Public Health Foresight Research Articles

Public Health Challenges for 2050 in the Netherlands

Abstract Every 4 years, the National Institute for Public Health and the Environment (RIVM) carries out the Dutch Public Health Foresight Study, commissioned by the Ministry of Health. The ninth edition (PHFS-2024) compiles an outlook on future public health and the health care system in the Netherlands. It combines a business-as-usual Trend Scenario with literature study and a range of qualitative and mixed-methods approaches. The Trend Scenario comprises projections up to 2050 for a broad range of epidemiological indicators. Such as (healthy) life expectancy, disease burden, life style factors. The qualitative and mixed methods approaches supported an incremental intersubjective process. Methods were a focus groups study, stakeholder sessions and workshops. An important innovation in this study was the Citizen Council and Panel. The outcomes show that demographic development, in particular growth of the group people at high age with multimorbidity, will lead to high pressure on the formal and informal health care system but also on e.g. mental health. A life course approach applied shows that decreasing mental health of youth will have long term consequences. Also, overweight will deeply impact older people’s health in the future. Lastly, climate change in combination with e.g. energy transition will deeply affect our society and living environment. Next to these challenges, there will also be opportunities to improve health. Building a climate-proof living environment that also stimulates healthy life styles and social interaction is one of them. However, improving health has linkages with policy areas outside the traditional public health domain as well and requires, firstly, a Health in/for All Policies approach. Secondly a whole-of-society approach in which companies and civil organizations take action is needed. All these efforts can only be effective if people and communities are put at the core of all health policies.

Contextual factors influencing the equitable implementation of precision medicine in routine cancer care in Belgium.

Precision medicine represents a paradigm shift in health systems, moving from a one-size-fits-all approach to a more individualized form of care, spanning multiple scientific disciplines including drug discovery, genomics, and health communication. This study aims to explore the contextual factors influencing the equitable implementation of precision medicine in Belgium for incorporating precision medicine into routine cancer care within the Belgian health system. As part of a foresight study, our approach evaluates critical factors affecting the implementation of precision oncology. The study scrutinizes contextual, i.e. demographic, economic, societal, technological, environmental, and political/policy-related (DESTEP) factors, identified through a comprehensive literature review and validated by a multidisciplinary group at the Belgian Cancer Center, Sciensano. An expert survey further assesses the importance and likelihood of these factors, illuminating potential barriers and facilitators to implementation. Based on the expert survey, five key elements (rising cancer rates, dedicated healthcare reimbursement budgets, increasing healthcare expenditures, advanced information technology solutions for data transfer, and demand for high-quality data) are expected to influence the equitable implementation of precision medicine in routine cancer care in Belgium in the future. This work contributes to the knowledge base on precision medicine in Belgium and public health foresight, exploring the implementation challenges and suggesting solutions with an emphasis on the importance of comparative analyses of health systems, evaluation of health technology assessment methods, and the exploration of ethical issues in data privacy and equity.

Why so far ahead? Climbing the participation ladder in public health foresight

Abstract Issue In the Netherlands, the National Public Health Foresight Study (PHF) is published every 4 years, as starting point for national and local public health policy development. As these policies impact citizens’ health and lives, it is important to include their voices. We piloted an approach to strengthen this engagement to learn and to inspire PHF in other (country) settings. Problem description PHF is usually expert-based. Citizen engagement, beyond consultation, is not yet common practice. In the Dutch PHF-2024, we engage citizens both as advisors (citizen council, N = 30 and panel, N = 500) and as target group (focusgroups N = 40). Intentionally the scope is diffuse, allowing for unexpected input. What can we learn from this approach, and how do the citizens contribute to the PHF? Results - Citizens of all ages, backgrounds and education types are well able to discuss health (determinants), data and indicators; - They have intrinsic motivation to contribute to better knowledge, feel responsible for effective engagement and are eager to engage across different backgrounds and population groups; - Integration of outcome into the PHF process is valuable, enriching scientific with experiential knowledge and facilitating results communication; - Fundamental questions, e.g., about foresight time frames (“why look so far ahead as the world is in crisis right now!”) are raised by the citizens, showing that these need to be better addressed in order to make PHF relevant for a broader public. Lessons - More permanent engagement of the citizens is needed to enable learning and development; - earlier engagement in the PHF process may enable joint development of core questions and issues to be addressed; - The results are highly encouraging; piloting this approach in other foresight types and in various contexts is therefore needed to refine and further develop it. Key messages • Citizen engagement can and should be strengthened to include citizen voices in the PHF process, informing policies that impact on their lives. • Citizens of all backgrounds, with their experiential knowledge, can be valuable partners in PHF, that provide important input.

Future Dutch DALYs as part of the Dutch Public health Foresight Study

Abstract The Dutch Public Health Foresight Study (PHFS) provides insight into the most important societal challenges for public health and health care in the Netherlands. An important element of this study are the Burden of Disease indicators, among which the Disability-Adjusted Life Year (DALY). In the last editions of the PHFS future DALYs are also included. The methodology applied to obtain future projections varies. For around 100 diseases and health conditions, projections are obtained from demographic and epidemiological projections. For the projections of causes of death, a Poisson regression technique is used, based on historical data from 1996 onwards. These projections are made consistent with the population projections from the Nacional Statistical Office. The life tables from these population projections for the projection period till 2050 are also used to calculate the Years of Life Lost. Next, projections of a set of health determinants are used to allocate the future DALYs to the risk factors, making used of population attributable fractions. The results show an enormous increase in the burden of disease due to dementia. Where dementia ranked 10th in 2015, in the future this will be by far the major cause of the burden of disease - because of an increase in prevalence, but also because an increase as cause of death, partly due to further progress in survival from cardiovascular diseases and cancer. Arthrosis will also be gaining importance - due to the ageing of the population in combination with increasing overweight. Smoking and dietary risks will be among the main risks factors for the future burden. The projections of DALYs for the Dutch PHFS show a strong increase in disease that progress with age, such as dementia. These are partly due to successes in survival from other diseases. Policy makers should be prepared for these future development, and at the same time invest in prevention to reduce future disease burden of for example cancer and arthrosis.

Impacts of climate change and environmental pollution: a public health foresight study

Abstract Background In the Netherlands, the National Public Health Foresight Study (PHF) is published every 4 years, as starting point for national and local public health policy development. A priority topic in the PHF2024 is climate change and living environment. The important transitions (energy, food, mobility, housing) that are required all require space and thus pose a societal challenge for the future quality of the living environment. Approach We use a mixed method approach to identify main trends and impacts on public health: - analysis of Demographic, Economic, Socio-cultural, Technological, Ecological and Political developments (DESTEP) based on a literature review and expert consultation; -organization of focus group discussions with young people (N = 41); -analysis of mortality data in relation to temperature; -evaluation of trend-scenarios. Results Direct and indirect health impacts of climate change will become more visible in the next 30 years. These need not all be negative. For example, an earlier edition of the PHF already showed that the increase in temperature may lead to less deaths in winter but more deaths in summer. In the PHF we will focus not only on adverse health consequences, but also identify opportunities for health improvement through climate mitigation and adaptation. Similarly we will look into related developments like energy and mobility transitions, that may (partly) result in health gains, depending on how they will be implemented and who will be affected. For example, we will look into possible improvement of air quality and its impact on health. The preliminary findings of our focus group study suggest, however, that young people are mostly pessimistic regarding developments in our living environment. This is particularly the case for climate change; young people fear that this may cause severe events. Nevertheless, they have high expectations regarding technological advancement in the energy sector. Key messages • Foresight studies should not focus on risk alone but also identify possible health promoting developments in the living environment. • Expert views and views of lay people, in particular youth, may not necessarily be identical. Both need to be addressed in foresight studies.

Normative uncertainties in public health foresight

Abstract Background People value health differently, based on the norms and values. This is important when looking into the future trends in health and health care., and the perception of challenges they may arise from these trends. Methods Together with stakeholders from a broad range of health-related professions, we identified several challenges for public health and healthy environments. Professionals working on these subjects came up with different goals and different ways to achieve them. These normative goals in health policies provide uncertainties in foresight, because they can be either synergetic or conflicting. Results In the Dutch Public Health foresight study of 2014 four societal challenges for public health and healthcare were identified and formulated, as follows: (1) to keep people healthy as long as possible and cure illness promptly; (2) to support vulnerable people and enable social participation’ (3) to promote individual autonomy and freedom of choice; and (4) to keep healthcare affordable. In 2022 we will update and deepen these perspectives on public health and at the same time we will broaden the usability of working with this method by focussing on environmental health. Conclusions To explicitly distinguish different perspectives on health leads to a better understanding and dealing with normative uncertainties by taking into account the trade-offs between competing interests and values. The challenge then is to identify policy options that have positive effect from different perspective, the win-wins.

3.Q. Workshop: Using foresight to anticipate future public health challenges

Abstract The COVID-19 pandemic brought great uncertainty about current and future health impacts. Uncertainty about how the virus would directly impact our health. And uncertainty about indirect impacts of COVID-19 on long-term health and wellbeing, including consequences due to delayed prevention, diagnosis, and medical treatment. At this point in time, we know a lot more about the immediate mortality and morbidity aspects. How we fare on the wider impacts on the longer term is more difficult to say. A structured tool for gaining in sight in this, is foresight. We use this tool within the Population Health Information Research Infrastructure (PHIRI). PHIRI supports research across Europe through the identification, access, assessment and reuse of population health and non-health data to underpin public health policy decisions. PHIRI is a practical use case and lays the foundation for ultimately developing a Distributed Infrastructure on Population Health (DIPoH). The joint workshop aims to show ways to better understand the complexity of the wider impacts of the SARS-COV-2 virus on population health across Europe; show how a research infrastructure might help researchers in Europe build capacity and helping each other to achieve higher goals. The workshop will begin with a presentation providing a brief overview of the PHIRI foresight work. This will be followed by two researchers who participated in the PHIRI foresight training program and undertook their own Public Health Foresight study. In the last presentation of the session foresight will be reflected on from a policy perspective. How can researchers and health policy makers better interact to have better foresight-informed policy making. Interaction with the audience will be guaranteed using Mentimeter questions. With this interactive element, insights art obtained what people find the most important trends to act upon, what they consider most important future challenges and how researchers and policymakers can better interact. Key messages • Foresight studies are essential to be better prepared for and to anticipate to future challenges. • With foresight-informed policy making direct and indirect health impacts of COVID-19 are addressed.

Potential gains by effective early detection of diseases: proposal to approach informing public health policy in the Czech Republic

Abstract Background Significant amount of disease burden could be averted by early detection and treatment of diseases. In the Czech Republic, National Screening Centre (NSC) of the Institute of Health Information and Statistics is responsible for informing public health policy in the field of early disease detection. The objective of the proposed early detection public health foresight study (PHFS) is to gather evidence, use available computational tools, utilise knowledge and opinions of stakeholders, and summarize it in a systematic manner to inform public health policies. The presentation outlines the approach undertaken within the proposed early detection PHFS. Methods The key source of data for monitoring of population health status and healthcare system in the Czech Republic is the National Health Information System (NHIS). The study will also utilise external sources of data, namely demographic projections and data on global burden of disease, as well as qualitative data from stakeholders. The study will also utilise analytical tools and outputs developed by NSC (situational analyses, decision modelling, etc.). The conceptual model of the study will cover important underlying aspects like public policies, driving forces, population health and healthcare system, and health impact variables. Results The proposal for early detection PHFS has been developed within the PHFS capacity building course, utilising the experience and insights of tutors and fellow participants. The development of study methodology was accompanied by gathering of evidence and consultations with relevant stakeholders. Conclusions PHFS is a very useful approach to assess possible future developments of public health system, achieve participation of stakeholders, and to inform public health strategies. Following finalisation of the early detection PHFS protocol, governing board of the NSC will decide on the degree of implementation of the study.

The inseparable relation between foresight and uncertainty

Abstract This presentation starts with an interactive mentimeter poll to involve the audience. They will be asked several questions about what they find important in dealing with uncertainty in public health foresight studies. Background The future is per definition uncertain. Our knowledge about the future is obviously limited, especially when we look further into the future. Next to limited knowledge, people also have different ideas about what they consider a desirable future. All these aspects of uncertainty play a role when doing a foresight study. One of the challenges when doing a foresight study is to address these uncertainties in a systematic manner. Methods The cognitive uncertainty addresses the lack of knowledge, which can easily be extended to the information that can be inaccurate or unreliable. These cognitive uncertainties can vary widely, and can be classified according to location, level and nature of the uncertainty. Especially in foresight studies with a strong quantitative character, the cognitive uncertainties can be crucial and can form the basis of developing scenarios. Next to the cognitive uncertainties, normative uncertainties can be distinguished which address desirable futures. These represent the obvious differences in norms and values that people have when valuing health. There are several examples of public health foresight studies that include a proper consideration of uncertainties involved. Conclusions Applications of foresight studies in the field of public health are still limited. However, the recent years we see a broadening of initiatives of doing a foresight study, including addressing uncertainty in an more systematic way. Especially in public health, the normative uncertainty might play a rather relevant role.

Using foresight methodologies to tackle SARS-COV-2 related health impacts

Abstract Background A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity. Methods PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues. Results The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. A PHFS capacity building course was developed, including videos posted on the PHIRI website and a template structuring the different foresight elements. Around 15 researchers undertook their own PHFS, covering a wide range of public health topics, using the material provided during the course. In addition, a compact guide was developed and provided, explaining the different foresight elements. Based on these studies, common challenges and promising policies are identified. Conclusions Foresight in public health is gaining more and more interest, especially now in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-CoV-2 pandemic and in translating this into policy options.

Foresight methodologies to unravel the indirect health economic impact of the COVID-19 pandemic on cancer care and management in Belgium studied in the HELICON project

Abstract Background The COVID-19 pandemic had indirect effects on segments of the population affected with non-COVID-19 diseases e.g. through delayed care and management of cancer patients. Early diagnosis and appropriate treatment are key to improving patient outcomes and reducing societal and health care costs. Tio support policymakers to anticipate these trends a public health foresight study (PHFS) was done. Methods The PHFS follows a structured approach provided through a compact guide and is supervised by PHIRI team members. Its evolution is measured through a template gathering data on the study's contextual information, objective, main target groups, conceptual model, indicators, driving forces, time horizon, spatial unit, identifying uncertainties, scenario logics, scenario type, stakeholders, data, tools and instruments, projection methods, communication strategy/products, and the uptake of results and evaluation. Results Several foresight elements were identified. Contextual information on the resources and governance structure were elucidated. The objective was made clear by identifying the topic, general issue, and sub-issues of the initial study. A conceptual model was developed to analyse the interaction of the topic with other aspects that could influence it. The main driving forces, which are factors that influence the studied topic, were then determined through the DESTEP method. Stakeholders were identified and classified through the power-interest matrix. Conclusions Establishing a foresight study on the indirect impact of the COVID-19 pandemic on the care and management of cancer patients allows exploring potential and unsuspected issues that may affect society, health care systems, and patients. Those groups should not be considered individually but as an ecosystem continuously interacting, where a decision may affect everyone. This type of information may be of high relevance to policy- and decision-makers in their public health interventions.

Policy interactions during the Dutch ‘Public Health Foresight, in the light of COVID-19'

When the sense of urgency of the COVID pandemic increased, in March 2020, the Dutch Ministry of Health commissioned RIVM to do the study “Public Health Foresight, in the light of COVID-19”. The aim of this study was to analyze Impact of the corona pandemic on current and future health and health care, to support broader consideration of measures and to be better prepared in the future. This was done by addressing not only the direct impacts, e.g. the disease burden of COVID-19, but also the indirect impacts of the measures, e.g. mental health, health impacts of changed life styles and delayed health care provision. During this 8 months trajectory, interaction with policy makers was frequent and intensive. In the context of Parliamentary elections there were constant pressures on policymakers from the virologists and hospital and ICU ward managers; as well as non-health Ministers in the government cabinet and the general public questioning decisions on whether to act or not. In the presentation we draw implications for public health experts on do's and don'ts in interaction with policymakers.

Dutch Public health Foresight Study, in the light of COVID-19

BackgroundThe future consequences of the corona pandemic for health are significant but uncertain. The Dutch Public health Foresight Study-2020 (PHFS-2020) analyses future trends in health status, determinants, prevention and care, in the light of COVID-19. The pandemic impacts health directly through COVID-19 and indirectly through changes in lifestyle, reduced regular care and socio-economic developments.MethodsThe Dutch PHFS-2020 applies a scenario approach which explores short- and long-term trends and their possible effect on health and health care. A Trendscenario is used, in combination with three scenarios for the future course of the pandemic and socio-economic developments. Based on these scenarios, societal challenges for the future are identified.ResultsIn 2020, COVID-19 was the most important causes of death in 2020, life expectancy was almost a year lower and the disease burden of the first wave was almost five times higher than an average flu season. The increase in overweight and smoking will lead to more health loss in the future, including increased mortality. The negative impacts of reduced health care and mental health are already visible and might worsen in the future. The socio-economic and intergenerational divides might become more prominent.ConclusionsThe PHFS-2020 shows that indirect effects of the crisis might be taken into account when considering future policy interventions targeting COVID-19. Negative impacts on mental health, possible increase of health inequalities and the long term effects of changes in life style are important indirect effects to be considered by policy makers. Next, a further ageing population might increase the vulnerability for possible future outbreaks.Key messages The results of this study supports broader consideration of measures and to be better prepared in the future.Public Health foresight help to be better prepared for future possible developments.

Using foresight methodologies to tackle SARS-COV-2 related health impacts

Abstract Background A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity. Methods PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues. Results The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. Literature research revealed a range of studies using stakeholder involvement and scenario analysis to explore alternative futures. A PHFS capacity building course was developed consisting of three parts: a general, introductory module; three advanced modules deepening on several PHFS elements; and a final module evaluating and preparing countries for developing scenarios together. Conclusions There is a lot of interest in using foresight in public health, especially in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-COV-2 pandemic and in translating this into policy options.

Dutch Public health Foresight study 2018/20

Abstract The four-year Public Health Foresight Study (VTV) provides insight into the most important societal challenges for public health and health care in the Netherlands. The seventh edition of the Dutch Public Health Foresight study was published in 2018, with an update in 2020. In this update a business-as-usual or Trend Scenario was developed using 2018 as a base year. In the trend scenario demographic and epidemiological projections have been used to depict the future trends regarding ageing, health, disease, health behaviors, health expenditures and health inequalities. Next, these trends are used to identify the most important future challenges and opportunities for public health. In the 2020 update, special attentions is given to climate change and the local living environment and their impacts and interaction with public health outcomes. Trends in lifestyle-related lifestyle show both positive (smoking prevalence) and negative (overweight prevalence) future developments. Dementia will be the leading cause of mortality and disease burden in 2040 by far. Health care expenditures will double by 2040, with cancers showing the most rapid growth of all disease groups. The insights of this study are directly used as input for the National Health Policy Memorandum and for the National Prevention Accord.

28.G. Workshop: Foresight studies at the global, European and national level: what can we learn from them?

Abstract Foresight studies provide valuable information for (strategic) policy-making. They provide insights into the most important future trends and challenges, which is essential for well-informed policy-making. The number of foresight studies in the field of Public Health was limited but the number of studies is growing rapidly over last years. With these studies becoming available, their findings might become a more a regular component of population health monitoring activities. Given the relatively early stage of development of foresight studies in the field of Public health, a proper understanding and interpretation of the future studies might need some further guidance. How to deal with an (uncertain) future in the policy making process is one of the issues that needs to be addressed. This workshop starts with an interactive session to get a better understanding of the level of knowledge and needs regarding foresight studies, followed by the presentations of four different applications of foresight studies. The first one is at the global level from the institute for health metrics and evaluation (IHME) who has a long track record regarding public health data gathering and applying these, for example, to calculate the Global Burden of Disease. Next, EURO-HEALTHY project will present the Scenarios for population health inequalities in 2030 in Europe, partly based on a Web-Delphi process with a multidisciplinary panel. The third presentation will be from Public Health Wales on Futures for Wales which puts future health in the broader perspective of wellbeing. The last presentation will also be a national one, the Public Health foresight study, which has been conducted for more than 2025 years with an update published in 2020. After these presentations, ample time will be reserved for discussion on how these studies could best contribute to better public health policy making. Workshop participants will be informed about the main results of recent foresight studies, allowing them to reflect on these from their own perspective. They will get insight into the approaches and methods used in these recent studies, which may be helpful or inspiring for their own practice. Key messages Public health foresight studies are done more frequently and their findings can influence public health policy making. In this workshop, the methodology and findings of foresight studies at the global, European, and national level will be discussed.

Environmental Burden of Disease in the Netherlands

Abstract Background RIVM-National Institute for Public Health and the Environment published as part of the 2018 Dutch Public Health Foresight report, an update of the Disease Burden, including the Environmental Burden of disease. This report is not only relevant for the Ministry of Health but also for other policy arenas, to support policy making with the objective of improving health. Methods Environment factors are distinguished by indoor and outdoor environment. The following environmental factors have been taken into account; Air pollution (PM10/NO2), UV radiation, noise, second-hand smoking, carbon monoxide poisoning and indoor dampness. The effects of chemical substances are not included. Making use of the population attributable fraction, the fraction part of mortality, disease burden and health care expenditures attributable to environmental factors is calculated. For this method, data on exposure as well as the dose-response relationship (relative risks) are used. Results Some 4% of the disease burden in the Netherlands is caused by environmental factors and that costs us more than 1 billion euros of care per year. This corresponds with 200,000 DALYs; of which 175,000 by outside environment and 25,000 by indoor environment. In total, almost 13000 deaths can be attributed to environmental factors. Air pollution causes by far most of this disease burden. After that, exposure to UV radiation and second-hand smoking rank highest. Conclusions A considerable disease burden, number of deaths and health expenditures is attributable to environmental factors and could at least in theory be avoided by improving our environment. Air pollution in particular plays an important role in this. In addition, even a greater health gain could be achieved if environment factors are tackled and healthy behavior is at the same time stimulated.

The Dutch Public Health Foresight Study 2018: an example of a comprehensive foresight exercise.

The use of foresight studies is common in some policy fields, but not in public health. Interest in such studies is growing. This paper gives a general overview of the Dutch Public Health Foresight Study (PHFS) 2018, providing insight into what performing a broad scenario exercise in the field of public health entails and its societal impacts. The aim of the PHFS-2018 was: (a) to show how public health and healthcare in the Netherlands will develop over the next 25 years if we pursue our current course and detect 'new' developments; (b) to give options for dealing with the major future societal challenges. Part a was addressed by means of a quantitative business-as-usual scenario exercise complemented with qualitative thematic studies, and part b by elaborating courses of action for three key challenges, based on stakeholder consultation. Typical aspects of the PHFS methods are a multidisciplinary, participatory and conceptual approach and using a broad definition of health. The PHFS-2018 is the basis for the upcoming National Health Policy Memorandum and the Trend Scenario is the baseline for the National Prevention Agreement. Unexpectedly, the findings about increasing mental pressure in young people received most attention. There still is room for expanding use of the study to its full potential. Long-term thinking could be stimulated by using back casting techniques and stronger involvement of policy-makers in the elaboration of options for action. Lessons learned from developing intersectoral policy at the local level could be applied at the national level.

9.P. Workshop: Public health foresight studies: how can we deal with the societal challenges we face?

9.P. Workshop: Public health foresight studies: how can we deal with the societal challenges we face?

The Dutch Public Health Foresight study 2018

The Dutch Public Health Foresight study 2018