Future projections of Burden of Disease in the Netherlands

Abstract Every four years, the National Institute for Public Health and the Environment (RIVM) conducts a public health foresight study to support evidence-based policymaking in the Netherlands. These studies project future health challenges by estimating risk factors, incidence, prevalence, and mortality for a wide range of diseases over the next 25 years. The foresight approach at RIVM uses advanced modeling techniques, including demographic projections, disease models, age-period-cohort models, and risk factor analyses. Both quantitative and qualitative inputs are used, drawing on historical data, surveys, registries, and expert consultations. The analyses also enable projections of disability-adjusted life years (DALYs), calculated by combining Years of Life Lost (YLL) and Years Lived with Disability (YLD). The results highlight future changes in disease burden. Dementia is projected to rise strongly, mainly due to an increase in YLL. Arthrosis will also grow, driven primarily by a rise in YLD. Cardiovascular diseases, although becoming less lethal, will continue to cause a significant burden, with YLD levels remaining high. Producing DALY projections requires key methodological choices. For YLL, remaining life expectancy is based on projected life tables from future all-cause mortality, rather than aspirational life tables. For YLD, it is assumed that the severity distribution of diseases stays constant, even though improvements in detection and treatment could change outcomes. Uncertainty is important and should ideally be addressed through scenario development. Despite limitations, RIVM's foresight studies are essential for proactive public health planning. By identifying future disease burdens and opportunities for action, these projections help policymakers better prepare for emerging challenges, strengthen health resilience, and optimize healthcare systems.