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Public Health 2030: Scenarios for the Boston Public Health Commission
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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 & schools2
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Scenario Zones
Visionary/Surprisingly Successful
Expectable
Challenging
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Public Health 2030: Scenarios for the Boston Public Health Commission
Scenario 1Smarter Public Health, Missed Opportunities
Scenario 2Under Water
Scenario 3Public Health as Chief Health Strategist
Scenario 4A Renaissance of Civic and Social Responsibility
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SCENARIO 1: SMARTER PUBLIC HEALTH, MISSED OPPORTUNITIES HIGHLIGHTS
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Boston economy grows in tandem with national economy.
– Mild national recessions in 2015 and 2022– Periodic federal and state cuts and program
eliminations
Scenario 1: Smarter Public Health, Missed Opportunities
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Climate change: increased sea-level rise, summer heat waves, and increased storm intensity and/or frequency.
Scenario 1: Smarter Public Health, Missed Opportunities
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2018 Hurricane - Called Boston's Hurricane Katrina- Evacuations OK but with disparities in recovery
Scenario 1: Smarter Public Health, Missed Opportunities
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In health care, 98% + access to care, and most care is integrated and capitated. • More people are effectively assessed and even treated
at home, yielding health care savings• Hospitals deploy community health workers (CHWs)
Scenario 1: Smarter Public Health, Missed Opportunities
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In health care, 98% + access to care, and most care is integrated and capitated. • Large health care provider systems routinely improve
neighborhood conditions
Scenario 1: Smarter Public Health, Missed Opportunities
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In health care, 98% + access to care, and most care is integrated and capitated. • Doc Watson, digital health coaches common
Scenario 1: Smarter Public Health, Missed Opportunities
“Dr. Watson” for Public Health Digital coach (“avatar”)
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In health care, 98% + access to care, and most care is integrated and capitated. • BPHC retains its hold on homeless, addictions, and
emergency medical services (EMS)
Scenario 1: Smarter Public Health, Missed Opportunities
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Surveillance, emergency prep, analyses improve. – City integrates surveillance systems, Internet of
Things
Scenario 1: Smarter Public Health, Missed Opportunities
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Surveillance, emergency prep, analyses improve. – BPHC uses games, digital coaches, and simulations to
improve health education and emergency preparedness, mitigation, and recovery
Scenario 1: Smarter Public Health, Missed Opportunities
Personal Health Advocate Avatar
V2.1
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Surveillance, emergency prep, analyses improve. – BPHC more effectively analyzes and targets
community conditions shaping health
Scenario 1: Smarter Public Health, Missed Opportunities
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But ACOs create their own epidemiology or population health units, turn to universities and private companies for most advanced analytics.
Scenario 1: Smarter Public Health, Missed Opportunities
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Key Outcomes• Challenging for BPHC to consistently prove its value to
HC and get recognized for advisor and convener roles• BPHC achieves 3 overarching goals in obesity, low birth-
weight babies, and chlamydia
Scenario 1: Smarter Public Health, Missed Opportunities
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Key Outcomes• Fundamental problems of poverty, social exclusion and
homelessness remain• BPHC forced to do more with less funding and fewer
staff
Scenario 1: Smarter Public Health, Missed Opportunities
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SCENARIO 2: UNDER WATER HIGHLIGHTS
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Boston faces serious municipal finance challenges.
• City’s economic health & revenue drops
– National 2016 recession
– 2018 superstorm hits Boston
– Reduction in resident students; Decline of Boston education sector
Scenario 2: Under Water
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Over time, cuts leave BPHC to focus on:
– infectious disease control and prevention
– emergency preparedness– emergency medical services– homeless and addiction
services.
Scenario 2: Under Water
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Health worsens especially for working poor.• Federal health reform was only partially implemented,
partially repealed
Scenario 2: Under Water
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Health worsens especially for working poor.• Addictions funding is
integrated into primary care, demand for mental health services increases
• But payment reductions and provider shortages disproportionately affect the poor
Scenario 2: Under Water
Shortage of primary care providers
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Health worsens especially for working poor.• Digital health coaches
and “virtual doctor” services grow but vary in quality
Scenario 2: Under Water
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Climate change and superstorm drain resources, leave significant physical and economic damages.• Hotter summers and related droughts, more intense
storms throughout the year, greater potential for infectious diseases and mold
Scenario 2: Under Water
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Climate change and superstorm drain resources, leave significant physical and economic damages.• Full recovery from superstorm takes years
Scenario 2: Under Water
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Climate change and superstorm drain resources, leave significant physical and economic damages.• BPHC improves ability to forecast and warn about, for
example, likely asthma attacks by neighborhood.– But this often does not lead to earlier response and
prevention because of resource constraints
Scenario 2: Under Water
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BPHC struggles to be effective and heard.• Big Data - Corporations and
health care providers hire skilled analysts to do their own big data analytics
• Big Data - BPHC has to work with growing volume of data with large blind spots for low-income people and people of color
Scenario 2: Under Water
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BPHC struggles to be effective and heard.• Public health messaging is tuned out among
proliferating competition in a variety of channels, ads, and communications
Scenario 2: Under Water
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Key Outcomes• Health gaps between the "haves" and "have-nots"
worsens• Little to no community prevention
– stymied by challenges in funding– difficulties in recruiting cross-sectoral partners– lack of political will
Scenario 2: Under Water
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SCENARIO 3: PUBLIC HEALTH AS CHIEF HEALTH STRATEGIST HIGHLIGHTS
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Boston becomes a beacon for the rest of the nation in successfully improving health equity and racial justice.• Nationally, strong economic recovery; Prevention Fund
restored; “Health in all policies” movement takes hold • By 2016, MA passes a living wage law with automatic
cost-of-living adjustments• Boston’s citywide long term vision for health
Scenario 3: Public Health as Chief Health Strategist
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Health care integrates equity lens into clinical practice and outcomes, performance assessments and quality improvement activities.• Near-universal coverage in the state, excellent care• Systematic screening for health and SDH factors and
needs lead to shared investments and programs in systemic solutions for violence prevention and health
Scenario 3: Public Health as Chief Health Strategist
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Health care integrates equity lens into clinical practice and outcomes, performance assessments and quality improvement activities.• Digital health coaches, social networks, games and
simulations guide users toward healthy behaviors • Demand for EMS services declines with improved care,
services, and prevention
Scenario 3: Public Health as Chief Health Strategist
Digital health agents, gaming,
social networking
Prevention
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Mapping, games, and simulations facilitate community engagement and planning.• BPHD develops health dashboards for each community
to track progress• Virtual simulations and games of Boston’s health allow
for exploration and consideration of emergency scenarios and fair access to opportunities for health.
Scenario 3: Public Health as Chief Health Strategist
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BPHC uses its convening powers and connections to identify and accelerate promising opportunities and evidence-based practices, initiatives, and policies.• BPHC functions as health equity and health promotion
coach for Boston government. • Enhances and leads effective community health
endeavors.
Scenario 3: Public Health as Chief Health Strategist
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Key Outcomes• Health equity and racial justice improve.• Widespread community engagement.• Boston’s government becomes a role model. • BPHC is widely recognized as the City’s chief health
strategist.
Scenario 3: Public Health as Chief Health Strategist
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SCENARIO 4: A RENAISSANCE OF CIVIC AND SOCIAL RESPONSIBILITY HIGHLIGHTS
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Constraints fuel creativity.• Nationally, unemployment remains high, another major
recession in 2017 is followed by slow and uneven recovery
Scenario 4: A Renaissance of Civic and Social Responsibility
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Constraints fuel creativity.• Growing excitement around innovative health-improving
technologies and vibrant social movement of “civic hacking” (including development of apps to help people manage their health)
Scenario 4: A Renaissance of Civic and Social Responsibility
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Constraints fuel creativity.• BPHC uses prizes and current
funding sources to accelerate innovations and save costs
Scenario 4: A Renaissance of Civic and Social Responsibility
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Publicly available simulations and comprehensive data:• Enhance impact
assessments and evaluations
• Improve policy design• Facilitate funding streams
Scenario 4: A Renaissance of Civic and Social Responsibility
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Health care often presses beyond clinical needs to improve population health.• Virtually all Bostonians gain
access to effective health care
• Most care is provided through integrated and capitated ACOs
Scenario 4: A Renaissance of Civic and Social Responsibility
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Health care often presses beyond clinical needs to improve population health.• BPHC joins ACOs and other
providers in population and community health endeavors, often as a leader and/or coach
• Demand for EMS, homeless, and addiction services declines
Scenario 4: A Renaissance of Civic and Social Responsibility
Community Centered Health
Home
Triple Aim
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Key OutcomesMany BPHC functions are taken on by other institutions and consumers; BPHC increasingly shifted to emphasize its role in capacity-building, mapping, and incentivizing the development of public- and private-sector solutions and consumer tools.
Scenario 4: A Renaissance of Civic and Social Responsibility
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• BPHC's successes inspire other Boston agencies and organizations.
• BPHC monitors innovations and assures community representation in the innovation process.
Scenario 4: A Renaissance of Civic and Social Responsibility
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Key Outcomes• Health equity and racial justice improve• Innovation platform provides sophisticated decision-
making tool that is inclusive of all Bostonians
Scenario 4: A Renaissance of Civic and Social Responsibility
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Key Outcomes• Many BPHC functions are performed to large extents by
other institutions, public- and private-sector solutions, and consumer tools
• Widespread community engagement, innovation platform provides sophisticated decision-making tool that is inclusive of all Bostonians
Scenario 4: A Renaissance of Civic and Social Responsibility
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Scenario 1 Scenario 2 Scenario 3 Scenario 4
MACRO AND OPERATING ENVIRONMENTSEconomy
Technology
Health and health care
Citizen science and engagement
Climate Change effects and mitigation
BOSTON PUBLIC HEALTH COMMISSIONFunding
IT and informatics
Workforce
Surveillance and epidemiology
Health education and promotion
Chronic disease prevention and control
Infectious disease prevention and control
Violence preventionEtc.
See the scenario matrix for a side-by-side comparison of the scenarios across multiple dimensions
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Rate the Likelihood & Preferability of Each Scenario
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Likelihood(0% to 100%)
Preferability(0 to 100)
Scenario 1: Smarter Public Health, Missed Opportunities
? ?
Scenario 2: Under Water ? ?Scenario 3: Public Health as Chief Health Strategist
? ?
Scenario 4: A Renaissance of Civic and Social Responsibility
? ?
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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?