Health System Scenarios

Publication +
Illustration that was extracted from the cover of the Health System Scenerios publication. The drawing features a diverse group of people, including a mother and child, a person with groceries, person with a drink and backpack and a woman in the foreground wearing a head wrap.

with Robert Wood Johnson Foundation and Reos Partners for health equity


Robert Wood Johnson Foundation


Reos Partners
Flavia López-Czischke
Tassiana Willis

In the United States, entrenched inequity leads to great disparities in health outcomes across population groups, especially by race, income, and geography. The root causes can be traced back to differences in healthcare access, exposure to environmental hazards, and the social determinants of health. Systems are often inequitable and can exacerbate these health inequities, threatening the prosperity of entire communities.

The Robert Wood Johnson Foundation supported Reos Partners in convening a group of system leaders from across the US to consider how the health system could change and what this would mean for health and health equity. Out of this work emerged three possible futures – or “scenarios” – for how the health system could change through 2030. These scenarios are not forecasts or policy recommendations, but rather stories about what could happen in the future based on current political, economic, social, and cultural dynamics.

To present these scenarios in a compelling way, we worked with Reos Partners to design the Health System Scenarios publication. It describes each of the three possible futures in narrative form, accompanied by a user guide to encourage reflection and conversation around health equity. We brought the health system scenarios to life through illustrations that focus on the actions and lived experiences of people within each scene. The illustrations are complemented by poems written by a member of the scenarios team which encourage intimate engagement with the content. For each scene, we carefully considered questions of power, privilege, and representation.

The hope is that the scenarios presented in this report enable system leaders from across disciplines to devise and implement solutions that lead to meaningful and sustained improvements in the lives of individuals and communities.


“They all have learned together, that power is in the hands of the people. That the government’s one-size-fits-all sick care system seems to fit few, if any.”