More on the future - thinking and planning

We can't know the future, our own or anybody else's, but we can think about it in a systematic way and put our plans on a firmer base than if we just go blindly on, letting things happen. The simplest method is to extrapolate past and present observed data onward into the future, assuming trends will adhere to past and present observations. It helps when we have reliable data sets that remain stable over a long period. 

But these don't always work. In the 1950s, soon after I graduated from medical school it was widely believed that the total conquest of all infectious diseases was imminent: soon we would have powerful antibiotics, antiviral agents, and vaccines that would control all forms of contagious or communicable diseases, and there would be no future career for infectious disease specialists. Belief in that notion deterred me from specializing in infectious diseases, a field to which I was quite strongly attracted. Perhaps I chose wrongly: in the last 30 years of the 20th century, at least 30 entirely new and for the most part deadly infectious diseases hit humanity. HIV/AIDS afflicted over 40 million people, killed about 12 million by the end of the 20th century.

Another way to think about and plan for the future is to imagine alternative futures, scenarios of probable and possible ways that events could come together and coalesce in game-changing ways. Royal Dutch Shell, one of the world's largest oil companies, based its planning for future petroleum demands on scenarios. One scenario imagined the impact on supply/demand interaction of a political upheaval that suddenly removed a major oil supplier from world markets.  Because they had plans ready for this, they were resilient and able to adapt rapidly to the Iranian revolution while all the other large oil companies were caught flat-footed, unable to adapt overnight to this major disruption of oil supply. The Dutch applied the scenario approach in the health field and detailed scenarios were prepared, dealing with the future of heart disease, cancer, old age, traffic crashes, mental disorders, innovative technologies, and much else. I paid several visits to the Netherlands (and to Sweden, which adopted a similar approach) in the early 1980s, and passed on what I learnt to health planners in the government of Canada. I must have selected the wrong senior bureaucrats, because so far as I could tell, nobody in Health Canada reacted to my suggestions.

A third method of future planning is 'visioning', in which the planning group imagines a set of alternative futures, decides which of these is the most desirable and which is the least desirable; planners then set out to make the most desirable future happen, and take action to ensure that the least desirable future doesn't happen.  Without actually applying this technique, there have been a few times in my life (and Wendy's) when we used visioning to help us plan our future. The most important of these, and the most spectacularly successful, was our decision to come to the University of Ottawa medical school, rather than to accept the superficially exciting cross appointment at Harvard medical school and the Harvard school of public health. I'm sure I'd have sunk without trace in Cambridge and Boston, Massachusetts, whereas I've had a wonderful time and a successful career in Ottawa.