This web article is based on the Trend Scenario and the Thematic Foresight Studies. The substantiation for the texts, numbers and figures presented here can be found in these documents, unless indicated otherwise. The Trend Scenario and Thematic Foresight Studies show how our public health situation and health care sector will develop over the next 25 years if we pursue our current course and do not take any additional measures. This approach makes it possible to map out the societal challenges for the future.
Better health, but more disease
Life expectancy will increase from 81.5 years in 2015 to almost 86 years in 2040. Virtually all the years we gain are in perceived good health. Moreover, we will not perceive an increase in activity limitations. However, the number of people with chronic diseases will increase. We are living longer and longer because people with health conditions such as cardiovascular disease and cancer are more likely to survive, amongst others due to better treatment. In addition to the ageing population, that is a significant contributing factor in the sharp increase in dementia as a cause of death. Since cardiovascular disease and cancer are increasingly survivable, more and more people will have to deal with the long-term effects of having had those diseases.
The population is ageing, but we do not feel unhealthier
Life expectancy will increase from 81.5 years in 2015 to almost 86 years in 2040. An increasing number of people will reach very old age in future. The flip-side of these advantageous developments is that there will be more and more people with chronic diseases. Despite this increase, we will feel just as healthy in future, and we will not perceive an increase in activity limitations. In 2015 and in 2040, almost 80 percent of the population will feel healthy, and approximately 86 percent will not experience any limitations in activities. These percentages are somewhat lower for older people, but people over 65 will also not feel any unhealthier or more limited in future. In fact, the percentage of older people who feel healthy will even increase slightly in 2040, as will the percentage of older people who do not experience any limitations.
Having a chronic condition therefore does not immediately imply that people will also be limited in what they can do in their daily lives. The majority of people with a chronic disease will feel healthy and not limited in carrying out activities related to seeing, hearing and mobility. Similarly, having a chronic disease does not always mean that people will need to receive care on a regular basis. 65 percent of people with a chronic disease have been in contact with their GP in the past year.
Minimal increase in years without any disease, but more years in good health
Total life expectancy as well as life expectancy in perceived good health will increase by approximately four years between 2015 and 2040. This means that virtually all the years we gain up to 2040 will be in perceived good health. We will also gain approximately five years without limitations. The number of years without chronic diseases will increase by approximately six months between now and 2040. Despite the fact that we gain hardly any disease-free years, we still add a number of years in good health and without limitations.
Changes in prevalence of diseases; more geriatric diseases
Due to the ageing population, geriatric diseases will occur more frequently. Geriatric diseases are diseases which are more prevalent amongst older people than in younger age groups. Examples include: arthrosis, visual and hearing impairments, diabetes, cancer, cardiovascular diseases and dementia. Dementia can be caused by a number of different diseases. Some of them are considered diseases of the brain and overall nervous system, while others are categorised as mental disorders. Other mental disorders, such as depression and anxiety, occur in every age group. That is why the fact that the population is ageing has a minimal impact on the frequency of those disorders. However, they will still cause considerable burden of disease, now and in the future, especially amongst young adults. In older people, diseases such as cancer, cardiovascular diseases and dementia will cause considerable burden of disease. In absolute terms, the burden of disease increases strongly with age (see figure).
Indicator(s) used: Burden of disease by 5-years age groups and by ICD chapter (dementia is singled out). Burden of disease is expressed in Disability Adjusted Life Years (DALY’s), a composite indicator consisting of healthy life years lost due to the occurrence of diseases (Years Lived with Disability, YLD) and Years of Life Lost (YLL) due to premature mortality. Dementia includes the ICD codes F01-F03, G30 which are part of the ICD chapters Nervous system and senses (Alzheimer’s disease) and Mental disorders (for example vascular dementia). The category Other includes all remaining ICD chapters (a.o. blood diseases, skin diseases, pregnancy, childbirth and the puerperium)
Source(s) used: Burden of Disease calculated by RIVM
• Methods and background of the Synthesis
Declining percentage of cancer and cardiovascular diseases in total mortality
We will also observe some shifts in causes of death. Since people are more likely to survive cancer and cardiovascular diseases, these diseases are responsible for a lower percentage of overall mortality, even though they will occur more often in 2040. In addition to the ageing population, the decline in mortality from these causes is also one of the reasons for the sharp increase in dementia as a cause of death in the future (see web article: ‘Impact of the ageing population’). Even though people will survive cancer and cardiovascular diseases more often, these two disease categories will still cause the biggest loss of life expectancy in future. In 2040, the loss of life years due to cardiovascular diseases will be about half what it was in 2015. This difference is much smaller for cancer. The loss of healthy years due to disease will remain significant in 2040 in relation to cardiovascular diseases: approximately three years. Mental disorders and diseases affecting the musculoskeletal system (including arthrosis) cause approximately the same loss in healthy years (see figure).
Loss of (healthy) life expectancy caused by disease groups
Indicator(s) used: Health-Adjusted Life expectancy (HALE) by ICD-chapter (selection), in 2015 and 2040. HALE is a composite indicator of healthy years lost due to disease and years lost due to premature mortality.
Source(s) used: HALE calculated by RIVM
• Methods and background of the Synthesis
Higher relative increase in mortality due to personal accidents and infections
Another notable shift in causes of death between now and 2040 is a large relative increase in deaths due to external causes and infections (see figure). The increase in mortality due to external causes is caused primarily by an increase in personal accidents. The increase in mortality due to personal accidents as well as infectious diseases are both primarily attributable to the ageing population.
Indicato(rs) used: Relative change in mortality between 2015 and 2040, for ICD chapters with more than 3 thousand deaths in 2015. The rounded absolute number of deaths in 2015 are displayed between parenthesis.
Source(s) used: Statistics Netherlands (CBS) Cause-of-death statistics, data processed by RIVM.
• Methods and background of the Trend Scenario
Increased survivability also has consequences for the lives of current and former patients
Increased survivability also has an effect on the consequences of diseases. For instance, the increased chances of survival in certain forms of cancer will result in more and more people having to live with the long-term consequences of the disease and treatment. For instance, many patients who have survived cancer suffer from loss of concentration, chronic fatigue and nerve damage. In addition, anxiety and depression occur more often amongst people who have or have had cancer. That not only affects health care demand, but impacts the lives of these current and former patients and their friends and family as well. Adults, for instance, have to deal more often with relationship problems, occupational disability and unemployment, while children often see a drop in educational achievement.