3.Q. Workshop: Using foresight to anticipate future public health challenges

Abstract   The COVID-19 pandemic brought great uncertainty about current and future health impacts. Uncertainty about how the virus would directly impact our health. And uncertainty about indirect impacts of COVID-19 on long-term health and wellbeing, including consequences due to delayed prevention, diagnosis, and medical treatment. At this point in time, we know a lot more about the immediate mortality and morbidity aspects. How we fare on the wider impacts on the longer term is more difficult to say. A structured tool for gaining in sight in this, is foresight. We use this tool within the Population Health Information Research Infrastructure (PHIRI). PHIRI supports research across Europe through the identification, access, assessment and reuse of population health and non-health data to underpin public health policy decisions. PHIRI is a practical use case and lays the foundation for ultimately developing a Distributed Infrastructure on Population Health (DIPoH). The joint workshop aims to show ways to better understand the complexity of the wider impacts of the SARS-COV-2 virus on population health across Europe; show how a research infrastructure might help researchers in Europe build capacity and helping each other to achieve higher goals. The workshop will begin with a presentation providing a brief overview of the PHIRI foresight work. This will be followed by two researchers who participated in the PHIRI foresight training program and undertook their own Public Health Foresight study. In the last presentation of the session foresight will be reflected on from a policy perspective. How can researchers and health policy makers better interact to have better foresight-informed policy making. Interaction with the audience will be guaranteed using Mentimeter questions. With this interactive element, insights art obtained what people find the most important trends to act upon, what they consider most important future challenges and how researchers and policymakers can better interact. Key messages • Foresight studies are essential to be better prepared for and to anticipate to future challenges. • With foresight-informed policy making direct and indirect health impacts of COVID-19 are addressed.

Prevailing narratives on health and illness emphasise individual choice and product 'misuse' for the disease and environmental burdens associated with harmful industries, deflecting from the wider environment in which these choices are made. Public Health frameworks such as the Dahlgren and Whitehead model enable us to consider the broader socioeconomic, cultural and environmental conditions that influence these choices (or lack thereof). Until recently, the influence of multinational corporations on these broader conditions has often been ignored, despite the global impact these corporations have in shaping science, policy and our environment. Increasingly Public Health academics and advocates are calling for an enhanced focus on these 'commercial determinants of health' (CDoH) to understand the ways through which corporate interests affect health, sustainability, and health inequities. The concept of CDoH considers (among other things) the harmful or damaging nature of certain products and the tactics employed by industries to protect their commercial interests. The harmful tactics employed by the tobacco industry are well documented, but there is growing evidence that similar tactics are employed by other harmful industries more generally, from alcohol, gambling and food, to agrichemical and fossil fuel industries. In addition to driving consumption (with resulting population and planetary ill health), these tactics have a cross-industry, complementary, cumulative effect; spreading misinformation, shaping 'personal responsibility' and 'nanny state' narratives, weakening regulation and undermining science and policymaking. The impact of these harms accumulates across the life-course, with differential exposure to both harmful products and tactics driving health inequities. We argue there is a need to make visible, or 'resurface' these tactics; at present, Public Health often fails to challenge corporate strategies and, more concerningly, can be complicit in reinforcing industry framings of issues. This session will outline how a life-course, complex systems approach can support this endeavour, exploring a range of industry strategies through a series of case studies and discussing actions needed to safeguard public understanding and policy from commercial interests. This workshop will include 3 short presentations to illuminate some of the more insidious and less overt tactics, with opportunities for questions and panel discussion. The CDoH is an emerging field in Public Health and this session will give audience members an introduction to industry strategies and influences within a life-course framework, focusing on less overt channels of influence and some of the lesser-known industries.

Key messages:
The commercial determinants of health present a significant threat to public and planetary health but are conspicuously absent in the majority of public health conceptual frameworks. Framing these hidden harms and exposures within the lifecourse model can support awareness of CDoH and facilitate public health professionals to counter corporate influences.

Background:
A better understanding of possible future developments is essential for policy makers to anticipate and influence these trends. Public health foresight studies (PHFS) are tools to support this. The current health crisis makes clear that PHFS are necessary more than ever to target possible future impacts resulting from SARS-COV-2 induced changes in e.g. regular health care services, lifestyle and socio-economic developments. To support European countries in doing their own foresight studies, PHIRI aims to strengthen foresight capacity.

Methods:
PHIRI follows a 4-step approach: 1. Making an inventory of current PHFS capacities and capacity needs across European countries using desk research and an online survey; 2. Providing PHFS capacity building via a training course and workshops; 3. Supporting the development of public health scenarios for the short term (0-5 years) and longer-term (5-20 years); 4. Supporting the identification of promising policy strategies, using policy dialogues.

Results:
The online survey was completed by participants of 21 countries and shed light on existing national PHFS and needs for capacity building. It also provided a basis for the development of a professional network on PHFS within the project. A PHFS capacity building course was developed, including videos posted on the PHIRI website and a template structuring the different foresight elements. Around 15 researchers undertook their own PHFS, covering a wide range of public health topics, using the material provided during the course. In addition, a compact guide was developed and provided, explaining the different foresight elements. Based on these studies, common challenges and promising policies are identified.

Conclusions:
Foresight in public health is gaining more and more interest, especially now in these times of crisis. PHIRI provides more insight in the wider public health impacts of the SARS-CoV-2 pandemic and in translating this into policy options.

Results:
Three focus groups were conducted. The first enabled to identify the two driving forces that may influence the digitalization of PHCs in the next 10 years: 1) service innovation and 2) Governance and Regulations. These two driving forces enabled to design three plausible scenarios: a) Innovate or Fade-away; b) Isolated PHC and c) Digital PHC. These scenarios were developed, and their impacts were reflected upon. It was found that the role of human Resources is critical.

Conclusions:
The process of reflection and discussion for the identification of the different driving forces made the different actors discuss the different points of view and find a meeting point to reach a conclusion. Furthermore, this study allowed the different stakeholders to understand the measures and actions to be taken for PHC digitization to be implemented in the most effective way, allowing the sustainability of the National Health Service in Portugal, which until this point were only ideas discussed at the institutional and individual level.