Public Health 2030: Scenarios for the Virginia Department of Health

1. Public Health 2030: Scenarios for the Virginia Department of 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 the Virginia Department of Health Scenario 1 Changing Priorities, Declining Resources Scenario 2 Overwhelmed and Ineffective Scenario 3 Successful Chief Health Strategist

5. Scenario 1: Changing Priorities, Declining Resources Highlights

6. Scenario 1: Changing Priorities, Declining Resources National Economy & Budget Challenges • Slow U.S. economic growth, recessions in 2015 & 2022 • Constrained federal public health spending

7. Scenario 1: Changing Priorities, Declining Resources VDH funding continues to decline. • Virginia’s economy outperforms national economy; but state spending is constrained • Public Health Spending challenged

8. Scenario 1: Changing Priorities, Declining Resources Political Priorities Vary • Focused Public Health: protection against infectious diseases, emergency preparedness, mandated inspections and reviews. • Broader Priorities include community prevention, environmental health, health equity

9. Scenario 1: Changing Priorities, Declining Resources Demand for emergency preparedness and environmental health services grows. • Hotter and longer summers, along with more intense, widespread, and frequent heat waves

10. Scenario 1: Changing Priorities, Declining Resources Demand for emergency preparedness and environmental health services grows. • Food and water prices rise

11. Scenario 1: Changing Priorities, Declining Resources Demand for emergency preparedness and environmental health services grows. • Increased health risks from drought, infectious diseases, vector- and waterborne illnesses, floods, worsening air quality, and worsening heat • Pre- and post-disaster coordination and actions vary among health districts

12. Scenario 1: Changing Priorities, Declining Resources Demand for emergency preparedness and environmental health services grows. • State makes major investments in environmental monitoring

13. Scenario 1: Changing Priorities, Declining Resources Health care advances and covers most residents. • Most care is integrated & through ACOs • ACO focus on population health by “hot spotting” high utilizers of health care • VDH relationships to these providers varies widely

14. Scenario 1: Changing Priorities, Declining Resources Health care advances and covers most residents. • Care improved through EHRs, genetic information, and “Doc Watson” applications • VDH assures health care access and quality; ensures effective use of telemedicine/telehealth Digital coach (“avatar”), Dr Watson Telemedicine Personal health record

15. Scenario 1: Changing Priorities, Declining Resources Mapping, data collection, and analysis become more granular, automated, and effective. • VDH ensures the quality of health-related data collected • VDH routinely mines aggregated EHR data to clarify health conditions in neighborhoods

16. Scenario 1: Changing Priorities, Declining Resources Mapping, data collection, and analysis become more granular, automated, and effective. • Analytic tools like “Watson, MPH” facilitates community needs assessments and identification of most cost effective solutions

17. Scenario 1: Changing Priorities, Declining Resources Key Outcomes • Some health disparities reduced, especially disparities in the rates of infant mortality and vaccinations • VDH does more with less funding and fewer staff

18. Scenario 2: Overwhelmed and Ineffective Highlights

19. Scenario 2: Overwhelmed and Ineffective Challenges to National Economy & Federal Spending • Severe national recessions in 2016 and 2023 • Federal spending cuts in civilian and defense programs hurt local economies • Federal funds reduced for most public health programs

20. Scenario 2: Overwhelmed and Ineffective VDH experiences significant funding cuts. • State general and special funds decreased • Health districts consolidate to 24 • Licensing and inspections charge their full costs, but some customers have difficulty paying.

21. Scenario 2: Overwhelmed and Ineffective Many more uninsured The number of Virginians uninsured or without effective access to care grows. • Health care reform falters

22. Scenario 2: Overwhelmed and Ineffective The number of Virginians uninsured or without effective access to care grows. • Health costs continue to rise • Reimbursement levels for health care are cut

23. Scenario 2: Overwhelmed and Ineffective The number of Virginians uninsured or without effective access to care grows. • EHRs spread but not fully interoperable • remain limited to medical and genetic info • VDH can do little aggregated analysis

24. Scenario 2: Overwhelmed and Ineffective Climate change impacts hurt especially the poor, homeless, elderly, and children. • Leave significant damages to crops, homes, and local economies

25. Scenario 2: Overwhelmed and Ineffective Climate change impacts hurt esp. the poor, homeless, elderly, and children. • 2016: Category IV hurricane hits Hampton Roads, Richmond, and beyond; floods many parts of the state • Evacuation largely successful but registries lacking, recovery slow and inequitable

26. Scenario 2: Overwhelmed and Ineffective Climate change impacts hurt esp. the poor, homeless, elderly, and children. • “Suffocation summers” • New and re-emerging diseases

27. Scenario 2: Overwhelmed and Ineffective • VDH remains committed to health equity, but can do little in the face of growing social, economic, and health inequities.

28. Scenario 2: Overwhelmed and Ineffective Key Outcomes • Health disparities worsen

29. Scenario 2: Overwhelmed and Ineffective Key Outcomes • Many VDH functions and services are eliminated, even with outcomes and ROI data • VDH staff size shrinks, remaining staff are overworked and underequipped. Open positions remain unfilled.

30. Scenario 3: Successful Chief Health Strategist Highlights

31. Scenario 3: Successful Chief Health Strategist National economy healthy & social value shift • Health, wellbeing & equity gained support • Healthy People & “health in all policies” (HiAP) • Federal Public Health spending increases selectively Virginia economysees modest consistent growth

32. Scenario 3: Successful Chief Health Strategist Health Care Reform works - Aggressive expansion of ACOs and PCMHs –nearly all residents gain access to effective, capitated, and integrated health care. Personal Health Advocate Avatar V2.1

33. Scenario 3: Successful Chief Health Strategist Aggressive expansion of ACOs and PCMHs – then primary care teams evolve from PCMH to CCHH – Community Centered Health Homes

34. Scenario 3: Successful Chief Health Strategist Support for broad public health, but flat or declining funding for many programs. • VDH shifts to assurance role and state dollars, improves foundational capabilities, shows ROI

35. Scenario 3: Successful Chief Health Strategist The state aggregates conventional and novel data streams to improve effectiveness. • VDH supports privacy and discrimination protections, assures quality

36. Scenario 3: Successful Chief Health Strategist Tech and informatics improve planning and public health. • Patient & environment monitoring automated • VDH models interventions and explores their impacts; • VDH improves targeted emergency preparedness, speeds up response to outbreaks

37. Scenario 3: Successful Chief Health Strategist Healthy Virginia supports enhanced community engagement. • VDH develops health dashboards for each community to monitor progress • Games and other means enhance emergency preparedness, public commitment to fairness and health equity

38. Scenario 3: Successful Chief Health Strategist Community planning is linked to population health  All school systemsintegrate injury and violence prevention, support students’ learning and educational attainment for all, teach to reduce racial bias and raise awareness of racism  Safe and affordable places to be physically active  Foster entrepreneurialism, job matching and training programs, affordable transportation Access to healthy and affordable foods  Programs and analyses are culturally appropriate Licensing, credentialing, and regulation activities integrate benchmarks to improve equity and eliminate racism.

39. Scenario 3: Successful Chief Health Strategist Key Outcomes • TB and many health disparities eliminated • Health in All Policies and health equity goals, metrics, and evaluations permeate Virginia agencies • VDH becomes the go-to entity for ACOs to help identify and design the most cost-effective strategies and efforts to improve population health • Rural health & health care improve • VDH successfully leads, facilitates supports as chief health strategist

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

41. Rate the Likelihood & Preferability of Each Scenario

42. 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?