In this chapter
After the scenarios are developed, you can use these scenarios to identify challenges and opportunities. This part of foresight might be most subject to interpretation. Also, many studies do not include these additional steps, so experience and reporting on this is very limited. Therefore we have used the Dutch PHFS as an example, since this study included Phase 1 (and Phase 2) explicitly. This example is not meant as a golden standard, but merely to guide and inspire other approaches as well.
In general, there is a stronger focus on challenges instead of opportunities, since many of a trends are entwined and as a consequence cause complex or wicked future problems. This might results in a rather pessimistic worldview which has a strong focus on problems (i.e. the challenges) and might ignore the opportunities. Therefore it is good to put effort as well on identifying opportunities. These opportunities might also be further identified and elaborated on in Phase 3, when thinking about the options for action.
| Steps: Actions and Objectives | Method |
|---|---|
| |
| |
|
4.1.1 What is it?
Challenges, or threads, are obstacles or difficulties that individuals or organizations may face in achieving their goals. These can be internal or external factors that may impede progress or create barriers to success. Opportunities, on the other hand, are favourable circumstances or situations that individuals or organizations can take advantage of to achieve their goals. By identifying challenges and opportunities, individuals and organizations can take a more proactive approach to foresight, rather than simply reacting to events as they occur. Identifying challenges and opportunities can help individuals and organizations prioritize their efforts and allocate resources more effectively, ensuring that they are focusing on the most important areas for their particular situation.
4.1.2 Why is it important?
Identifying challenges and opportunities in foresight studies is important in addition to the development of scenarios because scenarios are just one part of the foresight process. Scenarios are essentially descriptions of possible futures, and they are useful in understanding how the future may unfold. However, identifying challenges and opportunities goes beyond simply describing possible futures and helps to take concrete steps to prepare for those futures.
4.1.3 Method and outcome
The SWOT method is a strategic tool that stands for Strengths, Weaknesses, Opportunities, and Threats. It is used to identify and analyse the internal and external factors that can affect an organization or topic. Here the SWOT method will be employed focussing on the OT of the scenarios, though you could also extend it with the SW. For each scenario, you can make an inventory of the OTs. This can be done with the project team, and/or with stakeholders.
4.2.1 What is it and why is it important?
The first step of Phase 1 might result in a long list of 30-40 challenges, or more. Such a long list of challenges and opportunities might overwhelm the user and priorities are not easily determined. Therefore, further selection or clustering is needed. There is not an pre-set number of challenges, though it might be in the range of 3-5.
It is good to realize that not all challenges and opportunities are regarded in a similar manner by people. We have introduced already the different perspectives, representing normative uncertainties. If these perspective were also developed further in your foresight study, you can use these to account for the different ways that challenges in the scenarios are perceived.
4.2.2 Method and outcome
This selection should be based on a pre-defined set of criteria. The following criteria might be the most important ones: the policy relevance and the societal relevance. To assess the policy relevance, you have to have to good insight in, for example, (recent) policy documents, scope of (public health) policies, modifiability of the challenges at hand. For the societal relevance you can use the different normative perspectives to assess which challenges are relevant from preferably more than 1 perspective. Another criterion might be the added value in comparison with existing studies, you might not want only to duplicate existing challenges. Part of this step also involves clustering. Some challenges might overlap or even embedded in others. This of course, is very dependent on the list that you are working with.
This selection and clustering process can be done by the project team. However, this selection is always subject to interpretation and therefore a proper validation of this step helps to get a broader support for the selection. Additional consultations or even stakeholders sessions could serve this purpose.
Another way of making a selection is the consultation of groups is society. These groups can be (representative) citizen panels, or other groups. For the PHFS-2018 a survey was conducted among a representative citizen panel, public health professional, and students doing a academic study on public health. The latter 2 groups were not representative. In the survey, respondents first had to indicate how important they think it is that action is taken on a development now in order to prevent problems in the future. In doing so, they could indicate whether they considered the development 'very important', 'important', 'less important' or 'unimportant'. They were then shown all developments with a score of 'very important' in one overview and were asked to choose a top three of the most urgent developments. As a result, the questionnaire not only provided a picture of which developments were most often considered 'very important', but also of which developments respondents really consider most urgent (their top three). In doing so, we mainly look at which developments were most often put in the top 3 by the various groups of respondents. But sometimes we also look at which developments within that top 3 have been put at number 1 most often. When we talk about 'very important', we only mean that respondents considered the development very important, regardless of whether they also chose it in the top 3 most urgent developments.
4.2.3 Examples of PHFS-2018
For the PHFS-2018, a survey among citizens and professionals and students in the public health domain was used as input for selecting challenges. Together with other criteria such as relevance for public health policy, added value and the relevance of a challenge from more normative perspectives, resulted in the following three challenges:
- Cardiovascular diseases and cancer are health conditions that continue to occur frequently, will still be the cause of the majority of deaths in 2040, and have a major impact on patients’ lives
- The group of older people living independently who have dementia and other complex problems is increasing significantly.
- Mental pressure on teenagers and young adults is increasing, and may have consequences for their psychological health.
Other challenges such as increase of antimicrobial resistance and increase of health care expenditures were resulted as important from the survey but were not included as main challenge since they had limited coverage of the perspective and they were considered to be of lower added value. The assessment of these criteria and the formulation of the challenges is not a black and white process, and required validation steps as well.
4.3.1 What is it and why is it important?
Selecting and clustering challenges and opportunities might be helpful to get focus and priorities, you might also end up with challenges that are relatively abstract and comprehensive. This might not be sufficient to link them to (current day) policy making processes. To be able to do so, you have to concretize the challenges. This can be done along different dimensions which will be elaborated on.
4.3.2 Method and outcome
Breaking down the big challenges in sub-challenges. This might feel a bit like reversing the clustering again. However, that step of clustering is important to get a comprehensive description of the challenge, before you can identify the sub-challenges. Sub challenges can more easily be linked to specific actions. We will only provide examples here form the PHFS-2018 to illustrate how this can be done. Again, the project team might be doing most the work here, preferably validated in a broader setting such as stakeholder sessions.
A second option to make the challenges more concrete is to formulate goals for each challenge. Often these goals are time bound. You can use concentric circles to represent the near (5 years from now) and far future (25 years). Combining the goals with the scenarios gives an indication of the so-called distance-to-target how far are we from a certain goal given the various scenarios (see below for some examples regarding smoking and overweight in the Netherlands).
The table below provides a template to write down the challenges, associated sub challenges and goals.
Main challenge (examples) | Sub challenges | Goal(s) (in x years) |
|---|---|---|
Improve healthy behaviour of deprived groups in society | E.g. Reduce smoking and overweight in populations with low economic status | Smoking prevalence is below 10% in 2050 for people with a lower educational attainment. Overweight is below 50% in 2050 for people with a lower educational attainment.
|
Improve quality of life for elderly | Support people with (starting) dementia living at home with home care | All people with starting dementia are able to live independently by 2050. |
Health care for all | Target personnel shortages in health care | Halving of personnel shortages by 2030, no shortages by 2050 |
4.3.3 Examples of PHFS-2018
From the PHFS-2018 we have the following examples For the challenge: “Cardiovascular diseases and cancer are health conditions that continue to occur frequently, will still be the cause of the majority of deaths in 2040, and have a major impact on patients’ lives” the following sub challenges are identified:
- Working on integrative prevention measures
- Other health care resulting from technology and different organisational structures
- Dealing more effectively with physical, mental and societal consequences
Challenge: The group of older people living independently who have dementia and other complex problems is increasing significantly.
Sub Challenges:
- Improve care and support for older people living independently
- Ensure an environment that accommodates older people
- Caring effectively for informal carers
Challenge: Mental pressure on teenagers and young adults is increasing, and may have consequences for their psychological health
- Staying mentally healthy
- Acceptance of psychological symptoms
- Knowledge development about mental pressure in adolescents and young adults
Another interesting examples for the distance to target is the evaluation of the Impacts of the National Prevention Accord in the Netherlands.