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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.

Knowledge translation (KT) is an important concept to bridge the gap in health information between research and policy making. Also in Burden of Disease (BoD), with the Disability-adjusted Life Years (DALYs) as its main indicator, this gap exists. KT provides the theory and tools to better link researchers and policy makers to support evidence-informed policy making. The European Burden of Disease Network (COST Action CA18218), serves as technical platform for integrating and strengthening capacity in BoD assessment across Europe and beyond. The network promotes an interdisciplinary approach that integrates KT in the classical BoD framework. One of the work packages working groups focusses on the application of existing KT theory to BoD assessments. Several European countries are undertaking their own National Burden of Disease (NBoD) study, some of them already for many years. They have built up a substantial amount of knowledge on the practical side of KT in relation to BoD assessment. The joint workshop aims to bring together the more theoretical concept of KT with the more practical experiences in three different countries: Scotland, Germany and the Netherlands. The workshop will begin with a presentation on the different concepts of KT in relation to BoD. This will be followed by three presentations of NBoD experiences. Exchange with the audience will be facilitated by using an interactive Mentimeter poll during the session, In this poll, delegates will be asked what they consider to be good elements of KT, and what they consider as main obstacles for KT, in relation to BoD. Key messages Knowledge translation is crucial to bridge the gap between burden of disease research and evidence-informed policy making. Combining the theoretical approach with the practical experience of different countries give valuable complementary insights in effective knowledge translation.

What are the most relevant diseases in a country? Which risk factors are the strongest contributors to disease and death? How is the impact of different diseases evolving over time, and how does it compare to other countries or across sub-national units? With a constantly growing need to rationalize the allocation of available resources, a timely, sound and comprehensive answer to these fundamental questions is more than ever needed to inform public health decision making. Driven by the impact of the Global Burden of Disease study, several countries have decided to establish a national burden of disease study to address these questions. Central to any national burden of disease study is the establishment of a coherent framework for routinely quantifying the impact of diseases and risk factors in terms of Disability-Adjusted Life Years (DALYs). National burden of disease studies further allow to valorise existing health information, foster collaborations with national stakeholders, and support capacity building. Implementing a national burden of disease study is however highly resource demanding, and many researchers struggle to effectively translate their findings to decision makers. This skills building seminar gathers five inspirational examples of national burden of disease studies from across the globe. They reflect the diversity in approaches that currently exist. Indeed, while some countries have implemented their national burden of disease framework themselves, an increasing number of countries is collaborating with the Institute for Health Metrics and Evaluation (IHME) to conduct national and sub-national burden of disease studies. Both approaches have their own specific advantages, which will be outlined during the seminar. The selected examples further document the iterative, step-wise processes behind the implementation of a national burden of disease study, as well as the challenges, but also success stories, in translating data to policies. Overall, the aim is to demonstrate the added value of national burden of disease studies, and to share realistic, hands-on experiences on the steps needed to initiate, implement and maintain a national burden of disease study. Key messages National burden of disease studies are increasingly established across the world to support public health decision making. Different international initiatives are emerging to support countries initiate, implement and maintain a national burden of disease study.

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.

Purpose To explore the combined effect of trends in older people on their future healthcare utilisation. Methods A Delphi study consisting of two rounds was conducted. The heterogeneous expert panel (n = 16) in the field of elderly care rated the effect of combinations of trends in the Netherlands on the use of seven healthcare services: i.e. informal, home, general practitioner, acute, specialist, nursing home and mental health care. The percentage and direction of the overall consensus, for the different health services, and for three main trends were analysed. Results Experts reached consensus in 57 of 92 ratings (62%). Taking into account the interaction between trends, they expected an extra increase for informal, home, and general practitioner care, but no additional effect of interaction for specialist and acute care. Combinations that included trends leading to less support were expected to lead to an extra increase in utilisation. Conclusions Experts expect that interaction between trends will lead to an extra increase in the use of general practitioner, home, and informal care. This increase is mainly the result of interaction with trends leading to less support for older persons. The present results show the need to take the effect of interaction into account when designing new health policy and in research on future healthcare utilisation.

Background 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. Methods 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. Results 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. Conclusions 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.

An estimated 26% of current global child deaths can be attributed to various and modifiable environmental factors, which are addressed under multiple Sustainable Development Goals (SDGs). This study assesses future reductions in child mortality in relation to the achievement of environment-related SDG targets. It uses projections of health risk factors from the IMAGE 3.0 Integrated Assessment Model, based on the Shared Socioeconomic Pathways (SSPs), linked to a standard multi-state health model (GISMO), distinguishing risk factors, disease occurrence and cause-specific death. The study concludes that, on a global level, the SDG target on child mortality will not be achieved in any of the three SSP scenarios analysed, mainly due to persistent high mortality rates in Sub-Saharan Africa and South Asia. By 2030, environmental health risk factors – including childhood undernutrition, no access to improved drinking water and sanitation, no access to modern fuels and exposure to malaria – will still be responsible for 14% to 16% of total global child deaths (8% to 10% when excluding nutrition-related mortality). Under the middle-of-the-road SSP2 baseline scenario, achievement of the SDG targets on hunger, drinking water and sanitation and modern energy services, would avoid 433 thousand child deaths by 2030. If, in addition, also higher standards would be achieved for access to water and energy, as well as universal secondary female education and advanced malaria control, a total of 733 thousand child deaths is projected to be avoided by 2030 (444 thousand child deaths, when excluding nutrition-related mortality), which would reduce projected global child mortality by 13%. Overall, more than 25% of the child mortality reduction that is needed to achieve the SDG target in Sub-Saharan Africa can be achieved through SDG-related policies on food, water and energy. This requires integrated and intersectoral approaches to environmental health.

The processes of indicator selection and data collection have been explained in the previous chapters. The next step in climbing the information pyramid is the analysis phase. This includes the calculation of indicator values (moving from data to information) and, subsequently, placing these indicators into a context in order to make them meaningful for policy (moving from information to knowledge). However, performing an analysis does not only imply a contextualization of content. For a population health analyst, it is also important to understand the context of the process of analysis and ask questions like: who has commissioned the assignment, and for what purpose? What are the values, norms and customs of the organization I am working for, and how do they impact on my analysis approach? How do available resources influence the analysis process? In this chapter, first a framework for getting to grips with the context of the analysis process is provided. This includes understanding the why, how and what of the analysis. After that, a framework for contextualizing indicator values is described. This entails two main steps or activities: comparing indicator values and integrating the thus obtained information with information from other disciplines and perspectives. For both frameworks, practical guidance, examples, tools and caveats are provided. The chapter ends with an overview of current and future developments that are expected to significantly influence population health analysis practice.

Monitoring and assessment of population health often start with a conceptual framework or model. Although such frameworks may appear rather abstract and far away from everyday problems, they can be applied usefully in population health monitoring. This chapter will first address the potential use of frameworks and models: what are the differences between frameworks and models, and for what purposes can they be used? What are possible problems, pitfalls and complexities? Next, commonly used conceptual frameworks for population health monitoring will be addressed. Concepts, as defined in a model or framework, are often rather broad and abstract. Since such concepts cannot be monitored directly, they need to be translated into health indicators, which are specific and measurable. Therefore, the second part of this chapter addresses (health) indicators: what is an indicator, and what kinds of indicators exist? How can indicators be used and what are their limitations? What are commonly used selection criteria for indicators? The chapter will conclude with an overview of current and future developments in the field of conceptual approaches and indicators for monitoring population health.

One quarter of the global disease burden could be avoided with management strategies for environmental risk factors such as air and water pollution, food contamination, injuries and poor road safety. Many decisions influencing health are made outside the health sector; thus, the joint consideration and implementation of health and environmental factors in the relevant policies are becoming increasingly important.By means of a selective literature search, we identified important policy documents and selected research articles as a basis for the introduction and current discussion of the Health in All Policies (HiAP) approach. Parallels with the Environment in All Policies (EIAP) approach are debated.The consideration and reinforcement of environmental topics in HiAP and the link with health in the EiAP approach increase the chances of policies with mutually positive effects, especially with regard to the significance of social factors for health and the environment. The UN Sustainable Development Goals provide a good starting point for a joint strategy for reinforcing health and environmental aspects. Health and Environmental Impact Assessments are accepted procedures in many countries. The HiAP strategy implemented in South Australia provides a well-documented institutional approach to the integration and linkage of health and environmental issues. These examples can be used as well-established starting points for a definition of HiAP incorporating the equitable involvement of environmental issues. Barriers to this goal relate, for example, to the particular interests of the various participating sectors.

BACKGROUND: One quarter of the global disease burden could be avoided with management strategies for environmental risk factors such as air and water pollution, food contamination, injuries and poor road safety. Many decisions influencing health are made outside the health sector; thus, the joint consideration and implementation of health and environmental factors in the relevant policies are becoming increasingly important. MATERIALS AND METHODS: By means of a selective literature search, we identified important policy documents and selected research articles as a basis for the introduction and current discussion of the Health in All Policies (HiAP) approach. Parallels with the Environment in All Policies (EIAP) approach are debated. RESULTS AND CONCLUSIONS: The consideration and reinforcement of environmental topics in HiAP and the link with health in the EiAP approach increase the chances of policies with mutually positive effects, especially with regard to the significance of social factors for health and the environment. The UN Sustainable Development Goals provide a good starting point for a joint strategy for reinforcing health and environmental aspects. Health and Environmental Impact Assessments are accepted procedures in many countries. The HiAP strategy implemented in South Australia provides a well-documented institutional approach to the integration and linkage of health and environmental issues. These examples can be used as well-established starting points for a definition of HiAP incorporating the equitable involvement of environmental issues. Barriers to this goal relate, for example, to the particular interests of the various participating sectors. HINTERGRUND: Ein Viertel der globalen Krankheitslast könnte durch Strategien zum Management umweltbedingter Risikofaktoren wie Luft- und Wasserverschmutzung, Lebensmittelverunreinigung, Verletzungen und mangelnde Verkehrssicherheit vermieden werden. Viele die Gesundheit beeinflussende Entscheidungen werden außerhalb des Gesundheitssektors getroffen, sodass eine gemeinsame Betrachtung und Umsetzung von gesundheitlichen und Umweltbelangen in den relevanten Politiken immer bedeutsamer wird. MATERIAL UND METHODEN: Mittels einer selektiven Literaturrecherche identifizierten wir wichtige Policy-Dokumente und ausgewählte Forschungsartikel, anhand derer wir die Grundlagen und aktuelle Diskussionen zum Health-in-all-Policies(HiAP)-Ansatz darstellen und die Parallelen zu einem Environment-in-all-Policies(EIAP)-Ansatz diskutieren. ERGEBNISSE UND DISKUSSION: Die Berücksichtigung und Stärkung des Themas Umwelt in HiAP und die Verknüpfung mit Gesundheit im EiAP-Ansatz erhöhen die Chancen auf Politiken mit beidseitig positiven Wirkungen, insbesondere angesichts der Bedeutung sozialer Faktoren für Gesundheit und Umwelt. Die nachhaltigen Entwicklungsziele der Vereinten Nationen bieten Ansatzpunkte einer gemeinsamen Strategie der Stärkung von Gesundheits- und Umweltbelangen. Umwelt- und Gesundheitsfolgenabschätzungen sind akzeptierte Vorgehensweisen in vielen Staaten. Die südaustralische Health-in-all-Policies-Strategie bietet einen gut dokumentierten institutionellen Ansatz für die Integration und Verknüpfung von Gesundheits- und Umweltaspekten. Die Beispiele können als gut etablierter Startpunkte für eine Definition von HiAP inklusive eines gleichberechtigten Einbezuges von Umweltaspekten genutzt werden. Barrieren auf diesem Weg liegen u. a. in den Eigeninteressen der beteiligten Sektoren.

It is widely accepted that environmental change can influence human migration. In particular, the environment plays a role in migration processes in drylands, in which environmental change—including increasing variability of rainfall, increasing frequency of droughts, chronic water shortage, and land degradation—can heavily influence migration. However, systematic large-scale studies of the relationship between environmental factors and human migration are rare, and a global, consistent picture of environmental drivers of migration is lacking. In this study, we sought to fill this gap by analysing spatial patterns of environmental drivers of migration in drylands by performing a cluster analysis on spatially explicit global data. In this analysis, we focused explicitly on precipitation, aridity, drought, land degradation, soil constraints, and availability of cropland and pastures as potential environmental drivers of migration in drylands. In addition, we linked the identified clusters to two observed hotspots of out-migration—Burkina Faso and Northeast Brazil—to gauge the cluster results. Our results show that environmental drivers can be grouped into eight distinct clusters, and we identified the most severe environmental constraints for each cluster. These results suggest that out-migration—both in absolute and relative terms—occurs most frequently in a cluster that is constrained primarily by land degradation rather than water availability.

Hoe zullen de volksgezondheid en zorg zich in Nederland tot 2030 ontwikkelen als er veel meer ouderen komen? We putten daarvoor uit de nieuwste Volksgezondheid Toekomst Verkenningen van het RIVM (VTV-2014). Voor deze VTV is een trendscenario ontwikkeld waarin – op basis van simulatiemodellen – bestaande trends worden doorgetrokken naar 2030 zonder dat er nieuw beleid zal zijn. We presenteren hier een selectie uit dat trendscenario. Daarnaast bespreken we kort vier maatschappelijke perspectieven uit de VTV-2010, die het beleid en stakeholders kunnen helpen in het identificeren van kansen en keuzes voor het beleid, bijvoorbeeld rond ouderenzorg.

We present an innovative global-to-local modeling approach to analyze impacts of uncertain and complex futures on Vietnam’s economy via changes in land use patterns. Socio-economic changes are shown to have major implications for the Vietnamese landscape, including natural forest losses with negative consequences for biodiversity and greenhouse gas emissions, and losses of paddy rice and other agricultural lands in the Red River Delta and the Mekong River delta. Climate-related flood risks in these areas further threaten the population, economic assets, and food security. The scenarios reveal the importance of investments in agriculture, land markets, and climate change mitigation and adaptation.

Global environmental change scenarios typically distinguish between about 10–20 global regions. However, various studies need scenario information at a higher level of spatial detail. This paper presents a set of algorithms that aim to fill this gap by providing downscaled scenario data for population, gross domestic product (GDP) and emissions at the national and grid levels. The proposed methodology is based on external-input-based downscaling for population, convergence-based downscaling for GDP and emissions, and linear algorithms to go to grid levels. The algorithms are applied to the IPCC-SRES scenarios, where the results seem to provide a credible basis for global environmental change assessments.

Environmental change is an acknowledged factor influencing human migration. Analytical research regarding the relationship between the environment and human migration has increased in recent years yet still faces numerous hurdles, partly due to limited availability of suitable data. We review available data and methodologies for investigating the environment-migration nexus, identifying data inconsistencies resulting from the combination of different sources and illustrating the underlying reasons for them. We discuss a number of methods for investigating the environment-migration relationship, including frameworks and concepts; surveys; empirical, quantitative methods; and simulation approaches. Based on this overview, we offer recommendations for improved analyses of the environment-migration nexus including reporting data inconsistencies and uncertainties, combining approaches and data sources, and developing multiple-study approaches.

Thema dieses Kapitels sind die aktuellen und voraussichtlichen Auswirkungen von vier wichtigen Umweltfaktoren auf die menschliche Gesundheit: Luftverschmutzung (wobei sich der Blick vor allem auf die vorzeitigen Todesfalle durch Feinstaub in der Ausenluft, bodennahes Ozon sowie Innenraumluftverschmutzung richtet), mangelhafte Wasser- und Sanitarversorgung (u.a. im Kontext der entsprechenden Millenniumsentwicklungsziele), Chemikalien (chemische Gefahren, Chemikalienexpositionen) und Klimawandel (wobei es hauptsachlich um die Malariainzidenz geht). Fur jeden dieser Bereiche werden zunachst die aktuellen Trends beschrieben, um anschliesend zu untersuchen, wie sich die Situation im Jahr 2050 bei gleichbleibender Politik darstellen wurde (Basisszenario des Umweltausblicks); zuletzt werden dann die erforderlichen Politikmasnahmen erlautert. Luftverschmutzung, verunreinigtes Trinkwasser, unzulangliche sanitare Einrichtungen und gefahrliche Chemikalien stellen erhebliche Bedrohungen fur die menschliche Gesundheit dar, insbesondere fur altere Menschen und Kinder. Wahrend bei einigen globalen Trends eine Verbesserung festzustellen ist (z.B. hinsichtlich der Wasserversorgung), gehen von anderen Faktoren – beispielsweise der Luftverschmutzung in stadtischen Raumen und dem Mangel an sanitarer Grundversorgung – nach wie vor ernste Gefahren fur die menschliche Gesundheit aus. Zudem fuhren die inkrementellen Effekte des Klimawandels zu einer Erhohung der weltweiten Krankheitslast. Zur Bewaltigung dieser Risiken bedarf es ehrgeiziger und flexibler Masnahmen zur Verringerung der Umweltbelastungen (z.B. durch Standards, Kraftstoffsteuern, Chemikalienprufungen und -bewertungen, Methoden der umweltfreundlichen Beschaffung, Capand- Trade-Emissionshandel und verkehrspolitische Masnahmen) sowie weiterer Investitionen in die Wasser- und Sanitarversorgung. Erkannte Gefahren mussen thematisiert und beseitigt werden, und wir mussen wachsam bleiben, um rasch auf neue bzw. sich erst ankundigende Risiken fur die menschliche Gesundheit reagieren zu konnen, uber die wir noch nicht genugend wissen (z.B. endokrine Disruptoren und Nanomaterialien).

Background Aims:: Human health effects from exposure to outdoor air pollution, particularly ground level ozone and airborne particulate matter (PM), cause globally, 8% of lung cancer deaths, 5% of ...

This chapter explores dystopian futures. After a summary of the uncertainties and risks discussed for each of the subsystems, integrated experiments are presented in which world view and management style throughout the world system are at odds. We also investigate the effectiveness of various response options and of the timing of certain policy measures . Introduction In the previous chapter we outlined possible futures which are based on coherent sets of assumptions about how the world system functions and how it is managed. These are called utopias and constitute the diagonal elements in the matrix presented in Figure 10.7. In a way, they are idealised and therefore implausible images of the future. In this chapter we first present some simulation experiments in which dystopian trends are explored with the integrated TARGETS 1.0 model. This is a prelude to the next section in which we analyse in more detail images of the future where world view and management style are at odds. These are referred to as integrated dystopias (see Chapter 11) and they are actually more plausible because they contain real-world tensions between diverging world views and management styles. Two major chains which cause feedback loops are presented as a framework discussing some interesting dystopian futures and to give an assessment of associated risks. Finally, we explore the adequacy of response actions in terms of intensity and timing, and the consequences of allocating insufficient investments to the food, water and energy sectors.

Scenarios are used to explore the consequences of different adaptation and mitigation strategies under uncertainty. In this paper, two scenarios are used to explore developments with (1) no mitigation leading to an increase of global mean temperature of 4 °C by 2100 and (2) an ambitious mitigation strategy leading to 2 °C increase by 2100. For the second scenario, uncertainties in the climate system imply that a global mean temperature increase of 3 °C or more cannot be ruled out. Our analysis shows that, in many cases, adaptation and mitigation are not trade-offs but supplements. For example, the number of people exposed to increased water resource stress due to climate change can be substantially reduced in the mitigation scenario, but adaptation will still be required for the remaining large numbers of people exposed to increased stress. Another example is sea level rise, for which, from a global and purely monetary perspective, adaptation (up to 2100) seems more effective than mitigation. From the perspective of poorer and small island countries, however, stringent mitigation is necessary to keep risks at manageable levels. For agriculture, only a scenario based on a combination of adaptation and mitigation is able to avoid serious climate change impacts. © 2010 Elsevier Ltd.

This paper describes a conceptual framework for the health implications of globalisation. The framework is developed by first identifying the main determinants of population health and the main features of the globalisation process. The resulting conceptual model explicitly visualises that globalisation affects the institutional, economic, social-cultural and ecological determinants of population health, and that the globalisation process mainly operates at the contextual level, while influencing health through its more distal and proximal determinants. The developed framework provides valuable insights in how to organise the complexity involved in studying the health effects resulting from globalisation. It could, therefore, give a meaningful contribution to further empirical research by serving as a 'think-model' and provides a basis for the development of future scenarios on health.