BackgroundThe future burden of non-communicable diseases (NCDs) depends on numerous factors such as population ageing, evolution of societal trends, behavioural and physiological risk factors of individuals (e.g. smoking, alcohol use, obesity, physical inactivity, and hypertension). This study aims to assess the burden of NCDs in Europe by 2050 under alternative scenarios. MethodsThis study combines qualitative and quantitative forecasting techniques to examine how population health in Europe may evolve from 2015 to 2050, taking into account future societal trends. Four scenarios were developed (one business-as-usual scenario, two response scenarios and one pessimistic scenario) and assessed against 'best' and 'worst'-case scenarios. This study provides quantitative estimates of both diseases and mortality outcomes, using a microsimulation model incorporating international survey data. FindingsEach scenario is associated with a different risk factor prevalence rate across Europe during the period 2015-2050. The prevalence and incidence of NCDs consistently increase during the analysed time period, mainly driven by population ageing. In more optimistic scenarios, diseases will appear in later ages, while in the pessimistic scenarios, NCDs will impair working-age people. Life expectancy is expected to grow in all scenarios, but with differences by up to 4 years across scenarios and population groups. Premature mortality from NCDs will be reduced in more optimistic scenarios but stagnate in the worst-case scenario.
Background Health and healthcare are facing novel challenges ranging from broad, shifting trends to emerging innovative technologies and social practices. Foresight methodology aims to analyse emerging trends, building different future scenarios and identifying policy options to support the policy dialogue. Methods FRESHER and RARE 2030 are two EU-H2020 projects. FRESHER- FoRESight for hEalth policy development and Regulation (2016-2018) aimed at representing long term alternative health Scenarios testing future policies to tackle the burden of Non-Communicable Diseases. A micro-simulation model, specifically enhanced by the project, also computed the health outcomes of the different four Scenarios. Rare 2030-Foresight in Rare Diseases Policy (2019-2020) uses a participatory approach to identify the most relevant trends, anticipate their influence over the next decade and propose policy recommendations that could lead to a better future for people living with Rare Diseases. Different in scope, these projects share common features. Both follow a four steps foresight methodology: horizon scanning, trends identification and ranking, scenarios building, back-casting and policy elaboration. Taking a participatory approach, these studies apply structured qualitative tools, involve a wide range of stakeholders and include regional case studies. Results 20 trends emerged as key for the future of health and healthcare, among them: demographic change, rise of inequality, urbanisation, climate change and low carbon development, innovation in medicine, citizens empowerment and the potential for big data and Artificial Intelligence application. Conclusions The 20 trends analysed offering a litmus test for future proofing current health and healthcare policies. Foresight has proven to be a valid methodology to gather collective intelligence for identifying emerging trends and scenarios, evaluating risks and opportunities, setting long term goals and helping the decision making in health. Key messages To promote a transition toward better health policies, it is crucial supporting the collaborative attitude and ensuring a greater involvement of citizens and patients in the decision making. The importance and unpredictability recognized to the equity trend in both projects reveals the need for urgent actions to ensure the future access to better health and care to all European citizens.
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The aim of this study was to promote the construction of a real network and a shared diagnostic and therapeutic management model between hospitals and out-of-hospital healthcare services to capture as many patients with bone fragility as possible. Starting from the analysis of the clinical competences present in the province of Pavia, the bone specialists (BSs) organized some educational events involving both general practitioners (GPs) and hospital specialists. The Fracture Liaison Service (FLS) model, the revision of Note 79, the national plan for chronicity and the health reform of the Lombardy Regional Authority supported the structure of our model, in which the roles of clinicians are well defined and based on the complexity and severity of patients. In our method the GP has a central role as clinical manager, facilitating patient management and communication between the specialists and the BS. In January 2019, the Therapeutic Care Diagnostic Path (PDTA) shared between 2 bone specialists (BSs), 9 GPs, as reference treaters, and a multidisciplinary group of 25 specialists of the Province of Pavia was defined. The strategic directions of the two largest public hospitals in Pavia have supported the PDTA, which was validated by the quality departments of the hospitals themselves. Finally, sixty GPs belonging to the network have joined the PDTA. This model is the first example of integrated management between hospitals and out-of-hospital healthcare services for the primary and secondary prevention of fragility fractures (FF), where the GPs play a pivotal role as managers and supervisors to ensure proper care to chronic patients according to their levels of severity.
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