Health inequalities have deep roots in past systems, are shaped by present-day realities, and will continue to evolve based on the choices we make for the future. At our recent Involvement Series event, we explored these dynamics using the Futures Triangle framework. This exercise encouraged participants to reflect on three perspectives: the Pull of the Future, the Push of the Present, and the Weight of the Past. Through this, we uncovered valuable insights on how to shape a fairer and more sustainable health system.
The pull of the future: what are the health outcomes we want to see in 2050?
Participants painted a vision of a future where healthcare is proactive rather than reactive, with a strong focus on prevention. Physical activity, healthy eating, and sustainable living were identified as key elements in reducing the burden of chronic illness.
A truly equitable health system was another major aspiration – one where access isn’t determined by income, location, or digital skills. People emphasised the importance of co-production, ensuring that services are designed with and for the communities they serve. Mental health support was also a strong priority, with a hope that it would be embedded across all stages of life, from childhood through to older age.
However, challenges were also acknowledged. Would technology improve access or create new barriers? Would funding and workforce shortages stall progress? These uncertainties highlight the complexity of making lasting improvements.
The push of the present: what are the current trends and drivers creating change in the health system?
Current trends in healthcare are a mixed bag. Advances in technology offer opportunities for better, more personalised care, but digital exclusion remains a barrier, particularly for older adults and rural communities.
Mental health services were highlighted as an area where demand far exceeds available support, especially for young people. Chronic diseases, driven by poor diet, lack of exercise, and environmental factors, are also increasing, adding to the strain on the system.
Participants identified workforce shortages, funding constraints, and a lack of coordination across health and social care as significant challenges. Too often, healthcare remains reactive rather than preventative, with services stepping in only at crisis points. Short-term funding cycles were also seen as a key barrier, making it difficult to embed lasting change.
Trust in public institutions was another major concern. While co-production and involvement strategies are gaining traction, their real impact remains uncertain due to hesitation from some senior leaders to embrace a more long-term approach.
The weight of the past: what are the legacies and systems that led us to the health system of today?
Historical inequalities continue to shape today’s health outcomes. Our population has become increasingly diverse and the resulting needs haven’t always been met. In maternity care, for example, Black mothers still face disproportionately high risks, underscoring the need for systemic change.
The move away from local, community-driven healthcare was another key concern. As services have become more digitised and centralised, many people, especially those who struggle with online access, have found themselves excluded. There was a strong call to revive aspects of traditional healthcare models, such as family GPs and close-knit community support networks.
Past economic and policy decisions continue to weigh heavily on health inequalities today. The food system, shaped by industrialisation and mass production, has contributed to unhealthy, inaccessible, and unaffordable diets. Housing policies have also failed to incorporate the lessons learned about the links between safe, affordable housing and good health.
Mental health stigma, once widespread and even criminalised, still lingers. While there has been progress, many people still face barriers when seeking support. The past continues to cast a long shadow over efforts to make healthcare fairer and more accessible.
Shaping plausible futures for health equity
By examining these three dimensions, we can start to map out the steps needed to reduce health inequalities. A stronger emphasis on prevention, investment in social prescribing, and addressing social factors like housing and education must all be part of the solution.
Community engagement and co-production will be crucial. But for these approaches to truly make a difference, there needs to be a shift in power, funding models, and institutional mindsets. Without systemic change, co-production risks being just another buzzword rather than a meaningful tool for transformation.
Technology has the potential to be a game-changer, but only if it enhances accessibility rather than creating new divides. Digital health solutions must be designed with inclusion in mind, ensuring that no one is left behind.
Perhaps the biggest takeaway from this exercise is that real change takes time. Quick fixes won’t be enough to dismantle long-standing health inequalities. The vision for 2050 is ambitious, but it is within reach, if we recognise the weight of the past, navigate the challenges of the present, and take collective action toward a fairer, more inclusive future.
These reflections are based on learning from the Involvement series of events run through Project Dewi. With thanks to Petranka Malcheva at the Office for the Future Generations Commissioner for Wales for running a session on Futures Thinking with us.
As part of Project Dewi, we aim to share good practices and assist with each other’s challenges. Please get in touch if you would like to be involved: [email protected].