Tobacco Control Policy in the Netherlands

Twenty years ago I worked on an advisory report on the effectiveness of various tobacco control policy measures, commissioned by the Dutch Ministry of Health1 as part of the process of presenting a revised Tobacco Act to the parliament (Willemsen, De Zwart, & Mooy, 1998). Soon after the report was finished I attended the World Conference on Tobacco or Health in Beijing, where I spoke with a civil servant from the Dutch Ministry of Health. I asked him what would happen with the report and was shocked when he told me that many of the conclusions were “not politically feasible” and could not be taken up. This was the first time that I was confronted with the concept of “political feasibility.” In hindsight, this was rather naïve of me, but students and researchers who invest time and effort in understanding better ways of helping people to overcome tobacco addiction sooner or later come to realize that the tobacco problem has political roots. To do something about it on a societal level, one has to acknowledge what many people would describe as “nasty” politics. Many scientists shy away from this, just as I did then, because they believe that science is independent and politics-free or because they are intimidated by what they perceive as complexity, unpredictability, and irrationality in politics for which they are not prepared, being used to working from within an evidence-based science paradigm. A more effective strategy to address the tobacco problem on a societal level is to try to understand the policy process and why this process at times appears so irrational. Since my professorship in tobacco control research, journalists, scientific colleagues from other countries, and students have asked me the same question: why is the Dutch government not doing more to control tobacco? This book is my attempt to formulate an answer. As an introductory text to the field, it seeks to provide an understanding of the full complexities of tobacco control policy. It further aims to offer a broad framework for thinking about tobacco control policymaking. Many of the understandings in the book can be applied to other public health areas, and lessons drawn from the analysis of the Dutch case may be of interest to other countries, particularly those with similar multi-party parliamentary democracies.