The web articles in the ‘Future trends’ section of the Synthesis show how our public health and health care will develop over the next 25 years if we pursue our current course and do not take any additional measures. Collectively, all these trends offer an impression of the challenges that our society faces. Based on the results of a survey, three challenges were selected for which options for actions have been elaborated in this Public Health Foresight Study; what kinds of actions are necessary for tackling these challenges, and who can play a role? The options for action are based on wide-ranging stakeholders meetings. This web article summarizes the most important stakeholder recommendations. The options for action for the three selected challenges also provide insight into a number of general opportunities and themes for policy and society, and into focal areas for the knowledge and innovation agendas. (The latter web article is only available in Dutch).
Complex challenges require an integrative approach, and assistance from many different stakeholders
Some of the bigger challenges we face are complex in nature, and could be addressed most effectively with an integrative and personal approach. That requires the involvement of many different parties: from policy makers, health care and public health professionals, researchers and citizens, as well as societal stakeholders such as patient organisations, health funds, health insurance companies, employers, industry, retailers and schools. In addition, it requires wide-ranging collaboration: not just between various types of health care professionals, but also across the lines of public health and health care. Integrative policy not only requires local initiatives, but also collaboration between government ministries, especially when dealing with the physical and social living environment.
Options for action for a selection of three challenges
This Public Health Foresight Study provides detailed options for action to address three future challenges. The selection of these challenges is based on the results of a survey in which citizens, professionals and students in the public health domain were asked to state which developments from the Trend Scenario and the Thematic Foresight Studies of this Public Health Foresight Study they consider most urgent. More information about the results of this questionnaire can be found here. Additional criteria have been used for the selection (background information about the selection procedure is only available in Dutch). The box below presents the final selection of the three challenges for which options for action have been developed. The options for action are based on the results of a number of wide-ranging stakeholder meetings, and reflect what these stakeholders consider the most important courses of action to deal with these challenges. It is by no means an exhaustive list of all possible actions and courses of action. This web article summarises the main recommendations of the stakeholders.
This Public Health Foresight Study has developed options for action and possible courses of action for the following three challenges:
- Cardiovascular diseases and cancer are health conditions that continue to occur frequently, will still be the cause of the majority of deaths in 2040, and have a major impact on patients’ lives;
- The group of older people living independently who have dementia and other complex problems is increasing significantly;
- Mental pressure on teenagers and young adults is increasing, and this may have consequences for their psychological health.
Vulnerable groups are a specific key concern in developing solutions for all three challenges.
This selection is based on the results of a survey where citizens, professionals and students in the public health domain were asked which developments from the Trend Scenario and the Thematic Foresight Studies of the VTV–2018 they consider most urgent. In addition to developments related to the three challenges mentioned previously, these groups also consider antibiotic resistance and increasing health care expenditures very urgent. There are no options for action developed for these challenges, but in-depth descriptions of the future challenges that these trends will bring have been elaborated (only available in Dutch).
Cardiovascular diseases and cancer: focus on integrative prevention, different forms of care and better handling of the consequences of chronic diseases
Between now and 2040, cardiovascular diseases and cancer will remain common. In addition, both disease groups cause the majority of total mortality in the Netherlands, and will continue to do so in 2040 (see Trend Scenario). Based on the results of a wide-ranging stakeholder meeting on the topic, three societal goals have been formulated on how to deal with this challenge. First and foremost, it is key to prevent people from developing cancer or cardiovascular diseases. This takes an integrative approach which is not just aimed at individual lifestyle factors, but simultaneously targets the social and physical living environment as well. Secondly, if people do get sick, it is key for them to receive proper care. Various developments play a role in this, such as the increasing availability of genetic information and options for self-diagnostics, a rapidly changing health care landscape, and increasing knowledge about specific patient groups. A third goal is to take a more effective approach to dealing with the consequences of chronic diseases. Since more people continue to survive these diseases, more people will have to deal with the long-term effects. That will make even more important to handle the consequences of chronic diseases more effectively. This includes personal physical and psychological problems, but also the societal impact of the disease and treatment, as well as the role of self-management. The box below outlines the key courses for action for these three societal goals. The detailed plans for the options for action for these challenges are available here (in Dutch).
Key stakeholder-defined courses of action for three societal goals to address the high burden of disease caused by cardiovascular diseases and cancer
Societal goal: work towards integrative prevention
- Focusing on integrative programmes targeting lifestyle as well as the physical and social living environment.
- Investing more effort in collaborations between government ministries, especially when dealing with adaptations in the physical and social living environment.
- Focusing on underlying social issues in vulnerable groups.
Societal goal: different forms of care by means of technological applications and other organisational structures
- Focusing on developing reliable tests and options for a better and faster method of information exchange, in order to effectively utilise the options for self-diagnostics and genetic testing.
- Effectively managing tensions between ethical and legal considerations and health care interests in the context of genetic information via laws and regulations and agreements between various parties in health care.
- Consulting with all stakeholders (patients, health care professionals, health care institutions and government) to determine which care can be provided at home and which care cannot.
- Improving and extending structural collaborations between health care and social work professionals, municipalities, and Municipal Health Services to properly respond to the health care demand by people who have multiple diseases at the same time (multimorbidity).
- Scaling up knowledge development regarding gender-specific differences in the expression and treatment of diseases, such as cardiovascular diseases and cancer, and speeding up implementation in medical practice of new insights about this subject.
Societal goal: dealing more effectively with the physical, mental and social consequences of chronic diseases
- Focusing more on the later medical and social effects of cancer and cardiovascular diseases; this requires the involvement of health care professionals as well as parties outside the health care sector, such as employers, educational institutions, banks and insurance companies.
- Teaching skills to both patients and health care professionals to be able to handle self-management properly.
- Supporting people who are unwilling or unable to take control of their own health care process, for instance by providing a case manager or organising peer support.
Older people living independently: better care and support, an accommodating environment for the age group, and consideration for informal carers
The number of older people in the Netherlands will increase significantly between now and 2040. This will have consequences for public health. More often than younger people, older people suffer from multiple chronic diseases at the same time (multimorbidity). They are often geriatric diseases such as dementia, arthrosis or diabetes. In addition, older people often have to deal with other medical and social issues, such as incontinence, falling, poly-pharmacy (the use of multiple medicines at the same time) and loneliness. Between now and 2040, older people will more often live at home independently, and will also more often live alone (see the Trend Scenario and the Thematic Foresight Study about health care demand). Based on the results of a wide-ranging stakeholder meeting on the topic, three societal goals have been formulated on how to deal with this challenge. First, it is key to arrange for better care and support for the group of older people living independently who have dementia and other complex problems. Similar to the challenge regarding cardiovascular diseases and cancer, this will take an integrative approach: in addition to medical care, it usually also involves welfare and social support. A second societal goal is providing an environment that accommodates older people. This will also make it possible to provide part of the health care that older people need in their own environment. A properly structured living environment also contributes to prevention. Older people living independently often also receive informal care. Informal carers are under serious pressure, especially informal carers who help people with dementia. That is why providing good support for informal carers is a third key societal goal. The box below outlines the key courses for action for these three societal goals. The detailed plans for the options for action for these challenges are available here (in Dutch).
Key stakeholder-defined courses of action for three societal goals to address the challenge of older people living independently who have dementia and other complex problems
Societal goal: better care and support for older people living independently
- Organise care for older people around what they can still manage and want to do themselves. That requires integrative care networks (care, social work, support) around older people living independently, arranged by an independent coordinator.
- Support people who have difficulty expressing their preferences and needs, such as older people with a migration background, older people who have cognitive limitations and vulnerable older people.
- As a municipality, health care professional or health insurance company, adopt a flexible attitude when older people take the initiative in organising care in their own environment. These types of citizen initiatives often work outside the existing frameworks of health care and social work.
Societal goal: providing an environment that accommodates older people
- Take into account everything that is needed to set up a living environment (cities, public spaces, homes) in which people can grow old in a healthy, safe and pleasant way.
- Ensure a balanced view about older people and growing old: focusing more on the things older people can still do is key in making society more accommodating to older people.
Societal goal: taking good care of informal carers
- Ensure that informal carers receive more support. Information and practical tips on how to deal with difficult situations are important here, but also social, material and financial support, as well as offering replacement care (daytime activities and other forms of temporary care).
- Be alert to informal carers being ‘shy about asking for help’. Many informal carers are in need of support, but find it difficult to ask for it.
- Focus on the care needs of the informal carer, which can be caused by psychological and physical stress.
Mental pressure on young people: developing knowledge, staying healthy mentally, and accepting psychological symptoms
The Thematic Foresight Study regarding health care demand has observed that teenagers and young adults continue to experience more pressure to perform. This may have consequences for their psychological health. Based on the results of a wide-ranging stakeholder meeting on the topic, three societal goals have been formulated on how to deal with this challenge. The increased mental pressure on young people is a new problem, which is why we still know relatively little about it. Developing knowledge is therefore an important first goal. Important factors include developing clear terminology and a uniform framework of concepts, as well as generating more knowledge about the stressors and underlying mechanisms of mental pressure. It is also necessary to improve options to properly monitor mental pressure and mental health. A second societal goal is to keep teenagers and young adults mentally healthy. Important considerations here include strengthening knowledge and skills for dealing with mental stress as well as reducing stress factors in the environment (school, work). A third societal goal for this challenge is to combat stigmatisation. This is necessary to ensure that teenagers and young adults with mental problems can continue to fully participate in society. The box below outlines the key courses for action for these three societal goals. The detailed plans for the options for action for these challenges are available here (in Dutch).
Key stakeholder-defined courses of action for three societal goals regarding the challenge about increasing mental pressure on teenagers and young adults
Societal goal: development of knowledge regarding mental pressure
- Developing a uniform conceptual framework and clear terminology to avoid confusion regarding mental pressure.
- Developing more knowledge about stressors and the underlying mechanisms that cause mental pressure and mental problems among teenagers and young adults.
- Monitoring mental health among teenagers and young adults with comparable data to gain overview on the nature and scope of the problem.
- Developing more practical knowledge about what does and does not work, in consultation with ‘experience experts’.
Societal goal: stay mentally healthy
- Increasing the selection of interventions aimed at bolstering skills among teenagers and young adults to cope better with pressure factors and stay mentally healthy.
- Implementing changes in the learning environment, such as focusing on student well-being in higher education and healthy secondary schools.
- Focusing more on promoting mental health amongst young employees in a work environment, with a specific focus on personal development and growth.
- Focusing on early signals and support in places where teenagers and young adults gather and provide a suitable (integrative) selection with interventions incorporating social work and health care.
Societal goal: acceptance of psychological symptoms
- Counteract stigmatisation of psychological symptoms through communication activities, such as national and local campaigns and public information.
- Using ‘experience experts’ to lower the threshold as much as possible, making it easier for young people with psychological symptoms to seek help.
- Continue focusing on an inclusive society in which teenagers and young adults with psychological symptoms can continue to participate fully.
Complex issues require an integrative and personal approach...
The three challenges for which options for action have been developed in this Public Health Foresight Study are complex in nature. They have multiple causes and supersede disciplines and domains. For instance, the options for action to address the challenge of older people living independently make it clear that the medical and social issues that some of these older people have to deal with can be offset by a combination of formal and informal care and support. That requires the deployment of various disciplines (such as GPs and physicians, district nurses, social work professionals and informal carers) and domains (such as medical care, social support and spatial planning). In facing the challenge of increasing pressure on teenagers and young adults, a wide-ranging approach is needed, in which schools, health care professionals and employers play a role, and in which the focus is on different aspects, such as improving the resilience of young people, decreasing pressure in their environment and providing easily accessible and appropriate care. To encourage a healthy lifestyle that will prevent cardiovascular disease and cancer, interventions are needed that not only target personal lifestyle factors, but at the same time address the social and physical living environment as well. And in addition to physical and psychological health problems, the people with cardiovascular disease and cancer often also have to deal with issues in relationships and at work. Complex issues therefore require an integrative approach, which focuses on the needs and preferences of people. This is one of the common themes in all the options for action.
...and a wide-ranging commitment by societal stakeholders, also across the lines of public health
The options for action show that there is a wide range of stakeholders that could contribute to dealing with the future challenges we are facing. That not only requires policy makers, health care and public health professionals, researchers and citizens, but also all sorts of societal stakeholders and other parties, such as patient organisations, health funds, health insurance companies, employers, industry, retailers and schools. The options for action reveal the importance of collaboration across the lines of public health and care. To ensure a healthy future, it is crucial to provide a healthy environment, school and workplace. Achieving that result will require an approach that involves multiple government ministries committing to better public health, not just the Ministry of Health, Welfare and Sport, but the other ministries as well, such as the Ministries of Social Affairs and Employment; Economic Affairs and Climate Policy; Agriculture, Nature and Food Quality; Finance; Infrastructure and Water Management; the Interior and Kingdom Relations; and Education, Culture and Science. The options for action make it clear that, in addition to local and regional collaboration, it also takes an approach that involves multiple government ministries to address the complex issues we are currently facing.