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FoResight and Modelling for European HEalth Policy and Regulation

Periodic Reporting for period 2 - FRESHER (FoResight and Modelling for European HEalth Policy and Regulation)

Reporting period: 2016-07-01 to 2017-12-31

FRESHER objective was to represent alternative futures, detecting emerging health scenarios to test future policies to tackle non-communicable diseases (NCDs). The project aimed to identify alternative health scenarios for Europe, considering structural long-term trends in demography, technology, economy, environment and society up to 2050. FRESHER pursued four interrelated goals: I. To produce quantitative estimates of the future global burden of NCDs in the EU and its impact on health care expenditures and delivery. FRESHER developed a microsimulation model, based on advanced OECD models in this field, to produce quantitative forecast of NCDs burden and impact. 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. A Scenarios Building led to the creation of four alternative futures: the FRESHER Scenarios. III. To illustrate options for decision-makers to contain the burden of NCDs and its negative impacts on citizens well-being. The microsimulation model is also designed to assess the impacts of future policies. Sets of public health policies aimed at tackling smoking, harmful alcohol use and obesity were assessed as part of the project to determine their effects on chronic diseases, life expectancy and health care expenditure. IV. To promote an interactive process with key actors in health and European policies to produce recommendations to policymakers and to design an agenda for future European Health Research. The FRESHER Research Agenda intends to identify key research priorities as starting point for research strategies and funding programmes
In the second reporting period, the FRESHER Consortium achieved all WP and project objectives. WP1 and WP7 supported project development by ensuring management and communication with the EC, consortium partners and external stakeholders. WP2 and WP3, preliminary respectively to WP5 and WP4, successfully finalized their activities in the first reporting period by doing the ground work for the Micro-Simulation construction and the Scenarios building. WP4, WP5 and WP6 developed the Health Scenarios, the micro-simulation model and the Research Agenda.
The following activities were carried out and related results were achieved in the reporting period. WP4 ranked by importance and uncertainty the trends emerged in WP3 through the survey “What will impact your health the most?”, reporting results in in the “Health scenario stories” (D4.1). Fully fledged FRESHER Health Scenarios were subsequently developed thanks to consortium members and stakeholders’ inputs. The II FRESHER survey “How healthy will your future be?” elicited stakeholders’ contributions to liaise the scenarios with the micro-simulation model and to imagine innovative sets of policies. Three regional workshops downscaled the Scenarios (Warsaw, Coruna, Helsinki). Drawing on these activities, ISINNOVA wrote the “Report on consolidated scenario storylines and quantitative simulation results” (D4.2). WP5 conceptualised and implemented a “European Health Policy Model software” (D5.1) for an empirically-based dynamic micro simulation model. The Model contains: i) demographic model with exogenous births, accounting for net migration flows and trends in all-cause and cause-specific mortality over time; ii) (chronic) disease models based on disease incidence, remission (when appropriate) and fatality as functions of individual characteristics and risk factors; iii) risk factor models based on longitudinal trajectories of exposure and behaviour over the life-course; iv) 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 also collected data to capture and project geo-spatially population’s exposure to environmental factors with significant health risks within the same population modelling framework for three European cities (Lisbon, Vienna, Tallin). The results are in the report on projecting the future social, health and economic burden of risk factors, disease and injury in the EU (D5.2). The micro-simulations setting are described in the paper on micro-simulation methodology, results and recommendation for future research (D5.3). WP6 conducted a review of best practices and policies targeting risk factors and at early detecting, treatment and rehabilitation of NCDs (D6.1). ISS analysed the evidence, impact and cost effectiveness of existing policies (D6.2). ISS, in conjunction with EPHA, organized three Policy Events to elicit ideas on policies and research needs from stakeholders. The findings were used for the compilation of a list of alternative policy options for policy makers according to different scenarios (D 6.3) and for the elaboration of Future Public Health Research Agenda (D6.4)
FRESHER ambition to provide conceptual renewal and empirical improvement of health forecasting models, foresight activities and policies was achieved mainly through:
• An explicit relationship of quantitative modelling with qualitative approaches for building long term scenarios. FRESHER identified eight key trends that are likely to influence people’s health in Europe by 2050 and alternative policies to manage these trends. Four Scenarios were derived from alternative hypotheses about trends’ impact on NCDs risk factors and interfaced with a micro-simulation model
• A better understanding of the impact of non-health determinants on population health and health expenditures. Micro-simulation results show that NCDs rates may increase by up to a third in 2050 and health expenditures may increase by one fourth. Life expectancy, incidence and prevalence of NCDs are projected to grow to different degrees in the Scenarios. However, demographic trends, i.e. population ageing, will remain the main driving force for increase in NCDs and their impact
• An integration of the complex causal chains of NCDs, multiple risk factors and co-morbidities. FRESHER better took into account multimorbidity, which have significant amplifying consequences on the impact of NCDs. Socioeconomic and behavioural factors appear to be more important than clinical parameters in progression from a single disease to multimorbidity or risk of mortality in those with multimorbidity. In addition, economic analyses reveal a super-additive effect of comorbidity on costs
• FRESHER assessed the impact of a set of best public health policies aimed at tackling NCDs risk factors (poor diets, sedentary behaviours, obesity, smoking and harmful use of alcohol). Results suggest that scaling up these policies will have some, but limited effect on NCDs. Indeed, “Healthy Together”, which include innovative policies promoting environmental, nutrition, social protection and lifestyle improvements, would produce better results than just generalising conventional public health policies. Therefore, there is an urgent need for innovative policies targeting the above factors
• A dedicated webtool allows for comparisons among scenarios, their impact on NCDs and the effectiveness of standard public health policies. The tool will be further refined and can be used by policy makers from all sectors, researchers and the public health community at large
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