Why public health needs creative and arts-based futures thinking

Abstract

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Why Public Health Needs Creative and Arts-Based Futures Thinking

Global crises like climate change, unregulated technologies, inequality, and mental health struggles are creating fear and uncertainty. This article shows how creative foresight – using arts, imagination, and participation – can help communities, particularly those previously left out, envision fairer futures, build hope, strengthen trust, and take collective action for public health.

The world is evolving rapidly and in complex ways, bringing new opportunities alongside considerable public health challenges. Interconnected metacrises, including climate change, unregulated artificial intelligence and technologies, increasing economic inequities, geopolitical conflicts, democratic breakdowns, and a mental health and substance use crisis, are deeply affecting communities and creating uncertainty and fears about the future. Unsurprisingly, many people, particularly youths, are feeling increasingly pessimistic and cynical about the future which is adversely affecting their wellbeing. ¹ In a 10-country survey ² of 10,000 youths aged 16–25, more than 75% described the future as frightening. Public health has a vital role in helping people reimagine and collectively mobilize toward hopeful, thriving health futures. Building on emerging work at the intersection of public health, futures studies, and creative health, this article argues that creative foresight – imaginative, participatory, experiential, and artistic approaches to thinking about and shaping futures – should be integrated into public health. Systematically drawing from creative imagination can help the field respond to uncertainty, counteract pessimism and distrust, and activate hope.

Futures Thinking And Foresight In Public Health

Public health is increasingly turning to futures thinking and strategic foresight to navigate uncertainty, complexity, and distrust, especially since the pandemic exposed the need for anticipatory institutional capacities. ³ Futures thinking encourages exploring possible, plausible, and preferable futures, questioning assumptions and strengthening long-term vision. ⁴ Strategic foresight uses methods like horizon scanning and scenario planning to identify drivers of change, anticipate risks and opportunities, and inform strategic planning and decision-making. ³ Examples include the U.S. Centers for Disease Control and Prevention’s Strategic Foresight Initiatives, the WHO’s Global Health Foresight function, and European Centre for Disease Prevention and Control’s foresight programme, all of which aim to strengthen anticipatory governance and reduce vulnerability to crises like disease outbreaks/climate events. Yet, reliance on conventional foresight risks narrowing public health’s transformative potential. Often technocratic, Euro-American in orientation, and tied to linear models of time, these approaches may miss the complex, non-linear dynamics of challenges like climate change or youth mental health. By privileging technical expertise over inclusive participation, they risk sidelining those most affected by inequities. Conventional foresight, often applied for risk surveillance, may inadvertently keep public health in a defensive posture – focused on predicting crises rather than inspiring radically different futures.

Creative Foresight In Public Health

Creative foresight draws on artistic, imaginative, embodied, and participatory practices to envision futures and make them discussible, affective, and tangible. Creative foresight approaches are beginning to be used in public health and show promise. De Matas ⁵ explored how speculative science fiction can illuminate and critique current public health challenges like misinformation, technological dependence, cultural insensitivity, and lack of access to healthcare and reveal futures with these challenges resolved. The article highlights how science fiction can be an imaginative foresight tool in shaping the future of public health and ‘bridging the disconnect between people and public health policies’. ⁵ MacEntee and colleagues ⁶ scripted scenarios depicting peer navigators facilitating HIV testing and treatment, which were performed by local actors and recorded, and shown to adolescents and other stakeholders in Kenya and Canada to elicit feedback. The study illustrated how theatre testing can generate insights about future implementation of public health interventions in diverse settings. Using design fiction (fictional devices and scenarios), Ahmadpour et al. ⁷ explored older adults’ hopes, concerns, and values about wellbeing technologies. The study showcases how speculative methods can foster dialogue about the future of health innovation, particularly around ethical and social dimensions. OurCluj is a 10-year initiative to transform Cluj-Napoca (a Romanian city) into a place centred on youth health and wellbeing.^8,9 Central to the project was Imagining Futures, where youth, NGOs, policymakers, and artists engaged in workshops (e.g. Imagining a city in 2040 where youth flourish) and arts-based methods like role-play, games, and storytelling/comics/collages to co-create visions of a more equitable urban life, shaped by Romania’s history/context. This practice informed governance, fostered collaboration, and generated pathways for urban health and social innovation, including the Well-Being System Map showing how youth health depends on relationships across families, schools, and communities.^8,9

Broadening horizons with creative foresight

We recommend the meaningful integration of creative foresight in public health, particularly to engage diverse knowledge holders in creating tangible visions and experiences of desirable futures. Creative, playful practices can expand our imagination of possible futures, which is often limited by our tendency to narrowly extrapolate from current trends or the past. ¹⁰ These methods can broaden community engagement and centre lived experience and the voices of those most affected by health inequities. Creative foresight can also support wellbeing by nurturing a relationship to the future that shifts from anxiety and paralysis, towards curiosity, agency, solidarity, and hope. ¹¹

Creative foresight approaches must be grounded in diverse epistemologies. Afrofuturism and Indigenous futures thinking have long cultivated postcolonial futures imaginaries of health and survival, foregrounding justice, interconnection, and collective resilience.^12,13 For instance, researchers used culturally grounded futures thinking (e.g. eco-cultural maps/calendars) with communities in Benin, Kenya and Ethiopia. Doing so helped communities revitalize their ways of governing to strengthen health and wellbeing, using agroecology, sacred natural sites, and community rituals. ¹⁴ For public health institutions, respectfully engaging with diverse epistemologies can surface culturally resonant aspirations for health and equity, and challenge dominant narratives of dystopian futures. Research has shown that strong images of desirable futures can activate collective hope and action. ¹⁰ Bringing this into public health can generate futures that communities recognize themselves in and feel motivated to build together.

Imagining What is Next

The evidence for the potential of arts to transform public health is growing. The One Nation/One Project, which brought together artists, health leaders and residents in 18 U.S. cities/towns to co-create visions of No Place Like Home on the same day, is a large-scale exemplar of how collective civic imagination can advance health equity. ¹⁵ We stand at a juncture when it is critical to envision a plurality of healthier, equitable, and just futures. Creative foresight practices offer tangible ways for the public, particularly those marginalized, to navigate uncertainty, organize collectively, and imagine and translate visions of healthier futures into present-day change.