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Wales needs to face up to a number of long-term challenges which threaten to overwhelm our health service, cripple our finances and destabilise our environment.

That's according to a major new report by Public Health Wales which has outlined a bleak vision for our country and its population.

The report, simply called 'Futures for Wales', has called for all public bodies to change their mindset and start planning 20 or 30 years in advance, rather than just three to five years, in a bid to protect people's wellbeing.

Here are some of the major problems Wales is likely to encounter over the next couple of decades providing there are no major policy or societal changes...

Fewer working people paying more taxes to support more elderly people

In many ways it is a success story that people are living longer.

By 2066, a 65-year-old man can expect to live to 90.3 (compared to 85.4 in 2018) and a woman to 92.3 (compared to 87.6 in 2018) in Wales.

But an ageing population poses huge challenges to public services.

By 2039, the number of people aged over 85 is set to more than double (127%), with the number of people aged between 65 and 84 projected to increase by 27%.

More elderly people means the NHS and social care will be put under even greater strain than they are now.

A higher number of people will have increasingly complex care needs, and patients are more likely to need lengthier and increasingly frequent hospital stays.

There are also expected to be fewer working age people to pay taxes to fund those services as the birth rate declines.

This will either mean more taxes, fewer services or people working longer.

The report states: "A decline in the working-age population relative to the number of pensioners could result in lower tax revenues, placing a strain on the local economy and on the resources needed to provide health and social care."

According to the author's findings, more people are set to live near in the major cities of Cardiff and Swansea, whereas more rural authorities could see a drop in their population by 2039.

This could put a strain on the demand for housing in the cities, while threatening to make rural areas, and the people who live in them, more isolated.

Projected rise in population between 2014 and 2039 (by local authority)

Health services struggling to cope

(Image: Rui Vieira/PA Wire)

An ageing population with complex health needs will require a greater proportion of the Welsh Government's budget to be spent on health.

The report predicts that by 2024-25, up to 67% of the entire budget could be spent on health. Currently it is just under half of the overall budget.

This means either higher taxes will have to be raised or services cut to balance the budget.

The report projects that because of the UK Government's ongoing austerity measures, the budget for Wales will be 8% lower in real terms by 2020 than it was in 2010.

"While spending on public services is going down, there are longer term increasing demands on services, as well as rising expectations on service quality," the report states.

"By 2025, public services in Wales could have a revenue funding gap of between £2.6bn and £4.6bn (at 2010-11 prices) and this gap could continue to increase even when budgets rise again."

As a result of Brexit, the report notes there is "uncertainty" around areas that are recipients of EU funding such as the rural economy, food security, the labour market and employment.

Another major threat to Welsh jobs is the growth of automation - the use of machines and technology.

According to the Bank of England, in the next decade, a third of UK jobs are at risk of automation and advances in technology, computerisation and artificial intelligence, resulting in the loss of 700 occupations.

"Over the next 10 to 20 years, 35% of existing UK jobs will be at high risk from automation," the report staes.

"Unlike mechanisation of the past (where human participation has been required to provide information or instruction), white collar professions are likely to be affected."

These workforce problems could, in turn, lead to a downturn in people's mental health, the report warns.

More flooding, more droughts, more heat-related deaths

(Image: PA)

If you thought we had a scorching summer, it could pale in comparison to summers in 30 years' time.

The effects of climate are predicted to raise summer temperatures in Wales by between 1C and 4.6C by 2050, with rainfall set to drop by an estimated 17%.

Forecasters warn that droughts will be more frequent, with consequences for public water supplies, damage to biodiversity and threats to agriculture.

However in comparison, the amount of rain we see at other times in the year is expected to rise dramatically and could lead to serious flooding problems.

By the 2050s, there's anticipated to be a 17% increase in winter rainfall which could impact on roads, rail, electricity transmission and access to clean water.

The report states that deaths related to the heat are projected to increase from 2.4 deaths per 100,000 to 10.6 in 2080.

In contrast, deaths from the cold are likely to halve from 83.9 per 100,000 to 48.7 in 2080.

Growing weight problems, heart conditions and strokes

Despite substantial efforts to tackle obesity, current predictions state that the proportion of overweight or obese adults in Wales is projected to increase from 58.3% (2013-15) to 62.2% (2025).

Similarly, the proportion of adults not eating the recommended amount of fruit and vegetables is projected to increase from 67.7% in 2013-15 to 74.3% in 2025.

But encouragingly, the number of children aged 2-17 classed as obese is projected to decrease from 104,015 in 2017 to 103,746 in 2035.

Other common health conditions, such as diabetes, heart conditions and strokes are all set to increase in prevalence as a result of our poor lifestyle habits.

Projected rise in common conditions between 2017 and 2035

Similarly, the number of adults with a common mental health disorder will increase from 417,121 in 2017 to 447,159 by 2035.

And the number of people aged over 65 years old living with dementia in Wales is estimated to increase from 44,275 in 2017 to 72,769 in 2035.

Healthy life expectancy Women Least deprived 2010-2014: 73.8 (years old) 2024: 76.0 Most deprived 2010-2014: 61.7 2024: 63.3 Men Least deprived 2010-2014: 72.1 2024: 75.4 Most deprived 2010-2014: 60.8 2024: 64.0

The report states: "It is anticipated that Welsh NHS spending will need to rise by 3.2% a year in real terms as a result of demographic changes, cost pressures and an increase in the prevalence of chronic diseases, unless there is action to reduce pressures or increase efficiency.

"This would mean that spending would increase from £6.5bn in 2015-16 to £10.4bn in 2030-31."

Compared with the NHS, pressures on adult social care services are estimated to rise at an even faster rate (4.1% a year between 2015 and 2030-31.

The report concludes that the social care budget in Wales will need to nearly double to £2.3bn over the same period.

Between 2014-15 and 2021-22 relative poverty in the UK is projected to increase from 21.3% to 23.6%, with relative child poverty increasing from 29% to 35.7%

Will the Welsh language be lost?

(Image: Aled Llywelyn)

Approximately one in five people in Wales speak Welsh.

However, there is concern that the Welsh language is at risk of being lost to future generations, despite an increasing number of children and young people speaking Welsh.

According to the report, there is an estimated loss of between 1,200 and 2,200 fluent Welsh speakers each year.

"Any decline in the Welsh language in the future will be due to factors including: demographic changes and migration patterns; Welsh language not being spoken in the home; lack of confidence in speaking the language; and marriages between Welsh and non-Welsh speaking individuals," the report states.

So what can we do about it?

(Image: Andrew James)

The report makes 14 key recommendations for how public services should take their work on futures thinking forwards.

It calls on public services bodies to stretch their planning beyond their typical three to five years.

It also calls on them to learn from examples of "futures work" from other countries and consider how these can be applied to the Welsh context.

Tracey Cooper, chief executive of Public Health Wales, said: “The world is changing fast. Advances in technology, changes to our climate, and an ageing population are just some of the challenges we expect to face based on current trends.

“But there is something that we can all do together as a society to address the long-term thinking ‘gap’ and prepare for, or even change these different futures.

“This report provides valuable tools and strategies for organisations in Wales to help us think about the future, anticipate what might happen, and prepare.”

Sophie Howe, Future Generations Commissioner for Wales, said: "The Futures for Wales report provides a helpful overview of key future trends in Wales, as well as insights into futures and foresighting approaches from across the world.

“In collaboration with Public Health Wales I have recently appointed a Research Officer to provide additional capacity to work on futures in Wales, and help take forward some of the recommendations in this report, to ensure that our public bodies build their skills, capacity and confidence in futures thinking."

The full report can be found here.