Designing for Transitions: Visioning/Backcasting/Assessing the Present for the Lack of Access to Affordable Healthcare in Pittsburgh
Assignment #4: Designing for Transitions
Carnegie Mellon, Transition Design Seminar 2023
Team Diversity: Luis Garcia, Parrish Andre, Ariba Asad, Mary Priyanka Jacob, Emilie Zhou
Introduction
To determine how the wicked problem of lack of access to affordable healthcare in Pittsburgh can be better understood and broken into actionable steps, it is crucial to first envision what the desired future would look like if it were resolved. Through exploring how this wicked problem is prevalent in social, environmental, economic, political, and infrastructural issues (assignment 1), as well as how groups are affected differently by the wicked problem (assignment 2), we have started to build up an understanding of the implications and consequences of our wicked problem. Previously, we have also mapped the historical evolution of our wicked problem to learn more about the changes and developments that have contributed to the current state of our situation (assignment 3). Given how interconnected this wicked problem is to other wicked problems and all other aspects of people’s lives, the first part of this assignment required us to develop fragments of a long-term future for the household, neighborhood, city, region, and planetary levels. In the second part of this assignment, we backcasted from our future visions to start considering potential interventions in the present. As we reflected on the desired future and current state of our problem, we began to break down how, as a society, we can move toward a future where this wicked problem is resolved.
Our Process
We started our process by developing ‘vision facets’ of a long-term future in which the Lack of Access to Affordable Healthcare in Pittsburgh is resolved. As a team, we contributed several ideas using the Domains of Everyday Life framework developed by Gideon Kossoff, which prompted us to consider five different levels of scale: The Household, The Neighborhood, The City, The Region, and The Planet. For this process, it was critical to include complete and evocative sentences, an exercise that, on an actual project, would ask stakeholders to do.
The next step for our team was to consider each idea and its potential connection to the other levels in the framework. For example, if we included something at the City level, we asked ourselves: what could support this idea from a regional or planetary perspective? This exercise allowed our assignment to think of our ideas systemically instead of only populating the board with several disconnected ideas.
Finally, before jumping to the specific parts of our assignment, it is important to note that these ideas are about describing aspects of everyday life, at different levels of scale, in a future society. We were not looking to describe solutions, but rather, such “solutions” are implicit in the descriptions of our visions. This allows people to reflect on multiple paths toward an ideal future instead of focusing too much on specific ideas.
The second part of the assignment focused on backcasting from the desired future to a problematic present to create a ‘transition pathway.’ We used the matrix below to assess the present against the desired future, which challenged us to evaluate established and existing practices when considering a decades-long transition. We considered four areas for our ideation process: “what is not working anymore and needs to transition out,” “what should we keep,” “what existing innovation practices could ignite the transition,” and “what pieces of our future vision are already here.” Finally, this process ended in us developing three milestones: 5–10 years, 25–35 years, and 50–60 years out.
Developing Long-Term Future Visions
The 5–10 year short-term vision focuses on developing a committed, united group of stakeholders through rapid intervention. Pop-up clinics are established in low-access areas of Pittsburgh, funded and supported by both the government and private sector. Decision-making is mainly delegated to the residents of the areas. This stakeholder participation should foster relationships and serve as an example for future changes.
The 25–30 year vision Pittsburgh is undertaking an urban planning redesign, prioritizing carbon-reducing transit methods like buses, bikes, and walking. Neighborhoods are well equipped with the food, education, green spaces, and local clinics they need to support themselves. Environmental protection regulations are in full effect, and the air, water, and soil quality are slowly recovering. Local efforts to heal these natural resources are enacted.
The long-term vision looks 50–60 years in the future. There we imagine a Pittsburgh that thrives without the steel industry. Environmentalism is a crucial part of our collective social values, along with equitable access to clean water and air. Hospitals and clinics can bolster the care of one another while still maintaining progressive competition. Uninsured people have access to care despite their ability to pay.
Backcasting and assessing the present
As we backcast from our future visions, this also required us to think about established and emerging practices or ways of doing things we wanted to keep or leave behind as we move forward. In order to move toward a future vision where the wicked problem is resolved, it’s important to identify what current practices are holding us back and what could potentially help spur us in the desired direction.
We first identified established ways of doing things that need to be transitioned out to work toward a future where the lack of access to affordable healthcare is resolved. Current practices that need to be left behind include:
- The excessive privatization of medical services.
- The lack of regulation on UPMC as a non-profit.
- The continued discrimination against healthcare workers.
These existing ways of doing things will only create more divisions among people where wealth and status determine what kind of medical care people can access if these practices are included. While existing ways of doing things need to be transitioned out, we recognize that there are established ways of doing things that need to be kept. For instance, efforts to develop medical advancements and services should be continued. UPMC serving as a hub for research and medical developments has also attracted many medical professionals to Pittsburgh, which has benefited the service and care that can be provided to people.
Looking forward, some current innovations and practices can be utilized to disrupt business and ignite the transition into the future. The emergence of free clinics and telehealth services can continue to be used to make healthcare more accessible. Organizations that are spreading awareness and drawing attention to various healthcare initiatives can also be used to advocate for better healthcare services and plans for people whose voices are often ignored in society. Building on what practices can be used to pave the way for a future where the lack of access to affordable healthcare is resolved, we have also identified “pieces of our future vision” that are already present. Fragments, such as transformative technology and innovation, local healthcare-related programs, and increased awareness of flaws in the system, exist and will be critical components in helping steer the rest of society toward a desired long-term future.
How each idea is connected in the different levels of the framework.
To bring change, it has to begin from every level of human involvement. It cannot be just at a policy or a neighborhood level. Each stakeholder in the system will have to work equally to resolve the wicked problem at hand. This interconnectivity among each domain of everyday life is significant in directing the change and is explored by building connections in the long-term future map. Various interesting aspects emerged as we tried to understand the impact of a change at one level on the other. The norm of Health education programs at schools and local community centers in our future vision has created awareness among each member of society, emphasizing the importance of health and wellness workshops at the neighborhood level, contributing to shared knowledge and community learning. This helps push the concept to the household level, where parents make healthy choices regarding eating habits and try to maintain a healthy lifestyle. All these interventions work together to bring a systems-level change.
In the same vein, as the effects of climate change get addressed at a global level through technology and policy intervention, it helps transition towards an ecological mindset, thus forcing governments and authorities to enforce restrictions on pollution, carbon gas, and carbon waste emissions. These emissions are monitored at the city level by innovations like Breathe Pgh and resultantly make people aware of the actions they need to take for clean water, electricity, and gas. All this adds to the accessibility of affordable healthcare in Pittsburgh.
How this process has helped us think of ecologies of intervention
Long-term visioning is a broad exercise that helped to project a future where people have better access to healthcare and a cleaner environment, better and economically reachable medical education, good transport and communication connectivity, and a non-profit-based healthcare ecosystem. The need for ecologies of intervention is critical, in which cases not only the main stakeholders, such as hospitals, doctors, and insurance companies, are involved, but also governmental policies, industry, and the entire population to drive positive change.
The Lack of Access to Affordable Healthcare requires multiple interdisciplinary interventions to be solved. Backcasting allowed us to figure out how to find our “dreamed future.” This was a challenging task, as we had to bring our high-flying aspirations as close to ground reality and think of an actionable plan to achieve the vision.
Conclusions and next steps
As we pivot from defining the problem and finding its root cause, which we discovered is a myriad of factors rather than just one, we are using our well-developed knowledge of our wicked problem to envision a future where everyone has equitable access to healthcare services. We had time to bring in our optimism and creativity without getting too utopian. The framework provided was a new way of thinking about the future, as in most cases, we are used to forecasting and making the roadmap to the solution as we think of the solutions. This usually boxes our minds to think only with the frameworks, technologies, mindsets, and postures available in the current world. But reversing the exercise, and visioning before backcasting and making the pathway (though seemingly minimal change) removes the mental barriers and enables true transitional thinking and mapping.
We also reflected on the interconnectedness of our ideas across different scales, which came up in part 4A. In Transition Design, we emphasize the importance of acknowledging the ripple effects of solutions. In that context, it was key to draw connections between the visions of different groups, which helped us visualize the interdependency of complex ideas such as those dealing with better policies and leadership-level influence for healthcare or the environment giving rise to a climate and ecosystem-friendly planet. On the other hand, exercise 4B helped us realize the intellectual capacity and awareness needed to build a workable plan, as a city council would do. Our next steps will focus on producing tangible and applicable solutions to help us achieve our visions and sound convincing enough so that key stakeholders, such as the Mayor, would take our problem seriously.
A copy of our maps can be accessed here.
References
Kossoff, G. (2011). Holism and the reconstitution of everyday life: A framework for transition to a sustainable society. Grow small, think beautiful: Ideas for a sustainable world from Schumacher College, 122–142.
Possible Futures for Health and Health Equity in the USA — Reos Partners. (2017, September 6). https://reospartners.com/projects/possible-futures-health-health-equity-usa/
