Public Health 2030: Scenarios for Fargo Cass Public Health

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Public Health 2030: Scenarios for Fargo Cass Public Health

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 & schools2

Scenario Zones

Visionary/Surprisingly Successful

Expectable

Challenging

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Public Health 2030: Scenarios for Fargo Cass Public Health

Scenario 1Fargo Forward

Scenario 2UFF-DA! & the Flood of 2020

Scenario 3Fit and Healthy Fargo

Scenario 4Healthy People, Healthy Communities

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SCENARIO 1: FARGO FORWARD

HIGHLIGHTS

• FCPH’s is financial stabile, despite slow national economic growth and two normal recessions, and some federal public health cuts because of overall health of the City and region.

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Scenario 1: Fargo Forward

• FCPH took advantage of Patient Protection and Affordable Care Act (ACA) & health care advances

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Personal health record


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=wBuF2hve5Be7CM&tbnid=3ek2ix4F6AUcYM:&ved=&url=http://www.123rf.com/photo_12475794_quality-assurance.html&ei=sfulUsvDGpLLkAfpt4CgBQ&bvm=bv.57752919,d.eW0&psig=AFQjCNH3bDdkz9C_5DH6yUvMTmwWy5Ql-g&ust=1386695985862850

• Fargo had to adjust to climate change

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• Emergency Preparedness expands and coordinates with Public Information Officer, University of North Dakota (UND), and other local groups to increase “Fargo Emergency Preparedness and Awareness” (FEPA)

• Uses social media, gamification, community and school events, and simulations

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• FCPH and the FEPA efforts could not remove complacency and feelings of false security among residents

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• 2020 Derailment: major explosion– Leakage of anhydrous ammonia

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• Residents now recognize the need for FEPA

• And FCPH ramps up activities in behavioral health, environmental health, emergency prep, and outreach

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• FCPH partners with UND to use remotely piloted vehicles (RPVs) to conduct surveillance, monitoring, inspection during and after emergencies

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• Evolution of surveillance, monitoring, and inspection in non-emergency and pre-emergency periods as well – Video monitoring, automated analysis– Results available in consumer rating services

• Increased air and water quality monitoring by public, private, and citizen efforts enhance early warning and response systems

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• Telemedicine, ubiquitous smart phones, affect– Correctional health– Substance abuse and

tobacco control– Biomonitoring– Home health and

nursing services– Outreach

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Telemedicine


• FCPH leads or facilitates community coalitions to address social determinants of health and behavioral health

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• FCPH stimulates community collaborations to map community conditions, develop available land into community gardens or safe physical activity spaces, increase neighborhood safety, or develop “complete streets”

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• FCPH enhances engagement with the community and monitoring of these new spaces and activities via:– Citizen science groups– Health technologies– Mobile apps– Social media– Technologically adept young adults from North

Dakota State University (NDSU) and Microsoft

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• FCPH respected as advocate for sensible public health policies, community educator, and community partner.

• Relatively stable funding supports continuous quality improvement and enhanced emergency response capabilities.

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SCENARIO 2: UFF-DA! & THE FLOOD OF 2020

HIGHLIGHTS

• Initial local financial and economic health in the early 2010s was disrupted as farms suffered from four consecutive severe droughts beginning in 2014

• Most farmers produced only a fraction of their usual harvest, sometimes none at all

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Scenario 2: UFF-DA! & the Flood of 2020

• October 2019: severe winter; deep snow did not melt by early spring

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• April 2020: temperature shifted rapidly; several record-breaking warm days yielded sudden and large snowmelt

• Major rainstorms accelerated melting and increased water volume

• Several towns along the Red River were flooded

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• FCPH led a huge and successful evacuation with support from partners

• Water subsided after two weeks• Emergency response was as good as it could have

been; there were no deaths

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• Water topped the levy, reaching a height of 44 feet and flooding the area from the Red River to Interstate 29.

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• 15,000 homes housing 50,000 people were flooded, along with most businesses, schools, hospitals, and clinics

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• Water and sewer systems contaminated

• Summer rains; record heat• Many properties remained

unrepaired and unoccupied for years

• Spread of West Nile Virus

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• Local economy hit hard; many businesses folded• Many homes became uninhabitable; property values

dropped• Budgets were cut significantly; public and private

sector unemployment rose

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• FCPH funding was unstable and reduced– Non-mandated services without their own income

stream were eliminated– Environmental Health services only responded to

issues that presented imminent health risk or that could affect the community’s health

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• Health care reform had stalled by 2015• Access to health care was becoming more

limited, health worsened

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Many more uninsured


• Severe cuts to maternal and child, women’s, and elderly care programs

• Prevention and promotion activities halted

• FCPH refocused efforts on meeting the health needs of homeless and displaced persons (many of whom were flood refugees)

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• Health has severely declined since the 2010s• Disparities in health and access to health care have

grown, with environmentally displaced and low-income persons suffering most

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• FCPH funds cut repeatedly • FCPH regularly releases staff members and eliminates

or curtails its public health activities and programs

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SCENARIO 3: FIT AND HEALTHY FARGO

HIGHLIGHTS

• “Mind change” toward health and shaping the determinants of health

• “Common sense” policies receive bipartisan support• Private and public sectors strive to meet demands for

health promotion and sustainability

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Scenario 3: Fit and Healthy Fargo

• Health care reform was implemented, ACOs were successful

• Sanford, Ascentia, and Family Health Services joined with FCPH and other community partners in improving community conditions and addressing the social determinants of health

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• EHRs became ubiquitous and interoperable; stored and shared through a state-run cloud storage service that provided “big data” advanced analytics

• FCPH could conduct enhanced surveillance

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Electronic Health Records (EHRs)


• As smartphones became standard and inexpensive, citizens and New Americans were able to gather personal biomonitoring data

• Individuals became more skilled in learning from their information

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• Citizen science aided patient groups, FCPH, and health care providers in doing sophisticated data mining, mapping, and enhanced community needs assessments

• Community engagement processes allow people to help set health priorities for the community

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• Increased commitment to community prevention as preferred tool for health

• FCPH moved away from direct clinical services toward shaping policy, fostering community collaborations, and providing community health leadership

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• Community prevention activities ensure community resilience and health in the face of environmental change and potential environmental disasters

• Environmental sustainability became a core part of community prevention efforts

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• FCPH collaborated with neighborhoods and community groups focusing on self-reliance and community resilience in order to enhance:– Local environmental sustainability– Reduced emissions– Improved community conditions– Quality monitoring

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• Emergency preparedness evolved to foster “community health preparedness” (creating healthier personal practices and conditions before emergencies)

• Simulations and gamification enabled proper anticipation and response to potential hazards among community members, providers, and businesses

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• FCPH’s Nursing Services continued to provide personal contact and coaching; nurses and community health workers continue to “visit” individuals electronically and in person as needed

• Combined human touch with digital health coaches and personal electronic avatars

44Telemedicine Digital coach (“avatar”)


• FCPH continues to administer the city-owned homeless shelters

• FCPH’s Health Protection and Promotion services joined forces with community and urban gardens that provided fresh food for food shelters and food pantries

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http://en.wikipedia.org/wiki/File:New_crops-Chicago_urban_farm.jpg

• Improved case management and referral to appropriate community services decreased need for overflow shelter space and mental health services

• Health Protection and Promotion services advocated for policies supporting activity-enhancing developments such as Complete Streets

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• By 2030, FCPH has achieved many of its community prevention goals

• FCPH enjoys stable funding; staff has grown

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SCENARIO 4: HEALTHY PEOPLE, HEALTHY COMMUNITIES

HIGHLIGHTS

• A movement to combat disparities was taking hold as health care reform succeeded and the US experienced solid economic growth

• Baby Boomers sought to contribute to society as effectively as they could and leave a positive legacy for younger generations

• There are strong movements to mitigate the effects of climate change and adapt to it

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Scenario 4: Healthy People, Healthy Communities

• Technologies, social media, and crowdsourcing aid reporting, surveillance, monitoring, self-reporting, and self-monitoring

• FCPH expanded focus on shaping community health determinants and policy, works with private entities and citizen science groups

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• FCPH worked with employees on large farms to monitor conditions

• Large farms remained resilient and successful throughout the 2010s, but were periodically hurt by floods, tornadoes, droughts, and heat waves.

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• Extreme weather events (EWEs) highlighted disparities among residents

• Collaborations formed to expand open-access citizen science to improve health of marginalized and vulnerable populations

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• Expansion of “alternative economics” activities further reduces disparities

• FCPH’s Nursing and Health Protection and Promotion services coordinate and promote these activities

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• FCPH creates new positions to meet community needs:– Transport and Activity Facilitator– Sustainability Coordinator – Quality Improvement Officer

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• Environmental health has evolved into “environmental improvement,” led and coordinated by the Sustainability Coordinator across FCPH activities

• FCPH partners with other local and state agencies and community groups to create, promote, and improve ecological and environmental health within FCPH programs and in the community 55


• Many monitoring and surveillance functions had become automated, or were taken over by non-profit and commercial groups

• Video monitoring and automated analysis yielded near-continuous monitoring, with data aggregated into ratings for regulated businesses

• Companies and health care providers were adept with “big data analytics” to analyze data from social media, apps, environmental and biomonitoring tools, RPVS, and digital health avatars

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• Accountable Care Organizations became Accountable Care Communities focusing on cross-sectoral approaches to community health and equity

• PCMHs evolved into CCHHs• Health care merged mental and physical health

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Community Centered

Health Home

Triple Aim

• FCPH’s Nursing services found innovative ways to combine virtual care, telehealth, and in-person visits to optimize case management for elderly and mentally ill.

• These patients also benefited from virtual hangouts, counseling, and therapy sessions with loved ones, neighbors, and similar patients.

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Facilitated Disease NetworkTelemedicine


• Baby Boomers sparked a movement to leave behind a positive legacy, and improve conditions for younger generations

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• Senior citizens of Fargo actively contribute to community gardening, local citizen engagement, citizen science, community design, and environmental monitoring

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• By 2030, the health of residents, particularly among the vulnerable population, has improved significantly

• Community members have become so effectively engaged in their own health (and in that of their communities) that there is effectively less need for services from FCPH

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Scenario 1 Scenario 2 Scenario 3 Scenario 4

MACRO AND OPERATING ENVIRONMENTSEconomy

Technology

Health and health care

Citizen science and engagement

Climate Change effects and mitigation

FARGO CASS PUBLIC HEALTHFunding

IT and informatics

Workforce

Surveillance and epidemiology

Health education and promotion

Chronic disease prevention and control

Infectious disease prevention and control

Violence preventionEtc.

See the scenario matrix for a side-by-side comparison of the scenarios across multiple dimensions

Rate the Likelihood & Preferability of Each Scenario

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Likelihood(0% to 100%)

Preferability(0 to 100)

Scenario 1: Fargo Forward ? ?


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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?

Public Health 2030: Scenarios for Fargo Cass Public Health

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