For more than twenty years the Institute for Alternative Futures (IAF) has organized Foresight Seminars to provide Congress, executive agencies and the private sector a forum for looking to the future of health and innovation. This paper chronicles the forecasts and insights developed through these Foresight Seminars from 1978 through1998. The paper is also a guide to a larger body of information from the programs that is now available on the IAF website. Thanks to a grant from Merck & Co., IAF can now disseminate a large selection of summaries, transcripts and invitations from over 100 Foresight Seminars that were held for Congress. This paper provides electronic links that form a virtual table of contents to this information.

In retrospect, we believe the Foresight Seminars are proving successful beyond anyone’s expectations. The record of the seminars provides a treasure trove of insights into leading edge developments in science and technology, business, the economy and society. Taken as a whole, this record is arguably the best source of foresight available to understand emerging innovations and opportunities in health care.

The Foresight Seminars deal with scores of topics from nanotechnology and cloning to demographics, new businesses and global markets in a transforming economy. On every topic IAF has sought to help policymakers improve their decisions by creating programs to explore forecasts, multiple points of view and visions of the best that can be created.

Over the years IAF has worked to integrate ideas from the hundreds of leading thinkers who have joined the Foresight Seminars to create a coherent view of possibilities for the future of health. What has emerged can be described as a "4^th Wave Health System" that stands in sharp contrast to the traditional industrial model of illness care. Important elements of this emerging 4^th Wave Health System include:

• The rise of a Forecast, Prevent and Manage Paradigm that involves forecasting potential health problems based on genetics, environment and disease history. These forecasts will be used to prevent problems though lifestyle change and biomedical interventions. Health management will include routine biomonitoring that detects deviations from normal functioning to identify problems and opportunities for improvement;
  
• A deep change in health care priorities to address preventable mortality caused by lifestyle, poverty and environmental insults;
  
• An emphasis on self-managed care, done in partnership with health care providers and other supportive organizations;
  
• A focus on creating healthy communities and workplaces, as well as healthy individuals;
  
• Development of the potential of biotechnology for genetic profiling and anticipatory prevention with improved diagnostics and a wide range of new treatments;
  
• The emergence of a new stage of medicine—customized care—with therapies tailored to genetically similar population groups and individual biochemical uniqueness;
  
• Development of the full potential of telehealth, not only within and between health care facilities, but reaching into homes to provide health information access, video housecalls, biomonitoring, expert system health coaching, support groups and other services;
  
• Widespread use of outcome measures and provider rating systems to accelerate medical progress and empower consumers;
  
• The use of a much wider range of tools from various alternative therapies integrated with allopathic medicine and using outcome measures to evaluate all approaches;
  
• A view of health as a wholeness and potential that goes beyond the absence of symptoms to an appreciation of the importance of love, tolerance, compassion and joy—qualities that bring measurable physiological benefits as well as mental health;
  
• An emphasis on caring in the fullest sense; a view of patients as multi-dimensional, with treatment addressed not just to the physical level but also to the level of emotions, understanding, and ultimate meaning and purpose;
  
• A long-term shift in focus—as biomedical advances cure or control major diseases and as prevention and genetic medicine "design disease out" of society—toward physiological and mental enhancements of our highest capabilities.

These and other themes have emerged in the Foresight Seminars, interweaving like the strands of a DNA helix. They have given rise to a larger realization. Converging knowledge revolutions in biomedical, technological and social fields are reaching a point of critical mass. Together they create a synergy which is larger than the effects of any single field. Together, they create an overarching systems view of the radical transition in which healthcare is now embroiled.

Why is this so significant? Problem-solving can be undertaken at a much higher level, its effects are more accurately anticipated and directed, when previously disjointed issues are seen in relation to a whole. In fact, only a systems approach to problem-solving truly works. Countless ineffective problem-solving efforts throughout history provide a lesson we ignore at our peril: trying to solve narrowly defined problems in isolation breeds new sets of problems no less daunting than those that policymakers first set out to solve.

Thus, the Foresight Seminars have taught us that a public conversation about creating health in the 21^st century must adopt a systems approach if it hopes to be meaningful. The purpose of this report is to make the insights and information from the Foresight Seminars available to all health care stakeholders. We at IAF hope readers will see in this report that a new vision of health is waiting in the wings—a vision that encompasses innovation in policymaking as well as health care systems.

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