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Table 4 List of 178 potential drivers included in round 2 of the Web-Delphi, and distribution of the answers in that round

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

PESTLE category Driver SD D NAD A SA DK/ DWtA
Political Strength of liberal political orientations 7% 7% 10% 33% 38% 5%
Political Capacity to produce EU agreements   7% 40% 48% 5%  
Political EU integration process   2% 26% 55% 17%  
Political Confidence in EU policies 2% 2% 43% 48% 5%  
Political Cohesion funds (or other funds) for less-favoured regions   2% 7% 43% 48%  
Political Political commitment and ideological support towards universal access to healthcare 2% 5% 10% 29% 55%  
Political State involvement in public health 2% 2% 12% 33% 50%  
Political Commitment to appropriateness of the healthcare systems in the EU   5% 31% 36% 26% 2%
Political Market oriented reforms in healthcare (including privatization of healthcare) 7% 10% 14% 31% 38%  
Political Priority for investment in innovation in health 5% 7% 14% 45% 29%  
Political Social protection policies for the elderly   7% 5% 40% 48%  
Political Investments in national social security systems 2%   10% 48% 40%  
Political Global political evolution (e.g. the aftermath of the United States elections; Syria war, etc.) 2% 12% 26% 29% 31%  
Political Power of populistic, protectionist and nationalist radical political projects in the EU 5% 7% 19% 29% 38% 2%
Political Political stability in the EU and its Member-States (e.g. Brexit) 2% 7% 21% 50% 17% 2%
Political Municipalisation [i.e. power to the municipalities] 5% 10% 33% 33% 17% 2%
Political Application of road regulations/rules   10% 31% 48% 2% 10%
Political Degree of penalization associated with traffic policies to reduce traffic accidents 2% 12% 31% 38% 7% 10%
Political Policies for reducing traffic accidents in Eastern countries    29% 48% 19% 5%
Political Levels of investment in road safety   5% 26% 48% 19% 2%
Political Austerity policies 7% 5% 10% 31% 43% 5%
Political Growth of compulsory education   5% 7% 40% 45% 2%
Political Privatization of education 10% 17% 19% 31% 21% 2%
Political Investment in the modernization of the built environment   5% 21% 40% 33%  
Economic Financing of the healthcare sector (in proportion of the Gross Domestic Product) in more economically vulnerable countries 2% 2% 10% 55% 29% 2%
Economic Social insurance schemes 2% 7% 10% 40% 40%  
Economic Financial pressure on healthcare systems 5% 7% 10% 50% 29%  
Economic Public expenditure in the healthcare system   2% 7% 50% 40%  
Economic Healthcare costs 2% 5% 17% 36% 40%  
Economic Constraints on fiscal policies   2% 33% 43% 14% 7%
Economic Economic evolution in EU countries with a younger population compared to the economic evolution in EU countries with an older population   2% 24% 55% 12% 7%
Economic Economic growth of some EU countries, namely of the ones from the former Eastern block 2%   24% 64% 10%  
Economic Evolution of socioeconomic conditions and wealth in less developed countries/areas in Europe   2% 7% 57% 31% 2%
Economic Economic evolution (e.g. Gross Domestic Product, productivity)   5% 24% 43% 26% 2%
Economic Economic evolution in some countries of the Southern Europe (compared to the other EU countries)   2% 17% 52% 26% 2%
Economic Economic and social crises    5% 43% 52%  
Economic Financial crisis   2% 10% 38% 50%  
Economic Concentration of capital accumulation 2% 5% 24% 36% 33%  
Economic People's economic stress   2% 14% 38% 45%  
Economic Economic inequalities 2%   2% 21% 74%  
Economic Early retirement in some countries of the Southern Europe (compared to the other EU countries)   12% 52% 26% 7% 2%
Economic Pension levels and differences in working after retirement   2% 19% 57% 21%  
Economic Proportion of economically dependent population   2% 21% 45% 31%  
Economic Evolution of financial burden share between generations within families   5% 26% 45% 24%  
Economic Financial pressures leading to cuts in social expenditures (e.g. pensions)   2% 7% 40% 50%  
Economic Differences in pension regimes within the EU (e.g. differences in national net pension replacement rates)   2% 29% 45% 21% 2%
Economic Poverty levels    7% 21% 71%  
Economic Social benefits    12% 43% 45%  
Economic Global economic integration and interrelations   7% 21% 45% 21% 5%
Economic Inclusion of the refugees on the labour market 2% 10% 21% 40% 26%  
Economic Unemployment rate in Europe   2% 2% 48% 48%  
Economic Long-term structural unemployment    2% 33% 64%  
Economic Unemployment in late ages    7% 43% 50%  
Economic Employment precariousness    2% 52% 43% 2%
Economic Employment with low income/limited social benefits    7% 43% 50%  
Economic Unemployment in countries of the Southern Europe (compared to the other EU countries)   7% 21% 43% 24% 5%
Economic Employment opportunities for people with low qualifications   2% 17% 64% 17%  
Economic Employment opportunities for medical/health personnel 2% 14% 29% 45% 10%  
Economic Disparities in industry production   14% 50% 24% 7% 5%
Economic Investment in formal education   2% 24% 45% 29%  
Economic Demand for qualified workers   10% 33% 48% 7% 2%
Social Refugees and migrants’ fluxes   7% 17% 60% 14% 2%
Social Migrations to the most economically developed North-West European countries   7% 26% 57% 7% 2%
Social Emigration from EU countries already affected by population ageing and decrease in natality   12% 26% 48% 12% 2%
Social Urbanisation (attractiveness of urban areas)   7% 31% 50% 12%  
Social Concentration of people in suburban areas   7% 33% 45% 14%  
Social Concentration of people at risk (e.g. poverty) in problematic neighbourhoods   2% 7% 48% 43%  
Social Differential in regions’ ability (political and/or economic) to attract young people, including migrants and refugees   5% 21% 55% 17% 2%
Social Population ageing   14% 19% 31% 36%  
Social Quantitative evolution of the young population   14% 36% 36% 10% 5%
Social Birth rates across EU countries   14% 43% 33% 10%  
Social Birth rates in some countries of the Southern Europe (compared to the other EU countries)   14% 45% 33% 7%  
Social Ageing pace in Central and Eastern Europe compared to other EU countries   12% 43% 40% 5%  
Social Regional differences in ageing patterns at a European level   12% 40% 40% 7%  
Social Life expectancy   12% 19% 43% 21% 5%
Social Healthy life expectancy   10% 17% 29% 38% 7%
Social Differential in regions’ health expectancy   7% 19% 50% 17% 7%
Social Voting power of the elderly population 2% 12% 60% 21% 5%  
Social Population growth in relation to the “housing capacity”   7% 55% 29% 5% 5%
Social Awareness of the road safety problematic   17% 45% 31% 5% 2%
Social Road safety campaigns and education 2% 10% 38% 40% 7% 2%
Social Social pressure for “bridging the gap” in terms of built environment   5% 29% 62% 5%  
Social Overall quality of road infrastructure 2% 2% 31% 55% 7% 2%
Social Quality of the roads in Southern and Eastern Europe 2% 7% 29% 52% 7% 2%
Social Vehicles quality and safety   2% 36% 50% 10% 2%
Social Metropolization   2% 45% 45% 5% 2%
Social Traffic density   5% 38% 38% 19%  
Social Disparities in medical standards   2% 17% 43% 36% 2%
Social Medical quality   5% 17% 38% 40%  
Social Medical effectiveness of healthcare services   2% 12% 45% 40%  
Social Access to healthcare    5% 33% 62%  
Social Access to hospital emergency room   5% 10% 52% 33%  
Social Quality and accessibility of the primary health care services    5% 38% 57%  
Social Access to healthcare services in rural areas    10% 40% 48% 2%
Social Quality of Emergency Medical Services (EMS) in remote and/or rural areas   2% 10% 50% 36% 2%
Social Emergency Medical Services efficiency   5% 19% 45% 31%  
Social European medical network   7% 36% 45% 12%  
Social European citizens’ health literacy and collaboration capacity as patients    29% 43% 29%  
Social Educational and public health campaigns   10% 21% 43% 26%  
Social Education and training of health professionals   10% 24% 43% 24%  
Social Mobility of health professionals between countries and regions   10% 36% 40% 12% 2%
Social Concentration of equipment and clusters of medical activities   5% 43% 36% 17%  
Social Availability of health infrastructures   2% 19% 48% 31%  
Social Coverage of National Health Service    5% 52% 40% 2%
Social Response capacity of the health sector (quality of emergency/first respondents and hospital care) in less developed countries    12% 55% 31% 2%
Social Quality of healthcare organization and management   5% 10% 48% 38%  
Social Knowledge sharing   2% 33% 36% 26% 2%
Social Availability of information on better lifestyles   5% 36% 36% 24%  
Social Quality of the education in the EU    17% 52% 31%  
Social Academisation of the society   7% 40% 40% 10% 2%
Social Low qualifications in the EU    29% 64% 7%  
Social Impacts on the quality of jobs and enthusiasm for Tertiary Education    38% 52% 5% 5%
Social Monitoring of education results   7% 55% 36% 2%  
Social Capacity of Eastern European countries to cope with the collapse of the soviet society [i.e. with the loss of some of its key features, for instance in education]   10% 45% 38% 5% 2%
Social Educational attainment as an aspiration of EU countries   10% 29% 50% 7% 5%
Social Objectives in education in the EU   5% 43% 36% 14% 2%
Social Levels of education and literacy   2% 2% 69% 24% 2%
Social Flexibility of academic curricula in the EU 2% 12% 48% 31% 2% 5%
Social University fees   7% 40% 36% 12% 5%
Social Academisation of job profiles   14% 50% 29% 2% 5%
Social Existence of vocational training   10% 36% 43% 7% 5%
Social Differences in cultural traditions   19% 31% 36% 10% 5%
Social Globalization of style life   17% 31% 43% 5% 5%
Social Awareness regarding the impact of lifestyles on quality of life   14% 17% 50% 14% 5%
Social Stress   7% 17% 33% 40% 2%
Social Awareness campaigns tackling alcohol consumption   12% 12% 52% 24%  
Social Awareness regarding the impact of smoking   10% 14% 48% 29%  
Social Smoking restriction policies   2% 2% 48% 48%  
Social Smoking among women    12% 40% 48%  
Social Smoking among manual workers    14% 52% 31% 2%
Social Taxation and control of unhealthy food consumption   2% 10% 57% 31%  
Social Diet   5% 17% 38% 40%  
Social Disparities in health behaviours   7% 10% 52% 31%  
Social Sedentary lifestyles    17% 43% 40%  
Social Evolution of Non-communicable diseases like diabetes and hypertension   2% 10% 43% 43% 2%
Social Social mobility (change in hierarchies in socio-economic positions)   7% 14% 52% 26%  
Social Motorization in Eastern countries   7% 45% 38% 5% 5%
Technological Medical innovation (new medicines and technologies)   5% 17% 45% 31% 2%
Technological Technology and medical devices at home   10% 19% 45% 24% 2%
Technological Technology and innovation costs in healthcare systems   7% 17% 50% 26%  
Technological Evolution of vehicles batteries’ autonomy   19% 40% 31% 10%  
Technological Knowledge and innovation in technology and materials for road safety   10% 33% 45% 7% 5%
Technological Innovation in technology and materials for the built environment   10% 33% 40% 14% 2%
Technological Innovation in housing (new forms of housing)   14% 33% 33% 14% 5%
Technological Price of technology and materials for road safety and for the built environment   7% 38% 38% 14% 2%
Technological Acceleration in industry development in less developed countries   14% 33% 38% 12% 2%
Technological Pace of change in manufacturing in Europe (industry 4.0)   14% 43% 26% 12% 5%
Technological Automation of industrial production   7% 40% 33% 14% 5%
Technological Internet access 2% 5% 33% 48% 12%  
Environmental Quality of the living environment   2% 2% 50% 45%  
Environmental Quality of the outdoor air   2%   38% 60%  
Environmental Climate change   2% 14% 43% 38% 2%
Environmental Climate change actions and policies   5% 17% 43% 33% 2%
Environmental Concerns related to natural resources efficiency (e.g. energy efficiency)   7% 26% 43% 24%  
Environmental Energy efficiency efforts   10% 19% 52% 19%  
Environmental Recycling: taxation and quotas   12% 29% 45% 14%  
Environmental Social and political awareness/preoccupation with the physical environment, namely air and noise conditions   7% 14% 55% 24%  
Environmental Gap in “environmental awareness” between more developed and less developed countries   2% 24% 48% 26%  
Environmental Priorities in terms of economic model: green-based vs oil-based (e.g. evolution of the number of environmental friendly vehicles)   5% 10% 45% 36% 5%
Environmental Development of sustainable energy production (water, wind, sun)    21% 38% 40%  
Environmental Industrial development sustainability 2% 7% 29% 38% 24%  
Environmental Regional differences of the building construction boom   14% 29% 52% 5%  
Environmental Coordination of environmental-focused political measures   7% 21% 57% 14%  
Environmental Environmental protection policies focused on industrial manufacturing   7% 17% 57% 17% 2%
Environmental Environmental protection policies focused on vehicles circulation   5% 14% 60% 19% 2%
Environmental International and worldwide environmental agreements   7% 14% 45% 31% 2%
Environmental United States of America commitment towards the Paris Agreement on climate change global action   10% 14% 48% 26% 2%
Legal EU Legislation/ Directives and its transposition into the legislation of each country   10% 33% 43% 10% 5%
Legal Adaptability of EU regulations (especially inside the Eurozone) to Member-states specificities   7% 45% 33% 12% 2%
Legal Commitment to follow EU directives and World Health Organization guidelines   5% 19% 52% 21% 2%
Legal EU legislation / directives on built environment   7% 21% 57% 10% 5%
Legal National building construction rules and legislation   12% 31% 40% 10% 7%
Legal Differences in road safety national legislation 2% 7% 29% 55% 2% 5%
Legal EU environmental policies and regulations   5% 17% 64% 12% 2%
Legal Requirements of compliance to environmental regulations for market purposes (e.g. quality of fuel)   2% 24% 55% 17% 2%
Legal Evolution of intellectual property rights in health 2% 12% 43% 24% 14% 5%
Legal Impact of the TTIP (Transatlantic Trade and Investment Partnership) project in the access to the latest advances in medicines, diagnostic tools, and other life-saving medical technologies 5% 5% 45% 26% 17% 2%
Legal Integration of EU labour markets   10% 38% 38% 10% 5%
  1. SD Strongly Disagree, D Disagree, NAD Neither Agree nor Disagree, A Agree, SA Strongly Agree, DK/DWtA Don’t Know/Don’t Want to Answer
  2. Note: the 49 drivers selected after round 2, by applying the selection rules, are highlighted in bold; among these, in italic, are the drivers that resulted from the application of the second selection rule.