Objective: Current health surveillance is reactive and lacks the necessary perspective when processing signals and alerts, risking a failure to anticipate profound changes with significant health impacts in the medium or long term. To address this, the French Institute for Public Health Surveillance has explored a forward-looking surveillance approach. Methods: The steps were: 1) Selection of health determinants, 2) Identification of key variables derived from the determinants. The variables, classified into three groups (trigger factors for health events, dissemination, and responses), were the subject of hypotheses regarding future trends, 3) Identification, within the three groups, of microscenarios based on the assumptions regarding the variables, 4) Construction of macroscenarios based on three microscenarios from the three groups, and 5) Identification of challenges and needs for the future of public health. Results: Twenty-two key variables, 17 microscenarios, and five macroscenarios were identified. The challenges relate to social and regional health inequalities, health burdens, individual and collective responsibilities regarding health, ethical aspects, emerging phenomena, "Big Data" and data mining, new health technologies, and the nesting of analytical scales. Conclusions: The approach informs the programming choices of a public health institute, particularly regarding health monitoring and surveillance. Describing possible futures and the factors that point toward one scenario rather than another can help steer choices toward a future (or futures) that is more favorable for health.