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.

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).
 

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).

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).

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.