Imagining the future of health in 1992. How right were we?

“Declare the past, diagnose the present, foretell the future,” advised Hippocrates, the ancient Greek physician. An exploration of USP's online anniversary hub, launched in January, clearly embraces the past and present. In late 2019, USP and the MIT Center for Collective Intelligence(MITCCI) organized the Trust CoLab, an innovative online platform where more than 100 global leaders in health and science discussed developments that could shape people’s health between now and 2040.

Guided through a structured, online process developed by MITCCI and led by an expert scenario planner, CoLab participants sought to answer the following question: What developments will shape people’s health between now and 2040, and how will trust be critical in making sure these developments help people everywhere live longer and healthier? The resulting report, Trust or Consequences 2040: Will innovations in health and medicine deliver?, is designed to spark meaningful discussion on topics vital to the future of health and medicine.

The report isn’t USP’s first effort to take a thoughtful and creative look at the future. In 1992, the USP 2020 Strategic Context of Drug Standards and Drug Information Conference brought together 60 leaders from science, medicine, government, industry and consumer groups, as well as health futurists, to forecast the future of health and medicine. As the 200th anniversary of USP’s founding, 2020 was chosen as the focus. A summary of the meeting is captured in 2020 Visions: Health Care Information Standards and Technologies, published by USP in 1993.

The methodology 28 years ago was quite different from the online platform used to develop the Trust or Consequences 2040 report. Over the three-day conference, participants presented papers that summarized possible futures.

Participants broke into groups to answer the following question: If you were designing the ideal systems for standards and information systems for health technology in 2020, what would they be? Under the direction of Clement Bezold, Ph.D., founder of the Institute for Alternative Futures, participants’ responses, supplemented by interviews with experts from USP and other entities, drove the creation of four scenarios suggesting how the future might unfold.

The most powerful drivers were projected to be many of the topics that surfaced in the recent Trust or Consequences 2040 report: globalization, cost containment and outcomes, advanced personalized therapies and infrastructure advances, as well as the predict-and-manage paradigm in healthcare.

Participants’ predicted four future scenarios:

High Technology/Continued Growth
Despite technical advances and growth, distribution of healthcare resources and innovations is unequal. Many people are uninsured. Healthcare is mainly biochemical in focus. Most people with healthcare coverage begin receiving biochemically unique, genetically targeted healthcare between 2005 and 2010. Electronic medical records are the norm, including the use of DNA fingerprinting. Treatments for most diseases have advanced dramatically.

Hard Times/Focused Innovation
Economic hard times, political and economic turmoil and environmental disasters present difficult challenges. A single-payer insurance system provides minimal basic benefits. A third of people buy into private plans that provide access to more innovative technologies and approaches. Biochemically unique care is available in private markets by 2015. It is also available to people receiving publicly funded care when proved cost effective. Advances for treatment of major diseases in public-sector care occur when cost effective. They occur more rapidly in the private sector.

Global Business
High growth favors multinational corporations. Social programs and public support increase. This growth results in sophisticated and fully integrated health systems. A tax-based insurance system leaves few uninsured. Between 2005 and 2019, most people can receive biochemically unique healthcare. Dramatic advances occur in treatments for most diseases. Medicine is personalized for most conditions. Electronic medical records are widely used and include DNA fingerprinting.

New Social Contract
Sustainable development, greater justice and environmental concerns lead to growth and new products. Sophisticated advances occur in “hard” and “soft” technology integrated into biomedical, behavioral and environmental approaches to healthcare. A national health insurance plan is in place. In addition to fully available healthcare targeted to each individual, learning style and behavioral variations are included. Health information systems are similar to those in the Global Business scenario, with greater support for self-care and a more comprehensive array of therapeutic approaches.

Conference attendees voted on the probability and preferability of the scenarios. The Hard Times scenario was selected as the most likely to occur, while the New Social Contract was chosen as the most desired but least likely to happen. The editors of 2020 Visions found these results significant, as “most organizations plan for the future they believe is most likely.” See how these outcomes compare to the scenarios revealed in the Trust and Consequences 2040 report.