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

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 2

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 4

5. SCENARIO 1: SOME HEALTH GAINS, BUT DISPARITIES PERSIST  HIGHLIGHTS 5

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

7. 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 7 Scenario 1: Some Health Gains, But Disparities Persist

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

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

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

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

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

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

14. SCENARIO 2: BIG CHALLENGES, PUBLIC HEALTH CONSTRAINED  HIGHLIGHTS 14

15. 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 Recurrent severe recessions 15 Scenario 2: Big Challenges, Public Health Constrained

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

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

18. 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. 18 Scenario 2: Big Challenges, Public Health Constrained

19. 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 19 Scenario 2: Big Challenges, Public Health Constrained

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

21. SCENARIO 3: COMMON SENSE RETURNS, PUBLIC HEALTH WINS  HIGHLIGHTS 21

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

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

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

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

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

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

28. 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 28 Scenario 3: Common Sense Returns, Public Health Wins

29. SCENARIO 4: MY CODE IS YOUR CODE  HIGHLIGHTS 29

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

31. 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 31 Scenario 4: My Code is Your Code

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

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

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

35. 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 35 Scenario 4: My Code is Your Code

36. Scenario 1Scenario 2Scenario 3Scenario 4 MACRO AND OPERATING ENVIRONMENTS Economy Technology Health and health care Citizen science and engagement Climate Change effects and mitigation CUYAHOGA COUNTY BOARD OF HEALTH Funding IT and informatics Workforce Surveillance and epidemiology Health education and promotion Chronic disease prevention and control Infectious disease prevention and control Violence prevention Etc. See the scenario matrix for a side-by-side comparison of the scenarios across multiple dimensions 36

37. Rate the Likelihood & Preferability of Each Scenario 37 Likelihood (0% to 100%) Preferability (0 to 100) 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 ??

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? 38