The overall objective of the FRESHER project (2015-18) was the representation of alternative futures where the detection of emerging health scenarios is used to test future research policies to effectively tackle the burden of non-communicable diseases (NCDs). The project aimed to identify alternative future health scenarios for Europe, taking into account structural long-term trends in demography, technology, economic, environmental, and societal factors up to 2050.

More precisely, FRESHER has pursued four goals with a strong interaction between them:

  • To produce quantitative estimates of the future global burden of NCDs in the EU and its impact on health care expenditures and delivery, as well as on population well-being. Within the FRESHER Project a microsimulation model was developed, based on advanced OECD model, to produce quantitative forecast of NCDs burden and impact
  • To base such estimates not only on extrapolation of observed past health trends but also on foresight techniques giving credit to the interdependencies of structural long-term trends. This goal implied the run of a Scenarios Building exercise leading to the creation of four alternative futures: the FRESHER Scenarios
  • To illustrate options for decision-makers in order to contain the burden of NCDs and its negative impacts on citizens well-being. The microsimulation model is also designed to assess the impacts of future policies. Sets of public health policies aimed at tackling smoking, harmful alcohol use and obesity were assessed as part of the project to determine their effects on chronic diseases, life expectancy and health care expenditure
  • To promote an interactive process with key actors in health and European policies in order to produce recommendations to policymakers and to design an agenda for future European Health Research.

All efforts converged to elaborate and produce inputs for an empirically-based, yet unique, micro-simulation model capable of quantifying the current and future health and economic impacts of risk factors. The model provides opportunities for testing “what if” policy options regarding the potential future impact of the qualitative scenarios, as well as new policies and policy combinations. FRESHER is among the first European research project combining qualitative foresight and quantitative forecast approaches, including the assessment of major societal trends and computer simulations of their long-term outcomes.


The ambition of FRESHER to provide a conceptual renewal and empirical improvement of health forecasting models, foresight activities and policies was achieved mainly through:

  • An explicit relationship of quantitative modelling with qualitative approaches for building long term scenarios. The FRESHER project has identified eight key societal trends that are especially likely to influence the health of people in Europe between today and 2050, and alternative policies to manage these trends. Four different future Scenarios were derived from alternative hypothesis about their impact on the main risk factors for NCDs and interfaced with a micro-simulation model.
  • A better understanding of the impact of non-health determinants on population health and health expenditures. Micro-simulation results show that NCDs rates may increase by up to a third in 2050 relative to current levels, and health expenditures may increase by one fourth. Life expectancy as well as incidence and prevalence of NCDs are projected to grow to different degrees in the four FRESHER scenarios compared to current levels. However, demographic trends, i.e. population ageing, will remain the main driving force for increase in NCDs and their impact irrespective of the other structural trends affecting health.
  • An integration of the complex causal chains of chronic diseases and multiple risk factors and co-morbidities. The FRESHER project has attempted to better take into account multimorbidity than in previous prospective exercises. Multimorbidity will have significant amplifying consequences on the impact of NCDs. Socioeconomic and behavioural factors appear to be more important than clinical parameters in progression from a single disease to multimorbidity or risk of mortality in those with multimorbidity. In addition, FRESHER economic analysis reveals a super-additive effect of comorbidity on costs.
  • The FRESHER project has assessed the impact of a combination of the most efficient public health policies aimed at tackling NCDs risk factors (poor diets, sedentary behaviours, obesity, smoking and harmful use of alcohol). Results suggest that scaling up these policies across whole of Europe will have some, but limited effect for control of NCDs. Indeed, Scenarios such as “Healthy Together” which already include innovative policies promoting environmental, nutrition, social protection and lifestyle improvements would produce better results than just generalising conventional public health policies in all the other scenarios. Therefore, there is an urgent need for additional and innovative policies targeting the above factors.
  • A dedicated webtool www.fresher-explorer.eu allows for an in-depth comparison between the health scenarios, their impact on NCDs evolution and the effectiveness of standard public health policy interventions. The tool will be further refined and can be used by policy makers from all sectors, researchers and the public health community at large.