public health in the 21st century, european public health
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Dineke Zeegers Paget, Executive Director of the European Public Health Association (EUPHA) provides a fascinating glimpse of the new challenges for public health in the 21st century

As Europe enters the third decade of the 21st century, we have never been healthier and advances in knowledge and technology have enormously improved our ability to prevent and treat current diseases. Yet there are warnings of developments that could, ultimately, threaten the future of humanity. For this article, I will be focusing on five challenges for public health in the coming decades.

1.) Changing demographics in Europe

The first challenge is the changing demographics in Europe. Climate change, urbanisation, migration and an ageing population are transforming our demographics at the speed of light. For instance, global warming has an increasing impact on migration and we can expect a move to Northern Europe because of economic reasons (e.g. less fertile agricultural land in the South). It is estimated that by 2030, 80% of our citizens will live in urban areas (1) and this may have serious consequences for health if we don’t act now.

In addition, the population in Europe is ageing rapidly and we expect the proportion of people aged 65 and older to increase to 25% in 2050. (2) People will live longer, but not necessarily in good health and well-being, thereby, increasing the burden on health care systems to treat multimorbidity and chronic diseases. We need to address these changing demographics to mitigate their impact.

2.) Technological and digital revolution

The second challenge is the technological and digital revolution. The benefits of technology in health care is clear, developing medical equipment (robot surgery for instance) and better and faster diagnostics (e.g. genetic mapping) are beneficial to prevention and treatment.

On the other hand, there is a real risk in digitalisation. For instance, genetic information can be used in a more discriminative manner for health insurances or mortgage requests. And even though the digital revolution has given us access to all health information on the internet, the quality of information available is not always in our best interests (fake news).

Finally, technology has also led to new ‘diseases’, such as gaming addiction, which was included in the 11th International Classification of Diseases of the WHO. (3) We should be aware of the advantages and disadvantages of technology and digitalisation.

3.) Political influence on public health

The third challenge is the political influence on public health, as public health can only be achieved by concerted action at all levels. And to achieve that, we need politics. We need an understanding of the political system and should be willing to work with politicians. (4)

Especially now where politics are changing rapidly, populism is on the rise and we see a shift in public opinion on the value of scientific evidence. We need to invest in collaborating and coordinating with politicians to make sure our evidence-based voice is heard.

4.) Influence of vested interests

The fourth challenge is the influence of vested interests. In an era of globalisation, big companies have the power to influence politics as well as research. For instance, the Foundation for a Smoke-Free World describes itself as an independent, private foundation, but is funded by Philip Morris International. (5) Another example is the financial support for numerous health organisations in Spain by Coca-Cola. (6) But it does not stop there (e.g. food and petrol industry) and we need to find ways to make the collaboration with industry transparent and beneficial to the public’s health.

5.) New ethical issues of the 21st century

The fifth challenge is the new ethical issues that arise in the 21st century. The right to health, as described in the World Health Organization (WHO) constitution adopted in 1948, includes the right to housing, employment, living standards. But in an era of urbanisation, the right to adequate housing may be nearly impossible to implement. In an ageing population, the discussion between the right to life and quality of life needs to be put on the table, including the right not to live any longer, if the quality of life is decreasing. We need lawyers and ethicists to sit around the table with public health professionals to openly discuss these issues.

It seems clear that the public health network needs to adapt to 21st century challenges. The 21st century public health professional needs to be smart, persistent and creative, be able to be a diplomat and a negotiator at the same time. The approach of health in all policies is essential and the recently published manifesto: ‘All policies for a healthy Europe’ (7) is a step in the right direction.

To overcome all the challenges, old and new, we need to:

  • Be deliberately collaborative by forging broad alliances in and outside the field of public health to get our message across;
  • Be open-minded to engage with partners, including politicians, to jointly come to solutions that have a broad support base;
  • Tell compelling narratives, which address the concerns that people have in a way that people understand; and
  • Be transparent and open about potential uncertainties surrounding the evidence-base.


(2) last accessed 12 May 2019.
(3), last accessed 10 May 2019.
(4) last accessed 12 May 2019.
(5) 2 May 2019.
Last accessed 10 May 2019.
(7) last accessed 12 May 2019


Dineke Zeegers Paget

Executive Director

European Public Health Association (EUPHA)
Director of the EPH Conference Office
Tel: +31 30 2729 709


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