Written by Hayley Lapalme, Jennifer Reynolds and Cheryl Hsu ; with reference to Simon Mair’s article “What will the world be like after coronavirus?”
This article explores four possible futures for the Canadian health care and food systems post-COVID-19, and examines the implications for short-term strategies and long-term vision of Nourish moving forward.
““How do we not go back, but go forward to something better?” ”
This is the central question the Nourish team has been asking ourselves, as we watch the coronavirus thrive in so many of the weaknesses of our food and health systems.
Over the past seven weeks, we’ve witnessed hospital managers exchange strategies to support staff who are afraid to come to work due to PPE shortages; physician pleas from the frontlines for people to stay at home; people experiencing homelessness struggling to access shelter and food while awaiting test results; and farmers scrambling to find adequate accommodation to quarantine incoming skilled farm workers.
The pandemic has foregrounded and exacerbated the glaring inequities and food insecurity that already existed. However, there are bright spots. Restaurants are stepping up to donate food to frontline health care workers (#chopstickstoheroes). Community care-mongering efforts are bringing meals and groceries to isolated seniors. There is mobilization to parlay openings created by government fiscal stimulus packages into long-term progressive policy, like a Universal Basic Income.
We’re witnessing the largest prevention initiative in history. It’s imperative that some of this energy for prevention is cast well into the future so that the next crisis has fewer casualties.
“So what does the post-COVID future look like ahead of us — in 1 month, in 6 months, a year? We certainly cannot predict the future, but we can look for patterns and signals within this rapidly changing world that give us clues about where we might be headed. ”
So what does the post-COVID future look like ahead of us — in 1 month, in 6 months, a year? We certainly cannot predict the future, but we can look for patterns and signals within this rapidly changing world that give us clues about where we might be headed. We can use our questions about these signals and the biggest drivers of change to craft scenarios for the future. These scenarios cue us to the forces in the present that we should be working to amplify or that should be mitigated.
The Nourish team embarked on a foresight research exercise to this end — collecting signals of change within the system, observing trends both locally and globally, and tracking policy windows of opportunity for transition to a more resilient, sustainable and equitable health care system. We have imagined possible scenarios within a time horizon of two to three years into the future for the health care system post-COVID-19. None of these scenarios are meant to be predictive, but they are exercises to inspire hope and fear, and to push us to design better options for the future.
Exploring the Possible Futures of the Canadian Food-Health System Post-COVID
Simon Mair’s Four Scenarios
In response to ecological economist Simon Mair’s article “What will the world be like after coronavirus?”, the Nourish team designed a foresight exercise to build on the four future scenarios developed by Mair, to imagine what the food and health systems of the future might look like.
Mair created four futures using the foresight tool of developing a 2x2 based on two drivers (or critical uncertainties) that will shape the future. We stuck to the two drivers chosen by Mair — how we understand value, and who makes the decisions. In Mair’s words:
Critical uncertainty → Value “Value refers to whatever is the guiding principle of our economy. Do we use our resources to maximize exchanges and money, or do we use them to maximize life?”
Critical uncertainty → Centralization “Centralisation refers to the ways that things are organised, either by lots of small units or by one big commanding force.”
Simon Mair’s four original scenarios are named as they appear in the graphic above. We’ve adapted from his starting points and built them out as our own, renaming them to generate four possible health care futures for Canada post-COVID.
While these scenarios seem extreme, this exercise stretches our imagination to “future proof” our ongoing strategy work, to mitigate blind spots, and to observe what signals from each future are currently alive in the present. Signals about any one of these futures give us clues about what forces we should actively work to amplify or to mitigate in the present.
Four Possible Health Care Futures
Care-on-Demand
Building on Mair’s State Capitalism future: State interferes with Keynesian stimulus to keep the market functioning.
The Canadian government’s response pursues exchange value as the guiding light of the economy. Markets require support and people need extended welfare to keep the economy afloat. It enacts massive Keynesian stimulus by extending credit, making direct payments to citizens and bailing out companies. There are significant risks that certain industries and communities are left out of kick starting of the economy.
Health Care & Food System Scenario:
Risk of two-tiered healthcare system. Laws of supply and demand determine access to PPE and to the best quality health care.
Inequality deepens for essential workers. Health care and grocery workers celebrated during crisis, but essential workers do not keep the benefits won.
Keynesian economic stimulus focused on getting key industries back to normal and people back to work as fast as possible without any policy shifts.
Dreams of UBI die. Inequity continues to rise.
Indigenous communities are left behind along with other vulnerable populations, except for communities with a high degree of autonomy/sovereignty.
Vaccines purchased at any price. Wealthy countries like Canada have capacity to purchase and access vaccines first, and companies make significant profits.
Post-pandemic institutional double-down on getting ready for the next one (more hospital beds, warehousing PPE). Health care remains a significant part of the economy.
Unemployment means greater food insecurity. Certain sectors of the economy do not bounce back and leads to greater food insecurity.
Big food, tech companies celebrated for donating to charitable efforts to help low-income and more vulnerable communities in the short-term. They do not offer fairer work, entrenching status quo.
Small and mid-size producers survive only by collaborating and finding innovative ways to market, and temporarily claim more retail food market share.
Inequitable Collapse
Building on Mair’s Barbarism future: Chaos and starvation when markets fail and hospitals collapse under pressure.
A bleak future where the Canadian government focuses on exchange value and the protection of the market as its guiding principle, but it refuses to extend support to those who get locked out of markets by illness or unemployment. There are risks that the state and sectors collapse after an on-going period of political instability and social devastation.
Health Care & Food System Scenario:
Defunding of critical health services during austerity impacts the ability to respond to this pandemic.
Hospitals become overwhelmed and tough decisions are made about who lives and who dies when there are not enough ICU, ventilators and health care providers during pandemic waves.
Extreme inequity and collapse. The most poor and vulnerable, insufficiently supported by preventative health measures, enter the teaming health care system until it collapses.
Doctors, nurses and personal care workers strike because their personal safety is not protected, and wealthy people are able to purchase their private care provision and hospital equipment.
Death, betrayal, and social collapse: Lots of people and loved ones die as a result of COVID; citizens feel betrayed by lack of state support and response and trust in government completely erodes.
Scarcity mindset and opportunism: people resort to pillaging and protecting themselves. Rage at the wealthy and powerful.
Growing seasons disrupted for both large and small farms by not having sufficient seed, fertilizer, labour, and exacerbates food insecurity,
Vulnerable populations facing COVID-19 (like those experiencing homelessness, domestic violence, high density housing in Indigenous and remote communities) are left to fend for themselves with diminished services/
Deep recession exacerbated by lack of coordinated leadership on other threats such as climate event fires, heatwaves, flooding.
Baby boomers do not want to go into residential or long-term care and those with resources to pay for care at home, opening up greater privatization of healthcare.
Universal Access
Building on Mair’s State Socialism future: State protects essentials to life: care, food, energy, shelter.
We see a paradigm shift by Canadian government where equitable access to the basic needs of life is at the heart of the economy. The necessities of life are accessible to all and compensation is proportional to the usefulness of the work. This future may occur if the pandemic is protracted. There may be risks of authoritarianism and centralization of government power.
Health Care & Food System Scenario:
Increase in health spending to provide equitable care across the country and to mitigate risks of a future crisis, funded by increases in taxation.
Provision of housing, and payments to workers are seen not only as tools to protect markets, but a way to protect life itself.
Supermarket workers valued along with delivery drivers, warehouse stackers, nurses, caregivers, teachers — and compensation gaps with executives shrink.
Universal basic income: Demand for universal basic income and other social services (provision of food, housing) leads to increases in taxation to cover costs.
Indigenous communities receive targeted support and begin to rebuild and offer insights into resilience through relations with land and food systems.
Lighter burden on health care system forecast in the longer-term because people with more income in their pocket are able to access social determinants of health (food, education, housing, etc.).
Increased surveillance and preventative care. Tracking the health of people becomes the priority, and private telecom/internet companies collaborate with the government, justified first by the need for rigorous COVID-contact-tracing. This becomes a tool for also tracking the preventative health of citizens (e.g. similar to China).
Pandemic waves extend state responses around emergency benefits for the unemployed, deferring on housing rents and mortgage payments.
War-time rationing and redeployment of citizens around essential services. and/or the Green New Deal.
Community-Led Care
Building on Mair’s Mutual Aid future: Citizens lead around protection of life and organize care within communities.
Individuals and small groups begin to organize support and care within their communities while the state plays a smaller role. We see the roots of this future in self-organization around care-mongering. There are risks that current inequities between regions may continue in this future, where communities do not have initial resources to mobilize.
Health Care & Food System Scenario:
Decentralized networks of care self-organize based on the skills and needs in a given community.
Community support and policing of norms slows transmission and supports most vulnerable (e.g. West Africa during Ebola)..
New democratic structures emerge at the municipal, provincial, and federal structure over time, to guide planning based on ecological and social determinants of health.
Social bonds and support in communities are increasingly recognized. Stronger local economies.
Inequity between communities may increase as some communities are better resourced than others.
Many Indigenous communities flourish and their leaders are recruited to support others.
Family and community self-reliance rises around food and health being maintained by lifestyle, victory gardens etc.
Degrowth values mainstream. Due to the values shifting from production and growth towards care and flourishing, the economy slows, materialism and desire for travel declines.
Stress, isolation and depression lessen as life slows down to a mending/caring culture.
Community care workers are not just professionals, but part of a civic responsibility around helping, supporting, feeding each other,
Investments into acute care are de-prioritized or too expensive, which is a part of a cultural shift towards changing values around dying gracefully and with dignity (around community), rather than trying to fight death.
What did we learn about post-COVID-19 implications for the Nourish strategy?
“As Chilean Economist Manfred Max-Neef described: “The fundamental value to sustain a new economy should be that no economic interest, under no circumstance, can be above the reverence of life.” For Nourish, this is best expressed by the paradigm shift illustrated in the “Universal Access” and “Community-Led Care” scenarios.”
The present situation contains signals of all of these futures, some perhaps more so than others. At present, signals for the “Inequitable Collapse'“ scenario felt the weakest in Canada, although we are observing the costs and consequences of longstanding inequity in the country. We also witness new political awareness of the enormous strain on long-term care homes and the vulnerability of staff and caregivers.
Signals from the other three scenarios all felt alive in Canada as well. We see a rise in home and community gardens and with “Community-Led Care” in general, for example, through UHN OpenLab’s Friendly Neighbour Hotline for seniors or through food programs by the Haida Nation to Six Nations, which build from the strengths and resources within the community. In the “Universal Access” scenario, we’re also seeing the Federal government’s COVID-19 building evidence for the potential of a Universal Basic Income (UBI) program. Of course, the pandemic has also led to investments in acute care and ICU capacity in hospitals, as well as boosting tele-health and virtual care for enhanced “Care-On-Demand,” though these investments aren’t tied to this particular future.
These scenarios reveal to us that there are pockets of a desirable future already in the present, and like so many, our team wants to seize these to transition toward a more resilient, equitable, and sustainable health care system. As Chilean Economist Manfred Max-Neef described: “The fundamental value to sustain a new economy should be that no economic interest, under no circumstance, can be above the reverence of life.” For Nourish, this is best expressed by the paradigm shift illustrated in the “Universal Access” and “Community-Led Care” scenarios, and weaving in the most life-supporting developments in the “Care-on-Demand” scenario.
Ultimately, we aim to transition toward health care systems that are efficient and resilient, but above all that value life, prioritizing the flourishing of humans and ecosystems above the optimization for money and profit. Likely, we will see elements of all these scenarios in the future.
For now, our team is beginning to look for the openings created by COVID-19 to harness the power of food in health care to build climate leadership, equity, and community well-being.
The exercise of foresight work is not to be able to predict the future, but to be able to anticipate and prepare for the potential ways it might unfold. While the COVID-19 pandemic has led to a lot of uncertainty around our strategy and the future of Canadian health care, it has sharpened our principles and aspirations, which are clearer than ever.
It’s time to mitigate the narratives that discount the lives of the elderly and vulnerable for the revival of the economy, and it’s time to amplify narratives that recognize that the health and well-being of people is a collective responsibility, and interwoven with planetary health.
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Update: Since COVID-19 hit the Canadian health care system, we’ve delayed the launch of our Anchor Leadership program until at least September 2020 to turn our attention to the pandemic response. We will shortly be announcing plans for the interim period.