At some point in their careers, health practitioners find themselves preoccupied with issues that go beyond the confines of the clinical room. Beyond diagnoses and prescriptions lies a larger health care landscape, one shaped by policy, economics, culture, technology, and power. Health professionals then begin to ask how this broader system affects not only their individual patients, but also communities and society at large. It is often at this intersection that health advocacy emerges.
Health advocacy can be described as deliberate actions taken to influence social, economic, and political systems to improve health outcomes, reduce inequities, and protect the well-being of individuals and populations. Advocacy is not limited to lobbying legislators, writing op-eds, or position statements. It includes speaking up for patients, challenging harmful norms, shaping policies, and amplifying marginalized voices. While advocacy tends to be reactive, often in response to crises, there is growing recognition of forward-thinking advocacy. For meaningful advocacy, clarity and structure are essential. Without a clear sense of purpose, advocacy risks becoming fragmented or driven solely by urgency rather than impact. This is where foresight becomes a valuable discipline for health professionals.
Defining foresight in health care
Foresight is the structured application of futures concepts and tools to determine possible, probable, and preferable futures. Unlike prediction, which attempts to forecast a single outcome, foresight explores multiple plausible futures to help decision-makers act more deliberately in the present. It asks not only “What is likely to happen?” but also “What kind of future do we want?” It sheds light on “What actions today can move us toward that future?” In health care, where policy decisions and structural reforms can unfold over decades, this perspective is particularly relevant.
Foresight offers a range of tools that can strengthen health advocacy. These include horizon scanning to detect emerging trends, scenario planning to explore divergent futures, and systems mapping to understand complex interdependencies. Among these tools, backcasting is especially relevant for advocacy-oriented work.
Backcasting begins not with a focus on present constraints, but with a clearly articulated vision of a desired future. Once that future state is defined, the process works backward to identify the policies, behaviors, institutional changes, and milestones required to reach it. For advocates, backcasting shifts the focus from crisis-oriented approaches to transformative change. It helps clarify what must be challenged, built, or dismantled today to achieve desired health outcomes tomorrow.
Applying backcasting to Indigenous health
Consider the application of backcasting to Indigenous health. Imagine a future, for example, 35 years from now, in which Indigenous communities experience health outcomes equal to or better than national averages, and in which care is culturally safe, community-governed, and grounded in Indigenous knowledge systems. Starting from this future, advocates can work backward to identify necessary conditions: resource sovereignty, sustained investment in Indigenous-led health systems, legal recognition of Indigenous health products, workforce pipelines for Indigenous clinicians, and governance models that place decision-making power in community hands.
From the present, many of these conditions may seem politically unrealistic or institutionally disruptive. Backcasting reframes them not as radical or unreasonable demands, but as logical prerequisites for the future we desire. It exposes the gap between stated commitments to equity and the structural changes required to achieve it. This approach provides advocates with a coherent narrative and strategic roadmap rather than a collection of disconnected asks.
Countering burnout through future-oriented advocacy
Rooting health advocacy in the future may also help counter burnout among clinicians in their advocacy pursuits. Advocacy driven solely by crisis can feel endless and demoralizing. A foresight-informed approach, conversely, situates today’s struggles within a larger change process. It allows practitioners to see their efforts, whether small or large, as contributing to a broader transformation, even if they may not witness its full realization.
It is noteworthy that future-oriented advocacy does not ignore present realities. It underscores the need to align the present with long-term goals. It challenges health professionals to ask: Are the policies we support today reinforcing the systems we desire tomorrow?
In a landscape with considerable long-term consequences for short-term actions, reactive advocacy is no longer sufficient. By grounding advocacy in foresight and by using tools such as backcasting, health professionals can move toward actively shaping healthier, more just futures. The question is not whether clinicians should engage in advocacy, but whether that advocacy is future-focused enough to matter.
Lind Grant-Oyeye is a psychiatrist.
