In the mountain resort of Bad Hofgastein in Austria, exercise is King. In early October the power walkers head for the mountains and noticeably less fit conference goers head for the European Health Forum Gastein.

Attending conferences which start early, finish late, and include lunchtime workshops as well as a smorgasbord of parallel sessions, can be hard work. But good speakers make the going easier and this year an optimistic one cheered the horses.

There were plenty of storm clouds ahead. How are countries going to maintain services as the recession bites harder? How can we counter the impact of demographic change with its attendant increase in chronic disease? How much longer must we wait for innovations in information technology and “personalised medicine” to deliver on their promise? What can we do to sustain our ageing and shrinking armies of health workers? How much would the quality of care be improved if revalidation of health professionals was made mandatory?

 No wonder the conference organisers started proceedings with an upbeat message. “Health should not be portrayed as a cost issue,” said the heath minister from Salzburg. “It’s a motor of economic growth, a blooming industry which provides a massive number of jobs.”

Matthias Horx, a German trend analyst and self styled futurist, then set out “grounds for optimism.” Health has had an upswing in (political) status in the past 25 years, he underlined, and population ageing has been accompanied by a steady improvement in health status.

Today’s 50 year olds are glamorous sex kittens compared with the 50 year olds of their parent’s generation. A rosy future lay ahead he maintained – provided we adopt the life style of Kung hunter gatherers.

1. Run a lot – anything up to 100 km a week
2. Sometimes eat a lot but be hungry in between
3. Sing a lot and laugh a lot.
4. Be tense and alert at times (it’s necessary to net your prey) but relax afterwards

Health systems should focus less on providing technological fixes and more on developing social techniques to “nudge” people into adopting healthy life styles, he argued. Eighty percent of health care costs were due to smoking, lack of exercise, poor diets and too much alcohol.

The examples of “nudge” he cited included nutritional programmes in Finland and the stance taken by a Japanese company which measured the body mass index of its employees and supplied them with pedometers. If the workers BMI crept up the boss was held accountable. In another experiment in Stockholm, commuters were persuaded to take the stairs rather than the escalator by making it the fun choice.

Clever builders miraculously transformed the stairs into a piano keyboard and the video he showed of people enthusiastically playing musical stairs was a treat to behold.

Horx went on to urge health systems to become learning organisations which monitored not only the cost of illness, but the gain from healthy behaviour. Doctors should be paid by the number of people they keep well rather than for interventions to treat disease.

As discussions on the knotty challenges Europe’s health systems face ensued, “young Gasteiners” helped maintain morale. These are hand picked under 35 year olds from across Europe who have been selected for their potential to push the frontiers of health research, policy making, and practice.

They swarmed around the conference halls, charted every session, interviewed, Twittered, and blogged. Some of the fruits of their labour are available on the BMJ blogsite. The rest can be read on www.ehfg.org

Tessa Richards is an assistant editor with the BMJ.

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