I Don't Think We Know: The "Faster Horses" Problem in Health

There is a golden rule in modern design, business, and policy: listen to the user. In healthcare, this translates to engaging patient groups, hosting community forums, and asking the people most affected by an illness, "What do you need?"

It sounds incredibly empathetic. It sounds like the right thing to do.

But if we are being honest about how to shift global capital toward proactive health-ing and prevention, we have to confront an uncomfortable truth: I don't think we know what we actually need.

When we ask people what they want from a broken healthcare system, the answer is almost always "something." Something faster, something cheaper, something more accessible. But they rarely ask for the systemic overhauls that would make their illness a non-issue in the first place.

It brings to mind the famous quote attributed to Henry Ford regarding the invention of the automobile:

"If I had asked people what they wanted, they would have said faster horses."

The Emotion Trap (And Not Just for Patients)

In the health space, our "faster horses" look like this: better waiting rooms, cheaper pills, closer specialists, more case studies, more best practices and more advanced surgical robots.

This happens because the demands placed on the system are heavily driven by emotion. When you are advocating for a sick loved one, or suffering yourself, you are driven by the urgent, lived experience of pain. You want an immediate fix.

But this emotional trap doesn't just catch patients. It catches everyone who is emotionally involved - including the experts.

Think about the classic specialist or expert. There is a saying that some experts "know more and more about less and less." Driven by focus in their specific niche, they double down on hyper-focused, reactive silos. They fight fiercely for their specific department's funding, missing the wider ecosystem.

Who among us hasn't fired off an angry email, or said something in a heated moment, that we deeply regretted an hour later? When we are angry, scared, or fiercely protective of our egos, our vision narrows. We get tunnel vision.

You absolutely need to care to change the world. Empathy and passion are the fuel. But if you want to actually don't want the problem to be a problem in the future, you have to be able to manage that emotion. Raw emotion is a phenomenal catalyst for urgency, but it is a terrible architect for a sustainable future.

The 3% Blind Spot and the Study of Health

This tunnel vision has resulted in a massive, systemic blind spot.

It is a widely cited, maddening statistic that roughly 97% of government healthcare budgets go toward curing disease, while only about 3% goes toward prevention.

But here is the even more frustrating reality: Our research funding mirrors this almost exactly.

We spend the vast majority of our research dollars studying pathogenesis (the origin and mechanics of disease). We spend a fraction of a fraction studying salutogenesis (the origin of health, and the factors that support human flourishing).

While there is a dedicated community of researchers, practitioners, and systems thinkers championing salutogenesis - and this observation is by no means meant to disregard their, or our own, tireless work - the concept remains largely outside mainstream political and funding discourse.

Because the vast majority of our resources remain locked in traditional models, we are constrained in our ability to envision what the future of true, systemic health could look like. We aren't investing the proportionate capital needed to comprehensively answer the question of how to build health; we are still predominantly funding the study of how things break.

The Humility Imperative

To move past this, we need something that is often in short supply in boardrooms, policy summits, and research labs: profound humility.

"I don't think we know" isn't an insult to patient advocates, nor is it a slight against medical experts. It is a necessary baseline. We are currently navigating a landscape of massive egos - both personal and institutional. It is okay that we won't fix these dynamics overnight. We are human.

But for our systems to sustain, humility has to become the bedrock of innovation. We have to be willing to look at our deeply held convictions, our emotional demands, and our hyper-specialized expertise, and admit: Nobody actually knows the future.

The Humility Imperative

To move past this, we need something that is often in short supply in boardrooms, policy summits, and research labs: profound humility.

"I don't think we know" isn't an insult to patient advocates, nor is it a slight against medical experts. It is a necessary baseline. We are currently navigating a landscape of deeply entrenched systems and institutional pride. It is okay that we won't fix these dynamics overnight. We are human.

But for our systems to sustain and evolve, humility has to become the bedrock of innovation. We have to be willing to look at our deeply held convictions, our emotional demands, and our hyper-specialized expertise, and admit: Nobody actually knows the future.

So, How Do We Know What To Do?

If we don't know the future, and we can't simply trust the emotionally-driven demands for a "faster horse," what do we actually build?

We stop trying to predict a single outcome, and we start practicing futures thinking and scenario modelling.

Instead of asking people what to build, we must map out multiple possibilities. Scenario modelling takes the raw emotional data - the undeniable friction and pain people are experiencing today - and tests it against different future environments.

A community might demand a new, localized diabetes clinic. Futures thinking steps back. It looks at demographic shifts, climate data, urban planning, and agricultural supply chains over the next 20 years. It models a scenario where we build the clinic, and another where we redesign the neighborhood's food ecosystem and walkability. It allows us to test interventions in a safe space before committing millions of dollars in the real world.

Futures thinking requires a radically open mind. It requires the humility to realize that the ultimate solution might look absolutely nothing like the problem.

To spark the health-ing movement, to truly invest in proactive human flourishing over reactive fixing, we must stop expecting the victims of poor systems - or the siloed experts - to instinctively know the answer. We must use observation, scenario modelling, and a commitment to salutogenesis to build the paradigms we actually need, even if we haven't quite figured out how to ask for them yet.

All the Best,

Ushma