Foresight in public health: application and challenges

Abstract Background Foresight studies in the field of public health are limited. However, in the context of increasing uncertainty and complexity, such as with the COVID-19 pandemic, there is growing need to anticipate future trends and to plan for them. Foresight provides the tools to explore possible futures and develop policy strategies. Despite its value, foresight is an underused methodology. Hence, the aim of this study is to illustrate how foresight can be applied in public health, and how to deal with the associated challenges. Methods We describe the six-steps that are part of foresight methodology. In step 1 we discuss how to formulate study objectives. We illustrate in step 2, the application of the conceptual model and the DESTEP tool to identify and rank driving forces. We then discuss time horizon and spatial distribution, in step 3. In step 4, we discuss scenario logics. Finally in steps 5 and 6, we discuss the types of scenarios and tools for analyses. Possible challenges encountered when applying foresight methodology are drawn from the experiences and lessons learnt from the PHIRI project. Results Challenges during application of the foresight six-steps approach included difficulties in formulating research objectives, developing a conceptual model, identifying most important future trends, developing systematic, consistent and plausible scenarios with clear messages for policy makers. Understanding the concept of uncertainty was especially difficult, both in formulating scenarios and policy messages. Conclusions Understanding of foresight concepts and their relation to each other is difficult. Support from foresight experts, conducting foresight exercises and publication of tutorial papers on foresight can enhance understanding. Key messages • Foresight methodology is a valuable tool to explore possible futures with a diverse group of stakeholders. • Foresight promotes the development of policies that are appropriate and robust in their implementation in changing times.