Month: February 2019

public healthstrategic foresight

Futuring the Past

Flat Earth to Measles: Did We See That Coming?
In the first month of 2019 the United States saw more measles cases than it did in all of 2010. This disease of the past was once on its way to extinction (or deep hibernation) is now a current public health threat, which prompts us to think: how can our futuring better consider what we came from not just what it might lead to?

Measles was something that my parents worried about for me and my brothers more than forty years ago. Measles is one of those diseases that causes enormous problems that are both obvious and also difficult to see until they manifest themselves down the road. Encephalitis and diarrhea are two possible short-term effects, while a compromised immune system down the road is some of the longer-term effects. It’s a horrible condition, one of the most infectious diseases we know of, and also one that was once considered to be ‘eliminated’ from the United States,Canada and most of the Americas (which means existing in such small numbers as not worthy of large-scale monitoring).

In the first month of 2019 there have been more measles cases tracked than all of 2010. The causes of this are many, but largely attributable to a change in vaccination rates among the public. The fewer people who get vaccinated, the more likely the disease will find a way to take hold in the population — first of those who aren’t protected, but over time this will include some of those who are because of the ‘herd protection’ nature of how vaccination works.

Did We See That Coming?

Measles hasn’t featured prominently in any of the foresight models of the health system that I’ve seen over the course of my career. Then again, twenty-five years ago, it would have been unlikely that any foresight model of urban planning would have emphasized scooters or bicycles — old technologies — over the automobile as modes of transportation likely to shape our cities. Yet, here we are.

Today, those interested in the future of transportation are focused on autonomous cars, yet there is some speculation that the car — or at least the one we know now — will disappear altogether. Manufacturers like Ford — the company that invented the mass-market automobile — have already decided they will abandon most of their automobile production in the next few years.

The hottest TV show (or rather, streamed media production) among those under the age of 20? Friends (circa 1994).

Are you seeing a trend here?

What we are seeing is a resurgence of the past in pockets all throughout our society. The implications of this are many for those who develop or rely on futurist-oriented models to shape their work.

One might argue that a good model of the future always assumes this and therefore it isn’t a flaw of the model, but rather that, as William Gibson was quoted as suggesting: the future is here, it’s just not evenly distributed yet. The Three Horizon Framework popularized by McKinsey has this assumption built into it from the beginning. But it’s not just the model that might be problematic, but the thinking behind it.

Self-Fulfilling Futures

Foresight is useful for a number of things, but I would argue very little of that benefit is what many futurists claim. The arguments for investing in foresight is that, by thinking about what the future could bring we can better prepare ourselves for that reality in our organizations. This might mean identifying different product lines, keeping an eye out for trends that match our predictions, improving our innovation systems and “the impact of decision-making“.

Why is the case? The answer — as I’ve been told by foresight and futurist colleagues — is that by seeing what is coming we can prepare for it, much like a weather forecast allows us to dress appropriately for the day to account for the possibility of rain or snow.

The critique I have with this line of thinking is that: do we ever go back and see where our models fit and didn’t fit? Are foresight models open to evaluation? I would argue: no. There is no systematic evaluation of foresight initiatives. This is not to suggest that evaluation needs to concern itself with whether a model gets everything right — that the future turns out just as we anticipated — but whether it was actually useful.

Did we make a better decision because we saw a possible future? Did we restructure our organization to achieve something that would have been impossible had we not had the strategic foresight to guide us? These are the claims and yet we do not have evidence to support it. Such little evaluation of these models has left us open to clinging to myths and also to an absence of critical reflection on what use these models have (and also a wasted opportunity to consider what use they could have).

Yes, the case of Royal Dutch Shell and its ability to envision problems with the global oil supply chain in the late 1960’s and early 70’s through adopting a foresight approach gave them a step up on their competitors. But how many other cases of this nature are there? Where is the evidence that this approach does what it’s proponents claim it does? With foresight being adopted across industries we should have many examples of its impact, but we do not.

Layering Influence and Impact

Let’s bring it back to public health. There is enormous evidence to point to the role of tobacco use and lifetime prevalence of a litany of health problems like cancer and cardiovascular disease, yet there are still millions who use tobacco daily. Lack of retirement savings is a clear pathway to significant problems for health, wellbeing, and lifestyle down the road. The effects of human behaviour on the environment and our health have been known for decades (or millennia, depending on your perspective) to the point where we are now referring to this stage of planetary evolution as the Anthropocene (the age where humans influence the planet).

We can see things coming in various degrees of focus and yet the influence on our behaviour is not certain. Indeed, the anticipation of future consequences is only one element of a large array of factors that influence our behaviour. Psychologists, the group that studies and support the evidence for behaviour change, have shown that we are actually pretty bad at predicting what will happen, how we will react to something, and what will influence change.

Many of these factors are systemic — that is tied to the systems we are a part of. This is our team, family, organization, community, and society, and time — the various spheres outlined in Bronfenbrenner’s Social-Ecological Model. This model outlines the various ‘rings’ or spheres that influence us, including time (which encompasses them all). It’s this last ring that we often forget. This model can be useful because it showcases layers of impact and influence, including from our past.

Decision Making in the Past

By anchoring ourselves to the future and not considering our past, our models for prediction, forecasting, and foresighting are limited. We are equally limited when we use the same form of thinking (about the future) to make our models about the past. In this case, I think of Andrew Yang who recently spoke to the Freakonomics podcast and pointed out how our economic thinking is rooted in past models that we would never accept today. He’s wrong — sort of. We do accept this and it is alive and well in many of our ways of thinking about the future.

In speaking about how we’ve been through economic patterns of disruption, he points out that we are using an old fact pattern to inform what we do now as if the economy — which we invented just a few hundred years ago — has these immutable laws.


The fantasists — and they are so lazy and it makes me so angry, because people who are otherwise educated literally wave their hands and are like, “Industrial Revolution, 120 years ago. Been through it before,” and, man, if someone came into your office and pitched you an investment in a company based on a fact pattern from 120 years ago, you’d freakin’ throw them out of your office so fast.

Andrew Yang, speaking on Freakonomics

Foresight would benefit from the same kind of critical examination of itself as Yang does with the economy and our ways of thinking about it. That critical examination includes using real evidence to make decisions where we have it and where we don’t have it – we establish it.

Maybe then, we might anticipate that measles are not gone. Let’s keep our eye out on polio, too. And as for a flat earth? Don’t sail too far into the sunset as you might fall off if we don’t factor that into our models of the future.

Image Credit: “Flat Earth | Conspiracy Theory VOL.1” by Daniel Beintner is licensed under CC BY-NC-ND 4.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by-nc-nd/4.0