Thematic Foresight Studies

The thematic study on the future health care demand describes a number of important future changes in the demand for health care. This concerns changes in both volume (e.g. as a consequence of the projected increase in the occurrence of diseases), and the type of care demand (e.g. as a consequence of the successful treatment of certain diseases or the deployment of new technologies). These changes and their possible consequences for health care providers and the health care system are described in four web articles:

• Changes in health care demand through better treatments
• The mental pressure on young people seems to be increasing
• Patients are doing more and more themselves
• Illnesses of old-age put great pressure on the health care system
• Vulnerable elderly people have complex  care demands

Main developments

• The number of people with age-related diseases will rise sharply due to the ageing of the population. This increases the pressure on the entire health care system, from informal care to primary care and from emergency care to nursing home care.
• As the population ages, the number of people with multiple diseases (i.e. multimorbidity) will increase. Some elderly people also experience social problems, such as loneliness. The number of people with complex care needs beyond the health sector will increase.
• Health care demands change as a consequence of sustained improvement in the treatment of some diseases. This also has consequences for the longer term, especially for the quality of life of patients and their possibilities to participate in society.
• Self-management among patients will further increase. This will require new and different skills from both patients and health care professionals, but also attention for those groups incapable of self-management.
• The mental pressure on youths and young adults seems to be increasing, with possible consequences for their mental health. Technologies such as social media and virtual reality play a role in this. These technologies bring new risks, but also offer opportunities for the treatment of mental illnesses.
• Both patients and health care providers have increased expectations with respect to the potential of health care, partly fueled by technological developments. This lowers the levels of acceptance in situations when a disease cannot be cured.
• Diagnoses and treatments are becoming more specific. This leads to a continuing personalization of health care. An increase in unique treatment paths might put pressure on the efficiency of the care system, which benefits from uniformity in treatments.
• Care is increasingly being provided to patients at home. This requires adjustments in the care system and the skills of healthcare professionals and patients.
• There will be a growth in certain groups of patients, such as single older men, elderly migrants, and LGBT-elderly. As a result, their specific needs and requirements will become more visible.  The currently available information on these groups is quite scarce.

In addition to the more ‘classical’, lifestyle-related determinants of health, there are many more factors that influence our health. This thematic study explores these so-called wider determinants of health and describes a number of important future developments in the living environment, labour, and education. For example, changes in the design and quality of the living environment, further flexibilization of the labour market, and regional differences in the growth and decline of the population are covered. The potential positive and negative effects of these developments on health are also described.

The developments that have been selected for this thematic exploration are described in four web articles:

• Growth and decline
• Environmental quality
• Future design of the living environment
• Changes in the labour market

Main developments

• Larger cities continue to grow. This can have a positive impact on population health (more resources for facilities), but also a negative impact (for example, more air pollution and more hustle and bustle and stress).
• Differences between neighbourhoods within cities will grow, creating neighbourhoods with an accumulation of health risks and areas with a much more favourable profile.
• The demographic decline in an increasing number of municipalities and regions will put facilities under pressure. At the same time, these regions face a more advanced ageing of the population, with a higher demand for care.
• The living environment plays an important role in dealing with the impact of climate change, particularly when good use is made of green spaces and water. Health effects of climate change are, among other aspects, related to heat stress and the spread of pathogens and allergens.
• There is an increasing demand for customization in housing and living conditions. A planned future policy (‘Omgevingswet’) should ensure that spatial planning is more in line with the local situation. This will have positive effects (e.g. on well-being, possibilities for stimulating physical activity, tailor-made care facilities), but can also exacerbate segregation.
• The application of new technologies in the living environment provides citizens with opportunities for autonomy and self-reliance. Examples are self-measuring of air quality or noise in one’s own environment, the use of e-health and home automation (improving the accessibility of health care, possibilities for treating people at home, and enabling them to live longer at home), and the use of self-driving vehicles.
• Air, water and soil quality is expected to improve further in the future. However, there are new risks that require vigilance, such as the increase of medicine residues in surface water, caused by increased medicine use by the ageing population. Another potential risk is the increase of micro plastics in our environment. The effects of micro plastics on population health are not yet clear.
• Intensive livestock farming is related to certain risks for population health, for example by the emission of particulate matter, and by the distribution of pathogens and resistant bacteria. Policies to reduce these risks are being implemented, but alertness is required, for example, to detect outbreaks of zoonosis.
• Noise pollution is expected to increase in the future as a result of the increasing population density, the ongoing urbanization and the growth of traffic. Unwanted noise can lead to disease, annoyance, and problems with sleeping and concentrating.
• The 24-hour economy will continue, making evening, night and weekend work more common. This can lead to a disruption of the biological clock, which increases the risk of certain chronic diseases. Furthermore, the social pressure to be available at all times might lead to stress.
• Further flexibility of labour has positive effects on autonomy and control of one’s life, but is also related to job and income uncertainty, and with it adverse effects on mental health.
• Robotization will result in some jobs disappearing, but will also create new jobs. Robotization has a positive effect on the quality of work, because robots can be applied for physically demanding, dangerous, dirty and/or boring work. But it can also lead to job insecurity, resulting in mental health problems, such as stress or depression.
• Digitization requires other competences from employees, which change quickly. Lifelong learning is crucial. Low-skilled workers, the elderly, flex workers and people with poor health may fall behind in lifelong learning. This may be detrimental to their position within the labour market.
• Feminization and ageing are changing the composition of the labour force.  Feminization is positive for the participation of women, but it also results in increased pressure as work and care related responsibilities often have to be combined. An increase of older workers implies more people with chronic diseases in the workplace. The increasing pension age leads to more incapacitated workers and increasing socio-economic differences.

The thematic study on technology describes a number of technological developments, which are likely to have a substantial impact on population health and health care within the next 10-20 years.  These developments are data-driven technology in health care, Virtual and Augmented Reality, genetic technology, 3D-printing and robotization. This study addresses both the (potential) positive effects and opportunities of these technologies and their (potential) negative effects and risks. In addition, the preconditions for successful implementation and upscaling are explored; what conditions must be met to ensure that the potential for health of new technologies can be reached?

The following technologies have been selected and are described in a web article:

• Robotization
• 3D-Printing
•  Genetic technology
• Data-driven technology in health care
• Virtual and augmented Reality

A sixth web article describes the complex relationship between:

• Technology and healthcare expenditures

Main developments

• Data-driven technology in healthcare improves health and care, if it is deployed as a learning system, with open data exchange between parties involved. Data-driven technology plays a large role in many aspects of our daily lives, but the implementation and up-scaling of e-health lags behind. To reach the potential of applications such as e-health, barriers in, for example, funding systems, laws and regulations and the control of digital skills by health care providers and patients, have to be resolved. Using data-driven technology in healthcare also involves risks, in particular regarding data security and privacy.
• Robots are increasingly taking over more tasks in our daily lives. This automation can have a positive impact on health, for example by taking over high risk tasks (performed by platform workers and car drivers) and physically heavy labour (performed by construction workers and nurses).  The adverse effects and risks of robotization include the stimulation of inactivity and the increasing dependence on technology.
• Genetic technology can be of great added value for diagnosing and treating diseases. However, the link between personal genetic information and the likelihood of actually developing a disease is not always straightforward. This causes uncertainty. Genetic engineering also raises other ethical dilemmas, such as, for example, the right “not to know”, and the manipulation of genetic information and ideas regarding engineerability of life.
• 3D-Printing decentralizes product development and production and offers more customized products. It leads to less waste and more personalized tools, with a positive effect on health, autonomy and participation. At the same time, protection against the risks of unsafe products becomes more difficult when the production process is decentralized.
• Our reality is increasingly becoming a virtual reality. Virtual reality and augmented reality can be used to improve well-being and health, for example by preventing social isolation or by simulating the experience of patients for health care professionals. Virtual reality might also have negative effects on health, but scientific evidence of this is presently limited.
• The relationship between technology and healthcare expenditures is complex, and is also influenced by external developments, beyond the healthcare sector. New technologies often result in increased provision of care and thus in increased expenditures. They can also reduce expenditures if they lead to more efficient and effective care. Ensuring that the application of new technologies leads to reduced expenditures requires structural changes in healthcare organization.