‘Who we are?’ Reflections on who a Foresight Programme might involve, and why

Jackie Walumbe, Emmanuel Abalo, Muriel Levy, Graduate Assistants at the Foresight Pilot workshop, report:

Participants at this week’s Pilot Foresight event at Green Templeton College were tasked with discussing the key challenges for the future of health and care systems and to think forward to alternate futures and potential levers for change. Those invited to take part had undoubted expertise and influence across health and care and were distributed across national, organisational and disciplinary boundaries. A veritable who’s who of global health and care, if you will. What emerged as a consistent challenge from the group was the question ‘who are we?’ and, in response, a commitment to engaging with a broader constituency and set of ideas in ways that can secure a sustainable future for health and care systems across the world.

The intention in this event, as with similar Foresight initiatives, was to engage invitees in a participatory process and to begin to explore what a wider programme of work might look like and who it might involve. The question of who exactly was – and who could be – represented formed a consistent thread in discussions throughout the day. Participants reflected on the role of power relations, inequality (particularly of income), and the public perception of experts in shaping health and care systems of the future, and on their own – and others’ – role in challenging vested interests.

Many of the conversations around current challenges to health and care were expressed in terms that those present were familiar with and had confidence in. Debate covered known issues touching on demographic transitions, the role of technology and public expectations. However, many acknowledged that different scenarios may play out in the next 50 years that will likely be determined by a diverse range of actors. The ability to visualise these alternate futures will depend, not only on involving future generations, but also on enhancing the quality of conversations by engaging diverse experiences and opinions. Take the example of the role that inequality plays in health and care. Discussions amongst the group pointed to a global shift in power and resources away from historically developed countries towards developing and emerging economies, and yet it was representatives of the former that were in the majority on the day.

This was, of course, a pilot event. Through this lens it was an engaging and solid foundation from which to leap forth into helping to search out and support sustainable futures. Participants were individually and collectively reflexive on their own roles and what they might bring to a discussion about the long term future of health and care. They posed the question ‘who are we?’, and acknowledged their own limitations in thinking about and predicting what health and care systems might look like in 50 years. The challenge back to organisers, and Green Templeton, is to now engage young people, members of local communities, and those whose views do not align with their own.

Those with opposing views were an important group to involve. How to do this in a meaningful way was less clear. Nonetheless, there were some ideas about what this could look like, including: organising (face-to-face and online) training for young people, engaging the next generation of system leaders from global north and south, and creating fellowships to support interdisciplinary and geographical exchange, and learning for future generations to come. We also ask organisers to be mindful of the location of meetings (not least as some citizens are unable to move freely across borders), the potential of technology to enable participation and the on-going importance of fostering interdisciplinary and intersectoral dialogue. Doing so could well allow Green Templeton to foreground issues that often receive limited attention e.g., the role of conflict, issues of food security, disproportional impact of climate change, the gender imbalance in caring responsibilities.

In our view the reach, influence and applicability of the insights from the Green Templeton Foresight initiative will be greatly enhanced by opening up this particular space to groups that currently do not have as much representation. And we are in no doubt that conveners – as well as participants – aspire to such reach. The adage ‘no man is an island’ rang through discussions, with a rejection of isolationism and a caution against reducing the unit of intervention in health and care to the individual.

As conveners retire to consider how best to take the Pilot Foresight initiative forward, we urge them to avoid the trap of (borrowing a phrase from one of the participants) ‘deterministic optimism’ and group think, to look beyond existing networks and bravely seek out the ‘known unknown’. This will undoubtedly help to diversify the content of ideas and mitigate against accusations of a ‘global elite’ offering solutions that may not reflect the lived realities of so many of our fellow citizens. As students at Oxford and, we hope, future system leaders, we lay down the gauntlet for Green Templeton to work across borders and generations and help to prepare the ground for a sustainable future.

Jackie Walumbe, Emmanuel Abalo, Muriel Levy
26 March 2019