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Non-communicable diseases (NCDs) such as cardio-vascular problems, diabetes, cancer, multi-skeletal disorders, depression, neurologic disorders and many more are the major cause of health problems and death in OECD countries. These diseases develop earlier among underprivileged people. Chronic-degenerative diseases, however, are to a large degree avoidable. In our foresight project FRESHER (FORESIGHT AND MODELLING FOR EUROPEAN HEALTH POLICY AND REGULATION) we discuss policy options with stakeholders from health, research, care, patient organisations, insurances and policy-making that go beyond the usual activities and pose alternatives that promise to be more successful. From an analysis of trends that affect NCD development far beyond the usual determinants of tobacco and alcohol consumption, salt, sugar and fat intake or sedentary behaviour the most relevant and significant trends are combined to four scenarios depicting possible futures. The options for alternatives presented contribute to the discussion of policies for the future in a comprehensive approach to Bhealth in all policiesî n the EU. NCDs are not a matter of medicine and health only. Thus the traditional approach of health policy has to be extended. Out of the box thinking is needed to pay tribute to the complexity of future health systems that need to include aspects like equity, literacy, mobility or urban planning. A systematic and holistic approach is required to address all drivers and determinants leading to a healthy life and well-being.

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.