merging and we can see that this consolidation—which has driven us to where we are today—continues in the present, as the CVS-Aetna mega-merger continues through regulatory processes, and Cigna’s merger with Express Scripts creates another industry giant.
  1. What forces are present today that might slow down or even prevent change?
    Impediments to change—also called “stabilities”—help us better understand how changes might not go exactly where we’d expect them to. Stabilities (such as rules, traditions, behavior patterns, powerful stakeholders, and even the laws of physics) can slow or stop a trend line before it would run out of momentum on its own.

    What’s the opposite of stabilities?

    The opposite of stabilities are trends and emerging issues! Those two categories encompass all agents of change.

In the US House of Representatives, candidates who are already in office keep their seats in over ninety percent of elections despite low average approval ratings. This “incumbent advantage” suppresses change, because extra votes are needed to overcome this bias and elect someone with different ideas.
  1. What are the lived experiences and aspirations of everyday people (from diverse populations) in relation to health and well-being?

    We need to ask everyone—especially residents from underserved populations who are not often listened to—about their experiences related to health and well-being, as well as the changes they’d like to see in the future to improve those experiences. FORESIGHT’s public opinion researchers and regional philanthropic partners will collaborate with regional connectors to learn from residents about their lived experiences with health and well-being as well as their aspirations for how a new system for health and well-being could work.

To some decision makers, free or reduced-price school lunches may seem like a low priority—perhaps even something they can sacrifice in pursuit of another objective. They might be less likely to do so if they hear from the families with children who rely on school lunches as their only meal of the day, and learn more about what families experience when those free meals are taken away.

What Can We Learn From Today?

Trends are changes over time in a certain direction that we can quantitatively measure to make trend line graphs. It’s important to note that trends only describe the past and are never statements about the future—they merely imply a particular future if you assume the trend lines don’t change, which is far from certain. And often, we aren’t even concerned with the trend itself—instead, we’re really using the trend as a tool to shed light on the underlying forces that are causing it.

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Emerging issues, on the other hand, are weak signals of change that may or may not drive things in the future—think new prototype technologies, or new policy ideas that are starting to be discussed on the fringes of government. They may someday grow into full-blown trends, or they may fizzle out of existence—and they can be quite hard to detect.
As we develop stronger artificial intelligences and involve machines more deeply in our lives, we are approaching a point where some people are talking about the ethical treatment of machines—though for now, that debate’s mostly limited to academic settings and science fiction.
For a few decades now, housing prices have ballooned to the point of affordable housing crises in some urban areas, such as San Francisco, New York City, and Boston. This trend may continue, but we can’t know for sure whether the momentum behind the trend might cause it to bend one way or the other—or even break, with a crash in these housing markets setting off a chain reaction of mortgage defaults that could trigger a recession in the vein of the subprime crisis that began in 2007.

Gaining Foresight

In the case of FORESIGHT, our expert futurists will perform a Futures Scan, examining the health and well-being landscape to illuminate historical drivers, trends, stabilizers, and the weak signals of emerging issues with the potential to significantly impact the United States in the short term (~10 years) and long term (~50 years). Meanwhile, FORESIGHT’s public opinion researchers and regional philanthropic partners will collaborate with regional connectors to learn from residents about their lived experiences with health and well-being as well as their aspirations for how a new system for health and well-being could work. (You can learn more about this process in the description of Regional Resident Engagement.)

Once we’ve used these techniques to gather and organize our four sets of building blocks, it’s time to start stacking those sets into alternative futures scenarios, which you can learn more about here.

Could foresight have paved our way to . . . not paving?

Back when the automobile was first introduced, it would have been hard to imagine today’s car-reliant culture with its massive network of highways and suburban sprawl. Encouraged by the auto industry, we tore up public transit and rebuilt our world to accommodate our cars. Only later did the downsides become apparent, and some cities are suffering public well-being crises as what remains of the chronically underfunded, archaic transit breaks down. Our hope is that by gaining foresight, we can identify the “horseless carriages” of our current era, and make choices up front that may not seem obvious from where we stand now, but will serve us best in the long run.

Future Scanning Findings

Want to dig deep into the Futures Scan’s methods, results, and wider implications? You can read the latest report here. Please note that we consider this report a living document in that it will likely never be considered “final” because it contains concepts, language and framing that will continue to evolve. The most recent version (December 2019) contains some new pieces; including narratives on the implications of the trends and emerging issues, an exploration of broader interactions, and a noteworthy conclusion.

Expected Outcomes

  • Shared aspirations for a new future for health and well-being in the United States become a rallying cry for action across the country.

    The aspirations are based on a shared understanding of our interconnected past, present, and futures as they relate to health and well-being. In this new future, the health and well-being of all Americans is valued and well supported.

  • Replicable transition plans and tools, designed by regional leaders who are committed bring about their localized preferred visions in their regions.
  • Multisector partnerships in a handful of diverse regions are committed to continuing their work to boldly enact and evolve their transition plans.

    Multisector partnerships see this as doing their part to achieve the common aspirations. The partnerships, which likely include local philanthropic partners, connectors, and residents directly involved with FORESIGHT, ensure their plans and actions reflect what FORESIGHT helped cultivate:

    • Broadening understanding of the drivers of health disparities
    • Increasing commitment to systemic, longitudinal change
    • Growing dedication to investing in ways that will bring about the common aspirations and localized visions
    • Willingness to use the transitions plans as a means to dive deeply into critical new conversations that advance the bold actions needed to enact the localized visions
    • Drive to vulnerably connect with other regions engaging in this work to unite through common experience and make improvements based on what is being learned

If FORESIGHT is successful, it will also contribute to the following implications over time:

  • More and more regions develop localized visions based on the common aspirations and engage in their own transition planning processes.
  • State and federal policymakers support regions by enacting new policies and strategies that support this work.
  • There is radically transformed health and well-being in the regions engaged in enacting transition plans.
  • There is lower spending on health and well-being in the regions engaged in enacting transition plans.

The world is changing fast. It’s time we design a future for health together.
Our work begins with FORESIGHT.