Public Health 2030: Scenarios for Fargo Cass Public Health

1. Public Health 2030: Scenarios for Fargo Cass Public Health

2. 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 & schools

3. Scenario Zones Visionary/Surprisingly Successful Expectable Challenging

4. Public Health 2030: Scenarios for Fargo Cass Public Health Scenario 1 Fargo Forward Scenario 2 UFF-DA! & the Flood of 2020 Scenario 3 Fit and Healthy Fargo Scenario 4 Healthy People, Healthy Communities

5. Scenario 1: Fargo Forward Highlights

6. Scenario 1: Fargo Forward • 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.

7. Scenario 1: Fargo Forward • FCPH took advantage of Patient Protection and Affordable Care Act (ACA) & health care advances Personal health record

8. Scenario 1: Fargo Forward • Fargo had to adjust to climate change

9. Scenario 1: Fargo Forward • 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

10. Scenario 1: Fargo Forward • FCPH and the FEPA efforts could not remove complacency and feelings of false security among residents

11. Scenario 1: Fargo Forward • 2020 Derailment: major explosion • Leakage of anhydrous ammonia

12. Scenario 1: Fargo Forward • Residents now recognize the need for FEPA • And FCPH ramps up activities in behavioral health, environmental health, emergency prep, and outreach

13. Scenario 1: Fargo Forward • FCPH partners with UND to use remotely piloted vehicles (RPVs) to conduct surveillance, monitoring, inspection during and after emergencies

14. Scenario 1: Fargo Forward • 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

15. Scenario 1: Fargo Forward • Telemedicine, ubiquitous smart phones, affect • Correctional health • Substance abuse and tobacco control • Biomonitoring • Home health and nursing services • Outreach Telemedicine

16. Scenario 1: Fargo Forward • FCPH leads or facilitates community coalitions to address social determinants of health and behavioral health

17. Scenario 1: Fargo Forward • 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”

18. Scenario 1: Fargo Forward • 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

19. Scenario 1: Fargo Forward • 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.

20. Scenario 2: UFF-DA! & the Flood of 2020 Highlights

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

22. Scenario 2: UFF-DA! & the Flood of 2020 • October 2019: severe winter; deep snow did not melt by early spring

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

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

25. Scenario 2: UFF-DA! & the Flood of 2020 • Water topped the levy, reaching a height of 44 feet and flooding the area from the Red River to Interstate 29.

26. Scenario 2: UFF-DA! & the Flood of 2020 • 15,000 homes housing 50,000 people were flooded, along with most businesses, schools, hospitals, and clinics

27. Scenario 2: UFF-DA! & the Flood of 2020 • Water and sewer systems contaminated • Summer rains; record heat • Many properties remained unrepaired and unoccupied for years • Spread of West Nile Virus

28. Scenario 2: UFF-DA! & the Flood of 2020 • Local economy hit hard; many businesses folded • Many homes became uninhabitable; property values dropped • Budgets were cut significantly; public and private sector unemployment rose

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

30. Scenario 2: UFF-DA! & the Flood of 2020 Many more uninsured • Health care reform had stalled by 2015 • Access to health care was becoming more limited, health worsened

31. Scenario 2: UFF-DA! & the Flood of 2020 • 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)

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

33. Scenario 2: UFF-DA! & the Flood of 2020 • FCPH funds cut repeatedly • FCPH regularly releases staff members and eliminates or curtails its public health activities and programs

34. Scenario 3: Fit and Healthy Fargo Highlights

35. Scenario 3: Fit and Healthy Fargo • “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

36. 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

37. Scenario 3: Fit and Healthy Fargo • 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 Electronic Health Records (EHRs)

38. Scenario 3: Fit and Healthy Fargo • 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

39. Scenario 3: Fit and Healthy Fargo • 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

40. Scenario 3: Fit and Healthy Fargo • 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

41. Scenario 3: Fit and Healthy Fargo • 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

42. Scenario 3: Fit and Healthy Fargo • 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

43. Scenario 3: Fit and Healthy Fargo • 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

44. Scenario 3: Fit and Healthy Fargo • 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 Digital coach (“avatar”) Telemedicine

45. Scenario 3: Fit and Healthy Fargo • 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

46. Scenario 3: Fit and Healthy Fargo • 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

47. Scenario 3: Fit and Healthy Fargo • By 2030, FCPH has achieved many of its community prevention goals • FCPH enjoys stable funding; staff has grown

48. Scenario 4: Healthy People, Healthy Communities Highlights

49. Scenario 4: Healthy People, Healthy Communities • 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

50. 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