Choosing a healthy future
As a service to our international readers, we published an English translation of the Public Health Foresight Study 2024: 'Choosing a healthy future'
PHFS-2024
The main report 'Choosing a healthy future' provides an integrated overview of the most important findings. Besides the main report, we published:
- Three Thematic Foresight Studies (in Dutch, abstracts in English)
- An interactive online Trend Scenario (in Dutch)
- Methods and data background documents (in Dutch)
Abstracts in English are available for the Thematic Foresight Studies (see below). If you are interested in the Trend Scenario or the Methods section, we advice you to make use of the translation services in your (mobile) browser.
If you have any questions, you can contact us at vtv@rivm.nl. We are happy to help.
Abstract
In this part of the Dutch Public Health Foresight study (PHF), RIVM (Rijksinstituut voor Volksgezondheid en Milieu) explores what the mental and physical health and lifestyles of two generations will look like in 2050. The focus is on the generation of people who are currently 12–25 years old and on the current generation of middle-aged people (50–67 years old). In both generations societal developments and life-events during their lifecourse will have a significant influence on their future health.
The mental health of today’s young people is expected to be similar in 2050, or to have improved slightly. This is the net result of various positive and negative influences. In this generation, the negative effects of the coronacrisis are expected to steadily diminish. This gradual improvement may be slowed down by the long-term effect of mental health issues and disorders that are currently prevalent among young people. These current issues may give them a higher risk of mental problems in the future.
Many young people are already overweight, which gives them a higher risk of being overweight in the future. Furthermore, following significant changes in their lives, such as starting a degree programme, getting married or moving in with someone, or having a child, they face a greater chance of exercising less and gaining weight. This is and has been the case for every generation of young people, but it is especially worrisome when people are already overweight. In addition, overweight is something that can be passed on from one generation to the next, through socioeconomic circumstances and lifestyle preferences.
The mental health of people who are currently over the age of 50 is expected to be worse in 2050. This is because matters that negatively impact mental health, such as loneliness, providing informal care and financial insecurity, will be more ubiquitous among this generation in the future. The positive impact on mental health associated with retirement may be attenuated by the higher state-pension age.
Nowadays, around 60 per cent of people aged over 50 are already overweight, and this number will have increased even further for this generation by 2050. This will be accompanied by chronic conditions associated with overweight, such as cardiovascular disease. If middleaged people would be more physically active, this would be beneficial for their health later in life, but not even half of this generation is currently getting enough physical activity. Taken together, these lifestyle factors will have a considerable negative impact on their health and physical functioning in 2050.
Abstract
Sooner or later, we will all need care – whether for ourselves or for our loved ones. The viability of the healthcare system in the Netherlands is increasingly threatened by societal developments, such as a shortage of healthcare staff and informal carers. In this Dutch Public Health Foresight exploration (PHF), we explore how broad societal developments (together) impact future care demand.
Our ageing society will result in increasing numbers of people suffering from multiple conditions. This will in turn lead to higher, and also more complex, care demand. Care demand will become more complex because of combinations of conditions often requiring different kinds of care. Part of such care also relates to tackling causes in the social domain, such as a lack of socio-economic security.
Because of staff shortage, the care sector can only meet part of the increasing demand for care. Care demand from the informal network will grow, with many people currently already providing informal care. Looking forward to 2050, the number of people needed will far exceed the people able to provide care. If growing demand for both formal and informal care cannot be met, there is no guarantee that care in the future will be as accessible as it is now. Because of staff shortages, the care sector will only be able to meet some of the increased demand itself. Many people are already providing informal care, and towards 2050 many more informal caregivers will be needed. With an aging population, they are proportionally less available. But if the growing demand for both formal and informal care cannot be met, there is no guarantee that care will remain as accessible in the future as it is today.
More and more people are self-reliant into old age. They live independently at home and can manage the care they need well. They also have a network that supports them with informal care. In the future, more and more people will need to care for their loved ones into old age. This care can quickly fall away when these informal caregivers need care themselves. When people cannot get enough informal care, the demand for formal care may increase. This can widen the gap in health and quality of life between self-reliant and non-self-reliant people.
Future care will increasingly be given in digital form, for example through e-consults and smart sensors. These digital applications mean that remote care will become standard in most cases. A positive effect is that this will allow healthcare workers to remain in contact with people who continue to live in their own homes independently well into old age. A negative effect is that there is less room for personal contact between the care provider and the user. There will be more focus on bare data, such as examination results. Whether more digitisation can ease the pressure on care is uncertain; human intervention will always be needed.
Abstract
In the coming years, our living environment will change drastically due to climate change and population growth. Space will be needed for building homes and an energy system without fossil fuels. Furthermore, the design of urban and rural environments must be adapted to climate change. The challenge is to manage these changes in such a way that they contribute to the quality of the living environment and the health of current and future generations.
The living environment may affect health in both positive and negative ways. Around 4.5 per cent of total health loss is due to an unhealthy living environment, with the main causes being air pollution and noise. In urban areas and near large industrial estates and airports, more people suffer from ill health than on average in the Netherlands.
In the future, cleaner air will lead to a decrease in ill health, but climate change will lead to an increase. This is because climate change will lead to more heatwaves, drought and extreme precipitation. Heatwaves and high temperatures are causing more health problems, particularly among the elderly, people with chronic conditions, pregnant women, infants and young children. The effects are already noticeable in areas with an abundance of bricks and asphalt, and in poorly cooled homes. Health prevention policies, such as the national heatwave plan, seem to be effective: the number of heat-related deaths has fallen since the introduction of the plan.
Furthermore, high temperatures may lead to the introduction of new infectious diseases, for example because mosquitoes that carry infectious diseases – such as dengue fever – are better able to survive in the Netherlands. In addition, the pollen season is starting earlier and lasting longer, so that people who suffer from hay fever may feel the effects for a longer period of time. On top of that, increased exposure to UV radiation due to less cloud cover and more warm weather will likely result in more people contracting skin cancer.
Climate change also has consequences for the quality and availability of drinking water and food. In addition, more people will experience mental ill health and anxiety related to extreme weather events, such as floods and heatwaves.
The impacts of climate change will be greatest on groups lacking socioeconomic security. These often reside in neighbourhoods with more air pollution, traffic noise, lack of green spaces and more concrete, and in homes that are difficult to keep cool.
On the other hand, measures to mitigate the effects of climate change also offer opportunities to improve the living environment and health. Among other things, creating green neighbourhoods is vital to prevent heat stress and to buffer rainwater. A green environment also has health benefits: it encourages people to engage in physical activity, relax and meet each other. Moreover, the reduced use of fossil fuels will improve air quality and thereby health. Taking the bike instead of the car more often, and eating fewer meat and dairy products, leads to reduced greenhouse gas emissions and has health benefits as well. In conclusion, it is essential to consider health when drafting climate and spatial planning policy.