By Pepijn Tukker LLM, lecturer IT law, University of Groningen,  p.f.t.tukker rug.nl  and Dominique Mollet LLM, doctoral researcher, University of Groningen,  s.d.mollet rug.nl

For the past two years, there has been increased attention for (public) health-related topics among policy makers. However, due to new global crises, such as the war in Ukraine, Covid-19 is no longer the headliner of daily news and newspapers, and policymakers’ focus is shifting away: public health appears to lose its momentum as a topic for discussion.

In the Netherlands, the focus of policy makers is similarly shifting towards the energy/gas crisis, inflation and the war in Ukraine, and the increasing (relative)  poverty  as a consequence of these crises. However, public health matters are raised in relation to the consequences of these crises. On  Prinsjesdag, the third Tuesday of September, the ceremonial opening of the Dutch parliamentary year takes place, and it is on this day that the National Budget and the Budget Memorandum are presented by the Minister of Finance, after which the plans must be approved by the Senate and Parliament. The plans for the new parliamentary year have coined new discussions in Parliament. And, surprisingly or not, a number of health-related initiatives are currently on the table for discussion.

The King's speech

On  Prinsjesdag, prior to the presentation of the National Budget and Budget Memorandum, King Willem-Alexander introduces the government’s plans for the coming year. This year, the government acknowledged that the impact of the war and the international sanctions against Russia - and as a result of this the extreme rise in the prices of gas, electricity and food - and the inflation rate that has risen up to  17,1 percent  have a severe impact on the financial position of many individuals. The current circumstances negatively impact the underlying determinants of health, can accordingly have detrimental effects on individuals’ health and increase health inequalities.

First of all, the higher prices make it more difficult for individuals to pay their bills, including the  rising bills  for the mandatory national health insurance and voluntary health insurance packages. For many individuals, this can be a reason to increase the deductible excess of the basic health insurance and to cancel the voluntary packages, thereby increasing the threshold to consult a specialist or other healthcare facility, and decreasing their (economic) access to a wide range of healthcare facilities. In response to this, the government has pledged more than  €17 billion  to assist, primarily, low- and middle-income households financially. More concretely, the government has decided to  increase the healthcare benefit. Additionally, the  basic student grant  will also be increased, compensating the high prices and ensuring students' economic access to healthcare.

Besides these concrete plans, the King also raised more general questions, such as how the Dutch State can ensure that high-quality, personalised healthcare remains available and affordable. Additionally, he emphasised the adherence to the  National Prevention Agreement,[i]  an agreement focusing on health promotion and non-communicable disease prevention concluded in 2018 between the government and more than seventy different societal organisations.The National Prevention Agreement discusses three important topics: tobacco consumption, alcohol consumption and obesity). According to the government, the National Prevention Agreement is an important step towards achieving a healthier Netherlands, and with a specific goal for all citizens to have a healthy lifestyle in 2040.

The  Belastingplan 2023  (the Tax Plan for 2023), also presented on  Prinsjesdag, introduces an  important proposal  in the field of tobacco control. In accordance with the National Prevention Agreement, the government has proposed to increase the excise duty in two phases. If this plan is accepted by the Parliament and Senate, this would mean that by 1 April 2023 excise duties on tobacco will increase with €1,218 for cigarettes and €3,045 for smoking tobacco. For cigars, the excise duty will increase from 9 to 10% of the selling price. For cigarettes, the acceptance of this plan would mean that a package of 20 cigarettes will cost an average of €9 as of April 2023 and €10 as of April 2024 (now: €8); for rolling tobacco this means that will cost an average of €17 as of April 2023 and €20 as of April 2024 (now: €14).

Discussions in Parliament

The days following the speech are reserved for discussing the National Budget and the Budget Memorandum in Parliament. These  discussions  prove to be important, as they indicate which plans have a solid support base and are finally carried out. During these discussions, the leaders of the political parties in Parliament have the opportunity to file motions against the plans of the government or to ask for amendments of and additions to the plans.

This year, various interesting health-related motions were filed. The  first motion  suggested offering feminine hygiene products for free in schools and in public buildings. Unfortunately, the motion did not pass, as the coalition parties and several right parties voted against. Against the backdrop of recent developments in, for instance,  Scotland,  France  and  other countries, this can be considered a disappointing outcome for Dutch women.

Importantly, a  motion  concerning free school meals has received ample support. This motion proposes a free school meal as an extension to the existing  Rijke Schooldag  (a programme offering enrichment activities in elementary schools). This initiative aims to protect the diets of children in a vulnerable environment from being subjected to adverse effects caused by the regressive economic circumstances.

 Although the plans sound promising, we must remain vigilant. As the Dutch say: “Eerst zien, dan geloven” (seeing is believing). Despite the fact that the government appears to acknowledge the economic situation’s detrimental effect on public and individual health, it is also taking some steps backwards when it comes to the  regulation of alcoholic products. In fact, it is the same government that has agreed in their  coalition agreement, colloquially called ‘Omzien naar elkaar, vooruitkijken naar de toekomst’  (looking out for each other, looking ahead to the future), to ‘blur’ alcohol laws and enable entrepreneurs to mix functions in retail. Theoretically this would allow, for instance, hairdressers or clothing stores to serve alcohol and, thereby, lower the bar to consume alcohol.

17 million people, 17% inflation and 17 billion financial assistance: a long way to go for health

 An important observation is that the majority of these proposals have inequality and the regressive economy, rather than health, as a primary focus. While the majority of the above plans and proposals constitute a step in the right direction, a more health-centred approach should nevertheless be promoted. Additionally, it is important to note that, as indicated above, the majority of the government’s plans must still be accepted by the Parliament and Senate before they become effective. Let’s keep our hopes high for public health, but also remain sober like the Dutch are known for: ‘eerst zien, dan geloven’.

[i]  For the full document see: https://www.government.nl/documents/reports/2019/06/30/the-national-prevention-agreement, for a summary see: https://www.government.nl/binaries/government/documenten/leaflets/2019/06/30/national-prevention-agreement-summary/National+Prevention+pact.pdf.