Despite the Prevention Agreement, we continue to smoke, drink and eat unhealthy foods

The goals to reduce smoking, drinking and obesity are far from being achieved. For the first time since the government concluded the National Prevention Agreement with seventy civil society organizations at the end of 2018, the effect has been extensively calculated. Even in the most optimistic scenarios, the goals remain far out of reach.

More than five years ago, then State Secretary Paul Blokhuis (Public Health, Christian Union) presented the Prevention Agreement to make the Netherlands healthier with much fanfare. There was immediate disappointment about what happened not it stated: no sugar tax, no higher alcohol excise duties, no lower VAT on fruit and vegetables. The anti-smoking measures were the harshest: tobacco became more expensive and harder to obtain.

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The RIVM calculation confirms what the health institute already predicted in a quick analysis in 2018: the 76 pages with agreements measures to reduce lifestyle diseases and keep healthcare costs within limits are completely insufficient to achieve the ambitions. The target for obesity was a maximum of 38 percent of adults by 2040. But instead of less, only more people will become overweight. If the Netherlands had continued on the existing path after 2018, 58 percent would be too heavy in 2040; With the agreement, this does not fall below 55 percent. The percentage of overweight children is also hardly decreasing.

Smoking and drinking

The agreements also have little effect on smoking and drinking. In 2040, 10 percent will still smoke, the target was a maximum of 5 percent. The number of problem drinkers has also fallen much less than hoped: from 9 percent to 8 percent instead of 5 percent.

“To reduce those figures further, much more is needed,” says RIVM researcher Jolanda Boer. Consider even higher tobacco prices or a ban on advertising unhealthy food and alcohol. It is not surprising, says Boer, that the goals were so ambitious. “That can help get people moving. But to achieve them, more and stronger measures are needed.”

The RIVM calculated three trend lines. One based on continuing on the same footing, the other two take into account the effects of the Prevention Agreement: in an optimistic and a realistic scenario. It is striking that even the optimistic scenario hardly deviates from continuing in the same way. And all scenarios are far from the set goals.

This does not mean that the interventions are of no use, says Boer. As far as she is concerned, the Prevention Agreement has not been a failure. “Sometimes the effect of an appointment is negligibly small, but if you reach a lot of people with it, the impact can still be significant.” More benefits can also be achieved from existing agreements if the reach increases, such as with programs that help people quit smoking.

Vague agreements

It was not easy to calculate what the Prevention Agreement yields. Boer from the RIVM: “We have clustered the more than two hundred agreements, because many different agreements have the same goal.” But many agreements are vague and it is not always clear how many people are reached by a measure. “The coherence of measures can strengthen the effect, but you can also overestimate an effect because you reach the same group.”

The researchers sometimes had little data available, for example from progress reports. They then had to derive the effects from, for example, studies abroad. A group of experts contributed ideas about the assumptions in the models and the different scenarios. There are uncertainties, but according to the RIVM this does not alter the expectation that the ambitions will not be achieved with the Prevention Agreement.

The Collaborating Health Funds, which co-signed the agreement in 2018, are concerned that the current measures will only increase the burden of disease in the Netherlands. Smoking, drinking and obesity are already responsible for 35,000 deaths and 9 billion in healthcare expenditure per year. “If we do not fully focus on prevention, the pressure on healthcare will not decrease and this will be very detrimental to our economy in the long term,” they write in a joint response to the RIVM report. “A vital economy depends on healthy Dutch people.”

These organizations indicate the same effective measures as the RIVM to get closer to the goals: persistently rising tobacco prices, fewer points of sale, no alcohol advertising where children come, cheaper healthy food and a ban on children's marketing of unhealthy food.

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