Public Health 2030: Scenarios for the Cuyahoga County Board of Health

1. Public Health 2030: Scenarios for the Cuyahoga County Board of Health

2. 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 & schools

3. Scenario Zones Visionary/Surprisingly Successful Expectable Challenging

4. Public Health 2030: Scenarios for the Cuyahoga County Board of Health Scenario 1 Some Health Gains, But Disparities Persist Scenario 2 Big Challenges, Public Health Constrained Scenario 3 Common Sense Returns, Public Health Wins Scenario 4 My Code is Your Code

5. Scenario 1: Some Health Gains, But Disparities Persist Highlights

6. Scenario 1: Some Health Gains, But Disparities Persist • Slow economic growth between 2013 and 2030, financial constraints and instability lead to fluctuations in public health funding

7. Scenario 1: Some Health Gains, But Disparities Persist • Climate change provokes wetter Falls & Springs, periodic flooding, and summer droughts with increasingly frequent heat waves • HIP-C remained a community force, with priorities including resilience and sustainability

8. Scenario 1: Some Health Gains, But Disparities Persist • EPH focuses its activities on resilience, adaptation, and mitigation

9. Scenario 1: Some Health Gains, But Disparities Persist • EPH promotes activity and healthier food in schools, including farm-to-school food initiatives

10. Scenario 1: Some Health Gains, But Disparities Persist • ESI expands its work in emergency preparedness and response, disease outbreaks, and disease tracking, and analyzes larger amounts of data • Food safety challenges persisted

11. Scenario 1: Some Health Gains, But Disparities Persist • P&W’s efforts to improve population health are subject to political polarization • P&W staff numbers have decreased

12. Scenario 1: Some Health Gains, But Disparities Persist • P&W uses new data tools and sources to improve mental health and reduce violence, particularly sexual violence

13. Scenario 1: Some Health Gains, But Disparities Persist • Health gains; but health disparities persist (though in some cases they have been reduced)

14. Scenario 2: Big Challenges, Public Health Constrained Highlights

15. Scenario 2: Big Challenges, Public Health Constrained Recurrent severe recessions • Economic disparities and a cycle of recessions and slow recoveries constrain state and local financing as jobs are lost • CCBH staff has been reduced to half its 2013 numbers

16. Scenario 2: Big Challenges, Public Health Constrained Many more uninsured • Health care reform is largely halted by 2016 • CCBH cannot keep up with technological advances, which primarily benefit the affluent

17. Scenario 2: Big Challenges, Public Health Constrained • Climate change overwhelms the nation and Cuyahoga County • 100-year floods a few times each decade

18. Scenario 2: Big Challenges, Public Health Constrained • Scorching summer droughts and extreme weather events • Cuyahoga County beaches became unusable • New diseases and antibiotic resistant bacteria; Cyclospora outbreaks; increases in asthma and nosocomial infections.

19. Scenario 2: Big Challenges, Public Health Constrained • Harsh spending cuts and public dissatisfaction with government severely limit CCBH activities in prevention, emergency preparedness, HIP-C, policy, advocacy, and data collection • CCBH loses accreditation

20. Scenario 2: Big Challenges, Public Health Constrained • Health outcomes and disparities worsen

21. Scenario 3: Common Sense Returns, Public Health Wins Highlights

22. Scenario 3: Common Sense Returns, Public Health Wins • “Common sense” policies of community prevention, injury prevention, “living wages,” and environmental protection are established and broadly supported

23. Scenario 3: Common Sense Returns, Public Health Wins • Partisanship around climate change policy decreased and public policy includes earnest commitments to mitigate climate change

24. Scenario 3: Common Sense Returns, Public Health Wins • Redeveloped & mixed use neighborhoods; “complete streets;” health in all policies; and local food systems encouraged

25. Scenario 3: Common Sense Returns, Public Health Wins • Technology and digital divides are reduced, as environmental sensing, biomonitoring, and smart phone use become ubiquitous and inexpensive

26. Scenario 3: Common Sense Returns, Public Health Wins • Culture of greater equity, collaborative consumption, reuse, and crowdsourcing encourage inter- and intra-community improvement, resilience, and cooperation

27. Scenario 3: Common Sense Returns, Public Health Wins • Health care reform succeeds, health care is personalized, and health care systems (Accountable Care Organizations and Community Centered Health Homes) promote population health Community Centered Health Home Digital coach (“avatar”) Triple Aim Facilitated Disease Network Wellness & disease mgmt. apps Personal health record

28. Scenario 3: Common Sense Returns, Public Health Wins • CCBH serves as chief health strategist for the community • Facilitating HIP-C; • Using mapping, monitoring, social media, gaming, health in all policies • More financially stable; smaller staff

29. Scenario 4: My Code is Your Code Highlights

30. Scenario 4: My Code is Your Code • Major recession in 2017 increases visibility of disparities, and engaging advocacy leads to the My Code is Your Code Movement

31. Scenario 4: My Code is Your Code • My Code is Your Code uses technology, citizen science, and netizen advocacy to conduct “social coding” and “social programming” to reflect a code of fairness, and to eliminate disparities and marginalization that result from inherent differences in genetic codes or zip codes

32. Scenario 4: My Code is Your Code • “Alternative economics” activities and technologies are adapted and improve community health, resilience, and solidarity

33. Scenario 4: My Code is Your Code • Health care reform continued, and ACOs evolved into Accountable Care Communities (ACCs) Accountable Care Communities Triple Aim

34. Scenario 4: My Code is Your Code • CCBH is a strong ally and leader in climate and health goals and initiatives, including environmental mitigation, renewable energy

35. Scenario 4: My Code is Your Code • CCBH’s strong partnerships and collaborations with My Code is Your Code, citizen scientists, Groupnets, ACCs, government agencies, and businesses improve community sustainability, health, and health equity • CCBH has a smaller, but highly skilled and enthusiastic work force

36. See the scenario matrix for a side-by-side comparison of the scenarios across multiple dimensions

37. Rate the Likelihood & Preferability of Each Scenario

38. 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?