Table 1 Short descriptions of FRESHER Scenarios [17]

 The priority is to promote health and well-being for all.

Governments, the private sector and citizens’ networks collaborate closely to develop solutions promoting quality of life, healthy opportunities and efficient care. As governments take the lead, citizen participation is ensured throughout the policy making process, to promote equity, sustainability and human health in all policies. There is high value to leisure, sense of community and nature. Fair income levels up living conditions, ensuring better standards to all. A new socio-economic pattern provides for the means to take better care of one’s own health but also to care for others through informal networks and community engagement. Recycling and sharing practices replace the productivity paradigm and the pressure on the environment.

 The priority is to maintain a healthy workforce, for the continuation of economic productivity & for ensuring the sustainability of the healthcare systems

Thanks to big data, public and private investments effectively influence citizens’ behaviour towards healthy lifestyles. Employers provide healthy working environments and care services. Fair labour legislation is implemented to give workers money, time and knowledge to take better care of their health. The top down approach is ensured by ambient 24/7 surveillance and implanted chips for affordable early diagnostics, tele-medicine and tailor-made treatment. The new era of economic growth and social progress focused on delivering more to everyone, with environmental sustainability seriously monitored. Increasing amount of economic and environmental migrants are let into the EU following strict immigration policy and by primarily considering their skills and possible contributions to the EU’s economic growth.

 Freedom and meritocracy are the pillars of societal structure.

Market forces are dominant and a ‘light government’ guarantees their functioning. European states have privatised the health-care sector to reduce the public debt and have deregulated labour to revitalise the economy. Health is now just like many other services: potentially available, but expensive. Human health and lifestyle are left to individuals’ choices and capacities. The more you can afford, the better treatment you get, thanks to expensive medical innovations including new-generation biomedical devices. The global protection of the environment is ensured by pricing it. It is a socio-economic system where most of the economies are decarbonised and climate change is now under control. The demolition of the welfare state has created new challenges: the growing tensions among citizens cause security issues to rise in the political agenda and the number of marginalized citizens increases.

 The European model declined and the European governance, shared values and the common market were destroyed following the economic crisis.

To gain some legitimacy, national governments cooperate with different stakeholders for policies that are short-sighted and do not consider health implications. Economic stagnation has led many countries to gradually reduce the number of people that can avail public services, increase user charges for services and limit the number of public health providers. "Health shocks”, defined as unpredictable illnesses that diminish health status, increase and innovative medicines, focusing on quick-fix solutions, and treatments are hardly affordable for European states and citizens. The deterioration of living standards undermines the community values and leads to tensions among citizens and mistrust in policy making. Citizens suffer from the consequences of climate change as international containment agreements have been stalled for decades.