Designing Leadership for Difficult Futures
a public health incasting exercise

Background and instructions:
For the next hour, we will explore scenarios portraying four different future public health challenges in Metro Houston. YOU HAVE BEEN ASSIGNED ONE OF THESE SCENARIOS. Each begins in 2015; assume that in the years between 2000 and 2015 Houston has continued to grow (sprawl), with an economy that has boomed as the multinational energy companies sited here have diversified in the global information economy (the Enron model), and attracted even more e business entrepreneurs. Galveston has undergone a renaissance and renewal, due in no small part to Houston's successful bid for the 2012 Olympics: the laying of the Woodlands-to-Galveston, Katy-to-Channelview, and City Ring light rail lines as well as the enhanced sports, leisure, residential, and business infrastructures created to cater to both athletes and spectators attracted a continuing post-Olympic influx of tourists, new businesses, and new residents. By 2015, from Conroe to the coast, greater Metro Houston is an energetic, economically and culturally diverse and cosmopolitan city with business and communications links all over the world.

In this context, any one of the four scenarios described is possible. DO NOT DISCUSS ITS RELATIVE PLAUSIBILITY OR PROBABILITY; SUSPEND YOUR DISBELIEF -- a problem arises; simply consider how you would cope. After reading your scenario, address the following discussion questions:

• what challenges and opportunities does your scenario present to public health leaders?
• what "vision" might a leader try to bring about, given this context?
• does your scenario require a leader have certain qualifications or a specific knowledge base to lead successfully? would conditions require coordinated leadership by several people with different skills?
• what skills would most contribute to successful leadership in your scenario?

The Plague Years (adapted from WIRED Scenarios 1.01, January 1995)

2013. First outbreak of "Mao Flu" in Hong Kong: spread by aerosols (single 10 micron droplet enough to infect); incubation time of 10 hours, followed by six hours of increasing malaise fading into neurological disorder, as in rabies. Then massive internal clotting, organ dissolution, bloody vomiting and diarrhea, and hemorrhaging. But right up until the end, patients show marked frenetic energy. Mortality rate is 99.8 percent.
2014. Global travel precautions: attempts at sterilizing airports fail, followed by collapse of global air industry.
2015. UN-sponsored "Pandemicon" conference to address the Mao flu pandemic ends in disaster as world's most gifted bioresearchers are all infected and die.
2016. Mao flu now global; rapid onset decimates the population of health professionals attempting to fight the disease -- all the medical personnel in Africa died in the first six months; about 95 percent of personnel in Asia outside Japan and the "Asian tigers," and Latin America lost almost 90 percent of its medical personnel. In the developed world, only about one-third of the medical personnel succumbed.
2017. Cities empty out into the countryside; international commerce collapses; first "sterile enclaves" formed. Surviving junior bioresearchers and virologists contact each other from enclave to enclave using the Net/Web -- initial explorations of the Mao virus dynamics made possible by web-linked, immersive virtual reality biochemical modelling programs.
2018. "Hygienic Alliances" formed -- economic cooperation among various sterile enclaves. Health passports issued, although travel extremely rare.

The Rising Tides

2005. Designers and engineers surveying final site for Woodlands-to-Galveston light rail note land subsidence in Galveston more pronounced.
2012. Olympics holds its collective breath as category four hurricane blows up in the Gulf and veers south over Mexico -- international aid teams quickly mobilized in the atmosphere of international amity fostered by the Games.
2013. Meteorologists note that five successive record high temperatures for Houston have been set since the year 2000, with a record number of category three and four hurricanes during that time as well; weather-watchers worldwide add to growing database confirming global warming.
2014. Antarctic scientific teams note growing number of deep crevasses in Ross Ice Shelf. Marine scientists confirm half degree rise in sea temperature, voice concerns regarding algal blooms and coral die-off.
2015. Great Galveston Hurricane of 2015 -- Hurricane Jorge, a category four storm, sweeps across Galveston with unprecedented force. The storm surge is likened to a tsunami, and most of the island is underwater for over a week -- land subsidence over the last decade results in slower drainage, more infiltration of seawater into storm drains, sewers, and the water table.
2016. While rebuilding goes on in Galveston, continued concerns about the contamination of the water table and coastal water sources are exacerbated by heightened water demand through the increasingly longer, hotter summers.
2017. Catastrophic calving of Ross Ice Shelf off Antarctic land mass -- sea level worldwide increases by a half a meter in a week. Galveston becomes Venice overnight, and bayous throughout downtown Houston flood. Fresh water contamination by brine and petrochemicals creates potable water crisis.

The Drugs We Drink

2012. Drug testing during the Houston Olympics produces a startling number of "false" positives. Athletes, coaches, and officials are mystified until analysis of drinking water demonstrates noticable steroid levels. City officials point fingers at local agricultural businesses, and form a commission to investigate the issue.
2013. New England Journal of Medicine publishes reports on increasing percentages of "feminized" youth, calling for further research on synergistic effects of food additives and agricultural non-point-source pollution.
2014. Research by the Houston Commission on Water Quality highlights growing problem of non-point-source pharmaceutical pollution: drugs "passing through" the human system, unaffected by sewage treatment, finding their way back into the water system. Concerns heightened by lack of data on interaction between pharmaceutical pollution, petrochemical pollution, and agricultural pollution. Commission receives more funding.
2016. Cluster phenomena in Clear Lake, Katy, and the Woodlands of "flesh eating bacteria." In ensuing media frenzy, physicians point out related problems, such as faster obsolescence of new antibiotics in the face of rapidly evolving bacteria and viruses.
2020. Demonstrable weakening of immune system noted in over 35% of Houston population under fifteen; previously "mild" childhood diseases now life threatening for many.

The Economic Epidemic (note: an acute crisis -- no timeline)

It's 2012, and a record number of visitors have arrived in Houston in mid-mid September for the city's first hosting of the Summer Olympics. Designed to both celebrate and accelerate the city's burgeoning economic success, the city is overflowing with people from all over the planet. Mindful of the lessons of Atlanta, the city has just unveiled an efficient new light rail mass transit system -- and an equally widespread security program. Weaponry of all sorts is carefully controlled WITH the assistance of the NRA in a public campaign to make this the safest Olympics of the modern age; chemical sniffers -- both mechanical and canine -- are on guard against explosives.

Unfortunately, security systems are not calibrated to detect organic matter, and an international terrorist organization focussed on calling attention to continuing disparities in wealth, privilege, and resource exploitation have concluded that Olympics present the perfect opportunity to strike back at the global leisure class.

Via the blackmarket, terrorists acquire a stock of re-engineered anthrax virus from partially decommissioned bioweapons labs in Russia. Houston's call for part-time service and support staff for the Olympic activities offers innumerable opportunities to infiltrate the mass transit system as maintenance workers and janitors. The virus was "sponged" onto every available service in the mass transit system in the process of cleaning.