Trevor Hancock: We face alternative health futures

Last week, I referred to Norman Henchey’s categorization of four sorts of future: Probable, possible, plausible and preferable. This week, I explore the latter three, especially in the context of the future of health and the health-care system.

But first, an important distinction. Many of those who describe themselves as health futurists are really health-care-system futurists. They are focused on the future of the health-care system, rather than on health itself.

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But if you want to think about the future of health, you have to think about much more than just the health-care system; you have to think about the future of society as a whole and the state of our environment, as they are what largely determine the health of the population.

In fact, our society also determines what kind of health-care system we have, because that system will reflect the values and social norms of the society of which it is a part — not the other way around. So with that in mind, what can we say about the possible, plausible and preferable futures of health and health care?

The possible future encompasses all the things we can imagine happening, which can take it into the realm of science fiction. This is not to disparage science fiction; at its best, it can illuminate our present world and its values, and imagine and test ideas most of us have never considered.

But the possible can also get pretty wild, both scientifically and socially, which can make it implausible. The transporter beam of Star Trek is a case in point, as perhaps are its instant diagnostic scanners, or the extreme genetic manipulations in the novels of William Gibson or Iain M. Banks. I would put the visions of limitless free energy and hopes for instant cures for cancer and other diseases in the implausible zone.

The plausible future is a narrower band within the wide range of possible futures. It can be best explored by the use of scenarios — narratives of alternative futures based on what we know and can reasonably anticipate. In scenarios work, we not only explore the “business as usual” scenario, but a plausible future in which many things go wrong, which can be described as decline or collapse.

This is definitely not a preferable future, and people don’t like to explore it, but if asked, they find it plausible, even quite likely. By exploring such a future we can both recognize what we need to do to avoid it and/or to cope with and manage it.

Other plausible scenarios include some form of eco-social, economic and to some extent spiritual transformation, a sort of “green” future that sees us move away from the more high-tech “business as usual” or the conditions that lead to decline or collapse. Not surprisingly, such a future, while not necessarily seen as all that plausible or feasible, is often seen as quite healthy and thus desirable, especially when allied with the appropriate use of high-tech.

But embedded within and underlying each scenario are sets of values that guide the scenario, such as the value placed on health and how health is understood in that society — which in turn shapes that future’s health-care system. For example, is health just about physical well-being and length of life, or mental well-being and quality of life, or balance and harmony within society and nature?

In the first option, we might expect a more high-tech, biomedical system, but in the other two, a system more focused on achieving mental well-being or ecological well-being, while in a decline or collapse scenario we can imagine there would be a quite minimal, survival-oriented health-care system, and mainly for the rich and powerful.

But beyond imagining a range of plausible futures we face, the key question is what sort of healthy future we want for our kids and grandkids. As I said in last week’s column, thinking about the future should help us decide what we do and how we live today. Rather than just adapting to whatever happens, how do we help to shape and create the future we prefer? That will be the topic of next week’s column.

Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.

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