Academic journal article Bulletin of the World Health Organization

A Future without Health? Health Dimension in Global Scenario Studies

Academic journal article Bulletin of the World Health Organization

A Future without Health? Health Dimension in Global Scenario Studies

Article excerpt

Health dimension in global scenarios

The value of scenarios to explore possible futures and provide sound, policy-relevant guidance for decision-makers is increasingly and widely recognized (Box 1). Scenarios have been generated about, for example, global climate change (1) and water utilization, availability, distribution, and quality (2), and an assessment of future ecosystem composition, structure, and function is in progress (3).

Box 1. Scenarios

Scenarios are descriptions of journeys to possible futures that reflect different perspectives on past, present, and future developments; they are created with a view to anticipating the future. They are hypothetical, describing possible future pathways, and they consist of states, events, actions, and consequences that are linked causally. Scenarios include the depiction of an initial state, which usually lies in the present, or a final state at a fixed time horizon (or both).

Scenarios analysis has evolved significantly over the past decades. In the early days, scenarios were used primarily as planning and forecasting tools to display a rather mechanistic and deterministic world view. Later, scenario analysis moved beyond merely fulfilling a decision-support function to supporting a more open form of exploration. Nowadays, scenarios have evolved into powerful exploratory tools: they do not predict the future, but rather they paint pictures of possible futures and explore the various outcomes that might result if certain basis assumptions are changed. Currently, therefore, scenarios often are used to broaden and deepen the mindset of stakeholders involved in a process of exploring possible futures.

Based on this, the relevant question that scenarios can address is not whether any particular development will happen in the future, but rather what happen and how we act to encourage, discourage, prepare for, and respond to such an event or development. In this way, we can expand our thinking beyond the conventional paradigm to explore future possibilities that go beyond our conventional thinking and that may result in surprising and innovative insights.

In today's era of globalization, global environmental change and the subsequent increasing concern for our present and future health, the call for good global health governance is growing stronger. Scenarios are useful tools for exploring possible global health futures, gaining insights with regard to (the driving forces of) global health, and supporting the decision-making process. To date, however, a set of global integrated scenarios on future health development has not been generated. Even worse, as described below, in most of the global scenarios developed, the health dimension is lacking completely.

With the following three criteria "integration", "long-range outlook", and "global scope" in mind, we considered eight scenario studies (with a total of 31 scenarios) published since 1995 (Table 1). With regard to the health dimension in the selected scenarios, only 14 of the 31 scenarios gave a reasonable description of future developments in health (Fig. 1). Nine scenarios described only specific pressures or drivers with regard to human health or only certain aspects of health (for example, mortality and water-related diseases). Eight scenarios completely neglected the health dimension. Only four scenarios explicitly discussed several socio-cultural, economic, and ecological developments as determinants of health. The main global drivers and pressures of health were described adequately in most of the selected scenarios, with the exception of "education": only 14 scenarios described developments in "education", one mentioned that literacy goals were set, and 16 did not mention "education" at all (Fig. 1).


A mere 15% of the selected scenarios, therefore, describe health adequately and in an integrated way. Remarkable was the fact that of the six storylines developed by the Global Scenario Group, two described health specifically as an outcome of socioeconomic and environmental changes, one gave a reasonable description of future health, but health was absent in three of the scenarios. …

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