Table 1 Overview of the three scenario structures, composed by drivers and drivers’ configurations
From: Scenarios for population health inequalities in 2030 in Europe: the EURO-HEALTHY project experience
PESTLE category | Drivers | Worst-case (increase in inequalities) | To the best of our knowledge | Best-case (decrease in inequalities) |
|---|---|---|---|---|
Political | Cohesion funds (or other funds) for less-favoured regions | Reduction | Maintaining | Maintaining |
Political commitment and public support towards universal access to healthcare | Weak | Weak | Strong | |
Public expenditure in the healthcare system | Reductions | Priority with often insufficient funding | Increases | |
Social protection policies for the elderly | Significantly weaker | Significantly weaker | Significantly stronger | |
Investments in national social security systems | Significantly lower | Without significant change | Significantly higher | |
Extent of compulsory education | Limited and non-harmonized | Extension with weak harmonization | Throughout the EU and increasingly harmonized | |
Quality of Public Education | Decrease | A priority with often insufficient funding | Increase | |
Economic | Healthcare efficiency | Significant decrease | Without significant change | Significant increase |
Financial, Economic and Social crises | Deeper and long lasting | Occasional and regular | Mitigated cyclical global crises | |
People's material deprivation | Increase | Small decrease | Significant decrease | |
Economic inequalities | Increase | Increase | Decrease | |
Social Insurance Schemes | Weakening | Without significant change | Strengthening | |
Unemployment rate in Europe | Significantly higher | Without significant change | Significantly lower | |
Long-term structural unemployment | Significant growth | Without significant change | Significant decrease | |
Unemployment among 55+ | Significant increase | Significant increase | Decrease | |
Employment precariousness | Significant increase | Small increase | Decrease | |
Employment with low income | Significant increase | Small increase | Decrease | |
Social | Concentration of people at of poverty and social exclusion | Higher | Higher | Lower |
Medical quality and effectiveness of healthcare services | Deterioration | Improvements with many dissimilarities | Significantly higher | |
Access to healthcare | More limited | More limited | Widening | |
Quality and accessibility of the primary healthcare services | Significant reduction | Maintaining | Steady growth | |
Access and Quality of Emergency Medical Services (EMS) in remote and/or rural areas | Significantly lower | Without significant changes | Significantly higher | |
Smoking restriction policies | Softer | Stricter | Stricter | |
Diet and nutrition | Significantly less healthy | Limited improvement | Significantly more healthy | |
Sedentary lifestyles | Increase | Limited reduction | Reduction | |
Non-communicable diseases like diabetes and hypertension | Increase | Increase | Decrease | |
Food security | Compromised | Without significant change | Improved | |
Technological | Medical innovation (improved and affordable medicines, medical research and technologies) | Stagnation | Slow growth | Rapid growth |
Environmental | Quality of the built environment | Decrease | Without significant change | Significant improvement |
Quality of the natural environment | Decline | Without significant change | Improvement | |
Quality of the outdoor air | Decline | Sustain the current levels | Improvement | |
Climate change adaptation | Maladaptation | Limited adaptation | Improved resilient adaptation | |
Climate change mitigation | Disengagement | Limited action | Engagement | |
Priorities in terms of economic model: green-based vs. fossil fuel-based | Fossil fuel-based | Slow transition | Green-based | |
Development and penetration of renewable energy production (water, wind, sun) | Slowdown | Increase | Significant and rapid increase | |
Legal | EU environmental policies and regulations (air, water, soil, waste, noise, chemicals) | Ineffective | Limited improvements in effectiveness | Effective |