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To forecast future trends in diabetes prevalence, morbidity, and costs in the United States, the Institute for Alternative Futures has updated its diabetes forecasting model and extended its projections to 2030 for the nation, all states, and several metropolitan areas. This paper describes the methodology and data sources for these diabetes forecasts and discusses key implications. In short, diabetes will remain a major health crisis in America, in spite of medical advances and prevention efforts. The prevalence of diabetes (type 2 diabetes and type 1 diabetes) will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual deaths attributed to diabetes will climb by 38% to 385,800; and total annual medical and societal costs related to diabetes will increase 53% to more than $622 billion by 2030. Improvements in management reducing the annual incidence of morbidities and premature deaths related to diabetes over this time period will result in diabetes patients living longer, but requiring many years of comprehensive management of multiple chronic diseases, resulting in dramatically increased costs. Aggressive population health measures, including increased availability of diabetes prevention programs, could help millions of adults prevent or delay the progression to type 2 diabetes, thereby helping turn around these dire projections.

What are the requirements for successful, long-term, livable community strategies in the US? In early 2007, the Institute for Alternative Futures (IAF) was commissioned to offer a forward-looking review of the Livable Communities strategy of AARP, originally, the American Association of Retired Persons (with 37 million members, AARP is the largest non-profit organization in the US) [1] . This article summarizes the process and results of that project. It constitutes a case study in the evaluation of a large organization's plans from a strategic foresight perspective. Findings from this investigation suggest that many large-scale trends in the U.S., including urban sprawl, rising energy costs, climate change, and fiscal challenges are likely to work against efforts to make communities more livable. On the basis of these findings, IAF recommended that the association take a broad approach to livability, developing strategies that counter these negative trends while also improving the lives of older people. AARP is one of the best suited organizations to make such a long-term commitment.

PurposeThe purpose of this paper is to conclude the special issue on the topic of pro‐poor foresight.Design/methodology/approachThe paper takes the form of a draft synthesis statement and selected recommendations to emerge from the “Foresight for smart globalization” workshop.FindingsThere is a need for change at all levels of governance to address the challenges of global poverty, and efforts are needed to foster and improve national foresight capacities.Originality/valueAdding poverty as an explicit dimension of existing and future foresight activities is a key component of fostering pro‐poor decision making.

BACKGROUND Effective cancer surveillance is critical for understanding disparities in current cancer incidence and treatment. The years ahead will see significant changes in how surveillance can be done. METHODS Scenarios developed for the Cancer Surveillance Futures Project identify 4 paths for the next decade (Growth--Advances in science and technology for health care and cancer control; Stagnation--Hard times, slow and unequal progress on many fronts; Choice--Creating a healthy marketplace for health care; and Transformation--Accelerating cancer control for all). RESULTS AND CONCLUSIONS In terms of getting to near-term and longer term success with cancer surveillance, the Intercultural Cancer Council and C-Change have made several recommendations including consistent collection of socioeconomic status, risk factors, and treatment information as well as community involvement in collecting cancer information and developing cancer control approaches, developing data standards, and broadening cancer surveillance to include treatment quality, risk factor data, and preneoplastic events.

New technologies are posing new challenges to social science. Their very novelty also challenges the established methods that social research institutions have used to define their priorities. The UK’s Economic and Social research Council (ESRC) confronted these challenges, in part, by commissioning a futures study. It engaged the Institute for Alternative Futures (IAF) and the Centre for Research on Innovation and Competition (CRIC), to develop quickly a process for informing the choice of social science research priorities related to genomics. Four major reports were developed as background inputs to a scenario workshop process. As well as outlining a set of scenarios for the development of the genomics field, reports covered genomic applications, forecasts for drivers shaping genomics, and how the ESRC’s “thematic priorities” might relate to developments in genomics in the coming years. With this input and using advanced “groupware”, the scenario workshop identified five priority areas focused on how research should be conducted and 11 priority topics for what research is needed.

This paper develops four alternative scenarios depicting possible futures for genomics applications within a broader social context. The scenarios integrate forecasts for future genomics applications with key drivers that are shaping genomics. Each scenario is a narrative depiction of an alternative path towards four very different futures for genomics. The scenarios are intended to give the user the a framework to explore and test their assumptions about the future of genomics, and help them explore the wider interactions between genomics applications and society. Scenario 1, “genomics, inc.”, is a “best guess extrapolation” of key drivers shaping genomics. Scenario 2, “broken promises”, explores hard times for genomics. Scenario 3, “out of our control”, explores the opportunities and challenges brought about by the globalisation of genomics. Scenario 4, “genomics for all”, explores the successful and visionary development of genomics.

Scenario building is an essential element for working on, and creating, alternative futures. This paper, based on the work at the Institute of Alternative Futures, discusses the use of scenarios in the context of community development and explores three basic types of scenarios—`the official future', `hard times' and paradigm shift or visionary scenarios. With examples from Washington and elsewhere, the paper tries to show how communities can reinvent themselves and meet the challenges of the future with the aid of scenarios.

Health-care systems occupy from 6% up to 15% of developed countries' GDPs. Therapeutics, particularly hospital care, occupy the bulk of these expenditures, despite their focus on dealing with disease after it arises. In the 21st century health-care systems will focus on health gains. Therapeutics will have broadened to encompass prevention and treatment, and will be focused on each individual's unique biological, psychological and social needs. Major killers, most particularly heart disease and cancer, will be far more preventable or curable, because of changes in therapeutic paradigms to more holistic approaches as well as important biomedical breakthroughs. There are a variety of negative possibilities, including continued preeminence of the medical model, growing costs, increased inequality in access, and greater poverty and social disintegration. The movement to therapeutics more focused on health gains will be accelerated by a variety of trends, particularly the development by communities in the USA and many other countries of shared visions that guide the evolution of health care in these directions.

The incidence and prevalence of diabetes (primarily type 2 diabetes) has risen sharply since 1990. It is projected to increase another 64% between 2010 and 2025, affecting 53.1 million people and resulting in medical and societal costs of a half trillion dollars a year. We know how to prevent many cases of diabetes and how to treat it effectively. Early appropriate treatment makes a significant difference in preventing major complications and reducing premature death, but it does not cure the disease. Early detection of prediabetes, in conjunction with lifestyle changes, can reduce the number of people with diabetes. A dramatic reduction in diabetes prevalence over time will require significant lifestyle changes on the part of society as a whole. The purpose of this study is to increase public awareness of the severity of regional diabetes trends by providing detailed forecasts for all states and several metropolitan areas for 2010, 2015, and 2025. A model was created to utilize the latest national diabetes and population data and projections, and to transform these into state and metropolitan area forecasts for the whole population and major subgroups. These forecasts were then summarized in easy-to-understand briefing papers for each state and selected metro areas, which are provided online for easy public access. This research is important because little data exist that project the future prevalence and potential costs of diabetes at the state and metro area level. With this data, key stakeholders can make informed decisions concerning diabetes, its impact on their communities, and resource allocation.

The U.S. health care system is transforming. It must. Patient-centered care (PCC) is a core quality that the system should include. This article presents the highlights of a project on the future of PCC created for the Picker Institute. As an example of futures work, this project developed four images or stories of what might happen, as well as a vision and audacious goals for what should happen to PCC. The first and most likely scenario is an increase in patient-centeredness as a function of current trends. However, in the second scenario, health care could become even more stressed and leave PCC behind as it seeks to lower cost without focusing on quality. The third scenario envisions more excellent systems that integrate PCC seamlessly into their work. The fourth scenario sees collaboration and shared responsibility, in association with advanced information tools, thereby enabling PCC to contribute to preventing illness and lowering health care costs. The scenarios indicate that the patient-centeredness of health care could improve slightly, stall, or advance significantly. The PCC Vision calls for each of us to be in charge of our health, and to get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values. The audacious goals set an agenda with priorities from the PCC community. These include shared decision making by consumers, ensuring health care professionals are trained in supporting active patients, anticipating health and long-term care needs for individuals, adopting the Institute of Medicine's (IOM) simple rules for health care, and making the patient perspective a priority in policy and planning. Each of us and our organizations are confronted with the challenge of this vision and audacious goals. Health care professionals and provider systems, whether conventional or alternative in nature, face these issues. While complementary and alternative medicine (CAM) providers often get higher marks from consumers for their attention, many CAM modalities are largely provider-determined. Patient-centered care will require more empowerment and activation of patients and consumers.

Health care delivery, therapies and pharmaceuticals face major changes throughout the industrial world in the form and delivery of health care. As cost containment strategies are introduced by governments, as payers become more influential in decisions about therapies, and as consumers become more involved in directing their own health care, health care providers and pharmaceutical companies are being challenged to rethink the way they do business. To explore this challenge Schering AG held a workshop in December 1992 which focused on the papers in this volume. This chapter summarizes the discussions at the workshop. This workshop mixed scenario presentations and discussions with the papers developed by leading experts. Together they are intended to give the reader an enhanced sense of what the future holds and the enhanced capacity for more imagination and creativity.

Among the reasons that the OTC switch is occurring are an increased knowledge about drugs, and a greater consumer demand for more autonomy in the use of health care products. This rise in knowledge and personal autonomy correlates inversely with the public's perception of the power of physicians and directly with an increase in the efforts of society to avoid disease and maintain good health. The impact of this trend on the OTC drug market is that OTC drug use will rise in a linear fashion as life becomes characterized by more minor ailments and relatively fewer major chronic diseases.