Community Research and Development Information Service - CORDIS

H2020

FRESHER Report Summary

Project ID: 643576
Funded under: H2020-EU.3.1.

Periodic Reporting for period 1 - FRESHER (FoResight and Modelling for European HEalth Policy and Regulation)

Reporting period: 2015-01-01 to 2016-06-30

Summary of the context and overall objectives of the project

"The overall project objective of the FRESHER research consortium (FoResight and Modelling for European Health policy and Regulation) and project is the representation of alternative futures where the detection of emerging health scenarios will be used to test future research policies to effectively tackle the burden of non- communicable diseases (NCDs). More precisely, FRESHER is set out to pursue four goals with a strong interaction between them:

I. To produce quantitative estimates of the future (horizon 2030 and 2050) global burden of chronic non-communicable diseases (NCDs) in the EU and its impact on:
a. health care expenditures and delivery,
b. population well-being,
c. health inequalities and socio-economic inequalities.

II. To base such estimates not only on extrapolation of observed past health trends but also on foresight techniques giving credit to the interdependencies of structural long-term trends in demographic, gender relations, technological, economic, environmental, and societal factors for European countries (horizon 2050). This goal implies to develop and validate a comprehensive impact assessment framework mapping major driving factors, their interactions and their impacts on health and well being endpoints (a web of causal chains). It also implies a critical review of the data sets used in their application, and recommending a robust set of variables and indicators.

III. To illustrate options for decision-makers in order to contain the burden of NCDs and its negative impacts on well being of European individual citizens and societies as a whole. This goal implies to simulate modifications through time of the four above outcomes (burden of NCDs, health care expenditures, population well being and inequalities) according to alternative (health and non- health) policy choices.

IV. To promote an interactive process with key actors in public health and European policies in elaborating, fueling and disseminating both foresight scenarios and results of the micro-simulation model as well as policy recommendations deriving from their results for future health research and policies (health and non-health) affecting population health and well-being.

In order to fulfil these goals, the FRESHER project combines the insights from the exploration of current literature and data on evaluation of risk-factors and NCDs prevention and treatment policies (WP2), from possible scenarios for the future of health and health care (WP3 & 4) and from an organized policy dialogue with key European decision-makers and public health stakeholders (WP6 and 7). All these efforts converge to elaborate and produce inputs for an empirically-based, but yet unique, micro-simulation model capable of quantifying the current and future health and economic impacts of risk factors and testing “what if” policy options regarding the potential future impact of the qualitative scenarios, as well as potential new policies and policy combinations (WP5). An intensive effort is devoted to translating results of alternative scenarios and quantitative simulations into the definition and discussion of the future agenda for health research and health policies by European decision-makers and key public health stakeholders (WP6 & 7).

The attached image "FRESHER Workpackages structure" displays the 7 WPs of the project and their interaction."

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

"As detailed in the table below, the activities accomplished in the first reporting period were primarily focused on the literature review to map the determinants and impacts of NCDs, and on the horizon scanning process to identify the trends and drivers of NCDs. Key steps have also been undertaken for the development of the micro simulation model and for building the FRESHER Scenarios whose results will be available by November 2017. Specifically:
• WP2 and WP3 have fully achieved the planned results and have set the framework for WP5 and WP4 further work.
• WP4 and WP5 have started the scenario building and modeling work and will achieve the planned results in the next period.
• WP1, WP6 and WP7 - the cross cutting WPs- have conducted management, policy and communication activities.

The attached image "FRESHER Interaction of the different phases" represents the main activities of the project and what has been achieved in period 1.

Specifically, the following activities were carried out and the related results achieved in the first reporting period:

WP1 Project Coordination & Management has ensured appropriate guidance and support to the entire consortium by guaranteeing that outputs were delivered in time and quality and that partners receive assistance and opportunities for knowledge transfer. Among the main progress and results: the production of the Report on Data Management (D.1.1), the successful organisation of four project meetings and the continuous coordination with the Euro-Healthy Project;

WP2 Mapping social, behavioural, and biomedical determinants of chronic diseases has identified the key social, behavioural, and biomedical determinants of the seven chronic conditions, both as individual outcomes and when they are co-morbid. The work-package has produced the following four reports: an umbrella review on major NCDs (D2.1); a detailed protocol of the meta-analysis to be undertaken on comorbid conditions (D2.2.) a Report on comorbid conditions assessing the role of risk factors on comorbid conditions (D.2.3) and a report on heterogeneity (D2.4).

WP3 - Horizon Scanning and Driver Identification has identified the health related short, medium and long term trends, drivers, wild cards and weak signals in the future of health and NCDs and has scanned the scientific capabilities or technical solutions to be developed. The work-package has conducted an extensive literature review and has carried out a broad stakeholder’s consultation through the organisation of three regional workshops on trends and drivers of NCDs (Vienna, Brussels, Lisbon). The results of the horizon scanning and driver identification are available in the two reports Horizon Scanning Report (D 3.1) and D3.2 Synthesis report: “Health and well-being mapping” (D.3.2).

WP4 Scenarios has ranked by importance and uncertainty the trends emerged in WP3 through the launch and the dissemination of the survey “What will impact your health the most?” (June 2016). The results of the survey and a first draft of the FRESHER Scenarios space are available in the report “Health scenario stories” (D4.1).

WP5 Modelling and policy simulation has conceptualised and implemented an “European Health Policy Model software” (D5.1) that will serve as basis for a empirically-based dynamic micro simulation model.
The Model contains the conceptualisation and implementation of:
- a demographic model with exogenous births, accounting for net migration flows and trends in all-cause and cause-specific mortality over time;
- a (chronic) disease models based on disease incidence, remission (when appropriate) and fatality as functions of individual characteristics and risk factors;
- a risk factor models based on longitudinal trajectories of exposure and behaviour over the life-course;
- the assessment and implementation of joint distributions and interactions between chronic diseases and between risk factors, and their effects on health, longevity and health care expenditures
WP5 has also collected data to capture and project geo-spatially the population’s exposure to environmental factors with significant risks to health within the same population modelling framework for three large European cities (Lisbon, Vienna, Tallin) and thus integrate both exposure to environmental risk factors and exposure to social and behavioural risk factors for NCDs in one comprehensive European urban environment and health model.

WP6 Policy Recommendations has mapped the stakeholders to be targeted to policy workshops and run the first FRESHER Policy workshop “Good Practices” (Rome, December 2015). To fuel the workshop discussion and the subsequent WP activities, WP6 has conducted a review of the best practices and policies targeting risk factors and at early detecting/treatment/rehabilitation of NCD (D6.1) and an analysis of evidence, impact and cost effectiveness of existing policies (D6.2).

WP7 Dissemination and Stakeholder Involvement has continuously followed up and liaise the FRESHER activities with external stakeholders and policy makers. On the ground of the Dissemination Strategy (D7.3), EPHA has produced targeted communication and documentation tools (website, flyers, posters, brochures, film). The Stakeholders involvement strategy and mapping (D7.2) has ensured that the FRESHER participatory activities such as the regional workshops, the survey and the policy workshop reached a wide and competent audience."

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The ambition of FRESHER is to provide a conceptual renewal and empirical improvement of health forecasting models and foresight activities mainly through:

• An integration of the complex causal chains of chronic diseases and multiple risk factors and co-morbidities;
• A better understanding of the impact of non-health determinants on population health and health expenditures;
• An explicit relationship of quantitative modelling with qualitative approaches for building long term scenarios;
• A systematic sensitivity analysis allowing for best practice in management of heterogeneity of data and uncertainties.

It is clearly impossible, halfway through the project lifetime, to present any evidence of impacts, which will be accrued primarily towards and more realistically after the end of the project. The work carried out so far, and in particular the abundant and multifaceted interaction with a variety of stakeholders has however allowed to confirm that the impacts identified in the DoA are still relevant and that they are considered realistic: the expectations are therefore that the project will indeed produce “an integrated framework and operational model tool that will provide better knowledge and understanding of causal chains for chronic diseases and therefore lead to more effective/better targeted interventions to improve population health. It will contribute to optimization of resource allocation in health policy between prevention and care, biomedical innovations and policies targeting other determinants of health.

In a longer time horizon, the FRESHER Project aims to support the inclusion of new and better scientific and technological knowledge to address future health needs achieved thanks to the identification of priorities and the subsequent orientation of research, as well as more evidence-based policies to maximize public health and social welfare of the European population”.

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