Navigating Uncertain Futures: Dilemmas and Opportunities in Climate and Health in LMICs

Gareth Priday, Jose Ramos, Frederick Ato Armah, Mey Jurdi, Martin Muchangi, Gina Polo-Infante, Tin Tin Su, Yaser Abunnasr, Nazia Ahmad, Lauren Brown, David Teye Doku, Melina Galdos, Rima Habib, Simon Hearn, Rawya Khodor, Adelaide Lusambili, Stephen J. McCall, Samuel Muhula, Walter Mukwana, David Olaya, Vincent Pagiwa, Hussein Mohammad Rizal, Aminath Shazly, Tan Pei Jean, Anita Villacis, Anya Gopfert, Holly Gray, Montasser Kamal, Natacha Lecours, Samuel Oji Oti, Robert McLean

Climate-health planning in Low- and Middle-Income Countries (LMICs) is constrained by structural health-system vulnerabilities, cross-sectoral coordination challenges, and trade-offs that remain invisible within sectoral planning processes. This study addresses three methodological gaps: the scarcity of multi-regional, LMIC-led climate-health futures; the absence of methods that translate foresight into decision-making dilemmas; and the lack of approaches that integrate participatory foresight with structured intersectoral perspective-taking. A participatory futures workshop with 29 climate, health and funding experts drawn from five regional research locations across Africa, Asia, Latin America and the Caribbean, and the Middle East used the serious game ‘Future Care Force’ to negotiate intersectoral responses across divergent ten-year scenarios. To our knowledge, this was a first-of-its-kind gathering of Global South expertise in climate and health. The consensus between experts on climate and health trajectories underlies fundamental uncertainties and the need to examine alternative futures. A serious game provides a platform to imagine divergent climate and health futures, participants worked through epistemic complexity to reveal dilemmas and opportunities. The analysis identifies four cross-cutting structural dilemmas: technology deployment, knowledge authority, system architecture, and pace of change. The study positions serious games a method for making cross-sectoral trade-offs visible, an epistemic precondition for adaptive pathway development.