Robust public health policy making in uncertain times: The role of foresight and futures studies

Social, technological, economic, environmental and political forces are interacting to re-shape global conditions at an unprecedented rate. Increasing connectivity between groups, escalation in technological capabilities, rapid changes in social structures and other forces are producing new risks and opportunities. In response, foresight approaches and futures studies methods (including scenarios, Delphi studies, trend projections, modelling, visioning) are being used by business, government, non-government and community sectors to help set directions. In the field of public health policy, empirical evidence about the use of foresight/ futures studies is lacking.  This paper will present the findings of research that sought to examine how and why foresight/ futures studies have been used, and consider the implications for enhancing the robustness of public health policy making in uncertain and fast-changing environments. The research used a case study methodology. Three nationally significant examples of public health policy-making that used futures studies were chosen for individual and cross-case analysis. Case studies were prepared from interviews with policy protagonists, academics and others as well as document analysis, and focused on the preparation of seminal public health reports from Australia, USA and United Kingdom. Cases showed both similarities and variability in terms of how and why they used foresight/ futures studies. Foresight/ futures studies were used in problem identification and policy formulation stages of policy-making processes. They provided new types of information, knowledge and concepts for policy actors to consider and use and perhaps more importantly, structured social processes that influenced debate and promoted transdisciplinarity in policy-making. Foresight/ futures studies were used by policy actors for mixed reasons: to enhance understanding and communication about particular aspects of present and potential future conditions; to elevate issues that may have a low profile and as a device to justify decisions.