WHO/Europe is currently developing the second European Programme of Work 2026–2030 (EPW2), a collective health agenda for the 53 countries of the WHO European Region. Although EPW2 focuses on the next 5 years, a key measure of success is ensuring that health systems are sufficiently robust to meet the future challenges and opportunities in decades to come.
The health landscape in Europe is changing. Technological advances mean that we have greater access to data and more agency in our individual health choices than ever before. But climate change, ageing populations, the increasing prevalence of mental health issues and noncommunicable diseases, more frequent and severe emergencies and more threats to health security bring new challenges, collectively known as “megatrends”.
On 13 and 14 March, almost 50 health leaders from across the Region participated in a foresight exercise to discuss futures scenarios until 2050. Participants developed a range of future scenarios to understand whether existing plans are adequate to cope with shocks or unfamiliar situations. This is particularly important in a region as culturally, economically and politically diverse as the WHO European Region, where attitudes and access to health may be very different.
The event was hosted by the Copenhagen Institute for Futures Studies, an independent futures think tank employing a qualitative approach combined with economic forecasting to explore different versions of a plausible future. Participants were asked to examine megatrends in the context of different predominant forces:
- growth scenario – steady but modest health-care improvements amid ongoing inequalities and emerging health challenges;
- decline scenario – a scenario where, by 2050, Europe’s health-care systems are fragmented, inefficient and mistrusted, with health-care facilities struggling to cope;
- driver-based scenario – ethics, equity and sustainability are prioritized over rapid technological growth, but innovation is being stifled; and
- transformation-based scenario – Europe is leading a health-care revolution driven by biotechnology, precision medicine and artificial intelligence reshaping health and wellness, but some are left behind and the focus is on prevention rather than treatment.
Participants discussed how the various scenarios would have implications for health care, particularly around equity, accessibility and ethics. Issues included how climate change and ageing populations may accelerate the “brain-drain” of medical professionals seeking better paid overseas opportunities. Ethical issues around health technologies were raised, highlighting the need to ensure that private sector innovation does not mean vulnerable or economically marginalized groups are left behind. The rich cultural, economic and political diversity of the Region was reflected in participants’ lived experiences and perspectives.
Participants took part in a “backcast” method whereby events are identified that need to take place to reach a desired future goal. By assessing the events logically, connections between uncontrollable and controllable future and present events are made through the creation of a logically consistent timeline starting from 2050 and working backwards. By identifying these necessary events and procedures in advance, the design of EPW2 can be “future-proofed” to respond to potential shocks, challenges and opportunities within the Region’s health-care systems.
Bogi Eliasen, Director of Health for the Copenhagen Institute for Future Studies, summed up the learnings of the foresight exercise. “The learnings of the foresight exercise are very important. By working on specific scenarios, we’ve been able to identify what we need to do to ensure that certain potential outcomes do not come to fruition. But we have also been able to identify what we do want to happen, and how we can focus on building towards that outcome. We know where the bottlenecks exist – by approaching things in a new way we can change our way of thinking so that we can be ready to take giant strides when opportunities for change arise.”
The discussions and points raised during the foresight exercise will directly inform the development of collective actions depicted in EPW2 that will help the Region not only respond to the challenges today but also prepare us for the coming years and future decades.
Ending the exercise, WHO Regional Director for Europe, Dr Hans Henri P. Kluge, quoted the Danish philosopher Søren Kierkegaard, “Life can only be understood backwards; but it must be lived forwards.” Despite the current challenges posed by the ongoing emergencies and funding issues, Dr Kluge reiterated his personal commitment to living life forwards and ensuring that space remains for innovation, even in the context of difficult decisions.