How do we get from here—a failing US healthcare system that is rife with inequities—to a future of health and well-being that ensures communities thrive, without exception? Seventeen philanthropic partners sought an answer to that question, looking to move beyond the siloed, incremental work that characterizes contemporary efforts. It drew them to collectively invest in a greater effort called FORESIGHT, a courageous project to embrace the expansive scope of change necessary to make real progress on the nation's health by 2050.

The nationwide, collaborative effort seeks to equitably envision and bring about a new future for health and well-being. The Design Institute for Health team led efforts to bring a human-centered design lens and design-futures perspectives to the collective. We started with big questions and the catalytic approach of combining broad national collaboration with regional action to build a bold vision together.

From the outset, we recognized a fundamental truth: the future is not singular or static. It must live and breathe, because a monolithic view of the future is insufficient, polarizing, and inequitable. How might we build adaptive futures that honor the unique points of view of people who are not usually asked the question of what is possible for their health? What if we built something that allows people to define and create futures based on their own perspectives?

What emerged is the WhatifHealth.org visioning tool. We set out to characterize alternative near-term futures as they unfold, including hypothetical shifts through a visual, web-based, extensible, interactive platform that illustrates what is possible—building a vision of health for the nation. The tool allows users to react to trends and emerging issues across a wide spectrum of considerations. The initial list of building blocks included potential social and demographic shifts, possible changes in policy and funding, evolving diseases and care models, as well as advancements and breakthroughs in biotech, medtech, pharma, and consumer technologies.

What if Health offers an opportunity to dive into four possible, alternative future scenarios for health and well-being. Each of these stories of possible futures are built upon identified trends and emerging opportunities or challenges that could transform health and well-being in the United States. What if Health allows organizations, individuals and communities to react and add their own perspectives on what the future may hold. Those reactions are captured so that potential impacts can be compared, and to spark discussion on both the scenarios and the individual building blocks themselves.

What if Health transformed what would traditionally have been a static artifact—a several-hundred page report—into a tool that would allow philanthropic leaders and others to test hypotheses and see potential impact in a dynamic form, empowering them to shape the future of health. We offer What if Health as a tool to support your own work in building better futures.

We know from research that it's difficult for many of us to engage in a conversation about the future. Especially as people experience challenges in their day-to-day lives, it can feel impossible to project into the future and imagine what life might be like. The What If Health tool is one way to spark these conversations, inviting people to explore what might be on the horizon and to consider new opportunities, challenges, and ideas.

Seeing What's Ahead: Convening Around an Unknown Future of Health

At the heart of FORESIGHT's efforts to build a bold and equitable future for health and well-being has been an explicitly inclusive approach to the futuring process that brings gamechanging trends and emerging issues to thousands of people across the country – particularly those who experience the greatest inequities in our current system – to invite them into a conversation about what they want for the future. Centering a diversity of community voices shifted the focus of our futuring effort fundamentally, from doing something to or for others, to doing it with others, bringing grantmakers and communities together as allied change agents and allowing community to take the lead.

Building the Building Blocks

The road to bringing this tool to life began with a futures scanning process led by the Vision Foresight Strategy LLC (VFS) team, looking at the trends and emerging issues that could impact our health in the future. Understanding that our health is impacted by much more than health care, the scanning process identified 70+ trends and emerging issues on the horizon that reflect broad changes in climate, community, food access, technology, equity, and more.

These building blocks don't predict the future, but they allow us to see what's happening right now and help us to forecast where that might lead.

From Building Blocks to Four Scenarios

This process began in late 2019 and early 2020 when we took the FORESIGHT trends and emerging issues to a diverse group of almost 50 people, representing different geographies, races, ages, and professional and lived experiences, and invited them to lift up the challenges and opportunities that they felt were most likely to transform health and well-being into the future. Those themes were woven into a set of 4 stories of possible futures—what we call alternative future scenarios. Later in 2020, after that first round of community involvement and engagement, the FORESIGHT team took these scenarios to more than 7,500 people across the country, and invited them to explore these possible futures, and to reflect on what they and their communities want and need for the future.

These stories aren't intended as predictions. They don't describe a preferred future, or even a future that's likely. Instead, they are stories created to spark imagination and to provoke new ways of thinking about future possibilities and their implications for life and work. These scenarios leave out some important things; they don't touch on every key issue. We encourage additions from people as they use the tool to more broadly include issues from all perspectives.

You can engage with these possible futures, explore the building blocks that contributed to their creation, react, and contribute your own perspective on the future of health and well-being and, in doing so, begin to explore the implications these things might have on your community and/or organization.

Key Insights that Informed the Tool

The future is plural: It is not one scenario or one single direction, but a series of factors that connect and relate to each other. One vision of the future represents only one point of view, so our intent is to enable co-design and collaboration in shaping futures that represent us all. It's also not about predicting the future, but understanding what might happen and how we can work toward those possibilities.

Building a web-based tool served as a trojan horse: Websites are by no means novel, but the team found the act of convening around what was necessary to build the What if Health site as an inroad to developing alignment, understanding shared goals, and nurturing the collaboration that was essential to the success of the larger project.

Understanding tangible possibilities helps us make plans: As the VFS futurists researched and compiled data, there were 75 building blocks, a select group of which ultimately informed the four radically different alternative future scenarios. Recognizing that over time the building blocks will necessary evolve, What if Health was built flexibly to accommodate the emergent nature of this work, and can accommodate evolution of those building blocks.

Making it Tangible: From Idea to Product

Our collaboration with Star Global and the subsequent development of What if Health took shape over the course of 17 two-week sprints spanning Spring through Winter 2019. During this time we designed, developed, and refined the minimum viable product version of What if Health that preceded the current publicly-available version.

Usability testing with philanthropic partners took place in the spring of 2020 and involved various in-person and virtual user and stakeholder groups. Feedback from those sessions informed updates to content as well as additional features prior to the launch of the current version of What If Health at the FORESIGHT National Convening opening session in October 2020.

Igniting Creativity and Exploring the Unknown

What if Health serves, first and foremost, as an iconic, dynamic, public representation of FORESIGHT's intent—an engaging and compelling mechanism to track trends, explore potential effects of individual issues, and make more tangible possible futures of health. However, its utility does not end there.

For foundations and philanthropy, this tool can identify necessary investment, where catalytic

funding can spur necessary advancement of systemic capabilities that would otherwise be ignored. For regional stakeholders, this tool can highlight where interdependencies

require collaboration between partners to progress shared agendas. For industry players, this tool can serve as a strategic input to their market development plans, one that considers system dynamics rarely within the purview of their own planning. For policy makers and health policy programs, this tool can be a durable reference for past realities and previous models of the future, revealing the circumstances and considerations that shaped past policy, and as an exploratory research tool to influence new policy. For schools, historians, and teachers, this tool can be an educational resource to reveal how this complex system behaves presently, and how it behaves over time.

Additional functionality beyond the current live version are intended in future phases to allow users to publish their futures scenarios to the site to share regional and community-based visions widely.

The Futures of a Futures Tool

What If Health complemented work done in the FORESIGHT national convening in the fall of 2020, where more than 100 people from across systems of health and well-being—including health care professionals, corporate leaders, activists and community organizers, farmers, policymakers, and residents—began to identify pathways toward realizing these collective futures of health in our communities. The next stage of the FORESIGHT project could involve using the tool with regional and national leaders to bring ideas to reality and track both the impact and changes over time.

The What If Health website, as realized for FORESIGHT, also provides an extensible software architecture and platform that can be repurposed to envision and graphically depict future scenarios for any dynamic, multivariate system. It could be adapted to characterize models for narrower, more specific challenges (opioid epidemic, insurance marketplace) or large-scale challenges outside of or adjacent to healthcare (housing, transportation, and other social determinants of health).

While a tool that could be easily reprogrammed by a lay user was beyond the scope of this project, the vast majority of the platform should carry over to other complex system challenges, with only minor manipulation of variables, interdependencies, and visualizations.

Opportunities abound for utilizing this tool to support exploring, understanding, and creating the collaborative futures we all envision.