This paper presents a research study that is a valuable first project in setting the stage for bringing a foresight perspective to the impacts of severe flooding on health, poverty, and equity in Houston, out to the year 2050. Drawing on qualitative and quantitative research gathered from methodologies such as the Delphi and Cross-Impact Analysis combined with insights gained from interviews with subject-matter experts, it explores four alternative, plausible scenarios for Houston's long-term future. Exploring scenarios that feature the continuation of present-day trends, a system collapse, a system balanced by a new equilibrium, and a system transformation provides an opportunity for stakeholders and policymakers to work together to create a more inclusive future for all city residents.