‘Anticipatory democracy’ for a healthier future for all

‘Anticipatory democracy’ for a healthier future for all

Dr. Trevor Hancock

9 April 2019

702 words

Last week, I discussed some of the possible and plausible futures we face. This week, I will focus on the importance of thinking about and then working to create the future we prefer, and the need for ‘anticipatory democracy’.

Good thinking about the future begins with the recognition that the future is not fixed, but is ‘plastic’, it can be shaped. So even if we think the future looks grim, that does not mean it will happen; more to the point, it suggests that we can change that future to one we prefer.

Clem Bezold, founder in 1977 of the Institute for Alternative Futures, has spent more than 40 years helping people to think about the future they may face and the future they prefer, and I have been privileged to work with him over the years on health futures. We use scenarios to explore the future of health and health care, and we find the future people think we face and the future they would prefer are often very different.

People tend to think we face a ‘business as usual’ (BaU) future, more of the same but bigger and more high-tech. However, ‘business as usual’ is also beginning to look quite grim, as we witness extraordinary levels of inequality and learn ever more about the emerging global ecological crises of climate change, pollution, resource depletion and species extinctions.

In health care, a BaU future is often seen as more technology, more pills, more machines, but also more impersonal and less caring; such a future is often unappealing not only to the public but to health care providers themselves.

So while people may see such a future as likely it is not necessarily desirable; other alternatives may appear less likely but more desirable and thus preferable. In particular, many tend to prefer scenarios that depict a ‘green’ or transformative future, still high-tech, but using technology in a more humane, and environmentally and socially beneficial way.

To describe a preferable future, we use visioning. Clem Bezold summarises the benefits of visioning succinctly: “Vision is values projected into the future”. Such a future is not about what we think or fear will happen, but what we wish to have happen. In the vision workshops I conduct, I take people through a guided imagery journey through their community at some point in the future when it is healthy.

The images that emerge and the communities they depict are more like the ‘green’/transformative’ scenarios that Clem and I work with. So what does it mean if our minds tell us that the future we face is not all that desirable, while our hearts tell us we want a very different future?

 

In psychological terms, this is known as cognitive dissonance; our current collective behavior, which is delivering our ‘BaU’ future, is at odds with our values and with our mental map of what we want. Cognitive dissonance can be an important trigger for change. In this case, do we continue to work towards the future we don’t want, or try to move towards the future we prefer?

The Institute for Alternative Futures was established with the encouragement and support of Alvin Toffler, whose 1970 book “Future Shock” popularized futures thinking. One of Toffler’s ideas was what he called ‘anticipatory democracy’ – engaging people in thinking about and choosing the future they prefer in a participatory democratic manner.

One of my former students, Ottilia Berze, has just completed her PhD on foresight at UVic. One of her key findings is that “foresight literacy, communication and education around foresight and the facilitation of a culture of foresight are critical” if we are to meet the challenges of the 21st century. She suggests “developing foresight literacy for school-aged children” and recommends that we “embed foresight literacy into the grade school curriculum nationwide”.

Through their strikes against anthropogenic climate change and other activities, young people are expressing their alarm at the future they fear. Now we need to engage them – and their families and communities – in imagining and working to create a just, healthy and sustainable future for themselves. We need a more participatory and anticipatory democracy so that with foresight we can create the future our young people deserve.

© Trevor Hancock, 2019

 

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We face alternative health futures

We face alternative health futures

Dr Trevor Hancock

2 April 2019

700 words

Last week I referred to Norman Henchey’s categorisation of four sorts of future: Probable, possible, plausible and preferable. This week I explore the latter three, especially in the context of the future of health and the health care system.

But first, an important distinction. Many of those who describe themselves as health futurists are really health care system futurists. They are focused on the future of the health care system, rather than on health itself.

But if you want to think about the future of health, you have to think about much more than just the health care system; you have to think about the future of society as a whole and the state of our environment, since they are what largely determine the health of the population.

In fact, our society also determines what kind of health care system we have, because that system will reflect the values and social norms of the society of which it is a part – not the other way around. So with that in mind, what can we say about the possible, plausible and preferable futures of health and health care?

The possible future encompasses all the things we can imagine happening, which can take it into the realm of science fiction. This is not to disparage science fiction; at its best, it can illuminate our present world and its values, and imagine and test out ideas most of us have never considered.

But the possible can also get pretty wild, both scientifically and socially, which can make it implausible. The transporter beam of Star Trek is a case in point, as perhaps are its instant diagnostic scanners, or the extreme genetic manipulations in the novels of William Gibson or Iain M Banks. I would put the visions of limitless free energy and hopes for instant cures for cancer and other diseases in the implausible zone.

The plausible future is a narrower band within the wide range of possible futures. It can be best explored by the use of scenarios – narratives of alternative futures based on what we know and can reasonably anticipate. In scenarios work, we not only explore the ‘business as usual’ scenario, but a plausible future in which many things go wrong, which can be described as decline or collapse.

This is definitely not a preferable future, and people don’t like to explore it, but if asked, they find it plausible, even quite likely. By exploring such a future we can hopefully both recognise what we need to do to avoid it and/or to cope with and manage it.

Other plausible scenarios include some form of eco-social, economic and to some extent spiritual transformation, a sort of ‘green’ future that sees us move away from the more high-tech ‘business as usual’ or the conditions that lead to decline or collapse. Not surprisingly, such a future, while not necessarily seen as all that plausible or feasible, is often seen as quite healthy and thus desirable, especially when allied with the appropriate use of high-tech.

But embedded within and underlying each scenario are sets of values that guide the scenario, such as the value placed on health and how health is understood in that society – which in turn shapes that future’s health care system. For example, is health just about physical wellbeing and length of life, or mental wellbeing and quality of life, or balance and harmony within society and nature?

In the first option, we might expect a more high-tech, biomedical system, but in the other two, a system more focused on achieving mental wellbeing or ecological wellbeing, while in a decline or collapse scenario we can imagine there would be a quite minimal, survival-oriented health care system, and mainly for the rich and powerful.

But beyond imagining a range of plausible futures we face, the key question is what sort of healthy future we want for our kids and grand-kids. As I said in last week’s column, thinking about the future should help us decide what we do and how we live today. Rather than just adapting to whatever happens, how do we help to shape and create the future we prefer? That will be the topic of next week’s column.

© Trevor Hancock, 2019

 

 

 

Futures thinking can pay off

Futures thinking can pay off

Dr Trevor Hancock

26 March 2019

698 words

I am often accused, not unjustly, of being a ‘doom and gloom’ merchant when it comes to the state of the planet and of our society. While there are good reasons to hold that view, it is not the only way of looking at the future. Part of my professional work has been as a futurist, specifically a health futurist. That is to say, I have worked with people to help them think more effectively and creatively about the future of health and health care.

Futurists often get a bad rap, accused of being too visionary, even dreamy, by some, while others think futurists have done a poor job of predicting the future. Both those views, however, miss the point of good futures thinking.

Many years ago I worked with James Robertson, a British futurist and author of an infuential 1978 book, ‘The Sane Alternative’. In 1984 I brought him to Toronto to speak at a conference I was organising, and one of the things he said captured for me the very essence of good futures work. “Thinking about the future”, he said,”is only useful and interesting if it affects what we do and how we live today”.

So good futures work is very practical, because it helps us make better choices and decisions today that will shape our future. Of course, there is no guarantee that we will do so; witness the litany of failed opportunities over the past 50 years to avoid the environmental crisis that was predicted then and that we now face.

Which points to the other sort of problem; futurists may help us understand and anticipate future events, but there is no guarantee their ideas will be understood, taken to heart and acted upon. Moreover, prediction is a bit of a mug’s game; as another colleague, and one of the world’s leading futurists, Jim Dator, used to say, the probable future is the least likely future.

By that he meant that predicting the future as a form of ‘business as usual’, especially based on past trends and performances, is inherently wrong, because it assumes that things will continue much as they are, when in fact the only thing that is constant is change. The future, as futurists like to remark, is plastic, it can and will be shaped, often in ways we don’t anticipate – witness the way the internet has changed our world.

Moreover, as we have come to understand complex adaptive systems better – systems such as the human body, the economy or the Earth’s natural systems – we have come to understand two important things about them that make prediction hard, if not impossible.

First, within such systems, small changes can perturb the system in ways that result in massive change, the so-called butterfly effect. (The analogy is that the beat of a butterfly’s wings in China today can spawn a tornado days later in America.) The opposite is also true; large changes in input can have little or no effect, as the system adapts to them and smoothes out or absorbs their impacts.

The second realisation is that there can be sudden, non-linear state-shifts in such systems. These systems are dynamic, but stable, though when enough strain builds up, or just the right small nudge occurs and they cross a threshold – which we may not know about in advance – they can shift suddenly to a different state. Some climate models, for example, suggest the Earth’s climate can be stable in its present configuration or two much different states; ‘snowball Earth’ or ‘ice-free Earth’; at present, we are pushing the Earth towards the latter.

All of this suggests that there is no such thing as THE future, but rather we face many different futures. The Canadian futurist Norman Henchey put it well many years ago when he described four categories of future: Probable, possible, plausible and preferable. The probable, as we have already seen, while interesting, may be neither likely nor preferable; the other three are more interesting, and I will describe them next week, particlularly in the context of the future of health and health care, before turning to thinking positively about creating a preferred future in a third column.

© Trevor Hancock, 2019