|26 April 2001
National Public Health Leadership Development Network
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
- 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
- what skills would most contribute to successful leadership
in your scenario?
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
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
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
2018. "Hygienic Alliances" formed -- economic cooperation among
various sterile enclaves. Health passports issued, although travel
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
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
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.
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
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.
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.
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.