Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience

Alvarenga, António; Bana E Costa, Carlos A.; Borrell i Thió, Carme; Lopes Ferreira, Pedro; Freitas, Ângela; Freitas, Liliana; Oliveira, Mónica; Rodrigues, Teresa C.; Santana, Paula; Lopes Santos, Maria; Vieira, Ana

doi:http://dx.doi.org/10.1186/s12939-019-1000-8

Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience

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Alvarenga A, Bana E Costa CA, Borrell C, Ferreira PL, Freitas Â, Freitas L, Oliveira MD, Rodrigues TC, Santana P, Lopes Santos M, Vieira ACL. Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience. Int J Equity Health. 2019; 18(1):100. DOI: 10.1186/s12939-019-1000-8

Abstract

Background: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges. Objective: This paper describes the three 2030 time-horizon scenarios developed under the EURO-HEALTHY project, depicting the key factors that may affect the evolution of PH inequalities across European regions. Methods: A three-stage socio-technical approach was applied: i) identification of drivers (key factors expected to affect the evolution of PH inequalities across European regions until 2030) - this stage engaged in a Web-Delphi process a multidisciplinary panel of 51 experts and other stakeholders representing the different perspectives regarding PH inequalities; ii) generation of scenario structures - different drivers' configurations (i.e. their hypotheses for evolution) were organized into coherent scenario structures using the Extreme-World Method; and iii) validation of scenario structures and generation of scenario narratives. Stages ii) and iii) were conducted in two workshops with a strategic group of 13 experts with a wide view about PH inequalities. The scenario narratives were elaborated with the participants' insights from both the Web-Delphi process and the two workshops, together with the use of evidence (both current and future-oriented) on the different areas within the PH domain. Results: Three scenarios were developed for the evolution of PH inequalities in Europe until 2030: 'Failing Europe' (worst-case but plausible picture of the future), 'Sustainable Prosperity' (best-case but plausible picture of the future), and an interim scenario 'Being Stuck' depicting a 'to the best of our knowledge' evolution. These scenarios show the extent to which a combination of Political, Economic, Social, Technological, Legal and Environmental drivers shape future health inequalities, providing information for European policy-makers to reflect upon whether and how to design robust policy solutions to tackle PH inequalities. Conclusions: The EURO-HEALTHY scenarios were designed to inform both policy design and appraisal. They broaden the scope, create awareness and generate insights regarding the evolution of PH inequalities across European regions.