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

BACKGROUND: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges. OBJECTIVE: This paper describes the three 2030 time-horizon scenarios developed under the EURO-HEALTHY project, depicting the key factors that may affect the evolution of PH inequalities across European regions. METHODS: A three-stage socio-technical approach was applied: i) identification of drivers (key factors expected to affect the evolution of PH inequalities across European regions until 2030) - this stage engaged in a Web-Delphi process a multidisciplinary panel of 51 experts and other stakeholders representing the different perspectives regarding PH inequalities; ii) generation of scenario structures - different drivers' configurations (i.e. their hypotheses for evolution) were organized into coherent scenario structures using the Extreme-World Method; and iii) validation of scenario structures and generation of scenario narratives. Stages ii) and iii) were conducted in two workshops with a strategic group of 13 experts with a wide view about PH inequalities. The scenario narratives were elaborated with the participants' insights from both the Web-Delphi process and the two workshops, together with the use of evidence (both current and future-oriented) on the different areas within the PH domain. RESULTS: Three scenarios were developed for the evolution of PH inequalities in Europe until 2030: 'Failing Europe' (worst-case but plausible picture of the future), 'Sustainable Prosperity' (best-case but plausible picture of the future), and an interim scenario 'Being Stuck' depicting a 'to the best of our knowledge' evolution. These scenarios show the extent to which a combination of Political, Economic, Social, Technological, Legal and Environmental drivers shape future health inequalities, providing information for European policy-makers to reflect upon whether and how to design robust policy solutions to tackle PH inequalities. CONCLUSIONS: The EURO-HEALTHY scenarios were designed to inform both policy design and appraisal. They broaden the scope, create awareness and generate insights regarding the evolution of PH inequalities across European regions.

Transition in action: toward a social theory of the governance of transitions.

This article explores how a re-interpretation of the socio-technical, socio-ecological and transition design approaches to transition from the point of view of Niklas Luhmann's general systems theory of society. The need to understand and promote changes that include a technological and ecological dimension has led to different approaches, such as socio-technical or socio-environmental approaches, to incorporate links with society. While these approaches often include sociological insights, they rarely offer a general understanding of how these are embedded into society. We need a new environmental sociology that helps catalyze change processes with a collectively reorganized society, empowering more radically transformative actions to change the current structures and processes that have led us to where we are today. The article offers a cross-sectional look at the socio-ecological and socio-technical systems literature, specifically for what concerns their understanding of the 'systems' in transition and how they can be governed, and re-interpret it from the theoretical lens of the deep sociological knowledge, which refers to the profound understanding of social systems and their dynamics, embedded in Luhmann's theory of social systems. From here, we suggest the second-order coupling for a sociologically grounded understanding of the interactions that comprise socio-ecological and socio-technical systems, heterogeneous and almost self-organizing assemblies of social, technical, and natural elements and processes. At the same time, third-order couplings are analyzed, focused on governance, relationships between operations, and structures mediated by a deliberate attempt to ensure coherence and coordination against the autonomy and heterogeneity of socio-techno-ecological systems. Therefore, this manuscript offers a deeper conceptual and methodological understanding of socio-techno-ecological couplings and systems in the context of sustainability transformation and gives insights into its governance.